Health Calls Season 6, Episode 7 explores how CommonSpirit Health partners with those who have lived experience of homelessness to shape solutions and fund grants. Host Brian Reardon and Executive Producer Josh Matejka welcome Nicole Wilson, Community Health and Housing System Manager at CommonSpirit Health, to discuss the Research and Equity Advisory Council for Housing Insecurities (REACHI).
Health Calls Season 6, Episode 7 explores how CommonSpirit Health partners with those who have lived experience of homelessness to shape solutions and fund grants. Host Brian Reardon and Executive Producer Josh Matejka welcome Nicole Wilson, Community Health and Housing System Manager at CommonSpirit Health, to discuss the Research and Equity Advisory Council for Housing Insecurities (REACHI).
Wilson explains how REACHI elevates voices of the formerly unhoused in decision-making, from grant allocation to program design, ensuring initiatives reflect real-world needs. The conversation highlights innovative approaches like safe parking programs for women living in vehicles and the importance of trauma-informed care and low-barrier housing options. Nicole shares how authentic power-sharing and feedback loops transform strategies across diverse communities, from Los Angeles to Washington State. This episode underscores Catholic health care’s commitment to collaboration and equity in addressing homelessness and housing insecurity.
Resources
Read recent Catholic Health World articles on REACHI and one of the programs it helped fund, Safe Parking LA
Brian Reardon (00:05):
Welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Rudin, and with me is our executive producer, Josh Matejka. Hey Josh.
Josh Matejka (00:14):
Hello, Brian.
Brian Reardon (00:15):
So in this episode, we are talking about partnering with the formerly unhoused to care for those in need. And in a moment we're going to bring in our guest Nicole Wilson. She serves as the community health and housing system manager for CommonSpirit Health. She's going to be joining us from Los Angeles. We're here in St. Louis on a very cold day, which again kind of reminds us of how grateful we are to have shelter and a warm place. And in this episode we're going to talk about those who are not so fortunate. And Josh, the last episode that we recorded, we talked about food insecurity in rural America. In this episode we're going to talk about homelessness in the Los Angeles area. Can you tell us a little bit for our listeners, how we came about this particular conversation?
Josh Matejka (01:02):
Yeah, of course. I mean, maybe on the theme of partnership and collaboration, that is probably the best place to start for those who've been listening to health calls and it's various forms over the years, probably very familiar with the fact that some of our story ideas and some of our episode ideas we get from our partners at Catholic Health World and Health Progress. And this one specifically came from Catholic Health World. Our colleague, Valerie Hahn, very celebrated an award-winning reporter, very fortunate We get to work with her and pick her brain on story ideas. And she was actually headed out to this area to do a story on one of the programs that they've been working with about car parks and people who are living in their cars and affording the dignity of people finding spaces to live. And it was just really fascinating getting to pick her brain and hear about her experiences there.
(01:51)
And you and I started talking, we thought this would be a great way to talk about collaborating with those who are formerly unhoused because they're playing a big role in deciding what programs get funded and get these grants. I'm sure I'm going to say it wrong and Nicole will help us figure out exactly how it gets placed and how to talk about it. But yeah, I'm very excited to have Nicole here because I think this is a really innovative way of partnership when we talk about these issues that are kind of always around us and this seems to be a really innovative way to tackle them.
Brian Reardon (02:25):
And it's really about addressing needs in the community and doing in a very, again, collaborative way, bringing in voices that may otherwise not be heard.
Josh Matejka (02:34):
Yeah, exactly. And I think that one of the things about homelessness and working with people who are unhoused is oftentimes we're not working with people who are unhoused. We're just saying, here's the solution. And you follow that. And like I said, I think what they're doing at CommonSpirit Health and specifically with the program Nicole will talk about is really exciting because it brings those voices in and centers them in a really meaningful way.
Brian Reardon (03:00):
Alright, well let's bring in Nicole again. We're going to be talking with Nicole Wilson. She's the community health and housing system manager at CommonSpirit Health. Welcome, Nicole.
