HCH 101

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• HCH 101

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Overview of Content

• Realities of homelessness in the U.S.
• History of the HCH program
• Service delivery and sponsorship arrangements of
  HCH programs
• HCH approach to care
• Relationship of HCH programs to government and
  other funders
• Resources for HCH projects

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What are the realities of homelessness in the
United States?
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HOUSINGAccording to the 2001 report from U.S.
Conference of Mayors 27-city survey

• Requests for assisted housing for
  families/individuals increased 86.
• Average wait is 16 months for public housing 20
  months for Sec. 8 Certifi-cates 22 months for
  Sec. 8 Vouchers.
• 19 of cities have stopped accepting applications
  for at least one assisted housing program due to
  excessive length of the waiting list.

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HUNGER

• According to the 2001 report from U.S.
  Conference of Mayors 27-city survey
• Requests for emergency food assistance increased
  23.
• 14 of requests for emergency food assistance
  went unmet.
• 54 of people requesting emergency food
  assistance were members of families. 37 of the
  adults were employed.

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HOMELESSNESSAccording to the 2001 report from
U.S. Conference of Mayors 27-city survey

• Requests for emergency shelter increased 13.
  Requests by homeless families alone increased by
  22.
• An average of 37 of requests by homeless people
  overall and 52 of requests by homeless families
  alone are estimated to have gone unmet.
• People remain homeless an average of 6 months.

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Consequences

• More than 760,000 persons sleep on the streets or
  in shelters every night.
• As many as 2 million people experience
  homelessness every year
• Approximately 12 million adults in the U.S. have
  experienced homelessness during their lifetime.

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Who becomes homeless?

• 68 are male - 32 are female
• 66 are single adults
• 34 are families
• 84 of homeless families are headed by women
• Interagency Council on the Homeless, (1999).

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RACE/ETHNICITY
African American 186,600
37.7 Caucasian 162,423
32.8 Latino/Hispanic 93,905
19.0 Asian 13,003 2.6 Native
American 9,590 1.9 Unknown
29,875 6.0 Total 495,396
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HCH 1999
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• AGE
• 0-12 59,352 12.0
• 13-19 30,747 6.2
• 20-44 282,680 57.0
• 45-64 111,222 22.5
• 65-84 10,773 2.2
• 85 621 0.1
• Total 495,396 100

HCH 1999
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Interagency Council on the Homeless, (1999).
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What are the causes of homelessness?
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• Homelessness is caused by the interaction
  between

Economic Structure
Personal Vulnerabilities
Unemployment
Addictions
Domestic violence
Lack of housing
Poverty
Health problems
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What are the structural causes of homelessness?

• 1. Poverty
• 2. Housing
• 3. Health care system

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1. Increase in poverty

• Unemployment/underemployment
• Decrease in value or availability of public
  benefits

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2. Lack of affordable housing

• Increases in housing costs
• Decreases in availability of assisted housing
• Urban redevelopment, gentrification and loss of
  single-room occupancy (SRO) housing

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3. Health care system

• Increases in health care costs
• Lack of health insurance coverage
• Inadequate discharge planning
• Lack of mental health substance abuse treatment
  programs

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What personal vulnerabilities contribute to
homelessness?
1. Physical health problems 2. Mental
disorders 3. Addictions 4. Trauma and abuse,
including domestic violence 5. Lack of social
support
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Physical Health Problems

• Chronic health conditions
• Physical disabilities
• Injury or serious illness

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Alcohol, Drug or Mental Health Problems

• Alcohol problems - 50
• Drug problems - 33
• Mental health disorders - 20-25
• (50 of whom also have alcohol and/or drug
  problems)

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Domestic Violence

• Of 777 homeless parents interviewed in ten U.S.
  Cities,
• 22 said they had left their last place of
  residence because of domestic violence.
• Homes for the Homeless, 1998

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What is the history of the HCH program?

• Information adapted from McMurray-Avila, 2nd
  Edition (2001). Organizing health services for
  homeless people A practical guide

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How did the HCH program begin?

• 1985
• 19 demonstration projects were privately funded
  by the Robert Wood Johnson Foundation and the Pew
  Charitable Trusts with a focus on primary medical
  care and case management.

