Homelessness, Health, and Human Needs (1988) / Chapter Skim
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5. Health Care Services for Homeless People
5. Health Care Services for Homeless People
Pages 103-135
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From page 103... ...
Regardless of differences among homeless people or regional variations in services, however, homeless people are more susceptible to certain diseases, have greater difficulty getting health care, and are harder to treat than other people, all because they lack a home. Similarly, attempts to provide health and mental health care services, regardless of variations in such areas as history, funding levels, and nature of support, also have certain common elements.
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From page 104... ...
William Breakey (in press) has identified characteristics of homeless people that affect the provision of treatment and the planning of health care services: Daily Activities Some homeless people live under circumstances that pose particular problems for developing a treatment plan.
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From page 105... ...
However, in its review of various programs for health and mental health care services for homeless people, the committee found that four common elements enhanced a program's ability to provide services to this population: Communication—Those people and agencies involved in the effort to address the health care problems of homeless people interact regularly and frequently. Coordination Even if only in a most rudimentary form, there is some way in which clients can be linked with a wide range of existing services (i.e., health and mental health care, housing, social services, entitlements, etc.)
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From page 106... ...
These rescue missions are coordinated on the national level by the International Union of Gospel Missions, but there is an even greater strength of coordination locally. Having served the homeless for extended periods, they are known to the community and have substantial access to existing networks of, for example, health care services, housing, and social services.
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From page 107... ...
Health Care Services in Day Programs Day programs, which are similar to the shelter-based clinics identified above, provide services where homeless people can be found, but they differ from shelter-based clinics in that the sites are independent of * For a more detailed description of the St.
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From page 108... ...
Since 1982, SOME has been the site for a medical clinic operated by the Columbia Road Physician Group, a group practice composed of four physicians committed to serving homeless and indigent people and providing on-site social services and substance abuse counseling. It has also been the site for a dental clinic operated by the Georgetown University Dental School.t Free-Standing Clinics In 1979 a somewhat different model for the delivery of health care for homeless people was started in Washington, D.C.—the Zacchaeus Clinic.
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From page 109... ...
is funded by the New York City Human Resources Administration and is administered by the Volunteers of America, which is under contract with the city. The respite unit is adjacent to the on-site medical and nursing clinic administered by
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From page 110... ...
However, a comprehensive, cohesive system of services is lacking. Even those programs that had strong ties with a hospital did not network with programs that serve, for example, the mentally ill or substance abusers.
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From page 111... ...
One issue frequently raised as a result of the Johnson-Pew projects is whether it is necessary to develop separate health care systems for the domiciled and for the homeless. The answer to that question depends on the resources of an individual community and the willingness of existing health care systems to respond to the needs of homeless people.
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From page 112... ...
dental care) or general health care services to a specific geographic area (e.g., the New York City project has contracts with three existing health care agencies that provide services in different boroughs of the city)
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From page 113... ...
, proper supervision is provided. Case Management and Coordination of Services One of the most critical elements in serving the homeless involves the coordination of patient treatment and the provision of access to other health care and social services with the aim of breaking the cycle of homelessness.
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From page 114... ...
The Milwaukee project chose to contract with social service agencies for the social service component of the project and with four medical facilities for health care services. The medical facilities provide pharmaceutical and medical supplies, as well as x rays and laboratory services.
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From page 115... ...
Besides the stationary clinic, there is outreach to homeless people on the streets, on the river bank, in the shelters, and at various service agencies. Since the project began, the Meharry Community Mental Health Center and the Tennessee Department of Mental Health and Mental Retardation have provided funding for two mental health care professionals to work with the Johnson-Pew project, primarily in outreach to homeless chronically mentally ill people on the streets.
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From page 116... ...
What appears to be most significant are the presence of all or at least most of the seven common elements of health care programs for the homeless described above. Issues Raised by the '1ohnson-Pew Project Models Stationary Clinics or Mobile Teams Each of these models has a somewhat different approach to providing health care services to homeless people.
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From page 117... ...
Although there may be large numbers of guests, the patient flow and the abbreviated hours make it difficult for the efficient and effective use of staff. Small Social Service Agencies or Large Health Care Facilities Locating health care services in a social service agency may often mean that ancillary services or specialty clinic appointments must be negotiated on a case-by-case basis, which is a time-consuming procedure.
