School of Nursing faculty co-authors national report on homelessness and health

July 11, 2018
Barbara Brush photo

U-M School of Nursing professor and Poverty Solutions expert affiliate Barbara Brush.

University of Michigan School of Nursing (UMSN) Professor Barbara L. Brush, Ph.D., ANP-BC, FAAN, served on a prestigious National Academies of Sciences, Engineering, and Medicine committee tasked with understanding the connection between permanent supportive housing (PSH) and health outcomes for people experiencing homelessness.

The 11-person committee included experts in health, law, epidemiology, economics and social development. Brush was the committee’s sole nurse. She brought more than 20 years of research and practice expertise focused on homelessness to the effort. The committee collaborated for more than two years to produce the report, “Permanent Supportive Housing as a Foundation for Health: Evaluating the Evidence.”

Brush says the committee began its work with a comprehensive review of existing research and was surprised by the lack of data on the housing/health connection.

“We identified big problems with disconnected information,” Brush explained. “Places that deal with housing are often funded by organizations such as the Department of Housing and Urban Development (HUD). Places that are funded for health issues for those experiencing homelessness are generally supported by the Center for Medicare and Medicaid. Because these agencies don’t necessarily work together and define their services and programs differently from one another, it makes the work of connecting housing to health a challenge.”

Brush says this realization paved the way for two of the committee’s recommendations: to increase the depth and breadth of research in housing and health and to conduct research with community partners.

“If we don’t have good evidence, we can’t influence policy,” she said. “We need more long-term studies with rigorous designs that look at how permanent supportive housing influences physical, mental, and social health outcomes across individuals and families who were homeless and rehoused. We also need to engage the community in this research so that the evidence is relevant and reaches those it is intended to support. I also hope that more funding agencies will focus resources on understanding these connections.”

The minimal evidence the committee found and the information they extrapolated from existing research supports the hypothesis that people experiencing homelessness are more likely to have health issues that can be improved with safe and affordable housing.

“We knew it was important to keep the report objective and close to the evidence,” she said. “We were careful not to slip into an advocacy position even though we all agreed that housing is a social determinant of health. If you don’t have housing, your likelihood of having good mental and physical health decreases. For example, if you have housing you don’t feel stress about where you are going to sleep every night and whether you have a safe place to store your food, belongings, and medicine.”

Brush hopes the report will inspire researchers- especially nurse researchers- to address the gap in the scientific literature. She said she started to think about her own work as UMSN’s Carol J. and F. Edward Lake Term Clinical Professor, which includes a focus on population health.

“I’m interested in developing larger scale interventions that could influence policy,” she said. “I’d like to develop a multi-site project across the country to analyze how housing services are provided and measure associated health outcomes. Because this is a community issue that is about health promotion and illness prevention- where nurses are instrumental- it is important to know what models work best for different populations and where there are opportunities to be more cost-effective.”

Brush adds that the best approach to understanding and improving health in those who are homeless or housing unstable includes multiple viewpoints, especially those of community members and stakeholders.

“There are so many people across the country who are either literally homeless or on the brink of homelessness and that puts their health at risk,” she said. “I hope this report shows the importance of the housing and health connection. We need to know more about it, get our policies focused around this issue, and figure out the best way to move forward.”

Story courtesy of the University of Michigan School of Nursing.