Housing https://healthcity.bmc.org/ en BMC Launches New Housing Initiative at 'Mass and Cass' with City of Boston https://healthcity.bmc.org/population-health/bmc-launches-new-housing-initiative-mass-and-cass-city-boston <span>BMC Launches New Housing Initiative at &#039;Mass and Cass&#039; with City of Boston</span> <span><span lang="" about="/user/9661" typeof="schema:Person" property="schema:name" datatype="">kayla.anderson</span></span> <span>January 20, 2022</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/population-health" hreflang="en">Population Health</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">BMC Launches New Housing Initiative at &#039;Mass and Cass&#039; with City of Boston</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">The low-threshold, transitional housing model aims to help people experiencing homelessness alongside addiction, mental health, and other concerns.</div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/HealthCity/Mass%20and%20cass-main.png?itok=9RM9NNyW" width="1000" height="564" alt="The Roundhouse Hotel at Mass and Cass in Boston" typeof="foaf:Image" /> </div> <div class="field field--name-field-image-credit field--type-string field--label-hidden field__item">Boston Globe, Getty Images</div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/caitlin-white" hreflang="en">Caitlin White</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2022-01-20T11:17:00Z">January 20, 2022</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=BMC%20Launches%20New%20Housing%20Initiative%20at%20%27Mass%20and%20Cass%27%20with%20City%20of%20Boston" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=BMC%20Launches%20New%20Housing%20Initiative%20at%20%27Mass%20and%20Cass%27%20with%20City%20of%20Boston&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=BMC%20Launches%20New%20Housing%20Initiative%20at%20%27Mass%20and%20Cass%27%20with%20City%20of%20Boston&summary=BMC%20Launches%20New%20Housing%20Initiative%20at%20%27Mass%20and%20Cass%27%20with%20City%20of%20Boston" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=BMC%20Launches%20New%20Housing%20Initiative%20at%20%27Mass%20and%20Cass%27%20with%20City%20of%20Boston&body=The%20low-threshold%2C%20transitional%20housing%20model%20aims%20to%20help%20people%20experiencing%20homelessness%20alongside%20addiction%2C%20mental%20health%2C%20and%20other%20related%20concerns. https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p style="text-align:start">As of January 12, <a href="https://www.bostonglobe.com/2022/01/08/metro/mass-cass-word-cleanup-housing-has-begun-spread/?event=event12" target="_blank">Mayor Michelle Wu and the City of Boston proclaimed</a> that all tents and encampments in Newmarket Square—which has come to be known as "<a href="https://healthcity.bmc.org/policy-and-industry/address-mass-and-cass-crisis-transitional-housing-crucial">Mass and Cass</a>," identifying the intersection of Massachusetts Avenue and Melnea Cass Boulevard—must come down. Estimates from Boston Medical Center and the Boston Public Health Commission show that at its peak this fall, approximately 323 individuals were sleeping on the streets in this area. And though that number declined (to 248 in late November), BMC experts were quick to note that this was more likely due to moving encampments rather than finding alternative housing options. Now, however—unlike prior attempts to displace the encampments of people experiencing homelessness—finding suitable housing and addiction treatment options is a key part of the removal strategy.</p> <p>The colliding epidemics and pandemics of homelessness, opioid use disorder (OUD), and <a href="https://healthcity.bmc.org/research/why-does-homelessness-increase-risk-covid-19-reinfection">COVID-19</a>—alongside <a href="https://healthcity.bmc.org/population-health/upstream-healthcare-sdoh-root-causes">upstream health</a> issues and <a href="https://www.patriotledger.com/story/news/2021/10/28/quincy-vows-keep-fighting-plan-rebuilt-bridge-long-island-addiction-recovery-center/8521021002/" target="_blank">current</a> and historic flaws in housing models—have led to this public health crisis at Mass and Cass.</p> <p>Part of addressing this complex public health crisis is identifying the needs of the people who are experiencing homelessness. According to <a href="https://www.bmc.org/about-us/directory/doctor/miriam-s-komaromy-md">Miriam Komaromy, MD</a>, the medical director for the <a href="https://www.bmc.org/addiction">Grayken Center for Addiction</a>, the people sleeping at Mass and Cass are typically people with very high rates of substance use disorder and co-occurring mental health conditions, including psychotic disorders and "tremendous rates" of trauma.</p> <p>Komaromy is helping to spearhead BMC's involvement in the City of Boston's action-oriented approach to addressing the complex crisis at Mass and Cass.</p> <p>"BMC has a really strong interest in supporting the efforts at Mass and Cass, probably most importantly, because many of these folks who have been struggling on the street are our patients," Komaromy says. "This is our neighborhood. And we feel a major investment in the neighborhood and the area and the most marginalized populations in Boston. And arguably, this is ground zero for folks who are really struggling."</p> <h2 style="text-align:start; margin-top:3px">Obstacles to stable housing for people with addiction</h2> <p>There are numerous issues and roadblocks with existing treatment and housing models, according to Komaromy and Rob Koenig, BMC's executive director of Strategic Programs: housing in Boston can be restrictively expensive, the waitlist for <a href="https://www.mass.gov/service-details/section-8-housing-choice-voucher-program-hcvp">Section 8 housing</a> in the area is years long, and traditional shelter rules make it difficult for people with SUD to both enter and stay. Often, shelters restrict or ban the use of substances as a requirement for a stay, and people cannot come or go overnight—a combination that makes managing overnight withdrawal very difficult. These rules contribute to an environment in which people remain unsheltered and are unable to stabilize with regard to their substance use when they have such a difficult living environment.</p> <p>"For example, people addicted to fentanyl may have to inject 10 or 12 times per day, including overnight, to avoid going into an excruciatingly painful withdrawal," Koenig explains. "Yet, you typically can't leave overnight from a shelter. So, battling addiction while being in the shelter system is a major challenge for some guests, despite efforts by shelter programs."</p> <p>According to Komaromy and Koenig's presentation given to members of the community and internally at BMC, the hospital is implementing one component of the city’s plan to address these problems with a low-threshold, clinically based approach to housing and addiction treatment that aims to overcome some of these obstacles. The approach, Koenig notes, is for not only the people currently being removed from the Mass and Cass encampments but, ideally, people experiencing homelessness across the city.</p> <h2 style="text-align:start; margin-top:3px">BMC, Roundhouse hotel, and addressing the Mass and Cass crisis</h2> <p>The plan—which has already begun—is to open two clinical programs as well as crisis housing, creating a three-pronged approach:</p> <ul> <li>Opening a transitional care center (TCC), also known as a bridge clinic</li> <li>Opening a stabilization care center (SCC)</li> <li>Opening low-threshold crisis housing beds</li> </ul> <p>These initiatives function in conjunction or individually, depending on a person's needs.</p> <p>The TCC operates as an urgent care center to treat SUD—including starting <a href="https://healthcity.bmc.org/population-health/free-app-breaks-barriers-prescribing-medication-opioid-use-disorder">medications for addiction</a>—managing withdrawal, and treating co-occurring issues, such as acute mental health symptoms and increased risk of HIV and hepatitis C.</p> <p>The SCC will function as a sort of triage center for acute needs, so that clinicians can determine the best path for that person experiencing homelessness. It is intended to be short-stay, less than 24 hours, where people can be stabilized and observed if they come in with symptoms. For example, Komaromy explains, if a person comes in agitated, experts can determine if it's a result of withdrawal, mental health, or a stimulant, such as methamphetamine. That determination will set a course for care, whether in a mental health facility, hospital, or addiction treatment program, for example.</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fhealthcity.bmc.org%2Fpopulation-health%2Fbmc-launches-new-housing-initiative-mass-and-cass-city-boston&amp;via=The_BMC&amp;text=%22We%20hope%20to%20treat%20the%20conditions%20that%20have%20kept%20them%20down%20and%20prevented%20them%20from%20moving%20on%20to%20next%20phases%20of%20housing%20and%20care.%22&amp;hashtags=HealthCity">"We hope to treat the conditions that have kept them down and prevented them from moving on to next phases of housing and care." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <p>Both the transitional care and stabilization care centers will be co-located with the low-threshold housing program at the <a href="https://www.boston25news.com/news/local/new-roundhouse-hotel-resident-relieved-exit-encampments/ROJFHXIRUNFYNPQOWWQYSZ3QHM/" target="_blank">Roundhouse hotel</a> at 891 Massachusetts Ave., which has already been accepting people into its approximately 60 beds. The Roundhouse hotel will operate as housing, but unlike traditional shelter options, it will provide stabilization services to support addiction recovery. Ultimately, people who find shelter at the Roundhouse hotel will be transitioned into permanent housing.</p> <p>"It's a tremendously exciting opportunity for us to combine supportive housing with providing medical services that can help stabilize the folks who are in the housing. We hope to treat the conditions that have kept them down and prevented them from moving on to next phases of housing and care," says Komaromy.</p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/homelessness" hreflang="en">Homelessness</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/addiction" hreflang="en">Addiction</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/substance-use-disorder" hreflang="en">Substance Use Disorder</a></div> </div> </div> <div class="field field--name-field-research-brief field--type-entity-reference-revisions field--label-hidden field__item"><img alt="" src="https://www.bmc.org/sites/default/files/HealthCity/research_banner_725x45.svg"/> <article class="research-brief"> </article> </div> <div class="field field--name-field-dispatch field--type-entity-reference-revisions field--label-hidden field__items"> <div class="field__item"> <div class="dispatch-wrapper"> <section class="dispatch"> </section> </div></div> </div> <div class="field field--name-field-article-type field--type-list-string field--label-hidden field__item">Article</div> <div class="field field--name-field-bmc-tags field--type-entity-reference field--label-above"> <div class="field__label">BMC Tags</div> <div class="field__items"> <div class="field__item"><a href="/taxonomy/term/1921" hreflang="en">Miriam Komaromy</a></div> </div> </div> Thu, 20 Jan 2022 14:36:30 +0000 kayla.anderson 148181 at https://healthcity.bmc.org BMC Pediatrician Presents a Model for Stably Housing Families in White House Forum https://healthcity.bmc.org/policy-and-industry/bmc-pediatrician-presents-model-stably-housing-families-white-house-forum <span>BMC Pediatrician Presents a Model for Stably Housing Families in White House Forum</span> <span><span lang="" about="/user/9661" typeof="schema:Person" property="schema:name" datatype="">kayla.anderson</span></span> <span>December 21, 2021</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/policy-and-industry" hreflang="en">Policy and Industry</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">BMC Pediatrician Presents a Model for Stably Housing Families in White House Forum</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">One in five renters living with children are having difficulty keeping up on rent. Megan Sandel, MD, proposes a three-pronged solution. </div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/HealthCity/housing-instability-sandel_feature_0.jpg?itok=c7aohISC" width="1000" height="564" alt="mother and daughter facing potential eviction look toward their mobile home" typeof="foaf:Image" /> </div> <div class="field field--name-field-image-credit field--type-string field--label-hidden field__item">The Denver Post, Getty Images</div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/caitlin-white" hreflang="en">Caitlin White</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2021-12-21T16:00:00Z">December 21, 2021</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=BMC%20Pediatrician%20Presents%20a%20Model%20for%20Stably%20Housing%20Families%20in%20White%20House%20Forum" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=BMC%20Pediatrician%20Presents%20a%20Model%20for%20Stably%20Housing%20Families%20in%20White%20House%20Forum&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=BMC%20Pediatrician%20Presents%20a%20Model%20for%20Stably%20Housing%20Families%20in%20White%20House%20Forum&summary=BMC%20Pediatrician%20Presents%20a%20Model%20for%20Stably%20Housing%20Families%20in%20White%20House%20Forum" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=BMC%20Pediatrician%20Presents%20a%20Model%20for%20Stably%20Housing%20Families%20in%20White%20House%20Forum&body=%20One%20in%20five%20renters%20living%20with%20children%20are%20having%20difficulty%20keeping%20up%20on%20rent.%20The%20BMC%20pediatrician%20proposes%20a%20three-pronged%20solution.%20 https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>"One thing that the COVID-19 pandemic has really made clear is that it has increased housing stability from a crisis to now, really, a pandemic in and of itself," Boston Medical Center pediatrician <a href="https://www.bmc.org/about-us/directory/doctor/megan-t-sandel-md">Megan Sandel, MD</a>, said during her presentation at the <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/11/10/fact-sheet-biden-administration-announces-new-investments-to-support-covid-19-response-and-recovery-efforts-in-the-hardest-hit-and-high-risk-communities-and-populations-as-covid-19-health-equity-task/" target="_blank">White House Office of Public Engagement Health Equity Forum</a> last week.</p> <p>The forum, held virtually on December 14, brought together officials in the Biden-Harris administration, key stakeholders in the healthcare sector, and health equity experts to address the intersection of housing and health.  </p> <p>Sandel, who is also a leader in the <a href="https://healthcity.bmc.org/policy-and-industry/new-collab-targets-key-boston-areas-health-equity-initiatives">BOS Collaborative</a> housing initiative, spoke alongside members of the U.S. Department of Housing and Urban Development and U.S. Department of Health &amp; Human Services about the state of homelessness in the country—particularly amid the ongoing COVID-19 pandemic—and its effect on people's healthcare access and health outcomes.</p> <p><script id="infogram_0_87e01544-53ec-4d23-8260-91fe6779894c" title="Housing Instability" src="https://e.infogram.com/js/dist/embed.js?1MO" type="text/javascript"></script></p> <p>While homelessness was the main topic, Sandel also addressed <a href="https://healthcity.bmc.org/policy-and-industry/better-birth-outcomes-we-need-prevent-housing-evictions">the eviction</a> crisis and the issue of housing instability, which she called the "iceberg below the surface" of homelessness. She was clear in calling structural racism the root cause of housing inequities in these areas, citing historic and longstanding issues, such as <a href="https://healthcity.bmc.org/research/gun-violence-higher-boston-areas-were-redlined-1930s">redlining</a> and zoning.</p> <p><script id="infogram_0_bd2144f4-8704-4c0c-ac1c-86cd1c846ccc" title="Housing Instability-race" src="https://e.infogram.com/js/dist/embed.js?Il5" type="text/javascript"></script></p> <p>Noting her role as a pediatrician, Sandel highlighted the impact of housing instability on families with children. In the excerpt below, she offers a three-pronged pathway to addressing housing insecurity and an example of how housing interventions can deeply improve the health of families, particularly families with medical complications.