Massachusetts General Hospital

A trusting relationship between patient and doctor/clinician is the cornerstone of Boston Health Care for the Homeless Program’s (BHCHP) model of care. BHCHP provides direct care that is fully integrated within Boston’s mainstream health care system, and addresses the unique health-related needs of homeless people resulting from conditions like exposure to extreme weather, trauma, violence, chronic illnesses, persistent mental illness, and substance abuse. 

BHCHP at MGH offers primary care each weekday in the Medical Walk-in Unit and coordinates and assists with care and discharge planning for homeless patients throughout MGH. The Barbara McInnis House provides recuperative and rehabilitative care to homeless persons who are too ill or injured to withstand the rigors of life on the streets and in homeless shelters.  This innovative model fills a widening gap in the health care system for those without the safety and support of a home and family.

BHCHP’s Street Team, based out of MGH, provides direct care in a variety of unconventional settings: under bridges, down back alleys, in abandoned cars, on park benches and street corners, and in community meals programs, overnight drop-in centers, emergency departments, detoxification units, and nursing homes.  These dedicated professionals are a consistent presence on the streets, providing a continuum of care that brings people from the street corner, to the intensive care unit, to respite care, and ideally to secure housing.

In addition, BHCHP actively prepares future physicians in the art and skill of caring for homeless persons at MGH.  Primary care residents join BHCHP staff for community and street clinics during their ambulatory rotations, and spend two or four weeks with BHCHP in an elective rotation, working directly with various clinics and teams, learning firsthand about the special health care needs of homeless persons.

Program outcomes in 2012 include:   

• There were over 1,014 primary care and behavioral health visits to the MGH site during the Thursday clinic.  An additional 2,224 nursing and case management encounters were recorded at the Thursday clinic. 

• 119 housed Street Team patients accounted for 666 visits in the MGH MWIU.

• Medical and behavioral health clinicians made 1108 home visits to 176 housed patients, an increase from 161 housed patients in 2011. 45% of the patients seen in home visits were also admitted to the medical respite facility, the Barbara McInnis House.

• BHCHP liaisons, RNs and NPs, made more than 1,500 screening visits to homeless and formerly homeless inpatients at MGH and Brigham and Women’s Hospital for admission to the Barbara McInnis House after hospital discharge.

• 417 patients received integrated medical and behavioral care as part of a collaborative grant through MGH and the Department of Mental Health. In addition, 68 patients were seen in 200 visits at the West End Shelter by a BHCHP physician and RN, working closely with 2^nd year psychiatry resident in part of the MGH Community Psychiatry rotation.