The Harvard Square Homeless Shelter (HSHS) first opened its doors to the homeless of Cambridge in 1983 in the basement of University Lutheran Church. Since that time, HSHS has undergone significant growth and transformation. Today, the Shelter provides 24 homeless individuals at a time with a safe, clean, and caring place to stay during the winter months. In addition to temporary shelter, HSHS also provides counseling resources and a transitional program for guests who are employed and committed to saving money towards securing housing. Open from November 15th until April 15th, HSHS is also the only homeless shelter in the country operated entirely by student staff.

How is it that a 57-year-old sociology professor can transcend hyped-up numbers, ideological cant, and government obfuscation to tell us roughly how many homeless there are and where they come from? Our biggest and best news organizations have been unable to perform this simple task for nearly fifteen years.


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Alternative payment models such as accountable care organization contracts are increasingly prevalent among provider organizations that serve disadvantaged and lower-income populations. Understanding patterns of health care spending and utilization of these populations may help inform the design of such payment models. To date, detailed longitudinal claims data on populations experiencing homelessness have been generally not available.

In a study in Health Affairs, members of the Boston Health Care for the Homeless Program (BHCHP) and Boston Medical Center Health System, in collaboration with HCP faculty member Zirui Song, MD, PhD, examine health care spending and utilization of homeless and unstably housed patients cared for by the BHCHP program. BHCHP is one of the largest freestanding homeless health care programs in the United States, serving about 11,000 people across forty-five clinical sites in Boston.

Comparing data from 402 BHCHP patients who were continuously enrolled for 3 years to 18,638 similarly enrolled people insured by Massachusetts Medicaid (MassHealth) with no evidence of homelessness, the study found that observed spending for BHCHP patients was two and a half times higher than Massachusetts Medicaid beneficiaries. BHCHP spent on average $18,764 per person per year on health care. Currently, the risk adjustment for people experiencing homelessness that ACOs receive from Massachusetts Medicaid is $550 person per year. This amounts to only about one-eighth of the adjusted difference in spending between the BHCHP and comparison Medicaid populations observed in the study, suggesting that the current risk adjustment is inadequate.

Outpatient care explained the difference in spending between the two populations. The difference was smaller after adjustment for the risk score, which suggested that homelessness or housing instability was meaningfully correlated with higher expected health care spending.

J.Y.: Hello, and welcome to the 7Sage podcast.I'm J.Y.Ping.Today's guest is one of themost extraordinary people we'veever worked with at 7Sage.Brad went from an LSAT scoreof 157 to a 172, and fromhomelessness to Harvard Law.

And, like, a long storyshort, I got kicked out.And I think my parents' reasoning wasthat I'll kind of see the light andstart agreeing with them if I don'thave any money and I don't have any wayto get around, but that didn't happen.So I was just homeless for around amonth, and this was the summer of 2007.

When I was going through this homelessperiod, some people helped me.I didn't know anybody around thearea, but random people startedto kind of know me at this gasstation that I kind of stayed at.And I still had this plan inmind, right, which is to join themilitary, and there's a couple ofrecruiters that you can talk to.

I just think it would hurt thestory to have one without the other.So, like, it does say diversitystatement, one does say personalstatement, but I think it tellsone cohesive narrative, which Ithink is just the huge strength.And I focus on, I use that diversitypiece, in a way, like, Aaron helped meto use that diversity, like homelessnessand, hey, what am I tying that into?

Hey, what do I want to, whyam I telling the admissionscommittee that I was homeless?Like, what does that do?I don't want to justtell them a sob story.It's like, oh, it actuallyconnects to things that I wantto do in legal practice, or Ihope to do in my legal practice.And so maybe this is bold, but Ijust think I could swap my personalstatement for my diversity statement.It's just, I don't know,it's all so cohesive.

David: Yeah, I agree.And I, normally, I'm not sure thatI approve, normally, of writinga diversity statement that isalso a personal statement, butit really works well for you.I mean, one reason it works is thatat the center of it is what we cancall a diversity factor, which isthe fact that you were homeless.

