Abstract
As a result of working inside homes, city housing inspectors witness hidden and serious threats to public health. However, systems to respond to the range of problems they encounter are lacking. In this study, we describe the impact and enabling environment for integrating a novel Social Service Referral Program within the Inspectional Services Department in Chelsea, MA. To evaluate the first eight months of the program, we used a mixed-methods approach combining quantitative data from 15 referrals and qualitative interviews with six key informants (inspectors, a case manager, and city leadership). The most common services provided to residents referred by inspectors were for fuel, food, and rent assistance; healthcare; hoarding; and homelessness prevention. Half of referred residents were not receiving other social services. Inspectors reported increased work efficiency and reduced psychological burden because of the program. Interviewees described how quality of life improved not only for referred residents but also for the surrounding neighborhood. A simple referral process that made inspectors’ jobs easier and a trusted, well-connected service provider funded to carry out the work facilitated the program’s uptake and impact. Housing inspectors’ encounters with residents present a unique opportunity to expand the public health impact of housing code enforcement.
Highlights
IntroductionPoor housing is associated with health outcomes as diverse and far reaching as cardiovascular disease, lead poisoning, mental illness, and infectious disease [2,3,4,5,6]
A primary strategy for breaking the link between poor housing and poor health is the enforcement of housing codes [10]
Integrating a novel Social Service Referral Program within housing inspection allowed for better alignment between the problems residents and inspectors faced and solutions to those problems (Figure 2)
Summary
Poor housing is associated with health outcomes as diverse and far reaching as cardiovascular disease, lead poisoning, mental illness, and infectious disease [2,3,4,5,6]. These risks stem from physical problems, such as insect infestations causing asthma exacerbations [7], financial problems that result in poor property maintenance [8], and social problems, such as overcrowded conditions straining interpersonal relationships [9]. Smoke detector installation can dramatically reduce loss of life and livelihood from fire [11], while extermination of insects can reduce asthma-related emergency room visits [12]
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