Inverting the System: Social Supports That Put People First

At the end of 2020, St. David’s Foundation wrapped up its Health Starts at Home initiative. The goal of this initiative was to create conditions that foster self-sufficiency and/or stabilized health for individuals and families with low income levels. Specifically, the Foundation wanted to create a space for affordable housing providers to explore how to structure their work to:

• Empower resident voices
• Increase social connection
• Activate physical spaces
• Leverage existing assets

While the connection between safe, stable, and affordable housing and health is well-established, less well understood are the factors and approaches critical to making housing a platform for health. The Health Starts at Home Initiative allowed the Foundation to test ideas around the importance of social connection, resident voice, and community design in developing on-site services and supports for residents of affordable housing.

An example of the type of work supported by this funding was the thinkEAST project. The University of Texas at Austin Steve Hicks School of Social work received $245,000 for a collaborative project with the Design Institute for Health to create a prototype of a healthy community co-designed by early residents at this affordable housing community.

The project included a six-month, evolving pilot of social service offerings supporting health where people live—specifically delivering services to address social factors such as financial stability, food access, and community support.

The team listened to resident feedback to inform changes to programming throughout the project. While community events were initially deemed valuable, resident feedback showed how important one-on-support was, and thus the need to meet both community and individual needs.

By utilizing a licensed social worker instead of a service coordination company, this project both ensured sustainability of this program to live beyond the grant funding, and also brought a valuable and much needed asset to this community.

While gains at the individual level were one of the goals of the Health Starts at Home funding opportunity, a larger goal was advancing understanding in the field of affordable housing—specifically about how to design and deliver services to make housing a platform for health.

To document the insights and impact from this two-year project, the thinkEAST project team produced a case study that focuses on how this work can become sustainable and be used as a model for other affordable housing communities.

This project utilized social connection and a strengths-based approach, two of our principles for achieving health equity—and also highlighted how crucial it is to consider broader systems change. The case study noted the following:

“As we explore from a systems lens, we question whether the need for social service interventions within affordable housing is actually a lagging indicator of a larger-scale system issue. By the time people are uprooted and land in these communities—outside of the communities and social support structures they’re familiar with—has the system already failed them? Should we be looking further upstream to support health in people’s original homes?”

While the Foundation considers the necessary upstream interventions to support health at home, this cohort of grants offers insights into a variety of strategies to improve health outcomes and resident engagement in affordable housing communities.

You can dive into the thinkEAST project’s method, insights, and impact here: https://designcreativetech.utexas.edu/power-people-human-centered-design-within-social-service-coordination