</p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/policy-and-advocacy" hreflang="en">Policy and Advocacy</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/racial-bias-and-equity" hreflang="en">Racial Bias and Equity</a></div> </div> </div> <div class="field field--name-field-research-brief field--type-entity-reference-revisions field--label-hidden field__item"><img alt="" src="https://www.bmc.org/sites/default/files/HealthCity/research_banner_725x45.svg"/> <article class="research-brief"> </article> </div> <div class="field field--name-field-dispatch field--type-entity-reference-revisions field--label-hidden field__items"> <div class="field__item"> <div class="dispatch-wrapper"> <section class="dispatch"> <img class="dispatch__image" alt="megan sandel boston medical center pediatrician headshot" src=https://healthcity.bmc.org/sites/default/files/styles/medium/public/2021-12/megan-sandel-dispatch-headshot.png?itok=rKrniMg2/> <p class="dispatch__attribution">Megan Sandel, MD</p> <div class="dispatch__body"> <p>"[Because of the COVID-19 pandemic], we're seeing an increase in people not being caught up on rent, and we're seeing that the greatest impact of that is among renters of color. Then, as a pediatrician, I think it's really important to call out the disproportionate impact of this on families with children. One in five renters living with children are having difficulty keeping up with rent.</p> <p>One important way that we think about this is we think about the ways in which to leverage these opportunities in what I call a multipronged, upstream solution—the three-legged stool of how we need to move forward.</p> <p>First, it's capital for housing production. That's a critical part of how we address the decades of disinvestment in building more affordable housing. We also need to have rental assistance. The 70,000 emergency rental vouchers are critical, but other income-boosting programs, like the&nbsp;<a href="https://childrenshealthwatch.org/wp-content/uploads/jamapediatrics_coughlin_2021_vp_210043_1637014165.03277.pdf" target="_blank">Child Tax Credit</a>&nbsp;and others, need to be expanded and continued. And, third, being able to have access to tailored services for families and individuals in order to make housing its most healthy proposition possible.</p> <p>I'll give you one example of this. From our research at Boston Medical Center, we tested a multidimensional housing intervention among medically complex families. This was tested as a pilot, randomized control trial, where we assigned people to the housing intervention or usual care of having a curated list of housing resources a family calls on their own.</p> <p>We targeted families experiencing housing instability. They had to have at least one member of the household that was medically complex, either seeing multiple specialists or using emergency services on a regular basis. They had to have a child under 12, and they had to be Medicaid eligible.</p> <p>We published our preliminary research in&nbsp;<a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.01569" target="_blank"><em>Health Affairs</em>&nbsp;in April 2020</a>. What we were able to show is even after just six months of being enrolled in this housing prescription trial, we were able to see a 32% reduction in children being reported in fair or poor health. And [there were] statistically significant improvements in a generalized anxiety score and a depression score among a parent. This is just really important that we were able to pair a housing voucher—in this case a public housing authority unit—with services in order to see this improvement even over the first six months.</p> <p>I'll end on this idea that the investments in the&nbsp;<a href="https://www.whitehouse.gov/american-rescue-plan/">American Rescue Plan</a>&nbsp;and the pending&nbsp;<a href="https://www.whitehouse.gov/build-back-better/" target="_blank">Build Back Better</a>&nbsp;have the potential to be transformational in addressing historical disinvestment in housing and addressing racial and other inequities." It is time to pass this bill now, with these resources needed more than ever.</p> </div> <hr> <div class="dispatch__source"> <p><em>*This is only an excerpt from Megan Sandel's presentation at the December White House Office of Public Engagement Health Equity Forum.&nbsp;</em></p> </div> </section> </div></div> </div> <div class="field field--name-field-article-type field--type-list-string field--label-hidden field__item">Article with Dispatch</div> <div class="field field--name-field-bmc-tags field--type-entity-reference field--label-above"> <div class="field__label">BMC Tags</div> <div class="field__items"> <div class="field__item"><a href="/taxonomy/term/1951" hreflang="en">Megan Sandel</a></div> </div> </div> Tue, 21 Dec 2021 15:25:24 +0000 kayla.anderson 148126 at https://healthcity.bmc.org To Address 'Mass and Cass' Crisis, Transitional Housing Is Crucial https://healthcity.bmc.org/policy-and-industry/address-mass-and-cass-crisis-transitional-housing-crucial <span>To Address &#039;Mass and Cass&#039; Crisis, Transitional Housing Is Crucial</span> <span><span lang="" about="/user/36" typeof="schema:Person" property="schema:name" datatype="">jake.leidolf</span></span> <span>October 28, 2021</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/policy-and-industry" hreflang="en">Policy and Industry</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">To Address &#039;Mass and Cass&#039; Crisis, Transitional Housing Is Crucial</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">Low-barrier, temporary housing allows people with addiction to stabilize and prepare for transition into permanent housing.</div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/HealthCity/1500-mass-cass-tents.png?itok=10uiPkYp" width="1000" height="564" alt="Tents and makeshift shelters line Topeka Street in the area known as Mass and Cass in Boston" typeof="foaf:Image" /> </div> <div class="field field--name-field-image-credit field--type-string field--label-hidden field__item">The Boston Globe, Getty Images</div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/sandra-larson" hreflang="en">Sandra Larson</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2021-10-28T11:50:33Z">October 28, 2021</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=To%20Address%20%27Mass%20and%20Cass%27%20Crisis%2C%20Transitional%20Housing%20Is%20Crucial" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=To%20Address%20%27Mass%20and%20Cass%27%20Crisis%2C%20Transitional%20Housing%20Is%20Crucial&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=To%20Address%20%27Mass%20and%20Cass%27%20Crisis%2C%20Transitional%20Housing%20Is%20Crucial&summary=To%20Address%20%27Mass%20and%20Cass%27%20Crisis%2C%20Transitional%20Housing%20Is%20Crucial" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=To%20Address%20%27Mass%20and%20Cass%27%20Crisis%2C%20Transitional%20Housing%20Is%20Crucial&body=Low-barrier%2C%20temporary%20housing%20allows%20people%20with%20addiction%20to%20stabilize%20and%20prepare%20for%20transition%20into%20permanent%20housing. https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The intersection of Massachusetts Avenue and Melnea Cass Boulevard, close to methadone clinics and <a href="https://www.bmc.org/">Boston Medical Center</a>, has become Boston's visible epicenter of opioid addiction and homelessness. Unhealthy, unsafe conditions have affected local <a href="https://www.baystatebanner.com/2018/12/26/protest-over-needles-at-orchard-gardens-school/" target="_blank">school children</a> and <a href="https://www.bostonglobe.com/2021/09/20/business/you-can-have-empathy-ignore-situation-lawlessness-its-not-solution-businesses-near-mass-cass-scene-pay-steep-price/?p1=StaffPage&amp;p1=Article_Inline_Text_Link">business owners</a>, and in the face of a growing makeshift tent city, acting Mayor Kim Janey has just unveiled a <a href="https://www.wbur.org/news/2021/10/19/boston-kim-janey-mass-and-cass-plan" target="_blank">sweeping new plan</a>. Over the past few months, there's been no shortage of opinions about what should be done for the area known as "Mass and Cass." But whether it's placing people in a <a href="https://www.bostonglobe.com/2021/08/23/opinion/mass-cass-an-unused-hotel-people-sleeping-streets/?p1=Article_Inline_Related_Link" target="_blank">nearby vacant hotel</a>, a <a href="https://www.nbcboston.com/news/local/controversy-follows-proposal-to-move-homeless-from-boston-to-revere-hotel/2498772/" target="_blank">hotel in Revere</a>, or in an <a href="https://www.bostonglobe.com/2021/09/25/business/suffolk-sheriff-tompkins-proposes-convert-empty-detention-center-into-temporary-housing-people-living-tents-by-mass-cass/" target="_blank">unused detention facility</a>, resistance springs up from local <a href="https://www.bostonherald.com/2021/08/04/plans-for-boston-methadone-mile-hotel-housing-scuttled-in-face-of-community-opposition/" target="_blank">residents</a>, <a href="https://www.bostonglobe.com/2021/09/21/metro/revere-mayor-blasts-boston-officials-over-mass-cass-plans/" target="_blank">elected officials</a> and even the <a href="https://www.bostonglobe.com/2021/09/29/opinion/we-cant-arrest-our-way-out-mass-cass/" target="_blank">ACLU</a>.</p> <p>At its heart, the situation at Mass and Cass is a humanitarian and public health problem. It demands treatment-centered solutions—for a population that often has trouble accessing treatment. <a href="https://www.bmc.org/about-us/directory/doctor/miriam-s-komaromy-md">Miriam Komaromy, MD</a>, medical director at the <a href="https://www.bmc.org/addiction">Grayken Center for Addiction</a> at Boston Medical Center (BMC), co-authored a <a href="https://www.bostonglobe.com/2021/10/14/opinion/transitional-housing-is-key-solving-humanitarian-housing-crisis-mass-cass/" target="_blank">recent op-ed</a> describing the needs and fears faced by experiencing homelessness. She and her co-authors, Brendan Concannon, and Sarah Porter, argue that to provide a dignified "off-ramp" from the dire conditions at Mass and Cass, the city should offer low-barrier temporary transitional housing that allows people space and time, a few weeks or months, to stabilize.</p> <p>HealthCity spoke with Komaromy about Mass and Cass, solutions and challenges, and the opportunity that Boston's <a href="https://www.boston.gov/news/community-engagement-launched-bostons-use-american-rescue-plan-act-federal-funding" target="_blank">$400 million in federal funds</a> from the American Rescue Plan Act presents.</p> <h2>HealthCity: Can you describe the situation at Mass and Cass now? Who are the people clustered there and what problems are they facing?</h2> <p><b>Miriam Komaromy, MD</b>: While it may look to passersby like it's one population, it's actually a fairly diverse group of people gathered there. At BMC's low-barrier urgent care clinic for people with addiction, <a href="https://www.bmc.org/faster-paths-treatment">Faster Paths to Treatment</a>, we see quite a few people who are living on the streets who come in looking for services, so I hear about their situations.</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fhealthcity.bmc.org%2Fpolicy-and-industry%2Faddress-mass-and-cass-crisis-transitional-housing-crucial&amp;via=The_BMC&amp;text=%22At%20its%20heart%2C%20the%20situation%20at%20Mass%20and%20Cass%20is%20a%20humanitarian%20and%20public%20health%20problem.%22&amp;hashtags=HealthCity">"At its heart, the situation at Mass and Cass is a humanitarian and public health problem." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <p>There's a mixture. Some are people who originally came seeking treatment but have relapsed. Then there are people who take advantage of that situation and come to sell drugs to them, some running large drug operations, others just trying to scrape together money to avoid withdrawal themselves. The other component in the mix is people with serious mental illness. A substantial number have untreated mental illness and are not getting treatment.</p> <p>We've always had a population of people struggling with addiction who have not gotten treatment or for whom treatment doesn't feel like a feasible option for whatever reason. They use substances frequently to avoid withdrawal or to avoid emotional pain or traumatic memories. Often, they are not able to maintain a job or live in a group setting indoors, and so they end up on the street. That population has grown during the COVID-19 pandemic. Those sleeping on their cousin's couch or the like were no longer welcome there because of contagion fears. Shelters had to decrease their density. People lost employment when places shut down. That had a major destabilizing effect. Addiction problems tend to get worse when people are stressed, isolated, and fearful—so we have a perfect storm of factors increasing the population living on the street.</p> <h2>HC: Clearly, it's a complicated problem with both social and medical dimensions. What needs to be done?</h2> <p><b>MK:</b> A lot of the treatment offered now for both addiction and mental illness comes with strings attached. We demand certain behaviors as an "entry ticket" to getting help. People who have addiction and are not able to stop using drugs immediately and completely are often rejected from treatment, when in fact we know that addiction is a chronic relapsing disease, and relapse is a symptom of its severity. A much more rational approach would be to work with somebody who relapses to try to keep them engaged with treatment and strengthen the treatment supports, rather than rejecting them.  In fact, I would say that it is the norm, rather than the exception, that patients who start to engage with treatment continue using drugs for a time, and then are often able to taper down or taper off with ongoing treatment.</p> <p>Similarly, for mental illness, if people come into clinics and create a disruption, are loud, aggressive, talking to themselves, they may be told that they can't get help there. And yet they're the people most in need of treatment. Offering treatment that starts on the street has been demonstrated to be an effective model—and yet we're not doing very much of that.</p> <p>A model called <a href="https://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4344" target="_blank">assertive community treatment</a> has been shown to have an impact. An ACT team typically involves a psychiatrist, a case manager or social worker, and maybe a public health nurse who go out and interact with people on the street and gain their trust. There also are some long-acting anti-psychotic medications that can be given by injection that can help somebody who isn't able to take a pill every day or come into a clinic for care. But these require a real investment in outreach and relationship-building.  This would be an excellent approach for people who have co-occurring SUDs and mental health problems, as well.</p> <h2>HC: What about calls from local residents and businesses to just get people off the streets or move them elsewhere?</h2> <p><b>MK</b>: A big part of the problem in the Mass and Cass area is directly attributable to our lack of easily accessible housing. If you or I were unhoused and needed housing, we could go and sit in an office and cooperate and show our birth certificate and driver's license or passport. If someone ran a background check on us, they'd probably not find a serious criminal record. Many people living on the street can't sit still in an office, they don't have those documents, and they're often afraid of being incarcerated or mistreated. So what seems accessible and available is often actually unattainable for the people with the greatest need in our current system.</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fhealthcity.bmc.org%2Fpolicy-and-industry%2Faddress-mass-and-cass-crisis-transitional-housing-crucial&amp;via=The_BMC&amp;text=%22A%20big%20part%20of%20the%20problem%20in%20the%20Mass%20and%20Cass%20area%20is%20directly%20attributable%20to%20our%20lack%20of%20easily%20accessible%20housing.%22&amp;hashtags=HealthCity">"A big part of the problem in the Mass and Cass area is directly attributable to our lack of easily accessible housing." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <p>Our low-income housing is almost exclusively contingent on people stopping using drugs. People have to both say they're not addicted and behave as though they're not addicted. That is a huge barrier, and it sets people up for really bad outcomes, like overdose death. If I’m afraid, and I don't acknowledge that I'm addicted to fentanyl, you won't know to check on me frequently or give me <a href="https://healthcity.bmc.org/population-health/community-narcan-training-extends-our-life-saving-capacity">Narcan</a>.