The document discusses a proposed health screening and hygiene packet distribution program for homeless individuals. It provides background on the high rates of disability and disease among the homeless population. The homeless population in the target city consists mainly of ethnic minorities. There is evidence that ethnic and racial minority groups with severe mental illness often experience disparities in healthcare services compared to white individuals. The document outlines five domains related to barriers that homeless individuals, healthcare practitioners, and service systems bring to healthcare interactions that decrease their effectiveness. These barriers must be recognized and addressed in order to create an effective intervention program that meets the needs of homeless individuals.

1. A Health Screening/Referral and Hygiene Packet Distribution Program Author: Melissa Grindstaff

2. Conceptual Framework- “a structure of concepts and/or theories pulled together as a map…” (Lobiondo-Wood & Haber, 2006, p. 560) Model- “a symbolic representation of a set of concepts that is created to depict relationships” (Lobiondo-Wood & Haber, 2006, p. 115). Disabled person- one who is limited in any way in any activities because of physical, mental, or emotional problems (Anderson & McFarlane, 2008).

3. (Lewis, 2009)

4. “ The homeless are unique among marginalized groups. Those individuals who make up the nation’s homeless are among the most vulnerable to disabilities and disease, and represent up to 10% of all individuals living in poverty” (Anderson & McFarlane, 2008, p. 411).

5. Per direct observation and interview with the cold shelter director, the homeless population of Ontario is distinctly comprised of ethnic minorities. “ Evidence indicates that people with severe mental illnesses from minority racial and ethnic groups experience service disparities compared with whites with severe mental illnesses” (Horvitz-Lennon et al., 2009).

6. Domain 1: The homeless client comes into the healthcare interaction with a set of beliefs that affect his/her behaviors. Domains 2-3: Systems/Services for the homeless have a tendency towards ethnocentricity which makes these systems/services less effective. Domains 4-5: Practitioners/service systems tend to have bias that affects the interaction during the encounter, decreasing effectiveness and trust building. (Please see Slide 3 for referenced domains) (Lewis, 2009)

7. So, in effect, all actors in the healthcare interaction to be implemented will be carrying their own set of beliefs and behaviors into the encounter. To create an encounter that is effective, some of these barriers to effectiveness must be broken down. By recognizing these barriers, the intervention is modified to meet the homeless in their environment, on their terms, with a cognizant recognition of the domains previously discussed. (Continued)

8. Anderson, E. T., & McFarlane, J. (2008). Community as Partner: theory and practice in nursing. Philadelphia, PA: Lippincott Williams & Wilkins. Chitty, K. K., & Black, B. P. (2007). Professional Nursing: concepts & challenges. St. Louis, MO: Saunders Elsevier. Horvitz-Lennon, M., Frank, R. G., Thompson, W., Hyon Baik, S., Alegria, M., Rosenheck, R. A., Normand, S. T. (2009). Investigation of racial and ethnic disparities in service utilization among homeless adults with severe mental illnesses. Psychiatric Services, 60(8), 1032-1038. Retrieved from http://psychservices.psychiatryonline.org.libproxy.boisestate.edu/cgi/reprint/60/8/1032 Lewis, A. (2009). Disability disparities: a beginning model. Disability and Rehabilitation, 31(14), 1136-1143. Doi:10.1080/09638280902773737 Lobiondo-Wood, G., & Haber, J. (2006). Nursing Research: methods and critical appraisal for evidence-based practice. St. Louise, MO: Mosby Elsevier