Health Care for the Homeless: Beyond Repairing the Safety Net


Jeff Singer is the President and CEO of HCH, Inc. A clinical social worker, he has experience in child and adult protective services, mental health and addiction services, street outreach, and community organizing. In 1983, Mr. Singer organized HIV/AIDS and homeless services at the Baltimore City Department of Social Services, where he was employed for 14 years. In 1987, Mr. Singer moved to HCH, Inc. to organize that agency’s social work and addiction services. He later served there as Director of Community Relations, before becoming President and CEO in 1998. Mr. Singer also has served as the national policy staffer, lobbyist, and President of the NHCHC, the organization which represents 200 homeless healthcare agencies throughout the USA. In these roles, he has been involved in developing and advocating national policies and programs related to homelessness, healthcare, housing, and poverty. Mr. Singer is a founding member of the Baltimore Homeless Union, the Homeless Persons Representation Project, Inc., and City Advocates in Solidarity with the Homeless and has authored numerous articles regarding homeless health care.

Ernest saw dead bodies and blood in the streets – or at least he thought he did. A gentle, generous man, when not hallucinating he made coffee for everyone in the waiting room of Baltimore’s Health Care for the Homeless (HCH) program. When, however, he was in the thrall of hallucinations, his 300-pound frame would shake with fright and rage. “Take me to the morgue. I need to see the dead bodies,” he would plead, as if the experience of the verifiably real bodies would overwhelm the virtual corpses scattered about him.


Harm Reduction Addiction Treatment Affordable Housing Homeless Individual Emergency Shelter 
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  1. Baltimore City Planning Department (1985) The decline of SROs in Baltimore. Baltimore, MDGoogle Scholar
  2. Baltimore Homeless Services (2007) The 2007 Baltimore City homeless count. Baltimore, MDGoogle Scholar
  3. Barry D (2007) On the bottle, off the streets, halfway there. The New York Times. p A18Google Scholar
  4. Bassuk EL, Buckner JC, Perloff JN, Bassuk SS (1998) Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. Am J Psychiatry 155:1561–1564PubMedGoogle Scholar
  5. Baumohl J (1996) Homelessness in America. Oryx Press, Westport, CT 161Google Scholar
  6. Burt M (2000) A new look at homelessness in America. Urban Institute, Washington, DCGoogle Scholar
  7. Bush GW (2006) Presidential news and speeches: George W. Bush’s May 1, 2006 speech to the American Hospital Association. Accessed 1 June 2008
  8. Day D (1952) The long loneliness. HarperCollins, New YorkGoogle Scholar
  9. Dear MJ, Wolch JR (1987) Landscapes of despair: from deinstitutionalization to homelessness. Princeton University Press, Princeton, NJGoogle Scholar
  10. DePastino T (2003) Citizen hobo. University of Chicago Press, Chicago, ILGoogle Scholar
  11. Dixon S (2008) The journey home: Baltimore 10 year plan to end homelessness, Baltimore Homeless Services, Baltimore, MDGoogle Scholar
  12. Federal Bureau of Primary Health Care (1998) Health Center Program expectations. Policy information notice 98-23Google Scholar
  13. Fee E, Shopes L, Zeidman L (eds) (1991) The Baltimore book: new views of local history. Temple University Press, Philadelphia, PAGoogle Scholar
  14. Financial Trend Forecaster (2008) Accessed 1 Oct 2008
  15. Gold A (1989) Thousands march on Washington in protest against homelessness. The New York Times, 8 Oct 1989Google Scholar
  16. Health Care for the Homeless (HCH) Baltimore (2007) 2007 Annual report. HCH Baltimore, Baltimore, MD. Accessed 1 Oct 2008
  17. ——— (2008a) Health Care for the Homeless home page. Accessed 1 Oct 2008
  18. ——— (2008b) What’s new. Accessed 1 Oct 2008
  19. Koegel P, Burnam MA, Farr RK (1999) Utilization of mental health and substance abuse services among homeless adults in Los Angeles. Medical Care 37(3):306–317PubMedCrossRefGoogle Scholar
  20. Lamb HR (1984) Deinstitutionalisation and the homeless mentally ill. Hosp Community Psychiatry 35:899–907PubMedGoogle Scholar
  21. National Alliance to End Homelessness (2007) Homelessness counts. National Alliance to End Homelessness, Washington, DCGoogle Scholar
  22. National Policy and Advocacy Council on Homelessness (2008) Questions and answers about expanding HUD’s definition of homelessness. Accessed 21 Sept 2008
  23. Office of Management and Budget (2008) Public budget database. Accessed 1 Oct 2008
  24. Office of Transitional Services (2007) Annual Report on homelessness services in Maryland, 2007. Maryland Department of Human Resources, Baltimore, MDGoogle Scholar
  25. National Health Care for the Homeless (HCH) Council (2008) Homelessness and health. National HCH Council, Nashville, TNGoogle Scholar
  26. Prochaska J, DiClemente C (1984) The transtheoretical approach: crossing traditional boundaries of therapy. Dow Jones-Irwin, Homewood, ILGoogle Scholar
  27. Singer J (1996) Integrating service and advocacy: a prescription for homeless children and their health providers. The Child, Youth, and Family Services Quarterly, Division 37 American Psychological Association 19(1):9–11Google Scholar
  28. Traynor TL, Fichtenbaum RH (1997) Impact of post-PATCO labor relations on U.S. union wages. East Econ J 23:61–72Google Scholar
  29. Tsemberis S, Gulcur L, Nakae M (2004) Housing first, consumer choice, and harm reduction. Am J Public Health 94(4):651–656PubMedCrossRefGoogle Scholar
  30. Western Regional Advocacy Project (2006) Without housing. Accessed 1 Oct 2008
  31. World Health Organization (2000) The world health report 2000, health systems: improving performance. World Health Organization, Geneva, SwitzerlandGoogle Scholar
  32. Wright J, Weber E (1987) Homelessness and health. McGraw Hill, New YorkGoogle Scholar

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© Springer Science+Business Media, LLC 2009

Authors and Affiliations

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