Association for Public Policy Analysis & Management

In the policy arena of housing and health care for vulnerable populations, a solid evidence base defines the cost-effectiveness of housing first models that wrap permanent supportive services around long term housing. In the housing first approach, clients who experienced long-term homelessness are housed with agency to choose the timing and sequence of their own treatment paths, without jeopardizing the security of their housing assistance. Housing affords clients experiencing both homelessness and opioid addiction a higher measure of opportunity to choose medication assistance treatment (MAT) as a bridge out of addiction.

Beyond referrals, there is little standardized connection to coordinate and collaborate support system care, and knowledge of MAT options can be limited in the housing system. HomePath, an innovative housing treatment model for people who are frequent utilizers of healthcare, housing and criminal justice systems, formally interlinks the coordination of high-fidelity housing first providers with staff from the Shared Medical Appointment treatment, a clinical team model of MAT. Standardizing the coordination of housing and health care support networks for shared clients allows for an expansion of client-focused, whole person care of vulnerable populations with opioid addiction around improved treatment adherence, peer supports, health and housing stability outcomes.

Establishing a formal collaboration between the housing/homelessness/health care systems is a groundbreaking policy approach for systems of care around the country. Traditionally, housing providers receive clients from the City’s coordinated entry system after they trigger a housing match based on the prioritization of housing needs. For HomePath study participants, the CES generated housing match activates a study-intake worker to outreach to the client, screen for opioid use and, if a self-report opioid use diagnosis, connect them to their high-fidelity housing provider. A referral to the clinic providing the Shared Medical Appointment is also made at that time of outreach. For the client experiencing long-term homelessness and opioid addiction, the choice to access health care is a challenging one. Coordinating care across the housing first and health care SMA providers extends the critical supportive network for continuous, supportive, recovery options.

This formal collaboration required a cross-sector understanding of the SMA approach to MAT as well as a working understanding of high-fidelity housing first services. This process occurred during a yearlong stakeholder leadership engagement, involving the Continuum of Care, CES leadership, Data leaders, Medical Directors, Outreach staff, Organizational leaders and Researchers. This paper outlines the complex, knowledge sharing, consensus-building process that advanced this new model of housing and health care, illuminating challenges and constraints of evolving a housing first – SMA clinic coordination model that is client-centered across all systems of care, supported by a new group decision-making, data sharing, commitment to rapid cycle evaluation for course corrections in this emerging health-housing policy arena.