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Boston Health Care for the Homeless Program (BHCHP), established in 1985, is a Federally Qualified Health Center located in Boston, MA. Outreach from BHCHP extends to over 60 different locations in the greater Boston area. The community health center’s main goal is to provide primary care, behavioral health, dental care, addiction services, and other specialized services for the homeless population. BHCHP’s model of care enables fostering a trusting provider-patient relationship whilst targeting critical matters homeless individuals face such as weather-related injuries, trauma, abuse, chronic illness, mental disorders, and substance misuse issues. Though this is not the only population BHCHP caters to as chronically ill adults, veterans, youth, elderly, immigrants, and families also seek care from the facility. The overarching aim of BHCHP is to provide comprehensive, high-quality health care to all of the patients that walk through their door.

BHCHP's Contact Information
Address: Jean Yawkey Place, 780 Albany Street, Boston MA, 02118

Hours: Monday to Friday, 7 am to 4 p.m.,Thursdays, open until 8 p.m. for the Transgender Program

Phone Number: 617-726-2707

Email: info@bhchp.org

Founded
The Boston Health Care for the Homeless Program was founded in 1985 by a Family Team of health professionals who began to focus on the needs of homeless families. It received funding under the state of Massachusetts and a 4-year Robert Wood Johnson Foundation (RWJF) pilot grant. The staff of seven provided primary care, addressing needs at the basic level, and dental services at three hospital clinics and 14 adult and family shelter clinics. During this time, BHCHP opened the nation’s first medical respite program at the Lemuel Shattuck Shelter. A medical respite program has services provided in the short term for ill patients, who in this case, are too ill to be surviving on the streets but are not ill enough to be admitted to the hospital.

In 1986, BHCHP developed a Street Team to provide medical services two nights a week with the use of Pine Street Inn (PSI)’s van. Having a physician on the ground made it easier for those who are “rough sleepers,” homeless individuals who prefer to sleep on the streets rather than in shelters, to receive care. The PSI van is still used today, and it continues to provide primary care to rough sleepers wherever they reside.

The HIV Team was created by BHCHP in 1987, offering primary and specialty care for HIV-afflicted homeless persons. A year later, it qualified to receive federal funding as a health center under the McKinney-Vento Homelessness Assistance Act and also accepted aid from the Human Services Administration (HRSA)’s Bureau of Primary Health. BHCHP also began collaborating with schools in the Boston area to bring interns and residents in for training.

Presently, BHCHP is funded by the HRSA's Bureau of Primary Health Care; the facility is mandated to serve those who meet the federal definition of homelessness.

Mission Statement for BHCHP
The mission of BHCHP is to provide and ensure accessible, comprehensive healthcare for all homeless individuals and families in the greater Boston area. They prioritize "medicine that matters" through respect, sympathy, cooperation, and integrity that embody the Standards of Excellence in their work.

Sites of Practice
Over 35 years, the staff of 7 has quickly expanded to more than 400 clinics in more than 60 locations. Boston Health Care for the Homeless has a home-base medical clinic that operates directly across from Boston Medical Center (BMC) located on 780 Albany Street, Boston MA, 02118. The medical clinic provides primary care and supports follow-up and discharge planning after a hospital stay.

Jean Yawkey Place, an integrated medical facility in the South End, opened in 2008. It utilizes an interdisciplinary staff team to provide medical, behavioral, dental, and pharmaceutical care at the Barbara McInnis House, a 104-bed medical respite facility.

Another place that BHCHP provides care is at Pine Street Inn, St. Francis House, and at other shelters or day programs throughout the Boston area. By these means, healthcare services can be easily accessible to homeless people in the city. Going back to the original start of BHCHP, family team based sites like that of St. Mary’s Center for Women and Children, continue to provide healthcare for homeless families in Boston.

President
James O’Connell, M.D., is the current President of BHCHP.

Management Boards
Internally, the Executive Team works to run the daily operations of the facility. BHCHP has a Board of Directors that sets strategic plans and policies to maintain the finances within the program. The Consumer Advisory Board works to improve the patient experience. The Philanthropic Advisory Council provides oversight to fundraising initiatives. The Emerging Leaders Board plans creative ways to encourage donations and support for the medical clinic.

Employees
Within the leadership and staff, BHCHP works to provide the most diverse depth of care through an inter-professional team involving physicians, dentists, nurses, social workers, physician assistants, nurse practitioners, psychiatrists, mental health counselors, case managers, dental hygienists, administrative staff, facilities workers, and food service professionals. Every physician, nurse practitioner, and physician assistant are accredited by one or more academic teaching hospital. Additionally, doctors tend also to be teaching faculty at universities within the Boston area.


