From Duke Clinical and Translational Science Institute:

When Mina Silberberg, associate professor in Duke Health’s Department of Community and Family Medicine, and Donna Biederman, assistant professor in the Duke School of Nursing, first approached Emily Carmody to see if she would be willing to apply with them for a training and research grant, Carmody had a slight hesitation.

“I’ve been advocating for use of Medicaid for tenancy support services for about six years,” said Carmody, a program director with the North Carolina Coalition to End Homelessness. “Unless your project involves that, I don’t think I can do it.”

It was an answer Silberberg and Biederman were delighted to hear.

“We were looking for a project that was driven by community needs, and here it was,” says Biederman.

The three women applied, and in September were accepted, into the Interdisciplinary Research Leaders program, a new initiative sponsored by the Robert Wood Johnson Foundation and led by the University of Minnesota. The goal of the program is to nurture leaders who are comfortable working in interdisciplinary teams and skilled at using research to promote policy changes that can affect health. The three-year program includes leadership training, opportunities to explore different research methods, and research funds to conduct and apply high-quality, community-engaged, action-oriented health research with the intent to affect policy around social determinants of health.

The timing couldn’t have been better.

In 2015, the federal government clarified that states may choose to use Medicaid funds for providing housing support, recognizing that stable housing is a crucial component for good health. Because some people who have experienced homelessness often face challenges in maintaining housing, even when they can find it, experts are favoring combining affordable housing with tenancy support services. These services can range from assistance with housing applications to education about self-care, socialization, and other skills that may prevent someone from becoming homeless again. However, there is no national consensus about what these services should include, and what infrastructure is needed to ensure that the services are adequately, appropriately, and properly provided.

Biederman, Carmody, and Silberberg will attempt to bridge this gap through a study of two North Carolina programs that are in the vanguard of efforts to house the homeless: Homeward Bound, an organization instrumental in decreasing chronic homelessness in Buncombe County, NC; and the University of North Carolina’s Center for Excellence in Community Mental Health, which has led the state mental health system in making the connection between housing and recovery from mental illness.

“We want to learn from these agencies about what they think the services should include and how to train people to provide them,” says Silberberg.

As North Carolina moves forward in using Medicaid funds for tenancy support services, this team’s goal is to document best practices that could be helpful not only in North Carolina, but in others states as well.

“It is exciting to think about research that can help Medicaid develop the definition of tenancy support services with real information from the field,” says Carmody.

ASKING THE RIGHT QUESTIONS

The team will dive deep into the community to discover promising practices and definitions, talking not only to program administrators, but also to front-line workers and to the clients who receive services. They will be asking program directors what services they perceive as most important, and what local, state, and federal policies support effective tenancy support services. They will be asking frontline workers what training they need. And they will be asking people receiving tenancy support services to tease out what is most helpful to them.

“We want to do rigorous research, but the broader point isn’t just about doing good research, but about working with the stakeholders to find out what is important to them and develop a definition that meets their needs,” says Biederman.

Sometimes it may simply be a case of clarifying details, says Carmody. “For example, a program director may say it is important to teach a client to maintain a house, or to learn to cook, but a front-line worker will tell you that plunging a toilet is a specific skill that should be taught, and a client may say they need to learn more about how to store food properly,” she says.

DIVERSITY COUNTS

The team believes that their diversity of experience will be helpful in combining research with engaging stakeholders and navigating the policy world. Biederman is a nurse with a doctorate in public health and has worked with homeless people in multiple clinical settings; Carmody is a licensed clinical social worker and has a wealth of knowledge about policies in North Carolina to fight homelessness; and Silberberg is a social scientist who has considerable experience in community health program evaluation.

“Our initial meetings have been amazing because everyone brings overlapping but different areas of expertise,” says Silberberg. “It is clear that the ideas we come up with as a result of bouncing ideas off each other we couldn’t come up with alone.”

As if to emphasize the interdisciplinary nature of the perspectives needed to improve the health of the homeless, the RWJ Foundation grant is being administered through the Duke Center for the Study of Race, Ethnicity, and Gender in the Social Sciences.

Already, the multiple perspectives are blending within the team.

“It is clear that to make a difference in population health, you have to look beyond medical care,” says Silberberg, the academic health researcher. “There is a huge opportunity for researchers to learn how to make what they do useful and used in the crucial debates about policy and the environment that we live in.”

Carmody, the community advocate, expresses the same sensibility from a different perspective. “The vision I walk toward every day is that every Duke patient will have a home to be discharged to,” she says. “But this is the first time I’ve ever helped design and implement a research project. We’ve just started, and I’m already thinking that the next time someone comes in with a research idea, it will be less scary to take on.”