Women's Health - Boston Health Care for the Homeless Program

At BHCHP, we consider women’s health to be more than just GYN. It is a holistic approach to the many health needs of our female identifying patients that must also include issues of mental health, trauma, discrimination and homelessness. Representing one-third of BHCHP’s patient population, women are among the most vulnerable subgroups of the homeless population, with high incidences of mental illness, physical and sexual trauma, substance use disorder, acute illnesses, and chronic health problems.

With their vast and complex health needs, caring for our female-identifying population requires a trauma-informed approach adapted to their daily challenges and health threats. The prevalence of trauma and violence among these patients is staggering; studies show that 90% of homeless women have experienced trauma and 84% have been assaulted at some point in their lives. Trauma from physical or sexual abuse, rape, intimate partner violence, trafficking, childhood sexual/physical abuse has profound effect on cognition, trust, and health. Homelessness is often the result of a decision to leave unsafe and dangerous situations which then exposes them to even more violence and further victimization. Priorities of food, shelter, and safety along with the inherent chaos of living without a stable home compete with healthcare needs. Histories of trauma which produce mistrust are major obstacles for individuals in need of health care, sometimes causing them to avoid particularly invasive services such as Pap screenings that have been known to evoke trauma-like responses.

BHCHP is committed to addressing these unique health care needs of our female identifying patients. Our staff are trained in a trauma-informed approach, one that recognizes the near universal trauma experience of our patients and that ensures care is accessible, compassionate, and effective.

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Ensuring Access

Care for women (anyone identifying as female) is all about approach. Trauma-informed, caring, responsive, and focused on quality are how we describe our approach; and offering patients options for where they receive care is paramount. We offer a full range of health care at all of our sites and drop-in spaces so patients can choose where they receive care based on their own preferences. These include traditional feeling clinics based at women’s shelters and engagement centers to make it easier for female-identifying patients to access care in the places they are already waking up (overnight shelters) or spending the day (day shelters and engagement centers). Additionally, staff perform targeted street outreach to meet potential patients and connect them with care.

Here is a list of the women-only clinic sites located in partner facilities:

Pine Street Inn, Women’s Inn, 363 Albany Street, Boston
Women’s Lunch Place, 67 Newbury Street, Boston
St. Anthony’s Shrine, 100 Arch Street, Boston
Rosie’s Place, 889 Harrison Avenue, Boston
Woods Mullen Shelter, 794 Massachusetts Avenue, Boston – the largest women’s shelter in New England

Patient Education and Navigation:

BHCHP staff provide community-based outreach and engagement in preventive care within key shelter locations. The role of Patient Navigator in our care model engages with patients who may not come to our clinics on their own and provides health education, assistance with making appointments, care coordination, accompaniment, and assistance with follow-up care. Perhaps most importantly, the navigators form trusting relationships with patients which aids in building trust with the rest of our program wide services and staff. Our cancer screening patient navigator and the recovery support navigator (in conjunction with Rosie’s Place) are examples of navigators working closely with our teams and patients to provide much needed support in these areas.

Compassionate Care

Below, we highlight some programming for our female-identifying patients; but all of our sites offer full spectrum primary or episodic health care.

HER Saturday /Women Only Wednesdays drop in spaces:

Because many of our patients avoid traditional clinics due to fear or intimidation, BHCHP runs weekly female only drop in spaces/clinics. WOW (Women Only Wednesdays), based at the engagement center (in conjunction with the Boston Public Health Commission), and HER (Health, Empowerment and Resources) Saturday, based at our 780 Albany Street location, provide women with a safe, trusted place where they can access care or participate in a variety of enriching activities. Here, patients have the opportunity to take a deep breath, and relax away from the outside world.

Some services provided:

Providers and nurses to address health care needs
Behavioral health clinicians to offer 1:1 or group counseling
Case managers to assist with basic needs, benefits enrollment and referrals for care and other social services
Educational activities related to topics such as cancer screenings, heart health, contraception, staying safe, and domestic violence
Therapeutic activities including therapy dogs, yoga, meditation, arts and crafts, and showers
Fun activities such as karaoke, arts and crafts, nail painting, and movies

At our clinics/female-only sites and drop in centers, BHCHP staff provide care through a trauma-informed lens, allowing and empowering our patients to dictate their own needs and comfort levels through services such as:

Primary and episodic care; walk in access and scheduled appointments
Reproductive health, routine GYN care, contraception
Cancer screening
Substance use disorder treatment; medication assisted treatment
Behavioral health services, including counseling for intimate partner violence and trauma
Access to specialty care such as HIV care, Hepatitis C care, dermatology, and others
Access to dental care

Thought Leadership

BHCHP is fortunate to partner with the Boston Health Commission to regularly collaborate on improving health among women experiencing homelessness and sat among government officials and fellow health and service providers on the Massachusetts Women in Homelessness working group. Our participation in that group helped to infuse committee recommendations with our patient’s experience and our perspective. We continue to partner with other organizations who provide training to our staff. Most recently organizations like UPSTREAM and Boston Area Rape Crisis Center provided trainings on the topics of non-coercive contraceptive counseling and how to handle disclosures of sexual assault. We continue to build relationships with like-minded organizations so that care can be better coordinated and planned.

Additionally, our Women’s Health Initiative, a multidisciplinary group of experienced BHCHP staff members, meets monthly to develop new strategies to improve the quality, cultural competency and accessibility of care for homeless women. The Women’s Health Initiative informs our comprehensive multi-site (mostly where people are literally residing or accessing services) approach that includes primary and episodic care, mental health care, and addiction services. This group helps to set the program agenda for care and assures the development, review and delivery of the highest quality health services. They work to keep the complex needs of women at the forefront of staff’s minds; develop ways to better incorporate care for trauma and intimate partner violence into health services; and establish and monitor quality improvement measures, including around breast and cervical cancer screening.

“A typical 15 minute visit with a provider is not a lot of time for a patient to trust the clinician—especially if they don’t know them and especially if they have to get undressed and share very personal things. My visits are not 15 minutes; they’re probably an hour. Our patients trust us, they know us, we understand their needs. I don’t rush them. Things that might not get asked at a regular OBGYN visit, we ask. And we don’t create a sense of judgment or shock—when a patient says they’re a sex worker, or that they use drugs, I take it as if someone says they have high blood pressure. It’s about respect and being there for the patient—that’s what we do well here.”

Lisa Schwartz, nurse practitioner

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The best way to make an appointment is to call us at 857-654-1605.
This phone line is answered Monday – Friday, 8:00am – 5:00pm.

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Boston Health Care for the Homeless Program receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

Boston Health Care for the Homeless Program is a 501(c)(3) charitable organization. Gifts made to BHCHP are fully tax-deductible within the limits of the law. Boston Health Care for the Homeless Program, Inc. EIN #04-3160480

Contact

780 Albany Street
Boston, MA 02118

Phone: 857-654-1000
Fax: 857-654-1100

After-Hours: 781-221-6565

Email: info@bhchp.org

Donors: donorservices@bhchp.org

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Women’s Health

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Compassionate Care

Thought Leadership

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The Institute

Join Our Team

Women’s Health

Ensuring Access

Compassionate Care

Thought Leadership

Make an Appointment

Contact

Newsletter

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