And I'm going to keep, you know,because it's such a, it was a precarioussituation, I'm never going to forgetthose people in those situationsbecause I can't, right, I was there.I realized what it feels like tonot have anything, to not, youknow, people look at you likeyou're a dog or something, right?And so, in practice, I hope to, startingwhen I'm at school at Harvard and thenlater on, maybe pro bono cases, or maybeI'm doing more than that, helping twopopulations that overlap: homelessness,or homeless people, and veterans, right?Those are two, the intersectionthere is pretty big.

Like Brad says, I think we worrieda tiny bit about leading with thestory of homelessness, even thoughthe story would immediately beabout transcending that moment, justbecause we wanted to sort of startthe reader off on the right foot.So I think at the beginning, maybe itwas a relatively small decision, but aswe went along, there's this interestingthing that happens, which is that thepersonal statement ends with some ofBrad's work with veterans on campus,and some simple statements aboutwhat he might ultimately hope to do.

The diversity statement, eventhough it reaches back to a momentbefore the moment that the personalstatement begins with, also turnsout to just be a way of extendingthe whole story into the future.By discussing the experience ofhomelessness and linking that to theplight that a lot of veterans face,we were able to kind of, we reachback and then look forward again.

This event is the second in a series of university-wide events on housing and homelessness and is co-sponsored by the Initiative on Health and Homelessness at the Harvard T.H. Chan School of Public Health; the Harvard Kennedy School Government Performance Lab based at Taubman Center for State and Local Government; and the Harvard Advanced Leadership Initiative.

Living in extreme poverty means experiencing new trauma every day. This is why homeless students often fail to graduate and frequently enter the criminal justice system or suffer from debilitating chronic illness. I was doomed to fail, simply because I had lost the American life lottery.

Khadijah Williams, a survivor of homelessness, is the D.C. senior manager of Family and Community Engagement at Rocketship Public Schools, a nonprofit public charter network of 20 elementary schools serving low-income communities with limited access to excellent schools. She also serves as a board member for The National Homelessness Law Center and the D.C.-based Innovative Academy of Liberal Arts and Sciences.

I am where I am today because there are people who believed in me, and people took the time to support and motivate me. They gave me the tools to succeed, which made the difference between success and, honestly, the unfortunate reality of homelessness: chronic poverty, prostitution, and death.

Homelessness has long been a severe and persistent problem in Harvard Square. In recent years, there have been significant, commendable strides taken to confront this issue. The city of Cambridge has undertaken measures to help the homeless population obtain subsidized housing and the public restroom installed in 2016 offers great relief for the homeless population.

Volunteers, including many Harvard students, however, are really leading the charge in confronting homelessness in Harvard Square. Harvard Square Homeless Shelter and Y2Y Harvard Square, the only two shelters in the Square, are both affiliates of Phillips Brooks House Association and staffed mainly by Harvard students. These shelters and the volunteers that run them provide essential services to the most vulnerable members of our community.

Both of these shelters operate at full capacity and must use a lottery system, turning away many seeking a night of warmth. HSHS offers 24 two-week beds and five additional emergency one-night beds. They receive as many as 12 callers per two-week bed lottery and rarely have more than one or two beds to give away. These shelters do not have space, funds, or staff to deal with the endless flow of homeless patrons.

On Jan. 31, temperatures dropped to three degrees overnight with a windchill of 15 below. A U.S. Department of Housing and Urban Development count conducted the same night, found there were 561 homeless residents in Cambridge: 142 individuals in transitional housing, 340 in emergency shelters, and 79 unsheltered in the streets. It is a moral imperative on all of us, Cambridge residents, to provide a roof over these 79 heads on below freezing nights.

Yet, there are several reasons that the University has a duty to the vulnerable individuals that live in the streets around its campus. First, Harvard is partly responsible for the rising rent prices plaguing Cambridge. Since the leading cause of homelessness is the lack of affordable housing, the University is partially at fault for the scale of homelessness in Cambridge and, as a result, should help mitigate its effects.

Shelters are by no means a viable long-term solution to homelessness. There is no one-size-fits-all solution to a problem as complex as homelessness; however, Harvard can allocate funds and space to improve the current situation in numerous ways. The University should increase mental health and substance abuse counseling to lower the hurdles preventing the 227 homeless Cantabrigians suffering from substance use disorders and the 99 homeless Cantabrigians suffering from serious mental illnesses as of Jan. 31 from holding down a job and securing housing. e24fc04721

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