The Health Care for the Homeless Model of Care

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The Health Care for the Homeless Model of Care
You can look at a scar and see hurt, or you can
look at a scar and see healing. Sheri Reynolds
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Obstacles to using mainstream health services

• Lack of financial resources or health insurance
• Lack of comprehensive services
• Fragmented service system
• Lack of transportation
• Lack of client documentation
• Language and cultural barriers

• Lack of awareness of services
• Fear/distrust of large institutions
• Attitudes of staff who are not sensitive to the
  issues of homelessness
• Shelter and food are higher priorities than
  health care

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How do HCH projects overcome these obstacles?

• Accessible services
• Outreach
• Comprehensive services
• Service Adaptations
• Team Approach
• Sensitivity
• Consumer Involvement
• Advocacy

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Accessibility

• Take services where homeless people are located
• Arrange transportation to follow-up services or
  other agencies
• Provide services regardless of ability to pay
• Collaborate with other agencies to provide
  comprehensive services

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Outreach

• The principle maxim of social work
• is to start where the client is
• in a geographical, physical and psychological
  sense. If we dont
• start where they are, they wont
• become our client.
• Jeff Singer, MSW
• Baltimore, MD

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Where does outreach take place?

• Scheduled clinics in or near shelters, soup
  kitchens, drop-in centers or other homeless
  facilities
• Street locations - vacant buildings, alleys,
  camps, parks, under bridges
• Public facilities
• Motels/SROs
• Jails/detox programs
• Rural areas

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What services are provided through outreach?

• Engagement Strategies
• Initiate conversation, offer food/beverage,
  offer blankets and clothing
• Information and Referral
• HCH services, other agency services, housing
  options
• Direct Services
• Medical care, mental health, substance use, case
  management services

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Comprehensive HCH services

• Optional
• Restorative dental services
• Vision and eyeglasses
• Specialty care
• Complementary and Alternative Medicine
• Employment/job training
• Respite care

• Required
• Primary health care
• Outreach
• Substance abuse
• Mental health
• Case management
• Eligibility assistance
• Emergency services
• Referral for inpatient hospitalization
• Housing assistance

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Service Adaptations

• Recognize realities of homelessness in diagnosis
  evaluation, for example
• Screenings TB, HIV, abuse, substance abuse, etc
• Likelihood of one-time encounter
• Medication access/storage/refrigeration simple
  regimens
• Housing status/respite care
• Social income support needs
• See Adapting Your Practice series by HCH
  Clinicians Network, www.nhchc.org

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The team approach to care

• The care of homeless people is so complex, that
  to put that burden on one person would be
  impossible. What is impossible in a traditional
  system is a joy in a system where the care is
  shared by the team. I cant imagine practicing as
  a physician without the whole team. I dont think
  I could do it, nor could I deliver good care.
• Jim OConnell, MD
• Boston, MA

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Staff sensitivity to homeless persons issues

• Treat people with dignity and respect
• Be alert to cultural and ethnic diversity
• Understand that homelessness is caused by a
  combination of structural barriers and personal
  vulnerabilities
• Use interdisciplinary teams to approach the
  complex needs of clients

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Role of Consumers in Governance of HCH

• 51 consumer Boards required in all Consolidated
  Health Centers
• Waivers available for HCH, but participation
  required
• CABs
• Consumer surveys
• Focus Groups
• National Consumer Advisory Board

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Advocacy in HCH Practice

• Patients rights
• Securing access for individuals
• Improving service systems
• Public Education
• Policy Advocacy
• Legislative Advocacy

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HCH Approaches to Advocacy

• The 51 Solution
• Integration of Service Advocacy
• Consumer involvement
• Policy Analysis
• HCH Policy Symposium
• HCH Mobilizer

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Local, State Federal Issues Galore

• Health Center Appropriations
• Health Insurance/Single Payer
• Housing Affordability Accessibility
• Living Wages
• Entitlements/Income Supports
• Eligibility rules Processes
• Support levels
• Criminalization of Homelessness
• Federal Spending Priorities
• Discharge Policies/Service Coordination
• Many others -- choose your battles!

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For more information and resources contact
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National organizations

• The National HCH Council and the HCH Clinicians
  Network
• www.nhchc.org
• HCH Information Resource Center
• www.bphc.hrsa.gov/hchirc/
• National Coalition for the Homeless
• www.nationalhomeless.org
• National Alliance to End Homelessness
• www.endhomelessness.org

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Federal agencies

• Bureau of Primary Health Care
• www.bphc.hrsa.gov
• Center for Mental Health Services (CMHS) Homeless
  Programs Branch
• www.mentalhealth.org
• Center for Substance Abuse Treatment (CSAT)
• www.samhsa.gov

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Digital photographs provided by

• Colorado Coalition for the Homeless, Stout Street
  Clinic, Denver, CO
• Homeless Health Care LA, Los Angeles, CA
• Northeast Valley Health Corporation, North
  Hollywood, CA