Nicole Wilson (03:09):
Hi Brian. Hi Josh. Thank you so much for having me, and thank you so much for such an intentional framing of the discussion that we're hoping to have today. So very exciting to dig in.
Brian Reardon (03:20):
Yeah, great to have you with us. So let's start off with, first of all, it's called the Research and Equity Advisory Council for Housing Insecurities, kind of a long name and it goes by REACH-I?
Nicole Wilson (03:33):
REACH-I, that is our acronym that we like to use or REACHI. Yeah.
Brian Reardon (03:38):
So tell us a little bit about what is REACHI, how did it come about?
Nicole Wilson (03:42):
Yeah, thank you. It's one of my favorite questions to answer is how REACHI was originally created. So REACHI was actually an idea that came up before I started at CommonSpirit. So one of my colleagues and the person that was formally in my position, we had a kind of grant review council internally within CommonSpirit Health, but we didn't have a very diverse array of stakeholders really addressing and understanding the way that our programs and projects worked. So it felt a little bit like a checkbox, and we really wanted to create a group that could address the voices of individuals that might really have an understanding of what it would mean to go through one of the programs that we were funding and could really provide intentional feedback out of that recognized gap that we had. They created the concept of our research and equity advisory councils for housing insecurities, also known as ree. We first created the council in April, 2022 and have recently just expanded from our original foundational membership in the state of California to Washington state with the hope of continuing to expand into other regions
Brian Reardon (04:57):
And give us a flavor of who makes up the council. Is there a certain group, for example, does Dignity or CommonSpirit Chair the organization, how is it formed?
Nicole Wilson (05:08):
Yeah, so we kind of have collaborated with another organization when we were doing our initial recruitment. That organization is called Home Base, so they have experience lifting up advisory councils across the state of California and other states as well. And so we really engaged them and making sure that we were intentionally creating a survey tool of how we could really engage individuals with lived experience from a diverse background, diverse organizations, and really making sure that we were really being thoughtful of who our membership was going to be made up of. And so as I mentioned originally, we were focused within our geography in the state of California. So one of the baseline criteria we had for our members to be engaged was that they were in a community that was surrounding one of our hospitals. So that one of the main things, but also just having had previous lived experience and the diversity of our membership is very vast.
(06:04)
So there are people that have experience with homelessness as a child, as an adult, with their families experience, navigating through the hospital system, all of the different systems of care that there are when you're coming into experiencing homelessness. And so we had a very diverse array of individuals within our California market. We engage a lot of our direct service providers at our hospitals partnership to kind of engage and recruit individuals. And we have an amazing array of folks. And we did the same similar process when we were reaching out in Washington State. So really working directly with our community partners to get out this opportunity and make sure that we were engaging the right individuals who were really passionate about this work.
Brian Reardon (06:53):
Why is it important? And I think the answer is probably pretty obvious. Obviously you want to hear different perspectives, it's going to make the care for your community and your patients more informed, probably more effective. But can you talk us through a little bit about the impetus or the aha moment that said, you know what, we really need to have these voices as we make decisions on the kind of grants we provide, on the type of care we provide. Can you walk us through a little bit about the discernment process perhaps in being part of this council and recruiting individuals to serve on it?
Nicole Wilson (07:27):
Right. Yeah, that's a great question. I think it was a noticeable gap because we've all worked in the homelessness space, the folks that are on my internal team for quite a few years. But the difference is we've never actually experienced going through any of the projects and programs. We might've provided direct services as service providers, but to actually know what it's like to situate oneself in a medical respite bed because you don't have any place to go post discharge from the hospital or to be engaged by a street medicine team or to have the experience of experiencing homelessness with a pet and trying to find housing. Those are not experiences that we can speak to firsthand. And so when creating and crafting projects and programs that are trying to address those needs, we often go to our direct service providers who often have that same level of knowledge and expertise.
