The California Statewide Study of People Experiencing Homelessness “paints a representative picture” of homelessness and suggests policies backed by evidence, said Dr. Tiana Moore, the Policy Director at the UCSF Benioff Homelessness and Housing Initiative. “There's a lot of noise in California around who's experiencing homelessness and why,” Dr. Moore said, adding that the study pushes back against narratives that are dominating conversations right now. The study found that nine out of ten participants lost their last housing in the state. It is the largest study of its kind since the mid-1990s and the first large-scale study to use surveys as well as in-depth interviews, allowing researchers to “amplify the voices of those who are experiencing homelessness directly,” Dr. Moore said.

California is home to 12% of the United State's population, but makes up to half of all the country's unsheltered population. In this podcast episode of Fifth & Mission, host Cecilia Lei speaks with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative and lead investigator, about California's largest examination of homeless adults since 1996. "This is a story of deep poverty in a state with incredibly high housing costs." said Dr. Kushel.

Little is known how older adults with a current or recent experience of homelessness navigated the switch to telehealth during the COVID-19 pandemic. Researchers examined the perceptions and use of telehealth, sampling from a larger longitudinal study on homeless-experienced adults in Oakland, CA. They found that the participants experienced challenges accessing the necessary technologies for telehealth.

The United States has fewer labor protections and wage guarantees than most wealthy nations, leaving many workers vulnerable to economic hardship from job loss, reduced hours, or work-related injuries. Based on data from the California Statewide Study of People Experiencing Homelessness (CASPEH), this study shows how income disruptions—through layoffs, unstable gig work, caregiving tied to housing, illness or injury, probation and parole demands, and COVID-19-related impacts—can quickly lead to homelessness when housing costs are high and wages are low.

Nearly one-third of all Americans experiencing homelessness live in California. Starting in the fall of 2021, Aaron Shrank and Sam Comen conducted interviews and photographed unhoused people living in Los Angeles and Northern California as a companion piece to the University of California San Francisco Benioff Homelessness and Housing Initiative’s California Statewide Study of People Experiencing Homelessness to shed light on those affected. You can read a lightly condensed version of their stories. More of Comen and Shrank’s work is available at the website Unhoused CA.

Through interviews of HOPE HOME participants who reported living with family or friends, this qualitative study from BHHI researchers found that intergenerational trauma significantly a...

A large new study, conducted by the UCSF Benioff Homelessness and Housing Initiative asked people experiencing homelessness from all over California about what would have helped them avoid losing their housing. Margot Kushel, MD, the study’s principal investigator and director of UCSF BHHI, spoke with TIME about the studies key findings and recommendations. “You can’t build a homelessness prevention program only around eviction prevention. Those programs are important, but you’re going to miss a big chunk of people.” said Dr. Kushel.

California passed the Community Assistance, Recovery, and Empowerment (CARE) Act in 2022 to provide behavioral health and housing services to individuals with psychotic spectrum and schizophrenia disorders who are deemed unable to care for themselves. This policy brief from the Benioff Homelessness and Housing Initiative at UCSF and the California Policy Lab uses anonymized data to estimate how many San Franciscans in a database of individuals who have contact with the urgent and emergent care system may be eligible for referral to CARE Court and describe their service needs.

This paper describes the qualitative component of a large mixed method study, the California Statewide Study of People Experiencing Homelessness. The qualitative study consisted of seven sub-studies across eight counties, each exploring different dimensions of homelessness. BHHI researchers recruited participants from the overall sample, a statewide representative sample of adults experiencing homelessness recruited in eight counties, based on their responses to questions from the survey interviews. The researchers' mereological study design presents an approach for developing complex qualitative policy studies across a range of topic areas.

There are a lot of myths about people who are homeless in California: They’re from another state. They don’t want a job. They don’t want a home. A new study published by the University of California, San Francisco, paints a different picture, one of people who were working and living in poverty in the state until they suddenly lost their homes. Not knowing where to turn, they ended up on the street, where they endure violence and poor health as they try for years to climb back to stability. “Something goes wrong, and then everything else falls apart,” said the study’s lead researcher, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “Everything in their life gets worse when they lose their housing: their health, their mental health, their substance use.”

Cancer is the leading cause of mortality for people experiencing homelessness (PEH). However, not much is known about cancer-related surgical outcomes among PEH. This retrospective cohort study aimed to characterize access to care among PEH, evaluate postoperative outcomes, and assess costs associated with surgery for malignancy among PEH. Researchers found that PEH were less likely to undergo surgery for malignancy at cancer centers than hose who are housed. People experiencing homelessness also had a higher risk of requiring unplanned surgery.

