Implementation Research

Using Data to support the HCH movement

Research Archives

Research Archives

National HCH Council research projects and publications older than 5 years are located here.



Health and Homelessness among Veterans: Development and Pilot of a Military History Screening Tool | May 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 | April 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 | August 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 | 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.

Health and Homelessness among Veterans: A Needs Assessment of HCH Grantees | February 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 | 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.

Hepatitis C Among Clients of Health Care for the Homeless Primary Care Clinics | May 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).


HCH and HIV fact sheet | October 2011

A one-page resource for HIV/AIDS prevention and treatment resources available through the National HCH Council’s website.

HCH program fact sheet | May 2011 || HCH Fact Sheet | 2013

History, financing, and requirements of the health care for the homeless program. Use to educate community and government leaders about our program.

Pain Management Survey of Health Care for the Homeless Clinicians: Summary of Results | March 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 | March 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 | 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.

Knowledge and Skills Needs Assessment: Identifying the Needs of the HCH Field | September 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.

Harm Reduction: Preparing People for Change | April 2010

Harm reduction is an approach for substance use treatment that involves a set of practical techniques that are openly negotiated with clients around what is most likely to be achieved.

Medical Respite Care: Demonstrated Cost Savings | February 2010

Medical respite care meets the post-hospital recuperative care needs for people who are homeless while reducing public costs associated with frequent hospital utilization.

FAQs: Negotiating Medical Respite Care with Hospitals | January 2010

Hospital collaboration is essential to the success of medical respite programs. Hospitals are a source of patient referrals, data collection, and income for medical respite programs. In return, hospitals receive significant cost savings by avoiding inpatient stays and reducing readmission rates.

Homelessness & Health: What’s the Connection? | January 2010

Many people are reduced to homelessness in a downward cycle that begins with a health problem and rapidly escalates into employment problems, financial problems, and housing problems.


What is Single Payer Health Care? | September 2009

Defines single payer, compares the US to other countries on key health status indicators, examines myths vs. facts.

Research in HCH Settings: Advanced Quality in Primary Care (2009) | June 2009

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.

Survey Findings on Characteristics and Health Status of Clients Treated by the Federally Funded (US) Health Care for the Homeless Programs | February 2009

Zlotnick C and Zerger S. Health and Social Care in the Community Journal, 17(1):18-26.


An Evaluation of the Respite Pilot Project Initiative: Final Report | March 2006

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.


Homeless Young Adults Ages 18-24: Examining Service Delivery Adaptations | September 2004

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.


Social Supports for Homeless Mothers: Implications for Best Practices and Program Design | October 2003

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.

Providing Treatment for Homeless Persons with Substance Use Disorders: Six Case Studies | August 2003

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.

HCH UDS Pilot Project 2001-2002: A Technical Assistance Publication | January 2003

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.


Substance Abuse Treatment: What Works for Homeless Individuals | June 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.

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