Further Inspection: Integrating Housing Code Enforcement and Social Services to Improve Community Health
1.1. Housing, Health, and the Role of the Housing Inspector
1.2. Housing and Multisector Collaboration
1.3. Placing Modern Housing Inspections in Historical Context
2. Materials and Methods
- During routine inspections, inspectors identify residents in need of support beyond what inspectors can provide, ranging from crisis assistance (e.g., a family being evicted) to vital access to basic needs (e.g., heating fuel). Referrals can be made for landlords as well as tenants. No formal screening process is used in making referrals.
- To make a referral, inspectors obtain consent from residents and call a designated case manager at the social service agency, CAPIC. Inspectors received training from CAPIC’s case manager on this process.
- A case manager then contacts the resident, most often meeting them at their home, to determine what type of support is needed. If a resident accepts, the case manager connects them with services and provides follow-up care. Housing inspectors follow up to ensure housing code violations, if present, are corrected.
- CAPIC shares outcomes and progress with inspectors and the City Manager via monthly updates and quarterly reports.
2.2. Data Sources
2.3. Quantitative Data
2.4. Qualitative Data
3.1. Referral Characteristics
3.2. Qualitative Interview Themes
3.2.1. Challenges Inspectors Faced before the Referral Program
“So, we see all these social service problems. And there’s really not a lot we can do. It’s terrible… When you’re alone in the house, you see how people live. You see these people living with no food or you see this person that clearly has a mental health issue and, you know, that’s not our job. There’s not a lot we [could] do.”(Inspector 2).
“It would put a huge strain on my office. It would put a huge strain on each individual neighborhood. We have these issues that go on forever… And when we’re not working on it… there is no outcome, the neighborhood suffers, the family suffers, everybody suffers.”(Inspector 3).
3.2.2. Impact of the Program on Inspector’s Work
“[The Social Service Referral Program] took away the piece of the inspection for certain types of people that was causing problems for us. If people are going to be evicted or have mental health issues or can’t pay rent–these we can refer to CAPIC… CAPIC has time to case manage people’s needs. We still resolve problems in-house; we just refer our most challenging that are outside the scope of violations.”(Inspector 1).
“There’s more free time … so once we do our inspection and write up our report and get CAPIC involved … you don’t have to have it in the back of your head the whole time and check in on it every day… it gives you peace of mind, it releases my inspectors to do other work… It’s a good feeling, takes a lot of stress off us.”(Inspector 3).
“What’s interesting is that now these problems that were experienced by inspectors, but didn’t necessarily come up to our level, now do… They were simply wrestling with these issues all on their own. Making phone calls, trying to find the resources to address the issues. Sometimes failing, sometimes succeeding, but in a really scattershot way. I think that was sort of an invisible workload down in [The Inspectional Services Department] that has now become part of an understood process of engagement… and given a form and a direction on how to solve these problem situations.”(City Leader 1).
“When I challenge [inspectors] on the number of cases… it’s the intractable cases that can be time eaters for inspectors and endanger the client… So, I would say it makes [inspectors] more effective and therefore engenders a sense of actually assisting people to a solution that’s helpful to [residents] rather than punitive.”(City Leader 1).
“I’m only going to refer people who really need the services–who are destitute or needs can’t be met otherwise.”(Inspector 1).
3.2.3. Impact on Social Service Provision
“I spend more time with them [residents referred by inspectors]. Sometimes a client comes in here [to CAPIC] and I’m issuing them a food gift card. I don’t really know about their background… or living situation. I don’t know what their issue is, apart from they’re coming in and they’re telling me, ‘I’m hungry.’ Through [the Social Service Referral Program], it’s a more personal connection I have with the clients.”(Case Manager).
3.2.4. Impact on Residents and the Community
“When you take the biggest problem of [residents’] lives … and it gives them a better-quality life … dealing with their medical issues, their families, and mental health issues, things like that.”(Inspector 1).
“My first thought was to call the police. And now I’m thinking let me get [CAPIC] involved.”(Inspector 2).
“If you have one bad building, everything else is so much worse. Once you fix that one building the rest of the neighborhood gets better. Kids are going out and playing on the sidewalk where they weren’t before because the guy had, you know, prostitutes and drug addicts living at his house. So, when he’s kept in check, it changes the whole neighborhood … So, in most of these [cases] we’ve referred … it’s almost like the whole neighborhood had a problem. So, it’s helping the whole neighborhood, not just one person or one person’s life.”(Inspector 3).
3.2.5. Enabling Environment
“As far as I’m concerned, it’s real successful because sometimes it just takes a phone call for me … And it’s like ‘tag, you’re it’ and [the case manager] carries the ball, and she’s really good.”(Inspector 2).
“When I raised this as a budgetary issue with [the Director of Inspectional Services] or informally with his staff about moving forward with the program, there is no hesitation on their part … and they wouldn’t simply endorse something because it was there and occasionally it may be okay. So, I trust their judgements when they say to me, ‘This is really important for us to continue’.”(City Leader 2).
“You’ve got to identify the service provider who has the … case management experience to do something like this. … who understands all the connections, that has experience with all the resources that are out there on the state and nonprofit level and is able to bring those in to solve problems. … And on the day-to-day level, certainly making it as simple as possible. [Inspectors] didn’t want to have a complicated reporting system … so shifting the tracking and documentation of case management to the service provider so that it’s not an additional burden on the inspector was important to us.”(City Leader 1).
3.2.6. Limitations and Generalizability of the Program
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Proportion of Residents|
Referred to Services 1
|Sex (female)||53% (8)|
|Black (not Hispanic/Latino)||7% (1)|
|White (Not Hispanic/Latino)||40% (6)|
|Physically disabled||53% (8)|
|Has children under 5 years||20% (3)|
|Senior (aged 60+)||60% (9)|
|Accepted on first offer||60% (9)|
|Accepted after two or more offers||27% (4)|
|Connection to social services|
|First connection to services||20% (3)|
|Previously connected to services||33% (5)|
|Currently receives other services||47% (7)|
|Number of contacts made between resident and case manager||mean: 9, range: 1–33|
|Number of service types received||mean: 3, range: 1–5|
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Robb, K.; Marcoux, A.; de Jong, J. Further Inspection: Integrating Housing Code Enforcement and Social Services to Improve Community Health. Int. J. Environ. Res. Public Health 2021, 18, 12014. https://doi.org/10.3390/ijerph182212014
Robb K, Marcoux A, de Jong J. Further Inspection: Integrating Housing Code Enforcement and Social Services to Improve Community Health. International Journal of Environmental Research and Public Health. 2021; 18(22):12014. https://doi.org/10.3390/ijerph182212014Chicago/Turabian Style
Robb, Katharine, Ashley Marcoux, and Jorrit de Jong. 2021. "Further Inspection: Integrating Housing Code Enforcement and Social Services to Improve Community Health" International Journal of Environmental Research and Public Health 18, no. 22: 12014. https://doi.org/10.3390/ijerph182212014