Recommendations for Health Services Delivery Options for ECHO Village
PI: Julia Noguchi, DrPH Candidate, Department of Community Health Science, School of Public Health
Co-PI: Keith McInnes, Research Associate Professor, Department of Health Law, Policy and Management, School of Public Health
Mental health problems and substance use disorders (SUDs) have been a major driver of housing insecurity and homelessness in nearly every major U.S. city. As fentanyl spread rapidly in illegal markets during the COVID-19 pandemic, many more people turned to opioids when treatment facilities and other essential social services shut down. Policy and health service delivery interventions that are responsive to recently emerging characteristics of morbidity and mortality from SUDs and a sharp rise in homelessness are urgently needed. While this public health crisis will not be resolved through emergency responses alone, emergency housing solutions can help to prevent unnecessary illness and death in this population. Defined as 400-square feet or smaller, tiny homes have recently emerged as one option to bridge the gap between living on the street and permanent shelter for people experiencing homelessness (PEH). The proposed project is a mixed-methods case study of “Emergency COVID Housing Opportunities,” or ECHO Village, a tiny home community for Rhode Island’s unsheltered population.
House of Hope Community Development Corporation, a Rhode Island-based housing non-profit that advocates for housing policies to address structural inequalities and offers trauma-informed and harm-reduction services to empower PEH, plans to open ECHO Village to help address the state’s dual opioid and homelessness crisis. ECHO Village will accommodate up to 60 PEH for about one year in thirty, 64-square-foot tiny homes. This project aims to identify what health and harm reduction strategies will be feasible and acceptable at ECHO Village. Specifically, it will determine what clinical assessment, mental health, and behavioral health services will be delivered to ECHO Village residents, including what services will be offered onsite, through telehealth, mobile van, or community referral.
In Phase I of this study, we aim to characterize current healthcare delivery services for PEH in Rhode Island through semi-structured interviews with House of Hope staff and clinicians and affiliated healthcare providers. We will also administer a structured questionnaire to 130 PEH aged 18 or older to assess the role of various characteristics of vulnerability as an influence on the utilization of health services in this population. In Phase II, we will draw on lessons learned at a Minneapolis-based village for PEH, AVIVO Village, by conducting semi-structured interviews with agency leadership, health care providers, and AVIVO Village residents. Qualitative data will be analyzed using a deductive approach to identify patterns and themes in the data using NVivo 12. Quantitative data will be analyzed using bivariate tests of survey data in STATA. The ultimate goal of this research is to develop recommendations for processes and mechanisms by which PEH can receive and sustain health care at ECHO Village. Lessons from this work may also inform the development, expansion, or improvement of health care delivery systems in the over 100 other tiny home villages for PEH in the United States.
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