Housing Is Health Care: The Services for the UnderServed Model
October 15, 2018
The issue of housing and its relationship to health care services is relatively common in discussions about social determinants of health (SDH), mainly because it’s the SDH that is commonly paid for in health and human services (see U.S. Spending On Housing Assistance Programs: $44.7 Billion In 2016). The case for housing as an integral part of health care seems fairly laid out.
But for more this month from an organization that specializes in integrating housing and social services, we reached out to Donna Colonna, Chief Executive Officer at Services for the UnderServed (S:US), a New York City-based non-profit organization, with a staff of 2,400 that provides $214 million in services. They are supported by various local, state and federal government entities as well as foundations, corporations and individual donors. S:US was founded in 1978, opened its first supported housing program for people with behavioral health needs in 1981, its first residence for adults with intellectual/developmental disabilities (I/DD) in 1982, and has since grown to provide services in the following areas:
1. Developmental Disabilities ($80.8 million)
2. Homelessness Prevention & Shelters ($48.6 million)
3. Supported Housing ($43.4 million)
4. Behavioral Health Recovery & Treatment ($33.5 million)
5. Veterans ($7.9 million)
6. Urban farms
Ms. Colonna explained that S:US has built a values-based culture and philosophy that are the underpinnings of the work of the organization. S:US’ roots were in supported housing and community services; services that are now considered to be the social determinants of health. The core of S:US’ service delivery model is about partnering with people who come for services to build their personal toolkit for “leading a life of their choice.” She explained:
“Our model, or more accurately, our ethical platform, is our belief in human capacity and resilience and in opportunity for all. That’s fundamental to everything.
Today, we talk about Housing as Health Care. What does that really mean? We know that people do best in their natural environments—in their homes and communities. S:US provides 2,000 units of permanent supported housing (with another 1,200 in development) for people with behavioral health challenges who were once homeless, and an additional 400 residential opportunities for people with developmental disabilities. We also provide treatment, habilitation and recovery services. But for any of these services to work, you need a home.
We provide social services, but we are also a nonprofit housing developer. And when we build, we also create urban farms mostly in neighborhoods where produce is scarce and the number of people with diabetes, obesity and high blood pressure is disproportionately high. Our farms make it possible not only for individuals with disabilities to find steady employment as the stewards of the farms, but they also receive ongoing training and job coaching that build employable skills in urban agriculture, landscape maintenance, and basic carpentry. Participants receive the healing benefits of therapeutic horticulture and can enjoy the healthy products of their labor. This is something we’ve done on our own dime so to speak, integrating the idea of wellness and nutrition as part of building a supportive and healthy community. We were selected to participate in the National Health Outcomes Demonstration Project to evaluate the health outcomes of our Urban Farms initiative at three supported housing programs. We are excited to see the findings of that project.”
S:US touches the lives of over 35,000 people each year. These are individuals with high needs given their complex and challenging histories—of incarceration, unemployment, substance use, co-morbidities, domestic violence, and trauma. Realizing that it’s rare that just one thing keeps a person from leading a healthy, productive life of purpose, S:US’ services are designed to serve the whole person, and are tailored to each person’s unique needs.
S:US has a wide reach. The organization is funded by federal, state and city sources. Contract-based funding, Medicaid, Medicare and managed care plans are just a few of its payers. Ms. Colonna noted:
“We have contracts with all the major Medicaid MCO plans in New York City including the Fully Integrated Duals Advantage (FIDA) plans for people with developmental disabilities. For both people with behavioral health challenges and individuals with intellectual/developmental disabilities we offer crisis intervention supports that keep people from unnecessarily using emergency rooms and hospital services. We are proud of these hospital diversion support services.”
Ms. Colonna explained the approach to staffing takes the organizational mission strongly into account, stating:
“We employ 2,400 staff. We work hard to create a supportive work environment focusing a lot on culture. Given all the workforce challenges we face, it’s important. We spend so much time on our values, and if you can get champions around that, and you want to create a positive environment, and one where we can innovate, you need the right staff. You want to create an environment that creates a level of excitement about the work.”
S:US employs evidence-based and promising practices in their network of services. The organization measures the quality of their services through customer satisfaction, and other metrics to evaluate the impact they have on people’s lives e.g. frequency of ER use, hospitalizations etc.
Given S:US’ footprint in housing and the fact that housing is essential to good health, a critical measure is housing stability. In FY17, 92% of S:US’ permanent housing residents maintained stable housing.
Future of SDH
S:US present and future comes down to collaboration. Ms. Colonna explained:
Collaborate with other organizations. I’m on the board of Coordinated Behavioral Care—We are a health home and independent practitioner association (IPA)—with over $1.5 billion in network services (see Coordinated Behavioral Care). Success requires collaboration with both behavioral health and health care organizations and leveraging our individual organizational strengths, instead of being in our own silos. It also requires that we work collaboratively with other health care plans to drive innovation and value-based care for people with significant behavioral health challenges.
Finally, my other advice would be related to technology, EHR, data warehouses and adaptive technology. We need to embrace the benefits of technology and data. This requires substantial financial investment that most nonprofits don’t have access to. To address social determinants of health, collaboration among providers and community partners is essential.