mark fleming phd

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Mark Fleming, Ph.D., M.S.

Mark Fleming, Ph.D., M.S. is an assistant professor of health and social behavior at the University of California, Berkeley School of Public Health, and affiliated faculty in the Department of Anthropology and the Berkeley Center for Social Medicine. He specializes in the critical study of science and medicine in society. His work deals with structures of inequality and their intersections with health, service delivery, and the politics of poverty. He is currently conducting research on health care system efforts to address social determinants of health, and the shifting relations among health care, social services, and criminal justice sectors in the lives of vulnerable people.

Authored by Mark Fleming, Ph.D., M.S.

Medical anthropology's role in shifting the paradigm.

Research Expertise and Interest

ethnography and qualitative methods , stress and chronic disease , social determinants of health and health disparities , health systems research and healthcare access , social difference and power and inequality , criminal justice as a determinant of health , urban transportation , community-engaged research/scholarship , community-based research partnerships

Research Description

Mark Fleming specializes in critical approaches to social and structural determinants of health, housing and homelessness, mental health and substance use crisis response, and health care services and technology. His training is in anthropology and sociology and his work uses ethnographic, community-based participatory, and mixed methods.

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Mark Fleming

Mark Fleming is an anthropologist specializing in the social study of science and medicine and critical approaches to the social determinants of chronic illness, health care systems, work and economy, and the governance and politics of poverty.

last updated: November 12th, 2020

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Faculty Directory Mark Fleming

Departments

Mechanical Engineering

PhD Theoretical and Applied Mechanics, Northwestern University, 1997

MS Theoretical and Applied Mechanics, Northwestern University, 1994

BS Mechanical Engineering, University of Nebraska-Lincoln, 1992

Research Interests

My main research focus is computational fracture mechanics and failure analysis.  This includes research into the use of finite element analysis and multiscale methods coupled with fracture mechanics, damage mechanics and fatigue analysis.  Of particular interest is the application of these methods to solve real world problems.  These tools provide a "digital microscope" which allow a detailed view of structural performance under varying 

I am also interested in the development and application of computational tools for manufacturing analysis.  I am currently working on the DMDII Elastic Cloud Based Make project with a team of professors and students at Northwestern.  The goal is to develop educational materials to train students and working professionals on the use of the iFab toolset for assess manufacturability, analyze manufacturing cost, and perform assembly planning.  These tools will allow manufacturing engineers to perform a detailed assessment of a product to be manufactured prior to capital expenditure.

Selected Publications

• Huang, Hannah; Mojumder, Satyajit; Suarez, Derick; Amin, Abdullah Al; Fleming, Mark; Liu, Wing Kam, Knowledge database creation for design of polymer matrix composite , Computational Materials Science (2022).
• Tang, Shan; Yang, Hang; Qiu, Hai; Fleming, Mark; Liu, Wing Kam; Guo, Xu, MAP123-EPF , Computer Methods in Applied Mechanics and Engineering 373 (2021).
• Han, Xinxing; Gao, Jiaying; Fleming, Mark; Xu, Chenghai; Xie, Weihua; Meng, Songhe; Liu, Wing Kam, Efficient multiscale modeling for woven composites based on self-consistent clustering analysis , Computer Methods in Applied Mechanics and Engineering 364 (2020).
• Zhang, Gang; Guo, Tian Fu; Guo, Xu; Tang, Shan; Fleming, Mark A; Liu, Wing K, Fracture in tension–compression-asymmetry solids via phase field modeling , Computer Methods in Applied Mechanics and Engineering 357 (2019).
• Liu, Zeliang; Fleming, Mark; Liu, Wing Kam, Microstructural material database for self-consistent clustering analysis of elastoplastic strain softening materials , Computer Methods in Applied Mechanics and Engineering 330:547-577 (2018).

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Health and Social Behavior MPH

The mission of our program is to train scholars and practitioners to identify and analyze the major social, cultural and bio-behavioral determinants of health and health behavior; and to design, implement and evaluate social and behavioral interventions and social policies aimed at improving community and population health. Health and Social Behavior graduates go on to work for community-based organizations, city and county health departments, state health departments, research and academic institutions and policy/advocacy organizations.

The core curriculum includes course work in the behavioral, bio-behavioral, and social sciences as these relate to public health, in survey research methods and in program planning and evaluation. The role of race/ethnicity, culture, class and gender in influencing physical and mental health status, interactions between the individual and society, and ethical issues in the design and implementation of community-based interventions are also stressed.

In addition to required courses, students are encouraged to create a cluster of elective courses which will enhance their knowledge and skills in a particular area of interest. A comprehensive examination or original research paper completes the degree.

This is a two-year, full-time master’s degree program. Graduate students are expected to complete at least 48 units of coursework over four academic semesters and one summer. The minimum enrollment is 12 units per academic semester.

• PH 142: Introduction to Probability and Statistics
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The Graduate Division of UC Berkeley and Berkeley Public Health require a capstone—also known as comprehensive exam or integrative learning experience (ILE)—with both written and oral components. The capstone builds on the core curriculum requirements of the school and the program. It is intended to be a culminating experience for students, requiring synthesis and integration of knowledge acquired through coursework, internships and other experiences.

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The field placement is a school-wide requirement and is considered an essential component of our curriculum. The field placement is a 12-week, full-time work experience and completed over the summer between the first and second year.

Students work closely with the RISE Office to research and secure internship placements.

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• Coursework in one of the behavioral, social or biological sciences.
• Two years minimum of full-time health-related work experience in community, health promotion or health-related practice or research. Most students admitted to the program have one to two years of paid work experience. We strongly urge applicants to apply only after working in a professional capacity in public health or related fields .
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• GRE scores are optional for the fall 2023 admissions cycle. We recommend submitting a GRE if you have no other evidence of quantitative, verbal, or analytical abilities in your application.

