'It gives me hope'
Cross-sector Case Conferencing bridges gaps between healthcare and housing
It’s no secret that health and housing go hand in hand. Health challenges can be a factor leading to homelessness, while homelessness creates health challenges of its own.
“Your baseline of health is diminished just by the reality of being unsheltered, underfed and underresourced,” said Jenny Greenberg, a senior program specialist at the Homeless Services Department. “And the stress and trauma of all of that, it also takes its toll.”
But the systems providing healthcare and housing are often siloed, making it difficult for providers to coordinate care across those systems.
The Cross-Sector Case Conferencing program is designed to help break down those barriers. It’s the result of collaboration between Metro, the three Portland-area counties and Health Share of Oregon — and it’s made possible with the Supportive Housing Services measure.
Central to the program are meetings that bring together providers from homeless services, housing, healthcare and other social services. Each meeting is focused on a handful of “cases” — specific clients facing hardships or barriers to health and stability.
A provider bringing forward a case will share information about the individual, what barriers they are facing, what they’ve already tried and what they need help with. Other meeting participants ask questions and share information, resources and potential solutions.
Greenberg, who leads Multnomah County’s Cross-Sector Case Conferencing program, said what makes the program unique is that clients sign information releases that give providers the ability to talk in detail about their case — often including their
medical history. “We’re able to break down the silos and help with communication and coordination on the spot, in real time,” Greenberg said.
Promising early results
It’s a simple concept, but it can be transformative for the clients it serves. According to Health Share of Oregon, about 300 of its members have been part of the program across the three counties. Preliminary data shows that six months following a case conference, participants have fewer emergency room visits, fewer inpatient hospital admissions, increased engagement in substance use disorder treatment and decreased total cost of care.
Drew Grabham, director of outreach services at Central City Concern, said that he hasn’t experienced a space quite like it in his years of working in homeless services.
“It’s one of the few examples where so many of our systems are really coming together with the human in the center — not from a 10,000-foot point of view,” Grabham said. “Everyone in that meeting is thinking about the human that we’re talking about and how we can best serve them. That warms my heart and gives me hope.”
‘One more tool in our toolbox’
Haylee Hinkle, Shelter Plus Care Case manager on Northwest Pilot Project’s retention team, says she’s seen positive results for her clients.
In her role, Hinkle works with low- or zero-income older adults who are in permanent affordable housing, helping them achieve stability and retain their housing long-term.
Part of her role is helping clients access healthcare. But because she isn’t a healthcare provider herself, she sometimes runs into barriers when trying to get clients the help they need.
One of her clients needed medical care, but “wasn’t sure exactly what insurance he had. He was pretty sure he had a primary care provider, but he hadn’t seen her in a while and wasn’t sure if he was even still a patient there,” she said.
“I found out exactly what insurance plan he has …They were able to tell me that he did have a primary care provider and what office they were out of,” Hinkle said. “They were also able to connect me with a social worker at that primary care office that I could reach out to, to work together to support the client.”
“A lot of the time it really is just throwing things at the wall and seeing what sticks,” Hinkle said of her work. The Cross-Sector Case Conferencing meetings are “one more thing, one more tool in our toolbox, that we have to help us navigate these really complicated situations.”