1. Improved outcomes for homeless patient’s who use the ED to meet their basic needs.
Problem Statement:
Homeless patient’s over-utilization of the ED for non-
emergencies.
Need Statement:
ER systems need to engage in inter-agency interdepart-
mental collaborations to connect homeless patients to pro-
viders who can meet their basic needs as evidenced by
decrease use of the emergency department.
Research Results:
People who are homeless have to depend on a varie-
ty of emergency services to meet their needs which has
created a vicious cycle of service utilization that is difficult
to break. Being homeless can create a constant state of
crisis; this state of crisis is perpetuated by not being able
to meet basic needs, feelings of isolation, feelings of fear,
as well as compounding loss of social connections, job, and
health (Clarke, Williams, Percy, & Kim, 1995).
Current health systems lack services designed to
meet the needs and complexity of homeless persons and
this inadequacy enables the use of the emergency room
as these peoples’ needs continue to go unmet (Parker &
Dykema, 2013). Following discharge from an inpatient
facility patients are often left to navigate outpatient
services on their own, this leads to negative outcomes as
people go from having a shelter, meals and clothing as
an inpatient to having near nothing on the streets
(Rosenfield, 1991). Homeless patient’s also facing the
additional barrier of isolation from the dominant society
make it more difficult to sustain positive outcomes (Rowe,
Kloos, Chinman, Davidson, & Cross, 2001).
The research indicates a need for better interperson-
al, interdepartmental, and interagency collaboration to
do more to increase efficacy of initial interventions and
improved preventative measures to reduce unnecessary
readmissions.
Literature Cited:
Clarke, P. N., Williams, C. A., Percy, M. A., & Kim, Y. S. (1995). Health and life problems of homeless men and women in the southeast. Journal of Community Health Nursing, 12(2), 101-110.
Martin, M. (2014, October 30). Program Director. (J. Pinkerton, Interviewer) Tacoma, Washington.
Parker, R. D., & Dykema, S. (2013). The reality of homeless mobility and implications for improving care. Journal of Community Health, 685-689. doi:10.1007/s10900-013-9664-2
Reitz-Pustejovsky, M. (2002). Is the care we provide homeless people, just? The ethic of justice informing the ethic of care. Journal of Social Distress and the Homeless, 11(3), 233-247.
Clarke, P. N., Williams, C. A., Percy, M. A., & Kim, Y. S. (1995). Health and life problems of homeless men and women in the southeast. Journal of Community Health Nursing, 12(2), 101-110.
Rosenfield, S. (1991). Homelessness and rehospitalization: The importance of housing for the chronically mentally ill. Journal of Community Psychology, 19(1), 60-69.
Rowe, M., Kloos, B., Chinman, M., Davidson, L., & Cross, A. B. (2001). Homelessness, mental illness and citizenship. Social Policy and Administration, 35(1), 14-28.
Anticipated Outcomes and
Evaluation Criteria:
Outcome 1: Improved knowledge of commu-
nity resources.
Criteria: Patient has achieved outcome
indicators 1a and 1b.
Outcome indicator 1a: Knows who to contact to at-
tain community resources.
Criteria: Patient can identify their needs and ap-
propriate resources to meet those needs on a survey.
Outcome indicator 1b: Knows how to get community
resources.
Criteria: Patient is able to indicate on the survey
how to access services to meet their basic needs.
Outcome 2: Improved access to services.
Criteria: Patient has achieved outcome
indicators 2a and 2b.
Outcome indicator 2a: Accesses services that meet
needs.
Criteria: Patient is able to self-report where there
needs have been met and there will be a decreased
incidence of ED utilization.
Outcome indicator 2b: Implements action plan to
meet service needs with other community resources.
Criteria: During interview patient can articulate
the action plan and whether that plan has led to their
basic needs being met.
Acknowledgements:
I would like to thank those who have supported me
throughout this project both personally and profes-
sionally. Big thank you to my family who has been
both encouraging and patient.
Intervention:
Jacquelyn M. Pinkerton
jmj88@uw.edu
MSW Candidate, University of Washington, Tacoma
Class of 2015