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The Federal Response

• 1988
• Title VI of the Stewart B. McKinney Homeless
  Assistance Act created the HCH program under
  Section 340 of the Public Health Service Act (109
  projects in 41 states were funded)
• The McKinney Act also provided funding for
  programs such as emergency food/shelter,
  transitional/ long-term housing, mental health
  services, education/job training

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• The Federal Responsecontinued
• 1993
• The Bureau of Primary Health Care funded outreach
  programs for homeless children and their families
  in 10 HCH projects
• 1996
• Health Center Consolidation Act put HCH programs
  under Section 330(h) of the PHS Act (with
  Community and Migrant Health Centers)

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The Federal Responsecontinued

• As of January 2002
• There are now 138 homeless health care projects
  in all 50 states, plus the District of Columbia
  and Puerto Rico

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138 HCH ProjectsFunded by DHHS/HRSA/BPHC
1985
2001
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Growth of the Federal HCH Program The first
grantees received their initial awards in 1988,
and became fully operational in 1989

• 1987 46 million
• 1988 14.3 million
• 1989 14.8 million
• 1990 35.7 million
• 1991 51.6 million
• 1992 56 million
• 1993 58 million

• 1994 63 million
• 1995 65.4 million
• 1996 65.4 million
• 1997 69.4 million
• 1998 71.3 million
• 1999 80 million
• 2000 88 million

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What are the service delivery and sponsorship
arrangements of HCH projects?
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HCH Project Delivery Systems

• Free-standing HCH facilities such as clinics,
  respite units, drop-in centers, or residential
  units
• Hospital-based clinics
• Clinics and services in shelters or other
  homeless service sites
• Community health center clinics
• Mobile units
• Street outreach

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(No Transcript)
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What is the HCH approach to care?
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Obstacles to accessing mainstream health care
services

• Lack of financial resources or health insurance
• Lack of awareness of services
• Fragmented service system
• Fear or distrust of large institutions
• Finding shelter and food are higher priorities
  than health care
• Lack of transportation

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Obstacles to utilizing mainstream health care
services

• Provider attitudes
• Language and cultural barriers
• Scheduling difficulties
• Lack of comprehensive services
• Lack of documentation

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How do HCH projects overcome these obstacles?

• Comprehensive services
• Accessible services
• Staff sensitivity to homeless issues
• Philosophy of care

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Comprehensive Services

• Primary health care
• Outreach
• Substance abuse services
• Mental health services
• Case management
• Entitlement eligibility assistance
• Provision of or arrangement for emergency health
  services
• Referral for inpatient hospitalization

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Comprehensive Services

• Restorative dental services
• Vision services and eyeglasses
• Specialty care (podiatry, dermatology,
  cardiology, etc.)
• Complementary and alternative medicine therapies
• Housing assistance
• Employment/job training
• Respite/convalescent services

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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

• Contact with any individual who would otherwise
  be ignored (or unserved)in non-traditional
  settings for the purposes of improving their
  mental health, health, or social functioning or
  increasing their human service and resource
  utilization.
• Gary Morse, 1987

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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 such as 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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Staff Sensitivity to Homeless Issues

• Treat people with dignity and respect
• Sensitive 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 people experiencing homelessness

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Cross-Disciplinary Team Approaches

• Multidisciplinary
• Interdisciplinary
• Transdisciplinary
• Adapted from Patricia L. Rosenfield Potential of
  Transdisciplinary Research, Social Science
  Medicine. 3511,1992

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Multidisciplinary versus Interdisciplinary
Approaches

• Multidisciplinary
• Team members work parallel to each other to
  address common problems
• Results usually brought together at the end
• Doesnt ensure disciplines actually work together

• Interdisciplinary
• Team works jointly but still from
  discipline-specific perspectives
• New insights to address problems result from
  shared staff conferencing
• Improvement over the multidisciplinary approach

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Transdisciplinary Approach

• Teams work jointly to address common problems by
  using a shared conceptual framework drawing from
  discipline-specific theories, concepts and
  approaches
• Transcends separate disciplinary approaches
• Outside the box thinking
• Whole person orientation

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Philosophy of Care

• Ultimate goal of HCH Seek individual and
  systemic solutions to end homelessness
• Collaborate with others at local and national
  levels
• Involve homeless or formerly homeless people in
  HCH projects
• Avoid institutionalization of homelessness
• Put ourselves out of business

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What is the relationship between HCH programs and
other entities?
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Sources of Funding
FEDERAL
DHHS
HUD
Other fed

• HCH
• Community/Migrant Health Centers
• Non-Profit Organizations
• Public Health Departments
• Hospitals

STATE
LOCAL
PRIVATE Foundation Grants Individual
Donations
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Current Challenges Facing HCH Projects

• Persistence and increase of homelessness
• High rates of uninsured
• Continued focus on temporary rather than
  long-term solutions
• Partnering with other health care programs
• Concerns regarding institutionalization of HCH

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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.prainc.com/hch
• 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 - HCH Branch
  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