</p> <p>Even at most shelters, people have to give up their drugs and even the sterile syringes that they got from the city's harm-reduction sites. They get into a shelter, then go into withdrawal in the middle of the night. They don't have the drugs, so they go outside and then are not allowed back in.</p> <h2>HC: Your op-ed emphasizes the need for transitional housing to help people stabilize. Do you think Boston is ready to implement that? What challenges lie ahead?</h2> <p><b>MK</b>: I think the biggest barrier is buying a building (or ideally multiple buildings); but if the city would take the initiative to do that, using the federal ARPA funds, there are plenty of organizations that would be more than happy to run that facility with a low-barrier approach.</p> <p>Most people on the street want help, they don't like being addicted, but they're caught in a vicious cycle where they don't have enough stability in their lives to be able to engage with treatment and stop using. We need to change our paradigm and say, "Let's get people housed, and then they have a chance of stabilizing."</p> <p>But we have to allow it as a community. If every step that's taken is blocked, of course there's going to be a narrative that "Nothing's being done." In order for something to be done, people have to go somewhere—potentially to multiple sites around the city and the state. It doesn't all have to be in one place, it doesn't all have to be one building, but ultimately people have to go somewhere.</p> <p>Addressing this problem directly requires intervention by a larger government entity. Municipalities and state government need to step up to say, "This is similar to a public utility. We have to site it somewhere."</p> <h2>HC: Do you see any hopeful signs that it could happen soon?</h2> <p><b>MK</b>: Getting $400 million in federal funding is going to help shift the dialogue for Boston. I think the city needs to use a chunk of that money to solve this problem. And I think it could happen pretty quickly. I think the city could buy a hotel. You don't have to build something. You don't have to wait for the perfect setting.</p> <h2>HC: Are there programs in other cities that Boston could look to as a model?</h2> <p><b>MK</b>: In <a href="https://www.urban.org/urban-wire/housing-first-working-denver-city-needs-more-it" target="_blank">Denver</a>, they've implemented a <a href="https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/housing-shelter" target="_blank">housing first</a> approach—in which people can obtain housing not predicated on their stopping substance use and receive supportive services along with housing—and are seeing good outcomes. <a href="https://www.hopeofthevalley.org/tinyhomes/tarzana/" target="_blank">Tiny houses</a> is another idea to look at. Again, these require community cooperation and need to be well-run to be successful. It's quite possible that we'll have to spend more money than we save by housing the people at Mass and Cass. But, let's face it: The least expensive thing to do is let people die—and I don't think any of us want to live in that kind of society.</p> <p><em><a href="https://lp.constantcontactpages.com/su/0c04w70/healthcity" target="_blank">HealthCity elevates the conversation around issues of equity in healthcare. Sign up for our newsletter.</a></em></p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/addiction" hreflang="en">Addiction</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/drug-policy" hreflang="en">Drug Policy</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/substance-use-disorder" hreflang="en">Substance Use Disorder</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/homelessness" hreflang="en">Homelessness</a></div> </div> </div> <div class="field field--name-field-article-type field--type-list-string field--label-hidden field__item">Article</div> <div class="field field--name-field-bmc-tags field--type-entity-reference field--label-above"> <div class="field__label">BMC Tags</div> <div class="field__items"> <div class="field__item"><a href="/taxonomy/term/1921" hreflang="en">Miriam Komaromy</a></div> </div> </div> Thu, 28 Oct 2021 15:10:25 +0000 jake.leidolf 148016 at https://healthcity.bmc.org A Promising Program Pairs Housing Assistance with Injectable Opioid Agonist Treatment https://healthcity.bmc.org/policy-and-industry/promising-program-pairs-housing-assistance-injectable-opioid-agonist-treatment <span>A Promising Program Pairs Housing Assistance with Injectable Opioid Agonist Treatment</span> <span><span lang="" about="/user/36" typeof="schema:Person" property="schema:name" datatype="">jake.leidolf</span></span> <span>October 07, 2021</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/policy-and-industry" hreflang="en">Policy and Industry</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">A Promising Program Pairs Housing Assistance with Injectable Opioid Agonist Treatment</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">After one year, the Ottawa-based program&#039;s retention was 77%. Now, experts are looking at how it could inform opioid addiction treatment in the U.S.</div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/HealthCity/1500-injectable-hydromorphone-getty.jpg?itok=NdfPz29P" width="1000" height="564" alt="vial of hydromorphone and syringe " typeof="foaf:Image" /> </div> <div class="field field--name-field-image-credit field--type-string field--label-hidden field__item">iStock via Getty Images</div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/sandra-larson" hreflang="en">Sandra Larson</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2021-10-07T10:05:22Z">October 07, 2021</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=A%20Promising%20Program%20Pairs%20Housing%20Assistance%20with%20Injectable%20Opioid%20Agonist%20Treatment" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=A%20Promising%20Program%20Pairs%20Housing%20Assistance%20with%20Injectable%20Opioid%20Agonist%20Treatment&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=A%20Promising%20Program%20Pairs%20Housing%20Assistance%20with%20Injectable%20Opioid%20Agonist%20Treatment&summary=A%20Promising%20Program%20Pairs%20Housing%20Assistance%20with%20Injectable%20Opioid%20Agonist%20Treatment" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=A%20Promising%20Program%20Pairs%20Housing%20Assistance%20with%20Injectable%20Opioid%20Agonist%20Treatment&body=At%20one%20year%20of%20the%20Ottawa-based%20program%2C%20retention%20rate%20was%2077%25.%20Now%20experts%20are%20looking%20at%20how%20it%20could%20inform%20opioid%20addiction%20treatment%20for%20the%20most%20vulnerable%20in%20the%20U.S.%20 https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><a href="https://www.ottawainnercityhealth.ca/" target="_blank">Ottawa Inner City Health’s</a> Managed Opioid Program (MOP) combined injectable opioid agonist treatment with supportive housing for people with severe opioid use disorder and experiencing homelessness. An assessment of the program’s first year, published recently in the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395921003054?dgcid=author"><i>International Journal of Drug Policy</i></a>, showed high retention rates and notable improvements in several measures of patient health and social wellbeing. At one year, retention was 77%, 45% stopped non-prescribed opioid use, 96% connected to behavioral health services, 42% reconnected with estranged families, and 31% started work or vocational programs.</p> <p>HealthCity spoke with lead author <a href="https://www.bmc.org/about-us/directory/doctor/miriam-t-harris-md-msc" target="_blank">Miriam Harris, MD, MSc</a>, an addiction expert at Boston Medical Center and assistant professor at <a href="https://www.bumc.bu.edu/care/education-and-training-programs/care-program-fellowship-in-addiction-medicine/boston-university-addiction-medicine-fellowship/">Boston University School of Medicine</a>, about the program and how the MOP model might inform addiction treatment in the U.S.</p> <hr /> <p><em><a href="https://lp.constantcontactpages.com/su/0c04w70/healthcity" target="_blank">HealthCity elevates the conversation around issues of equity in healthcare. Sign up for our newsletter.</a></em></p> <hr /> <h2>HealthCity: Can you describe the managed opioid program study and its purpose?</h2> <p><b>Miriam Harris, MD, MSc:</b> This program paired injectable opioid agonist therapy in the form of injectable hydromorphone, with assisted low-barrier housing. Our study retrospectively described the first cohort of 26 participants experiences with treatment and their treatment outcomes. We undertook this study because we think the Ottawa program was innovative and beneficial and merits a discussion with a broader addiction audience.</p> <h2>HC: How does injectable opioid agonist treatment differ from what people get at methadone clinics or at the safe injection sites that operate in some other countries and have been <a href="https://healthcity.bmc.org/policy-and-industry/safe-consumption-sites-directly-meet-needs-bmc-community" target="_blank"><b>proposed</b></a> in Massachusetts?</h2> <p><b>MH:</b> First, injectable opioid agonist therapy is not available in the United States at this time, so this is very different from that perspective. In Canada, it is a treatment for people with severe opioid use disorder who have already tried first-line treatments like methadone, and despite trying these first-line, lower-risk treatments, remain severely addicted to opioids and are still injecting drugs. It’s very structured treatment and requires a lot of engagement.</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fhealthcity.bmc.org%2Fpolicy-and-industry%2Fpromising-program-pairs-housing-assistance-injectable-opioid-agonist-treatment&amp;via=The_BMC%20&amp;text=This%20Ottawa%20program%20took%20a%20group%20of%20folks%20with%20the%20highest%20risk%20and%20the%20most%20severe%20disease%2C%20and%20despite%20that%2C%20found%20better%20retention%20outcomes%20than%20with%20methadone%20or%20buprenorphine%20or%20with%20housing%20alone.&amp;hashtags=HealthCity">"This Ottawa program took a group of folks with the highest risk and the most severe disease and, despite that, found better retention outcomes than with methadone or buprenorphine or with housing alone." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <p>Methadone vs. injectable treatment also differ in that one is oral, taken by mouth, and the other one is prescribed injectable treatment—injecting heroin or, in this case, hydromorphone.</p> <p><a href="https://www.ama-assn.org/delivering-care/opioids/will-us-get-its-first-supervised-drug-consumption-site" target="_blank">Safe injection sites</a> or safe consumption sites are quite different. They are a harm-reduction interventions for people with varying types of substance use and varying degrees of severity of their addiction. People may choose to use drugs at these sites without actually having an addiction. What safe consumptions sites do is provide a legal, safe, hygienic, warm, and welcoming space for people who use drugs to use without being persecuted and where they can access the materials they need to safely use drugs. They are observed after using their drug to make sure they don't have an overdose event.</p> <h2>HC: A key piece of this program was providing housing along with treatment. What type of supports linked with the housing are needed for success?</h2> <p><b>MH:</b>  One major support is expansive addiction treatment. Also, a recognition that people are not going to stop using the second they are housed—and having services that can flex to that. In this case, there was a safe and monitored injection space where people used their prescribed treatment. The supports also created an environment where participants felt safe disclosing their substance use. Almost 100% of program participants were still actively using stimulants, but they were not kicked out of the program. That is appropriate, and we should learn from that experience.</p> <p>Other important services address other health and wellbeing metrics. There were cooking classes, for example, and group therapy sessions focused on re-engaging with friends and family and vocational programming. I think those are really important to the people getting the treatment—equally as important as the outcomes we talk about as public health or addiction providers, such as overdose rate and non-prescribed use.</p> <p>Embedding mental health services, including psychiatric and pharmacotherapy and counseling, was really important. The vast majority of people in this program had severe mental health needs. Only about 50% were having those needs addressed in some form at the beginning of the program. By the end, almost all of them were.</p> <h2>HC: What do you see as the most promising outcomes in the Ottawa pilot?</h2> <p><b>MH:</b> I think the retention outcome—77%—is incredibly compelling. This is a group of folks who were not retained on the other best treatments that we have, methadone and buprenorphine. So they've already demonstrated that that doesn't work for them, which reflects a very high degree of severity of addiction. They also were all experiencing homelessness, which we know has detrimental effects for one's ability to stay engaged in treatment.</p> <p>So,this Ottawa program took a group of folks with the highest risk and the most severe disease, and despite that,found better retention outcomes than with methadone or buprenorphine or with housing alone—which are the interventions mainly implemented here in the U.S.</p> <p>The big takeaway for me is that this study builds on many others that show injectable opioid agonist therapy is safe and effective. What this study adds is this innovation of combining low-barrier housing with harm reduction and addiction treatment and the value of that. Low-barrier housing with embedded innovative addiction treatment was effective and we should be thinking about how we could scale this and implement this in other settings.</p> <h2>HC: Were any outcomes of the managed opioid program surprising?</h2> <p><b>MH:</b> One surprise was that the folks who stayed in the program had more than a 50% reduction in nonfatal overdose events, and no one died. These were people who had multiple overdoses before this program and were at imminent risk of death. So that's really remarkable. There were two deaths related to overdose among those who disengaged with the program, which I think speaks to how incredibly vulnerable to overdose this population was.</p> <h2>HC: Where does this method of pairing opioid treatment with housing stand right now in the U.S.?</h2> <p><b>MH:</b> Here in the U.S., many of our housing programs do not tolerate substance use. So what are folks supposed to do who are actively experiencing addiction that's worsened by experiencing homelessness? Getting housing isn't going to magically resolve the substance use, yet that's the expectation that we have. That can be seriously problematic and dangerous, which is why a huge proportion of our overdoses in Massachusetts are among people who are housed, not only those who are unhoused.</p> <p>I hope the low-barrier housing piece of this model isn't lost in the anxiety or excitement around the injectable opioid agonist treatment component. The treatment is interesting and important, but so is the housing. Housing alone is not enough, and treatment alone is not enough.</p> <h2>HC: Are you hopeful about the U.S. taking steps in this direction?</h2> <p><b>MH:</b> There is action in terms of moving legislation forward for states to pilot safe consumption spaces. That's important, because looking at innovative housing models that include things like safe consumption spaces is an important policy direction the U.S. should be considering. I'm optimistic we'll have the tools to think about it soon. For example, Rhode Island recently <a href="https://www.providencejournal.com/story/news/2021/07/07/gov-mckee-signs-legislation-allowing-safe-injection-sites-into-law/7891057002/" target="_blank">passed legislation</a> allowing for a pilot safe consumption space. That's a big deal for the U.S.