There is a massive shortage of affordable housing for people with very low incomes in California. Only 24 units of housing are affordable for every 100 extremely low income households in California, compared to 33 units nationally. To address the housing crisis, the statewide study on people experiencing homelessness recommend a variety of policies to increase affordable housing and provide more effort to prevent people from becoming homeless. "This is all about the disconnection between people’s incomes and housing costs" said Margot Kushel, MD, a physician who treats homeless people, and the lead investigator of the study for the UCSF Benioff Homelessness and Housing Initiative.

California is home to 30% of the nation's homeless population, and 50% of the nation's unsheltered population. The UCSF Benioff Homelessness and Housing Initiative released the largest representative study on homelessness in decades. The study's findings dispel common myths and take a systematic approach to understanding the causes of homelessness and potential solutions. Inside the Issues host Alex Cohen speaks with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, about the landmark study and the root causes of homelessness. When talking about older people experiencing homelessness, Dr. Kushel said, "The story of homelessness in California is really older adults, usually older adults of color, living their last years on our streets."

Older homeless-experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. Researchers conducted a cross-sectional analysis of a cohort of 350 homeless-experienced adults aged 50 and older in Oakland, California. They assessed the prevalence of potential surrogate decision-makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives). Researchers found a low prevalence of engagement in a full range of ACP behaviors, including contemplation, discussions, and formal ACP documentation.

High users of the health care system use a disproportionate amount of health services yet have poorer health outcomes. This study aimed to examine natural trends in emergency department visits among high users of health and social services and assess whether the trends differed during the COVID-19 pandemic. In this retrospective cohort study, researchers found that there was a decrease in emergency department visits. Further research is needed to elucidate COVID-19 pandemic specific factors associated with a decrease in emergency department visits.

Unhoused patients have worse outcomes and higher health care utilization compared to their housed counterparts. Previous research has primarily focused on physical and behavioral health. This retrospective cohort study investigated the association between housing status and the nature of surgical care provided, health care utilization, and operational outcomes. Researchers found that unhoused patients commonly underwent emergent operations and had more complex hospitalizations.

Research from BHHI in collaboration with the San Francisco Department of Public Health and UC Berkeley School of Public Health showed how shelter-in-place emergency housing during the C...

The homeless population is aging and adults who experience homelessness for the first time in older age are more likely to progress to chronic homelessness. To prevent or delay homelessness, many people live temporarily live with family or friends. In this qualitative study of homeless older adults, researchers conducted 46 semi-structured interviews. They found that structural barriers to family and friends providing housing for temporary or permanent exits from homelessness included housing regulations, geographic and transportation challenges, and environments inconducive to older adults.

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.

Behavioral health challenges both contribute to and are exacerbated by homelessness. To better understand behavioral health and homelessness, we examined data from the California Statewide Study of People Experiencing Homelessness. Our latest report examines the relationship between homelessness, substance use, and mental health, providing critical insights for policymakers, program leaders, Continuum of Care leaders, and healthcare systems.

Although only 9% of Sacramento's general population is Black, Black residents now comprise 35% of Sacramento's homeless population. A special report released by the UCSF Benioff Homelessness and Housing Initiative on Black Californians' experiences of homelessness highlights the systemic causes that have left so many unhoused. Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, said, "When you consider (leaving) homelessness, you think about the requirements needed to get back into housing — waiting lists, who gets a voucher, who doesn’t get a voucher. It’s hard to get housing or a room. It’s even harder for Black Americans."

California harbors 30% of the United State's homeless population, despite being home to 12% of the nation's population. A new study released by UCSF Benioff Homelessness and Housing Initiative tries to provide a comprehensive picture of how people become homeless and offers policy recommendations to build better programs to address the crisis in California and nationwide. Margot Kushel, MD, BHHI director and lead investigator speaks with Ali Martin about the study's findings. "Absolutely, we need more services, but you can’t ask the health care system to solve a housing problem." said Dr. Kushel.

A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness found that nearly half of California's homeless population is now 50 and older. These older adults are staying homeless for longer and are in poorer health than their younger peers. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "These are people living on fixed incomes, on disability, on really meager pensions, and they really need housing that they can afford."

California invested $17.5 billion over four years to combat homelessness. However, despite the investment, there has been an increase in the number of people experiencing homelessness across the state. A recent report by the UCF Benioff Homelessness and Housing Initiative dispelled common myths about homelessness. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative and lead investigator said, "Nine out of 10 people lost their stable housing here. These are Californians. We have to create the housing for all Californians"

On this podcast episode of Think Out Loud, Dave Miller speaks with Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, about the new study on homelessness and how the findings could be relevant to Oregon. When talking about how the study's findings could provide insight to Oregon, Dr. Kushel said, "I'm afraid what we're seeing in California is definitely a model, in not a good way, up and down the west coast, and throughout other parts of the country."