Assisting families in procuring safe, stable housing requires a multi-sector, multifaceted approach. Throughout its history since the landmark 1995 Thompson v. HUD lawsuit, the Baltimore Regional Housing Partnership (BRHP) has engaged with stakeholders in the housing field to develop innovative practices and offer a unique approach to housing assistance that pairs housing vouchers with mobility counseling.

Over the past several years, however, BRHP has considered how to engage stakeholders from other sectors as an approach to housing security and stability. With funding from The Kresge Foundation, in 2019 BRHP embarked on the design stages of an initiative housing voucher program that approaches housing through a health lens.

The Healthy Children Voucher Demonstration has been a project long in the works in Baltimore City. Even before the planning stage, the need for a housing voucher that addresses the effect of home and environment on health was discussed and considered throughout the Baltimore housing assistance sector, according to Pete Cimbolic, BRHP managing director of operations and program evaluation.

Though we know that environmental factors impact health, adverse health incomes are especially common in Baltimore City, where the rate of asthma-related hospitalizations is nearly three times higher than the U.S. average and about 2.2 times higher than the average rate for Maryland. Additionally, research from the Abell Foundation and the Environmental Integrity Project shows that lower-income neighborhoods in Baltimore have the highest rates of asthma hospitalization and emergency room visits.

Such adverse health effects extend beyond asthma-related illnesses. Throughout neighborhood health reports published between 2011 and 2017, the Baltimore City Health Department found that lower-income neighborhoods consistently have higher mortality rates, more pre-term births, higher areas of land located in food deserts, and other factors that contribute to worsened health outcomes. These statistics contribute to a growing body of literature and research surrounding the effects of housing and environment on health and why interventions are crucial.

Given the demonstrated connection between health outcomes and housing, the Baltimore Regional Housing Partnership held meetings with Baltimore stakeholders on how to create a pilot program that addresses Baltimore’s adverse health outcomes through housing resources and expertise. In collaboration with the Housing Authority and Health Department of Baltimore City, a team of public health researchers from Johns Hopkins University, the Green and Healthy Homes Initiative, and additional supports, BRHP launched the Healthy Children Voucher Demonstration (HCD) in early October of 2022.

With a focus on public health, the Healthy Children Voucher Demonstration couples the rental assistance services of the Housing Authority of Baltimore City (HABC) with the renowned mobility counseling services offered by BRHP, and is targeted toward families with children who have one or more health need or condition from a wide-ranging list including asthma, anxiety, and diabetes. For its participants in the Baltimore Housing Mobility Program, BRHP provides comprehensive housing counseling, housing search assistance, and educational workshops to support the transition to a high-opportunity neighborhood.  Through participation in the HCD, these resources will become available to 150 families with an existing HABC voucher.

The HCD works through a referral system that brings housing and health professionals into coalition. Our community health workers, who conduct home visits for low and moderate-income families throughout Baltimore City, will make a referral to BRHP for participation in the HCD. This referral is based on the health worker’s visit with the family, where they conduct an informal assessment of whether the family may benefit from participation in the program. The referral does not require a family to document their condition as eligibility for the program, but rather, makes use of the social work component of community health resources in Baltimore, including the Health Department’s B’more for Healthy Babies initiative, HealthCare Access Maryland, and Johns Hopkins Hospital. Health workers will discuss the program and the potential benefits of moving to a new environment and home for the family’s health, and make a referral based on whether the family is open to a health-related move.

Because each family may have different health concerns, the counseling and housing search for each family will look different on an individual basis. For example, a family moving for asthma-related reasons may look for a neighborhood with greater air quality, or a home with few potential asthma triggers such as carpets or gas stoves. Another family may seek a home close to preventative health care and may need additional support being connected with medical specialists. The connection between violence and crime in a neighborhood and increased rates of anxiety may lead families to seek homes in low-crime areas that are more resourced.

After a series of orientations and workshops, participating families will receive one-on-one counseling sessions, receive assistance with the housing search process, and will have access to the broad services BRHP has for its more than 4,300 families. After finding and moving to a new home, BRHP counselors will remain in contact with participating HCD families to ensure additional supports are available, and any goals related to the program are met. Families will also have the option to participate in an evaluation study, conducted by the Johns Hopkins School of Public Health, to measure the efficacy of the community health worker referral process.

The Healthy Children Demonstration strives to reach several short- and long-term goals. Most immediately, BRHP is excited to be able to offer counseling to HABC families and strives to demonstrate the value and necessity of a robust approach to rental assistance programs.

Additionally, BRHP and HABC will contribute to the field evaluating and studying social determinants of health and demonstrate that collaboration between health and housing experts is not only feasible, but necessary for a comprehensive and all-encompassing approach to greater public health and welfare. As part of The Kresge Foundation’s Advancing Health Equity through Housing cohort, we are thrilled to be joined by many innovative and inspiring organizations with similar aims and are excited for the potential to learn from our health and housing peers.

Roxy Blocksdorf is the grant coordinator at the Baltimore Regional Housing Partnership. To learn more about BRHP, click here.