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From page 118... ...
TARGETED SERVICES FOR POPULATIONS WITH SPECIAL NEEDS Concurrent with the development of the Johnson-Pew Health Care for the Homeless projects, other new forms of services to the homeless have been introduced. These programs provide health care to specific subpopulations among the homeless such as the chronically mentally ill, adolescents and youth, and homeless people with AIDS (acquired immune deficiency syndrome)
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From page 119... ...
are also important in creating services for the homeless chronically mentally ill. To ensure effective treatment for this group, specialized forms of housing (including a range of supportive services, from independent living with minimal supervision to round-the-clock supervision in a community residence)
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From page 120... ...
It provides a model apartment as part of an ADL skills training program. A similar program exists in Phoenix, where six apartments are used to help chronically mentally ill homeless people learn the skills required for independent living before moving into such situations.
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From page 121... ...
Veterans Administration Homeless Chronically Mentally III Program One of the most recent and most extensive efforts to address the needs of the mentally ill homeless is the Homeless Chronically Mentally Ill (HCMI) program operated by the VA as mandated by P.L.
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From page 122... ...
VA medical centers throughout the country. Outreach teams of two or more staff work in the streets and at community sites (e.g., shelters and soup kitchens)
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From page 123... ...
The Guest House in Milwaukee serves a homeless population that is evenly divided between the chronically mentally ill and chronic substance abusers. Harbor House in St.
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From page 124... ...
group home for homeless alcoholics is also the setting for day activities (e.g., counseling, vocational training, education, and leisure time activities) , as well as referrals for health and mental health care services.
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From page 125... ...
These two programs are not specifically health care programs; however, Pilgrim House receives on-site health care services from Kansas City's mobile homeless health care team, and Project Hope receives services from the Boston Johnson-Pew family team. Another program that the committee toured was the Emergency Lodge in St.
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From page 126... ...
This program, funded in part by federal, state, and local governments and in part by charitable donations, serves runaway and throwaway youths in the Tenderloin section of that city. It provides services, including health and mental health care services, in a drop-in setting.
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From page 127... ...
Communication Notwithstanding the lack of specific funding for health care programs for the homeless, each of the four cities evidenced effective communication networks. Even though Kansas City and St.
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From page 128... ...
St. Louis has residential programs near the psychiatric hospital that serves many chronically mentally ill homeless people.
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From page 129... ...
An assumption of these health care services is that provision of social services is an integral component of health care. Although many of these services are appropriate for all people (homeless or not)
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From page 130... ...
It is true that there are insufficient appropriate options for discharging homeless people from acute-care hospitals; but networks of institutional providers, community-based service providers for the homeless, and the public social welfare offices could at least facilitate a more appropriate discharge than to the streets or to an inappropriate shelter. It is also highly desirable that shelter providers set aside beds that could be used for infirmary care or convalescence.
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From page 131... ...
The COSMOS Corporation, under contract with the National Institute of Mental Health, has published a report, Intensive Case Management for Persons Who Are Homeless and Mentally Ill (Andranovich and Rosenblum, 19871. These two reports together provide a wealth of information for anyone who wishes to read a detailed analysis of this process and for those who work with homeless people.
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From page 132... ...
that are needed, with one of the ultimate goals being that the client eventually becomes his or her own advocate. The COSMOS report also identified "intensive" case management as critical to working with chronically mentally ill homeless people.
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From page 133... ...
in the provision of health care services to the homeless. The committee observed the involvement of the schools of nursing of the University of Kentucky in the programs for the homeless in Lexington and of the University of California, Los Angeles, in the Johnson-Pew project in Los Angeles.
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From page 134... ...
Still others may have worked with a different population of homeless individuals. Training might include: · issues relating to the homeless, for example, the causes of homelessness, the subpopulations, and the health problems of homeless people; ~ orientation to the agency, including its policies, procedures, and opportunities for staff development; · supervision, including the medical and social service aspects of the program; · interview techniques or other means of assessing emotional problems; · crisis intervention techniques; · problems of working with the chronically mentally ill; · identification of and strategies for confronting manipulative behaviors; and · issues of case management, for example, other resources that are available and how a homeless person can access those resources.
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From page 135... ...
1987. Progress Report on the Veterans Administration Program for Homeless Chronically Mentally Ill Veterans.
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