</p> <p>We have tools available now that we could embed within low-barrier housing to serve people with severe addiction who are experiencing homelessness. For instance, housing that includes wraparound services to prevent overdose; harm reduction staff who do outreach to folks in the housing; low-barrier addiction treatment, like starting buprenorphine or having methadone clinics connected to housing; and not making housing contingent on abstinence. We could be doing those things right now, and we don't have them, not even in Massachusetts.</p> <h2>HC: Now that we have this encouraging data for this relatively small sample, what types of further studies or pilots would you like to see?</h2> <p><b>MH:</b> I'd love to see studies about safe consumption spaces and housing. I would love to see some interest from the <a href="https://www.drugabuse.gov/" target="_blank">National Institute on Drug Abuse</a> (NIDA) in injectable opioid agonist treatment here in the U.S. as a third-line option for people who have not had success on methadone or buprenorphine—starting some clinical trials for that. And finally, I would love for us to more actively work with people who use drugs in the development of housing and addiction treatment—asking people who use drugs what they need, implementing that, and then seeing what happens compared to when you don't. That is really exciting, and we should be doing more of it. I think we would arrive at more effective and innovative housing and addiction treatment models much more quickly if this was the approach we universally took.</p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/opioids" hreflang="en">Opioids</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/addiction" hreflang="en">Addiction</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/drug-policy" hreflang="en">Drug Policy</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> </div> </div> <div class="field field--name-field-article-type field--type-list-string field--label-hidden field__item">Article</div> <div class="field field--name-field-bmc-tags field--type-entity-reference field--label-above"> <div class="field__label">BMC Tags</div> <div class="field__items"> <div class="field__item"><a href="/taxonomy/term/1926" hreflang="en">Miriam Harris</a></div> </div> </div> Thu, 07 Oct 2021 13:37:53 +0000 jake.leidolf 147986 at https://healthcity.bmc.org Why Safe Housing Is Pivotal for Transgender Women's Health https://healthcity.bmc.org/population-health/why-safe-housing-pivotal-transgender-womens-health <span>Why Safe Housing Is Pivotal for Transgender Women&#039;s Health</span> <span><span lang="" about="/user/36" typeof="schema:Person" property="schema:name" datatype="">jake.leidolf</span></span> <span>June 22, 2021</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/population-health" hreflang="en">Population Health</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">Safe Housing Is a Pivotal Determinant of Health for Transgender Women</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">Nurse Pam Klein and advocate Dreya Catozzi explain why housing initiatives specific for trans people are essential for health and safety.</div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/images/article/transgender-transitional-housing_feature.jpg?itok=YysYaNE_" width="1000" height="564" alt="black trans lives matter trans flag sign on a tree" typeof="foaf:Image" /> </div> <div class="field field--name-field-image-credit field--type-string field--label-hidden field__item"> Shannon Finney, Getty Images</div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/sandra-larson" hreflang="en">Sandra Larson</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2021-06-22T04:00:00Z">June 22, 2021</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=Why%20Safe%20Housing%20Is%20Pivotal%20for%20Transgender%20Women%27s%20Health" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=Why%20Safe%20Housing%20Is%20Pivotal%20for%20Transgender%20Women%27s%20Health&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=Why%20Safe%20Housing%20Is%20Pivotal%20for%20Transgender%20Women%27s%20Health&summary=Why%20Safe%20Housing%20Is%20Pivotal%20for%20Transgender%20Women%27s%20Health" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=Why%20Safe%20Housing%20Is%20Pivotal%20for%20Transgender%20Women%27s%20Health&body=Nurse%20Pam%20Klein%20and%20advocate%20Dreya%20Catozzi%20explain%20why%20housing%20initiatives%20specific%20for%20trans%20people%20are%20essential%20for%20health%20and%20safety.%0D%0A https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>According to the <a href="https://transequality.org/issues/housing-homelessness" target="_blank">National Center for Transgender Equality</a>, 1 in 5 transgender people in the U.S. have experienced homelessness at some point in their lives, and more than 1 in 10 have been evicted because of their gender identity. Discrimination, family rejection, and violence can all contribute to homelessness, especially among transgender youth. The Massachusetts Commission on LGBTQ Youth’s recently-released annual <a href="https://www.mass.gov/doc/mclgbtqy-annual-recommendations-fy-2022/download" target="_blank">report</a> shows concerning levels of housing instability among transgender youth, higher than among non-LGBTQ and other LGBTQ youth.</p> <p>Housing stability is an increasing <a href="https://www.ishiboston.org/" target="_blank">focus of attention</a> for healthcare providers, as it is recognized as a key <a href="http://www.hpoe.org/resources/ahahret-guides/3063" target="_blank">social determinant</a> impacting physical and mental health. Pam Klein, RN, MSN, spends much of her time at the intersection of health, housing, and gender identity. She is nurse liaison for Boston Medical Center’s <a href="https://www.bmc.org/center-transgender-medicine-and-surgery">Center for Transgender Medicine and Surgery</a> (CTMS), manager of the <a href="https://www.bhchp.org/specialized-services/transgender-program">Transgender Program</a> at Boston Health Care for the Homeless Program, and co-chair of a Massachusetts governor’s commission examining health and safety for LGBTQ people in correctional facilities. Dreya Catozzi is founder of the <a href="https://www.facebook.com/Urban-Trans-Women-Center-2008572852729582/" target="_blank">Urban Trans Women Resource Center</a> and has worked as a CTMS peer navigator, a role that included assisting individual patients and providing <a href="https://www.bmc.org/news/bmc-brief/2019/04/24/bmc-brief-volume-8-issue-4#diversity-and-inclusion-month">gender competency training</a> sessions for the hospital community. She is a board member at the <a href="https://transemergencyfund.org/" target="_blank">Transgender Emergency Fund</a>, which is dedicated to supporting low-income and homeless transgender individuals in Massachusetts through initiatives including homeless prevention and shelter assistance.</p> <p>HealthCity spoke with Klein and Catozzi about health and housing challenges for transgender people, what health and housing providers could do better, and some sources of hope.</p> <h2>HealthCity: What health issues are common for transgender people?</h2> <p><b>Pam Klein, RN, MSN: </b>One way to look at that question is, what are the <i>disparities</i>? There are a lot of health disparities for the LGBTQ population as a whole and even more so for the transgender population. A constellation of factors—whether it's family rejection, discrimination in employment or housing, getting bullied at school—can lead up to people being less advantaged. Then there’s stigma, even within healthcare systems. Sometimes, health issues have to do with people not seeking care because they've had bad experiences at a place or their friend has. So people will show up with really high blood pressure, or diabetes that's out of control because they haven’t had any regular care.</p> <h2>HC: The Transgender Emergency Fund is raising money for a <a href="https://transemergencyfund.org/transitional-housing"><b>transitional housing initiative</b></a> to assist transgender people coming out of homelessness. Why is transitional housing needed for this population?</h2> <p><b>Dreya Catozzi:</b> While I am not personally involved <a href="https://transemergencyfund.org/transitional-housing">TEF's Transitional Housing Program</a>, which is for trans and nonbinary individuals, I want to speak about the need for this type of housing specifically for trans women of color. We are marginalized and targeted—<a href="https://time.com/5601227/two-black-trans-women-murders-in-dallas-anti-trans-violence/">with deaths</a>, <a href="https://harvardcrcl.org/americas-war-on-black-trans-women/">with abuse</a>, we are up there in rates, and we don't have the support. A lot of us have gone into sex work, and there’s a ripple effect to HIV, drug use, sometimes death. Some are doing it to keep a roof over their head. If the opportunities were there for employment, housing would not be such a huge issue.</p> <p><b>PK:</b> Because of employment issues leading some [trans women of color] into sex work, it can put them in risky situations and at increased risk for HIV and also substance use, partly because bars are often where they meet customers, but also because people often self-medicate in response to engaging in sex work. I'm generalizing of course, because there are plenty of transgender women not engaged in sex work,  but it is true that the demographic in the U.S. with the highest risk and prevalence of HIV infection is transgender women of color, particularly Black trans women.</p> <p><b>DC: </b>I hope the transitional housing, when it’s complete, includes an employment program that offers guidance for residents on resume writing, how to look for housing, and access to whatever they need to look for a job. For instance, residents may need access to counseling both for drug use and mental health. This housing is meant to be a transition, to help get you back into life.</p> <h2>HC: Before we have a housing project specific for transgender and nonbinary people, what can existing shelters do to create a safe space?</h2> <p><b>DC:</b> Women’s shelters need to allow trans women in—some don't. And when they do, shelter staff definitely need to be educated. For example, you cannot put a trans woman with a biological man. You are putting her in danger. Just as you wouldn’t put a cisgender woman in with men—the same rules need to be followed.</p> <p><b>PK:</b> Shelter staff have made a good effort, but shelters are not the best places for this population in general because of [discrimination from] other shelter guests. It can be very uncomfortable and even dangerous.</p> <p>Housing issues also come up when people are recovering from <a href="https://www.bmc.org/center-transgender-medicine-and-surgery/surgical-services">gender-affirming surgery</a>. Especially with complex procedures like vaginoplasty, it’s really necessary to have a private space for aftercare, for weeks upon weeks. I can think of one patient whose family was very unsupportive, so they were not going to get the post-surgery help or care they needed at home, and the respite facility at the <a href="https://www.bmc.org/healthcity/population-health/how-bhchp-successfully-vaccinating-homeless-shelter-guests">Boston Health Care for the Homeless Program</a> was helpful.</p> <h2>HC: What changes can health providers make to serve transgender people more fully?</h2> <p><b>DC:</b> Honestly, it’s really simple: Get educated. It should not be shocking. When some people hear the word “transgender,” their brains seem to go haywire. I’ve seen nurses and doctors misgender people, and I don’t get it. I come in, I need help. This is my name, this is what I’m here for. Everyone, no matter what their gender is, wants to be called by name.</p> <p><b>PK:</b> There's so much out there now in terms of training and education. The issue is having the understanding and the will to make the changes that need to happen. On a practical level, you need to figure out, for your system, how to call people by the names that they use, even if they haven't legally changed them. Address people or talk about them with the pronouns that they use.</p> <p>Since 2016, HRSA has mandated that federally funded settings collect SOGI (sexual orientation and gender identity) data, but <a href="https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/collecting-sexual-orientation.html">this is not always done</a>. You need something in your system that offers the opportunity to ask patients these questions—and you ask them of everybody. You can't assume somebody's gender identity or what pronouns they use.</p> <p>People of lived experience are so often the best teachers. Someone like Dreya coming in and talking about their experience in an institution can be really elucidating for people—and I want to note that they definitely need to be compensated for that kind of help.</p> <h2>HC: What do you see positive right now in terms of resources and policies in support of trans people?</h2> <p><b>PK:</b> President Biden’s early <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-preventing-and-combating-discrimination-on-basis-of-gender-identity-or-sexual-orientation/" target="_blank">executive order</a> affirming that LGBTQ people are protected from housing discrimination was great. But housing discrimination can be hard to prove. When Suffolk University <a href="https://www.suffolk.edu/news-features/news/2018/05/23/15/14/transgender-rental-bias-revealed-through-suffolk-law-housing-discrimination-tests" target="_blank">documented</a> discrimination against transgender apartment hunters in Boston, it showed up in subtle ways: transgender people not being offered the same financial incentives as other prospective renters or not being shown amenities, like a pool or lounge area.</p> <p>Something really important right now is the federal <a href="https://www.americanprogress.org/issues/lgbtq-rights/reports/2021/03/15/497158/need-know-equality-act/" target="_blank">Equality Act</a>, which would offer protection from housing and other discrimination. It was passed overwhelmingly by the U.S. House of Representatives but still needs Senate approval. Right now, people can let their senators know that they support this.</p> <p>Aside from housing, I'm part of the <a href="https://www.masstpc.org/health-care/" target="_blank">Mass Trans Health Coalition</a>, focused on advocacy and working with insurance companies to increase access. <a href="http://negendercare.org/" target="_blank">New England Gender C.A.R.E Consortium</a> lists all the providers in New England who provide gender affirming care, including BMC, so we can coordinate and refer to each other.</p> <h2>HC: Is there anything else you’d like to add about access to support and services?</h2> <p><b>DC:</b> If you see someone who is a trans woman who’s doing well, it’s because she had to take what she needed—it wasn’t given. If I had the support and tools I reached out for, there’s so much more I could have accomplished. But I’ve survived. I’m 51, and ready to start living life. The fight I want to fight now is to get my life on track and move forward.</p> <p>There are always going to be hurdles, but I’m going to live my life as Dreya. That’s what we need to start focusing on: Showing that if you have access and support, this is what you’re capable of. If I can be an example, that would be my best way of advocating.</p> <hr /> <p><em>This interview has been edited and condensed.</em></p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/lgbtq-health" hreflang="en">LGBTQ Health</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/policy-and-advocacy" hreflang="en">Policy and Advocacy</a></div> </div> </div> Tue, 22 Jun 2021 13:54:48 +0000 jake.leidolf 147671 at https://healthcity.bmc.org New Collab Targets Key Boston Areas for Health Equity Initiatives https://healthcity.bmc.org/policy-and-industry/new-collab-targets-key-boston-areas-health-equity-initiatives <span>New Collab Targets Key Boston Areas for Health Equity Initiatives</span> <span><span lang="" about="/user/36" typeof="schema:Person" property="schema:name" datatype="">jake.leidolf</span></span> <span>June 10, 2021</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/policy-and-industry" hreflang="en">Policy and Industry</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">New Collaboration Targets Key Boston Neighborhoods for Health Equity Initiatives</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">Boston hospitals and orgs join forces to drive employment and housing programs in the city&#039;s underserved neighborhoods with a focus on sustainability.