Capacity Building for Health and Housing Equity

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I started Gilvar Consulting Services to partner with organizations providing health care, housing, and homeless services and help expand their capacity to meet the needs of patients, residents, clients, and the broader community.  I especially wanted GCS to support community partnership development and efforts to bring to scale cross-agency collaborations integrating physical and behavioral health care as well as housing and shelter services.  As the director of large Health Care for the Homeless programs in both Texas and Washington, I developed and managed numerous successful collaborative initiatives with these same goals. I’m now using my strategic planning, advocacy, policy development, and operations management experience in a variety of new ways.

I want to strengthen leaders coming together from different sectors with a realization that they need to work together to transform systems in service of greater health and housing equity.  Increasingly, Continuum of Care planning entities, Managed Care Organizations, hospitals, Community Health Centers, community mental health agencies, substance use disorder treatment providers, housing authorities, Public Health Departments, Medicaid agencies, and city and county governments are finding ways to break down silos, reduce fragmentation, and more systematically address homelessness and racial disparities in health and housing outcomes.  Some examples of how I can help support such efforts include:

  • Executive coaching
  • Leadership development, mentoring, and team building
  • Strategic planning, including facilitation, research, analysis, and workplan preparation
  • Facilitating health and housing collaborations
  • Diversity, Equity, and Inclusion work
  • Training and technical assistance, including:
    • Board of Directors development
    • Federal grant compliance, including Operational Site Visit preparation
    • Community Needs Assessments involving patients and front-line service providers
    • Public-entity Community Health Center special issues
    • Mobile medical, dental, and behavioral health services
    • Medicaid 1115 waivers
    • Communicable disease prevention
    • Disaster planning
    • Medical respite care program development, financing, and management
    • Provision of clinical services in shelters, supportive housing buildings, and other non-traditional settings
    • Outreach-based health services for unsheltered individuals and families
    • Grant proposal development and writing
    • Integrating services across disciplines, agencies, and sectors, including:
      • Medical care
      • Oral health care
      • Mental health care
      • Harm reduction and other Substance Use Disorder services
      • Vision care
      • Social work
      • Outreach and case management
      • Communicable disease prevention
      • Benefits enrollment

Other Articles

The Capitol

A Public Health Lens on Homelessness Exposes Problems with the Trump Administration’s Proposed Approach

A recent
University of California study titled Health
Conditions Among Unsheltered Adults in the U.S.
brings into focus
public policy blind spots that make progress challenging for clinicians and
other professionals working to end homelessness.  Personally, the study’s findings evoke a
question that preoccupied me during my tenure as director of a 10-agency
health care network
treating over 21,000 unduplicated homeless individuals
per year: Why do policy debates about homelessness pay such scant attention
to significant health needs that both precipitate the loss of housing and
create daunting obstacles to regaining stability after an individual or family has
become homeless?

Reflections on Leading for Racial Equity

Data unmistakably link race with poor health and housing outcomes, and leaders within public health agencies, community health care organizations, and housing and homeless services entities have attempted to develop new strategies to produce more equitable outcomes. In seeking deep and lasting impact, however, these leaders encounter barriers stemming from the persistent influence of unconscious bias and white supremacy that pervades our culture. For instance, researchers found that the most commonly used assessment tool for prioritizing access to scarce housing units for people experiencing homelessness results in statistically significant discrepancies in scores that favor whites over people of color. Genuine dialogue around these issues, which includes both clients and staff of color as well as managers at all levels, regardless of their racial identity, is needed.  

A top view of homeless beggar man with belongings outdoors in city.

Housing is Health Care. Yes, And…

As Public Health thought leaders push for greater understanding of the social determinants of health, they increasingly focus on stable, affordable housing as a critical piece of the puzzle for reducing the risk of worsening chronic health conditions, frequent and/or avoidable hospitalization, increased costs, and early mortality for vulnerable populations.   Kaiser-Permanente Chief Community Health Officer Bechara Choucair and National Health Care for the Homeless Council CEO Bobby Watts persuasively argue in Rx for Health: A Place to Call Home that “homelessness itself can accurately be characterized as a dangerous health condition.”[1] The statistics they cite demonstrating dramatic health outcome and mortality disparities for people experiencing homelessness strongly suggest that increasing access to safe and secure housing would, at a population health level, have an enormous impact. [2]  Simply stated, preventing people from losing their housing in the first place also prevents poor health outcomes.  In turn, re-housing people who have become homeless reduces the danger of rapidly deteriorating health that is part and parcel of homelessness.  Yet there are thousands upon thousands of people across the U.S. whose unmanaged chronic conditions have already been exacerbated by homelessness.  Effectively and sustainably addressing their needs entails grappling with an array of policy and operational challenges.  

The Aging Homeless Population: Resetting Policy Priorities

National experts have called out the aging of the homeless population as an impending crisis. [1] This demographic shift is happening rapidly, mirroring general population trends. Nationwide, currently half of single homeless adults are aged 50 or older, compared to 11% in 1990. [2] Moreover, according to a white paper prepared by the Corporation for Supportive Housing (CSH) and presented to a New York City coalition studying ways to address the aging of the homeless population, “not only are those on the streets getting older, but their health is deteriorating at rates much faster than the general population.” [3] The paper cites research showing that homeless adults over 50 had a higher prevalence of geriatric conditions than that seen in housed adults 20 years older. [4] Another study showed that older homeless adults were 3.6 times as likely to have a chronic medical condition as homeless adults under 50. [5] Such findings clearly indicate a pressing need for housing and services that specifically address geriatric conditions among older homeless adults living across varied environments. [6]