Hospital-to-Housing: Behavioral Health Services and Comprehensive Case Management for People Experiencing Homelessness - Address: 4901 Forest Park Blvd, St. Louis, MO 63108-1402 Project Director: Calencia Mitchell Project Director Phone: 314-503-0063 Project Director E-mail: calencia.mitchell@bjc.org Applicant Website: https://www.bjc.org/community-health-improvement Grant Program Funds Requested: $797,885.00 Hospital-to-Housing (H2H) is a program that provides unhoused adults with behavioral health and/or substance use disorders with comprehensive case management services addressing critical social determinants of health (SDOH), including housing. The population to be served includes vulnerable patients identified as being homeless or housing insecure (e.g. lacking a current nighttime permanent residence) with high hospital emergency department usage while also suffering substance use and/or mental health disorders. Such individuals often are both the most complex to support as well as the most impactful to assist. The population served are unhoused, aged 18 or older, and from St. Louis City or St. Louis County. Eligible patients are identified based on established diagnoses of behavioral health and/or substance use disorders who also manifest unusually high emergency department utilization. Upon subsequent presentation to the emergency department, such patients are offered opportunity to enroll into the program. Those who enroll are provided supportive housing and assisted with comprehensive case management services provided through St. Patrick Center and Behavioral Health Network of Greater St. Louis. From a multitude of social, clinical, financial and population health perspectives, evidence increasingly demonstrates a connection between positive outcomes and services focused on SDOH – defined by the CDC as the interactive conditions where people live, learn, work and play. Reliance on crisis systems in healthcare by people who are homeless and suffer from substance use and behavioral health disorders is a challenge that is ripe for the innovative intervention that H2H provides. Without stable housing and comprehensive case management, individuals are more likely to lack routine healthcare, resulting in frequent visits to emergency departments, often with hospitalization, resulting in sporadic, poorly coordinated care that can produce poor health outcomes at a high public cost. Evidence shows that programs such as H2H can decrease homelessness, increase housing stability, improve clinical outcomes, and increase quality of life for people experiencing homelessness. The Hospital-to-Housing program will aim to serve up to 50 program participants each year. This $797,885.00 request will fund direct services for participants, as well as staff from the community and hospital, who will coordinate to identify and serve participants. This program is positioned to increase access to care as well as coordination of effective treatments and community support services. Program goals aim to improve mental health outcomes, provide access to Medication-Assisted-Treatment for substance use disorders, increase housing stability, enhance coordination of support services in the target population, and reduce unnecessary utilization of the hospital emergency department. An important objective of this program work is also to act as advocate and liaison for program participants in a variety of areas in the community.
