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Bringing Oral Health Home. An Implementation Evaluation of Heartland Alliance Health’s Shelter-Based Oral Health Outreach Program

May 10, 2022

In response to the COVID-19 crisis, Heartland Alliance Health (HAH) aligned with multiple residential sites serving people experiencing homelessness and people with substance use disorders to expand access to oral health services for their residents through site-based outreach.The HAH Shelter-Based Oral Health pilot program aims to improve the oral health of individuals experiencing homelessness and increase access to oral health services and other services addressing social determinants of health. The pilot program aims to do this by establishing stronger partnerships with residential sites and providing on-site dental services. The long-term goals of the program are to increase knowledge for medical providers to successfully implement and deliver on-site oral health care and continue developing strategic alignment between Heartland Alliance Health and residential sites.Recognizing the importance of program implementation in effective service delivery, the evaluation of the Oral Health Service followed the World Health Organization's Implementation Framework. To understand how the service was operationalized, the outcome variables of acceptability, adoption, appropriateness, feasibility, fidelity, coverage and sustainability were assessed. Research questions were developed within each of the overarching outcome variables, sourced from relevant literature and the HAH Oral Health Logic Model (Appendix A). The logic model was co-developed by the research team, HAH Oral Health staff, and outreach partner staff. Specifically, the research questions for this report focus on the implementation of the Oral Health Service based on identified short- and mid- term outcomes.

The Shrinking Geography of Opportunity in Metro America

May 10, 2022

The coronavirus pandemic continues to both illuminate and deepen the challenges of structural racism and housing inequity in the United States. While rent relief programs are sunsetting and rents are skyrocketing, millions of renters negatively impacted by the pandemic's economic fallout face crushing rent debt, eviction, and homelessness. And the renters who have been hit the hardest are disproportionately people of color and people living on low incomes. This extreme precarity stems from a housing crisis that has plagued communities for decades. At the onset of the pandemic, there was not a single state, region, or county in the US where a full-time worker earning the minimum wage could afford a two-bedroom rental home, and nearly half of Black and Latinx renters (and more than a third of all renters) were paying unaffordable rent.Not only is there an overall shortage of affordable rental homes, but they are rarely located in "high-opportunity" neighborhoods that have high-quality schools, safe streets, clean air, parks, reliable transit, and proximity to jobs, retail, and services. Instead, they are concentrated in disinvested neighborhoods that lack these "opportunity structures" and are often replete with harms ranging from polluted air to decrepit infrastructure to excessive surveillance and police violence. The overcrowding of affordable homes in lower opportunity neighborhoods and lack of affordable homes in higher opportunity neighborhoods have significant negative consequences for people living on low incomes. Decades of research underscore that living in a neighborhood lacking critical opportunity structures negatively affects health, access to educational and economic opportunities, and life outcomes — especially for children. This uneven "geography of opportunity," or access to neighborhood conditions that influence positive life opportunities and outcomes, is a defining hallmark of American metropolitan regions — and it is one that is deeply rooted in systemic racism. In the past, racially discriminatory policies, including redlining, urban renewal, and government-backed home loans (almost exclusively for white homebuyers), created geographic concentrations of opportunity and disadvantage throughout regions. Today, policies that are not explicitly discriminatory yet have racially inequitable impacts (e.g., exclusionary zoning), maintain these patterns of spatial inequality — effectively locking many people of color out of educational and economic opportunity.This analysis is the first in a series exploring the changing geography of opportunity in American metropolitan regions, building from our earlier analysis of the San Francisco Bay Area. In that study, we found that only 5 percent of census tracts in the region had median market rents that were affordable to a renter household of two full-time workers each earning $15 per hour. Those affordable neighborhoods were located on the outskirts of the region, and 92 percent of them were "low opportunity," according to the Child Opportunity Index produced by researchers at Brandeis University. Our findings underscored the pattern of regional resegregation in the Bay Area described by Urban Habitat, in which tech-driven growth has been pushing low-wage service-sector workers out of core cities to the outer parts of the region.Expanding our lens to the largest 100 metros, in this analysis we ask three questions: First, how does neighborhood affordability for low-income households differ across metros? Second, how does neighborhood affordability vary for Black, Latinx, and white households across metros? And third, is the geography of opportunity for low-income households and households of color shrinking over time, restricting housing choices to an even smaller number of neighborhoods far away from the locus of economic activity? We answer these questions using data on median market rents by zip code from Zillow and metro-level census data on household income overall and for Black, Latinx, and white households for the years 2013 and 2019 to capture the period of economic recovery between the Great Recession and the pandemic. Forthcoming analyses in this series will examine the changing geography of opportunity for Asian and Pacific Islander communities and Native American communities across the country.Using median market rent as a measure of neighborhood affordability means two important things: First, we are focusing on the costs faced by households searching for available rental housing in a metro, not the cost of all rental housing units in a metro. (In other words, we are excluding the housing units of incumbent renters, which tend to have lower rents.) Second, given that a median means that half of the rents are below it and half are above it, this is a summary measure of neighborhood affordability, not a precise measure. So, affordable rentals might exist in a specific neighborhood, but they are not plentiful.To examine affordability by race/ethnicity, we define an affordable zip code as one with a median market rent that is affordable to households at the median household income for that racial/ethnic group within that metro. For example, in 2019, 13 of 350 zip codes were affordable to Black households at the median income for all Black households in Chicago ($76,394) and 48 zip codes were affordable to Latinx households at the median income for all Latinx households in Chicago ($101,643). In the proceeding analysis, the terminology "median-income Black households" and "Black households at the median income" refer to Black households at the median household income for Black households within that metro. This is true for Latinx and white households as well.

