Document Type

Research Report

Publication Date



In the winter of 1998/99, after the deaths of 16 homeless people in the streets of Boston attracted wide attention by the media, the Commissioner of the Massachusetts Department of Public Health (MDPH), Dr. Howard Koh, convened a group of I stakeholders serving the homeless street population. The goal of this MDPH Homeless Taskforce was to reduce the number of homeless people dying on the streets as well as to improve service delivery to those homeless individuals most at risk of dying. A wide range of individuals serving or encountering the homeless street population, including homeless outreach teams, law enforcement personnel, and homeless advocates, were invited to participate in the task force.

Contrary to common beliefs that the homeless do not want to accept services and help (Boston Globe, 2/13/2002), an investigation into the lives of those who died in the streets of Boston in the winter of 1998/99 by members of the MDPH homeless taskforce indicated that service providers knew most of them. This fact clearly demonstrates that homeless people use services when they are available, and that street deaths can be attributed, at least to some extent, to the failure of the homeless service delivery system (Hwang, Lebow, Bierer, O’Connell, Orav, & Brennan, 1998). It is therefore important to evaluate the homeless service system as it pertains to the homeless street population. Due to a lack of consistent and coordinated data collection among service agencies, little is known about the overall service utilization of Boston’s homeless street population, and this study begins to fill this gap.

Starting in January 2000, the Boston Health Care for the Homeless Program (BHCHP) implemented an intensive medical care plan for a group of street dwellers identified at high risk of death. Many of these “chronically” homeless individuals on the streets do not move along the homeless continuum of care (CoC) as planned, but remain on the streets for long periods of time. This study documents their health and substance abuse service utilization pattern, demonstrates their movement through different service agencies and documents where these services fail.



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