Admissions Statistics

Associated concurrent degrees.

• MCP/MPH with the College of Environmental Design
• MJ/MPH with the Graduate School of Journalism
• MSW/MPH with the School of Social Welfare

Emeriti Faculty

Adjunct faculty.

Affiliated Faculty A-M

Patricia Baquedano-López

Phd applied linguistics, uc-los angeles.

Thomas Biolsi

Phd anthropology, columbia university.

Teresa Caldeira 

Phd anthropology, university of california, berkeley.

Stephen Collier

Phd anthropology, uc berkeley.

Mark Fleming

(Italian Studies - Department Chair)

Denise Herd

Phd medical anthropology, uc berkeley.

Seth Holmes 

Phd ucb/ucsf medical anthropology.

Elizabeth Hoover

Phd american studies, brown.

J ovan Lewis

Phd anthropology, lse.

Lev Michael

Phd anthropology, university of texas, austin.

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Association of Shelter-in-Place Hotels With Health Services Use Among People Experiencing Homelessness During the COVID-19 Pandemic

Mark d. fleming.

1 School of Public Health, University of California, Berkeley

Jennifer L. Evans

2 Benioff Homelessness and Housing Initiative, University of California, San Francisco

3 Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco

Dave Graham-Squire

Caroline cawley.

4 Department of Emergency Medicine, University of California, San Francisco

Hemal K. Kanzaria

5 Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco

Margot B. Kushel

Maria c. raven.

Accepted for Publication: May 18, 2022.

Published: July 27, 2022. doi:10.1001/jamanetworkopen.2022.23891

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2022 Fleming MD et al. JAMA Network Open .

Author Contributions: Ms Evans and Dr Graham-Squire had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Fleming, Evans, Graham-Squire, Kanzaria, Kushel, Raven.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Fleming, Evans, Raven.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Evans, Graham-Squire, Cawley.

Obtained funding: Kushel.

Administrative, technical, or material support: Kanzaria, Kushel.

Supervision: Raven.

Conflict of Interest Disclosures: Dr Kanzaria reported being a consultant for Amae Health, Inc outside the submitted work. Dr Kushel reported receiving a donation from the Marc and Lynne Benioff Foundation Philanthropic and grants from National Institute of Aging during the conduct of the study and reported serving on the board of Housing California. No other disclosures were reported.

Funding/Support: This work was supported by grant K01HS027648 from the Agency for Healthcare Research and Quality. Dr Kanzaria’s and Dr Raven’s salaries were supported by a grant from the Benioff Homelessness and Housing Initiative at the University of California, San Francisco.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Additional Contributions: We thank the San Francisco Department of Public Health and the partnering San Francisco County agencies for their leadership and implementation of the work described in this article.

Was placement in a shelter-in-place (SIP) hotel during the COVID-19 pandemic associated with health system utilization among people experiencing homelessness with a history of high use of acute health services?

In this cohort study of 686 high users of acute county services experiencing homelessness, those who received a SIP hotel placement had significantly fewer emergency department visits, hospital admissions, inpatient days, and psychiatric emergency department visits compared with matched controls without a placement.

These findings suggest that provision of noncongregate shelter with supportive services in SIP hotels during the COVID-19 pandemic was associated with reduced use of acute health services among people with prior high use.

This cohort study evaluates the association of shelter-in-place (SIP) hotel placements during the COVID-19 pandemic with health services use among a subset of people experiencing homelessness with prior high acute health service use.

Some jurisdictions used hotels to provide emergency noncongregate shelter and support services to reduce the risk of COVID-19 infection among people experiencing homelessness (PEH). A subset of these shelter-in-place (SIP) hotel guests were high users of acute health services, and the association of hotel placement with their service use remains unknown.

To evaluate the association of SIP hotel placements with health services use among a subset of PEH with prior high acute health service use.

Design, Setting, and Participants

This study used a matched retrospective cohort design comparing health services use between PEH with prior high service use who did and did not receive a SIP hotel placement, from April 2020 to April 2021. The setting was 25 SIP hotels in San Francisco, California, with a daily capacity of 2500 people. Participants included PEH who were among the top 10% high users of acute medical, mental health, and substance use services and who had 3 or more emergency department (ED) visits in the 9 months before the implementation of the SIP hotel program. Data analysis for this study was performed from February 2021 to May 2022.

SIP hotel placement with on-site supportive services.

Main Outcomes and Measures

The primary outcomes were ED visits, hospitalizations and bed days, psychiatric emergency visits, psychiatric hospitalizations, outpatient mental health and substance use visits, and outpatient medical visits.

Of 2524 SIP guests with a minimum of 90-day stays, 343 (13.6%) met criteria for high service use. Of 686 participants with high service use (343 SIP group; 343 control), the median (IQR) age was 54 (43-61) years, 485 (70.7%) were male, 283 (41.3%) were Black, and 337 (49.1%) were homeless for more than 10 years. The mean number of ED visits decreased significantly in the high-user SIP group (1.84 visits [95% CI, 1.52-2.17 visits] in the 90 days before SIP placement to 0.82 visits [95% CI, 0.66-0.99 visits] in the 90 days after SIP placement) compared with high-user controls (decrease from 1.33 visits [95% CI, 1.39-1.58 visits] to 1.00 visits [95% CI, 0.80-1.20 visits]) (incidence rate ratio [IRR], 0.60; 95% CI, 0.47-0.75; P  < .001). The mean number of hospitalizations decreased significantly from 0.41 (95% CI, 0.30-0.51) to 0.14 (95% CI, 0.09-0.19) for SIP guests vs 0.27 (95% CI, 0.19-0.34) to 0.22 (95% CI, 0.15-0.29) for controls (IRR, 0.41; 95% CI, 0.27-063; P  < .001). Inpatient hospital days decreased significantly from a mean of 4.00 (95% CI, 2.44-5.56) to 0.81 (95% CI, 0.40-1.23) for SIP guests vs 2.27 (95% CI, 1.27-3.27) to 1.85 (95% CI, 1.06-2.65) for controls (IRR, 0.25; 95% CI, 0.12-0.54; P  < .001), as did psychiatric emergency visits, from a mean of 0.03 (95% CI, 0.01-0.05) to 0.01 (95% CI, 0.00-0.01) visits for SIP guests vs no change in the control group (IRR, 0.25; 95% CI, 0.11-0.51; P  < .001).

