The Floating Hospital’s Social Determinants of Health Study Yields Vital, Actionable Results

The needs of a person experiencing homelessness may seem clear. Shelter is priority No. 1, right? But, the fact is that although finding safe haven is indeed imperative, there is a battery of other often-unarticulated issues linked to being unhoused. And, without a way of identifying those myriad issues—as unique as the people experiencing them—moving toward a solution is extremely difficult, if not impossible.

But, The Floating Hospital found these issues could be revealed in a simple and direct way: just by asking.

Project director Sarajane Brittis Ph.D., and coordinator Habiba Alcindor were the force behind this year’s Social Determinants of Health Study, a questionnaire that gathered critical data on everything from patient environment and living conditions to quality of life and education for children to basic daily-living needs, and other key factors.

The questions were designed not only to hone in on specific issues, but also give voice to the voiceless, whose unfiltered comments revealed the brutal domino effect of homelessness.

“So many things were coming from our patients,” says Dr. Brittis, whose other specialty is organizational development focused on healthcare. “Many of our patients said that no one had ever asked them what we were asking—questions that showed an interest in their lives. They opened up and told us about their struggles with trying to access basic needs like food, clothing, housing, childcare and even internet service.”

Dr. Brittis said nearly everyone expressed the desire to get out of their present circumstances and build a better life for themselves and their children. “We found that listening and systematically identifying their barriers was a critical first step towards building a concrete program that will tangibly help bring positive changes in their lives.”

And what they heard was poignant. Said one respondent, “I feel like I’m in a pit. I see the light to climb out so close, and yet I’m so far… my blood pressure has gone up and I’m now on five medications because of tremendous stress.” It was an issue echoed by many of the nearly 400 survey respondents.

“Stress has an enormous impact on health, especially when you feel voiceless, judged, and stuck in the homeless system,” Dr. Brittis said.

Solange Medina; Habiba Alcindor; and Sarajane Brittis

The three-phase study was designed with questions from a national industry protocol and the institutional knowledge of Floating Hospital outreach workers. It focused on adults in myriad housing situations, including residents of hotels and motels converted to homeless shelters in New York City, Long Island City community residents using The Floating Hospital’s community health center, and patients living in shelters throughout the five boroughs.

The results of the study yielded the kind of real human data needed to close the gaps created by homelessness. It also drew the attention of the Frances L. and Edwin L. Cummings Memorial Fund, longtime supporters of the Floating Hospital who increased their support in 2021 to seed the creation of a new staff life-skills case manager to link patients to the resources they need to end the cycle of poverty and poor health.

As such, Solange Medina has been tending to five to 10 patients a day, providing the direction and assistance that was missing in their lives before. Thanks to the SDoH study, she has feedback from patients on what they are lacking and what they need.

“There are so many programs and resources, but [patients] don’t have access to them because they don’t know about them,” she says. “I connect them to these things, I’m an advocate for them; I want to help them get out of their current situations and be successful,”

Medina helps patients research resources such as linkages to benefits and housing programs and fill out vital documents such as applications, health reimbursement account or disability forms. The Cummings Fund grant also allotted for a navigational assistant to support Medina’s efforts. The project is currently vetting candidates—ideally, someone who has been through the shelter system herself—for the position.

The SDoH study will not exist in a vacuum. Dr. Brittis plans to renew the effort, so the clinic can continue learning how to best serve The Floating Hospital’s patient population as their circumstances shift, and the conditions resulting from the pandemic continue to affect New York City’s most vulnerable families. This month, she assembled a feedback focus group of 10 women who participated in the survey. Gathering at The Floating Hospital’s new clinic, the women weighed in how to fill in the gaps, enhance future lines of communication and questioning, and express their feelings in a safe space.

“We’re creating a support network at The Floating Hospital. It goes back to why we were created and why we’re still here – to serve the whole person,” says Dr. Brittis.

— Amy Zavatto