Providing Health Care to People Experiencing Homelessness: Strategies and Challenges for Cross-Sector Initiatives

Context: Cross-sector collaborations among health care and housing services organizations promise more efficient use of resources and delivery of more coherent and effective services to people experiencing homelessness (PEH). This study analyzes challenges and strategies reported by those currently implementing cross-sector programs.

Methods: Data were collected through in-depth interviews with staff of health care and housing services at eight programs systematically selected to typify the scope and nature of cross-sector collaborations in New Jersey. Respondents included administrators (n = 14) and frontline providers (n = 10). Questions focused on motivations to collaborate, approaches to sustaining partnerships and managing operations, mechanisms for financing services across sectors, and strategies for effectively engaging PEH in health care services. Interviews were audio-recorded and inductively analyzed using standard qualitative techniques.

Findings: Collaborations were motivated by the impact of housing on health, the ineffectiveness and costs of attempting to address unmet health care needs in the absence of providing shelter, and the promise of harnessing resources from both sectors. Accounts of successful approaches for engaging PEH in health care services had four fundamentals in common: establishing rapport through matching client preferences with readily achievable options, maintaining intensive interaction, initiating outreach where clients are, and co-locating health and housing services. Favored policies for promoting effective implementation included financing case management services through contract or capitation arrangements, resolving ambiguities in licensing regulations and reimbursement practices that impede co-location of services, securing direct financing for delivery of nursing services at shelters, and providing greater support for frontline providers.

Conclusions: The programs’ accumulated experiences in successfully implementing cross-sector programs yielded valuable insights for other organizations seeking to mount similar initiatives and for creating a more hospitable policy environment for programs to succeed. Policies of the new federal administration may raise new challenges but are unlikely to diminish the importance of lessons for achieving effective cross-sector collaboration.