Exploring the Complexity of Homelessness in Emergency Medicine: Dissecting Myths, Evidence, and Solutions (Social EM and Population Health Interest Group Sponsored)

Since 2017, homelessness in the US has risen by 6%, with a simultaneous increase in unsheltered homelessness rates and a record high count of chronically homeless individuals in 2022. The Emergency Department (ED) serves as the healthcare system's safety net for the growing population of patients experiencing homelessness (PEH). PEH exhibit higher ED visit frequencies, elevated rates of substance use disorder and mental illness, and increased morbidity from treatable diseases compared to housed patients. This population faces substantial stigma, contributing to health disparities and elevated mortality rates. Emergency Medicine providers can profoundly impact the lives and health outcomes of PEH. Our interactions with this group present vital opportunities for assessment, intervention, and care linkage, shaping their perception of the healthcare system. The challenge of meeting these patients' complex needs can lead to moral distress when physicians cannot align care with their ethical values. Grounded in an evidence-based framework, this didactic session aims to address common biases and misconceptions, introduce the concept of structural violence and the policies underpinning homelessness, explore the burden of disease and healthcare utilization patterns among this population, and examine potential solutions at both systemic and individual levels. The session will discuss the evolving demographics of homelessness in America. We will explore chronic disease prevalences among PEH, alongside the health implications of homelessness itself. We will further characterize patterns of acute care utilization, hospitalization rates, associated costs, and mortality trends. Finally, the session covers evidence-backed interventions, including housing-first models, trauma-informed and harm reductionist approaches, encampment and street outreach strategies, and clinical practice adjustments to enhance health outcomes. This session offers an up-to-date and evidence-based overview of homelessness in the context of Emergency Medicine. Participants will acquire knowledge and practical insights, equipping them to contribute to a more compassionate, equitable, and effective healthcare landscape for individuals experiencing homelessness.

Presenters:

Caitlin Ryus, MD, MPH
Christine M. Shaw, MD, DTMH
Kian Preston-Suni, MD, MPH
Hannah Janeway, MD, MSPH

Authors

Caitlin Ryus, MD, MPH

Yale University School of Medicine

Dr. Caitlin Ryus MD, MPH is an Assistant Professor in Emergency Medicine at Yale University and a Drug use, Addiction, and HIV prevention Research Scholar (DAHRS). Dr. Ryus’s current research combines the disciplines of community-engaged research with health services research and political epidemiology to evaluate the evidence bases for health and social policies. In their work, they examine health outcomes and service utilization among patients experiencing homelessness. Dr. Ryus leads the Yale ED Homelessness Task Force– an interdisciplinary team of community organizations, government representatives, street medics, social workers, and people with lived experience of homelessness dedicated to improving ED care among New Haven’s homeless population.  Additionally, Dr. Ryus serves as the Co-Director of the Yale Emergency Scholars Program, a five-year combined residency and research fellowship. Their research also encompasses diversity, equity, and inclusion in the healthcare workforce, addressing the importance of representation and inclusivity in medicine as a means towards achieving health equity.
Christine M. Shaw, MD, DTMH

University of Alabama

Dr. Christine Shaw MD, DTMH, is a Global and Social EM fellow at the University of Alabama at Birmingham in the Department of Emergency Medicine. She completed her residency training at Louisiana State University at Shreveport, LA, and is currently working on her MSPH at UAB. Throughout medical school and residency Dr. Shaw has focused on providing care for people experiencing homelessness, including founding various outreach programs, starting a flu shot clinic, and establishing a free mobile bus clinic to improve access to care. As a fellow, Dr. Shaw continues to focus research on addressing health inequities within this population.
Kian Preston-Suni, MD, MPH

University of California, Los Angeles

Dr. Kian Preston-Suni MD, MPH is the Acting Chief of Emergency Medicine at the Greater Los Angeles VA Healthcare System and Assistant Professor of Clinical Emergency Medicine at David Geffen School of Medicine at UCLA. He leads a department commited to emergency care for veterans, with a committed EM trained faculty and programs including Geriatric Emergency Medicine and SUD treatment. He also oversees an effort to improve emergency care for patients experiencing homelessness.
Hannah Janeway, MD, MSPH

University of California, Los Angeles

Dr. Hannah Janeway MD, MSPH is an Assistant Clinical Professor at the University of California Los Angeles and the co-founder and co-director of Refugee Health Alliance. They are the Enhanced Care Management clinical lead for UCLA’s Homeless Healthcare Collaborative, a street medicine project. In addition to serving the unhoused throughout Los Angeles, they also work clinically at White Memorial Medical Center, the West Los Angeles VA and at RHA’s clinics. Their work focuses on reestablishing communities as guardians of their own health, border health and border abolition, and re-envisioning healthcare spaces to serve the people who visit them including freeing them from carceral forces and infra/structural barriers.