The articles listed here are the same ones we use for our journal club each month.


How I Helped Create A Flawed Mental Health System That’s Failed Millions—And My Son

A former state legislator experiences firsthand the devastating consequences of past policy mistakes—and imagines what he’d do differently now.

Mortality and Access to Care among Adults after State Medicaid Expansions

Smoking Cessation in a Homeless Population: There Is a Will, but Is There a Way?

The Promise and Peril of Accountable Care for Vulnerable Populations:  A Framework for Overcoming Obstacles

The Boston Health Care for the Homeless Program: A Public Health Framework

What You Need to Know When Called Upon to Be a Good Samaritan  

Understanding your legal protections and ethical obligations can make it easier to respond when duty calls.

Schizophrenia for Primary Care Providers: How to Contribute to the Care of a Vulnerable Patient Population

A Successful and Sustainable Health System — How to Get There from Here

Supreme Court Review of the Health Care Reform Law

The Fate of Health Care Reform — What to Expect in 2012

Cost-Effectiveness of Services for Mentally Ill Homeless People:   The Application of Research to Policy and Practice

Hypothermia in a desert climate: severity score and mortality prediction

The Role of the Emergency Department in the Care of Homeless and Disadvantaged Populations

Sheltered Versus Non-sheltered Homeless Women

This study interviewed homeless women of LA county to contrast the epidemiological and healthcare risks of women who were sheltered versus unsheltered.  The in-time study concluded that shelter greatly decreases the healthcare risks of homeless women and aggressive outreach is necessary to give care to those living without shelter.

Health Care For Homeless Women 

This cohort study examines the perceived barriers to healthcare that homeless women face.  The study was done in 1997 and interviewed homeless women of LA county to determine whether they had a perceived unmet need for healthcare and then examined what caused this unmet need.  The study concluded that several factors including a regular source of care, short waiting times, and better knowledge of the services available will increase the chances of women getting the healthcare they need.

Risk Factors for Death in Homeless Adults.

This case study looks specifically at a small population of homeless in Boston who use the Boston Health Care for the Homeless Program. In the study, homeless patients who died between 1988 and 1993 were matched with patients of similar age who lived. Results indicated certain medical conditions that significantly increased the risk of death. The most deadly conditions include liver and renal disease, cold-related injury, and HIV/AIDS.

A Public Health Approach to Reducing Morbidity and Mortality Among Homeless People in Boston

A public health task force was created in response to an inordinate number of deaths among Boston’s homeless in the winter of 1998-1999. The project was a collaborative effort involving many state health programs and included an intensive investigation of 13 deaths. Findings are discussed and potential solutions are presented.

Premature Mortality in Homeless Population: A Literature Review

Dr. Jim O’Connell reviews research on homelessness in western culture through the 19th and 20th Centuries. By analyzing various studies done in major cities in Europe, Canada, and the United States, he demonstrates several commonalities among homeless populations. People with the highest risk are consistently male, alcohol or other substance abusers, and sleeping on the streets. In addition, Dr. O’Connell provides criticism for previous research methods and assesses needs for future studies.

Medicaid Costs and Homelessness

This article discusses permanent supportive housing as an effective method to reduce Medicaid costs in the U.S. According to data from several major U.S. cities, Homeless Medicaid recipients constitute the majority of high-cost emergency room visits. A cross-analysis of Medicaid cost data with housing programs shows support for the Common Ground intitiative.

Hot Spotters

Atul Gawande details the story of a doctor in Camden, New Jersey who works to make medical programs more effective for the homeless and economical for the health care industry. The conversational tone, full of anecdotes and testimonials, makes this article accessible to all interested in the humanitarian effort.

Sheltered vs Nonsheltered Homeless Women

This study analyzes the key difference between sheltered vs. non-sheletered homeless women. There is a critical need for aggressive outreach programs that provide mental health services and substance abuse treatment for homeless women on the streets. Comprehensive services that also include medical care, family planning, violence prevention, behavioral risk reduction may be particularly valuable for homeless women, especially those living in unsheltered environments.

The Homeless in America- Adapting Your Practice

Intended for physicians working with homeless populations, this article reveals practical guidelines for examining patients and prescribing medications. These guidelines promote awareness of limitations presented by unusual living conditions. For example, homeless patients living in shelters will have difficulty adjusting their diet. Several similar situations are provided and discussed.

Taking it to the Street-Homelessness, Health, and Health Care in the United States

The author opens his discussion with three facts of homelessness; it causes health problems, exacerbates health problems, and makes administering quality health care difficult. Despite large number or health care programs tailored for underserved populations, homelessness is a growing problem in the U.S. The author poses his opinion that this will persist until health insurance, housing, and income disparities are addressed.

Health Care Headaches–Accessing Safety Net Services

The effectiveness of the Operation Safety Net program in Maryland, which offers health care for the homeless, is analyzed in this editorial. Barriers to access are discussed with emphasis on the lack of health insurance. Statistics of the uninsured population demonstrate that many have jobs, but employers are not providing benefits.

Hard to Reach- Rural Homelessness and Health Care

This article alerts readers to the reality of homelessness in rural areas.  Topics discussed include the causes of rural homelessness and differences in the quality and quantity of health care programs for the underserved in rural versus urban areas.

Prevalence of Skin Infections in Sheltered Homeless

Infections in the Homeless