In search of the prescription for homelessness in Anchorage

Presented by Providence Health & Services Alaska

In this data-driven age, analytics inform everything from how we shop to the way our favorite sports teams prepare for the playoffs. Today, the Anchorage Coalition to End Homelessness is using applied data in a different way: to identify ways to get Anchorage residents out of poverty and into stable, permanent housing.

“People always ask, ‘What’s the answer to end homelessness or end hunger?’” said Bean’s Cafe Executive Director Lisa Sauder, who serves on the coalition’s advisory committee. “There’s no one answer, because people get there in a lot of different ways.”

By tracking paths into and out of homelessness, advocates say they hope to find real solutions to the crisis that has been one of Anchorage’s most challenging issues for years. It’s just one of the creative ways of thinking that service providers say is necessary to solve the city’s greatest health needs.

A disciplined, data-driven approach

Five years ago, Providence Health & Services Alaska approached Anchorage homeless service providers with a question: How could we partner with you on a community-based strategy that will result in a more coordinated way to reduce homelessness?

“They conducted community-wide strategic planning efforts and came back with a proposal on how they believed we could affect real systems change,” said Nathan Johnson, regional director of community health investment for Providence Health & Services Alaska.

This involved client-focused navigation services, rapidly rehousing families experiencing homelessness, critical safety net services, landlord liaisons, and building out coordinated data entry via a shared homelessness management information system (HMIS).

Providence invested in that strategic plan, and the coalition now maintains the HMIS and an accompanying dashboard that gives service providers near real-time information to help the system be more responsive to emerging needs of Alaskans experiencing homelessness.

While the idea of data itself may not sound very exciting, the results can be. Bean’s Cafe recently completed a Geographic Information System project that mapped income and use of food program benefits and overlaid it with every food source in the city to identify areas where it’s harder to access healthy foods. That data will be used to deploy a mobile food distribution truck to the areas most in need -- a much more precise and targeted approach.

“That’s a very different way of doing it,” Sauder said.

Since then, many other partners have invested and the result is a greater focus on data and systems change. Anchorage is now a pilot community for Built For Zero, a national movement of cities that use a disciplined approach to data to inform community-wide response to homelessness. The goal is to reach “functional zero,” a sustained end to chronic homelessness for a population. So far, 14 cities have reached functional zero among veterans, and five have achieved functional zero for the chronically homeless.

“The success of this approach comes from the recognition that homelessness is not a housing problem; it’s a problem of understanding and addressing the complex array of needs and circumstances of those experiencing homelessness,” Johnson said. “Built For Zero is kind of a revolution in the homeless space. It has given homeless response systems and communities a very sensitive tool to understand the problem and to communicate that with community leaders and policymakers.”

Looking upstream

Alaskans who primarily associate the Providence brand with hospitals and doctors’ offices might wonder why the health care nonprofit is interested in housing issues.

“Alaska has historically seen Providence as an acute-centric organization,” said Providence Health & Services Alaska Chief Executive Preston Simmons. “But we’re actually a system of care, and our vision, going back to our mission, states that we are steadfast in serving all, especially those who are poor and vulnerable. We are much more than a collection of hospitals.”

Leaders from social services agencies say Providence’s mission aligns perfectly with the work on homelessness that was already happening in Anchorage.

“We also have a mission to serve the most vulnerable people in our community,” said Lisa Aquino, executive director of Catholic Social Services. “We very much share values and a mission as organizations. We’re very much tied in that -- to make sure that people in our community, especially the most vulnerable, especially the people that are historically left behind, don’t fall through the cracks.”

Three years ago, Providence completed a community health needs assessment in Anchorage, something it does every three years in the communities it serves. Through a combination of surveys, federal data, qualitative interviews and other research methods, the organization identified social determinants of health -- largely poverty and homelessness -- as the top issue in Alaska’s largest city.

“We know there’s a huge connection between homelessness and hunger with your health outcomes,” Sauder said. “It’s irrefutable. If you’re not sheltered and do not have access to nutritional foods, your health is going to suffer.”