</div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/images/article/fairmont-corridor-revitalization_feature.jpg?itok=DVIJBaPV" width="1000" height="564" alt="blue hill ave mattapan fairmount corridor mbta station" typeof="foaf:Image" /> </div> <div class="field field--name-field-image-credit field--type-string field--label-hidden field__item">Boston Globe, Getty Images</div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/meryl-bailey" hreflang="en">Meryl Bailey</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2021-06-15T04:00:00Z">June 15, 2021</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=New%20Collab%20Targets%20Key%20Boston%20Areas%20for%20Health%20Equity%20Initiatives" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=New%20Collab%20Targets%20Key%20Boston%20Areas%20for%20Health%20Equity%20Initiatives&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=New%20Collab%20Targets%20Key%20Boston%20Areas%20for%20Health%20Equity%20Initiatives&summary=New%20Collab%20Targets%20Key%20Boston%20Areas%20for%20Health%20Equity%20Initiatives" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=New%20Collab%20Targets%20Key%20Boston%20Areas%20for%20Health%20Equity%20Initiatives&body=Boston%20hospitals%20and%20organizations%20join%20forces%20to%20drive%20employment%20and%20housing%20programs%20in%20the%20city%27s%20most%20underserved%20neighborhoods%20with%20a%20focus%20on%20sustainable%20solutions.%0D%0A https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>On a map, the thin indigo line of the Fairmount MBTA bisects Boston, running south from the city center through the neighborhoods of <a href="https://www.bmc.org/healthcity/policy-and-industry/map-covid-19-vaccine-access-bostons-vulnerable-communities">Dorchester, Mattapan, and Hyde Park</a>. The rail line connects some of the city’s most diverse, culturally vibrant, and historic districts—but also the city’s most marginalized and underserved. In the <a href="https://uphamscorner.org/fairmount-corridor/" target="_blank">Fairmount Corridor</a>, almost half of the households earn less than $40,000 per year, which is a staggering inequity compared to Boston’s median household income of $71,000. The concentrated poverty in these neighborhoods is a direct result of generations of disinvestment and historical trauma.</p> <p>At Boston Medical Center (BMC), physicians are accustomed to treating the illnesses caused by living in low-income ZIP codes like those in the Fairmount Corridor: respiratory attacks triggered from inadequate housing; obesity resulting from a lack of fresh food options; depression from the stress of raising a family on minimum wage with no chance to earn more. These factors have nothing to do with people’s biology, yet they severely impact health trajectories and life expectancy and perpetuate a generational cycle of poverty and poor health.</p> <p>Current systems and subsidies are designed to fill gaps temporarily rather than advance families toward sustainable livelihoods.</p> <h2>To sustain health equity, focus on specific zip codes</h2> <p>BMC pediatrician <a href="https://www.bmc.org/about-us/directory/doctor/megan-t-sandel-md">Megan Sandel, MD, MPH</a>, believes to move toward true, sustainable advancements in health equity, health systems must directly address the disinvestment in communities of color and work to change systems that make economic opportunities, including <a href="https://www.bmc.org/healthcity/population-health/building-wealth-improve-health-streetcreds-job-training">living-wage jobs</a>, inaccessible for so many.</p> <p>“Place is where we concentrate inequity in this country. It is places and neighborhoods where systems don’t work and where policies perpetuate inequities," Sandel says.</p> <p>As a result, Sandel says that BMC as a health system is looking to extend work beyond the person-level to adopt a set of ZIP codes and make these ZIP codes how it focuses its work.</p> <p>"Place-based investing, place-based hiring, and place-based small business procurement is part of our healthcare anchor mission," Sandel explains. "We want Nubian Square, Roxbury, 02119, to be the healthiest neighborhood in Boston. There is no reason it can’t be. We just have to undo decades of racism to get there."</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fwww.bmc.org%2Fhealthcity%2Fpolicy-and-industry%2Fnew-collaboration-targets-key-boston-neighborhoods-health-equity-initiatives&amp;via=The_BMC&amp;text=%22Place%20is%20where%20we%20concentrate%20inequity%20in%20this%20country.%20It%20is%20places%20and%20neighborhoods%20where%20systems%20don%u2019t%20work%20and%20where%20policies%20perpetuate%20inequities.%22&amp;hashtags=HealthCity">"Place is where we concentrate inequity in this country. It is places and neighborhoods where systems don’t work and where policies perpetuate inequities." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <p>Sandel is the principal investigator for The Boston Opportunity System (BOS) Collaborative, a new community-driven, systems-change approach to open pathways to employment and affordable housing options for people in Boston’s historically disinvested neighborhoods. Launched through an initial investment of a $5 million JP Morgan <i>Advancing</i>Cities Grant, the BOS Collaborative is a partnership between the City of Boston; large city hospitals, including BMC, Boston Children’s Hospital, and Brigham and Women’s Hospital; and community organizations <a href="https://www.dsni.org/" target="_blank">Dudley Street Neighborhood Initiatives</a>, <a href="https://www.jvs-boston.org/" target="_blank">Jewish Vocational Services</a>, and <a href="https://www.action4equity.org/" target="_blank">Action for Equity</a>.</p> <h2>Reinventing Boston's job ecosystem with training and hiring</h2> <p>The collaborative’s goal is to radically reinvent the city’s jobs ecosystem by supporting people interested in new opportunities through skills training and the hiring process, ultimately helping launch them in new careers within the city’s anchor institutions. Much of the work will be offering holistic support so that people can stay and thrive in their new roles.</p> <p>“When people begin to earn more money, they hit a ceiling when they are no longer eligible for certain governmental programs like <a href="https://www.bmc.org/healthcity/policy-and-industry/loss-snap-benefits-linked-economic-hardship-poor-health">SNAP</a>, childcare subsidies, or housing subsidies,” describes Sandel. “We are going to be really intentional about how we tear down these barriers so people can be successful at every stage in the process. We are innovating in the system as we move forward.”</p> <p>Residents living in Boston’s Fairmount Corridor will be the initiative’s primary focus. Before the COVID-19 pandemic dramatically changed the city’s job landscape, the Fairmount Corridor’s direct transit into the city was seen as a benefit to help employees commute to their new positions. Post-2020, the collaborative is focused on identifying recession-proof career paths that span the city’s major industries, including banking, life-sciences, tech, and healthcare. Although the BOS Collaborative’s three anchor institutions are currently hospitals, BOS Collaborative director Gina Patterson believes commitments from anchor institutions in other industries are crucial to create needed change and that these partnerships would be mutually beneficial.</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fwww.bmc.org%2Fhealthcity%2Fpolicy-and-industry%2Fnew-collaboration-targets-key-boston-neighborhoods-health-equity-initiatives&amp;via=The_BMC&amp;text=%22We%20know%20that%20besides%20San%20Francisco%2C%20Boston%20and%20Cambridge%20have%20the%20largest%20tech%20firms%20in%20the%20country.%20We%20also%20know%20the%20hiring%20and%20retention%20of%20Black%20and%20Brown%20people%20in%20the%20tech%20industry%20have%20been%20dismal.%22&amp;hashtags=HealthCity">"We know that besides San Francisco, Boston and Cambridge have the largest tech firms in the country. We also know the hiring and retention of Black and Brown people in the tech industry have been dismal." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <p>“We know that besides San Francisco, Boston and Cambridge have the largest tech firms in the country. We also know the hiring and retention of Black and Brown people in the tech industry have been dismal. With the economic crisis caused by the pandemic and the serious racial reckoning in 2020, we think this is a huge opportunity for those companies to say ‘yes’ to the commitments that they have made to hire people of color. We want to help support them as we know there is plenty of talent within Mattapan, Dorchester, and Roxbury to help fill those positions,” Patterson explains.   </p> <h2>Stewardship and collaboration are key for long-lasting health equity</h2> <p>The BOS Collaborative’s initial work aims to fulfill 500 jobs at a family-sustaining wage. Action for Equity is leading the work to recruit 1,100 people as candidates so that 500 can quickly be trained and hired into the career pipelines that anchor institutions and other downtown businesses will offer. Jewish Vocational Services will provide the necessary training for many roles and connect participants across many other job pipeline programs. The collaborative is also working with Dudley Street Neighborhood Initiative to leverage $1 million into more creative investment strategies for tangible neighborhood revitalization.</p> <p>The effort to open opportunities for individuals and families to become more economically stable is a natural outgrowth of BMC’s, Boston Children’s, and Brigham and Women’s <a href="https://www.bmc.org/news/press-releases/2019/08/07/boston-medical-center-boston-childrens-hospital-and-brigham-and">Innovative Stable Housing Initiative</a>. The hospitals first partnered in 2019 to provide $3 million to preserve and create affordable housing in the Boston area. For both initiatives, the hospitals invested heavily in community partners doing the work on the ground. Sandel believes anchor institutions can effectively wield influence to create change yet also must lean back and let the community lead the way.</p> <p>“Institutions need to change, not people," says Sandel. "Community needs to lead. By building trusting, respectful relationships, we can make long-lasting change. We're really trying to live that theory of change every single day in the BOS Collaborative."</p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/racial-bias-and-equity" hreflang="en">Racial Bias and Equity</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/job-training" hreflang="en">Job Training</a></div> </div> </div> <div class="field field--name-field-article-type field--type-list-string field--label-hidden field__item">Article</div> <div class="field field--name-field-bmc-tags field--type-entity-reference field--label-above"> <div class="field__label">BMC Tags</div> <div class="field__items"> <div class="field__item"><a href="/taxonomy/term/1951" hreflang="en">Megan Sandel</a></div> </div> </div> Thu, 10 Jun 2021 15:43:51 +0000 jake.leidolf 147541 at https://healthcity.bmc.org For Better Birth Outcomes, We Need to Prevent Housing Evictions https://healthcity.bmc.org/policy-and-industry/better-birth-outcomes-we-need-prevent-housing-evictions <span>For Better Birth Outcomes, We Need to Prevent Housing Evictions</span> <span><span lang="" about="/user/36" typeof="schema:Person" property="schema:name" datatype="">jake.leidolf</span></span> <span>May 18, 2021</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/policy-and-industry" hreflang="en">Policy and Industry</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">For Better Birth Outcomes, We Need to Prevent Housing Evictions</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">Stopping evictions of pregnant women and addressing inequities that lead to them may improve newborn health, leading to intergenerational benefits.</div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/images/article/eviction-during-pregnancy_feature.jpg?itok=u77JdRue" width="1000" height="564" alt="pregnant woman housing eviction with boxes outside her home" typeof="foaf:Image" /> </div> <div class="field field--name-field-image-credit field--type-string field--label-hidden field__item">John Moore, Getty Images</div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/sandra-larson" hreflang="en">Sandra Larson</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2021-05-25T04:00:00Z">May 25, 2021</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=For%20Better%20Birth%20Outcomes%2C%20We%20Need%20to%20Prevent%20Housing%20Evictions" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=For%20Better%20Birth%20Outcomes%2C%20We%20Need%20to%20Prevent%20Housing%20Evictions&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=For%20Better%20Birth%20Outcomes%2C%20We%20Need%20to%20Prevent%20Housing%20Evictions&summary=For%20Better%20Birth%20Outcomes%2C%20We%20Need%20to%20Prevent%20Housing%20Evictions" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=For%20Better%20Birth%20Outcomes%2C%20We%20Need%20to%20Prevent%20Housing%20Evictions&body=Stopping%20housing%20evictions%20of%20pregnant%20women%20and%20addressing%20inequities%20that%20lead%20to%20them%20could%20improve%20newborn%20health%2C%20leading%20to%20lifelong%20and%20intergenerational%20benefits.%0D%0A https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Eviction during pregnancy is associated with adverse birth outcomes, including prematurity and low birth weight, according to a study published in <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2776776" target="_blank"><i>JAMA Pediatrics</i></a> in March. Adverse birth outcomes are known to have lifelong and even multigenerational health and economic consequences, and the authors conclude that policies to protect tenants from eviction and assist pregnant women at risk for eviction may improve infant health.</p> <p>In an accompanying <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2776770?guestAccessKey=1aab5001-bdab-4b8b-8adc-02089993f8b8&amp;utm_source=fbpage&amp;utm_medium=social_jamapeds&amp;utm_term=4531734826&amp;utm_campaign=article_alert&amp;linkId=112383398" target="_blank">editorial</a>, <a href="https://www.bmc.org/about-us/directory/doctor/michael-silverstein-md">Michael Silverstein, MD, MPH</a>; <a href="https://www.bmc.org/about-us/directory/doctor/erika-g-cordova-ramos-md">Erika (Gaby) Cordova Ramos, MD</a>; and Robert Koenig, MBA, discuss how the study’s findings shed light on the disproportionate toll eviction takes on low-income women of color, especially Black women, and their babies. The writers emphasize the importance of addressing the <a href="https://www.bmc.org/healthcity/population-health/upstream-healthcare-sdoh-root-causes">upstream factors</a> that lead to health inequities and eviction.</p> <p>HealthCity spoke with Cordova Ramos, a Boston Medical Center (BMC) clinical neonatologist, health services researcher, and assistant professor of pediatrics at Boston University School of Medicine, and Koenig, BMC’s senior director of strategy and operations, about the study, the inequities that lead to disparate eviction rates, and what health systems and policymakers can do to help.</p> <h2>HealthCity: What makes this study on housing evictions during pregnancy important or groundbreaking?</h2> <p><b>Gaby Cordova Ramos, MD: </b>The study is very methodologically rigorous. When we look at something like eviction, there are so many unobserved confounders between mothers who have never been evicted and mothers who have experienced eviction. I think it is just tremendous work, how this study linked the data to generate the most informative comparison: mothers who experienced eviction during pregnancy compared to mothers who experienced eviction at any other time. It really gets at the question, what is the impact of in utero exposure to eviction on birth outcomes?</p> <p>It is great also to see work that points out a very actionable target for interventions—eviction—to try to offset that disparity early on in life. A study that identifies tractable intervention targets strongly linked to adverse birth outcomes is highly consequential, because of the lifelong downstream effects of what happens at birth.</p> <p><b>Robert Koenig, MBA: </b>Findings like these are really important in how they reinforce the need for us to stretch beyond the traditional clinical setting in order to care for our patients. At Boston Medical Center, where people experiencing homelessness are approximately 10% of our inpatient stays, we see firsthand the link between housing status and health—but studies like this are critically important for quantifying impact and pointing us to remedies. It’s a clear imperative for us to continue to tailor our operations to support patients experiencing housing instability and homelessness.