By Monica E. Oss, Chief Executive Officer, OPEN MINDS
What are the solutions to the intractable problems related to housing insecurity and homelessness? A recent report, Policymakers Can Solve Homelessness By Scaling Up Proven Solutions: Rental Assistance And Supportive Services, suggests that rental assistance combined with supportive services (like housing navigation services and community-based health care services) is the best option.
The analysis cites a few key factors. First, the incomes of renters havenât caught up with the rise in rent and housing costs. Since 2001, the median rent went up 23.4% while median renter household income went up 9.7%. When it comes to this gap between income and rent costs, families with children and non-elderly adults without children were in most need of rental assistance.
In supporting their recommendation for long-term rental assistance and wraparound supportive services, the success of the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is citedâa program that has cut veteran homelessness in half. HUD-VASH provides eligible veterans with rental assistance and individualized supportive services. Due to this program, 83 communitiesâincluding rural, suburban, and urban areasâand three states had functionally ended veteran homelessness as of 2022.
But people who are housing insecure have other needs than rental assistance. We learned more about running a successful health care program for unhoused people in the session, Assessing Integration Readiness: The Family Service Association Of Bucks County Case Study, at The 2024 OPEN MINDS Whole Person Care Summit. Julie Dees, Chief Executive Officer at Family Service Association Of Bucks County (FSABC), discussed the Family Service Street Medicine Programâa mobile care unit that addresses immediate medical/mental health and basic survival needs for the unsheltered population.
FSABC is a Pennsylvania-based, $11.1 million, non-profit organization. The organization provides mental health and substance use disorder treatment, housing services, an emergency homeless shelter, housing first blended case management, school-based counseling, and a mobile health care unit.
The Family Service Street Medicine Program was launched in 2022 to serve individuals experiencing homelessness who face serious medical, behavioral health, and social challenges. The program emerged in response to urgent needs in the community, like winter deaths, amputations, untreated pregnancies, overdoses, and lack of access to preventive care. The model is a nurse-led, mobile street medicine program that delivers care directly to individuals in encampments, at convenience store gathering spots, and on the streets. Consumer engagement starts with meeting basic needs like food and water before medical and behavioral health interventions are introduced. The program integrates case management, health screenings, referrals, and follow-up services, and it addresses social determinants of health (SDOH) such as housing, identification, and transportation.
In its first year, the program was funded primarily through the U.S. Department of Housing and Urban Development (HUD) grant dollars administered by Bucks County, which made up 68% of the budget. Additional support came from Keystone First, St. Mary Medical Center (which provided the mobile unit), and a philanthropic community bank that funded the program evaluator. Now, the program is funded through braided funding, with approximately 80% coming from Bucks County Housing and Community Development, 13% from Keystone First, and 7% from Health Partners Plan. The heavy reliance on grantsâparticularly HUD fundsâmeans the program is restricted to serving individuals who meet the federal definition of homelessness, creating gaps in continuity of care once clients are housed.
The Family Service Street Medicine Program has resulted in positive outcomes in both community impact and operational development. From year one to year two, the organization saw a significant shift from primarily case management encounters to more medically focused services. And in those first two years, the program recorded 1,248 total encounters and delivered 1,823 services, including increases in wellness checks and medical supplies (58%); obtaining medication, medical records, or bloodwork (114%); and transportation to a specialty provider (41%).
Ms. Dees offered three pieces of advice for organizations looking to implement mobile integrated care models and be sustainable long termâstart before youâre ready, use data to drive funding and move beyond grant funding, and build strong partnerships with health systems. Ms. Dees emphasized that launching innovative care models like street medicine doesnât require perfect conditions. FSABCâs success resulted from a willingness to begin with available resources, strong community need, and a clear sense of purpose. She said that waiting for every funding stream, partner, or policy alignment to fall into place can delay urgently needed services. Starting small, testing models, and learning through iteration proved more impactful than waiting for the ideal circumstances.
And from the very beginning, FSABC prioritized outcome tracking, referral volume, and service delivery data. The focus on measurements and outcomes allowed them to demonstrate value to stakeholders and future partners. While the street medicine program began with grant funding, Ms. Dees stressed that financial sustainability relies on developing billable service lines. FSABC is actively working to transition from grant dependence by integrating advanced practice providers who can enable Medicaid billing. Grants were essential to launch the program, but reimbursement through Medicaid and partnerships with managed care organizations (MCO) are necessary to keep it running long-term.
âWe are mostly grant-funded, but we are changing,â said Ms. Dees. âIf we want to keep this program, we need to be able to bill services. Many people rely on grants, but as the political climate changes, we donât know whatâs coming down the road. At this point, weâve pretty confidently secured funding for another two years, but by the end of those two years, I want to be able to fully bill for the services weâre providing.â
Finally, Ms. Dees noted that early collaboration with local hospitals and health plans should have been more robust from the beginning. Over time, the FSABC executive team learned that forming strong relationships with provider organizations, funders, and referral networks is critical not only for service delivery, but also for ensuring consumers are not discharged into homelessness.
Ms. Dees left us with this observation: executives must be willing to assess whatâs not working, make real-time adjustments, and navigate uncertainty with clarity and flexibility. Sustaining these efforts requires both the humility to shift course and the strategic insight to recognize when a change is needed. âYou have to be flexible and be willing to acknowledge that you totally had no idea what you were doing there, and thatâs okay.â