“There is a growing recognition that, for people and neighborhoods to be healthy and successful, different sectors must work together and that investments in one sector can bring dividends to another. Housing, for example, is increasingly understood to be an important determinant in life, affecting health, access to education, and the opportunity for upward mobility.”

Stuart M. Butler and Marcela Cabello of The Brookings Institution make this point in a new report, “Housing as a hub for health, community services and upward mobility.” While the Bainum Family Foundation does not work directly in the area of housing, we recognize that having adequate housing is essential to overall child and family well-being, and that families with lower incomes struggle greatly with housing quality and stability in a market as costly as Washington, D.C.

We also recognize, as the authors do, that service hubs can come in many forms. Our school mental health work aims to create effective models for providing mental health services through schools, which are already a central focus of family life. And our support for children’s health recognizes pediatricians’ offices as an excellent way to connect families with a range of community services and supports.

And so we are pleased to offer this guest post, below, which explains the particular importance of housing to the well-being of children and the opportunities and challenges of leveraging housing as a service hub.

Nisha Sachdev, DrPh, PsyD
Senior Director of Evaluation

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While it takes a village to raise a child, empowering a village to tackle health and development problems facing a child often takes a hub. In our work examining social determinants of health, we’ve found community institutions that play a key linking role in daily life — what we call hubs — frequently act as nerve centers or catalysts to help address such problems as mental health. And when hubs partner with each other in a community, they reinforce each other’s comparative strengths.

Recently we looked at how housing can function as a hub for health, community services, and upward mobility. Combining health with social services often is the most effective health strategy for the elderly and young families. With mental illness typically originating in childhood and adolescent years, and often exacerbated by home and community conditions, it can often make sense to build supports around the home setting.

“Research shows that housing stability and housing quality significantly affect a child’s long-term health and well-being … Homelessness and housing stability have been shown to greatly affect a child’s near-term growth and long-term development, and they can have long-lasting effects on health, education and other social outcomes later in life. Studies have also shown that higher degrees of housing instability are associated with higher degrees of household stress, in particular maternal stress, resulting in greater levels of toxic stress for children. In addition to the importance of housing stability, housing quality and the living environment are also linked to children’s outcomes.”

“Housing quality, such as mold and lead-free environments, are equally important for child health outcomes. Asthma may be caused by airborne contagions that often are prevalent in substandard housing. Research indicates that perceived safety and overall neighborhood quality also profoundly influence a child’s stress response systems as well as physical health and well-being.”

Source: “Housing as a hub for health, community services, and upward mobility,” The Brookings Institution, 2018.

In earlier reports, we examined how other institutions, such as hospitals and schools, can also be hubs for assembling a range of supportive services.

In our research, we have found utilizing institutions as hubs is far from plain sailing, and that the wide variety of hubs actually encounter similar challenges.

One of the toughest challenges is collecting and sharing the data needed to coordinate services. Helping a child with behavioral or mental health issues, for instance, may require the school, the home, physicians, and perhaps the juvenile justice system to share information to facilitate coordination. But privacy rules can frustrate this and need to be navigated carefully, as do concerns about nosey neighbors; and even government agencies, as well as private-sector organizations, need help in complying with federal privacy requirements. The national organization representing large public housing authorities has helped address this by creating several data-sharing agreement templates to help the housing and education sectors collaborate and share data.

A related challenge is figuring out what kind of hub structure will get the best results. Many hubs lack adequate data or analysis capacity to evaluate their operations and justify expansion funding. This is especially problematic for projects and organizations spanning multiple sectors, where many data sets are involved or where the impact of an intervention (for instance, addressing children’s behavioral health) may take several years to measure accurately. This also makes it more of a challenge to obtain public or private funding.

Another data problem is that housing authorities and schools trying to function as hubs, or to partner with other hubs, are hampered because typically they have little knowledge of the family backgrounds of their tenants or students. Washington, D.C.’s housing authority is tackling this by working to identify the needs and opportunities of the 5,000 children in its properties.

In addition, hubs usually face skills gaps when they try to operate outside their familiar lane. Philanthropy can play a crucial role in building up those skills and connections. An example is the Bainum Family Foundation’s $4.1 million investment in school-centered mental health services in disadvantaged areas of DC. Another approach is to use an intermediary to provide the experience and broad knowledge needed to build a hub or successful partnership.

Fortunately, we found important housing hub initiatives that are tackling these and other challenges. In a venture known as Housing Opportunities and Services Together (HOST), for instance, a group of housing authorities in Washington, D.C. and three other cities, in conjunction with the Urban Institute, is testing approaches to using housing as the platform for a variety of services and supports, including mental and behavioral health. HOST employs a two-generational, place-based approach that goes beyond physical health, using social services to improve families’ social and economic futures, while integrating services for adolescents and children. HOST sites also partner with local organizations and customize mental and behavioral health strategies for children and their families.

As the connection between housing and health becomes better understood, and the research is catalogued, expect to see more on housing as a hub. And thanks to efforts like HOST, the Resilience Collaborative, and other ventures we have found in our work, there are more and more models of how supportive housing strategies can be a powerful and positive influence on mental health and overall well-being.