The Special Projects of National Significance (SPNS) Program Building a Medical Home for Multiply Diagnosed HIV-positive Homeless Populations initiative was a multi-site demonstration project funded during fiscal years 2012-2017. The nine demonstration sites designed, implemented, and evaluated innovative interventions to improve the timely entry, engagement, and retention in HIV care and support services for homeless and unstably housed people living with HIV with co-occurring mental illness and/or substance use disorders. The interventions employed models of care focused on the development of sustainable linkages to mental health, substance abuse treatment, and HIV primary care services for homeless or unstably housed people living with HIV. The transient and unstable lives of homeless people living with HIV and co-occurring mental health or substance use disorders required coordinated efforts to engage and retain them in care by addressing their complex service needs and to ensure their adherence to treatment.
Therefore the interventions adopted a set of organizational structures characterized by integrated or co-located strategies for service provision by each demonstration site. Demonstration sites also provided intensive coordination of care and service needs to ensure retention and adherence to treatment. Integrated services were defined as the management and delivery of HIV primary care, substance abuse and mental health treatment. Demonstration sites also included access to housing resources and services for their target population through the co-location of services within an HIV primary care clinic, within a public housing facility that serves the target population, or by building a network of providers through the execution of memoranda of understanding or contracts.
The Center for Advancing Health Policy and Practice (formerly the Health and Disability Working Group) of the Boston University School of Public Health (BU SPH) worked in partnership with the Boston Health Care for the Homeless Program to comprise the MEDHEART (Medical Home Evaluation and Research Team) Evaluation and Technical Assistance Center. MEDHEART coordinated the multi-site evaluation and provided programmatic technical assistance to the demonstration Sites. The demonstration site recipients included AIDS Arms, Dallas, TX; San Francisco Department of Public Health, San Francisco, CA; City of Pasadena, Pasadena, CA; County of Multnomah, Portland, OR; Family Health Centers of San Diego, San Diego, CA; Harris Health System, Houston, TX; CommWell Health, Newton Grove, NC; University of Florida, Gainesville, FL; and Yale University, New Haven, CT.
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