# Presentation: 110896

## Health & Behavioral Health Needs of Homeless Families

- Jay Sanchez, LMSW
- Policy Academy—April 20, 2005
- Houston, Texas

## Health Needs:  physical exams, STD treatment, vision care, dental care, depression/anxiety management, parenting, emotional support, immunizations, pharmacy, substance abuse, domestic violence prevention, adjustment disorders 

- Health Services:
- Primary Care
- Medical
- Dental
- Mental Health
- Vision Care
- Lab
- Pharmacy

- Ancillary Services
- Health Education
- Transportation
- Case Management
- WIC Services
- Child Development
- CareLink Enrollment
- Substance Abuse

## CentroMed HCH (9 - 17)

- 1.	South Park Clinic
- 2.	South Park Dental Clinic
- 3.	Family Resource Ctr. / WIC
- 4.	Elder Services / Outreach
- 5.	Southside Clinic
- 6.	Somerset Family Clinic / WIC
- 7.	Santa Rosa Clinic
- 8.	Lanier Student Health Center
- 9.	Salvation Army Hope Center
- 10.	Dullnig House Clinic
- 11.	Dwyer Center Clinic
- 12.	SAMM Clinic
- 13.	Children's Shelter Clinic
- 14.	Infants' Shelter Clinic
- 15.	La Paloma de Paz Clinic
- 16.	Respite Care Davidson  House Clinic
- 17.	Respite Care Daycare Clinic
- 18.	Walzem Clinic

## Who Are HCH Patients?

_**For Calendar Year 2004**_**: (N = 7,131)**
- Shelter				5179
- Transitional			  278
- Doubling Up			    94
- Street				1214
- Other				  366

## CentroMed Supportive Services

- Acute care, pediatric, OB-GYN,  podiatry,  family practice, adult/children’s dental care
- Five CHC Clinics
- Counseling resource center
- One school-based clinic
- Senior day care services
- Ryan White HIV Early Intervention and referrals to community services

## Collaborative Referral Services

- Mainstreamed comprehensive services
- University Health System (County)
- Mental health & psychiatry (CHCS)
- Medical specialty clinics (UHS)
- Diabetic collaborative (South Texas Diabetes Center)
- Substance abuse treatment
- Transitional housing—SAMM, Dwyer
- HCH Veterans

## HCH Diagnosis

- Acute: dermatophytosis, upper respiratory infections, conjunctivitis, cellulitis, viral enteritis, pediculous capitus, scabies, allergic rhinitis, otitis media, pharyngitis, muscular skeleton strain (back/extremities)
- Chronic: anemia, adjustment disorder, alcoholism/drug abuse, hypertension, depression, dermatitis, asthma, diabetes

## Some Barriers to Health Care

- Self imposed limited access— “I didn’t know I could go to the clinic—I thought it was for children only”
- Transportation
- Continuity of care—linkage with local hospitals
- Medicaid managed care
- Medical care not always a priority while homeless
- Severe depression/mental illness
- Addiction issues

##  Who Are Our Patients?

**Homeless persons or persons at risk **
- Newly homeless
- Chronic homeless
- Emergency shelter guests
- Persons staying on the street
- Families in transitional housing
- Homeless individuals doubling up
- Women/men transitioning from incarceration
- Halfway houses

##  Outreach: Where Do We Go?

- Shelters
- Halfway houses
- The street and homeless camps
- Substance abuse treatment programs
- Daycare facilities for homeless children
- Faith-based homeless day centers
- Service events for homeless population

## Engaging Families

- What we do...
- Group health education
- Parenting/child development
- Anger management
- HIV/STD/Hep
- Parent/child interaction activities
- Substance abuse risk reduction/relapse prevention
- Incentives—fun stuff
- Counseling
- Developmental delays screening/referral
- Substance abuse process group

## Who Does Outreach?

- Team approach
- Medical/dental professionals
- CentroMed social workers: health/medical orientation
- Collaborating with community outreach workers from other agencies

##  Why Do Outreach?

- Objectives:
- Increase access to care
- Connect homeless families to services
- Promote wellness, problem solving techniques, and healthy behaviors through risk reduction education
- Because it’s effective!

## Cultural/Societal Challenges

- Addiction issues
- Lack of trust in system
- Stigma attached to mental health disorders, some medical diagnoses
- Not wanting to disclose family medical history
- Stigma attached to homelessness while children are attending school

## Cultural/Societal Challenges

**Some challenges may be more significant for Hispanics:**
- Embarrassment and modesty, especially for women—talking about STDs, sex, domestic violence
- Women prioritize their family’s needs over their own
- Fear of family, friends, employer discovering that they’re homeless
- Vulnerability of women in shelters: revealing risk behaviors or abuse can set her up for further victimization
- Children not wanting school or friends to know they are homeless

## Culturally Competent Approach

- Objective 1: Provide services where homeless individuals & families are located
- Integrate health services into shelter program
- Culturally sensitive trained staff
- Clinic can be a resource for connecting to other services
- Use family approach: invite partner, schedule children for well-child exams, outreach to children’s programs
- Provide health education at events and venues where homeless families can be found

## Culturally Competent Approach

- Objective 2: Bring homeless people into care
- Mainstream individuals & families into medical/mental health care—linkage & knowledge to community resources
- Empowering with preventive behaviors
- Use group & individual approach to promote early intervention
- Establish trusting relationship
- Emphasize health care partnership - promote wellness
- For women, appeal to their desire to be well for kids’ sake

## Culturally Competent Approach

- Objective 3:  Promote healthy behaviors
- Small group education
- Men’s group, women’s group, children’s group
- Use culturally-appropriate curriculum: language, health beliefs, cultural norms
- Adapt as needed: homeless circumstances, San Antonio’s more rural character
- Include health care provider because of Hispanic respect for physician
- Use peer support

## HCH Patient Profile

- 100% & below poverty		7055
- 101 - 150%				    28
- 151 - 200%				      7
- Over 200%				    41
- Male 					4047
- Female					3084

## Patient Ethnic/Gender Profile

- Asian/Pacific Islander				30
- Black/African American			       1177
- Native American			   		45
- White non-Hispanic			       2173
- Hispanic				                  3721
- Patients served in language other than               English					      3138
- Children					      1971
- Adults				                 5160

## Lessons Learned

- Homelessness
- Presents unique barriers to care
- Exacerbates general barriers
- Using outreach increases clinic access
- Though people access care, health may not be a priority while they are homeless
- Support, education, trust, and the message of hope are essential for breaking barriers

## Slide 22