Optimizing Care for People Experiencing Homelessness

January 17, 2020

Second-year students learn to put the patient at the center of the health care team.

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After more than 20 years of homelessness and housing instability, Lisa felt safer on the streets than in a shelter. In the shelter, she hurt her neck using her backpack as a pillow to safeguard her belongings. On the streets of Boston, she faced the elements and numerous challenges, but her medications were not stolen.

That’s where she met Kara Bray, aenior community health worker for the Massachusetts Behavioral Health Partnership/Beacon Health Option’s Hospital to Housing (H2H) Program.

Lisa’s interactions with the health care and housing system had left her thoroughly disenchanted, and Bray faced some difficulty in getting Lisa to open up about her problems. Bray would often search the streets, tracking Lisa down to support her keeping appointments. But as they met repeatedly for coffee, Bray was able to gain Lisa’s trust. Through ups and downs she helped her navigate housing applications and the health care system, and Lisa now has permanent housing and is regularly seeing doctors about her chronic health problems.

Bray empowered Lisa to be at the center of her own care. She attended dozens of meetings alongside Lisa, advocating for her when other organizations missed complexities of Lisa’s situation.

Lisa and Bray, along with Kevin Sullivan, a physician at Boston Health Care for the Homeless, and Jennifer King, MSN ’19, presented at the Ann W. Caldwell President’s Lecture: Interprofessional Rounds on January 15. The annual event, named after the MGH Institute's fourth president, provides second-year students with successful examples of how interprofessional clinical teams collaborate to provide patient-centered, compassionate care. It’s a key component of the Institute’s mission to prepare health professionals to advance care for a diverse society.

Dr. Sullivan discussed the challenge of seeing, treating, and even counting people experiencing homelessness. The most recent national data available is from 2010, when, “it was estimated that there were three-and-a-half million folks in the U.S. who were experiencing homelessness annually. A third of those were children. The fastest growing section was children.”

Sullivan remarked on the importance of building rapport and trust by providing patient-centered, trauma-informed care that respects survivors. “I ask permission to ask a question…That’s the trauma-informed lens.”

King described her current experience working at Homeless Health Care Los Angeles as well as a one-semester clinical rotation at Boston Health Care for the Homeless as a nursing student that led to her working there for two years prior to her recent move to California. King said that the homeless population are “the most resilient people, and that the most important objective is to combat “isolation and marginalization.”

“In street medicine it can take days, weeks, sometimes even years to have someone trust you enough just to take their blood pressure,” King added. “You just have to show up for them, be consistent, and demonstrate that you care before you can expect to build a relationship.”

View information on how to get involved with the Boston Health Care for the Homeless program.

Video of the Ann W. Caldwell President's Lecture: Interprofessional Rounds