Connecting Boston's Public Housing Developments to Community Health Centers: Who's Ready for Change?

What Is the Purpose of This Study?

• • Compare the readiness of housing developments versus health centers to address community-identified health priorities using the Community Readiness Model developed by the Tri-Ethnic Center for Prevention Research.

• • The Community Readiness Model scores a community's readiness on a scale of 1 to 9 across six dimensions of readiness; each community receives one composite readiness score.

• • Readiness score determines the types of actions that are appropriate to address health priority in that community.

• • Identify community-specific barriers to primary care for public housing residents.

• • Bridge prevention efforts in two unique communities targeting similar populations.

• • Engage public housing residents and community health center staff in research process through a community-based participatory research approach.

• • Determine appropriate strategies for larger intervention study to link public housing residents with primary care.

What Is the Problem?

• • Public housing residents bear a heavy burden of chronic health problems, including high rates of asthma, cancer, obesity, hypertension, and diabetes.

• • Public housing residents underutilize care despite close proximity to several health centers and academic medical centers in Boston.

What Are the Findings?

• • Findings indicate a mismatch in communities' readiness to address health priorities; readiness was significantly higher for health centers than housing developments.

• • Housing development overall readiness stage: Vague awareness; local concern but no immediate motivation to take action.

• • Health center overall readiness stage: Preparation; community leaders have begun planning in earnest, but the community itself offers modest support of these efforts.

• • Both health centers and housing developments scored highest in existing programs/policies and resources.

• • Health centers scored lowest in leadership and community knowledge of efforts.

• • Housing developments scored lowest in community knowledge of efforts and community knowledge of the issue.

• • Housing development key informants repeatedly reported barriers to health that are attributable to basic life needs, including violence/safety, substance abuse, financial issues, insurance, and housing conditions.

• • Housing development key informants reported tremendous variability in where residents get their care.

Who Should Care Most?

• • Health center administrators.

• • Health center staff involved in program planning and community outreach.

• • Public housing development management.

• • Public housing resident leaders.

• • Community health workers who work with community health centers and/or public housing residents.

• • Researchers interested in the health of underserved populations.

• • Community members interested in addressing a health priority within their own community.

• • Program planners interested in implementing a health intervention within a particular community.

Recommendations for Action

• • These data can help us to better prepare for successful partnerships between community organizations and to understand why they fail when they do.

• • This type of data collection and application is a great benefit to the intervention planning group as it struggles to implement a full intervention in communities with limited budget and staff.

• • Develop intervention strategies based each communities' unique readiness score and focus on stage-specific goals to better align housing development readiness with health center readiness.

• • Goal for housing development strategies: Continue to gather information and work with key leaders to introduce information about the issue and current efforts to the target population.

• • Example housing development strategy: Visit existing small groups within the developments to inform them about heart health.

• • Goal for health center strategies: Raise awareness that the community can do something

• • Example health center strategy: Conduct patient interviews and surveys to identify service gaps, improve existing services and identify key places to post information.

• • Strategies targeting public housing residents must address multiple barriers around basic life needs to be successful.