Research Publications

Publications older than 5 years are located in the Research Archives.

Addressing the Opioid Epidemic: How the Opioid Crisis Affects Homeless Populations (August 2017)

Brett Poe and Alaina Boyer, National Health Care for the Homeless Council 

This fact sheet examines how the opioid crisis affects people without homes. America is facing an opioid crisis, and that epidemic has significantly impacted people without homes. Homeless populations have higher rates of substance use disorders, poorer health, and higher mortality rates by opioid overdose than national averages. Our publication examines the social determinants of health that contribute to that increased prevalence and morbidity. It also details the systemic barriers that hinder access to care and success in recovery for people without homes, as well as best practices to address those barriers. Read the fact sheet.

Using the Social Ecological Model to examine how homelessness is defined and managed in rural East Tennessee (2016)

Claudia Davidson, Velma M Murry, Molly Meinbresse, Darlene M Jenkins, and Robert Mindrup

Often conceptualized as an urban issue, homelessness in rural communities is pervasive due to high rates of poverty, lack of affordable housing, inadequate housing quality, unemployment/underemployment, and geographic isolation. In 2014, the National HCH Council in collaboration with Vanderbilt University and Cherokee Health Systems conducted a study in rural East Tennessee. The purpose of this study was to provide insight to how rural communities define and manage homelessness as well as engage unstably housed individuals on homeless services by investigating the perceptions of different levels of influence of the Social Ecological Model including the individual, organization, and government levels. This publication gives an overview of rural homelessness, methodology, results, and discussion of findings. Read the full publication.

Health and Homelessness among Veterans: Development and Pilot of a Military History Screening Tool (2015)

Claudia Davidson and Darlene Jenkins, National Health Care for the Homeless Council 

Accurate knowledge of veteran status is essential, as veterans may qualify for a number of Veteran Affair’s (VA) services and benefits that can resolve their health conditions and/or experiences of homelessness. Moreover, information regarding military service may be clinically significant to Health Care for the Homeless (HCH) providers, as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), sexual trauma and certain toxic environmental exposures are common among veterans. In 2013, the National HCH Council conducted a veterans needs assessment which revealed that though providers are inquiring about veteran status, their methods in doing so were inconsistent and not culturally appropriate. Based on these findings, staff at the National HCH Council in collaboration with VA experts developed and piloted a Military History Screening Tool for its use by HCH programs and potentially other organizations. This report includes the steps used in developing the tool and presents results of the pilot conducted in Boston, MA.

Homeless Care Providers and Rapid HIV Testing (2015)

Patrina Twilley and Darlene Jenkins, National Health Care for the Homeless Council 

HIV testing and counseling are the cornerstones of HIV prevention response, allowing individuals to know their HIV status and access appropriate services. The Centers for Disease Control and Prevention (CDC) recommends routine, voluntary HIV screening for all patients aged 13 to 65 years in all health care settings as a normal part of medical practice, similar to screening for other treatable conditions. In the spring of 2013, staff of the National HCH Council in collaboration with Dr. Cathie Fogg, Associate Nursing Professor at St. Anslem College in Manchester, NH developed a survey based on Pender’s Health Promotion Model. The survey was administered to homeless care providers  to assess their Rapid HIV testing practices. The report contains the results of the survey.

Exploring the Experiences of Violence Among Individuals Who Are Homeless Using a Consumer-Led Approach (2014)

Meinbresse M, Brinkley-Rubinstein L, Grassette A, Benson J, Hall C, Hamilton R, Malott M, Jenkins D. Exploring the Experiences of Violence Among Individuals Who Are Homeless Using a Consumer-Led Approach. Violence and Victims, 29(1):122-136.

The purpose of this study was to estimate the prevalence of violence victimization among individuals who were homeless and patients of HCH grantees and to describe the characteristics related to their perpetrators, injuries incurred and assistance sought. The National HCH Council Research Committee provided consultation to the National Consumer Advisory Board in developing a rigorous research process to explore these issues. Results from this survey were presented in 2011 as a workshop at the National HCH Conference and as a poster at the American Public Health Association 139th Annual Meeting & Expo in Washington, DC. View the poster.

Teaching Health Centers: A Resource Guide — Academic & HCH Collaborations (2013)

Patrina Twilley, National Health Care for the Homeless Council

The purpose of this resource guide is to assist Health Care for the Homeless (HCH) grantees with their efforts to establish and strengthen collaborations with academic institutions, which include medical and allied health professional training schools. A large number of HCH grantees already collaborate with academic entities in providing education to students and residents; however, many are not accredited and/or do not receive additional funding for providing these educational opportunities. This guide will provide the resources needed to assist in developing meaningful relationships with academic partners and information on how to seek accreditation as a Teaching Health Center (THC) to provide Graduate Medical Education (GME).

