Research Partners and Collaborations

Table Of Contents

1. Routine, Rapid HIV Testing
2. Nicotine Anonymous
3. Teaching Health Centers
4. Health & Homelessness among Veterans
5. Health Care for the Homeless Quality Leaders
6. Chronic Pain Management
7. Clinical Outcome Measures
8. Violence on the Streets
9. Traumatic Brain Injury
10. Contraceptive Services in the Health Care for the Homeless Setting

Routine, Rapid HIV Testing

In 2013, the National HCH Council partnered with Dr. Catherine Fogg (Saint Anselm College) to survey HCH clinic staff regarding HIV testing practices and assess barriers and facilitators of this testing. A report of survey findings will be available fall 2014. The report will highlight how HCH clinic staff informs patients of HIV testing availability, testing practices, and care models utilized.

The Council will further assess the qualitative findings of this survey to:

• Explore reported best practices around HIV testing, including routine, rapid implementation;
• Examine staff perceptions to further assess barriers to successful implementation of routine, rapid HIV testing in HCH clinics; and
• Compare survey findings to the Health Promotion Model, which aims to increase behaviors that enhance patient well-being and associated positive health outcomes.

Nicotine Anonymous

Nicotine Anonymous is a 12-step peer support group for smoking cessation. Three members of the HCH Practice-Based Research Network (Providence, RI; Boston, MA; Nashville, TN) will implement NicA meetings at their sites for three months to explore the feasibility of hosting these meetings within the HCH setting. If the NicA groups are found to be feasible, the National HCH Council will seek funding to test the effectiveness of NicA for smoking cessation with individuals who are homeless.

On January 5, 2014, the National HCH Council hosted a webinar to train sites on how to conduct NicA meetings. Sharon Czabafy, LSW, CAADC, TTS, CET (Tobacco Treatment Specialist of Ephrata Community Hospital Wellness Center) and Molly Meinbresse, MPH (Program & Research Specialist of the National HCH Council) presented. View the archived webinar Nicotine Anonymous Feasibility Study: Study Protocol & Running Meetings. Click here to learn more about NicA.

Teaching Health Centers

In 2012, the National Health Care for the Homeless (HCH) Council began exploring the collaborative relationships between medical/allied health professional training schools and health centers that provide services to individuals experiencing homelessness. In order to understand more about the dynamics of these collaborations and learn the factors that contribute to successful collaborations, the Council conducted a survey of all HCH grantees to explore their existing collaborations.  The findings revealed that while many health centers have a long history of established “informal” collaborations with academic institutions and recognize the benefit of having medical residents serve patients and learn at their sites, they are not accredited and do not receive additional funding for providing these educational opportunities. The findings also revealed several advantages of collaborating with academic institutions, some of which have been evidenced in other research, and provides rationale for why seeking accreditation may be a beneficial endeavor for HCH grantees.

To provide a contextual understanding of Teaching Health Centers (THC) and further assist grantees in formalizing their collaborations by pursuing THC accreditation, the Council has developed a case study, which explores the experiences and benefits of seeking accreditation. A toolkit that details promising practices in this process will be available in May 2013. Qualitative interviews of grantees that have existing academic collaborations are currently being conducted and will help inform a journal article submission around barriers and facilitators to successful health center collaborations with academic institutions.

Health & Homelessness among Veterans

Over 22,000 veterans received services from Health Care for the Homeless (HCH) grantees in 2011, yet existing research is predominantly focused on unstably housed veterans served by the Veterans Health Administration. To examine the characteristics and needs of veterans within the HCH setting, the National HCH Council launched a veterans research initiative in December 2011. In Phase 1 of the initiative, the National HCH Council conducted key expert interviews and focus groups with HCH clinicians and administrators to learn more about veterans accessing HCH services. The Phase 1 Report presents the major themes that resulted from the qualitative research, which informed future phases of the veterans research initiative. In the fall of 2012, the National HCH Council began Phase 2 of the study by conducting a needs assessment survey of all HCH grantees to further explore these issues. The Final Report synthesizes findings from Phases 1 and 2 of the study.

