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UCSF BHHI director Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, says solving homelessness shouldn’t be just one neighborhood or community’s responsibility. “Everyone wants homelessness solved but people are worried. They have concerns and to be honest, neighborhoods block the things they most need, which is if they had housing in their neighborhood they would have fewer people facing homelessness,” Dr. Kushel said.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, is among the panelists discussing how the partnership between UCSF scientists, government officials, advocacy organizations, and media has changed the way older adults experiencing homelessness received support from the City of Oakland. The film highlights how structural inequities can be addressed through influencing and widely scaling local policies and programs.

This brief on the Home Safe program summarizes key findings from the UCSF Benioff Homelessness and Housing Initiative’s (BHHI) interim evaluation of the program. It includes a brief description of the program, an overview of the evaluation’s design, and an assessment of the Governor’s 2021-22 budget proposal to expand Home Safe eligibility.

The UCSF Benioff Homelessness and Housing Initiative collaborated with the California Homeless Coordinating and Financing Council and the California Health Care Foundation to create resources to help homelessness response systems with COVID-19 vaccination planning. The second in a series, these materials detail key lessons learned from the early rollout of COVID-19 vaccination events for sheltered or service-connected people experiencing homelessness.

The homeless population is aging and people experiencing homelessness are at a heightened risk of experiencing physical and sexual victimization. This study examined whether homelessness is independently associated with experiencing physical or sexual abuse. Researchers found that older homeless adults experience high rates of victimization.

The San Francisco Department of Public Health implemented the Coordinated Care Management System (CCMS) in 2007. The CCMS is used to develop High Users of Multiple Systems (HUMS) tp identify individuals with the highest use of emergency medical services. Researchers described the HUMS scoring system and the characteristics and service use of the highest scoring 100 individuals. Researchers found that nearly all of the individuals had a history of homelessness in SF, and over half were unsheltered at their last point of contact.

With cities implementing new camping bans and conducting new removals, advocates and homelessness experts are troubled by the new wave of enforcement around homelessness. In addition, temporary shelter still falls short of what is needed to move people off the street for good. “The goal should be to get everyone into permanent housing,” said Ned Resnikoff, policy manager at the University of California, San Francisco Benioff Homelessness and Housing Initiative. “If getting them sheltered doesn’t get you closer to that goal, then you actually haven’t solved anything.”

Several shelter-in-place hotels, where people with medical vulnerabilities have safely quarantined since the pandemic broke out, will close by the end of August, and the city’s largest congregate shelter has paused intakes for weeks due to positive COVID tests from residents. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, “Non-congregate shelter is a really important intervention. It has been throughout the pandemic and with the virulence of the delta variant is, arguably, more so now. Getting people into safety is important for all.”

In this podcast, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, explains the country’s rise in homelessness and the critical impact of housing on the health needs of vulnerable populations.

In this article about Project Homekey, Margot Kushel, MD, director of the University of California San Francisco's Benioff Homelessness and Housing Initiative, described how the goal is to make sure even the “hardest-to-house” people will come inside. To that end, Dr. Kushel said Homekey gets the most important part right: providing permanent supportive housing, not temporary shelter. “Some people need services that go along with that housing, and some people don’t. But the really essential thing is that without the housing, the services don’t work,” she said.

An event in San Francisco called “Public Health is Public Safety,” brought together a dozen experts from homelessness services, policy, research, and jail health services backgrounds. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed a successful “housing first” study conducted in Santa Clara, which found that simply providing housing to people who most needed it helped reduce emergency room visits and allowed people the chance to get mental health services.

Although the majority of San Francisco residents have been vaccinated against the coronavirus, people experiencing homelessness may still face barriers to vaccination. By walking the streets and offering immunizations on the spot, Code Tenderloin has collaborated with UCSF and Glide to try to overcome those barriers. Margot Kushel, MD, who directs the UCSF Benioff Homelessness and Housing Initiative, said UCSF health workers asked Code Tenderloin to take the lead in the outreach work, "I can’t emphasize enough how much our efforts were led by Code Tenderloin, who really in the Tenderloin is seen as a very trusted entity. They know the community. They’ve been there, they get it."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted regarding lower vaccination rates in people experiencing homelessness in the Bay Area, where multiple outbreaks and rising case rates in homeless shelters have experts concerned. "You have to be able to trust science, you have to be able to trust the health care system, you have to be able to trust the people you’re around," said Dr. Kushel. "And I think people who are homeless often have had a lot of trauma and a lot of reasons to not trust those systems."

In this podcast, follow along on a walk through the Tenderloin where outreach workers from Code Tenderloin offered on-the-spot COVID-19 vaccination, and hear how Margot Kushel, MD, a physician and researcher who directs the UCSF Benioff Homelessness and Housing Initiative, is part of a collaborative multi-organizational effort to bring the vaccines to people out on the streets. UCSF BHHI and Dr. Kushel hope approaches like this can build trust and immunity.

Margot Kushel, MD, a professor of medicine at University of California San Francisco, who leads the UCSF Benioff Homelessness and Housing Initiative, also said there’s little evidence of correlation between mental health and homelessness. Instead, she said the places with highest homelessness have a split population of high earners who can afford to pay housing costs, and those who can’t, competing for a limited supply of housing. Think: San Francisco. Dr. Kushel recently conducted a study in which researchers approached the 400 most chronically homeless people in Santa Clara and offered them a permanent home. All but one said yes.

This UCSF study reported the public health response to a COVID-19 outbreak in a San Francisco shelter where 67% of residents and 17% of staff tested positive for SARS-CoV-2. The researchers describe the limited utility of case investigation, person-based contact tracing and symptom screening, and the benefits of mass testing in outbreak response.

When pandemic aid programs begin expiring at the end of September, advocates worry that San Francisco’s most vulnerable homeless women will once again be left behind. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed the rate of violence impacting homeless seniors, women, and transgender people. After two decades of studying high rates of assault and the health impacts of homelessness, she has watched Bay Area seniors placed into hotels during the pandemic transform, to the point where staff didn’t recognize some of them. “It’s been a life-changing experience,” Dr. Kushel said. “When people regain housing, everything gets better.”