Conclusions and Relevance

These findings suggest that in a population of PEH with high use of acute health services, SIP hotel placement was associated with significantly reduced acute care use compared with high users without a placement.

Introduction

People experiencing homelessness (PEH) have disproportionately high emergency department (ED) use, and this has held true during the COVID-19 pandemic. 1 , 2 , 3 , 4 , 5 , 6 ED visits among the general population decreased by 42% nationally during the first months of the pandemic 7 and remained 23% below prepandemic levels by November 2020. 8 , 9 Despite this decrease in ED use among the general population, use among PEH remained close to prepandemic rates in some jurisdictions. 6 Because of limited public health resources, many regions reduced existing outpatient health, mental health, and substance use treatment services and diverted efforts to COVID-19 diagnosis and treatment. Although many patients leveraged telehealth during the pandemic, PEH’s unstable living situations and lack of consistent access to telephones or computers may have contributed to continued barriers to accessing nonemergency care. 10

PEH are at increased risk of COVID-19 infection and related morbidity and mortality, 11 , 12 , 13 , 14 in part because of high transmission rates in congregate homeless shelters. 15 People who are older or who have comorbidities are at higher risk for poor outcomes with COVID-19; many PEH meet these criteria. 16 , 17 PEH do not have options for isolation or quarantine, which could lead to increased transmission and downstream outcomes, including the need for hospitalization. 18

In April 2020, the City and County of San Francisco, California, implemented an emergency, shelter-in-place (SIP) hotel program to provide noncongregate shelter to PEH who were considered vulnerable to severe COVID-19 because of their age and/or comorbidities. 19 As the result of federal policy allowing states to use Federal Emergency Management Agency funds to place PEH in noncongregate settings during the pandemic, localities have repurposed hotels as alternatives to high-density shelters. Beyond preventing COVID-19 transmission, 20 little is known about other benefits of using hotels as noncongregate shelters. Other interventions based on housing-first principles, such as permanent supportive housing, have been shown to decrease use of emergency services. 21 , 22 , 23 , 24 , 25 , 26 Some studies of permanent supportive housing have shown large reductions in emergency service use among those with prior high use, 27 although other programs for frequent ED users have shown mixed results. 28 , 29 Furthermore, medical respite programs—shelter and supportive services for PEH with medical need—have been shown to reduce use of hospital services, although less is known about the effects of these programs on PEH with prior high use. 30 , 31 The rapid implementation of San Francisco’s SIP hotel program provides an opportunity to examine whether placement in noncongregate shelter with supportive services was associated with changes in service utilization for PEH who had been high users of acute health services.

Study Design and Setting

To reduce the transmission of COVID-19 among PEH, the City and County of San Francisco established SIP sites at 25 hotels, ranging from 30 to 450 beds, serving up to 2500 individuals at a time. 19 To understand the impact of the program on those with high use of acute health services, we focused our analysis on the subset of SIP guests and their matched controls who were identified as the top 10% high users of multiple acute medical and behavioral health services in San Francisco and had 3 or more ED visits in 9 months. We used a matched retrospective cohort design to compare health services use among PEH with prior high use of acute health services who were placed in SIP hotels (intervention) and those who were not (control). We used negative binomial regression to compare changes in service utilization across intervention and control groups for 90 days before and 90 days after SIP placements occurring between April 2020 and April 2021. The University of California, San Francisco, institutional review board approved this research. Our report follows the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline for cohort studies. Informed consent was not provided because the study did not involve contact with individuals, in accordance with 45 CFR §46.

Participants and Eligibility

Individuals were eligible for placement in a SIP hotel if they were experiencing homelessness and met the Centers for Disease Control and Prevention’s definition of high risk for severe COVID-19 based on age and underlying conditions. 32 SIP programs defined individuals as experiencing homelessness if they lived outside or in a location not meant for human habitation, or were staying in the shelter system or another facility (eg, hospital, treatment facility, or jail) and had no other place to stay.

We included all SIP guests who were in the top 10% of high utilizers of multiple systems (HUMS) and used the ED 3 times or more during the eligibility period and a group of matched controls who were not placed in SIP hotels. Although all SIP guests were considered at risk for poor COVID-19 outcomes, those with high service use have greater disease burdens than the general PEH population. 16 We assessed service utilization during the 9-month period before the implementation of the SIP hotel program from July 1, 2019, to March 31, 2020. The San Francisco Department of Public Health (SFDPH) assigns HUMS scores according to use of 9 emergency services across the medical, mental health, and substance use disorder systems, including ED visits, inpatient stays, psychiatric ED visits, and detoxification services. 33 , 34 The HUMS score is an unweighted sum of these 9 urgent-emergent services. SFDPH uses HUMS scores to identify individuals experiencing fragmented care across multiple systems who would benefit from improved care coordination.