Health Care for the Homeless Quality Leaders

With increased focus on quality of care and improvement processes, the National HCH Council initiated a study of HCH grantees leading the way in key quality measures. To highlight these high-performing grantees, a case study, quick guide, clinician tip sheet, and QI resource list were produced to identify the practices that HCH quality leaders have instituted to improve and support quality of care, as well as techniques they use to track, evaluate, and improve their performances. This initiative has identified fresh ideas, promising practices, and tools that HCH grantees can integrate into their work—all to improve quality of care and patient outcomes.

Chronic Pain Management

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. A report of the 2010 survey results is now available and can be downloaded here: Pain Management Survey of Health Care for the Homeless Clinicians: Summary of Results.

Most recently, the HCH PBRN submitted 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. If funded, a group CBT intervention (based on the John Otis model) will be implemented at 2 PBRN sites in Portland and Baltimore. Molly Meinbresse is Principal Investigator for this project with Joseph Schumacher from the University of Alabama as Co-Principal Investigator. Barbara Wismer, Director of the HCH PBRN, is Co-Investigator.

Clinical Outcome Measures

The Council received funding from the Health Resources and Services Administration (HRSA) to conduct a feasibility study to identify supplemental clinical outcome measures specific to homeless individuals who seek care at HCH projects and Medical Respite Care facilities.

A task force was formed and made decisions regarding which clinical outcome measures would be included in the feasibility study and assisted in the construction of a survey that was distributed electronically to Medical Directors who serve in HCH projects and Coordinators at Medical Respite Care programs. Representatives from 11 projects also participated in focus groups for the study.

Results of the survey and focus groups are documented in a report entitled Clinical Outcomes Feasibility Study Report. The National HCH Council hopes that additional funding will be obtained in the near future to conduct a pilot study as a follow-up to this feasibility report.

Violence on the Streets

Each year NCAB conducts a Consumer Participation Outreach survey on rotating topics. Consumer Advisory Board members at local HCH projects across the country go out in the streets and survey individuals experiencing homelessness about various topics from health care utilization to perceived quality of services.

The Research Coordinating Committee (RCC) provided consultation to the NCAB Executive Committee in developing a rigorous research process to explore the prevalence and impact of violence experienced while homeless. This research project was approved by the Institutional Review Board of the Nashville Metropolitan Department of Public Health with NCAB Chair Amy Grassette as Principal Investigator. Surveying began in July 2010.  View the poster of the violence study findings presented at the 2011 American Public Health Association conference.

The manuscript detailing results of the survey–“Exploring the Experiences of Violence Among Individuals Who are Homeless Using a Consumer-Led Approach”–was accepted for publication in the journal Violence and Victims for early 2014. Authors include National Health Care for the Homeless Council research staff (Molly Meinbresse and Darlene Jenkins, DrPH), National Consumer Advisory Board members (Amy Grassette, Joseph Benson, Carol Hall, Reginald Hamilton, and Marianne Mallot), and a Vanderbilt University PhD candidate (Lauren Brinkley-Rubinstein).

Traumatic Brain Injury

In February 2010, the HCH PBRN submitted a research proposal to the Agency for Healthcare Research and Quality for a $100,000 grant to study the prevalence and impact of traumatic brain injuries in homeless patients. All HCH PBRN organizational members were invited to participate in this pilot study and 10 organizations submitted letters of support for the grant application. If funded, the Boston HCH program will serve as the lead agency with Dr. Carol Waldmann as Principal Investigator. Other researchers serving as consultants on the study include:

• Dr. Stephen Hwang – Toronto, Canada
• Dr. Lillian Gelberg – Los Angeles, CA
• Dr. Pam Diamond – Houston, TX
• Dr Barbara Wismer – San Francisco, CA

Thanks to everyone who came together to develop this grant application. Unfortunately, the application was not approved for funding, but we are continuing to discuss how to study the impact of TBI on homelessness. The RCC has plans to conduct a survey of HCH clinicians regarding knowledge and practices surrounding TBI for the 2013-2014 year.

Contraceptive Services in the Health Care for the Homeless Setting

This survey of HCH providers regarding the availability of contraceptive services at their projects and barriers to providing those services was the first project conducted with the HCH Practice-Based Research Network. The investigators were Barry G. Saver, Linda Weinreb, Lillian Gelberg and Suzanne Zerger. 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). Read the abstract of the article published in Women & Health (2012) – Provision of Contraceptive Services to Homeless Women: Results of a Survey of Health Care for the Homeless Providers.