</p> <h2>HC: It seems intuitive that eviction would be a highly stressful event during pregnancy and would have a negative impact on a baby’s early life. Is this the first time a study has shown specific medical outcomes for newborns after eviction?</h2> <p><b>GCR: </b>This is the first to do it so rigorously. There have been some ecological studies that have looked at rates of eviction in certain counties and rates of adverse birth outcomes and other studies linking other types of housing instability and adverse birth outcomes. This is the first study to do a comparison within families, comparing a child where the mom experienced eviction during the pregnancy and a sibling of the same mother that didn't. It also is the first study that examined the effects of eviction in the three trimesters of pregnancy, which further supports the potential causality in this association.</p> <h2>HC: What does this study reveal about disparate outcomes for Black and brown mothers?</h2> <p><b>GCR:</b> It confirms that eviction disproportionately affects women of color. This study in particular also shows that the size effect—how much lower the birth weights were—was much greater for Black mothers. So, not only were pregnant women of color more likely to be exposed to eviction, but they were also more likely to experience more severe effects.</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fwww.bmc.org%2Fhealthcity%2Fbetter-birth-outcomes-we-need-prevent-housing-evictions&amp;via=The_BMC&amp;text=%22Not%20only%20were%20pregnant%20women%20of%20color%20more%20likely%20to%20be%20exposed%20to%20eviction%2C%20but%20they%20were%20also%20more%20likely%20to%20experience%20more%20severe%20effects.%22&amp;hashtags=HealthCity">"Not only were pregnant women of color more likely to be exposed to eviction, but they were also more likely to experience more severe effects." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <p>Our intent in this piece was to make it exceedingly clear that low-income women of color are being more affected and to underline the importance of structural racism in all sorts of health outcomes—in this case, a very important one: birth outcomes.</p> <h2>HC: Your editorial refers to “stacking inequities” for Black families. Can you talk about that?</h2> <p><b>GCR:</b> Hardships don't often come alone, and low-income families of color experience the burden of multiple hardships. Discrimination and structural racism lead to socioeconomic disadvantage, and that leads to other disparities that affect health. For example, families that are at risk for eviction are often also at risk of not having the means to afford nutritious food.</p> <p>It’s often so hard to find an effect at all linking a hardship to actual health outcomes in a study, because you're looking at myriad overlapping hardships. So, in this study, the sole fact that there was a significant result seen in prematurity and low birth weight is, by itself, pretty remarkable.</p> <h2>HC: Your editorial makes it clear that we need not only to prevent evictions of pregnant women, but to also look upstream at the social determinants that lead to eviction. What are some examples?</h2> <p><b>GCR:</b> Black mothers are disproportionally affected by eviction actions, and this stems from much larger problems. There are upstream issues that lead to being in eviction court in the first place, which is having low wages, having insecure jobs, not having access to resources to weather unexpected circumstances—and these are not distributed equally in the population.</p> <p><b>RK:</b> To underscore that, myriad interconnected social factors can lead patients to face the risk of eviction, and we need to think about them in a coordinated manner—employment, nutrition, child care, among others—individually or together can affect health outcomes. We need to acknowledge the role of race and structural racism in all of these upstream factors and their relationship to health outcomes.</p> <h2>HC: What can health providers and policymakers do to help?</h2> <p><b>GCR:</b> At the clinician level, just awareness of the magnitude of the problem is something. Next is getting physicians to know that patients can benefit from interventions like medical-legal partnerships and connection to community resources, either to offset being behind on rent or to connect them to safe and affordable housing.</p> <p><b>RK:</b> Health systems can make investments in tools like BMC's <a href="https://www.bmc.org/healthcity/research/model-integrating-sdoh-screening-and-referral-ehr">THRIVE</a> screening and referral tool, where we screen patients for housing instability and homelessness when they come into BMC and can connect patients to services or supports that they request help accessing.</p> <p>From a policy standpoint, rent assistance programs to help people behind on rent, counsel to assist people facing eviction, and, a step above that, access to affordable housing in the first place are some of the important tools. Affordability is an especially acute challenge in Boston, where we face such high housing costs in the first place.</p> <p><b>GCR:</b> Also at the policy level, we need regulations around what landlords can and can't do. Besides housing instability, there's substandard housing that affects the health of the mother, which affects the health of the newborn and of the children as they grow. And after we wrote this piece, I came across another paper explaining that the disparities are not only in eviction filings, <a href="https://sociologicalscience.com/download/vol-7/december/SocSci_v7_649to662.pdf" target="_blank">but in repeated filings</a>. These families are just caught in a constant stream of these hardships, and there needs to be more regulation around it.</p> <h2>HC: You also note the need for further research. What would that look like?</h2> <p><b>GCR:</b> Any time a disparity is identified, there is a need to understand the mechanisms behind it in order to actually design interventions to close the gap. And so showing that low-income women of color are disproportionally evicted is tremendously important, but then we also need to understand the specific drivers of what is happening. That’s what will really inform policy changes.</p> <p><b>RK:</b> Measuring and observing a disparity is an important and constructive starting point, but at the end of the day, in terms of health system operations, we need to identify and successfully implement mechanisms that close racial inequities, not just observe them. More work to help go beyond measurement and understand how programs actually move the needle would help health systems and policymakers alike.</p> <hr /> <p><em>This interview has been edited and condensed.</em></p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/social-determinants-health" hreflang="en">Social Determinants of Health</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/pregnancy" hreflang="en">Pregnancy</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/neonatology" hreflang="en">Neonatology</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> </div> </div> <div class="field field--name-field-article-type field--type-list-string field--label-hidden field__item">Article</div> <div class="field field--name-field-bmc-tags field--type-entity-reference field--label-above"> <div class="field__label">BMC Tags</div> <div class="field__items"> <div class="field__item"><a href="/taxonomy/term/2286" hreflang="en">Erika Cordova Ramos</a></div> <div class="field__item"><a href="/taxonomy/term/2291" hreflang="en">Michael Silverstein</a></div> </div> </div> Tue, 18 May 2021 15:59:53 +0000 jake.leidolf 147101 at https://healthcity.bmc.org ‘Space Is a Luxury Not Everyone Has’: Design’s Role in Health https://healthcity.bmc.org/policy-and-industry/space-luxury-not-everyone-has-designs-role-health <span>‘Space Is a Luxury Not Everyone Has’: Design’s Role in Health</span> <span><span lang="" about="/user/6471" typeof="schema:Person" property="schema:name" datatype="">Amanda Doyle</span></span> <span>May 21, 2020</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/policy-and-industry" hreflang="en">Policy and Industry</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">‘Space Is a Luxury Not Everyone Has’: Discussion on Design’s Pivotal Role in Health Outcomes</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">COVID-19 underscores the necessity of investment in infrastructure both inside and outside the hospital to protect patients.</div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/images/article/design%20and%20health.jpg?itok=2-0u3W0-" width="1000" height="564" alt="The design of the physical environment can hurt or heal, panel experts say, calling for greater investment in housing and community spaces. " typeof="foaf:Image" /> </div> <div class="field field--name-field-image-credit field--type-string field--label-hidden field__item">Getty Images</div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/meryl-bailey" hreflang="en">Meryl Bailey</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2020-05-21T04:00:00Z">May 21, 2020</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=%E2%80%98Space%20Is%20a%20Luxury%20Not%20Everyone%20Has%E2%80%99%3A%20Design%E2%80%99s%20Role%20in%20Health" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=%E2%80%98Space%20Is%20a%20Luxury%20Not%20Everyone%20Has%E2%80%99%3A%20Design%E2%80%99s%20Role%20in%20Health&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=%E2%80%98Space%20Is%20a%20Luxury%20Not%20Everyone%20Has%E2%80%99%3A%20Design%E2%80%99s%20Role%20in%20Health&summary=%E2%80%98Space%20Is%20a%20Luxury%20Not%20Everyone%20Has%E2%80%99%3A%20Design%E2%80%99s%20Role%20in%20Health" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=%E2%80%98Space%20Is%20a%20Luxury%20Not%20Everyone%20Has%E2%80%99%3A%20Design%E2%80%99s%20Role%20in%20Health&body=A%20panel%20discussion%20on%20COVID-19%20retrofitting%20underscores%20the%20necessity%20of%20investment%20in%20infrastructure%20both%20inside%20and%20outside%20the%20hospital%20to%20protect%20patients%20and%20respond%20to%20emerging%20needs.%0D%0A https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The COVID-19 pandemic is revealing the lack of flexibility in capacity and adaptability of physical design at U.S. hospitals. With little time to prepare for a new disease that has no infection control guidelines, hospital administrators have confronted <a href="https://www.pbs.org/newshour/show/how-the-pandemic-is-reshaping-hospital-architecture-and-design">rigid historical architecture</a> that makes finding additional space difficult or creates the task of building a field hospital from the ground up to care for an influx of severely ill patients.</p> <p><a href="https://massdesigngroup.org/">MASS Design Group</a>, a collaborative of architects and designers, focuses on designing transformative healthcare infrastructure in developing countries, but the nonprofit is now building a COVID-19 response team to help U.S. health systems facing the massive task of quickly retrofitting clinical spaces. The group recently hosted a panel discussion, “Architecture Can Heal: Adapting Healthcare Spaces in Response to COVID-19,” to highlight lessons learned as physicians and designers come together to reconsider space as it relates to health outcomes.</p> <p><em><a href="https://massdesigngroup.org/videos#lightbox=/video/architecture-can-heal-adapting-healthcare-spaces-response-covid-19"><span style="color: #a8ad00; font-family: 'Source Sans Pro',sans-serif; font-size: 16px; font-weight: 400;">Watch the panel discussion »</span></a></em></p> <p>The panel included Michael Murphy, founding principal and executive director at <a href="https://massdesigngroup.org/">MASS Design Group</a>; <a href="https://twitter.com/jessiegaeta">Jessie Gaeta, MD</a>, chief medical officer for <a href="https://www.bhchp.org/">Boston Health Care for the Homeless Program</a>; <a href="https://twitter.com/jabarocas">Joshua Barocas, MD</a>, infectious diseases physician at <a href="http://bmc.org/">Boston Medical Center</a>; and <a href="https://twitter.com/johnbucuvalas">John Bucuvalas, MD</a>, vice chair of faculty affairs at <a href="https://www.mountsinai.org/locations/kravis-childrens">Mount Sinai Kravis Children's Hospital</a>. <a href="https://twitter.com/neel_shah">Neel Shah, MD, MPP</a>, director of the Delivery Decisions Initiative at <a href="https://www.ariadnelabs.org/">Ariadne Labs</a>, moderated the conversation.</p> <p>The discussion featured two case studies in clinical design: Mount Sinai Hospital’s <a href="https://www.pbs.org/newshour/show/how-the-pandemic-is-reshaping-hospital-architecture-and-design">transition of traditional health care spaces into COVID-19 wards</a>, and a <a href="https://www.wbur.org/commonhealth/2020/03/23/tent-medicine-to-treat-those-with-the-coronavirus-in-bostons-homeless-community">parking lot tent structure</a> to quarantine or treat unhoused individuals erected by the Boston Healthcare for the Homeless Program (BHCHP). As COVID-19 lays bare the stark health disparities among U.S. populations, panelists continually underscored how physical space, or the lack of it, is not neutral. It can either hurt or heal.</p> <p>“I think the major theme that has come out is that we're asking people to physically distance — we're asking people to take these measures that really are not just for their own health and protection, but for the protection and health of their community,” said Barocas during the discussion. “But we're not taking into account that space is in fact a luxury that not everyone has, and that I don't think our system is built for.”</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fwww.bmc.org%2Fhealthcity%2Fpolicy-and-industry%2Fspace-luxury-not-everyone-has-design-health&amp;via=The_BMC&amp;text=%22We%27re%20not%20taking%20into%20account%20that%20space%20is%20in%20fact%20a%20luxury%20that%20not%20everyone%20has%2C%20and%20that%20I%20don%27t%20think%20our%20system%20is%20built%20for.%22&amp;hashtags=HealthCity">"We're not taking into account that space is in fact a luxury that not everyone has, and that I don't think our system is built for." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <p>As an infectious disease physician, Barocas served as an infection control consultant for BHCHP’s pop-up tent hospital structure on a large South Boston parking lot in late March. As it became clear that COVID-19 would disproportionately impact the city's most vulnerable, officials moved swiftly to find <a href="https://www.bmc.org/healthcity/population-health/east-newton-pavilion-provides-continuum-care-homeless-coronavirus">shelter alternatives</a> that could provide medical care for the sick and quarantine the infected. Using input from MASS Design’s experience in West Africa during the 2014 Ebola outbreak, BHCHP erected the MASH-like medical tents within two weeks of the initial conception. They reached patient capacity the day after opening.</p> <p><em><a href="https://www.bmc.org/healthcity/policy-and-industry/collaboration-more-important-ever-protecting-homeless-coronavirus"><span style="color: #a8ad00; font-family: 'Source Sans Pro',sans-serif; font-size: 16px; font-weight: 400;">Related read: Collaboration More Important Than Ever for Protecting the Homeless »</span></a></em></p> <p>The structure is serving as a blueprint for other temporary field hospitals erected throughout the city to handle the potential overflow of vulnerable patients who lack shelter to quarantine. The irony is not lost on Dr. Gaeta, however, that these tents are needed in Boston, which has one of the most robust healthcare systems in the United States. The city is home to 18 hospitals, including 14 world-class teaching hospitals. Yet despite the abundance of healthcare resources and infrastructure, the COVID-19 crisis is <a href="https://www.bmc.org/healthcity/population-health/coronavirus-worsen-disparities-distrust-black-community">furthering health disparities</a> more than ever before.</p> <p>“The poor health that we see is magnified so much for people who lack housing. It's just so evident from this particular pandemic how space, or a lack of space, the inability to socially or physically distance — it's just so dramatically shown with this particular population,” said Gaeta.