Detroit has a rich history, expanding in the mid-20th century to one of the largest cities in the US with roughly 1.8 million people, spread out over 139 square miles. The city was constructed with multiple highways, large single-family homes and no true public transportation infrastructure—predicated on the booming automobile industry and the premise that everyone would own cars. The decline of the automobile industry and racist federal urban policies such as redlining created an accelerated decline in the population (now 673,104), leaving extreme pockets of low density, blight, concentrated poverty (37.9%), and a vastly spread out population without transportation modalities needed to sufficiently access services and employment.
The Detroit Health Department (DHD) started its occupied foreclosure work in the Kettering and Chandler Park neighborhoods, on Detroit's Eastside. Similar to rest of the city, these neighborhoods are predominantly Black, with high rates of unemployment and home foreclosure. Our service population are individuals and families living in foreclosed housing owned by the Detroit Land Bank Authority (DLBA—the largest property holder in the City of Detroit). Many of these families live with limited access to utilities and are unable to meet their most basic needs.
The health impacts of housing instability are well documented. Our service population has borne the burden of years of economic disinvestment, housing market instability, and rising unemployment rates which resulted in large swaths of the City's once vibrant housing stock being abandoned and in varying levels of disrepair. Many now find themselves occupying foreclosed housing in decline, posing dangers to physical and mental health.
To best support our service population, DHD created the Emergency Solutions Grant (ESG), a program to discover and provide resources to those living in foreclosed housing. In summary, DHD sought:
Goal: To provide stable housing to all currently precariously housed families and individuals (Status: In progress)
Objective: Demonstrate success through current practices to obtain funding to expand program (Status: Accomplished)
Objective: To discover alternative housing means through existing Detroit Land Bank housing stock for identified squatters” so as not to flood Detroit's at-capacity homeless housing system (Status: Accomplished)
Stable housing is not only shelters and participating low-income housing systems—it has come to be redefined through this program as occupied DLBA-owned properties that pass structural inspection. With a lengthy waiting list for housing within the City's CAM (Coordinated Assessment Model) system, assessing and using available housing stock through the DLBA as an alternative is a novel approach.
The practice was implemented by building and training a team of Community Health Workers to survey DLBA-owned properties with a custom-build needs assessment. While these needs are case managed, the program works with the DLBA on behalf of the participant to assess the property and provide resources to qualify the individual or family to purchase the current home or be relocated to a new home if the structure is not viable.
Intended Outcome: Directly inform the DLBA of the actual occupancy rates of these abandoned structures
Actual Outcome: The creation of an electronic, multi-departmental platform where information is collected and shared
Intended Outcome: Identify homeless but precariously sheltered individuals, and provide direct assistance leading to housing outside of the City's beleaguered CAM system
Actual Outcome: New eligibility standards at the DLBA for program participants who demonstrate the ability to own and maintain a dwelling, using program CHW's as advocates.
Intended Outcome: Create a model upon which the Health Department may build its own universal intake, needs assessment, and case management platform
Actual Outcome: This program leads the current development of this platform, advancing a departmental "No Wrong Door" policy to reduce silos between programs with a concerted and functional referral and needs management system
Factors leading to success were a concerted, targeted case management process created within the program, a strong network of community partners, and a very strong relationship with the DLBA, who committed to widening their home purchase eligibility standards.
Public health impacts of practice included secure housing for individuals and families living in deplorable housing conditions and decreasing the number of homeless individuals and families. Assessments for food, transportation, employment and health services for homeless individuals looking to purchase a home are provided. As these emergent needs are met, needs relating to substance use disorders, mental health and physical health are discovered and case managed. Finally, as homes are being surveyed by the program team and marked vacant, the DLBA then boards up and removes this blight from Detroit neighborhoods, which in turn reduces potential crime and unsafe occupation.
Homelessness is a significant issue in Detroit. Coupled with that is the problem of abandoned structures with no water, power, or both, which serve many times as a haven for individuals or families for months or years. The problems exist of how to 1) identify the occupied structures and their occupants, and flag the unoccupied structures for demolition or repair 2) Discover individual barriers to adequate shelter 3) provide resources or connections to lower these barriers 4) facilitate relocation or more ideally home ownership to squatting” individuals without burdening the already saturated homeless network here in Detroit.