Intervention

The SIP hotels provided private rooms, bathrooms, and 3 meals per day. Guests had access to on-site health care services, although availability varied by site. Each SIP hotel offered a minimum of 1 half-day nursing clinic and 1 half-day medical clinic per week and, at maximum, offered 40 hours per week of medical staffing at hotels geared toward guests with higher medical needs. The on-site medical clinics offered basic evaluations, treatment of minor conditions (eg, basic wound care), buprenorphine induction, and referrals and transportation to off-site clinics for full-scope primary and specialty care. Community clinics offered limited, prioritized scheduling for primary care appointments for individuals referred from a SIP hotel. Each SIP hotel had a housing navigator who assisted guests in transitioning from SIP hotels to permanent housing. Community-based organizations offered additional services (eg, naloxone, needle exchange, and benefits enrollment), although availability differed by site.

Data Sources

We used administrative data from the Coordinated Care Management System (CCMS), an integrated database managed by the SFDPH that links information at the person-level from multiple county agencies. 16 , 33 CCMS includes medical, behavioral health, and social service delivery data, as well as information on social needs including homelessness and shelter use. CCMS creates a record for anyone who self-reports as homeless in a health care encounter, uses homelessness services (eg, shelter or housing navigation), uses county behavioral health or emergent-urgent health services, or is booked in the county jail. 16

To describe the characteristics of the intervention and control groups at baseline, we used measures of age, gender, race and ethnicity, years homeless, in the top 5% and top 1% HUMS, and receipt of Social Security Income. Race and ethnicity were extracted from the CCMS records. We also included baseline measures of urgent care visits, outpatient medical visits, and all service use outcomes of interest. For outcome measures, we extracted encounter data on ED visits, inpatient stays and bed days, psychiatric ED visits, inpatient psychiatric stays, outpatient medical visits, outpatient mental health visit, and number of methadone or buprenorphine treatment visits.

Statistical Analysis

We extracted records of individuals in the CCMS with emergency service use between July 1, 2019, and March 31, 2020 (45 473 individuals) and kept those with a HUMS score in the top 10th percentile (4665 individuals) ( Figure ). We excluded anyone without 3 or more ED visits in the eligibility period, leaving 3445 people. We then excluded people placed in nonhotel SIP sites including trailers, safe sleep sites for tents, and reduced-capacity congregate shelters. We isolated the subset of these high users who were placed in SIP hotels between April 2020 and April 2021 (440 individuals). We excluded those who were in SIP hotels for short stays (<90 days), resulting in 343 eligible people in the intervention group.

SIP indicates shelter-in-place; Q, quarter.

To create a matched control group, we isolated 3005 eligible controls who were the top 10% HUMS and had 3 or more ED visits during the 9-month eligibility period but were not placed in SIP hotels. We excluded those who died during the study period (206 individuals) leaving 2799. From these, we identified 343 controls, matched on demographics, homelessness status, and prestudy medical and behavioral health use. We used the GenMatch package to create a control group 35 with a distribution of covariates similar to that of the SIP hotel cohort. We chose matched controls without replacement and used a 1-control-per-intervention strategy to optimize the similarity of the covariate distributions across the 2 groups. We compared baseline characteristics across the groups using χ 2 tests (Fisher exact χ 2 where cell counts were <5) for categorical measures and the Kruskal-Wallis test for continuous measures ( Table 1 ).

Abbreviations: HUMS, high utilizers of multiple systems; SIP, shelter-in-place.

After constructing the matched control group, we applied a parametric model to measure the impact of placement in a SIP hotel. This match-then-model approach aims to make parametric models produce more accurate and less model-dependent causal inferences. 36 During the early months of the pandemic, there was lower use of EDs overall. To model these ED visits, we used a negative binomial regression model. As all outcomes were counts with a right-skewed distribution, we chose to analyze using negative binomial mixed models with random intercepts for each subject. We compared mean utilization at 2 time points: before and after SIP entry. Mean utilization was derived from visit-level utilization history, averaging visit counts across the 90-day period before SIP entry (baseline) and in the 90-day period after SIP entry (3 months). We calculated effect sizes to examine mean differences across SIP and non-SIP groups at baseline and 3 months and determined that mean differences at baseline were in the very small range (Cohen d  = 0.02-0.18) for all outcome measures except outpatient visits (Cohen d  = 0.21) ( Table 2 ). We compared the experimental conditions across time by testing the group-by-time interaction effects using mixed-effects models. Fixed effects included in all models were intervention group assignment, time, and their interaction, with both group and time effects treated as categorical variables. We estimated mixed-effects models using maximum likelihood, which we specified to contain random intercepts with an unstructured covariance matrix. Significance was set at P  < .05 (2-tailed). We used Stata statistical software version 17 (StataCorp) to perform the analyses. We performed a sensitivity analysis on a smaller subgroup of SIP hotel guests who stayed 180 days or longer and their matched controls to examine utilization in the 180 days before and after SIP hotel placement. Data analysis for this study was performed from February 2021 to May 2022.

Abbreviation: SIP, shelter-in-place.

After matching, we identified 686 (343 SIP intervention; 343 control) PEH who had 3 or more ED visits with a HUMS score in the top 10%. The 343 SIP guests who met criteria for our study comprised 13.6% of all 2524 guests who stayed in SIP for at least 90 days. Participants spent a mean (SD) of 301.0 (116.8) days in a hotel. Table 1 shows the demographics and characteristics of the matched study sample. The study sample consisted of participants aged 21 to 88 years (median [IQR], 54 [43-61] years), with 485 (70.7%) self-identifying as male, 283 (41.3%) as Black, 227 (33.1%) as White, and 61 (8.9%) as Latino or Latina. Approximately one-half (337 participants [49.1%]) were homeless for more than 10 years. In the 9-month period before the SIP hotel implementation, 518 (75.5%) had 3 to 9 ED visits and 104 (15.2%) had 10 to 19 ED visits. More than one-half (368 participants [53.6%]) had 1 or more hospitalization. The median (IQR) HUMS score was 9 (6-15). We found no significant differences between the intervention and matched control groups for any covariates.

