Meeting the Needs of People Experiencing Homelessness in the Time of COVID-19

This post is authored by Christine Simiriglia, CEO of Pathways to Housing PA in Philadelphia, PA. 

There are very few positive words to describe 2020.

Far too many people this year have been filled with anxiety, stress, hunger, pain, hopelessness, and sorrow due to COVID-19. Data shows that along with physical health needs most people are aware of, that behavioral health needs have imploded during the pandemic as well: The Census Bureau surveyed 99,000 households and found that more than one-third of adults reported symptoms of depressive or anxiety disorder – triple the rate reported in 2019. Another survey found that 1 in 10 adults had considered suicide, more than double what was reported in 2019. The American Medical Association (AMA) further reports that more than 40 states have seen an increase in opioid related deaths since the outbreak of COVID-19.

Coupling the effects of this pandemic on people already experiencing the crisis of homelessness, service providers in our field are now faced with even more insurmountable challenges.  There is no use trying to sugar coat that – but taking immediate steps, such as removing barriers to evidence-based treatment for those with a substance use disorder as well as for harm reduction services, can go a long way to mitigate some of that suffering, and bring hope back into the lives of the people we serve. As the CEO of Pathways to Housing PA, I am committed to making the changes needed to house and care for people during this troubling time.

Making Changes and Taking Action  

Pathways to Housing PA, a high-fidelity Housing First agency, has moved 550+ people out of homelessness and into market rate apartments throughout the city of Philadelphia. We provide holistic case management and treatment services to ensure that program participants are well and can maintain their new housing. We also opened the Philadelphia Furniture Bank to furnish homes for individuals and families moving out of shelter and transitional housing and into permanent housing. We recently launched Housing First University to teach other organizations and communities how to do what we do, and enjoy similar positive outcomes. 

At the onset of the virus, Pathways implemented a multi-pronged approach to maintain (and in some instances increase) levels of service, ensure staff and participant safety, and innovate service delivery. The organizational principles that have guided our approach include:

  • Sustain Operation and Services Continuity – safely and effectively for both staff and participants.
  • Prioritize Adaptation over Restoration – service delivery needed to be quickly adapted to the changing landscape with the understanding that restoration to pre-COVID operations may be very different
  • Maintain Culture – We are committed, although physically distant, to remain a social community of service.

These are steps that other communities can prioritize in their efforts to house people during the COVID-19 pandemic. The list of steps below include practices that were successful for our organization, and may work well in others. All of these steps involved the organizational principles above: sustaining operations, adapting services, and committing to serve.

Here are some of the steps we took to address the overall health of our clients during the pandemic, and ways in which your organization may be able to also adapt service delivery:

Innovation in Clinical Services

Virtual Visits, Telehealth, and Technology. We invested in new technologies in early March to conduct daily clinical rounds to ensure that no participant falls through the cracks. We adopted a telehealth platform to maintain psychiatric and behavioral health services. Understanding the digital divide, we purchased devices to ensure access to services for our most vulnerable participants. We trained staff on best practices for a meaningful virtual visit. Our virtual work is supported by a new intranet system that houses critical information for our staff. These efforts resulted in 28% increase in unique participant encounters from January to May of this year.

Transitioning to more virtual services allowed us to continue our work, but in a safer way given the COVID-19 pandemic.

Prioritization of Services Based on Clinical Need. We categorized people across three tiers by clinical need. We implemented a weekly 3-2-1 approach to in-person and virtual visits, where Tier 1 received three contacts weekly, Tier 2 received two contacts weekly, and Tier 3 received one contact weekly. Implementing this prioritization system allowed us to keep constant awareness of the health of our clients during this critical time.

Integrated Care Services

Opioid Use Disorder Center of Excellence (OUD-COE). Pathways operates the only non-hospital based OUD-COE in Philadelphia, in partnership with Project HOME and Prevention Point. Our COE maintained medication-assisted treatment, recovery support services, and benefits coordination to 450 Participants with OUD. We are providing virtual services where possible, and in-person services where necessary.

Opioid use doesn’t stop during a pandemic. Continuing these partnerships is essential to ensure that the full scope of clients’ health is considered, including what may make them more vulnerable to contracting COVID-19.

Integrated Care Clinic. We offer integrated primary care and behavioral health services on site. Pathways has maintained in person services (which have increased as hospitals became inaccessible), implemented a telehealth model, and conducted house calls or street medicine for our most vulnerable folks.

The COVID-19 pandemic has brought the provision of these services into sharper view, and underscores the connection between housing and health care. When possible, organizations should be further integrating these kinds of services into their models.

Housing and Other Support Services

Supporting Participant Choice. We believe that offering participants the choice of where they want to live supports recovery. The COVID-19 physical distancing guidelines complicated our efforts to show apartment units. In response, we filmed apartment showings to allow people to shop for their apartments virtually. This is something that providers can do to make housing choice more accessible, even after the pandemic ends.

New Team Ramp-Up. As COVID-19 emerged, we were at the beginning of starting a new service team. Despite the challenges, we moved 77 people off the streets, out of shelters and into housing between March and June of this year.

New Services to Combat Food Insecurity. We conducted a comprehensive food security assessment; where there were gaps, we filled them. We expanded our emergency food pantry and have created a system to deliver thousands of care packages, from lunch bags to CSA shares of produce. Everyone contributes, including administrative staff making deliveries to meet the need. Identifying this need in the face of the pandemic, and integrating the response among all levels of staff, ensured that we were able to feed people in these extraordinary circumstances.

New Approaches Are Worth the Risk

Do all of these changes in response cost money? Yes.

Do you sometimes need to take action before you identify funding? Yes.

As providers, we sometimes need to take risks. No great accomplishments come without risk, and it is worth it given the lives at stake. Finding new ways to serve clients during the pandemic is challenging, but the innovation of our staff has allowed us to adapt our practices during this time. Identifying needs and gaps in service delivery, adapting these methods, and maintaining our commitment to service has allowed us to better protect people experiencing homelessness during the pandemic.