Alaina Boyer is the senior Director of programs at the National Health Care for the Homeless Council, which is headquartered here in Nashville.
Boyer holds a PhD in cancer biology and forged her own path making her way into research at the intersection of health and homelessness.
“Although unconventional, I have managed to end up where I feel I am contributing my training [to] address public health crises that have a meaningful impact on human rights and dignity,” Boyer wrote on her LinkedIn profile.
Boyer is a former member of the Homelessness Planning Council and currently serves on the board of Open Table Nashville.
What is the NHCHC, and what does your job entail?
The National Health Care for the Homeless Council is a national training and technical assistance organization that focuses on the intersection of homelessness and health.
I started as the director of the research team and have been promoted to the senior director of programs. I’ve been in that role for about three years. I provide oversight to the teams at the Council, which include our community engagement and implementation team, as well as our clinical team; and I work alongside our policy team and medical respite team.
In that role and oversight, I’m making sure that we’re responsive to the field and providing the best practices that we know to be shared among our partners so that we’re doing the best that we can for our folks on the ground.
A lot of it is training the workforce, and that includes our federally qualified health center workforce. We are very broad in that training. It includes anything from board governance, the C-suite, to the clinical and non-clinical staff. We also provide curriculums and asynchronous trainings to the field and stay on top of policy and advocacy to make sure that we are advocating for what is equitable and fair when it comes to housing policies and homelessness and health.
What made you make the switch from cancer research to homelessness?
My PhD is in cancer biology, and I was studying breast cancer and looking at drug targets. When we moved to Nashville, I was lucky enough to get a job at the Meharry Vanderbilt Alliance under Dr. Consuelo Wilkins, who served as a mentor and introduced me to community engaged participatory research. I felt that was more in my field of interest and soul filling. I was working in disparate communities in North Nashville and trying to engage folks so that they were contributing to how research is done as opposed to a top-down academic focus. It should be the people leading that.
When I was working closely with the North Nashville communities, I saw a lot of suffering. There were a lot of challenges that we saw people encountering. We saw a lot of homelessness from people losing homes, the cost-of-living increases, even the tornadoes that went through the area. As I was seeing that rise in homelessness, I figured that my expertise could lend to that field and support our fellow neighbors.
You have been involved in national research on homelessness. Is there something that you studied in homelessness that surprised you or that you think people working in homelessness should pay more attention to?
I always saw homelessness as a systems problem. And so, I was not surprised when I got into the field and started researching that the root causes are not an individual’s failure, but rather that there’s multiple systems at play. Homelessness is not only a housing problem, it’s a failure of multiple systems that include lack of living wages, cost of healthcare and education to name a few. We also need to recognize that the causes of homelessness for most individuals are related to being hurt on a job, or a multitude of factors including criminal misdemeanors that make it difficult for employment, historical injustices that we saw with redlining and home loans, and the criminal justice system. National policy and national budgets also play a role in what creates individuals entering homelessness, these are moral documents.
I think it’s important that if we want to solve homelessness, we need to look at the larger systems to actually make change.
Are there any new trends that research shows that we need to be more aware of?
We’re seeing a lot of harmful and cruel policies and legislation that are coming to the forefront because of individual perspectives and not looking at the science and the evidence. We do know that harm reduction works. We know that Housing First works. When we’re facing policies that promote treatment first or blame an individual’s failure, that is counterproductive to what we know is working.
One thing I would say is that we do a lot of building of housing, but there’s new research and new policies around adaptive reuse of structures that are already existing. In Detroit, where I’m from, I see this a lot, where abandoned buildings that were either schools or previous hospitals are remodeled into apartments. If we think about how to reuse those spaces that are already zoned, it could be an area of showing some advancement in how we house our folks.
I would also add that we spend a lot of time in the reactive space to homelessness because we’re seeing so many people entering. But what that means is that we should be investing in prevention and looking upstream and working across sectors.
Homelessness is not just a housing provider issue. It’s not just a health issue. Rather, it’s a public investment. We need to build our civic muscle, and research shows that if we put the right frameworks in place, invite the right voices and stakeholders to the table, then we could really make some headway in solving homelessness.
