Leadership Interview: Frank Alexander

Frank Alexander has been director of the Boulder County Department of Housing and Human Services (BCDHHS) since January 2009, overseeing the merger of the former Housing and Social Services Departments into a fully integrated human services agency. In his time with BCDHHS, he has led a comprehensive system redesign process for Boulder County’s housing and human services system, which included forging strong local and state partnerships, promoting cross-disciplinary systems integration, and developing award-winning and creative housing and human services programs. He is also director of the Boulder County Housing Authority and is a past president of the Colorado Human Services Directors Association.
The Ascent: What role does housing instability or a housing crisis play in the health and well-being of individuals and families?
Alexander: Housing is a huge part of everyone’s well-being. A lot of times when we talk about a community’s infrastructure we think of the roads and schools, but we don’t consider adequate, affordable housing as a key part of it. As a society, we really underestimate the place housing holds in overall individual and family health.
With our growing understanding of the social determinants of health, housing is clearly a core component. The housing issue often surfaces when we are dealing with families who are facing economic challenges or a health crisis in their lives. We see a huge overlap among people experiencing homelessness with physical and behavioral health issues like brain injuries, substance abuse and co-morbid health problems. And health plays a huge role in exacerbating the problems that can cause housing instability.
The Ascent: How does failing to address housing instability affect the health care system?
Alexander: The worst-case scenarios show us what happens when we fail to address root-cause issues like housing. Studies show that when you house people who are in unstable health and mental health situations, it can dramatically decrease their use of high-cost ER services. Individuals with chronic health situations can’t manage them when they’re living in a car or they’re homeless. 
The opportunity we have is to work with health care providers, insurers and social systems to recognize housing instability for what it is, and to see how bad those outcomes can be for everyone involved—for individuals, for public health and safety, for hospitals and insurers. Housing stability is a great place to focus our efforts and learn lessons we can then apply to the entire population.
The Ascent: Tell us about the role community partners play in preventing housing stability.
Alexander: We’ve built significant partnerships linking housing and human services providers—private and public—and with core mental and physical health care systems. Those relationships have grown in sophistication, vision and purpose. The most strategic thing we’ve done is adopt a vision around social determinants of health, and we’re operating broadly within that vision. 
We understand our success is connected with working together. That takes a lot of effort and doesn’t happen overnight. But because of that shared vision, we can take on any number of prevention-based activities within that construct. 
We’ve built out a family resource network with providers in the nonprofit sector, to pair with access to core governmental supports and resources. So when a family shows up to a nonprofit with a need, such as clothing or food, we use a common assessment to determine their need for housing support, too. That reduces duplication of services; it’s a no-wrong-door system with a common assessment and integration of information. 
We work actively to help those at risk of becoming unhoused to stay housed. We have a continuum of housing support, including emergency rent assistance and security deposits, funding for homeless activities in the school districts and veterans housing vouchers. We work with individuals and families on budget development and eviction intervention. And there’s a lot of work to get them to a level of housing sustainability--so we have the resources to help the next person.