Improving housing stability for low-income families in Boston, and assisting them in accessing social services, sharply reduced their health problems, a five-year study has found.
On Tuesday, the Boston Foundation released a report on the impact of Health Starts at Home, an initiative launched in 2015 with two nonprofits, Health Resources in Action and the Urban Institute. Its goal was to establish collaborations between housing services and health care providers to offer comprehensive support to families with children who were struggling to make rent and put food on the table.
“Part of the partnership between health care and housing is you have one person connecting the household to a whole range of services, whereas in the past you would have sent them to a housing specialist, and then someone who specialized in [food assistance] benefits, and then a different person doing a different thing,” said Soni Gupta, senior director of Neighborhoods and Housing for the Boston Foundation, New England’s largest community foundation. “It’s a kind of focus in service provision that we don’t typically fund at this level.”
The initiative served 261 families between 2016 and 2019 and collected data over a 12-month period to determine whether increased housing stability led to better health outcomes among children. The initiative funded four housing-healthcare partnerships in the Boston and Chelsea area, giving each team $200,000 a year to spend on services that included legal aid, financial counseling, housing support, and medical care. In addition, the Boston Foundation secured 50 housing vouchers from the state’s Department of Housing and Community Development, which were distributed across the four groups in proportion to the number of families they served.
The study, which focused on 137 households, found that participants’ housing stability and overall health improved after one year in the program. The percentage of families living in their own apartment jumped from 41 to 65 by the end of one year, while the number of those staying with friends or living in homeless shelters dropped sharply. Additionally, the average number of times children in these families visited the emergency department dropped from 2.3 visits to 1.3 visits by the end of the program.
Most of the families, 78 percent, were Hispanic or Latino, and two-thirds of families spoke in Spanish at home. The majority were led by single mothers, and nearly half had not finished high school. The children involved in the study were all younger than 13, with more than 70 percent of families having at least one child younger than four.
The study also found that connecting families with a guide or case manager proved to be instrumental, frequently leading to improved mental health among caretakers even in cases where their housing situation remain unstable.
Overall, the number of caregivers who reported symptoms of anxiety dropped from 63 percent at the start of the program to 42 percent after one year. Similarly, depression symptoms fell by nearly half, dropping from 60 percent at the outset to 37 percent by the end of the observation period.
“We thought we’d be saying all these things about children’s health — knowing that if you improve parent-caregiver health, you’ll improve child health, too — but I don’t think we anticipated that the behavioral health piece among parents would be so significant,” said Heather Nelson, one of the authors of the study. “But it makes sense: if you are helping a caregiver take care of themselves, it’s definitely going to benefit the child.”
The study suggested that improving quality of life is not just a question of resources, but of consistent and culturally appropriate support to access those resources.
“Many folks who had mixed status or are undocumented, they avoided signing up for public benefits because that could put their green card or their citizenship in jeopardy, and Health Starts At Home served many, many of these folks,” Nelson added. “Those trusting relationships and being able to speak in folks’ native language was really important for a population who are still low resource, who still need more support.”
While the study substantiated their theory that housing security and better health are linked, Gupta and Nelson believe that no program can fill the gap left by a housing system in serious need of reform.
“These models were wonderful and we have results to show the improvements, both in housing and health,” Nelson said. But “long term, we want policies and systems changed so we don’t have to do these wrap-around services.”
“If we were to make housing vouchers available anywhere that a family shows up and needs one,” Gupta added, “then we will have truly addressed the need for housing stability.”
Ivy Scott can be reached at firstname.lastname@example.org. Follow her on Twitter @itsivyscott.