With an increase in complaints, local politicians are desperate to move people out of neighborhoods. Encampment sweeps keep being the norm and they appear to have increased across the nation under recent laws. What are we missing?
This is hard because I don’t know if it’s what we’re missing.
We know that homelessness is cyclical. And when you get in that cycle, once you have interactions with law enforcement or you’re in the justice system or you’re in the healthcare system or you might be suffering other family issues, food insecurity, living costs and wages, that cycle needs to be broken. I think that’s known. And I think we continue to think that something’s missing when what we need is the civic will to want to change.
Also, when we look at the cost to keep people in this cycle, I think a lot of eyes would be open to understanding that there’s a lot of savings if we all focus on the framework to become part of solving this issue. It’s not just the homelessness providers that need to solve this.
Which peer city is doing well in addressing homelessness, and what can we learn from them?
Serving as a national organization, we do have the opportunity to look nationally where we see successes and where we see gaps. I would say that first of all, addressing homelessness is hard everywhere.
I don’t know if there’s a city that does everything right, but there are cities that do certain parts very, very well. From the healthcare perspective, Medicaid expansion states absolutely are farther along in caring for our homeless folks. When you reduce the barriers and provide health care to a lot of folks, they start to do better because it allows them to be able to be stabilized and have all the vital conditions met.
To elaborate on the vital conditions, these are the basic needs for health and safety, lifelong learning, meaningful work and wealth, humane housing, thriving in the natural world, and reliable transportation. We rely on these frameworks a lot. When we look at this balance between urgent services, which relates to being in the moment and trying to address the current issue, the vital conditions allow you to do that upstream prevention work.
So cities that know how to meld those two things well with urgent services and supporting vital conditions is where we see success.
If you had a conversation with local funders, what gap in homeless services would you ask them to address immediately?
Coming from the health care world, I would say there’s been so much investment in health care, a lot of investment into the systems for EHRs (Electronic Health Records). And when I look at the HUD housing providers, I know that there’s been a lot of work in the HMIS (Homeless Management Information System). But I think we need to make an investment in being able to up those systems and support the internal capacity at homelessness provider organizations.
A lot of the money homeless organizations receive goes to the direct services they provide. But we need to support these organizations to be able to maintain data systems and focus on integration between healthcare systems, EHRs, HMIS, and justice systems as well.
And then, we need to have a focused group that has individuals from multiple sectors at the table. We need to be transparent, we need to be open about those conversations, and we have to be willing to allow those experts to make the decisions, to make the recommendations, and invest in either adaptive reuse of existing structures or create low barrier solutions to homelessness. We need to be able to counteract harmful policies that criminalize just existence in general.
Do you think we are listening enough to people with lived experience/expertise?
No, I do not. There’s a stigma that we want to solve the problem from a top-down approach. We need the individuals who are experiencing the day-to-day systems to share the multiple burdens and complexities that they have to encounter on a day-to-day basis.
As the Council, one of our foundational pieces is making sure lived experience folks are driving our strategies, our agendas, and our priorities, because if we’re not listening to them, we’ll continue to think we have the solutions and continue to fail. Homelessness is not just looking at the data. It’s also understanding the narratives and the experience of the day-to-day person who is experiencing the challenges that our systems have created.
And I’ll add that these systems were created and working exactly the way that they were supposed to, which is to not allow for certain groups of people to be successful, at least in our current world as it exists right now.
Is there anything else you would like to add?
What’s important is making sure from an advocacy and policy standpoint that we’re leaning into advocacy with our lawmakers, our state representatives. We have to advocate with state and federal lawmakers to ensure programs like permanent supportive housing are not only adequately funded but funded without restrictions. We’ve seen restrictions proposed in lots of ways, mixed status rules (regarding housing eligibility of households including citizens and non-citizens), and work requirements.
So if we coalesce around policy and solutions that we know work, such as adaptive reuse, investing in underutilized buildings, rezoning appropriately without gentrifying and gentrification, and working with public work offices, are going to be important to make that system change we want to see in Nashville.