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By JULIE MINDA

Two-plus years into the five-year Healthy Housing Initiative pilot, Catholic Charities agencies and their partners in Catholic health care and Catholic dioceses are making headway building up networks to address the housing, health and social service needs of vulnerable community members. In addressing these issues, many of the collaborators are making progress toward increasing the supply of permanent supportive housing in their communities.

Knights of Malta volunteer dentist Dr. Charlie Zammit treats a walk-in dental patient with the assistance of volunteer Nikki Branson in April. The Malta Dental and Medical Clinic is in the Center for the Works of Mercy in Detroit, part of Catholic Charities of Southeast Michigan.

Launched in January 2020, Catholic Charities USA's Healthy Housing Initiative brings together local Catholic organizations in five pilot cities: Detroit; Las Vegas; Portland, Oregon; Spokane, Washington; and St. Louis. The Catholic health system partners are Ascension in Detroit; CommonSpirit Health in Las Vegas; Providence St. Joseph Health in Portland and Spokane; and Mercy and SSM Health in St. Louis.

Together, the partners are implementing strategies to reduce chronic homelessness in part by providing this vulnerable population with case management and ready access to social services and medical and mental health services. The organizations say their efforts are particularly attuned to the plight of vulnerable people from minority populations.

Garrett-Ray

"Our goal is to reduce chronic homelessness, but we know we need to provide more than just housing" because of the interrelationship between housing instability, health and the social determinants of health, says Dr. Stacy Garrett-Ray, Ascension senior vice president and chief community impact officer. "The model we're creating is not just about housing. Giving that additional care provides the ability to create healthier outcomes."

Johnson

Building a foundation
Curtis Johnson, vice president of housing strategy for Catholic Charities USA, says that organization began the Healthy Housing Initiative pilot on the strength of the positive outcomes its Spokane agency recorded after Providence Sacred Heart Medical Center provided health care services and the Catholic Charities agency in Spokane stood up social services in Catholic Charities' housing complexes. "This made an incredible impact," says Johnson.

Catholic Charities of Oregon is constructing this complex, called the Annex, on its campus in Portland. The development will have 27 units of permanent supportive housing and long-term transitional housing, where people who are coming out of homelessness can stay for up to two years. Residents will have access to health and social services.

Another impetus for the program's creation was research Catholic Charities USA was aware of that showed that housing alone is insufficient to stabilize the lives of people experiencing chronic homelessness. Permanent supportive housing — complete with easily accessible wraparound social and health services — greatly increases the odds that an individual or family will achieve housing stability.

In 2019, Catholic Charities USA selected five pilot cities where local agencies and dioceses had the capacity to address the needs. Catholic Charities' goal is for each pilot city to reduce chronic homelessness by 20% by 2025, connect at least 35% of newly housed clients to primary and behavioral health services and decrease homeless clients' hospital readmission rates by at least 25%.

Since then, the Catholic Charities agencies, Catholic health care providers and dioceses in each city have been developing place-specific strategies for linking housing, health care and social services.

In some of the cities, the partners have long-standing relationships and already had started along this path; in others the connections are new, or the partners have changed their priorities or approaches.

Housing stock
The Catholic Charities agencies have been working to identify property that can be redeveloped as affordable housing complexes, with some units designated as permanent supportive housing. While some of the housing will be new construction, partners also are considering redeveloping as housing diocesan schools, convents or other church buildings.

Volunteer Kimberly Nava organizes a shoe display for the clothing closet at the Center for the Works of Mercy in Detroit in April. The center is operated by Catholic Charities of Southeast Michigan.

According to the U.S. Department of Housing and Urban Development, affordable housing is generally defined as housing that costs the occupant no more than 30% of their income.

Johnson explains that permanent supportive housing is a specific type of affordable housing. Under this model, people who were chronically homeless and, once housed, are at risk of returning to homelessness get rent subsidies as well as intensive case management.

At existing and planned housing complexes, the Catholic Charities agencies participating in the pilot program aim to establish on-site social services and primary care and mental health clinics. Each housing complex has or will have an in-house case manager, sometimes called a navigator. This individual assesses clients' needs and helps clients access social services and health care services. The case manager coaches clients in the pursuit of goals such as reconnecting with family members or finding work.

