The BHCHP Institute serves as a multidisciplinary, collaborative center of excellence in homeless health care, with the mission to improve the health of individuals and families experiencing homelessness through work across six distinct pillars: research, quality, policy and advocacy, value-based care, writing and ethics, and education. We believe strongly in including patients as both participants and advisors in all phases of our research and quality improvement work, and aim to support BHCHP’s programs and the field of homeless medicine at large through scholarship, analysis, and data-driven management.
Read more about the Institute pillars:
Research
Since BHCHP’s inception, the Institute has led the way in research on homeless health care, fostering research by both internal and external investigators. Our research helps not only BHCHP, but also fellow clinicians, implementers, and policymakers across the state and country better understand the health care needs and utilization of people experiencing homelessness. And it informs how we identify and address health inequities and continue to adapt and refine care.
Click here to explore a full list of the Institute’s published research. Seminal publications include:
The health care of homeless persons: a manual of communicable diseases and common problems in shelters and on the streets. O’Connell JJ. Boston Health Care for the Homeless Program with the National Health Care for the Homeless Council. 2004.
The Boston Health Care for the Homeless Program: a public health framework. O’Connell JJ, Oppenheimer SC, Judge CM, Taube RL, Blanchfield BB, Swain SE, Koh HK. American Journal of Public Health. 2010 Aug;100(8):1400-8.
Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. Baggett TP, Hwang SW, O’Connell JJ, Porneala BC, Stringfellow EJ, Orav EJ, Singer DE, Rigotti NA. JAMA Internal Medicine. 2013;173(3):189-95.
Health care utilization patterns of homeless individuals in Boston: preparing for Medicaid expansion under the Affordable Care Act. Bharel M, Lin WC, Zhang J, O’Connell E, Taube R, Clark RE. American Journal of Public Health. 2013 Dec;103(S2):S311-7.
Drug overdose mortality among people experiencing homelessness, 2003 to 2018. Fine DR, Dickins KA, Adams LD, De Las Nueces D, Weinstock K, Wright J, Gaeta JM, Baggett TP. JAMA Network Open. 2022;5(1):e2142676.
Quality
The Institute oversees a robust quality improvement program to ensure that health care services are delivered with both excellence and equity. Quality improvement at BHCHP is team-based, and all clinical sites are involved in efforts to advance our quality metrics. The Institute provides leadership, coordination, and support with data analytics and evaluation.
A Quality and Efficiency Committee monitors progress on an annually updated set of priority quality metrics, and proposes and oversees action steps for improvement on each measure. This multidisciplinary team includes clinicians, care coordinators, consumer advisory board members, and site directors. The Institute also conducts an annual survey to assess patient experiences using a validated tool designed to measure the experiences of homeless individuals in the primary care setting.
Policy and Advocacy
The Institute uses our findings from research and evaluation, and our voice within local and national public health debates, to advocate for public policies that will enhance the health and wellbeing of people with an experience of homelessness. Further, we critically examine those social policies that create disparate, negative impacts on the health of people of color and other populations who have historically faced stigma, discrimination, and inequities in our health care system and broader society.
Our team routinely produces op-eds, public testimony, issue briefs, blog posts, invited remarks and presentations, trainings, letters to elected officials, interviews, and other written and oral products on a range of issues affecting people experiencing homelessness—from poverty, mass incarceration, and substance use services to racism, discrimination, and deportation, and much more. At times, BHCHP employees engage in direct actions, rallies, and demonstrations that uplift the needs of those we serve.
Importantly, people with an experience of homelessness are also actively involved in advocacy efforts. For example, Joanne Guarino, BHCHP Consumer Advisory Board and Board of Directors member, developed The Housing Guide to help people who have experienced homelessness transition more successfully into housing. This guide has been distributed to case managers across BHCHP sites as well as similar programs in other cities, so they can compile a similar resource for their patients with the appropriate city-specific adaptations. Joanne has also presented on this guide at national conferences, advocating for the unique needs of people who are newly housed.
Value-Based Care
The Institute is involved in efforts to demonstrate and improve the overall value of BHCHP’s services, which means considering the quality of the care we provide as well as the impact of our program on health care costs and utilization. Due to the complex nature of patients’ health care and housing needs, BHCHP participates in a variety of initiatives and partnerships aimed at addressing both complex medical conditions and the social determinants of health, with a goal of improving health outcomes and lowering medical costs.
As a Behavioral Health Community Partner, we partner with Accountable Care Organizations in the Boston region to provide focused and effective care coordination to MassHealth patients with high behavioral health-related social needs. We are also a primary care provider with the Boston Accountable Care Organization, affiliated with Boston Medical Center, as well as the Centers for Medicare and Medicaid Services Duals Demonstration with the Commonwealth Care Alliance. Every day, our staff engages thoughtfully and collaboratively in efforts to deliver excellent, equitable, and efficient care.
Writing and Ethics
BHCHP has a long-standing tradition of ethically sharing the stories of our patients through writing, invited presentations, and press engagements, in an effort to help others understand the tremendous challenges faced by people who lack housing and the ways in which health care providers and members of the public can help. The Institute supports BHCHP staff, patients, and others interested in writing about the intersection of homelessness and health.
Highlights include:
Education
Health care for homeless persons is a unique, challenging, and deeply humane specialty within the field of medicine and public health. It calls on each of us to be humbly committed to a lifetime of learning. We aim to educate the next generation of homeless health care professionals, while also standing up for equitable and compassionate services within mainstream health care, and calling for an end to homelessness across our country.
We partner with universities to provide clinical education to medical, nursing, physician assistant, pharmacy, dental, and social work students. We also partner with universities to provide internship opportunities for pre-clinical students and educational opportunities for public health and public policy students. On a case-by-case basis, we work with individual students completing projects for course credit or with other goals.
Click here to find out more about our educational opportunities and partnerships.
