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Boston Health Care for the Homeless Program Harm Reduction Technician/Milieu Manager in Boston, Massachusetts

Who We Are:

Since 1985, BHCHP’s mission has been to ensure unconditionally equitable and dignified access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. Over 10,000 homeless individuals are cared for by Boston Health Care for the Homeless Program each year. We are committed to ensuring that every one of these individuals has access to comprehensive health care, from preventative dental care to cancer treatment. Our clinicians, case managers, and behavioral health professionals work in more than 30 locations to serve some of our community’s most vulnerable—and most resilient—citizens.

From our earliest days as a program, we have always sought to do work that is transformational: recognizing our shared humanity; centering dignity, compassion, mutual respect and supporting the right of every individual to access the highest levels of health care and every staff member to reach their fullest potential. We continue to be committed to building bridges and breaking down barriers, including systemic racism which harms us all. We provide community-based health care services that are compassionate, dignified, and culturally appropriate, incorporating social determinants of health, with the goal of breaking down the physical and systemic barriers that our patients face.

Bilingual, Bicultural, LGBTQIA identifying, Black, Indigenous, and People of Color are encouraged to apply.

To learn more about working at BHCHP, watch our video Please Click Here ( .

Job Summary:

The Harm Reduction Technician/Milieu Manager in our medical respite facility plays a pivotal role in providing compassionate care and support to patients with substance use disorders, trauma histories, chronic medical illness, mental health disorders, and behavioral challenges. This position requires a combination of skills in emergency medical response, expertise in trauma-informed care, motivational interviewing, harm reduction approaches, and de-escalation techniques to create a healing and empowering environment for our patients in the respite milieu.

The BMH Harm Reduction Technician/Milieu Manager will aid in identifying patient concerns and immediate needs to determine the most appropriate type of support, collaborating with other clinicians/providers, nurses, unit secretaries, and case managers to enhance the services delivered to our patient population. You will assist in identifying patients under the influence of substances/psychiatric illness and work with other disciplines to provide necessary monitoring and support.

Hours: 40 hours a week; Monday-Sunday: 7am-3:30pm, 3pm-11:30pm, and 11am-7:30pm


  • Respond appropriately to emergencies by contacting appropriate staff.

  • Act as a member of an interdisciplinary team of caregivers; collaborate with the team RN and Behavioral Health clinicians throughout the shift to determine appropriate work assignments and priorities; communicate the status of delegated tasks and outcomes of patient data findings.

  • Act as a role model for patients by demonstrating appropriate professional boundaries with patients and staff.

  • Assist the security staff in realizing a safe and dignified space through de-escalating conflict and managing the milieu.

  • Create a safe and supportive environment that fosters patient empowerment, choice, collaboration, and trust.

  • Adhere to patient confidentiality standards/policies.

  • Foster a non-judgmental and empathetic approach to addressing substance use and related behaviors, recognizing each patient’s autonomy and inherent worth.

  • Provide crisis management/debriefing/assistance with behavioral issues as needed.

  • Assist clients with immediate case management needs (i.e., material needs).

  • Work closely with unit secretaries/transportation managers in supporting patients with methadone appointments as needed.

  • Employ motivational interviewing techniques to engage patients in exploring their goals, values, and motivations for positive change.

  • Utilize trauma-sensitive communication techniques to minimize triggers and promote safety and belonging.

  • Utilize de-escalation techniques and crisis intervention strategies to manage challenging behaviors and conflicts within the facility safely.

  • Provide education and resources on harm reduction strategies, including safer substance use practices, overdose prevention, and access to naloxone.

  • Collaborate with a multidisciplinary team including nurses, behavioral health clinicians, treatment program specialists, case managers, and other team members to assist with crisis interventions around behavioral issues in the milieu as needed. 

  • Attend morning admission and team huddles to discuss behavioral issues in the milieu.


  • Commonwealth of Massachusetts EMT Certification required.

  • Experience in managing behaviors required.

  • Minimum of 2 years EMT or paramedic experience strongly preferred.

  • Strong assessment skills.

  • Understanding of substance use disorder and behavioral health issues.

  • Interest and experience with underserved population preferable.

  • Experience in understanding the effects and management of sedating medications and polysubstance use.

  • Individuals with lived experience encouraged to apply.

  • Bilingual in English, Spanish, Haitian Creole, or Portuguese is strongly preferred.

  • Effective verbal, written, and interpersonal skills with the ability to interact with providers and team members from various settings and backgrounds.

  • Sensitivity to ethnic, cultural, gender, beliefs, and behaviors.

  • Ability to work in a fast-paced environment, with excellent communication skills, critical thinking, and problem-solving abilities.

  • Knowledge of Harm Reduction/motivational interviewing techniques under a trauma-informed approach.

  • Ability to work effectively with clients displaying various unpleasant and bizarre behaviors.

  • Ability to work with patients with complex medical/PTSD/ complex post-traumatic stress disorder (CPTSD).

  • Self-directed, motivated, and flexible, able to work independently and as part of a team.

    Compensation and Benefits:

  • The compensation starts at $31.11 per hour and increases based on years of experience.

  • BHCHP full time employees are eligible for our competitive time off policy of 4 weeks’ vacation, health, dental and vision insurance, 403B retirement savings plan and employer retirement contribution, and pre-tax MBTA pass program with 40% discount. In addition, eligible employees will receive yearly increases, additional compensation of seven thousand five hundred dollars added to your base hiring rate for demonstrated bilingual proficiency and the opportunity to work with local hospitals and community health centers.

    Does this amazing opportunity interest you? Then we'd love to hear from you.

    As an Equal Opportunity Employer, BHCHP pledges not to discriminate against and encourages those from underrepresented and underserved backgrounds to apply, particularly Black, Indigenous, and People of Color (BIPOC), LGBTQIA identifying, first generation college students and adults without a college degree, Bilingual and Bicultural persons; and individuals from low economic backgrounds.

    Covid-19 Vaccination: Proof of Covid-19 vaccination(s) is optional for employment. Candidates who are offered employment will be given details about how to demonstrate receipt of vaccination if they choose to.

Please Note: Employment at Boston Health Care for the Homeless is at-will. Boston Health Care for the Homeless does not sponsor work authorization visas.

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