Housing Advocacy for Low-Income Mothers and their High-Risk Infants Experiences of PROJECT ACCESS

1. Housing Advocacy for Low-Income Mothers and their High-Risk InfantsExperiences of PROJECT ACCESS APHA Annual Meeting November 10, 2004 • Jocelyn Hirschman, MPH • Sinai Urban Health Institute

2. Background • Chicago is in the midst of an affordable housing shortage ~1 affordable unit for every 2 renters • Chicago Housing Authority is tearing down 18,000 public housing units • Section 8 has a waiting list of ~30,000 & is “closed” • Few other housing subsidies available • Gentrification is pushing low income families farther from the city center & farther from convenient public transportation • Housing stock is 3 times older than the national average

3. Background • Lack of affordable, safe housing may take its greatest toll on low-income mothers with medically high risk infants • Serious health risks result from poor housing stock such as asthma or lead poisoning • Unsafe areas pose significant barriers to accessing both health care & social services Unstable home environments may lead to missed medical appointments & failure to apply for public benefits or social services.

4. Overview of Presentation • Introduce Project Access, a case management and legal services intervention • Describe the housing needs of our cohort of low-income mothers of high-risk infants • Discuss the strategies used by Project Access to advocate for improved housing for study participants

5. What is Project Access? • Medical, legal & case management collaboration to assist families of infants with special health care needs • Four years of program operations, 2000–2004 • Partners: • Health & Disability Advocates • Mount Sinai Children’s Hospital • University of Chicago Children’s Hospital • Sinai Urban Health Institute • Helping families access broad range of social support services & developmental therapies

6. Key Elements of Project Access Services • Participants are low-income families of infants admitted to two large, urban NICU’s due to… • very low birth weight (75%) • other medical complications • Receive intensive case management & legal services for ~ one year post-NICU discharge • Services provided on-site at hospital & outpatient follow-up clinic • Interdisciplinary model • Proactive approach – addressing problems before they reach crisis level

7. Description of Housing Needs At time of enrollment… • 63% had annual household income of less than $10,000 • 57% were living without their babies’ father • 54% lived in one of the poorest communities in Chicago 70% expected that they would need help finding housing now that they had a new baby

8. Description of Housing Needs - Continued Many were in unsafe or substandard housing: • 27% lived in crowded housing • 3 or more persons/ bedroom • 21% lived in poor housing conditions • 3 or more major problems such as leaky roof, broken or stopped up plumbing, too little heat… • 23% had pests like cockroaches or mice • 34% heard gunfire outside their home in the last 6 mos.

9. Most were in unstable housing situations: 32% moved at least once in the last year 44% lived in someone else’s home 53% found it difficult to pay rent each month 17% were currently behind on rent payments Few received housing assistance: 6% lived in public housing 9% were receiving a subsidy to help pay for rent Description of Housing Needs - Continued

10. Implications • Mothers who moved at least once in last year were less compliant with their infants’ medical care in the first 6 months post-NICU discharge • (missed 33% of their medical appointments v 19%, p=0.06) • Frequent moves make it hard for medical providers to keep track of patients • Changing addresses result in missed notices regarding public benefits or even missed checks Living in unstable or unsafe housing was associated with poor compliance with medical appointments

11. Strategies used by Project Access • Address family’s situation before it reaches crisis level & help them maintain a stable environment • Enhance ability of medical, legal & case management professionals to advocate for family (multi-disciplinary team approach) • Empower families by giving them the skills to address problems that arise in the future • Connect families with resources to assist them with problems they are unable to resolve Key to Project Access Model:PROACTIVE SERVICE DELIVERY

12. Case Management Intervention - Proactive Service Delivery Model • Assistance locating housing referrals • Case managers provided families w/ affordable housing lists • Assistance securing homeless prevention funds • Individual finds their own housing • Case managers then link families to funding sources that provide first month’s rent & security deposit directly to landlord enabling individual to move into the apartment • Education for families on common misconceptions regarding housing subsidy programs • Referral to project attorney when legal intervention became necessary

13. Case Management Intervention - Case Example 1 • Family of 3: Mother, toddler & infant living with mom’s family in crowded apartment • Inappropriate environment for infant - smokers were problematic for her under-developed lungs • Infant’s monthly SSI check was primary source of income & enough to cover rent but mom had no savings to pay security deposit or other move-in costs • With referral from project case manager, Mom located apartment she could afford on limited income • Case manager helped mom secure homeless prevention funding which paid security deposit & first month’s rent directly to mom’s new landlord • Family was able to successfully move into their own apartment

14. Legal Services Intervention - Proactive Service Delivery Model • Negotiate lease terms with landlord at time lease is signed • Set up payment methods acceptable to both landlord & tenant • Work directly with landlord to address housing problems • Educate families on tenants’ rights • Obligations as tenants • Legal & effective ways to make landlords address problems with their housing • When eviction occurs, provide representation at hearings

15. Legal Services Intervention - Case Example 2 • Family of four: mom, 2 toddlers & infant living in their own apartment • During the winter months, mom complained that apartment was always very cold & landlord would not fix heat • Attorney advised mom to buy a thermometer & for one week, take the temperature in each room of apartment when she first woke up in the morning, in the middle of the day & again at night to see if temperature met the required legal minimums • With mom’s written record, attorney drafted a letter to landlord using recorded temperatures to show that they were below legal minimums & informing him that he was required to fix the heat • Landlord did fix heater in the apartment & mom & children were able to comfortably stay through the winter

16. Conclusions • There is great need for safe, affordable housing among low-income mothers of high-risk infants • But little to no housing assistance is available to most of these families • Providing case management & on-site legal services may be one effective strategy for addressing their housing needs, but more research is needed Further public policy action is necessary in order to ensure access to more safe, affordable housing for our most vulnerable populations

17. Co-Authors • Laura Barnickol, JD, MSW Health and Disability Advocates • Minerva Esparza, LCSW Mount Sinai Children’s Hospital • Elaine Mister, RN University of Chicago Children’s Hospital • Julie Justicz, JD Health and Disability Advocates