Project HERO

Yale Community Health Care Van and Clinic, and Liberty Community Services, Inc. empowered clients to set and achieve employment and housing goals, as well as strengthened the ability of community-based organizations to provide related services. This initiative known as Project HERO (Housing and Employment Resources for Improving HIV Outcomes) was implemented between 2017 and 2020 as part of the HIV, Housing, and Employment Special Projects of National Significance (SPNS) initiative.

New Haven, CT

Emerging Intervention
Support service delivery model
Retention in HIV medical care
Treat
People who are unstably housed
RWHAP SPNS
Hospital or hospital-based clinic; Community-based organization/non-clinical setting
Need Addressed

The city of New Haven experiences high rates of poverty, homelessness, and unemployment. New Haven also has the highest number of people with HIV in the state and struggles to provide them with adequate housing.

"Connecticut AIDS housing providers turned away 91% of people with HIV requesting housing because there is a lack of space."

Core Elements
Virtual patient centered medical home (PCMH)

Project HERO was a “one-stop shop,” where clients had access to medical, mental, and behavioral health care, case management, and housing and employment supports. Project HERO staff communicated across organizations about client care needs and support through case conferencing, text, and email.

Structured enrollment process

Clients were eligible for Project HERO if they were:

  1. Out of medical care or at risk of falling out of care,
  2. Unemployed or underemployed, and
  3. Unstably housed.

Project HERO received referrals internally and from community partners, such as other RWHAP clinics and case managers. After passing an initial eligibility screening by phone, clients then participated in housing and other needs assessments for service plan development.

Employment supports

Project HERO provided employment supports through The POWER (Pursuing Opportunities With Employment Resources) initiative. Built upon a Job Club model, POWER involved an eight-week program of biweekly sessions to facilitate progress toward employment. Sessions focused on identifying individuals’ strengths, improving self-confidence, and the development and implementation of a career or self-development plan.

Employment & income navigator

Employment and income navigators helped clients identify goals and strengths and connected clients to employment, educational, and volunteer opportunities. The employment and income navigators also helped clients to understand the impact of work on their benefits. 

“[The POWER curriculum] included gaining knowledge, demystification of wages & benefits relationship, volunteerism, networking, wellness, discovering strengths within, trying new things, education, temporary jobs, part-time jobs, full-time jobs.” 

Housing navigator on the PCMH care team

As a key member of the PCMH care team, the housing navigator secured affordable and stable housing for clients enrolled in the program and provided case management support to prevent future homelessness.

Health housing & employment/income coalition (HHE)

HHE was a coalition of support service providers in the area that worked to improve client referrals across agencies and remove siloes in service provision. HHE also provided opportunities for cross-training and allowed members to share information about local resources. Members included libraries, food pantries, and providers of housing, homeless, employment, medical, behavioral health, educational, and case management services.

Outcomes

The majority of the 42 people enrolled in Project HERO experienced improvements in employment, housing, and health status at 12 months.

Category Information
Evaluation data Housing and employment status was tracked through surveys, and clinical outcomes were identified through medical chart review.
Measures

Percentage of clients who:

  • Experienced improvements in employment status
  • Were permanently housed
  • Were linked to care
  • Were retained in care
  • Were virally suppressed
Results
  • 71% of clients achieved progress on the employment spectrum
  • 75% of clients were permanently housed
  • 75% of clients were linked to care
  • 60% of clients were retained in care
  • 60% of clients were virally suppressed

“Daniel obtained an amazing full-time job which allowed him to drive trucks and interact with his staff, and he can’t say enough about how much he loves his job. He was most excited the job offered benefits and he no longer had to rely on Medicaid for his health needs. He is currently in the process of looking for an apartment that will be his very own and that he will be able to afford with his own wages.”

Planning & Implementation
  • Project HERO staff included a project director to manage the overall project and HHE, employment and income navigators, and housing navigators. The employment and income navigators coordinated POWER, in addition to providing one-on-one supports, with a caseload of 12–20 clients each.
  • Project HERO staff participated in the Housing and Urban Development (HUD) Getting to Work Technical Assistance trainings, in addition to trainings related to motivational interviewing, trauma-informed care, and cultural competency. Employment fact sheets were distributed more broadly to providers to help them incorporate employment supports into their regular activities.
  • While Project HERO was funded through SPNS, Liberty Community Services, Inc. has sustained and increased housing and employment personnel through funding from multiple sources including HUD, state, and city grants.
  • At the start of this initiative, Liberty Community Services, Inc. conducted a community assessment to identify and compile local resources related to housing and employment in a user-friendly online forum.
  • Job Club POWER meetings took place at Liberty Community Services, Inc., a trauma-informed, welcoming environment that promotes feelings of safety and choice.
  • Client input was collected through formal feedback forms and incorporated into activities. For example, when clients indicated they needed legal support, Legal Aid was asked to participate in HHE and present at POWER sessions.
  • Clients were provided these incentives: snacks at the meetings, notebooks, hygiene kits, haircuts, and transportation, including a 10-ride bus pass for those who secured employment.
Sustainability

While the SPNS initiative is over, HHE continues to function and add new partners to ensure that the project has local buy-in and meets the changing needs of the community. HHE, Yale Community Health Care Van and Clinic, and Liberty Community Services, Inc. continue to share lessons learned, pursue other grant opportunities, and continue evaluation efforts to reinforce this evidence-based practice.

Lessons Learned
  • While a Job Club provides a structured curriculum around employment supports, it should be flexible and changing to meet client needs. The curriculum should focus on the “employment spectrum,” to reduce resistance and fear, making it possible for individuals to move in and out of phases of employment and education at a pace that is safe for them.
  • Clients struggled to consistently attend Job Club POWER meetings. To encourage participation, the employment and income navigator stayed in close contact with clients. As noted above, incentives were also provided to participants when they attended meetings.  
  • Many community partners, including representatives from community banks, community colleges, and volunteer organizations, made themselves available to lead modules within the POWER curriculum. These partners were eager to spread their organizations’ internal missions and to generate more clientele. However, Project HERO often booked two speakers for a given session in case one was not able to attend.
  • The partnership between Yale Community Health Care Van and Clinic and Liberty Community Services, Inc. was essential for connecting people with HIV to housing support. Liberty Community Services, Inc. staff provided key technical support on implementation of the POWER model.    
Contact
Yale University
Frederick Altice
Professor of Medicine
Liberty Community Services, Inc.
Silvia Moscariello
Program Director

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