There are estimated to be around 16,000 homeless individuals in the City (based on 2015 numbers of how many people sought shelter). Anywhere from 1,500 to 4,000 city-wide could be living in these structures. Currently, the program has knocked on 240 doors and encountered and case managed 36 households comprised of 62 individuals through its pilot phase (2 neighborhoods). Through this work, the program has obtained funding to expand outreach through the entire city. Current outreach has encountered between 1.5% and 4% of the total homeless population in the City. Prior to the ESG program, there had been no comprehensive policy to address the service needs of individuals who are housing insecure by aligning them with policies aimed at clearing out abandoned properties. These policies only served to increase the size of the homeless population. The idea of using existing housing stock to confront homelessness is a novel approach. Instead of dismissing the needs of squatters” and condemning the home, this program assesses the needs of the individual, works with the agency that owns the home to inspect it for structural viability, and then looks to facilitate home ownership by meeting the emergent needs of that individual. We foster self-sustainability by not only providing door-to-door resources, but connections to literacy resources, employment, health services, transportation or any other indicated barriers to improve quality of life.
HP 2020's Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review” and Projects for Assistance in Transition from Homelessness” both indicate methodology to increase access to beneficial services to those that are currently homeless. This evidence was leaned upon in part to create the network of resource partners at the inception of the program.
The approach created to perform outreach to this transient population uses a unique case management framework that disrupts the cycle of homelessness and creates a foundation for increased overall stability. The health department first received a list comprised of addresses assessed by the Detroit Land Bank's Occupancy Predictor. The ESG Team reordered this list into an outreach plan and deployed three staggered visits (due to the transient housing patterns of this population) to confirm occupancy. The Detroit Health Department supplements these visits with program door hangers. If the door hanger disappears or is removed within one of the three staggered visits, it is replaced by another and the property is marked ‘tentatively occupied' in the program data system. Once contact is made by the health department, the occupant is entered into the HMIS system here in Detroit, and receives the ESG needs assessment. The ESG Team liaises with the Detroit Land Bank Authority to facilitate the home-purchase process, while meeting any indicated needs (e.g., ID, cell phone, food, water, clothes, lead testing, immunizations, and transportation via LYFT or bus pass). The occupant is case managed through a series of resources until closing on a DLBA home or being relocated to secure housing.
The current practice uses evidence-based and promising practices for serving individuals who are housing insecure. Through this demonstration pilot, the health department will be expanding outreach citywide and performing more rigorous evaluation of the program.
The overall goal of the ESG program is to identify individuals who live in insecure housing and connect them to health and human resources partners, as well as link them to homeownership opportunities. Through door-to-door outreach, eligible individuals complete a comprehensive needs assessment with the ESG Team and are provided holistic case management and follow-up.
From the earliest stages of program development, the Detroit Health Department engaged Wayne State University Center for Urban Studies and Wayne Metro Action Agency to consult on best practices for working with homeless populations in Detroit. These initial conversations also mapped the current services offered by these institutions and discussed gaps that could potentially be addressed by the ESG model. After several follow-up discussions, the health department convened meetings with local health human service providers to discuss their program offerings, including the Detroit Land Bank Authority (DBLA) and United Community Housing Coalition for administration of the Own It Now and BuyBack housing programs; Gleaners and WIC for food assistance; DWSD, DDOT, DTE, Assurance Wireless, and LYFT for utility support and transportation; MDHHS MIBridges, Detroit Health Department, Detroit Wayne Mental Health Authority, Southwest Solutions, and Wayne State University Street Medicine for health care and prescription services; Wayne Metro Tax Preparation for financial skills training; and the Detroit Municipal ID for administration of city-issued identification. After the launch of the ESG Program, these internal and external partnerships with ESG have continued to thrive via the pipeline of referrals made by the ESG case management team.
In developing the ESG model, the Detroit Health Department mapped the eligibility criteria for each stakeholders' program or service, creating a tiered needs assessment to assess and route clients based on needs. As a means of increasing collaboration and providing development opportunities to local community partners to strengthen their case managing processes, the health department provided free technical assistance and training on the MDHHS MIBridges platform. Over 30 organizations attended this half-day training, equipping them with the same holistic needs assessment and case management framework used by the ESG program.