Clients of Catholic Charities of Southern Nevada eat a meal in the agency's dining area in February. In partnership with Catholic health facilities, the organization provides food, shelter and comprehensive services to vulnerable people.

The Healthy Housing Initiative also wants to ensure Catholic Charities clients living in single family residences have ready access to health and social services.

Catholic Charities USA gave $50,000 grants to each of the five partnerships and has given direct support and technical support to each of the five pilot agencies. In some communities, the Catholic health systems involved in the work are providing additional grant funding. Pilot participants are securing low-income tax credits and housing vouchers and pursuing state and local grants as well as financing and additional aid from HUD.

Bak

Priced out
Rose Bak, chief program officer for Catholic Charities of Oregon, says the concerns that the Portland partners are tackling are complex and intractable. The homeless population in Oregon is disproportionately large compared to other U.S. states, according to a March 2019 study by ECONorthwest, an independent economic consulting firm.

Case manager Emily Corey takes a client to get clothes and food at St. Patrick Center, a homeless services provider in St. Louis. Corey was employed by St. Patrick Center. The position is funded by SSM Health. Corey spent much of her workweek at SSM Health Saint Louis University Hospital as part of the Hospital to Healthy Housing program, which is connected with Catholic Charities' Healthy Housing Initiative.

Not surprisingly, Bak says the severe lack of affordable housing in the Portland area has a direct correlation with the growing number of unhoused individuals and families. But it is not the only factor. Homelessness can be the result of — or contribute to — mental health crises.

She notes that people of color and veterans with post-traumatic stress disorder are disproportionately represented among homeless populations.

Bak says many people who are homeless — and especially people of color — fear and mistrust medical providers. And so, they don't seek timely care, which can worsen their health concerns.

Yoder

Shelley Yoder is director of population health program integration at Providence St. Joseph Health in Portland. She says when people who are homeless are discharged from the hospital and return to the streets or encampments, it is difficult for them to follow post-hospitalization treatment plans and restore their health. A facility planned as part of the Healthy Housing Initiative would provide semi-private accommodations where patients who are homeless could recover and find respite after hospital discharge.

Anthony D'Agostino is chief executive of the St. Patrick Center, the largest social service provider for the unhoused in St. Louis. He says that given super-heated housing markets and high inflation, it is increasingly difficult for people to find housing they can afford — and it is a growing challenge for agencies like Catholic Charities to acquire new housing stock, given the escalating costs.

Wortham

Stable housing is an equity issue, says Ben Wortham, Catholic Charities USA vice president of behavioral health integration. He explains that people of color often make up a disproportionately large percentage of homeless populations and a disproportionately small percentage of the population in affordable housing complexes. They also are more likely than white people to return to the streets from housing. Wortham says all organizations serving housing insecure populations should assess what percentage of their clientele are people of color, as compared to the local population, and address inequities in program reach.

Propson

Game changer
Paul Propson, chief executive for Catholic Charities of Southeast Michigan, says it is essential to be intentional about increasing access to health and social services in the communities where the most vulnerable live.

The Detroit Healthy Housing Initiative partners are planning to open a permanent supportive housing complex in a predominantly Black, low-income community. That community now lacks sufficient access to social services and to some health care services. People who live in the complex will have on-site access to case management, wellness programming and some health care services. The surrounding community will have access to the wellness and health care services.

Walrath

Bryan Walrath, vice president of operations for SSM Health Saint Louis University Hospital, says since the St. Louis Healthy Housing Initiative group has been developing its programming and putting it in place, the majority of its clients have secured stable housing. He says about 75% of the 150 clients served by Healthy Housing programming in 2021 achieved this level of security.

He says the program is "about getting the right resources at the right time to the right people."

Additional information about the Healthy Housing Initiative is in prior Catholic Health World and Health Progress coverage:

https://www.chausa.org/publications/catholic-health-world/article/may-15-2019/catholic-charities-pilots-housing-initiative-in-five-cities

https://www.chausa.org/publications/health-progress/article/september-october-2019/catholic-charities-usa-supports-housing-and-health-care-integration