GA
Positive Impact Health Centers (PIHC) implemented the Housing Opportunities Medical Employment Services (HOMES) Program from 2018–2020, as part of the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) initiative, Improving HIV Health Outcomes through the Coordination of Supportive Employment and Housing Services. Through HOMES, PIHC introduced employment services and bolstered its housing supports for clients, by bringing on two new case managers and strengthening external partnerships. These expanded services enhanced PIHC’s existing 'one-stop shop' model of medical care, behavioral health care, and case management, leading to improved client outcomes. HOMES participants were more likely to be engaged in care and virally suppressed in 2020 than at the time of program enrollment.
People with HIV often struggle to access housing, especially in areas with tight housing markets, like Atlanta, Georgia, where rising rents have pushed people out of once affordable neighborhoods. Incorporating a ‘housing first’ model helps people with HIV to address their housing instability while working towards obtaining employment and maintaining consistent medical care. HOMES is based on the belief that housing and employment are forms of healthcare and can ultimately lead to better care engagement and viral suppression.
“This is a high-need population, but this work—and the outcomes that follow—are possible.”
As part of HOMES, PIHC hired two non-medical case managers to provide employment support by connecting clients to local organizations that provide job training and placement services. Case managers first met with clients for up to 90 minutes to discuss employment and housing goals and barriers, ranging from childcare needs to criminal convictions, and to develop an individual service plan. Case managers and clients worked together to implement their plans, address barriers, and met on a weekly basis to discuss progress.
HOMES leveraged external partners and search tools to provide housing support, including:
- Open Doors, which leverages real estate and business partnerships to place people in affordable housing
- Georgia Housing Search, which has tools that support housing, such as details on available rental properties, an affordability calculator, and renters’ rights
- Roomies, which connects people to potential roommates and helps develop rental agreements.
Case managers also connected clients to transitional housing until a long-term solution could be identified.
Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) can play critical roles in providing eligible people with financial support. Case managers and PIHC benefits coordinators helped clients apply for and access these benefits. HOMES also educated staff and clients on the effect that earned income can have on SSI/SSDI, as well as on eligibility for other governmental programs.
PIHC provides medical care, mental health care, and substance use treatment onsite. The clinic also has an onsite pharmacy, offers an environment that is welcoming to all clients, and hosts support groups and events. These comprehensive offerings helped PIHC meet HOMES participants’ full physical, emotional, and support needs.
Grocery store cards, ride-sharing services, professional clothing, hygiene products, and moving services were offered through HOMES to promote the use of housing and employment services and, in turn, better client outcomes.
PIHC recruited 118 participants who were unemployed or underemployed and facing housing challenges (e.g., homeless, unstably housed, at risk of homelessness) into the HOMES program. PIHC assessed care engagement and viral suppression at enrollment and in May 2020, and found that clients were more likely to be engaged in care and virally suppressed at the end of the program.
| Category | Information |
|---|---|
| Evaluation data | Data collected through PIHC’s electronic health record system and an Excel spreadsheet that tracked transitional hotel lodging stays, length of stay, and cost. |
| Measures |
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| Results | The percent of clients:
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Source: Positive Impact Health Centers. Housing Opportunities Medical Employment Services (HOMES) Program. [SPNS Intervention Manual] 2020.
“This program has definitely changed my life… [HOMES staff] went a step beyond to check up on me to make sure I was doing the things I needed to do to continue to excel in life.”
Extensive partnerships. PIHC formed partnerships with community organizations to ensure clients’ housing and employment needs could be met in a comprehensive way. Many of these organizations had not traditionally served people with HIV, so PIHC assessed their ability to provide non-stigmatizing care and educated them on the population’s unique needs. Goodwill of North Georgia, Jewish Family & Career Services, NOVO Health Services, First Step Staffing, GA Works, and the Atlanta Center for Self Sufficiency all provided employment services and opportunities for HOMES clients. Housing supports were offered through governmental programs, such as Housing Opportunities for Persons with AIDS (HOPWA), county housing authorities, and multiple private and nonprofit non-governmental organizations. Finally, PIHC partnered with external health care organizations to provide medical care and other client supports.
Foundational supports and training. The Getting to Work Employment Initiative, supported by the U.S. Department of Housing and Urban Development, provided a framework and related training materials for HOMES staff including the two new case managers. HOMES also partnered with Emory University to train staff on trauma-informed care and leveraged the SSI/SSDI Outreach, Access, and Recovery (SOAR) effort to help case managers enroll eligible clients into SSI/SSDI.
Consumer and staff input. PIHC obtained input from members of the Consumer Advisory Board, through both a client survey and focus groups conducted during substance use treatment support groups, which helped PIHC identify client housing and employment needs. PIHC staff presented these findings and staff survey results to its Board of Directors.
Generating client referrals. External partnerships and education provided to PIHC staff and leaders helped PIHC generate referrals for the program. HOMES staff conducted many presentations throughout the Atlanta area during the three months before the program’s launch to garner interest.
“The case manager. . . sat in the park with the client for two hours and engaged in natural conversation that built trust to establish care, and eventually establish housing. Over time, the client was able to achieve undetectable status for the first time since his initial diagnosis.”
HOMES was funded through the RWHAP SPNS initiative, Improving HIV Health Outcomes through the Coordination of Supportive Employment and Housing Services, which covered the costs of staff, transitional housing, client incentives, and transportation. PIHC has diverse funding streams that support the clinic and its service delivery models on an ongoing basis, including Ryan White HIV/AIDS Program Parts A, B, and C, the 340B Drug Pricing Program, and grants from local and other federal agencies, foundations, and religious charities.
- Braided funding. Funders may place restrictions on types of services funded. Therefore, PIHC leveraged multiple funding streams to ensure HOMES participants had access to a range of services.
- Building strong coordination. PIHC staff met regularly to coordinate activities, identify referral processes, and discuss client needs and outcomes. For example, HOMES case management staff met daily to discuss specific client cases, while all client services staff met monthly to review general processes and data.
- Housing-related barriers. PIHC ran into roadblocks that were hard to mitigate. Staff faced challenges communicating with people who were unstably housed due to inconsistent phone numbers and service. In addition, the general lack of housing stock in the Atlanta area made it difficult to find permanent situations for people, regardless of the effort put in by case managers and partner organizations.
- Persistence pays. Despite these challenges, PIHC found that persistence in finding solutions, continuous education to clinical providers to generate program referrals, and an ample network of partners helped connect people to needed services.