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A special report, released by UCSF Benioff Homelessness and Housing Initiative, explored the relationship between intimate partner violence (IPV) and homelessness in California. Findings from the report showed how violence and economic insecurity can be intertwined. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "There are only so many places you can hide when you’re unsheltered."

Domestic violence, frequently referred to as intimate partner violence (IPV), is a common precipitant of homelessness. This webinar is about the intersection of intimate partner violence and homelessness. Anita Hargrave, MD; Lived Expertise Advisory Board Members Jesica Giannola and Dez Martinez; Tiana Moore, PhD, and Debbie Chang, MPH, CEO of the Blue Shield of California Foundation discussed relevant findings from the California Statewide Study of People Experiencing Homelessness (CASPEH), highlighted key policy recommendations, and answered audience questions.

To better understand the experiences of survivors of intimate partner violence currently experiencing homelessness, this report analyzed data related to IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH)—the largest representative study of homelessness since the mid-1990s. The mixed-methods study included data about participants’ experiences of violence across the life course, in the six months prior to homelessness, and during their current episode of homelessness. The report presents these findings to advance research-backed solutions for preventing and responding to homelessness among survivors of IPV. 

SAN FRANCISCO – The University of California, San Francisco Benioff Homelessness and Housing Initiative (BHHI) today released a special report on the relationship between intimate partner violence (IPV) and homelessness in California. The analysis is based on survey data and in-depth interviews from the California Statewide Study of People Experiencing Homelessness (CASPEH), the largest representative study of homelessness in the United States since the mid-1990s.

In this op-ed, Morgan Philbin, PhD, MHS, associate director at the Benioff Homelessness and Housing Initiative and director of the Educations Program, calls for progressive states to become safe havens for LGTBQ+ adolescents. She highlights the various discriminatory policies that have been introduced across the US and how those policies force LGTBQ+ individuals to move, often to more expensive areas. Dr. Philbin writes, "While supportive policies are imperative to counteract the discriminatory legislation enacted nationwide, progressive states must also develop policies and programs to support LGBTQ+ adolescents who are being forced to move there to access healthcare and maintain their physical and mental wellbeing." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

A growing number of people with lived experience of homelessness are finding opportunities in California to influence academic projects. More entities are beginning to create entire boards or councils of people who know what it is like to lose their housing. With regards to including a lived expertise advisory board in UCSF BHHI's California Statewide Study of People Experiencing Homelessness, Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, said, "The researchers had missed an entire world of economic insecurity, and the survey was much richer because the board members could see things the researchers could not."

In this op-ed, Jesica Giannola, one of the CASPEH Lived Expertise Advisory Board members, calls attention to the unfair polices in the "Fair Housing Act". She outlines the issues and the need for reform, calling for young-adult and high school students to also be included under the same protections of families with minor children. "While it’s absolutely fair to ensure tenants can reliably pay rent, it’s incomprehensible that the same screening conditions applied to adults are also required of their 18-year-old high school students." Ms. Giannola writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Cheyenne Garcia, senior research analyst at the Benioff Homelessness and Housing Initiative, calls for colleges to step up in helping students who experience homelessness. She outlines the how the school breaks disrupts the lives of students, as not every student has a place to go once classes are over. "The chronic stress of finding short-term housing break after break and year after year can take a toll on the mental and physical health of already stressed students." Ms. Garcia writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Maria Raven, MD, MPH, associate director at the Benioff Homelessness and Housing Initiative, outlines the civic responsibility physicians have, even as private citizens, to be thoughtful in how they share their views. She explains that free speech protections are crucial for physicians regarding their practice of clinical medicine, but physicians should take care to not create an environment that could cause patients harm. Dr. Raven writes, "While hate speech from a physician's private social media account may be protected by the First Amendment, it stands in stark contrast to the ethical embodiment of 'first do no harm.'" This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

California accounts for about a third of the nation’s homeless population and among this population, seniors are the fastest growing group. Research shows that living on the streets prematurely ages and sickens people. “When talking about homelessness, 50 is the new 75,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “Whether it be measures of cognitive decline, mobility, problems with function falling, all of the things that we usually think of happening to people in late life just happen to people 20 or 30 years earlier,” said Dr. Kushel. “And tragically, people also die.”

In this op-ed, Tom Murphy, the Senior Director of Communications for the National Alliance to End Homelessness, calls congress to fully fund and expand veteran homelessness programs. He highlights the rise in veteran homelessness while also acknowledging the sterling track record of the federal government's veteran homelessness programs. "It is wholly unreasonable and inappropriate not to invest in resources that would protect veterans and the citizens on whose behalf they served. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Unhoused patients have worse surgical outcomes than the general population, resulting in premature mortality. Researchers conducted 26 semi-structured interviews of clinicians who care for patients with surgical disease. The researchers identified 5 themes, including, but not limited to: patients and clinicians face multiple challenges meeting preoperative requirements; although surgeons do not make major operative decisions based on housing status, some take it into consideration for minor care decisions; clinicians perceive that unhoused patients have negative postoperative experiences in the hospital.

In a cohort of over 100,000 patients who received care from the Department of Veterans Affairs (VA) health system, those experiencing homelessness were more likely to be diagnosed with stage IV colorectal cancer compared with those who had housing. The patients who experienced homelessness also had longer hospital stays for all the cancer types studied. However, the findings differed across healthcare settings. In a commentary accompanying the study, Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, said "Reducing healthcare disparities for people experiencing homelessness is essential, and the [VA] can serve as an example of what it takes to do so."

Cancer is a leading cause of death among older people experiencing homelessness. In this retrospective cohort study, researchers sought to characterize the diagnosis, treatment, surgical outcomes, and mortality by housing status of patients who receive care from the US Department of Veterans Affairs (VA) health system for colorectal, breast, or lung cancer. Researchers found that homelessness was associated with later stages at diagnosis for colorectal cancer.

In this commentary of the study "Housing Status, Cancer Care, and Associated Outcomes Among US Veterans", Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, provides lessons from the Veterans Health Administration. In 2009, the VHA began a multipronged initiative designed to end and prevent homelessness among veterans, which led to a 45% reduction in veteran homelessness from 2009 to 2017. Dr. Raven writes, "The results of this study indicate that in addition to providing housing at comparatively high rates for unhoused veterans, the system’s initiative to prevent and end veteran homelessness has also likely helped reduce important disparities in oncologic care for this population."

In this op-ed, Margot Kushel, MD,  professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, calls attention for the need of federal investments in affordable housing. She outlines that the federal governments disinvestment in affordable housing has forced local governments to use general funds to provide assistance, further highlighting it will take a coordinated effort between agencies to solve the crisis. "Increased federal funding is necessary, but not sufficient. Yet without it, it will be difficult to end homelessness. This crisis is solvable. Ensuring that people have housing that they can afford – through higher income, lower rents and dedicated rental assistance, as well as access to appropriate services – is essential." Dr. Kushel writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In the state of California, the three major utility companies, have nearly doubled electricity rates over the last decade. With growing increase in energy demands, the rising utility costs are pushing families already at the margins to the brink of homelessness. Many people are forced to making an impossible choice. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I think recognizing energy insecurity as a contributor to this crisis, this is the next frontier that we need to really worry about."

An increase in the number of deadly attacks on people experiencing homelessness has coincided with a spike in people experiencing homelessness in the US. What concerns many is that the attacks occur regularly and without notice. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "This violence is happening every day, just outside of our vision."