BHCHP Staff Present at the Annual NHCHC Conference

From May 15-19, more than a dozen BHCHP staff attended the annual National Health Care for the Homeless Council (NHCHC) Conference in Baltimore. Many of our staff were presenters at the conference, sharing their expertise and thought leadership with the broader network of professionals working in homeless healthcare across the nation.

Shared below are the titles and excerpts of the different presentations given by our staff at the conference.

Aura Obando, MD | Promoting Safe and Stable Housing for Children and Youth: A Call to Action

• Safe and stable housing is foundational for child and adolescent health. When children and youth do not have a place to call home, their physical and psychological health suffers. In this talk we will seek to: (1) describe the impact of stable housing, housing instability, and homelessness on child and adolescent health, (2) outline the clinician’s role in addressing housing instability and homelessness in clinical practice, and (3) promote clinician advocacy for key policy interventions that address housing instability and homelessness locally and nationally. We describe clinical interventions clinicians could implement in practice including: proactively identifying housing instability and other social drivers of health, mitigating associated health risks, reducing barriers to care, engaging in individual advocacy to prevent eviction and support healthy housing, and forging partnerships with community resources. Several promising policy level interventions to improve child and adolescent health will be discussed, including: solutions that promote housing affordability and choice, strategies that support families experiencing homelessness and facilitate exit into housing, and cross-sector approaches that address the complex drivers of homelessness. Through case-based discussions, we will highlight the role clinicians can have as advocates. This talk is a call to action, to not only meet the needs of current HCH patients, but also to inspire clinicians to engage in advocacy for homelessness prevention efforts. Clinicians can have quite a powerful role in addressing the health impacts of homelessness through direct patient care, institutional-level activism, and advocacy for policy changes that improve the lives of families and youth.

Aura Obando, MD and Maggie Sullivan, NP | Addressing the Needs of Immigrants Patients with Experiences of Homelessness: Tools for Best Practice

• Immigration status is a well recognized social determinant of health and can compound the social and medical needs of HCH immigrant patients. Immigration law directly influences non-citizens’ eligibility for a wide array of benefits and services, including health insurance. The health consequences of limited access to care are particularly magnified for those experiencing homelessness. This workshop will employ case-based discussions to describe and address common barriers to care immigrant patients face. We will specifically address how to optimize health care delivery for immigrant patients experiencing homelessness by ensuring appropriate language access, developing policies on law enforcement requests to enter the premises, and use of welcoming signage, among other tools. In small groups, we will discuss the importance of understanding our patients’ immigration journeys, how to elicit such histories in a trauma-informed way, and how this information may be useful in revealing previously unidentified medical and mental health needs. Additionally, we will discuss how disclosure of certain kinds of trauma such as torture and domestic violence, may provide the patient a path toward a more permanent legal status, emphasizing the role of the health care worker in facilitating referrals to immigration attorneys. In this workshop we will share some of the steps we have taken at BHCHP to inform and empower our immigrant patients, including: Know Your Rights trainings, creating a clinic dedicated to immigrant health, forging Medical Legal Partnerships, and more. We will also share staff capacity-building opportunities that have helped close gaps in care across patients of various language backgrounds, including trainings, hiring practices that prioritize cultural and language diversity, enhanced access to interpreter services, and more. We will also discuss the value of coalition building in enabling the sharing of best practices and prioritizing advocacy opportunities. One potential outcome from the workshop may be to generate a working group amongst HCHs interested in immigrant health and policy.

Avik Chatterjee, MD, Mike Mayer and Yesenia Mejia | Living through an Encampment Sweep: Community and Uncertainty

• The number of people experiencing homelessness (PEH) in tent encampments has increased significantly in the past 20 years. Citing concerns over public health, safety, and substance use, many cities have taken steps to clear encampments in highly visible “sweeps.” In January 2022, nearly 200 PEH were displaced from a major encampment in Boston’s South End. Some displaced individuals were offered placement in harm reduction-focused transitional housing, while others were not. This housing offered guests their own rooms, wrap-around healthcare and social services, and staff with specialized training to support people with addiction. We investigated the impact of these sites and the sweep on public health, safety, and substance use.

Becky Lee, MD and Jen Nunes, PA | Using Point of Care Ultrasound as a Diagnostic and Engagement Tool in HCH Settings

• Point-of-Care Ultrasound (POCUS) is an attainable skill for medical providers working in the field of homeless health care. It can function as an engagement tool as well as offer valuable clinical data for patients who often have major barriers in accessing traditional medical imaging modalities This workshop will consist of several case studies followed by four hands-on stations using mobile, handheld ultrasound devices. The cases will highlight examples when POCUS was instrumental in making a diagnosis or determining a course of action. Participants will be exposed to and get the opportunity to practice a variety of ultrasound techniques including lung, cardiac, abdominal and musculoskeletal scans. We will also provide equipment to practice POCUS-guided phlebotomy.

Katherine Koh, MD | Managing Controlled Medications in Homeless Patients: A Framework Informed by Lived Experience

• Managing controlled medications in patients experiencing homelessness (PEH) is one of the most common clinical challenges faced by providers. Patients often ask for controlled medications like benzodiazepines and stimulants to survive “the rigors of homelessness.” Prescribers are often torn between prescribing to maintain alliance or reduce suffering in the patient vs. not prescribing due to concerns for addictive potential or safety risk of overdose and death. As a person with lived experience and two street psychiatrists practicing for a total of 15 years, we have found this to be one of the most significant challenges in the provider-patient relationship in caring for PEH. This presentation will a) provide novel, original research on the rates of benzodiazepine prescribing for PEH vs. housed patients with mental illness in the VA, b) review the existing literature on controlled medication prescribing for PEH; c) provide the perspective of a person with lived experience of mental illness and describe the reasons that patients may want these medications; d) discuss how to assess the risks and benefits of prescribing controlled medications for PEH and e) solicit audience participation regarding challenges and effective approaches for managing controlled medications in PEH. The goal of this workshop is to help generate and offer ideas for how to effectively and compassionately treat PEH who ask for controlled medications.

Pam Klein and Sanju Nambang | Collecting SOGI Data in a HCH Setting: A Multi-Pronged Approach

• Collecting patients’ Sexual Orientation and Gender identity (SOGI) information is recognized as a key aspect of providing holistic, patient-centered health care. It is an intervention that fosters retention in care for gender and/or sexual minority patients who often feel unconnected and invisible to health care providers who have no knowledge of their patients’ gender identity and/or sexual orientation. It also enables health care practices to identify health care disparities among gender and/or sexual minority patients as compared with those of their cisgender heterosexual counterparts and then to tailor interventions to address these disparities. For health care entities that receive federal funds, collecting SOGI information is now mandatory. However, there may exist multiple barriers that negatively impact the ability to reliably collecting SOGI information in a health care setting, especially in the setting of serving a population experiencing homelessness. This presentation aims to describe a multi-pronged approach to addressing low SOGI data collection rates within a federally qualified health center serving a population experiencing homelessness. Some examples of the strategies we discuss include adding SOGI data collection to our quality measures, sending patient messages via the EMR portal, staff education, utilizing volunteers for patient outreach, and offering patients the option to fill out a SOGI form on their own in the waiting room. We present our best practices in hope that the information is applicable in other HCH settings.

Mike Mayer and Andy Maier | Addiction Recovery and Sober Living

Travis Baggett, MD | ‘What’s new in Homeless Health Care?’ A no-jargon summary of the latest research