 * The Behavioral Health Team has psychiatrists, clinical nurse specialists, psychologists, clinical social workers, and licensed mental health counselors.
 * The Dental Health Team operates full-time within the Jean Yawkey Place and holds a part-time dental treatment center at the Pine Street Inn.
 * The HIV Care Team is composed of physicians, a physician assistant, nurse practitioners, nurses, behavioral health professionals, dentists, and case managers.
 * The Hepatitis C Services Team consists of primary care providers, a nurse, and a case manager with expertise in hepatitis C.
 * The Street Team utilizes two internists, two psychiatrists (one from Massachusetts General Hospital (MGH) and one from Massachusetts Mental Health Center), a nurse practitioner, and a case manager.
 * The Supportive Place for Observation and Treatment (SPOT) Team used in Substance Use Disorder Services is comprised of addiction nurses, harm reduction specialists, and peers who are in recovery themselves.

Employee Benefits
All staff receives pay except for volunteers. Health benefits for employees are the following:


 * Affordable and comprehensive health insurance plans
 * Insurance for vision
 * Vacation days, sick days, personal days, and holidays per year
 * Automatic enrollment in the Profit Sharing retirement plan
 * Employer contribution to a retirement plan
 * Subsidized MBTA passes
 * Fully sponsored life insurance and long-term disability insurance
 * Reimbursement for clinical licensing
 * Educational opportunities, including conference days

Patient Demographics
Boston Health Care for the Homeless Program mainly targets the homeless population, treating over 11,000 patients afflicted by homelessness each year. In the U.S., 13.5 million Americans are estimated to be homeless at one point in their lives. There is also a premature mortality rate found among the homeless. The majority of BHCHP patients have at least one substance misuse problem, a chronic condition, and or psychiatric illness. These compounded health problems, if left untreated, can be fatal. Follow-ups go unattended, and relapse can occur if a patient does not take the initiative towards improving their health. Healthcare can fall on the back burner due to prioritizing looking for one’s next meal or shelter. Practicing healthy behaviors, proper nutrition, and the storage of medication is a difficult challenge for the homeless population.

Additionally, BHCHP also treats chronically ill adults, veterans, families, youth, and the elderly. BHCHP provides care to those without questioning their “race, color, gender, gender identity, sexual orientation, age, disability, veteran status, military service, national origin, immigration status, genetic information, or marital status".

Patient Stories
On their website, BHCHP tends to focus on patient stories, which gives insight into the individuals that the clinic cares for. There are several of these stories listed on the website, the most recent being that of Sam. The story details Sam’s life on the streets, the psychological issues he has endured, and the tireless effort of a BHCHP staff member named Becky to find Sam’s housing. Stories like this shed light on a topic that many are ignorant towards and know not much about.

Annual Events
There are many events sponsored by BHCHP. An annual Winter Walk is hosted in the early winter months as people walk two miles in Boston, share a meal, and listen to stories told from the homeless perspective. The Medicine that Matters Gala works to create a night for fundraising for BHCHP. The 2020 Marathon Team also plans to raise funds for BHCHP through the support of the John Hancock Non-Profit Marathon Program. This year will be the ninth year for BHCHP members running the Boston Marathon. Sox for Socks is another event being held in late June that asks for Red Sox fans to bring a pair of white socks to support homeless patients who have a vast range of foot issues from standing, enduring the New England weather, and battling chronic diseases like diabetes.

Adult Primary Care
Adult primary care involves a model that examines a patient’s primary care, behavioral healthcare, dental care, and case management services. The goal is to provide care for homeless individuals dealing with communicable diseases and chronic illnesses. It relies on an all-encompassing intake, assessment, and treatment process.

The most common primary health diagnoses of adult individuals at BHCHP include, but are not limited to, the following treatable conditions:


 * Anxiety
 * Cancer
 * Depression
 * Diabetes mellitus
 * Emphysema (COPD)
 * Gastrointestinal disorders
 * Heart Disease
 * Hepatitis C
 * HIV infection
 * Hypertension
 * Infestations and other skin diseases
 * Pneumonia
 * Substance Use Disorder
 * Tuberculosis

Behavioral Health
The Behavioral Health Services Team was created in 1994 to better respond to the mental health problems affecting the homeless population. They deliver a full range of mental health services such as:


 * Individual and group counseling
 * Psychiatry
 * Child and family therapy
 * Medication management
 * Referrals to detoxification and rehabilitation programs
 * Substance use disorders services

Family Respite Care
BHCHP serves as the primary health care presence for more than 20 family and domestic violence shelters, hotels, and motels across the greater Boston area. The Family Team works to provide care for over 1600 patients and children every year. The essential services include:


