Exploring the connections between social factors and health

September 18, 2023

Providence Center for Outcomes Research & Education

[6 MIN READ]

The Community Connections Initiative of SW Washington is an innovative research project exploring the relationships between the education, housing, legal and health care sectors.
Providence’s Center for Outcomes Research and Education (CORE) linked data across these sectors to study how people interact with them, so we can better serve their health needs.
CORE’s report shows associations between student mobility, health and chronic absenteeism; mental health illness, substance use and the legal system; and acute care use, the legal system and housing instability.

At Providence, we believe the opportunity for health starts long before illness begins. Many factors contribute to a person’s physical and mental health — and they include more than a person’s well-being, the social support they receive or their physical environment.

In fact, they cover all the conditions in which people live, work, learn and play. These factors, called social determinants of health, impact health and health care access. They drive health inequities, help inform health policy, and include everything from education and housing to the way people interact with the legal and health care systems.

We wanted to take a closer look at the intersection between these sectors, and their effects on health outcomes, so we can better meet the needs of the people we serve. That’s why our Center for Outcomes Research and Education (CORE) — an independent team of scientists, researchers and data experts — joined forces with organizations in Clark County, Washington, to form the Community Connections Initiative of SW Washington.

The initiative’s goal is to compare health outcomes across education, housing, legal and health care and to use those findings to inform more effective community-based interventions, including better care delivery and early childhood social services, for people in southwest Washington.

CORE partnered with the Clark County Sheriff’s Office, the Evergreen Public School District (EPS), the Vancouver Public School District (VPS), the Vancouver Housing Authority (VHA) and the Southwest Accountable Community of Health (SWACH) for the initiative.

The team recently released a report describing the findings of a three-year study that analyzed data pulled from cross-sections of education, housing, legal and health care.

Key findings

CORE used an innovative research approach called fuzzy matching to link data across sectors. This allowed it to collect valuable, actionable insights from people’s interactions with multiple areas. For example, fuzzy matching allowed CORE to look at the relationship between a student at EPS who received housing through VHA and/or health care services under Medicaid.

The relationship between student mobility, health and chronic absenteeism

Housing instability is a known risk factor for moving between school districts. To explore this association, the study looked at the correlation between the number of students who moved between EPS and VPS and sought housing assistance from VHA.

We found:

Students who moved between EPS and VPS were three times more likely to seek housing assistance from VHA than students who remained in a single district.

Moving between districts can also interfere with school attendance, which can then lead to poor socioeconomic and health outcomes later in life. For this reason, we explored the overlap between chronic absenteeism (defined as being present less than 90% of the time over the course of one school year) and chronic health conditions (most commonly behavioral health conditions like anxiety disorders and depression). We also looked at the overlap between chronic absenteeism and the need for housing assistance.

We found:

Students who experienced chronic absenteeism were more likely to have chronic conditions.

Students who experienced chronic absenteeism were two-thirds more likely to seek housing assistance.
Elementary school students who received housing through VHA saw a significant increase in attendance rates.

The relationship between mental health illness, substance use and the legal system

People lacking mental health and substance use resources often end up in the legal system. In fact, as many as 1 in 4 people with a severe mental illness such as schizophrenia or bipolar disorder are in the legal system every two years.

To explore the association between interactions with the legal system and mental health and substance use needs, we looked at whether increased access to mental health and substance use services would lower a person’s risk for re-entering the legal system.

We found:

Adults who had been in jail were 70% more likely to have been diagnosed with a mental health condition. They were also five times more likely to have a diagnosed substance use disorder after accounting for age, gender, race/ethnicity and language.
Receiving outpatient mental health services within three months of leaving jail:
- Decreased a person’s likelihood of re-entering the legal system.
- Increased a person’s average time to rearrest.

The relationship between acute care use, the legal system and housing instability

People who have been in jail and people experiencing housing instability tend to use acute care (i.e., visits to the emergency room or inpatient hospital stays) more often. That’s due to different and often more intense health burdens than other people enrolled in Medicaid.

To explore the association between acute care use, the legal system and housing instability, we looked at patterns of acute care use across these populations.

We found:

Adults who have been incarcerated were more likely to have chronic substance use and mental health conditions. Adults experiencing housing instability were more likely to have chronic physical and mental health conditions.
Adults experiencing housing instability were over 50% more likely to visit an emergency room. They were also 30% more likely to have an inpatient hospital stay.
Adults who had been in jail averaged nearly one more emergency room visit in the year following their release.

Insights will drive more effective interventions, better health equity

Social determinants of health like access to housing and interactions with the education and legal systems play a large role in health disparities and, ultimately, patient outcomes.

By understanding and addressing social determinants of health and how people interact with them, we can align community-based interventions to better influence health and meet social needs — and improve quality of life.

The Community Connections Initiative of SW Washington will continue to drive cross-sector collaboration, promote evidence-based public health solutions and foster community health in the region.

You can read all the findings in the full report.

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