Health In Housing Initiative: Increasing Access, Integration, and Impact
Presenter Disclosure Presenter: Tosha Densky, Shelly Happy Relationships to commercial interests: Grants/Research Support: N/A Speakers Bureau/Honoraria: N/A Consulting Fees: N/A Other: Core Funding (LHIN)
Disclosure of Commercial Support This program has received financial support from LIHC in the form of core funding from the Southwest LHIN This program has received in-kind support from the following sources: - Unifor local 27 - ReHarvest London - Trinity United Church Community Centre in the form of: - Volunteers - Food and other program resources - Program staffing support
Potential for conflict(s) of interest: – No conflicts identified
Mitigating Potential Bias • Selection of Social Housing buildings and Housing Cooperatives were based on previous relationships with Housing Managers and demographic information collected by the City of London, Census data, and the HEAL Lab through Western University • Interviewer bias may have been a factor in participant responses when collecting data
Health in Housing Initiative
Goal and Vision Goal: Increase overall health and wellness outcomes of residents in select housing complexes within an 18-month period
Vision: Residents in housing complexes will have increased control over, and ability to improve, their health
Logistics January 2016 - June 2017: Housing Cooperatives (2) January 2016 - March 2018: London & Middlesex Housing Buildings (2)
September 2017- Present: New London & Middlesex Housing Building
Integrative Approach to Care • • • • • • • • •
Community Development Workers Seniors Health Worker Social Workers Nurses Dietitians Youth Outreach Workers Health Promotion Workers Community Workers Seniors Wrap Around Facilitators
Structure Integrative approach to care
• Outreach and engagement activities • Education and personal development sessions/workshops • On-site health and wellness services and programs
Context • Part of larger community health and development strategy that is integral to CHC approach to care • Guided by learning from community needs and previous community work
Highlights of 18 mo. HiHi Pilot • How we have supported and increased ACCESS to Health Centre and community services and programs • How we have INTEGRATED our work and broadened the circle of care
• How we have made an IMPACT
Data Collection Methods • Weekly tracking sheets • Strengths, Needs, and Discoveries interviews (6 months and 18 months) • Exit surveys • Health Centre program questionnaire • Electronic Medical Records (NOD) • Multi-disciplinary staff survey • Housing Manager survey
How We Have Supported And Increased ACCESS Over 185 individuals attending HiHi (January 2016-June 2017)
How We Have Supported And Increased ACCESS HiHi Participants June 2016 (6 mo.)
36%
64%
New Clients as of Jan. 1, 2016 Existing Clients before Jan. 1, 2016
How We Have Supported And Increased ACCESS HiHi Participants June 2017 (18 mo.)
36%
Existing Clients before Jan. 1, 2016
64% New Clients as of Jan.1, 2016
How We Have Supported And Increased ACCESS
Total Visits to Health Centre
709
1920
July 1, 2014 January 1, 2016 (18 months prior to HiHi) January 1, 2016 June 30, 2017 (18 months of HiHi)
How We Have Supported And Increased ACCESS HiHi Participants
connected to 2 or more Health Centre services - 18 months
connected to 2 or more Health Centre services - 6 months
0%
10%
20%
30%
40%
50%
Increased Community ACCESS • • • • • • • • • • • • •
City of London - Ageless Grace and Seniors Satellite Boys and Girls Club- Summer Camp and Club memberships London Public Library - Visits MLHU - Resiliency Workshops, Harvest Bucks, and Bed Bugs Education CYN - Health Promotion and Fitness Fanshawe - Dental Hygiene Program Beautiful Edibles - Community Gardens Trinity United - Seniors engagement Money Matters – Financial Literacy Elder Abuse Coalition- Elder Abuse Education Unifor – Holiday Meals and Bike Maintenance Workshops ReHarvest London- Food Rescue Old East Village Grocer- Social Enterprise
How We Have INTEGRATED Our Work HiHi Participants by Provider Type Diabetes, 40
Allied Health (e.g. Physio, Foot Care), 22
Community Work (e.g. Seniors WrapAround, WOW, YOW), 61 Primary Care, 45
Mental Health, 53
How We Have INTEGRATED Our Work Number of Client Encounters
How We Have INTEGRATED Our Work Sample Activities: Cooking Tax Credits & Budgeting Exercise Health Workshops Complex Beautification One-to-one counselling Crafts/Games
“Ask a…” Nurse, Dietitian, Social Worker, Youth Worker Field Trips Employment Support Community Garden Youth Drop-in
How We Have INTEGRATED Our Work
How We Have Made An IMPACT
IMPACT Pre-
Post-
• Almost all have more than two chronic conditions
• 92% indicate they are managing their chronic conditions better • 83% feel better informed about their health
• 50% identified challenges in understanding health information delivered at medical appointments • Majority identified their overall health as average to very poor
• Majority indicate being idle during the day
• 67% report increase in health status, with no reported decreases • 66% spend their days more productively
IMPACT Pre-
Post-
• Overwhelming majority rarely socialize with neighbours, community members, or friends • Majority do not have a strong sense of belonging in their buildings/complexes
• 81% reported increased or improved relationships with neighbours and family
• Half of respondents are on specialized diets due largely to chronic conditions, incl. diabetes
• 100% identified increased food skills and knowledge; 93% are eating better and more nutritious foods
• 71% reported increased sense of belonging in their community
IMPACT Statements
IMPACT Statements
IMPACT Statements “The value of this program is immeasurable. Residents are empowered, educated, [and] have improved life skills.” – Housing Manager “My co-op was able to take an issue that affected them all that initially they felt afraid to voice….and found courage and purpose to create an environment they all feel comfortable in.” – Housing Manager
Learnings • Many individuals requiring an increased level of comprehensive support and follow up, i.e. case management • Evaluation: too many tools, too often • Greater clarity around staff roles, expectations, and responsibilities • Time of day/structure – childminding vs. parents/adults; didactic vs. interactive; scheduled activities vs. drop-in • Site selection– recognizing our own capacities and time commitments • Transition planning integral at many levels
Challenges • • • • • • •
Hard-to-reach populations Complexity of life circumstances Systemic issues Environmental limitations Staffing constraints Addressing gaps in service Over-surveying clients
Questions