(08:19)
But that missing piece is what would it actually feel like to have felt safer in this project or programs? What are things that maybe are gaps that we're missing when we're trying to initially have these conversations? And I think it was just knowing what we didn't know was I think very, very much a part of why we felt was important to engage in individuals lived experience in this process. Because there is an acknowledgement that there is different levels of what it means to be a professional and to be able to provide expertise. We hire hire folks with PhDs and certain levels of education. It's honoring the fact that this particular experience isn't something that you can be taught in school, but there's so much value in the expertise that our members provide. And being able to not only engage them in these conversations as colleagues, but also to be honoring that level of expertise that they're bringing to the table and how it really transforms our work.
Brian Reardon (09:22):
So when it comes to awarding grants or considering maybe what's going to be funded, how has REACHI changed that thought process or that decision making process and saying, you know what, if you've got a pool of money, you've got a million dollars and you have to divide it up so many different ways, has it had an impact on how those funds are allocated? And can you give some examples of that?
Nicole Wilson (09:47):
Yes, a hundred percent yes. So I think it's significantly changed our grant making process. Actually, one of the subcommittees that I mentioned is specifically just focused on grant making and evaluating how we are delivering grants. So they've changed everything from, for example, we have a grant application that our potential grantees submit. They've revised that for us and added in additional questions around not just the incorporation of lift expertise voice, but also what are the ways in which folks are engaging in trauma-informed care delivery, what are the ways in which folks are staffing their projects and programs? And really asking very intentional questions, not just about what are the ways in which you as an organization feel that these tenants apply to you, but actionably, how is that showing up in the services that you're providing and the funds that you're expecting? So that's kind of one piece.
(10:45)
And then we also have had the opportunity to, and this speaks to kind of how we all got connected with Valerie for our members to oversee some of our grant funds from start to finish, meaning that they were in charge of creating the grant application. They were charge of interviewing all of our potential grantees, reviewing the applications that they submitted, and making the final decision on those particular sets of grants that were focused on two different areas of focus. One is CalAIM, which is within the state of California and the way that certain housing related supports are provided to participants in those projects and programs, the funding stream changed. And so there was a gap in funding still even with that transition. And so our members oversaw some funding that was related to supporting that initiative within the state of California. And then also on interim housing, which is short-term housing.
(11:49)
Oftentimes when we're talking about homelessness, we're talking about getting people into housing permanently. The ideal is housing first, however, oftentimes it takes upward of a year even to secure permanent housing for someone. So where does someone stay in that interim? And oftentimes they're staying in their cars or on the street and still providing interim housing is an often unrecognized gap, especially for folks that are exiting the hospital and are trying to recover from surgery or from any other medical need. Normally, we'd be able to go home and stay in bed and rest and recover. And if you don't have a safe place to be, it's much harder to obviously recover. So that's where interim housing comes into play. So that was another stream of funding.
Brian Reardon (12:35):
And as you speak about interim housing, I think a lot of folks think, well, if someone is unhoused, there's a shelter that they can go to, maybe the Salvation Army or some place in the community. And really a lot of times that is not appealing to people, particularly folks that may have kids may have pets. And so this interim housing approach, I guess what I'm getting at is there's a lot of different ways to meet the needs of those who don't have a shelter. And so what are some of the programs that maybe reaches come up with to address the one size does not fit all in saying, well, there's a shelter that maybe has 50 people in it. Can you walk us through maybe some of the more innovative approaches to making sure people, even on an interim basis if it's only for several weeks or maybe a month or two, can provide housing until they can get a more permanent solution?
Nicole Wilson (13:28):
So I think REACHI has been really focused on not just the housing that we provide, but the way in which these programs are serving their tenants, their residents, the folks that are actually staying and utilizing these services. And what a lot of folks will tell you from our council and from the programs and projects that we're funding, it's also not just about having a bed, but whether there's supports at that organization beyond just that itself. Right? We're looking at, for someone like you mentioned that might have a pet, if you can't bring your pet into that household or into that resident, it's not going to be a long-term sustainable solution for you. Or if you have a partner, for example, the three Ps, it's pets, people, obsessions. So if those things aren't in place at that organization, that's something that our members are going to consider when we're thinking about funding.