 * Primary care clinics
 * Vaccinations, well-child visits, cervical cancer screenings, weight counseling, and family planning care
 * Quality nursing and medical care
 * Behavioral health and substance use disorder counseling
 * On-site case management services to facilitation connections to social services such as Supplemental Nutrition Assistance Program (SNAP) benefits, cash assistance, transportation support, disability, health insurance benefits, and advocacy

Medical Respite Care
Men and women requiring medical respite care include those who need a supportive place to recuperate from chemotherapy, burns, broken bones, and other serious medical problems that will only worsen if not properly treated. The medical respite team works to provide short-term care for those who are not sick enough to be treated at the hospital for a maximum stay of about two weeks.

The two main medical respite care facilities include the Barbara McInnis House and the Stacy Kirkpatrick House. The Barbara McInnis House is a 104-bed facility located at the Jean Yawkey Place on the campus of the Boston Medical Center (BMC). The facility was named after Barbara McInnis, a nurse who cared for thousands of homeless individuals while advocating for reform within Boston.

The 20-bed Stacy Kirkpatrick House, named after another well-respected and compassionate nurse, welcomes patients who are recovering from surgeries and long-term treatments. It is a joint venture from BHCHP, the Pine Street Inn, the Jamaica Plain Neighborhood Development Corporation, and the Francis Grady Apartments that house homeless individuals, many of whom are medically frail.

Oral Health Services
BHCHP has a dental team that provides accessible oral healthcare to homeless persons. The services provided are:


 * Preventive care
 * Oral hygiene and oral health education
 * Emergency services, including extractions
 * Restorative services
 * Periodontal treatment
 * Denture services

Specialized Services
Specialized services are provided to fulfill gaps in care and include HIV Care, Hepatitis C Services, Street Outreach, Substance Use Disorder Services, a Transgender Program, and HER Saturdays.

HIV Care Team
Beginning in 1986, the HIV Care provided at BHCHP addresses low CD4 counts, a glycoprotein that is deficient in these individuals. The HIV Team works to combat HIV/AIDS by providing the following:


 * HIV testing and counseling program
 * Linkage and retention in care for those newly diagnosed with HIV
 * Patient education, support groups, and nurse-driven HIV medication adherence support
 * State-of-the-art HIV primary care is given to homeless persons infected with HIV

Hepatitis C Services
Hepatitis C is a blood-borne infection that is the leading cause of liver cancer and liver transplantation in the U.S. The Hepatitis C Consult Service was established in 2014 to provide a tolerable curative therapy for the treatment of Hepatitis C.

Street Team
The Street Team includes:


 * Pine Street Inn’s Overnight Van with the doctor providing care two nights each week
 * Daytime street rounds three mornings each week
 * Weekly anchor clinic at Massachusetts General Hospital dedicated rough sleepers
 * Daily direct care for rough sleepers at the Barbara McInnis House
 * House calls to chronic rough sleepers

Substance Use Disorder Services
In Boston, substance use replaced HIV as the primary cause of death among homeless individuals. Overdose awareness day is acknowledged on August 31st by BHCHP. The Supportive Place for Observation and Treatment (SPOT) Team offers various support and medical supervising services for 8-10 substance users at a time. The ultimate goal is to offer medication-assisted therapies, counseling, or detoxification, followed by inpatient or outpatient care.

There are opioid treatment programs at the Jean Yawkey Place and the St. Francis House clinic, which were established in 2008 and 2013, respectively. Suboxone treatment, counseling, and case management are among the services provided for substance misusers. Suboxone is for patients experiencing withdrawal in an outpatient setting. BHCHP provides prescriptions for Naloxone, or Narcan, and teaches patients how to use it if an opioid overdose were to occur. Case management targets assistance with various programs, education, and reduction and prevention counseling. Support groups are utilized in counseling and well-attended by patients battling addiction.

The Addiction Collaborative and Expedited Support Services Team, or ACCESS Team, follows a patient-centered model that focuses on an interprofessional, long-term disease management approach. It prioritizes those who are at the highest risk of dying from an overdose. ACCESS services include:


 * Expedited access to primary medical care
 * Suboxone therapy
 * Behavioral health services
 * Weekly substance misuse support groups

Transgender Program
Using an integrated service model, the Transgender Program opened in November of 2008 at BHCHP. It was designed to provide medical and support services to members of the Transgender Boston community, an overlooked and vulnerable population. BHCHP is the only clinic to serve homeless transgender individuals in the Boston area; thus, the program was created specifically to target the health disparity. The Transgender Program fills gaps in care by allowing those who feel distrust and detached from the healthcare system to receive specific care pertaining to challenges the transgender population may face. The services provided include the following:


 * Primary care
 * Urgent care
 * Behavioral health services
 * Crisis intervention
 * HIV counseling and testing
 * Case management
 * Support group
 * Free legal clinic offered monthly by Massachusetts Transgender Legal Advocates

HER Saturdays
To counteract women’s feelings of angst, BHCHP developed HER Saturday: Health Empowerment Resources. HER Saturdays are weekly morning services at BHCHP that provide “pre-cancer screenings, such as pap smears and mammograms, as well as activities to promote better hygiene and well-being like pedicures and yoga”. The all-women team, comprised of case managers, counselors, and other healthcare professionals, works to address behavioral as well as medical health needs.

Trusting the Patient-Provider Relationship
Staff who work at the facility operate under a model of care and provide full-time health services to homeless individuals; they continue to ensure consistency and continuity for patients who lack that in their lives.

A trusting patient-provider relationship is valued in all settings, especially in that of the Street Team. The Street Team directly helps patients and prioritizes this relationship as they are boots on the ground, tending to homeless patients in their dwellings. They rely on those patients to be upfront with them about the issues they are experiencing and to trust them.

During HER Saturdays, experts operate under the principle of “trauma-informed care”—here, they respond to the trauma that women have experienced and evade re-triggering them.

The Quality and Efficiency Committee (QEC) works to select a comprehensive program and site-specific measures for needed areas of improvement through the core steps of data collection, team-based approach to care, clinical reminders, and reporting of data. An annual primary care patient satisfaction survey is also given to BHCHP patients that evaluates four categories: patient-provider relationship, access/coordination, cooperation, and homeless-specific care.

Countering the Stigma Associated with Homelessness
BHCHP states that the reason homeless people require their healthcare program is that they have obstacles and barriers in a typical healthcare setting that can deter them from the system. They receive substandard care due to the complexity of their needs and also encounter the stigma associated with being homeless.

Providing the Basic Necessities
Case managers work with patients to enable them to enroll and obtain MassHealth benefits. This service allows patients to receive the treatment services they need when in primary care or chronic disease management programs.

There are still necessities that are lacking as transportation is a barrier towards the homeless being able to attend appointments. Low health literacy, or a lack of understanding of necessary health information, is another barrier that BHCHP aims to overcome.

The Institute for Research, Quality, and Policy in Homeless Health Care
The Institute operates as a collaborative center to develop projects that address quality of care as well as policy and advocacy for patients. Health Care for the Homeless Councils, local hospitals, colleges, and government agencies all collaborate with the Institute.

The objectives of the Institute are as follows:


 * Measure and evaluate the accessibility, quality, and delivery of health care services
 * Tell the stories of our patients and share the expertise and knowledge of the program
 * Catalyze for change and a mechanism for advocacy in the realm of policy and practice
 * Ensure the recruitment, retention and professional development of highly skilled and curious clinical staff
 * Impact and inform public policy, support, and awareness through the dissemination of research results.

Volunteer Opportunities
BHCHP refers to its volunteers as the backbone of the program. Volunteers do not participate in direct clinical work, but they do help with administrative services and connect directly with patients.

Role titles for volunteers include:


 * Benefits Administrative Assistance
 * Case Management Assistant
 * Child Care Assistant
 * Clinic Assistant
 * Development Department Intern
 * Equity and Inclusion Intern
 * Family & Friend Liason
 * Foot Care Assistant
 * HER Saturday Clinic Assistant
 * Independent Patient Representative
 * Meal Program Assistant
 * Milieu Assistant
 * Patient Activities Leader
 * Patient Navigator
 * Recovery Group Coordinator
 * Unit Secretary Assistant

For more information on the volunteer roles, please visit the BHCHP Volunteer Opportunities for Individuals page. BHCHP also offers internships to undergraduate students to gain experience in homeless medicine. The facility offers group opportunities for on-campus clubs, faith-based groups, and another recreational group to participate in activities with individuals.

Donation Drives
Faith-based groups, schools, corporations, and colleges organize donation drives to meet the needs of patients at BHCHP. These drives include annual holiday season drives, the Sox for Socks Event, Lawyers, Bring Us Your Briefs, Corporate Jeans Day, and Diaper Drives.

The on-going needs for patients yearly include underwear, food chain gift cards, new socks, T Passes, toiletries (excluding products containing alcohol), and backpacks. Summer and winter care kits are also recommended for donations. BHCHP does not accept donations of clothing due to a lack of storage. Healthcare regulations prohibit them from accepting medication or medical supplies as well.