Research has also established that people who have a high number of adverse childhood experiences (ACEs), such as abuse and family trauma, become adults who are more likely to experience chronic health problems, diseases like cancer, and homelessness.

“We just had this emerging epiphany around ACEs and all of this upstream work,” Johnson said. “Many of the people who walk into our emergency room could have avoided that with a small amount of prevention and intervention.”

This “upstream work” takes the form of multiple new efforts. Among them are a behavioral health and wellness outreach initiative among seasonal fishing industry workers in Valdez; a partnership with Volunteers of America Alaska to integrate behavioral health clinicians in Anchorage schools; and a program under development that will address health disparities in select Anchorage neighborhoods with trained resident community health liaisons.

These programs are funded through “community benefit” investments, a Providence initiative that provides financial support to community organizations and programs to create lasting change in four focus areas: foundations of health, reducing barriers to care, community resilience and innovating for the future. In 2020, Providence provided $70 million in community benefit across Alaska.

Making stone soup

Providence isn’t the only Alaska organization that has been evolving in its approach to community health. Fallout from the COVID-19 pandemic prompted Anchorage social services providers to explore new partnerships and find new ways to reach their clients. At Bean’s Cafe, the pandemic triggered a colossal expansion of services.

“People think of us as a soup kitchen,” Sauder said. “We’ve expanded quite a bit.”

Since March 2020, the nonprofit has operated the city’s emergency shelter at the Sullivan Arena while at the same time providing more than 920,000 meals to local adults and children.

“When Bean’s stepped up to the plate and said they would run this emergency shelter, they moved into a new space for them,” Johnson said. “To take over a whole shelter of that magnitude was really huge.”

Behavioral health issues and chronic homelessness often go hand-in-hand, and Bean’s reached out to Providence to help with a solution for guests to receive needed services on-site. “Providence reached out to its peers to collaborate, and convened Anchorage Neighborhood Health Center, Southcentral Foundation, and the Municipality of Anchorage and said, ‘We all want to do this -- how can we do this together?’” Johnson said.

A vision for long-term impact

While its intensified focus on homelessness is relatively recent, Providence has long been a supporter of programs that serve vulnerable Alaskans, particularly when it comes to hunger.

“They make sure that our food pantry is fully stocked,” said Aquino, who also sits on Providence Alaska’s region board of directors. “They’re big supporters of our refugee assistance program, serving the world’s homeless.”

Providence delivers dinner to Brother Francis Shelter every day, an in-kind arrangement worth hundreds of thousands of dollars annually that has been in place for many years.

“They have a vision for really addressing some of the long-term impacts of homelessness,” Aquino said. “More than just a safety net, but really investing in the solutions.”

The health care and homeless outreach partnership in Anchorage really began to expand in 2016, when Providence helped establish a medical respite program at Brother Francis Shelter. In the initial pilot program, 80 percent of clients who used medical respite did not return to homelessness after their recovery.

“You can’t imagine being sick and not having a place to go heal, right?” Aquino said. “Being in safe housing is critical to healing.” In 2017, funded by Alaska Native Medical Center, Alaska Regional Hospital, and Providence, the clinic expanded to 10 beds.

Much of the work Providence supports, like the data initiative and medical respite, goes on behind the scenes, according to Aquino.

“It’s not the flashy stuff,” Aquino said. “Providence sees the benefit of making big investments to really shift the paradigm, but they also see the benefit of making sure there’s strong infrastructure so we can build to that paradigm-shifting type of programming. I think they really see the big picture.”

And that picture, ultimately, is very clear about one thing: In order to keep Alaskans healthy, it’s critical to keep Alaskans housed.

“We’ve come, really, to this understanding that having a home is truly the first prescription,” Johnson said. “Everything follows from there.”

Providence Health & Services Alaska has been serving Alaskans since 1902. Learn more about Providence’s $70 million investment in Alaska’s health in the 2020 Community Benefit Annual Report.

This story was produced by the sponsored content department of the Anchorage Daily News in collaboration with Providence Health & Services Alaska. The ADN newsroom was not involved in its production.