Learn how the Sidney Borum Jr. Health Center's integrated care model helps Boston-area LGBT youth experiencing homelessness build hope and trust.
It’s often acute conditions that bring new patients experiencing homelessness to the Sidney Borum Jr. Health Center in Boston. That fits with these individuals’ approach to many things, says Medical Director Ralph Vetters, M.D.: they have episodic concerns and want rapid responses and then are just as quick to move on. But the center’s nonjudgmental environment and integrated approach to care means patients—who are between the ages of 12 and 29 and self-identify as lesbian, gay, bisexual, or transgender (LGBT) in significant numbers—frequently end up returning for routine appointments.
Treating the acute problems is the hook that gets patients in the door, and the medical team at the Borum can then “follow up with an approach to care that makes them feel valued and that they’re going to be respected appropriately, that we’ll see them when they’re high or drunk or smelly, and we won’t try to change them,” says Dr. Vetters. “We operate at their speed and give them all the resources they need.” Those include free showers (which are really a “medical intervention,” he says), health care navigators to help them access social services and benefits and complete related paperwork, and a resource nook complete with a laptop that allows users to find housing and health care information and print out any needed forms.
Service providers generally refer patients to the Borum, usually for visits ranging from treatment for an abscess or laceration to a refill on psychiatric medications or trouble with “funky feet,” says Dr. Vetters. Patients “then begin to think of us as their doctor,” he says, “and then we’re able to provide chronic care management and make sure they get all their vaccines and so forth.”
The Borum Practice
The Borum’s namesake was an HIV/AIDS activist and educator who worked with young people at risk for HIV transmission. He advocated for condom distribution while helping establish programs to provide medical care for uninsured people living with HIV; he died of AIDS complications in 1992.
The Borum itself began as a clinic within a center for youth experiencing homelessness in nearby Harvard Square. That onsite presence allowed medical providers to establish a history and level of comfort with youth who came in, a rapport that has continued into its present location in Boston’s Chinatown and its more recent affiliation with Fenway Health, a comprehensive health care provider for LGBT communities. Dr. Vetters is hoping to focus the practice on younger clients, with a future age limit of 25, in recognition of the need for adult-focused care beyond that. Since most homeless service organizations’ cutoff age is 24, continuing care at the Borum allows for a more gentle transition to self-reliance.
Some 30% to 40% of youth experiencing homelessness nationwide self-identify as LGBT, but not all of the Borum’s patients fit into one or both of those classifications. Dr. Vetters says many LGBT kids who are housed with their middle-class families come to the Borum’s medical team for sexual health medicine while continuing to see their primary care doctors for everything else, knowing that state law means their parents won’t be informed of any sexual health treatments they undergo. At the same time, “travelers”—youth experiencing homelessness who survive by riding freight trains up and down the East Coast—continue to use the Borum’s services in large numbers. But of the 5,000 patients who visit each year, some 2,000 use the Borum as their primary care facility.
Most Borum-related health care and prescription costs for youth experiencing homelessness are covered by MassHealth, the Medicaid program in Massachusetts. Coupled with the Affordable Care Act, the ability to bill insurance is a game changer for the center, which no longer has to rely on funding from grants and the Title X Family Planning Program to operate.
The Borum’s integrated care model means providers routinely combine psychiatry, substance use treatment, and primary care medicine. The staff also collaborates with Bridge Over Troubled Waters, a Boston nonprofit that provides services and shelter to youth experiencing homelessness. Staff hold monthly case conferences to discuss Borum patients who are undergoing therapy with Bridge’s social workers and to create wraparound plans for them.
“When you think of what it is our patients are accessing and need, it’s mental health, behavioral health, psychiatric services, and support for substance use,” says Dr. Vetters. “So if we can tie all that together in one place, we really are responding to those things that tend to drive a lot of the indicators for homelessness among these youth and hopefully finding those people who might end up chronically homeless if they remained untreated and, by treating and supporting them, really help them transition to a different type of housing status.”
Dr. Vetters notes it is common among youth experiencing homelessness to have difficulty trusting others. “The idea of having to go and tell their story again to someone else, who may then have some disrespectful response to their history of homelessness or substance abuse—they don’t want to go through that again,” he says.
Yet even after they’ve found housing, many of the Borum’s patients keep coming back because, having developed relationships with their care providers, they want to maintain them.
Access more information about LGBT youth experiencing homelessness. Learn how SAMSHA works to promote behavioral health equity, including for the LGBT community.
This article was originally published to highlight the February 2015 theme of Minority Behavioral Health Conditions. Access more behavioral health and homelessness resources.