Housing as Healthcare
Policy, Program, Intervention or other types of research evaluation
Issues : Caracole is an ASO in Cincinnati, Ohio with permanent housing programs for homeless individuals and families, homelessness prevention support, and prevention/education services. In 2013, the housing programs transformed from a housing ready to a housing first model in an effort to address client needs. A greater percentage of our clients are people who inject drugs, are newly released from prison, and/or are engaged in sex work. As a housing ready agency, our program was under-utilized and clients were struggling. Following our belief that housing is a right and housing is healthcare, Caracole identified the need for new programming, including HIV/HCV testing, Evidence Based interventions, and site based harm reduction services.
Description : Four years into this new model, we have powerful data to support that our clients are experiencing decreased viral loads, fewer arrests and overdoses, increased earned income related to positive HIV health, and increased housing stability. The Caracole staff includes case management, prevention and education services, specialized housing support, and mental health services. In addition, relationships with MAT providers, mental health and treatment agencies, shelters, outreach workers, and other housing programs provide a continuum of care. We are proud of our client’s successes and look forward to sharing not only our data, but continued barriers, implementation, outcomes, staff challenges, and client response.
Lessons learned : Themes we’ve encountered since implementing this new model are that our clients often respond best to support, rather than direction. We have found that punitive actions have unintended negative consequences, leading to inability to develop and maintain relationships with clients. Removing barriers for both clients and staff has positively impacted the relationships between those we serve and staff. In addition, these efforts have prompted improved medication adherence and viral suppression, which leads to better health outcomes and a positive impact on public health. When a client’s basic needs are met, we are able to more effectively impact their larger medical needs, mental health, and overall quality of life. We have found that those we serve are receptive to receiving individualized harm reduction education.
Recommendations : We will continue to integrate harm reduction services and a focus on public health into all of our programs. We will consistently track viral load suppression, other health outcomes, and health literacy to demonstrate that housing is healthcare. We will maintain ongoing and regular review of viral load and CD4 lab results. We will continue receiving training and support regarding the program model as a means to supporting staff’s professional development. Our ability to provide a continuum of services will lead to sustainable health literacy and improved health outcomes. With our model, we will be able to increase our capacity to house more people living with HIV/AIDS quickly, effectively, and respectfully.