Ending Street Homelessness in Vanguard Cities Across the Globe: An International Comparative Study

April 5, 2022

Street homelessness is one of the most extreme, and visible, manifestations of profound injustice on the planet, but often struggles to achieve priority attention at international level. The Institute of Global Homelessness (IGH's) A Place to Call Home initiative, launched in 2017, represented a concerted effort to support cities across the globe to eradicate street homelessness. A first cohort of 13 'Vanguard Cities' committed to a specific target on ending or reducing street homelessness by December 2020. Our independent evaluation of this initiative found that:Two Vanguard Cities – Glasgow and Sydney – fully met their self-defined target reductions for end 2020. In addition, Greater Manchester, while it did not meet its exceptionally ambitious goal of 'ending all rough sleeping', recorded an impressive 52% reduction against baseline.Overall, there was evidence of reductions in targeted aspects of street homelessness in over half of the Vanguard Cities. In most of the remaining cities data limitations, sometimes as a result of COVID, meant that it was not possible to determine trends. In only one Vanguard City – Edmonton – was there an evidenced increase in street homelessness over baseline levels.Key enablers of progress in reducing street homelessness included the presence of a lead coordinating agency, and coordinated entry to homelessness services, alongside investment in specialized and evidence-based interventions, such as assertive street outreach services, individual case management and Housing First.Key barriers to progress included heavy reliance on undignified and sometimes unsafe communal shelters, a preoccupation with meeting immediate physiological needs, and sometimes perceived spiritual needs, rather than structural and system change, and a lack of emphasis on prevention. Aggressive enforcement interventions by police and city authorities, and documentary and identification barriers, were also counter-productive to attempts to reduce street homelessness.A key contextual variable between the Vanguard Cities was political will, with success in driving down street homelessness associated with high-level political commitments. An absolute lack of funds was a major challenge in all of the Global South cities, but also in resource-poor settings in the Global North. Almost all Vanguard Cities cited pressures on the affordable housing stock as a key barrier to progress, but local lettings and other policies could make a real difference.The impact of the COVID-19 crisis differed markedly across the Vanguard Cities, with people at risk of street homelessness most effectively protected in the UK and Australian cities. Responses were less inclusive and ambitious in the North American and Global South cities, with more continued use of 'shared air' shelters, albeit that in some of these contexts the pandemic prompted better coordination of local efforts to address street homelessness.IGH involvement was viewed as instrumental in enhancing the local profile, momentum and level of ambition attached to reducing street homelessness in the Vanguard Cities. IGH's added value to future cohorts of cities could be maximised via a focus on more tailored forms of support specific to the needs of each city, and also to different types of stakeholders, particularly frontline workers.

