Our Research

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.

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.

This commentary coauthored by BHHI faculty describes how a coalition of Bay Area community organizations, academic institutions, and public health departments collaborated to provide high-risk populations with Covid-19 testing and vaccination, and also took the opportunity to connect them with other essential services.

This UCSF study compared infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States. In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness.

A UCSF study found that during the COVID-19 pandemic in California, older adults, Black and Latino residents, and those without college degrees experienced the highest per capita excess mortality. The researchers suggest that this pattern reflects the risk of COVID-19 death faced by low-wage, essential workers and their social networks owing to occupational exposure, crowded housing, and inadequate access to testing or treatments.

COVID-19 impacted access to medical care and social services, potentially worsening HIV outcomes among people experiencing homelessness. In San Francisco, Ward 86, initiated POP-UP, a low-barrier, multicomponent model of care to address barriers to care for people living with HIV experiencing homelessness. Researchers found that care engagement and viral suppression did not worsen among the 85 patients enrolled, despite concerns that the COVID-19 pandemic might worsen outcomes. The study suggests that multicomponent interventions may help maintain viral suppression despite unanticipated structural barriers.

A new study from UCSF Benioff Homelessness and Housing Initiative and the San Francisco Department of Public Health describes how San Francisco rapidly scaled a hotel-based isolation and quarantine (I/Q) system of care for people experiencing homelessness during the COVID-19 pandemic. Researchers found the program safely delivered integrated medical and behavioral health support to more than 1000 individuals outside the hospital setting, while helping to preserve hospital capacity.

During the COVID-19 pandemic youth experiencing homelessness (YEH) were disproportionately impacted; there were common upstream factors, including racism, homophobia, poverty, and structural violence that place youth at risk for homelessness and exposure to SARS-CoV-2. Public health guidelines overlooked YEH. In this commentary, researchers discuss practical strategies to address the unique health and social needs of YEH.

This UCSF study examined whether permanent supportive housing reduces the use of acute health care and other services among people experiencing chronic homelessness. The Permanent Supportive Housing program intervention was able to house 86% of chronically homeless adults randomized to the treatment group based on their high use of multiple systems. Even the most frequent clients of medical, psychiatric, and emergency services were housed successfully, as demonstrated in this study of Project Welcome Home in Santa Clara County.

Older homeless-experienced adults have low rates of advance care planning (ACP) engagement. In this cross-sectional qualitative study, researchers examined potential barriers and solutions to ACP engagement. Researchers found that participants believed that ACP is important, but acknowledge the multiple barriers to engagement. Potential solutions include capitalizing on opportunities outside health care setting and focusing on the period after housing and tailoring content.