</p> <p>Rethinking the impact of the design of healthcare spaces also means addressing the areas that people inhabit daily, explained Murphy.</p> <p>“We are all undergoing this massive paradigmatic change, where we recognize that the space around us, as individuals, as we isolate here in our homes, has the potential to infect us, to injure us, but also on the flip side, to potentially heal us, to help us breathe better, to provide safe, uncontaminated air,” he said.</p> <p>Studies continually link inadequate housing with poor health outcomes. <a href="https://www.sciencedirect.com/science/article/pii/S2211335517300992">Respiratory illness</a>, <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2762000">asthma</a>, <a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2019.305092?journalCode=ajph">lead exposure</a>, and <a href="https://link.springer.com/article/10.1007%2Fs00127-020-01849-1">mental illness</a> all have roots in substandard housing. <a href="https://www.kff.org/slideshow/how-health-expenditures-vary-across-the-population-slideshow/">Five percent</a> of hospital users are responsible for half of the healthcare costs in the United States, and many of those patients are living below the poverty line and are <a href="https://www.bmc.org/healthcity/policy-and-industry/multiple-policy-approach-needed-improve-housing-security">housing insecure</a>. Investing in affordable housing and community revitalization is <a href="https://www.aha.org/system/files/media/file/2019/05/AIHC_issue_brief_final.pdf">an emerging priority</a> for hospitals across the nation who are interested in lasting better health for their patients. In 2017, Boston Medical Center <a href="https://www.bmc.org/news/press-releases/2017/12/07/boston-medical-center-invest-65-million-affordable-housing-improve">invested $6.5 million</a> to support community partnerships and affordable housing initiatives in local neighborhoods. It became the first hospital in Massachusetts to put all of its required community health investment into this one social determinant of health.</p> <p><em><a href="https://www.bmc.org/healthcity/policy-and-industry/multiple-policy-approach-needed-improve-housing-security"><span style="color: #a8ad00; font-family: 'Source Sans Pro',sans-serif; font-size: 16px; font-weight: 400;">Related Read: A Smarter Policy Approach to Housing Insecurity »</span></a></em></p> <p>As COVID-19 forces health systems to rethink the design of hospital infrastructure, the pandemic is also underscoring the need for investment in safer and more equitable spaces.</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fwww.bmc.org%2Fhealthcity%2Fpolicy-and-industry%2Fspace-luxury-not-everyone-has-design-health&amp;via=The_BMC&amp;text=%22In%20addition%20to%20really%20wanting%20space%20to%20promote%20health%20and%20decrease%20transmission%20of%20infectious%20diseases%2C%20we%20need%20space%20to%20promote%20community%2C%20be%20dignified%2C%20and%20give%20people%20hope.%22&amp;hashtags=HealthCity">"In addition to really wanting space to promote health and decrease transmission of infectious diseases, we need space to promote community, be dignified, and give people hope." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <p>“If we had a trillion dollars to invest in spatial redesign, I think the most bang for our buck would be in community spaces that have a profound impact on health. Those spaces are, most importantly, housing, schools, shelters, prisons, and community spaces in general,” said Gaeta. “In addition to really wanting space to promote health and decrease transmission of infectious diseases, we need space to promote community, be dignified, and give people hope.”</p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/covid-19-coronavirus" hreflang="en">COVID-19 (Coronavirus)</a></div> </div> </div> <div class="field field--name-field-article-type field--type-list-string field--label-hidden field__item">Article</div> <div class="field field--name-field-bmc-tags field--type-entity-reference field--label-above"> <div class="field__label">BMC Tags</div> <div class="field__items"> <div class="field__item"><a href="/taxonomy/term/2271" hreflang="en">Jessie Gaeta</a></div> </div> </div> Thu, 21 May 2020 19:23:24 +0000 Amanda Doyle 138166 at https://healthcity.bmc.org Building Reopens to Provide Continuum of Care for Homeless https://healthcity.bmc.org/population-health/building-reopens-provide-continuum-care-homeless <span>Building Reopens to Provide Continuum of Care for Homeless</span> <span><span lang="" about="/user/6471" typeof="schema:Person" property="schema:name" datatype="">Amanda Doyle</span></span> <span>April 14, 2020</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/population-health" hreflang="en">Population Health</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">BMC Reopens Building Sold to State to Provide Continuum of Care for Homeless COVID Patients</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">In record time, local and state collaboration stands up respite care for stable COVID-positive people without a safe place to quarantine.</div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/images/article/east%20newton%20pavilion%20covid_feature.jpg?itok=YrgWBqD4" width="1000" height="564" alt="face of the East Newton Pavilion building " typeof="foaf:Image" /> </div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/dave-wedge" hreflang="en">Dave Wedge</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2020-04-14T04:00:00Z">April 14, 2020</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=Building%20Reopens%20to%20Provide%20Continuum%20of%20Care%20for%20Homeless" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=Building%20Reopens%20to%20Provide%20Continuum%20of%20Care%20for%20Homeless&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=Building%20Reopens%20to%20Provide%20Continuum%20of%20Care%20for%20Homeless&summary=Building%20Reopens%20to%20Provide%20Continuum%20of%20Care%20for%20Homeless" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=Building%20Reopens%20to%20Provide%20Continuum%20of%20Care%20for%20Homeless&body=In%20record%20time%2C%20local%20and%20state%20collaboration%20stands%20up%20respite%20care%20for%20stable%20COVID-positive%20people%20who%20otherwise%20wouldn%27t%20have%20a%20safe%20place%20to%20quarantine.%0D%0A https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Boston Medical Center CEO Kate Walsh has seen staff and volunteers perform countless incredible feats as the community rallies to face the <a href="https://www.bmc.org/healthcity/policy-and-industry/modeling-staffing-and-operational-planning-coronavirus-surge">COVID-19 surge</a>. But nothing could have prepared her for the miraculous transformation of the vacant East Newton Pavilion, formerly a hospital building on the BMC campus, into an emergency respite center to help stop the virus from ravaging Boston’s homeless community.</p> <p>BMC had sold the building to the state in 2018 and plans were in motion for a $200 million project to transform it into a new facility for the <a href="https://www.mass.gov/locations/lemuel-shattuck-hospital">Lemuel Shattuck Hospital</a>. But when it became clear that the homeless population was going to be <a href="https://www.bmc.org/healthcity/population-health/covid19-is-not-a-virus-of-equity-homeless-vulnerable">hit especially hard</a> by the coronavirus, forces moved to return the building to BMC and convert it into a safe place for COVID-positive homeless people to recover. The discussions were challenging, says Kate Walsh, with <a href="https://www.bmc.org/healthcity/population-health/covid19-is-not-a-virus-of-equity-homeless-vulnerable">Pine Street Inn</a>, <a href="https://www.bmc.org/healthcity/policy-and-industry/collaboration-more-important-ever-protecting-homeless-coronavirus">Boston Healthcare for the Homeless</a>, as well as Governor Charlie Baker and Mayor Martin J. Walsh trying to figure out the best use of the asset in a surge capacity.</p> <p>The building had been part of the hospital — it had ICUs in it — before BMC consolidated its campus. Perhaps it would be better used not for shelter-type beds, but for hospital beds for medsurg, ICU, or overflow from BMC and other Boston hospitals, some argued. But the decision was made as evidence mounted that the homeless population was being disproportionately impacted by the virus — which would have consequences for the larger Boston community.</p> <p>“What we kept saying from the BMC side is, ‘Look, if we don't find a way to better treat homeless patients and help them quarantine, we're gone. We'll be overwhelmed with the surge,’” says Kate Walsh. “It's almost a self-fulfilling prophecy.”</p> <div class="align-center"> <figure class="image img-responsive"><img alt="Experts stand outside the East Newton Pavilion during preparations" height="1003" src="https://www.bmc.org/sites/default/files/HealthCity/EORDI-NRS-EAST-NEWTON-3153.jpg" style="margin-bottom: 10px;" width="1504" /> <figcaption>Bob Biggio, left, senior vice president of facilities and support services at Boston Medical Center, stands with two others outside the East Newton Pavilion during early preparations. (Erlyn Ordinario)</figcaption> </figure> </div> <p>Now, the new respite facility at East Newton Pavilion will help fill a desperate need to <a href="https://www.bmc.org/healthcity/population-health/covid19-is-not-a-virus-of-equity-homeless-vulnerable">spread out the homeless population</a> and ease the burden on Pine Street Inn, <a href="https://stfrancishouse.org/">St. Francis House</a>, Boston Healthcare for the Homeless, and other local organizations, which have already taken measures to increase capacity and ability to quarantine, including designating space at the <a href="https://www.bhchp.org/medical-respite-care">McInnis House</a> and erecting tents as temporary respite care.</p> <p>The city and state have quickly <a href="https://www.bostonherald.com/2020/04/05/coronavirus-field-hosptial-at-boston-convention-ready-for-patients-this-week/">built a hospital for the homeless at the Boston Convention and Exhibition Center</a>, while BMC and other medical centers have expanded ICU space and treatment beds. But Walsh says the Pavilion fills a gap by expanding recovery space.</p> <p>“It can't be a mini hospital, because if people need to be in a hospital, they should be in a hospital,” Walsh says. “What the East Newton Pavilion really provides is the kind of capabilities that shelters would provide if they had the space and the resources. We had this physical resource, we just had to figure out how to staff it and get people there. And we did.”</p> <div class="align-center"> <figure class="image img-responsive"><img alt="Loading dock at East Newton Pavilion" height="1003" src="https://www.bmc.org/sites/default/files/HealthCity/EORDI-NRS-EAST-NEWTON-3132.jpg" style="margin-bottom: 10px;" width="1504" /> <figcaption>Loading docks were quickly filled as donations poured in, and quickly emptied as staff and volunteers worked to furnish the facility in the short hours after receiving keys to the building and before guests arrived. (Erlyn Ordinario)</figcaption> </figure> </div> <p>Given the green light, facility managers, physicians, nurses, cleaning staff, and countless volunteers sprang into action. The shelter community partnered with the clinical staff to map out needed services: IV and medical equipment, wireless internet, televisions, beds, chairs, tables, and other furniture. The floor had to be fully stocked with food, drinks, basic medical supplies, clothing for guests, and <a href="https://www.bmc.org/healthcity/policy-and-industry/hospital-prepares-worst-case-ppe-demand">personal protective equipment</a> for staff.</p> <p>“It’s a facility that was shut down and largely unutilized for a year and a half,” says Rob Koenig, the senior director of strategy and operations at BMC, noting the extraordinary effort and coordination that occurred to stand up the operation when time was of the essence. “It’s quite amazing that it’s ready, safe, and comfortable for guests.”</p> <div class="align-center"> <figure class="image img-responsive"><img alt="Respite care guest bed at East Newton Pavilion" height="1003" src="https://www.bmc.org/sites/default/files/HealthCity/EORDI-NRS-EAST-NEWTON-3140.jpg" style="margin-bottom: 10px;" width="1504" /> <figcaption>A guest room at the new East Newton Pavilion respite center for people who are COVID-positive. Guests are also given clean linens, clothing, and toiletries for their stay. (Erlyn Ordinario)</figcaption> </figure> </div> <p>Every facet of BMC joined in the effort, including <a href="https://secure2.convio.net/bmc/site/Donation2?df_id=3121&amp;mfc_pref=T&amp;3121.donation=form1&amp;utm_campaign=Health-city-campaign&amp;utm_medium=general-link&amp;utm_source=hyperlink&amp;utm_content=article" target="_blank">philanthropy</a>, which received a flood of donations: Wayfair and Jofran donated 250 nightstands, chairs, coffee tables, recliners and dining sets. Ocean State Job Lot donated tens of thousands of clothing items. BJ’s donated TVs and accessories. The Gap donated 10,000 pairs of underwear. Microsoft donated 50 tables. Sony gave TVs and video games. Many others chipped in with essential items, labor, and <a href="https://secure2.convio.net/bmc/site/Donation2?df_id=3121&amp;mfc_pref=T&amp;3121.donation=form1&amp;utm_campaign=Health-city-campaign&amp;utm_medium=general-link&amp;utm_source=hyperlink&amp;utm_content=article" target="_blank">financial donations</a>.</p> <p>A key concern was ensuring the new respite facility met infectious disease standards and that protocols were in place to minimize the risk of spreading infection. Creating isolation areas, secure areas for garbage and waste, and clearly delineating “clean” and “dirty” zones are important transmission control measures for any care center, but especially so for a COVID-19 facility.</p> <p>“Our infectious disease physicians were consulting on how we could keep <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923482/">‘clean’ corridors</a> versus ‘dirty’ corridors, like when you're going in and out of the ORs, to have a flow of patients and make it safe for staff,” says Sarah Carignan Arbelaez, vice president of clinical services at Boston Medical Center.</p> <div class="align-center"> <figure class="image img-responsive"><img alt="A communal space at the East Newton Pavillion respite center with lounge chairs and board games" height="1003" src="https://www.bmc.org/sites/default/files/HealthCity/EORDI-NRS-EAST-NEWTON-3102.jpg" style="margin-bottom: 10px;" width="1504" /> <figcaption>Inviting communal spaces are supplied with entertainment like cards, board games, and magazines. All of the furnishing was made possible by generous donations from companies including Wayfair, Jofran, BJ's, and Microsoft, among others. (Erlyn Ordinario) </figcaption> </figure> </div> <p>The layout was carefully planned with the population in mind to minimize risk for patients and staff.</p> <p>“One of our infectious disease doctors, <a href="https://www.bmc.org/healthcity/policy-and-industry/infectious-disease-physicians-need-new-subspecialty-addiction">Dr. Josh Barocas</a>, and one of our physicians who specializes in substance use disorder, <a href="https://www.bmc.org/healthcity/population-health/preventing-next-wave-opioid-crisis-during-covid-19">Dr. Miriam Komaromy</a>, came up with a care plan, all the flow,” says Walsh. “It's quite a sophisticated operation.”</p> <p>The first patients started arriving as soon as the doors opened on Thursday, mere hours after BMC got the keys to the building. Some were unexpected, displaced by flooding at the makeshift hospital for the homeless at the Boston Convention and Exhibition Center in South Boston, but staff were able to adapt quickly.</p> <p>Staff and volunteers at the Pavilion are from a range of disciplines, including pediatrics, behavioral health, dermatology, and other departments. Everyone attended orientation training on <a href="https://www.bmc.org/healthcity/policy-and-industry/stigma-barrier-to-sud-treatment-public-policy">reducing stigma</a>, <a href="https://www.bmc.org/healthcity/population-health/community-narcan-training-extends-our-life-saving-capacity">naloxone for overdose emergencies</a>, and <a href="https://www.bmc.org/healthcity/population-health/preventing-next-wave-opioid-crisis-during-covid-19">behavioral health needs</a> for understanding the shelter population. It was a truly thoughtful response that could have easily been lost in something that was happening so quickly, says Arbelaez: “We were counting in hours, not days.”