ORGANIZING IS DIFFERENT NOW

March 23, 2022

RTCNYC and TakeRoot Justice conducted a participatory action research project to investigate the impact of Right to Counsel on tenant organizing among low-income tenants. We conducted focus groups with tenants and with housing organizers. Utilizing a participatory action research model, tenants and organizers participated in the development of research instruments, were trained to administer the research, facilitated focus groups, and engaged in opportunities for skill-building and leadership development.Our research shows:* Right to Counsel strengthens organizing in a variety of ways. It serves as a know-your-rights tool, helps build a base of involved tenants, and opens the door to new organizing tactics and strategies.* Tenants feel less stress and fear knowing they have the right to legal representation in court, which helps them navigate housing court with confidence and success and prompts them to take action against their landlords.* Right to Counsel creates opportunities for tenants, organizers, and attorneys to navigate relationships, share knowledge and history and provide trainings, all in the service of building the tenants' rights movement.* The Right to Counsel NYC Coalition is deliberate and successful in creating and sustaining a tenant-led infrastructure and movement-building spaces.These findings demonstrate the various ways in which the Right to Counsel meaningfully contributes to New York City's robust tenant movement. These findings also offer insight and inspiration for tenants and organizers fighting for the Right to Counsel in their cities.

Reclaiming Vacant Houses & Preventing Foreclosure: Lessons from LISC’s New York State Vacants Initiative

March 13, 2022

The housing instability caused by COVID has continued into 2022, even as foreclosure moratoria end at federal and state levels around the country. This report, Reclaiming Vacant Houses & Preventing Foreclosure: Lessons from LISC's New York State Vacants Initiative, a collaboration of LISC and the Urban Institute, provides lessons and evidence of outcomes of a path-breaking law and LISC initiative in reducing vacant houses and preventing foreclosures in jurisdictions across New York State.

Home Front and Center: Supporting Access to Affordable and Quality Housing

February 23, 2022

We are excited to share with you RRF Foundation for Aging's (RRF) latest issue brief in a series of publications describing the Foundation's approach to grantmaking and improving the quality of life of older people. Home Front and Center: Supporting Access to Affordable and Quality Housing gives an overview of the rise of housing insecurity for older adults, describes some of the work the Foundation is funding to promote safe and affordable housing, and invites others to join us.Our Approach to Increasing Safe, Affordable Housing for Older AdultsWhile the issue of accessible housing confronts millions of Americans, the problem is especially acute for older adults. But for those whose access to safe and affordable housing has been limited by economic inequities and discrimination, such as communities of color and LGBTQ+ individuals, the disparities of housing insecurity loom much larger. And with the end of COVID-19 eviction moratoriums, the threat of homelessness confronts many older adults with low or fixed incomes. For these reasons, and more, studies show that the ranks of homeless older people are rising fast, despite a decline in homelessness in other age groups.RRF Foundation for Aging has been at the forefront of collaborating with organizations and individuals developing and advocating for promising approaches to bolstering housing access, security, and equality for older people. Our grantees are helping older tenants of Chicago organize for better housing, advocating for stronger rights under federal housing laws, gathering data on affordable housing availability, and much more.Read our latest issue brief to learn more about our Three Strategies for More Affordable, Supportive Housing and the innovative work of our grantees in this important area.We look forward to partnering with you on this critical work!Click "Download" to access this resource online.