The initial ESG program budget was $150,000, of which approximately $143,497.59 has been spent and committed for start-up and current operational expenses. The budget funds one part-time Project Coordinator ($30,902.48 annually), four part-time Community Outreach Workers ($25,535.64 annually), staff training ($4,000), data collection ($700), mileage reimbursement ($400), transportation ($40,000), equipment and supplies ($24,000.30), and cell phones, laptops ($17,959.17).
The ESG Team utilizes an interagency database through Salesforce serving the Detroit Health Department and Detroit Land Bank Authority (DLBA), which provides information on the housing occupancy and contact information for residents. The program also captures secondary data through the HMIS system, which includes contact information for current individuals who are housing insecure. An internal DHD system also collects and tracks case management resources, progress and next steps for individual clients. The program collects intake data that includes demographic, health status, and housing information. Across these three platforms, the ESG Team provides wraparound case management to the individual and family, as well as assists clients through the DLBA BuyBack program.
Since the start of the program in March 2018, the ESG Team has knocked on 240 homes in the two targeted zip codes. Of those, 36 were determined to be occupied and with willing families to participate in the program. Of those 36 households, 25 are actively pursuing homeownership, 5 are actively closing on Detroit Land Bank Owned homes, 3 households were relocated to other safe and secure housing, and 3 are actively pursuing relocation. Among the data collected, the ESG Team has observed transportation and food assistance as the most critical needs of the population served. The program has provided 200 subsidized transportation passes and 238 food bags. The ESG Team is working with clients to connect them with services such as prenatal care, immunizations, primary care and WIC. Every month, the program observes hundreds of calls and interactions with clients enrolled in the program.
Several key performance measures are also tracked and reported monthly, including doors knocked (#); vacant addresses (#); total intake (#); number pursuing home ownership (#); number closing on DLBA homes (#); number relocated (#); number pursuing relocation (#); number relocated (#); resource provision - food bags distributed (#), bus passes distributed (#), LYFT rides provided (#); utility status - water on/off, electric on/off; client information - name, age, address, needs indicated, case management record.
As a result of monitoring program implementation and feedback received from community members, door knocker casing and case management procedures were modified. Program improvements included increasing knocking frequency to more accurately determine occupancy, case management procedures across the housing continuum to be more individually tailored, and the implementation of LYFT rides to increase access to services. The Detroit Land Bank BuyBack eligibility criteria was also expanded as a result of recommendations proposed by the ESG program. The criteria now allows for inhabitants with no legal tie to the home a path for homeownership through demonstrated stability via case management services. The Detroit Land Bank reviewed the qualitative evidence corroborating this work, and approved this monumental policy development.
After the initial intake, the ESG model provides on-going case management to clients that may include transportation resources, food and nutrition services, employment connections, and literacy skills training. In addition, program case managers are assigned as MDHHS MIBridges navigators for the clients, meeting emergent needs based on available state programs and assistance.
Over the past year, DHD has also undergone transformative reorganization, aimed at integrating its programs and services more seamlessly to capture and increase referrals system-wide. In 2019, the health department will be piloting implementation of customer relationship management (CSR) technology in one of our infant mortality programs as a citywide initiative. This innovative approach will soon assist the entire department in managing and analyzing client interactions and data at every point of delivery at the health department, including our door knocking programs. The new tools will also improve service delivery, efficiencies, and increase utilization of health department services. The clients served in the ESG program will be entered into the Salesforce platform, which will provide unique opportunities to identify specific health needs, improve referrals across internal and external stakeholders, and increase connectivity with clients who are more often loss to follow-up.
As a result of the success of the initial pilot, the City's Housing and Revitalization Department (HRD), which manages HUD funds, has committed additional support to expand this program city-wide, with teams eventually operating in all 7 City districts. Pairing the safety net programming of ESG with the DLBA housing stock presents a viable opportunity for housing security and economic mobility for many individuals and families in Detroit. To assist with home ownership, ESG was also awarded federal dollars to provide minor home repairs and relocation assistance. Lastly, the health and human services providers involved in the partnership have committed to continued participation, and the model has served as an example of improved coordination across the private and public sectors.