The majority (54% [185 individuals]) of the total SIP guests with a minimum of 90-day stays had no acute service use during the eligibility period. ED visits decreased in the intervention group from a mean of 1.84 visits (95% CI, 1.52-2.17 visits) before the SIP intervention to 0.82 visits (95% CI, 0.66-0.99 visits) in the 90 days after the intervention, a 55.4% decrease, compared with a 24.8% reduction in the control group from 1.33 (95% CI, 1.39-1.58 visits) to 1.00 (95% CI, 0.80-1.20 visits) (incidence risk ratio [IRR], 0.60; 95% CI, 0.47-0.75; P  < .001), representing a 40% reduction in ED visits relative to the control group ( Table 3 ). The number of hospitalizations decreased from a mean of 0.41 (95% CI, 0.30-0.51) to 0.14 (95% CI, 0.09-0.19) for the intervention group and from 0.27 (95% CI, 0.19-0.34) to 0.22 (95% CI, 0.15-0.29) visits for the control group (IRR, 0.41; 95% CI, 0.27-063; P  < .001), a 59% reduction for the intervention group relative to the control group. Inpatient hospital days decreased by 75% in the intervention group relative to the control group, from a mean of 4.00 (95% CI, 2.44-5.56) to 0.81 (95% CI, 0.40-1.23), a 79.8% decrease compared with an 18.5% decrease from 2.27 (95% CI, 1.27-3.27) to 1.85 (95% CI, 1.06-2.65) among controls (IRR, 0.25; 95% CI, 0.12-0.54; P  < .001). Psychiatric ED visits among those placed in SIP hotels decreased by 75% relative to the control group, from a mean of 0.03 (95% CI, 0.01-0.05) to 0.01 (95% CI, 0.00-0.01) compared with no change among controls (IRR, 0.25; 95% CI, 0.11-0.51; P  < .001). We found no difference in outpatient medical visits (IRR, 0.80; 95% CI, 0.56, 1.15; P  = .24), in-patient psychiatric stays (IRR, 1.18; 95% CI, 0.26, 5.46; P  = .83), outpatient mental health visits (IRR, 1.15; 95% CI, 0.46, 2.85; P  = .77), or number of methadone or buprenorphine treatment visits (IRR, 1.19; 95% CI, 0.30, 4.76; P  = .81). In the sensitivity analysis looking at 180-day time spans, we found similar results as in the primary analysis, with a significant postintervention reduction in ED visits, hospital length of stay, and psychiatric ED visits when compared with matched controls ( Table 4 ).

Abbreviations: IRR, incidence rate ratio; SIP, shelter-in-place.

In a matched retrospective cohort study of PEH with prior high use of acute health services, we found that people who spent at least 90 days in SIP hotels had significant decreases in acute health services use compared with similar people who did not receive a SIP hotel placement. Our findings support our hypothesis that noncongregate shelter combined with on-site supportive services can reduce use of acute health services among PEH with prior high use.

For study participants who did not receive a SIP hotel placement, ED visits decreased by 24.8% during the pandemic. This was similar to the 23% decrease in ED use seen in the general population, 8 but much smaller than the 55.4% reduction seen in the group who received a SIP placement. Other housing interventions, such as permanent supportive housing, have not shown a similar association with ED visits for PEH with prior high use of acute health services, 29 although there is some evidence these programs may reduce acute care use for the general PEH population. 25 , 26 , 37

PEH have longer hospital lengths of stay, because of the difficulty of identifying safe discharge options. Here, SIP placement had a substantial impact on length of stay, decreasing inpatient days by 79.8% over the study period, whereas the length of stay for controls decreased by 18.5%. Our findings are consistent with previous research 31 demonstrating that access to medical respite—that is, shelter with medical services—reduces inpatient days for PEH. In addition, compared with matched controls, participants who received a SIP hotel placement had significantly fewer hospitalizations and psychiatric ED visits.

These findings provide evidence that using hotels as noncongregate shelters can benefit PEH who are high users of acute health services, beyond preventing outbreaks of COVID-19. SIP hotel placement in Washington State was associated with improvements in self-reported health, increased sense of safety, and reduced conflicts and 911 calls. 38 The SIP hotels in San Francisco had varying degrees of embedded health services, as well as increased access to local clinics. These services may have contributed to the reductions in acute health services use by meeting the needs of this high user population outside of the hospital system. It may also be that the provision of temporary noncongregate shelter prevented some acute problems experienced by PEH, such as exposure-related illness, violence, or public intoxication, that can result in ED visits or hospital admissions.

We found significant differences in acute health services use in a relatively short 90-day period for the subset of PEH placed in SIP who were also frequent users of acute health services. Conversely, studies 29 of the impact of permanent supportive provision among frequent health system users have shown it can be difficult to achieve these outcomes. Chronically homeless individuals who are eligible to receive permanent supportive housing placements may be more ill than our study population and already have heavy burdens of illness and high mortality rates, making acute health services use difficult to reduce or avoid. In addition, few permanent supportive housing programs include the level of embedded on-site health care offered by the SIP sites, which may have contributed to our findings.

The implementation of SIP hotel programs throughout the US demonstrates the possibility of rapidly transforming unused or underused locations such as hotels for noncongregate shelter. However, SIP hotels were funded by Federal Emergency Management Agency and were intended to be a temporary emergency measure. Further research and policy making should continue to focus on increasing the supply of permanent supportive housing, and affordable housing for extremely low-income households, as well as sustainable models of noncongregate shelter where needed.

