In Franklin County, Ohio, pre-term birth/prematurity has remained the leading cause of newborn illness and mortality since 2013. Healthy Beginnings At Home (HBAH) is a pilot program that was launched mid-year 2018 by CelebrateOne, Homeless Families Foundation, Columbus Metropolitan Housing Authority (CMHA), Nationwide Childrens Hospital, and CareSource. The program provides rental subsidies and housing stabilization services to Medicaid-eligible pregnant women who are near homeless or experiencing homeless and are at greater risk of infant mortality.
CareSource participated in this program by providing care coordination through a nurse case manager and life coaching services through a team of social workers to HBAH families. Additionally, CareSource provided claims data for the HBAH health outcomes The CareSource Foundation provided the initial grant to launch HBAH along with funding from the Ohio Housing Finance Agency (OHFA).
“It’s a true honor to join the amazing organizations involved with making Healthy Beginnings at Home a reality in Franklin County,” said Amy Riegel, Director of Housing at CareSource. “Instinctively, we know stable, affordable, quality housing is good for our members but we need more data to prove it’s an effective strategy to help pregnant women with a high risk of infant mortality.”
The Healthy Beginnings At Home (HBAH) Pilot Design
The design followed many components of Family Critical Time Intervention (CTI), an evidence-based, time-limited case management model designed to help families experiencing homelessness re-establish themselves in stable housing along with needed emotional and practical support. Fifty of the participants were randomly assigned to receive community-based services, while the other 50 received community-based services, a rental subsidy and housing stabilization services.
Kelly J. Kelleher M.D., MPH is the Vice President of Community Health at Nationwide Children’s Hospital and partner in the research study.
“Our cohort of young women experiencing pregnancy and homelessness faced many systemic barriers to caring for themselves and their babies,” he explained. “Just having shelter can dramatically improve access to other essential services. Additionally, those services are just not as effective when a housing situation is unstable.”
The Pilot Outcomes
Through collaborative partnerships, the study was able to house 100% of housing intervention participants despite either no, or limited income, poor credit and other barriers to housing.
“Before Healthy Beginnings at Home, I was sleeping on the floor at my boyfriend’s mom’s house—pregnant. Nobody wants to do that. It’s not easy to do that,” said a Healthy Beginnings At Home participant. “Now, not only do I have a stable place to raise my family, but I have a place for myself.”
Preliminary findings show differences between the birth outcomes for the intervention group and the usual care group. There were four fetal deaths in the usual care group and none in the housing intervention group. Additionally, 40 of 51 babies in the intervention group were born full-term and at a healthy birth weight in comparison to 24 of 44 babies in the usual care group. Infants from the intervention group were more likely to be admitted to the Neonatal Intensive Care Unit (NICU). NICU admissions were significantly shorter for the intervention group than the control group - 8 days compared to 29 days. Dr. Megan Sandel from Children’s Health Watch served as the pilot’s research advisor.
While other studies previously demonstrated the health consequences of families not having housing, HBAH is groundbreaking as it is demonstrating that it is not too late to intervene with housing during pregnancy.
The Recommended Policies
The study has led to two key recommendations from the organizations involved.
Core Policy Recommendation 1:
Test the HBAH model in other communities and at a greater scale to better understand the impact on maternal, birth and child health outcomes and potential cost benefits related to investment in the HBAH model. Apply a racial equity lens to better understand and reverse disparities associated with race and ethnicity.
Core Policy Recommendation 2:
Promote housing stability for pregnant women, with extremely low incomes who experience homelessness or housing insecurity, by providing rental assistance and access to safe, quality rental units with housing stabilization services. Use an equity lens to better understand and reverse health inequities associated with racism.
The Future of Housing and Health
Housing is inextricably linked to health. Future research, policy and practice strategies that improve health and housing stability are needed to develop and amplify evidence-based strategies to effectively support pregnant women who are experiencing housing instability. CareSource believes that these efforts can improve maternal health and birth outcomes which may ultimately reduce infant mortality.
“As a managed care organization, we make commitments to state governments to improve overall health and well-being of their residents while also lowering costs for taxpayers,” said Riegel. “We are committed to continuing to pursue partnerships that address housing stability and research innovative ways to improve our members’ overall health outcomes and quality of life.”