Housing Needs and Economic Conditions of Cook County’s Older Adults, 2021

December 14, 2021

The development of impactful policy to address the unique housing needs of Cook County's older adults requires local and timely data on changing conditions, informed by the data needs of issue-area stakeholders. This analysis leverages the local knowledge of roughly 20 Chicago-area organizations working on older adult housing issues to create a practitioner-focused resource on key demographic and socioeconomic conditions related to older-adult housing demand and economic and housing insecurity in Cook County.Click "Download" to access this resource online.

A Portrait of California 2021–2022

November 10, 2021

A Portrait of California 2021–2022: Human Development and Housing Justice, the third volume in Measure of America's Portrait of California series, takes a human development approach to understanding the country's most populous and diverse state. Using the American Human Development Index (HDI), it presents a detailed picture of how Californians are doing on three key dimensions of well-being—a long and healthy life, access to knowledge, and a decent standard of living. In addition to an in-depth survey of well-being levels across the state, this volume in the Portrait of California series focuses on a central prerequisite to a good life, one that far too many Californians struggle to attain: access to safe and secure housing. The Covid-19 pandemic dramatically underscored the importance of stable, affordable housing when it comes to access to education, living standards, and health. A Portrait of California 2021–2022: Human Development and Housing Justice explores the impact of California's housing crisis on all three components of the index and outlines policies that can help the state address homelessness and housing insecurity to ensure that all Californians have a safe place to call home.This report presents HDI scores for the state overall as well as by gender, by race and ethnicity, by nativity, by metro area, and by neighborhood cluster. In addition to providing HDI scores for various groups and geographies, it also delves deeper into the underlying causes of the gaps in well-being between them—structural racism, discrimination, sky-high housing costs, among others—and offers recommendations for addressing these challenges and building a fairer future for the Golden State, one in which every Californian can lead a freely chosen life of value.

2021 Park County, Montana Housing Needs Assessment

November 3, 2021

In recent years, housing has become a critical issue in Park County, but identifying exactly what is happening in the ever-changing housing market can be difficult. The Park County Housing Coalition -- a collaborative project of the Park County Community Foundation and Human Resource Development Council of District IX (HRDC) -- produced the 2021 Park County Housing Needs Assessment to compile the best information available about this community-wide challenge.

Housing Needs for Older Adults in Southeastern Wisconsin [Two-Pager]

October 8, 2021

The Social IMPACT Research Center has conducted an assessment of the affordable housing needs of older adults in Kenosha, Milwaukee, and Racine Counties in Wisconsin. The report documents the affordable housing gap in Southeastern Wisconsin for older adults, and details the services that the growing aging population will most need. The full report can be found at: https://socialimpactresearchcenter.issuelab.org/resource/housing-needs-for-older-adults-in-southeastern-wisconsin.html.

Does a Drop-in and Case Management Model Improve Outcomes for Young Adults Experiencing Homelessness: A Case Study of YouthLink

September 30, 2021

This study used two approaches to examine YouthLink as an example of a drop-in and case management model for working with youth experiencing homelessness. These approaches investigated the same group of 1,229 unaccompanied youth, ages 16 to 24 and overwhelmingly Black, who voluntarily visited or received services from YouthLink in 2011. Both approaches looked at the same metrics of success over the same time period, 2011 to 2016. One approach—Study Aim 1—examined the drop-in and case management model overall, asking whether YouthLink's service model resulted in better outcomes. It compared a YouthLink cohort with a group of highly similar youth who did not visit YouthLink but may have received similar services elsewhere. A second approach—Study Aim 2—investigated within the YouthLink cohort the ways in which YouthLink's drop-in and case-management approach worked toward achieving the desired outcomes.

Housing Needs for Older Adults in Southeastern Wisconsin

September 13, 2021

This report provides an assessment of the affordable housing needs of older adults in Kenosha, Milwaukee, and Racine Counties in Wisconsin. It documents the affordable housing gap in Southeastern Wisconsin for older adults, and details the services that the growing aging population will most need.