(14:25)
What's the low barrier approach to substance use? What's the approach to things like having to get rid of certain possessions before coming into the shelter? And then there's the concept of actually a congregate versus non congregate shelter settings, whether someone who might be experiencing a behavioral health need like schizophrenia, if that is the best placement for them, if they're going to feel safe in that environment. So it's sometimes there's this concept that folks, that they just are resistant to shelter. And I think the stigma of the experience of homelessness and how folks find themselves in that experience is often what our members help to elevate for folks to understand. It's not just poor choices and it's not being shelter resistant or not wanting to get support or help due to substance use or due to losing your job. It's often much more layered and complex than that. And sometimes shelters are also unsafe places for people. So our members get to advocate for understanding that it's not a one size fits all approach when we're serving people, especially people with complex co-occurring behavioral health and medical needs, and potentially having children or pets or other things that might come into play in terms of creating a safe environment for them to stay.
Brian Reardon (15:56):
And one example that we featured in our Catholic Health War coverage was those individuals who are living in their automobiles and ensuring that they have a safe place to park, essentially,
Nicole Wilson (16:07):
Right? Yes. So safe parking is really an innovative approach that is being explored across a few different geographies. One of them being Los Angeles, and that's the site that Valerie got to visit. And so this specific program that we provided funding for in Los Angeles is geared also towards women because even within a safe parking facility, there are certain services that aren't always considered when we're serving mixed gendered groups. And so for example, in the bathroom at the safe parking facility, they'll have sanitary napkins. They also just experience, for some women who are experiencing homelessness, they're often fleeing violence. And so having an all female space for them to be and safely park their vehicles is a very, very unique project and program to be seen. And even within the safe parking space itself, and living in your car is also a underrepresented experience. Not everyone is aware of the fact that some people are experiencing homelessness in that setting and the difficulties of what it means to actually be living in your car and not having access to a bathroom or needing to move your car from area to area so you don't get a ticket and your car doesn't get towed, and then you're less unsheltered on the street.
(17:30)
And so it's not only providing these women a safe space to be and to rest, but it's also linking them to other resources while they're staying within the safe parking area and connecting them to other housing resources in a way that's really their unique needs.
Brian Reardon (17:51):
And I think that speaks to really listening to the voices of those who are receiving services and understanding, again, some of the complexities and nuances that you've outlined in this discussion. And I think the safe parking one is a great example. You gave several factors that would impede somebody really being able to effectively have shelter in their car and feel safe. So I guess it gets back to the council and understanding the voices of those that are served. And maybe before I turn it back to Josh for some final comments and questions, can you speak to really making sure that those voices are not only heard, but like you said, there's action taken based on the feedback you're receiving?
Nicole Wilson (18:33):
So our council leadership, so we have two now, three co-chairs, actually, one from the state of Washington and two in the state of California. And they create and facilitate our meetings collaboratively with myself and my other colleagues who manages this work stream. So they're the ones that are dictating our agendas. They're the ones that are deciding and supporting us and whether or not we're going to be exploring a particular grant, their leadership informs our entire strategy of how we actually are prioritizing the goals of the council and their attention and their time. And so for us, it was really about true, authentic power sharing and not just dictating to our council, these are the priorities that we want you to focus on, and this is what we're going to be doing. It's really asking them, this is the direction that we're thinking about going in.
(19:27)
Does that feel right to you? Does this feel like the way that we should be prioritizing our strategy within our homeless health initiative? And really giving them the opportunity to not only provide that feedback, but to listening to them and enacting that feedback in real time and making sure we're providing that feedback loop, which is a huge part of it. The last time we're at a meeting, this is what we discussed, this is where we're at with that now, and not just losing the thread. And it's not to say that we are never able, that we're able to always act on all of the requests that we receive from the council, but it's always something that we're considering. And that includes everything, not just from the actual engagement within our Homeless Health initiative strategy, but also the council processes themselves. Because in creating the council, this was the first time that a council of this nature has ever been created within a health system of our size that we're aware of. So it was a lot of understanding that we would need to iterate and we're not always going to get it perfect. And it's requesting that feedback from our members and changing as is needed.