Limitations

We examined health service use among a subset of SIP hotel guests who were high users of acute health services, and our findings may not apply to the broader SIP guest or PEH populations. The majority (54%) of the total SIP guests with a minimum of 90-day stays had no acute service use during the eligibility period. Furthermore, regression to the mean can bias studies of high users of health services. Although we used a matched control group to mitigate this issue, by focusing on the high user population, we selected for participants who would be most likely to show changes in acute service use.

We evaluated our outcomes over 90 days only. Except for inpatient stays, our results also held over a 180-day period, but more research is needed to verify the durability of our findings. Observational studies are a lower standard of evidence than experimental studies, are more prone to bias and confounding, and cannot be used to demonstrate causality. We mitigated these limitations by using a matched control group. People who consented to enter SIP hotels may differ from controls in ways we did not measure. The intervention was based in San Francisco County, and our findings may not be generalizable to other jurisdictions.

Conclusions

In a population of PEH with high use of multiple health services, SIP hotel placement during the COVID-19 pandemic was associated with significantly reduced acute health service use compared with high users without a placement. Using existing hotels as noncongregate shelter with embedded health services may be an effective strategy to mitigate COVID-19 risks as well as to reduce acute care use among PEH with a history of high health services use.

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Meet Our Seminarians

Ricky Armstrong

Christopher Busser

Louis Candelaria

Jorel de Guzman

Alexander Fleming

Matthew Fulton

Dakota Gates

Tyler Gates

John Paul Grabowski

Benjamin Harris

Caleb Malec

Austin Smith

Michael Santos

Vincent Washburn

Ricardo Velasco

Ricky Armstrong was born on December 23, 2003 and later adopted by Esther Armstrong. He was baptized into the Catholic Church shortly after his adoption. After his first communion, he became an altar server at Our Lady Queen of the Apostles Catholic Church in Palm Beach. It was during that time, Ricky felt his first call to become a priest. He joined the Knights of Columbus at Prince of Peace Catholic Church, in Sun City Center and started working for the church.  He is attending seminary at St. Joseph Seminary College in Louisiana. He will miss his younger brother, Jonathan, and his mother. He also appreciates everyone’s prayers.

On a personal note, he is a second-degree black belt in Taekwondo and a lover of sports. Ricky graduated second in my high school’s class. Before the pandemic, he was on the football team for his high school. He hopes to be actively involved with sports and weightlifting at the Seminary. He looks forward to beginning this journey and to becoming the man God will shape him to be.

Seminary: St. Joseph Seminary College

Studies: Propaedeutic

Home Parish: Prince of Peace, Sun City Center

Christopher Busser was born on February 11, 1999 at Saint Joseph’s Hospital in Tampa Florida. He was baptized February 12, 2000 at Christ the King. He has grown up at Christ the King going to catechism, church and even went to school there. At Christ the King, he had received first communion, confirmation and was an avid member of Boy Scouts, going all the way from Tiger to Eagle. Christopher has one younger brother, Michael, that has accompanied him along the way. He attended Jesuit and the University of Wyoming. Christopher previously discerned with the Salesians and worked for them as a private fundraiser and a member of their summer camp administration team. He has also worked for a professional sport fishing charter company. He enjoys fishing and spearfishing in his free time. His faith is extremely important to him.

In listening to Gods will for his life, he has heard the call to the priesthood in his heart. He is discerning particularly to serve God in the sacraments as he takes this journey. 

Home Parish: Christ the King, Tampa

Louie Candelaria is thirty years old and was born in Appleton, Wisconsin. He graduated from the University of South Florida with a degree in Communication and is going into his second year of seminary as 4 th Discipleship at St. Vincent De Paul Regional seminary. His parents are Lou and Sherrie Candelaria. He has four siblings named: Jessica, Tom, Julia, and Sister Josefina. His home parish is St. Raphael’s Catholic Church and before seminary Louie had a career in software sales.

He loves to read, go hiking, play card games and fishing. Spending time with his family is very important to him. He would not be in the position that he is in today if it wasn’t for them and their support. What attracts Louie to the priesthood is the ability to celebrate the Holy Mass, administer the sacraments to others and to be a Shepard for all those in need of Christ’s mercy. Also, the idea of becoming a spiritual father and a man for others is a burning desire in Louie’s heart and believes that this vocation is the answer for that.

Seminary: St. Vincent de Paul Regional Seminary

Studies: 4th Discipleship

Home Parish: St. Raphael, St. Petersburg

Isaac Cruz was born in Deland, Florida and raised in Mount Olive, New Jersey. As a teenager his family attended an Assemblies of God church in Hackettstown, New Jersey.

Isaac was received into the Catholic Church in 2017 during the Easter Vigil at his home parish, St. Michael the Archangel in Clearwater. Our Lady played a pivotal role, not only in his conversion, but in his ultimate call to the priesthood.

He has an amazing father, mother, sister and niece who have been so supportive of this journey he is on.

He enjoys watching Red Sox and Patriots games, reading history books, reading and watching ANYTHING Star Wars related and cooking.

Home Parish: St. Michael the Archangel, Clearwater

Jorel de Guzman was born and raised in Tampa, Florida. Along with his mom, dad, and sister, he spent the entirety of his life up until seminary within the Diocese of Saint Petersburg. He began schooling at Most Holy Redeemer and then graduated from Mother Teresa Catholic School in Lutz. After middle school, he went to Jesuit Tampa. While in high school, he worked at Panera Bread and as a parker for Tampa Sports Authority at Raymond James Stadium. He is an avid reader and enjoys taking hikes in the 1200 acres that surround the seminary. A huge basketball and football fan, he tries to represent the Diocese in all the sports, especially soccer, that the seminary offers.

