National HCH Council research projects and publications older than 5 years are located here.
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 | February 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.
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 | November 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.
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).
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).
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.
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 | September 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.
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.
Health Care for the Homeless (HCH) clinicians strive to provide integrated primary and behavioral care of high quality to a diverse clientele, many of whom have multiple and complex health problems that are exacerbated by their unstable living conditions and limited resources. Interrupted care, often provided in nontraditional settings, makes strict adherence to standard practice guidelines difficult. Moreover, patient populations for whom such guidelines are developed often differ from HCH patients. The following articles describe the research agenda of the National HCH Council, explore the history of practice-based research networks (PBRNs), and explain how such networks can foster collaboration among researchers, primary care providers, and patients to improve the delivery of care.
Zlotnick C and Zerger S. Health and Social Care in the Community Journal, 17(1):18-26.
The National HCH Council assisted the Bureau of Primary Health Care in evaluating their ten respite pilot projects. The primary goal of the evaluation was to assess the effect of respite services on the health of homeless people, which included examination of differences in outcome based on client or program characteristics. A common database was developed to collect client-level data from each of the pilot projects. These results will enable the HCH Program to determine the efficacy of respite services and in what configuration they are most appropriate.
HCH Research Agenda | May 2005
The National HCH Council’s Research Committee developed a National HCH Research Agenda, which documents research priorities in the health care and homelessness field, identifies gaps in the published research literature, and documents feasibility issues in conducting needed research. This agenda describes a consensus of leading academic and community-based researchers, healthcare providers, program administrators, and other professionals regarding what is needed in research on homelessness and health care.
Young adults (ages 18 – 24) are especially vulnerable to homelessness. The estimated numbers of young adults who experience an episode of homelessness each year range from approximately 750,000 to two million, and are believed to be increasing; families as well as individuals are affected. To articulate and address some of the urgent issues facing these young adults, six seasoned clinicians and researchers working with displaced youth collaborated with National HCH Council staff in developing this report. Homeless Young Adults Ages 18-24: Examining Service Delivery Adaptations is organized around four main topics: health care, housing, education and employment, and social support. Testimonials from homeless assistance providers and their clients and examples of recommended interventions are interspersed with program descriptions and proposed strategies, and a list of resources, including references that illustrate the issues described, is appended.
Health Care for Homeless Native Americans | February 2004
Native Americans experience among the most severe health disparities of any group in the United States, and they are disproportionately represented among numerous high-needs groups, including the homeless. This report describes some of they key factors contributing to this inequity, the effects of which are expected to continue worsening, and then describes in general terms how health services are delivered to Native Americans and barriers preventing adequate access to those services. Finally, interviews with individuals providing health care to Native Americans who are homeless are used to offer some tentative solutions for overcoming access barriers in the short-term.
The purpose of this qualitative study was to understand more fully the social support needs of homeless mothers and to translate these findings into programmatic recommendations in areas such as case management, parenting programs, and health/mental health services. Suzanne Zerger, former Research Specialist for the National HCH Council, facilitated focus group discussions and client surveys with homeless mothers at ten locations across the country between July 2001 and January 2002. The National HCH Council conducted this study in collaboration with Dr. Ellen Bassuk, Director of the National Center on Family Homelessness in Newton Centre, Massachusetts.
Clinicians working with homeless individuals who have substance use disorders understand the critical need – and dire lack of – appropriate, accessible, and effective treatment for those in their care. Much of the scientific research on what effective treatment for substance related disorders looks like is not directly applicable to persons without homes. In response to these gaps, a Council committee of clinicians and researchers explored the practices of those providing “model” treatment to homeless people with substance related disorders, to share with others what seems to work well in practice, and for whom, according to those currently working in the field. This report summarizes the results of these efforts.
The HCH Uniform Data System (UDS) Pilot Project was initiated in 2000 by a group of HCH project representatives in Public Health Service Region IX. This technical assistance publication describes the rationale for the collection of additional data by HCH projects for inclusion in their annual UDS reports, and proposes data collection tools for this purpose that were developed and pilot tested by the HCH UDS Work Group in 2001-2002.
In substance abuse treatment, a gap exists between scientific research and clinical practice that is not common to other fields of medicine. This gap between research and practice is a concern shared in the HCH field as well, a concern which led to the formation of the “Translating Research Into Practice” subcommittee. This report represents the subcommittee’s first endeavor, a summary of peer-reviewed published literature on substance abuse treatment and homeless persons.
This paper summarizes resources addressing the relationship between chronic medical conditions and homelessness, including published research and evaluations as well as “renegade” sources. Because this is a “preliminary” literature review, the paper provides an introductory assessment of the general topics covered in the available resources, their primary message(s), and access to additional resources which may be useful.