Teaching Health Centers: A Case Study (2013)

Patrina Twilley, National Health Care for the Homeless Council

Many health centers recognize the benefit of having medical residents serve patients and learn at their sites, and thus, consider their organizations “Teaching Health Centers (THC).” However, many of these health centers are not accredited and do not receive additional funding for providing these educational opportunities. Last spring, the National HCH Council conducted a survey of Health Care for the Homeless (HCH) grantees on their existing academic collaborations. The findings revealed several advantages of collaborating with academic institutions, some of which have been evidenced in other research. The survey findings provide rationale for why seeking accreditation may be a beneficial endeavor for HCH grantees. In addition to sharing survey results, this case study explores the Affordable Care Act and its role in educating residents; the role of HCH grantees in providing this education; an overview of the HRSA Teaching Health Center Graduate Medical Education program, which provides resident reimbursement; and highlights the experience of Care Alliance, a Health Center Program grantee located in Cleveland, OH, which is currently in the process of seeking GME accreditation.

Health and Homelessness among Veterans: A Needs Assessment of HCH Grantees (2013)

Sarah Knopf-Amelung, National Health Care for the Homeless Council

The National Health Care for the Homeless (HCH) Council has released a final report on its multiphase veterans needs assessment. While most research on veterans experiencing homelessness is focused on those accessing care in the Veterans Administration (VA) setting, this study examines the subset of the veteran population accessing care from health care for the homeless grantees. Through key expert interviews and focus groups that culminated in a survey of HCH grantees, this study explored veteran demographics, health status, service utilization, unmet needs, and factors influencing preference for HCH services as well as the processes used by HCH grantees to identify consumers with veteran status and the nature of collaborations between HCH grantees and VA medical centers.

HCH Quality Leaders: A Case Study (2012)

Sarah Knopf-Amelung, National Health Care for the Homeless Council

With increased focus on quality of care and improvement processes, the National Health Care for the Homeless (HCH) Council identified four HCH grantees leading the way in key quality measures. This case study highlights these high-performing grantees, including practices they have instituted to improve and support quality of care and the techniques they use to track, evaluate, and improve their performances.

Hepatitis C Among Clients of Health Care for the Homeless Primary Care Clinics (2012)

Strehlow AJ, Robertson MJ, Zerger S, Rongey C, Arangua L, Farrell E, O’Sullivan A, Gelberg L. Journal of Health Care for the Poor and Undeserved, 23(2):811-33.

The purpose of this study was to examine the prevalence of Hepatitis B/C in the homeless population in eight HCH clinics nationally. Surveys and blood samples were collected from approximately 400 patients. Findings have been presented at the National HCH Conference & Policy Symposium and the Annual American Public Health Association Meeting (2005).

Provision of Contraceptive Services to Homeless Women: Results of a Survey of Health Care for the Homeless Providers  (2012)

Barry G. Saver, Linda Weinreb, Lillian Gelberg & Suzanne Zerger. Women & Health, 52(2):151-61.

The investigators surveyed HCH providers regarding the availability of contraceptive services at their projects and barriers to providing those services. The survey revealed that a majority of the participants provided some form of contraception (i.e. condoms, oral, injectable) but that very few provided the most effective forms of contraception (i.e. intrauterine devices, implants).

Pain Management Survey of Health Care for the Homeless Clinicians: Summary of Results (2011)

In a direct response to clinical priorities expressed by the HCH Clinician’s Network, the Network Steering Committee decided to survey HCH clinicians across the country regarding chronic pain management practices, knowledge, attitudes and resources. Members of the National HCH Council Research Committee helped develop the survey, analyze results and prepare a written report (see link above). In April 2013, the HCH PBRN submitted a research grant proposal to the Patient-Centered Outcomes Research Institute (PCORI) to compare the effectiveness of cognitive behavioral therapy (CBT) versus usual care in managing patients with chronic, noncancer pain who are homeless. The project was not funded, but the research team has plans to resubmit to PCORI in November 2014.

Data Resource Guide: Learning about Homelessness and Health in your Community (2011)

This updated resource guide is intended to assist those who work to meet the health care needs of homeless people in their communities. It will be particularly useful to those who are preparing funding applications for the federal Health Care for the Homeless (HCH) or other Consolidated Health Center programs. It will also be of interest to other advocates, researchers, and service providers.

Clinical Outcomes Feasibility Study Report (2010)

A feasibility study was conducted to evaluate ten clinical indicators that could serve as supplemental clinical outcome measures specific to homeless individuals who seek care at HCH grantees and Medical Respite Care facilities. Surveys and focus groups were completed with medical directors and respite coordinators. Results of the survey and focus groups are documented in a report titled Clinical Outcomes Feasibility Study Report.

Knowledge and Skills Needs Assessment: Identifying the Needs of the HCH Field (2010)

Since 1997, the National HCH Council has provided training and technical assistance to consolidated health centers and other organizations through a cooperative agreement with the Health Resources and Services Administration (HRSA). In 2010, the Council conducted a knowledge and skills needs assessment to help focus its work with the HCH field. Several hundred administrators, clinicians, and consumers affiliated with HCH grantees and medical respite programs participated in the three-stage process of key informant interviews, focus groups, and online and paper surveys.