Ever since fourth grade, he was a parishioner at Mary Help of Christians. His attraction to the priesthood, especially the Diocesan life, has found its root in my upbringing in this Diocese. Throughout his discernment, the grace to provide ministry to the very people who helped support him in prayer has been nothing short of humbling.

Studies: 3rd Discipleship

Home Parish: Mary Help of Christians, Tampa

Mark was born and raised in the Diocese of Saint Petersburg and came from a large Catholic family. He is 1 of 6 kids and has an uncle who is a priest! Blessed Sacrament in Seminole is his home parish and where he attended grade school. For high school, Mark attended St. Petersburg Catholic until changing schools his senior year and graduating from Clearwater High in 2014. After high school he had a profound conversion like that of the prodigal son (Lk 15:11-32).

Having his mind set on becoming a firefighter, Mark attended St. Pete College for their EMT and Fire programs. He always assumed his vocation was marriage; the priesthood wasn’t even on his radar. When Mark’s plans left him feeling out of place, he sincerely asked God what His plan for his life was. In that prayer, the Lord put the call to priesthood on Mark’s heart. He then entered seminary in the fall of 2016 (the year of mercy). After over four years in the seminary, he took a leave of absence and taught theology at SPCHS where he had attended high school. In January 2023, Mark re-entered seminary formation and is entering Configuration II. Thank God for His love and mercy!

Studies: 2nd Configuration

Home Parish: Blessed Sacrament, Seminole

Alexander Fleming was born and raised in Tampa and graduated from Robinson High School in South Tampa in 2019. He was baptized and confirmed at Christ the King Parish in south Tampa in 2020. He worked as a cook at a local Tijuana Flats for three years and left to go into seminary. He is now in his second year of formation at St. Joseph Seminary College in Louisiana.

He has always been close to his family; his mom and dad, grandparents and brother all have played a huge role in his journey to becoming Catholic and discerning the priesthood. Alexander first felt Gods call to discernment when he was in the RCIA program to become a Catholic. At first, he thought it was just an interest in what the priesthood was, but as time moved on, he could not stop thinking about the possibility of becoming a priest. Going to Mass and a daily prayer life were two major ways that he has been discerning the call.

He loves sports, especially the Tampa Bay Buccaneers and loves to read during his free time. Cooking is another passion of his, as well as cooking for his friends and family. He is grateful for your continued support as he continues the journey in discerning God’s call.

Matthew Fulton was born in Clearwater, FL as one of five boys given by God to his loving parents. He grew up in the bay area and received his sacraments at St. Luke the Evangelist in Palm Harbor. Upon arriving at the University of Florida, Matthew encountered the Lord in a deeply personal way for the first time and was introduced to a full life in the Church by new and lasting friendships. After receiving a degree in economics, he found himself working at an intelligence company, first in Tampa and then New York City. After three years in a variety of roles, Matthew resigned and moved into full-time mission work with the poor and homeless in the South Bronx with an organization called LAMP Catholic Ministries. It was here that the Lord fostered healing and a great love of his beloved poor. After two years as a missionary, and in the search for peace around unanswered questions, he made the decision to apply for seminary, choosing to come back to his home Diocese of St. Petersburg. Matthew is looking forward to hearing ever more clearly God’s voice and will for his life.

Home Parish: St. Luke, Palm Harbor

Dakota Gates was born in Clearwater, FL but his parents, Krist and Nancy, are originally from upstate New York. He has one older brother, Tyler, who is also a seminarian of our diocese. Dakota graduated from Countryside High School in 2019 and received an Associates Degree from St. Petersburg College. He had worked at Publix (the best grocery store) and was a Life Teen missionary in Georgia for two years. He enjoys fishing, Star Wars, and competing in all sports. His attraction to the priesthood sprung through sharing in real graces with the faithful of Jesus Christ, and he is humbled to be on this journey. Dakota will be studying at St. Joseph Seminary College in Louisiana.

Home Parish: St. Ignatius, Tarpon Springs

Tyler was born in Albany, NY and a year later moved to Pinellas County. His parents are Krist and Nancy Gates who reside in Palm Harbor. Tyler has a younger brother, Dakota, who is also a seminarian of this diocese.

Tyler attended Florida State University and graduated with a bachelors degree in Biological Science. He was actively involved in the Catholic Student Union at FSU, which inspired him to answer the Lord’s call to discern the priesthood. He returned to the Tampa Bay area after finishing college and spent a year working in the operating room at Mease Countryside Hospital. This past spring, he graduated with a master’s degree in Philosophy from St. Vincent de Paul Regional Seminary in Boynton Beach, FL.

Tyler is currently in his third year, I Configuration, at SVPD. His home parish is Christ the King in Tampa. Tyler became drawn to the priesthood when he witnessed the fraternity and example of the priests in this diocese. He enjoys watching FSU and Tampa Bay sports and spending his free time with his family and friends, at the beach, the pool, or on the golf course.

Studies: 1st Configuration

John Paul Grabowski was born in Binghamton, NY. After high school, he moved down to Florida from Pennsylvania to study Aerospace Engineering for two years. Then he transferred over to University of South Florida – Tampa where he studied Industrial Engineering for three years before transferring to seminary.

He is the fourth of five children of his lovely parents, Joseph and Alaine and his home parish is the Catholic Student Center at USF – Tampa. In the past, John Paul has worked for the Boy Scouts, Lowe’s, Allegiant Air, and Busch Gardens.

In his spare time, he enjoys being with friends, playing the Ukulele, gaming, trekking in the outdoors, and collecting LEGOs. Most importantly, John Paul was attracted to the priesthood because of the total self-giving of different priests he had met and the sheer love for God that they emit.