</p> <div class="align-center"> <figure class="image img-responsive"><img alt="BMC staff who care for the guests at East Newton don full protective gear" height="1003" src="https://www.bmc.org/sites/default/files/HealthCity/EORDI-NRS-EAST-NEWTON-3168.jpg" style="margin-bottom: 10px;" width="1504" /> <figcaption>BMC staff who care for the guests at East Newton Pavilion don full personal protective equipment to protect themselves from infection. (Erlyn Ordinario)</figcaption> </figure> </div> <p>“Our volunteers certainly feel challenged and vulnerable, tired, but they also feel a great sense of purpose in being part of the solution in a very important project,” Arbelaez says. “COVID-19 has the potential to really rip through the homeless community in a devastating way — and so to be part of the help, nobody thought twice.”</p> <p>The facility was staffed for 63 guests by the weekend, and staff are preparing for many more. The facility is adapting as the surge develops and needs fluctuate and change. Getting it open is just the beginning, says Koenig, who explains the team will continue to learn and refine and serve as long as they have people to serve.</p> <p>“Medically speaking, if we can create an opportunity for people who are otherwise unable to observe public health measures like <a href="https://www.bmc.org/healthcity/population-health/covid-19-infectious-disease-expert-talks-social-distancing">social distancing</a> and hand washing, then that's what we should do. We're a healthcare provider,” says Walsh.</p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/covid-19-coronavirus" hreflang="en">COVID-19 (Coronavirus)</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> </div> </div> <div class="field field--name-field-article-type field--type-list-string field--label-hidden field__item">Article</div> <div class="field field--name-field-bmc-tags field--type-entity-reference field--label-above"> <div class="field__label">BMC Tags</div> <div class="field__items"> <div class="field__item"><a href="/taxonomy/term/1921" hreflang="en">Miriam Komaromy</a></div> </div> </div> Tue, 14 Apr 2020 21:42:54 +0000 Amanda Doyle 136936 at https://healthcity.bmc.org Social Distancing May Increase HIV and Overdose Risk https://healthcity.bmc.org/population-health/social-distancing-may-increase-hiv-and-overdose-risk <span>Social Distancing May Increase HIV and Overdose Risk</span> <span><span lang="" about="/user/6166" typeof="schema:Person" property="schema:name" datatype="">Catherine.Murphy</span></span> <span>April 13, 2020</span> <div class="field field--name-field-categories field--type-entity-reference field--label-hidden field__item"><a href="/population-health" hreflang="en">Population Health</a></div> <div class="field field--name-field-homepage-headline field--type-string field--label-hidden field__item">Social Distancing May Increase HIV and Overdose Risk for At-Risk Populations</div> <div class="field field--name-field-subhead field--type-string field--label-hidden field__item">Isolation and barriers to harm reduction services could increase overdoses and new HIV infections among people who use drugs, experts worry.</div> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <img src="/sites/default/files/styles/feature_image/public/images/article/hiv%20sud%20coronavirus_feature.jpg?itok=sVVDXjgD" width="1000" height="564" alt="Coronavirus social distancing measures may lead to isolation and cutoff from services that can precent HIV and overdose" typeof="foaf:Image" /> </div> <div class="field field--name-field-image-credit field--type-string field--label-hidden field__item">Getty Images</div> <div class="field field--name-field-written-by field__items"> <span class="field__item"> <span>By </span> <a href="/author/meryl-bailey" hreflang="en">Meryl Bailey</a> </span> </div> <div class="field field--name-field-public-publication-date field--type-datetime field--label-hidden field__item"><time datetime="2020-04-13T04:00:00Z">April 13, 2020</time> </div> <div class="field field--name-field-social-share-markup field--type-string-long field--label-above field__items"> <div class="field-items"> <!-- Sharing template --> <div class="sharing"> <!-- FB --> <a id="shareBtn" href="http://www.facebook.com/sharer/sharer.php?u=https://healthcity.bmc.org/taxonomy/term/866/feed&t=Social%20Distancing%20May%20Increase%20HIV%20and%20Overdose%20Risk" target="_blank" class="share-popup"> <i class="fab fa-facebook" aria-hidden="true"></i> </a> <!-- Tweet --> <a href="https://twitter.com/intent/tweet?text=Social%20Distancing%20May%20Increase%20HIV%20and%20Overdose%20Risk&url=https://healthcity.bmc.org/taxonomy/term/866/feed" id="tweet" target="_blank"> <i class="fab fa-twitter" aria-hidden="true"></i> </a> <!-- LinkedIn --> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https://healthcity.bmc.org/taxonomy/term/866/feed&title=Social%20Distancing%20May%20Increase%20HIV%20and%20Overdose%20Risk&summary=Social%20Distancing%20May%20Increase%20HIV%20and%20Overdose%20Risk" target="_blank" class="linkedin-share"> <i class="fab fa-linkedin" aria-hidden="true"></i> </a> <!-- Email --> <a href="mailto:?subject=Social%20Distancing%20May%20Increase%20HIV%20and%20Overdose%20Risk&body=Isolation%20and%20barriers%20to%20harm%20reduction%20services%20could%20increase%20overdoses%20and%20new%20HIV%20infections%20among%20people%20who%20use%20drugs%2C%20experts%20worry.%0D%0A https://healthcity.bmc.org/taxonomy/term/866/feed"> <i class="fa fa-envelope" aria-hidden="true"></i> </a> <!-- Bookmark --> <!-- Print --> <a class="print" href="javascript:window.print()"> <i class="fa fa-lg fa-print" aria-hidden="true" alt="print this page" id="print-button"></i> </a> </div> </div> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>To prevent COVID-19, public health messaging is clear: avoid public places and stay six feet away from other people. But for people facing homelessness and living in a shelter setting or on the street, these practices are nearly impossible to maintain. For people who also struggle with substance use disorders, social distancing messages seem directly at odds with harm reduction recommendations that keep them safe from overdose. And social distancing messages don’t necessary address common substance use behaviors that increase the risk of COVID-19.</p> <p>The fear of coronavirus among people experiencing addiction and homelessness in Boston is palpable. In shelters, the virus has the potential to <a href="https://www.wbur.org/commonhealth/2020/04/06/massachusetts-homeless-covid-19-coronavirus">spread like wildfire</a> with life-threatening consequences. Adding to the intensifying stress, people are now largely cut off from in-person counseling, <a href="https://www.bmc.org/healthcity/research/harm-reduction-opportunities-prevent-opioid-overdose-deaths">harm reduction</a> services, and other social supports. For people with <a href="https://www.bmc.org/healthcity/opioids">substance use disorder,</a> it is a formula for increased relapses and overdoses. Difficulty accessing clean injection equipment could also drive a surge in new HIV infections.</p> <p>Jessica Taylor, MD, medical director of Boston Medical Center’s <a href="https://www.bmc.org/programs/faster-paths-to-treatment">Faster Paths to Treatment</a> program, shares her concerns about people currently caught in the crossfire of separate epidemics, the unique risks they face under social distancing orders, and her hopes for innovative outreach that is emerging to support this community.</p> <h2>HealthCity: What risks do people with substance use disorder and homelessness face while the city is shut down to stop the spread of coronavirus?</h2> <p><strong>Jessica Taylor, MD:</strong> Many recovery support services like behavioral health counseling and peer support groups are upended right now. We are circulating online resources, and luckily a lot of groups are offering virtual support meetings and contact with recovery coaches. But it’s a real change for a lot of our patients, and it’s a sudden loss of concrete support.</p> <p>As we move toward an enforced <a href="https://www.bmc.org/healthcity/population-health/covid-19-infectious-disease-expert-talks-social-distancing">social distancing</a> approach across the country, we also worry that people could have their supply of substances interrupted. We worry that use becomes less safe when people experience withdrawal or when they can’t access their usual dealer and seek out a supply that they know less about – this puts them at <a href="https://www.bmc.org/healthcity/research/few-patients-receive-life-saving-treatment-after-opioid-detox">high risk of overdose</a>.</p> <h2>HC: Another major concern is an increase in HIV during the coronavirus pandemic. Why’s that?</h2> <p><strong>JT:</strong> Before the COVID-19 outbreak, we were talking every day about the <a href="https://www.bostonglobe.com/metro/2020/01/08/state-moves-prevent-surge-hiv-infections-among-homeless-drug-users/s38RVLebgffscxiHvGdqSK/story.html">new HIV outbreak among people who inject drugs</a> that’s happening in Boston right now. A lot of our energy and public health resources were being directed there. And now, of course, public health efforts are focused on COVID-19 prevention, as they should be. But I do worry that the COVID-19 pandemic will separate people who inject drugs from services that provide clean syringes and injection equipment. We could see increased sharing of injection equipment and a further rise in HIV infections.</p> <p class="tweet-border"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fwww.bmc.org%2Fhealthcity%2Fpopulation-health%2Fsocial-distancing-hiv-overdose-risk-substance-use-disorder&amp;via=The_BMC&amp;text=%22Before%20the%20COVID-19%20outbreak%2C%20we%20were%20talking%20every%20day%20about%20the%20new%20HIV%20outbreak%20among%20people%20who%20inject%20drugs.%20I%20worry%20that%20the%20COVID-19%20pandemic%20will%20separate%20people%20from%20services%20that%20provide%20clean%20syringes%20and%20injection%20equipment.%22&amp;hashtags=covid19%2C%20healthcity">"Before the COVID-19 outbreak, we were talking every day about the new HIV outbreak among people who inject drugs. I worry that the COVID-19 pandemic will separate people from services that provide clean syringes and injection equipment." <span class="bctt-ctt-btn">Click To Tweet</span></a></p> <h2>HC: What unique considerations are needed to protect people who use drugs in the coronavirus pandemic?</h2> <p><strong>JT:</strong> One challenge is that the public health messaging to stay socially distanced is really in direct conflict with the overdose prevention messaging that we’ve been giving people for many years — never use alone, use in a group, have someone close to you <a href="https://www.bmc.org/healthcity/population-health/community-narcan-training-extends-our-life-saving-capacity">who can give you Narcan</a> and call 911. We need to be thoughtful about how we apply social distancing messaging to patients who face significant risks from isolation. How can we keep you as safe as possible from COVID while making sure you are monitored in case of overdose?</p> <p>Additionally, we need to talk to our patients about common behaviors that increase COVID-19 risk. For example sharing cigarettes or a pipe to smoke stimulants puts you at really high risk for transmitting COVID-19 because of close proximity to the other person and the potential to pass saliva and respiratory secretions.</p> <p class="pull-quote">Sharing cigarettes or a pipe to smoke stimulants puts you at really high risk for transmitting COVID-19 because of close proximity to the other person and the potential to pass saliva and respiratory secretions.</p> <p><a href="https://www.bmc.org/healthcity/policy-and-industry/collaboration-more-important-ever-protecting-homeless-coronavirus">Boston Healthcare for the Homeless</a> and the outreach teams at Project Trust, <a href="https://www.bphc.org/whatwedo/Recovery-Services/services-for-active-users/Pages/Services-for-Active-Users-AHOPE.aspx">AHOPE</a>, and the <a href="https://www.bphc.org/whatwedo/Recovery-Services/roadmap-to-recovery/Programs-and-Services/Pages/Engagement-Center.aspx">Engagement Center</a> have all been leaders in this in the space. As providers, it’s important that we make sure we keep talking to patients about how to <a href="https://www.bmc.org/healthcity/policy-and-industry/new-remote-dispensing-naloxone-policy-will-increase-access">avoid overdose</a> and <a href="https://www.bmc.org/healthcity/population-health/prep-hiv-prevention-costs-and-coverage-not-only-barriers">prevent HIV</a> and also give them the best information we have on how COVID-19 is spread and what changes they can make, even within the confines of unstable housing.</p> <h2>HC: How are these prevention messages getting out?</h2> <p><strong>JT:</strong> Street-based outreach is a primary method right now. We are very fortunate to collaborate with outreach workers who have built a lot of trust among the community. Our patients have dealt with <a href="https://www.bmc.org/healthcity/policy-and-industry/stigma-barrier-to-sud-treatment-public-policy">so much stigma</a> from the healthcare system that as providers or public health experts or government officials, we often — and rightfully — <a href="https://www.bmc.org/healthcity/research/why-do-people-who-inject-drugs-delay-treatment-infections">don’t have the credibility with this population</a>. So we are relying heavily on the leadership of outreach and harm reduction teams that have really been in the community doing good service and building bridges for a long time.</p> <p>We are also focusing on prevention messages for the patients who do come through the doors. In Faster Paths, our low-barrier addiction bridge clinic, we are maintaining our usual business hours so that we can see the patients who walk in because they don’t have another way to get to us.</p> <p>For those we can connect with by phone, we are offering to move as many new and follow-up visits as possible to telemedicine. With changes in state and federal regulations due to the coronavirus emergency, we are currently able to start and refill buprenorphine to our patients using telemedicine.</p> <h2>HC: Are there challenges to providing telemedicine to clients who are housing insecure?</h2> <p><strong>JT:</strong> One concern that we’ve had with the overall move to telemedicine is that it risks <a href="https://www.bmc.org/healthcity/population-health/preventing-next-wave-opioid-crisis-during-covid-19">exacerbating disparities</a> for patients that are already at the highest risk – patients who don’t have a phone or a private place to have a call. They might be in a shelter, or on the street, or couch surfing. To maintain access for those patients, we’ve partnered with community organizations that already do street outreach and have set up a new pathway where our street outreach workers set up a video conference or telephone call between their device and an addiction specialist.</p> <p><em><a href="/healthcity/population-health/relaxed-federal-policies-enable-street-outreach-substance-use"><span style="color: #a8ad00; font-family: 'Source Sans Pro',sans-serif; font-size: 18px; font-weight: 400;">Keep reading: Faster Path’s street outreach for SUD telemedicine services » </span></a></em></p> </div> <div class="field field--name-field-healthcity-tags field--type-entity-reference field--label-hidden field__items"> <div class="field-label" >Read more related to: </div> <div class="field-items" > <div class="field__item"><a href="/covid-19-coronavirus" hreflang="en">COVID-19 (Coronavirus)</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/hiv" hreflang="en">HIV</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/substance-use-disorder" hreflang="en">Substance Use Disorder</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/opioids" hreflang="en">Opioids</a></div> <span class="seperator"> | </span> <div class="field__item"><a href="/housing" hreflang="en">Housing</a></div> </div> </div> <div class="field field--name-field-article-type field--type-list-string field--label-hidden field__item">Article</div> <div class="field field--name-field-bmc-tags field--type-entity-reference field--label-above"> <div class="field__label">BMC Tags</div> <div class="field__items"> <div class="field__item"><a href="/taxonomy/term/1931" hreflang="en">Jessica Taylor</a></div> </div> </div> Mon, 13 Apr 2020 17:01:57 +0000 Catherine.Murphy 136901 at https://healthcity.bmc.org