1/This report on the homeless “sweep” at Boston’s Mass & Cass highlights a tragedy to which the city contributes, and some helpful points for people thinking about unsheltered homelessness wgbh.org/news/local-new…
2/The City’s accumulation of persons who are unsheltered partly results from the City’s closure of its Long Island Shelter, which was often used by people with drug use disorder - I used to work there Image
3/But it is also true many people really do not tolerate congregate shelters at all. Close quarters with people who might be intoxicated or paranoid is actually not an easy thing.
4/It is mentioned that the City is putting some people with active opioid use disorder in jails without treatment (an inhumane practice but in no way unique to this state). But it is Mass. data that show ⬆️ overdose death rate for people who go through this.
5/It may help to note that Boston sits on a spit of highly developed land with high cost properties (a bit like SF). This likely contributed to having more unsheltered people in one place - that arrangement is a collective decision
6/Given the primitive state of online debates on homelessness, I encourage reading professor Brendan O’Flaherty - the place characteristics are more strongly associated with the number of persons homeless and the people characteristics influence who becomes homeless Image
7| Unsheltered homelessness draws community upset and rancorous polarized discussion. But for all of that @naehomelessness reminds us the majority of persons homeless are in sheltered settings, often including families with children Image
8/I understand the community frustrations with seeing people homeless. I want to note that it is usually pretty awful to *be homeless* even if the statement “I am here because I choose to be” is sometimes said. Behind the “choice” is a story we can’t presume to know /fin

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More from @StefanKertesz

4 Nov
1/Join us for "Research to Measure What Matters in Primary Care for Persons Experiencing Homelessness: What's the Point, Really?"

@HarvardChanSPH Initiative on Health & Homelessness
Register online for our event Wed 11/10, 1pm EST
Let me offer a brief 🧵: Image
2/I began focusing on homeless patients' views of care after working in Boston's shelters.

"Wow!" I thought "much of what we do we doesn't look good with traditional ways of measuring quality of care!"

My co-presenter Dr. Roncarati has >15 yrs with the @BHCHP Street Team Image
3/Standard quality of care metrics (visit counts, blood pressure checks) seem good

but what if what we homeless health clinicians *really focus on* is:

"Spending hours to build trust with a person who has been traumatized by repeated bad experiences in health care?"?
Read 9 tweets
3 Nov
1/It is bad that clinician performance on matters related to the opioid crisis is *still* being measured in terms of # of opioid prescriptions.
These metrics, which ape prior metrics that drove the original⬆️ reject the approach we normally require for measuring quality of care
2. To be clear. Optimal health care metrics require
a) clear denominator of eligible patients with the condition
b) clear evidence that the treatment's provision is wholly good or its nonprovision wholly bad
c)evidence that imposing the metric leads to improvements in health
3. For example, a metric such as "provision of cervical cancer screening" would be BAD if it includes persons with no cervix either because of hysterectomy, or because they are cis-male.
Read 11 tweets
29 Oct
1/For any discussion of homelessness - please remember: the key driver of *total number of people homeless* in any area of the US is the number of units that are affordable to poor renters
2/Efforts to blame homeless numbers in West Coast cities to "fentanyl" are not based in evidence. Here's an opioid overdose per capita map. States with horrific overdose crises often have lower homeless counts per capita than ones like California, where the OD rate is lower Map of overdose by state in the USA showing high overdose ra
3/Still not convinced? San Francisco's homelessness is high per capita. It's fair market rent for a 2-bedroom apartment is $3500!!! That translates downhill to poorer folks not being able to afford an extra bedroom or accommodate family members with problems of any kind
Read 14 tweets
13 Oct
1/Prescription opioid counts have fallen to levels last seen in 1992,reports ⁦@US_FDA⁩ Corinne Woods, PharmD for workshop at Duke Margolis today
2/Prescription #opioid milligrams are at levels of early 2000s. That number is higher (relative to prescription count) according to @US_FDA Corinne Woods, PharmD at Duke-Margolis today - I think this difference reflects the patients with long term receipt.
3/Total milligrams and total count of oral tablets in an “initial prescription” have declined, reports @US_FDA Corinne Woods, PharmD to today’s session for Duke-Margolis and FDA (2 images here)
Read 7 tweets
5 Oct
1/An excellent new article reviews this summer’s controversial pushback against efforts to remediate the antisemitic mistreatment of Mountain Brook Jewish youth, by other youth. I will share some comments as a regional resident too atlantajewishtimes.com/adl-embroiled-…
2/First, antisemitic comments or mistreatment of Jewish students in suburbs south of Birmingham is the “modal experience”, ie most Jewish students hear comments denigrating their religion, from peers. This doesn’t mean most non-Jewish students say such things or harbor such views
3/I base my statement that it is the “modal” experience from talking with Jewish youth who grew up here and with their parents and confirming with multiple Rabbis. And *none of this is unique to Mountain Brook* - it typifies *all the bourgeois suburbs south of Birmingham*
Read 17 tweets
4 Oct
1/Preventing evictions saved lives during this pandemic writes Matt Desmond (aka @just_shelter) in this new piece - one key problem is we haven't acted to deal with the prepandemic situation. Normally, we have 7 eviction filings per minute nytimes.com/2021/09/30/opi…
2/The national eviction moratorium lasted 331 days, averting 1.6m evictions, reducing pandemic deaths by 11%. Southeastern states, where evictions are⬆️& vaccinations⬇️have not robustly acted to limit evictions, he writes
3/Small landlords have lost real money. However foreclosures on their properties are ⬇️78% vs prepandemic era, due to a moratorium on foreclosures. The $47bn Congress allocated to protect tenants & landlords has been very slow in distribution...
Read 8 tweets

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