Home Parish: Catholic Student Center, USF - Tampa

Benjamin Harris is in his fourth year of philosophy studies at St. Joseph Seminary College in Saint Benedict, Louisiana. He was born in Indianapolis, Indiana, but is proud to have grown up mostly in the Tampa Bay area, calling the Diocese of St. Petersburg his spiritual home for most of his life, with St. Anthony the Abbot in Brooksville being his home parish. Benjamin comes from a family of 6, being the second oldest of 4 kids.

His hobbies are reading, cooking/BBQing, playing/watching sports, rosary making, and swimming in the rivers near his house and at the seminary. What attracts him to the priesthood is the thought of devoting his life to the study of the Word and being a vessel of the Lord’s love and mercy for His people. He loves the fatherhood aspect of it, fatherhood being a desire of his heart that the Holy Spirit continues to foster.

Home Parish: St. Anthony the Abbot, Brooksville

Caleb Malec is from St. Stephen Catholic Church in Riverview, Florida. He was the 4th of 5 children to be born in New Jersey from his family. He grew up in Florida where he attended St. Stephen Catholic Middle School, Tampa Preparatory High School for two years and graduated from Riverview High School in 2018. Growing up and throughout high school he raced motocross, BMX (bicycle motocross) and played lacrosse. Caleb loves to spend quality time with friends and family, especially if they are able to have fun and explore the outdoors or play sports. Right out of high school he became a full-time missionary for two years. His first year was with NET Ministries and second year was with Life Teen, in which he lived at Camp Covecrest.

Thankfully, Catholicism has always been a part of Caleb’s life. With God’s grace, he began taking the faith much more seriously in high school because of his youth group. Ever since restoring his relationship with Christ, he has had this zeal to help others encounter the love, generosity, and freedom the Lord provides. The many young priests he has interacted with during high school and as a missionary, daily personal prayer, and a faithful community were the three pivotal factors that helped him to realize this desire of his to pursue the priesthood so that he can serve God and His Church in such a unique way!

Home Parish: St. Stephen, Riverview

Austin Smith grew up in Brandon, Florida, and has attended his home parish of Nativity Catholic Church since he was very young.  Before entering seminary, he attended Jesuit High School in Tampa and felt the call to be a priest the summer before his junior year of high school while sitting in solitude and silence.

After graduating, Austin moved to Nashville for two years where he ministered to teens in middle school and high school with a group called the Love Good Apprenticeship Program. While in Nashville, his calling to priesthood was deepened, and after a year at Ave Maria university, he joined the seminary in the fall of 2020.

Studying and praying in seminary is a blessing, but outside of these activities, he enjoys shenanigans with friends, watching and playing sports, working out, reading fiction, adventuring, eating, and listening and analyzing music.

What attracts him to priesthood most is the idea of being a spiritual father, and being able to hear confessions.

Home Parish: Nativity, Brandon

Michael Santos was born August 12, 1998, to Edwin and Denise Santos. Growing up in New Port Richey he received all his sacrament at St. Thomas Aquinas Catholic Church and was always very active in the life of the parish, where he got his first job in high school as a maintenance man. He is also blessed with a younger sister, Mary Santos. Michael was home schooled through high school and attended Ave Maria University, receiving his bachelor’s degree in music and history with a minor in Medieval Studies. After graduating college Michael worked as a teacher for two years, teaching 3 rd grade and then 6th grade history/high school art history. Michael has always felt very close to the priesthood and feels that now God is calling him to a new love, to step out in faith and surrender to God’s will, in service to the Diocese of St. Petersburg.

Home Parish: St. Thomas Aquinas, New Port Richey

Vincent Washburn is a seminarian from St. Michael the Archangel Parish in Hudson. He spent his entire childhood growing up in Hudson, graduating from Fivay High School in 2016. After attending Pasco-Hernando State College, Vincent transferred to the University of South Florida – Tampa in 2018 and graduated in May 2020 with a degree in Psychology. He was involved in his parish for many years as a volunteer before joining the staff in 2018 as the Youth Minister; eventually becoming responsible for Liturgical Ministries and their outreach to the sick and homebound as well. His hobbies include watching movies and TV, reading, playing piano, exercising, and hanging out with friends.

While the idea of becoming a priest has been in his head since childhood, he seriously began discerning the possibility of a vocation during his transition from high school to college. Encountering a priest much like himself, who joyfully lived out the gospel in his own vocation, opened Vincent’s eyes to the Lord’s call for him in his life. After two awesome years at St. Joseph’s in Louisiana, this year he is in Configuration I at St. Vincent de Paul Regional Seminary in Boynton Beach, FL.

Home Parish: St. Michael the Archangel, Hudson

I was born in Bao Loc a small town in Vietnam. When I was 12, my family moved to America. I graduated high school and have an Auto-Body Certificate. I am the youngest in a family of five. We attend Holy martyrs of Vietnam Parish in St. Petersburg. I like to work outside and I like kayaking but I actually don’t know how to swim. In my young age I always felt the call to become a priest.

Studies: 1st Discipleship

Home Parish: Holy Martyrs of Vietnam, St. Petersburg

Ricardo Velasco was born in Miami Florida, but his family moved to Riverview Florida when he was about two years old. He has four siblings, and his parents are migrants from Venezuela. He was raised Catholic, and as a kid, would attend Resurrection Catholic Church. As a kid, Ricardo had always felt interested in priesthood and the life of a priest, then after graduating high school, the calling for priesthood grew significantly. He spent a year attending Hillsborough Community College while at the same time discerning the priesthood. He has entered his first year in seminary and the Lord has blessed him significantly. He likes to watch and play sports, chess, and he likes being social.

Home Parish: Resurrection, Riverview

All seminarian pictures are done by Will Staples Photography