In March, WHI Communications Committee Co-Chair Maria Alfonso spoke with Aubrey Patino, executive director of Avalon Housing, to discuss Aubrey’s passion for housing, the health challenges that keep her up at night, and her many sources of inspiration.
Q. What originally inspired your passion for housing?
Patino. I started out as a homeless outreach worker in Seattle. Our job was to identify people who were actively displaying symptoms of psychosis and were either shelter dependent, so would not leave the shelter, or shelter aversive.
We worked with really sick people, people who were suffering tremendously and on the streets, many of them for decades. And within a matter of months after moving them into supportive housing, we’d watch them completely–physically, spiritually, emotionally–transform.
From that point on I was hooked because the intervention was so effective for what felt like this really intractable social issue.
Q. Which health challenges or gaps keep you up at night?
Patino. I don’t think any of us can imagine our lives without our home. And yet we’ve gotten to this really perplexing place as a society where we’ve normalized homelessness.
When people don’t have their basic material needs met—needs like housing—they’re likely to have health issues. But those health issues are a manifestation of not meeting their material needs. So I think fundamentally it’s about how we can meet the material needs that improve people’s lives first and foremost, and then how can we address their remaining health issues.
And there are racial inequities that are so present in that narrative. It started out as, ‘Oh, homelessness is a character defect disorder. Fix the person, then you’ll fix homelessness.’ Then that wasn’t working and we said, ‘The system is broken, we have to fix the system.’
Now I think we’re waking up to the fact that the system is working exactly as it’s intended to work and it is racist and it is intentional and it’s structural racism. And I think that until we can name the problem we cannot address the problem.
There’s been a lot of performative attempts to address social determinants, like that became this very sexy thing. But how are those interventions substantively improving the material conditions of people’s lives? That is what keeps me up at night.
There’s time, energy, and resources invested in interventions. And I think more than ever, I’ve been wondering what would it look like if we put all of those resources directly into the hands of people.
I think we as a collective, we as a sector, need to take a hard look at how we could more effectively meet people’s needs, in lieu of what we’ve been doing.
Q. What are your proudest professional accomplishments?
Patino. Oh man. I will say it was an honor and a privilege to be a small part of the brain trust and group of organizers who helped to pass Prop C, a 20-year housing and services millage for the city of Ann Arbor.
Obviously being the executive director of Avalon housing is a highlight. And you know, that’s simply because I work with the most incredibly smart, dedicated, values-driven humans that I know. And they embody the spirit of what Avalon strives to accomplish in the community—in partnership and community with those that we serve. And because you know, we do effectively provide this foundational support to folks that allows people to stabilize and reclaim their lives.
I will say too, I’ve been afforded the opportunity to play a role in systems change in the homeless response sector.
I’ve heard it said, and I often say, that a bad system will trump a good intervention any day of the week. So playing a role in making systematic changes that have been needed over the years has been a highlight. For us, that’s having a data-driven, by-name list; coordinated entry; having a 24/7 single-site supportive housing development that meets the needs of the most vulnerable in the community. Those have been major highlights.
Q. Why did you join the Washtenaw Health Initiative, and how has it been helpful?
Patino. It was with the FUSE program, our community’s first attempt to target high utilizers of our health system who were homeless and had chronic health conditions, and then see if supportive housing could make both qualitative and quantitative impacts. So both improve quality of life as well as reduce costs.
Editor’s note: The multi-year Frequent Users Systems Engagement (FUSE) program was piloted in Connecticut, Los Angeles, San Francisco, and Washtenaw County, MI. In Washtenaw, FUSE was found to reduce loneliness and instability, improve the quality of life for participants in significant ways, and reduce dependence on emergency department care. Locally, health care costs were reduced by $6,000 per person, on average, for the highest utilizers. However, costs increased by $4,000 per person, on average, for the lowest utilizers, suggesting that the program also improved access to medical and dental care. Read more.
The WHI helped by providing both policy and advocacy-level support for cross-system health care. And then some of the lessons that we learned with FUSE iterated into MI Community Care (formerly known as the Livingston-Washtenaw SIM), the WHI’s community-wide care coordination program, as it evolved.
I think every community should be measured by the way in which it cares for its most disenfranchised citizens. And I am very grateful to live in a community that is very committed and well coordinated in its efforts to address homelessness. But we still have a lot of work to do.
In Washtenaw County, housing affordability has become more and more problematic for more and more people. There is a corollary relationship to homelessness, so we will watch more and more people fall into homelessness. We have to address housing across the spectrum of socioeconomic need and we have to help people understand how it’s the fundamental social determinant of health for all.
To me, it seems so foundational when we try to address other things and we haven’t addressed housing, we’re sort of spinning our wheels. So I appreciate the role that the WHI has played in helping to educate and communicate that need to the community.
Q. Who or what inspires you to continue working for improved health in our county?
Patino. A hundred percent our client population, they’re incredible and I’m inspired by them every day.
I’m also inspired by the work of Yodit Mesfin Johnson [president and CEO of NEW, the Nonprofit Enterprise at Work]. She’s been an important coach, teacher, mentor, and disruptor.
I’m inspired by a lot of the grassroots organizing that has surfaced and gained traction, particularly over the last year. Washtenaw Camp Outreach, Survivors Speak, and others who have been doing really important work.
I’m really inspired by the Washtenaw County Health Department and our county’s Office of Community and Economic Development, both of whom have really risen to the occasion throughout the pandemic and don’t get the same recognition other organizations might because there’s this expectation that they are governmental entities, and this is their role. But it’s unimaginable the ways in which they’ve adapted and supported so many of us.
And I’m grateful for the leaders in the community who are doing racial equity work and who are embodying that in accountable and loving ways that are elevating all of us.