Healthy Start in Housing: A Case Study of a Public Health and Housing Partnership To Improve Birth Outcomes

Emily Feinberg
Boston University School of Public Health
Boston University School of Medicine

Bricia Trejo
Brianna Sullivan
Zhandra Ferreira-Cesar Suarez
Boston University School of Public Health

This article describes the collaboration that supported the development and implementation of the nation’s first contemporary program to use housing as a strategy to promote healthy birth outcomes. Using case study methodology, we examine how two agencies with distinctly different missions, the Boston Housing Authority (BHA) and the Boston Public Health Commission (BPHC), were able to successfully collaborate and develop the program Healthy Start in Housing (HSiH) in 2011. HSiH provides priority access to housing in the city’s traditional family housing developments to homeless and housinginsecure pregnant women who have existing medical risks associated with poor birth outcomes. Data were collected from eight key stakeholder interviews, two focus groups with HSiH staff, program documents, and archival records. The contextual factors, chronology of the development of HSiH, and lessons learned were identified from an analysis of the case. We found that recognizing the need for interdependence, having a history of previous interagency collaboration, and clear and mutually shared goals facilitated the development of the HSiH collaboration. The challenges to cross-agency collaboration between the BHA and BPHC were minor but did exist, including difficulty in assessing BHA eligibility at program entry. This case study provides insights to the key components of a unique collaboration that aims to promote healthy birth outcomes and sets the stage for future research to assess the health effects of program participation.