Improving Cross-Sector Collaborations between Healthcare and Housing: Challenges and Strategies Identified By Unhoused People with Complex Health Needs

Background and Purpose: Research findings clearly demonstrate a bidirectional relationship between healthcare and housing. Thus, there is growing recognition of the need for collaboration between the healthcare and housing sectors to address the needs of people experiencing homelessness and complex health needs. This study explores how these cross-sector collaborations can be improved from the perspective of individuals with histories of homelessness and complex health needs. Current research on cross-sector initiatives has shown promising routes forward for such collaborations, but this study fills an important gap in informing those directions with the voices of people who are currently or recently unhoused and who have complex health needs.

Methods: In-depth, semi-structured qualitative interviews (N=23) were used to 1) understand the challenges faced by this population when navigating services at the intersection of healthcare and housing and 2) identify strategies for improving these services. Participants with histories of homelessness and complex health needs were purposively sampled from seven (of 21) counties within New Jersey to ensure variability in potential exposure to cross-sector efforts. Thematic analysis involved consensus coding by the two first authors with input sought from a community partner, as well as the rest of the research team on emerging themes. Results were also presented to a stakeholder advisory board as a form of member checking.

Results: While some participants reported experience accessing cross-sector services, many found those efforts to be lacking and in need of improvement. Participants reported that it was more common to receive support with healthcare needs from housing providers than assistance with housing needs from healthcare providers. Common challenges described by participants included frequent provider turnover, perceived stigma and discrimination from providers, and insufficient access to resources. Participants proposed solutions included modernization and centralization of care, providing more effective in-person services with virtual offerings available as appropriate, and improving provider sensitivity to reduce perceived stigma in care settings.

Conclusions and Implications: These findings are consistent with existing research on cross-sector collaborations across fields and highlight the need for effective, compassionate care that is sensitive to the unique needs of people experiencing homelessness. Cross-sector services could be improved with greater awareness and attentiveness to the historical mistrust that many people experiencing homelessness have of healthcare and housing service providers. This study also underscores the urgent need for more comprehensive implementation and evaluation of cross-sector efforts to improve outcomes for this vulnerable population.