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Boston Healthcare for the Homeless Program (BHCHP), established in 1985, is a medical clinic located in Boston, MA. Outreach from BHCHP extends to 45 different locations in the greater Boston area. The community health center’s primary role is to provide primary healthcare services to the homeless population. BHCHP’s model of care enables fostering a trustful provider-patient relationship whilst targeting critical issues homeless individuals face such as weather-related injuries, trauma, abuse, chronic illness, mental disorders, and substance misuse issues. Although this is not the only population they cater 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: 780 Albany Street, Boston MA, 02118

Phone Number: 617-726-2707

Email: info@bhchp.org

History of BHCHP

Founded

The Boston Healthcare 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. The team 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 sick to be living on the streets but are not sick 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, still used today, and continues to provide primary care to rough sleepers where they are.

The HIV Team was created by BHCHP in 1987, offering primary and specialty care for homeless people with HIV. A year later, it qualified to receive federal funding as a health center under the McKinney Act and received funding for 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.

Mission Statement for BHCHP

The mission of BHCHP is to provide and ensure accessible, comprehensive health care for all homeless individuals and families in the greater Boston area. They prioritize medicine that matters” through respect, compassion, teamwork, and integrity that embody the Standards of Excellence in their work.  

Sites of Practice

Currently, BHCHP provides comprehensive health care in over 60 locations throughout Boston. 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 the follow-up and discharge planning after a hospital stay.

Jean Yawkey Place, and 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 104-bed medical respite facility known as the Barbara Mcinnis House.

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, health care services can be easily accessible to homeless people throughout the area.

Going back to the original foundation of BHCHP, family team based sites like that of St. Mary’s Center for Women and Children, continues to provide healthcare for homeless families in Boston.

Team Components

President

James O’Connell, MD, is the President of BHCHP. Over 35 years, the staff of 8 has quickly expanded to more than 400 clinics in more than 45 locations. Medical, dental, psychiatric, addiction, and other specialty services are implemented to provide the highest quality of care possible.

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 and depth of care through an interdisciplinary 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 at one or more of the academic teaching hospitals. 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 clinic 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 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 receive pay except for volunteers. Health benefits for all employees are entitled to 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 Healthcare for the Homeless Program mainly targets the homeless population, treating over 11,000 patients afflicted by homelessness each year. The majority of their 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. However, follow-ups go unattended and relapse can occur if a patient does not take initiative towards improving their own 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.

Media Attention and Events

Patient Stories

On their website, BHCHP tends to focus on patient stories, which gives insight to 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 works 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 marathon. Sox for Socks is another even being held in late June that asks for Red Sox fans to bring a pair of white socks to support the homeless patients who have a vast range of foot issues from standing, enduring the New England weather, and battling chronic diseases like diabetes.

Patient Services

Adult Primary Care

Adult Primary Care involves a model that examines a patient’s primary care, behavioral healthcare, dental care, and case management services. 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 in 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 services include:

• Primary care clinics at three of our largest shelter and hotel sites
• Vaccinations, well-child visits, cervical cancer screenings, weight counseling, and family planning
• 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 SNAP benefits, cash assistance, transportation support, disability and health insurance benefits, and advocacy

Medical Respite Care

Men and women who need 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). Barbara McInnis was a nurse who cared for thousands of homeless individuals while advocating for reform within Boston.

The Stacy Kirkpatrick House, known after another well-respected and compassionate nurse, welcomes patients who are recovering from surgeries, long-term treatments and offers 20 medical respite beds. 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 provides 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 the low CD4 counts, 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 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 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 31^stby BHCHP. The Supportive Place for Observation and Treatment (SPOT) 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 support.

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 offered. Suboxone is for patients experiencing withdrawal in an outpatient setting. BHCHP provides prescriptions for Naloxone, or Narcan, and teaches patients how to use 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 or (ACCESS) team follows a patient-centered model that focuses on an interprofessional, long-term disease management approach. Prioritizing 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

HER Saturdays

To counteract women’s feelings of angst, BHCHP developed HER Saturday: Health Empowerment Resources. HER Saturday 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.

Quality of Care

Continuity of care

Countering the Stigma Associated with Homelessness

- Why do medical professionals have this stigma?