PROJECT SUMMARY/ABSTRACT
The public health crisis engendered by the coronavirus (COVID-19) pandemic has fueled unprecedented
efforts to address the risk of infection and transmission among vulnerable populations, including provision of
non-congregate housing to people experiencing homelessness. The expedited implementation of housing
services also addresses one of the oldest and most entrenched contributors to health disparities—lack of
safe and stable housing. In this unique moment, we have the opportunity to examine whether swift provision
of housing at the community level mitigates the impact of COVID-19, as well as how doing so may affect the
individual, social, and structural factors that contribute to consequences of COVID-19. We propose a mixed-
methods study of Operation Safer Ground (OSG), a community-level intervention deployed to stem
COVID-19 infection among people experiencing homelessness in Alameda County, CA. Initiated in April
2020, OSG provides long-term housing to homeless people who are vulnerable to COVID-19 infection
because of age (>65 years) or chronic illness. To date, more than 1,000 people, roughly 10% of the county’s
homeless population, have entered OSG. The proposed study is a “natural experiment.” In Aim 1, we will use
document reviews and qualitative interviews with OSG participants, staff, and local public health officials to
describe the development and implementation of the program, define its operational characteristics, and
investigate contextual factors that influence outcomes for program participants. We will use the Consolidated
Framework for Implementation Research (CFIR) to structure this inquiry. In Aims 2 and 3, we will compare
individual-level outcomes over time among the intervention group (OSG clients) with outcomes among
similar non-clients in a carefully constructed comparison group, which we will create using propensity score
weighting methods. We will incorporate mediation and moderation analyses to examine mechanisms and
interactions that help explain outcomes. Data will be drawn from a county-level database called the Social
Health Information Exchange (SHIE), a centralized system that coordinates health care, housing, and social
service use by county Medicaid consumers with complex health and social needs. Approximately 8,000
homeless consumers, including all OSG participants, are represented in the SHIE. By pursuing this unique
opportunity, we will gain valuable knowledge to help improve the long-term response to the pandemic and
prepare more effectively to protect the health of vulnerable populations in future public health crises.
