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Our Research
Barriers and Facilitators to Resolving Older Adult Homelessness Through Stays With Family: Qualitative Findings From the HOPE HOME Study
Journal of Social Distress and Homelessness • February 8, 2022
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.
Our Research
Barriers and Solutions To Advance Care Planning Among Homeless-Experienced Older Adults
Journal of Palliative Medicine • September 22, 2020
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.
News
Bay Area cities crack down on RV living, pushing homeless residents across borders
May 7, 2026
People who live in cars and RVs throughout the Bay Area are moving between cities as crackdowns on street encampments ramp up, a trend that pushed Oakland officials to adopt a new policy speeding up tows over concerns the city is becoming a “destination” for displaced residents. BHHI Director Dr. Margot Kushel says that cities are competing in a “race to the bottom” to pass stronger restrictions on encampments than their neighbors.
News
Bay Area Homelessness Could Be Solved With $11.8 Billion, Says New Report
San Francisco Chronicle • June 2, 2021
The Bay Area Council released a report stating that it would take $11.8 billion to get every unhoused person in the Bay Area off the streets. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, who advised on the report, said, "One thing that’s great is for people to have an honest conversation about what homelessness would really cost to end. Maybe that way we won’t just constantly criticize efforts being made, which have never been scaled to address the problem, which has existed for 40 years." Dr. Kushel dates the beginning of modern homelessness to Ronald Reagan’s decimation of poverty programs in his first years as president.
Research Area
Behavioral Health
The stress of experiencing homelessness can amplify previous mental illness and trigger anxiety, depression, fear, substance use, and sleeplessness.
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Behavioral Health and Homelessness
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. Key Findings Nearly half (48%) of people experiencing homelessness in California have complex behavioral health needs—regular drug use, heavy drinking, hallucinations, or recent psychiatric hospitalization. About one-third (35%) report regular drug use; 42% reported that they began to use regularly after the first
Reports
Behavioral Health and Homelessness
March 19, 2025
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.
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Benioff Homelessness and Housing Initiative
The Benioff Homelessness and Housing Initiative (BHHI) provides accurate, timely policy-oriented research about homelessness for local, state, and national policymakers and practitioners. Funded by a generous gift from Marc and Lynne Benioff and based at the UCSF Action Research Center for Health Equity, BHHI aims to be a trusted source for evidence-based practice, policy, and scalable solutions—turning evidence into action to prevent and end homelessness.
News
Berkeley’s Strategy for RV Encampments Could Be a Model for California
June 12, 2025
In January 2025, the City of Berkeley launched an innovative program to resolve the 2nd Street encampment by combining a low-barrier motel shelter with cash payments for residents’ RVs. Outreach workers built trust and tailored policies—allowing pets, partners, and friends—to boost participation. So far, 36 people and 26 animals have moved into the Capri Motel, and only three RVs remain on site. “The city designed this to really gain people’s trust and to make sure that people were not left worse off than they were when they started,” said Dr. Margot Kushel, calling the program “quite innovative.” BHHI is independently evaluating its impacts to inform future strategies.
Person
Berty Arreguin, PhD
Berty is a Mexican-American scholar, a first-generation college graduate, and the first in her family to earn a doctoral degree. Born and raised in Fresno, California—a community deeply affected by persistent health inequities; including many of her own family—she was inspired early on to pursue meaningful change through scholarship. This commitment led her to complete a PhD in Medical Sociology at UCSF. Her research centers on understanding how social, emotional, and structural forces intersect to shape health outcomes and healthcare experiences, particularly among racially and socioeconomically diverse populations living with diabetes. Drawing on both quantitative and qualitative methodologies, Berty brings
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BHHI Education Programs
Due to funding constraints, we are not currently recruiting for these programs. For updates, connect with us at the links below. Postdoctoral Scholars Program The BHHI postdoctoral scholars training program educates the next generation of strategic scientists empowered to address upstream causes of homelessness. Our projects rely on various research methodologies including quantitative methods, qualitative methods, or mixed methods and utilize a wide-ranging set of research designs including longitudinal, cross-sectional, quasi-experimental, natural experiments, implementation and translational science, and policy evaluation. Scholars work closely with BHHI faculty, including an assigned mentor from within BHHI, to conduct research related to homelessness and
BHHI Guidance on COVID-19 Vaccination Planning for Homelessness Response Systems
CA Homeless Coordinating & Financing Council, Benioff Homelessness and Housing Initiative, California Health Care Foundation • February 2, 2021
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 first in a series, these materials detail strategies for vaccinating homelessness service workers and people experiencing homelessness in California.
News
Biotech Takes On Racial and Social Equity. Are the Efforts Sustainable?
San Francisco Business Times • March 24, 2021
This article reports on weekly vaccination events in partnership with UCSF Benioff Homelessness and Housing Initiative, Glide Memorial Church, the San Francisco Community Health Center, and the city's Department of Public Health to distribute COVID vaccines and support packages. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said biotech companies have helped fund the efforts, allowing community-based organizations to hire trusted ambassadors to spread word about the vaccination events.
News
Black People Are Increasingly Overrepresented in Sacramento Homeless Population, Report Says
Sacramento Bee • June 11, 2024
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."
News
Boomers Own Half of U.S. Wealth. So Why Are We Seeing More Homeless Boomers?
The Wall Street Journal • May 13, 2024
Baby boomers own over 35% of all large homes in the US, and many of these older Americans are choosing to stay in their homes, exacerbating housing costs. This problem is even more apparent in California because their unique tax law incentivizes people to stay. On the other hand, younger boomers reaching retirement are increasingly facing homelessness. The University of California, San Francisco Benioff Homelessness and Housing Initiative California Statewide Study of People Experiencing Homelessness, found that over 40% of homeless older adults in California were homeless for the first time after the age of 50.
Opinion
Breaking the Silence: A Call for Rapid Hepatitis C Testing to Save Black Lives in America
Visible • February 20, 2024
In this op-ed, Meghan D. Morris, PhD, MPH, an associate professor at the University of California, San Francisco, calls for rapid hepatitis C testing. She outlines the current testing process for hepatitis C, creating structural barriers, and how improving testing can address racial disparities. Dr. Morris writes, "It’s time for a comprehensive approach to eliminate hepatitis C, addressing racial disparities and ensuring timely diagnosis and treatment initiation." 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.
Our Research
Brief Report: Heterogeneous Preferences for Care Engagement Among People With HIV Experiencing Homelessness or Unstable Housing During the COVID-19 Pandemic
Journal of Acquired Immune Deficiency Syndrome • June 1, 2022
People living with HIV (PLH) experiencing homelessness or unstable housing have lower rates of viral suppression compared to people who are housed. In 2020, only 20% of PLH experiencing homelessness in San Francisco were virally suppressed, compared to 71% of those who were housed. Researchers examined case preferences among PLH experiencing homelessness during the COVID-19 pandemic in San Francisco. They found that the strongest preference were for the same provider, visit incentives, and drop-in visits.
News
Building Emergency Housing to Meet the Unique Needs of Older Adults
Route Fifty • June 21, 2024
The face of homelessness in America is growing older. Recent projections report that the population of unhoused older adults will triple between 2017 and 2030. As more generations reach retirement age, there is a need for policymakers to consider how housing and homeless services should be adapted to meet the needs of the aging unhoused population. Marc Dones, policy director at the UCSF Benioff Homelessness and Housing Initiative, said, "The country is in the midst of a housing crisis so severe that people who have worked their whole lives are suddenly becoming homeless."