Spotlight On: Housing as a Platform for Health and Well-Being

Abt Global’s research teams combine expertise in housing and health to deliver leading-edge evaluations of initiatives that promote health and well-being among vulnerable populations. Our work joins deep knowledge of supportive housing programs with extensive experience studying the impacts of community-based services, enabling us to understand how integrated housing and health supports can improve health and well-being.

Housing is recognized as an important “social determinant” of health. Researchers and policy makers acknowledge the role a healthy, affordable, accessible and quality place to live plays in improving or maintaining physical and mental well-being. This linkage is especially critical for older adults who want to avoid moving to nursing facilities, people with disabilities who want to stay in their communities, infants and children who require a safe and healthy home in order to grow and develop, and individuals experiencing chronic homelessness.

The federal and private sectors are developing holistic approaches to promoting positive—and preventing adverse—health outcomes through the integration of health services and housing. Abt’s rigorous evaluations of these efforts, including conditions before and after implementation —as well as our work to link cross-agency data sources—make it possible to identify successful approaches to addressing housing and health challenges. Lessons from our work can inform, refine, and scale innovative approaches for better health, improved outcomes for children and opportunities for elderly and people with disabilities to remain in their homes.

Examples of Our Work

Evaluation of HUD’s Supportive Services Demonstration

Abt is evaluating a U.S. Department of Housing and Urban Development (HUD) demonstration of the Integrated Wellness in Supportive Housing (IWISH) model, which is designed to help elderly adults in HUD-assisted multifamily housing age in place. New staff at IWISH sites—full-time Resident Wellness Directors and part-time Wellness Nurses—follow a person-centered approach to engaging residents in activities designed to address the use of potentially unnecessary medical services, delay transitions to nursing homes, and reduce housing turnover. Using administrative data matching, interviews, site visits, and focus groups, Abt will compare outcomes at 124 sites (40 treatment sites and 84 control sites) across seven states, and evaluate how successfully treatment sites have implemented the IWISH model.

Opioid Use Disorder, Housing Instability and Housing Options for Recovery

Abt is working with the U.S. Department of Health and Human Services (HHS) to document the continuum of housing models available for individuals who experience housing instability or homelessness and opioid use disorder (OUD). Abt’s approach offers a systematic look at housing models that might aid individuals in their recovery from OUD to help HHS, HUD, and providers use and further evaluate promising models. To implement the project, Abt is conducting an environmental scan. We’re also interviewing experts in the areas of homelessness, housing and opioid use disorder, as well as providers of services for individuals and families that are impacted by OUD and experiencing homelessness or housing instability.

Evaluation of the Section 811 Project Rental Assistance Program

Under the Section 811 Project Rental Assistance (PRA) program, HUD is providing project-based rental assistance that enables very low-income people with disabilities to live in integrated affordable housing developments that serve a broader population. To be eligible, state housing agencies must partner with state Medicaid agencies and/or health and human services agencies to ensure residents have access to community-based long-term services and supports. Abt is using a mixed-methods approach to assess the impact of this program on residents’ access to supportive services, quality of life, health outcomes and perceptions of their housing and neighborhood quality. Data sources include in-person resident surveys, interviews with administrative staff and property owners, a review of PRA documents and data, and analysis of Medicaid and Medicare claims data and HUD administrative data.

Evaluation of the Medicaid Innovation Accelerator Program Technical Assistance Activities

Funded by the Center for Medicare and Medicaid Innovation, Abt is conducting an evaluation of technical assistance provided to state Medicaid programs as part of the Medicaid Innovation Accelerator Program (IAP). The goal is to support states’ Medicaid reform innovations through the development of new delivery models, data analytics, quality measurement and rapid-cycle learning and evaluation that builds on lessons and recommendations contributed by state partners.

Technical Assistance for the Supportive Services for Veterans Families Program

Abt provides intensive, on-site technical assistance and remote support to help dozens of communities strengthen their systems for serving veterans experiencing homelessness. Through the U.S. Department of Veterans Affairs’ Supportive Services for Veterans Families program, in partnership with the Technical Assistance Collaborative, we bring together local stakeholders to identify the key barriers to ending homelessness among veterans and then create community-specific systems to overcome these barriers. Our support ranges from helping to develop systems that improve communities’ ability to understand local needs to providing guidance and training in the design and implementation of new policies and best practices.

Case Study of the Benefits of Lead-Based Paint Remediation

Children are commonly exposed to lead via contaminated dust, which is often a result of deteriorating lead-based paint within a home. We conducted a case study to evaluate the health and monetary benefits of three different methods for lead-based paint remediation. For each remediation strategy, we estimated the resulting changes in dust levels and subsequent changes in blood lead levels. Based on these changes, we then estimated changes in IQ and prevalence of ADHD. We also calculated the monetary benefits associated with avoided IQ loss. Our results demonstrated that lead-based paint remediation is both cost-effective and successfully prevents IQ loss and the development of ADHD in children. We estimated that full remediation of all U.S. homes with lead-based paint would result in net monetary benefits of up to $73 billion.