Brian Reardon (20:37):
Yeah, great process. Josh, as we wrap up, any follow up questions or comments you have for Nicole?
Josh Matejka (20:43):
Yeah, yeah. I have one specifically that's been coming to my head, Nicole. I love the way that y'all talk about experiencing homelessness as a lived experience that you can't learn in school. And one of the things I've been thinking about, especially as you've talked about the growth of this program moving into the state of Washington and looking to touch all of these communities that CommonSpirit Health is caring for, is that that lived experience can look different based on where you're at. The experience of being unhoused in Seattle could be very different than the experience of being unhoused in Los Angeles. Different populations, the different geographies come with their own challenges as you seek to expand and care for more communities in this really innovative way. What are some of the challenges you face, but also how has your team and the council looked to add some of those lived experiences to its own kind of knowledge base in order to best care for those communities as you move in and seek to partner with them?
Nicole Wilson (21:46):
Yes. So even when we were still just within the state of California, we immediately recognized the nuances of what it means to try to create solutions for a community depending on where our members were situated. So we had members, for example, in Bakersfield, which has a more rural kind of element to it. It also engages different stakeholders in moving things forward, right? Your city council representatives, your government, what your general neighborhood feels like towards this issue. And so what was really special in bringing everyone together, not just within the state of California, but with Washington and having our members come together, we recognize that exact thing, that there was going to be different factors at play, different ways in which people were able to be supported because of different programs and initiatives that that community might be upholding. But more than anything else, there was so much shared learning from what one community had already done and accomplished, and them being able to share with another community that was just at the beginning stages of trying to create a peer working program, for example, with individuals that have lived experience of homelessness and how they were able to push that through city council or a project or program that was lifting up a street medicine program and another individual that had experience as a street medicine provider and what worked well for them.
(23:14)
And so there's a lot of differences in the way that maybe a community can create solutions, but there's also so much shared knowledge of what has worked and being able to really borrow those ideas so that we're not having to recreate the wheel anywhere. And even as a system team, we're working across very diverse geographies across the 24 states, right? Omaha and in Nebraska and Chattanooga, Tennessee, and then over here in Los Angeles, California. Those are all vastly different communities with vastly different ways of approaching, serving their community members. But it's understanding there's also so much knowledge to be shared because of our membership.
Brian Reardon (23:58):
Yeah. Now this approach I think is just so important. And again, it speaks to the theme of this season of health calls about collaborating united for change. And I think your approach to, it's not only deep listening, it's really constructive dialogue. So these aren't just listening sessions. You're bringing those who are affected by the services you're providing into the conversation and helping shape decisions. And I think that's very laudable and something that we can all learn from in Catholic health care. So Nicole, thanks so much for sharing your insights on REACHI and your approach to homelessness. I think it's really important and just appreciate you sharing your expertise and insights with us.
Nicole Wilson (24:37):
Yeah, thank you so much, Brian and Josh for giving us space. Just chat a little bit more about our work. So thank you both.
Brian Reardon (24:45):
And again, you can check out more on this topic in Catholic Health World. The December issue online and in print edition has stories about this innovative program. And again, we were talking with Nicole Wilson. She's the community health and housing system manager for CommonSpirit Health. And I'm your host Brian Reardon. Our executive producer is Josh Matejka. Our production assistant is Sarah Marchant. Health Calls is engineered and produced at Once Films here in St. Louis, Missouri. And you can listen to health calls of course, at the chha website, a usa.org, or on all of your favorite podcast streaming services such as Spotify, Apple, or Google Play. And if you do like an episode, we encourage you to comment, share, and of course subscribe to our podcast on your apps and favorite streaming services. And on this episode, the information that was provided in Catholic Health World can also be found on our website, chausa.org. You can get both the podcasts and the publications from our news and publications tab on the website, check it out. And as always, thanks for listening.