USICH Blog

12/17/2012 - Integration of Services and Housing: an International Perspective

I recently participated in an Organisation for Economic Co-operation and Development (OECD) consultation on the topic of Integrated Services and Housing Consultation. 

Participants came from across Europe, Australia, New Zealand, Japan, Canada, and the US.

US participants included: 

Dennis Culhane      University of Pennsylvania

Deborah Desantis  Corporation for Supportive Housing

Richard Frank         Harvard University

Jennifer Harwood  U.S. Department of State

Donald Moulds       U.S. Department of Health and Human Services

Debra Rog                WESTAT

Nan Roman              National Alliance to End Homelessness

Robyn Stone           Leading Age

Roseanne Haggerty  Community Solutions

David Wertheimer  Bill & Melinda Gates Foundation

While homelessness wasn't the sole focus, a substantial part of the two day meeting focused on research, policy, and practices related to homelessness.  In addition to those issues, there was discussion around the importance of the integration of services and housing for the aging population, those with mental health and substance abuse disorders, and families with children. 

Among the nations represented, there was tremendous shared experience even as there was tremendous variation in the respective approaches to the provision of housing, healthcare, and supportive services.  I observed that perspectives were heavily impacted by the profession of the presenter or commenter.  For instance, physicians viewed healthcare as the preeminent issue while housing providers viewed housing as the foundation.  Likewise, perspectives also varied by the type of organization the presenter or commenter represented such as the level of government (i.e. national or local), nonprofit provider, advocacy organization, or private sector. Though perspectives differed, there was clear consensus that integration (however defined) improves outcomes for those with the most complex needs.

A report on the consultation and some official next steps will come later.  In the meantime, I would like to offer a summary, through my lens, of the key dimensions and needs for research and practice tools, as well as models, planning, and policy approaches:

1.    Person-centric approaches that are asset-based (versus programmatic deficit-based approaches) hold the greatest promise for the best outcomes for the client and the community.

2.    A range of housing options, including scattered site supportive housing apartments, single site supportive housing, mixed income rental housing with set-asides for special needs, and home modifications for aging homeowners/renters to be able to maintain their homes as they age in place, need to be offered in order to meet the continuum of individual needs and preferences. There was very heated discussion from proponents of the various types, each arguing for the superiority of their approach in terms of cost efficiency and effectiveness.

3.    Social integration (ability to live fully as part of a community) is a key indicator that the residential setting is not institutional.  We discussed how social integration can come in a range of housing types and neighborhoods but can also be completely absent due to issues related to real or perceived personal safety, interpersonal skills, and poor quality of services implementation.

4.    Outcomes data for individuals, the community, and fiscal outcomes should be collected and measured to assess impact and results.  Using data will drive ongoing service and housing quality improvements. There appears to be insufficient research in this area to truly assess evidence that leads to best practices.

5.    The impact of the built environment on well-being and outcomes regardless of housing type should be recognized. High quality design can support and encourage social integration, provide opportunities for support programs to exist, and enhance resident’s quality of life.. This is an area that easily crosses borders, as good design can be nearly universal. The need for some culturally specific features can also be incorporated to enhance living environments.

6.    Services integration among housing, human services, and health care versus independently delivered services requires horizontal and vertical integration (i.e. financing, policy, service delivery). This creates complexity and requires planning beyond the delivery of programs and services. 

7.    Collaboration (cross-sector, cross-government, horizontal and vertical cross-professional) is required to achieve services integration.  The skills and capacity to collaborate is difficult for small and large organizations, for public as well as private and nonprofit providers, but is a crucial asset to successful services integration. It is a challenge worth taking on.

8.    The role of technology is under-developed in this area.  International cooperation might be quite fruitful as there could be jointly-issued requests for tech solutions, shared standards, and more.

9.    Identifying where spending in one area saves cost in another area (i.e. spending on housing can reduce inpatient healthcare costs) is important even for countries with single payer systems.  As costs vary dramatically across countries, it is very challenging to identify exact spending costs for each intervention that could be used across world.  However, in the time of austerity it is even more important and could be compelling in the creation of smarter policies.

10.Housing can be a platform for services and health care integration, as housing is essential but not sufficient to solve homelessness. I heard repeatedly how the provision of high quality, safe housing really advances quality of life and well-being. Consistently, it was noted that for people with complex needs, integrating services and healthcare were necessary requirements for the housing "intervention" to work.

There are many possibilities for future cooperation among OECD members on this topic. I look forward to seeing where this all goes. 

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