Health Care for the Homeless 101   An orientation for clinicians, administrators, consumers, and  board members National H...
Sponsored by National HCH Council  & HCH Clinicians’ Network
Overview <ul><li>Realities of homelessness </li></ul><ul><li>History and organization of HCH program  </li></ul><ul><li>HC...
Realities of homelessness  in the United States Homeless people are the sum total  of our dreams, policies, intentions, er...
Hunger and shelter requests <ul><li>In 23-city survey by U.S. Conf. of Mayors in 2006:  </li></ul><ul><li>Requests for eme...
Cost of housing <ul><li>The federal minimum wage has remained at $5.15 per hour for the past ten years (last raised in1997...
Estimates of number of people experiencing homelessness <ul><li>More than 760,000 persons sleep on the streets or in shelt...
Single  Women 17% Single  Men 51% Families with  Children 30% Unaccompanied  Youth 2% A portrait of homelessness The US Co...
White 39% Native American 4% African- American 42% Asian 2% Hispanic 13% A portrait of homelessness The US Conference of M...
Where do we find people who are homeless? Urban Institute, 1999
Emerging trends in homeless  demographics: children and families <ul><li>Families with children are among fastest growing ...
Homeless youth <ul><li>730,000 to 1.3 million nationally on annual basis </li></ul><ul><li>50% run away secondary to abuse...
Adverse childhood experiences reported by homeless clients <ul><li>27% history of foster care, group home or other institu...
Victimization and violence <ul><li>In a study of homeless and poor housed women, 67% reported severe physical violence by ...
Severe mental illness <ul><li>It is estimated that 25 percent of homeless people have at some time experienced severe ment...
Co-occurring disorders <ul><li>Some studies suggest that as many as half of homeless adults with severe mental illness als...
Homelessness and poor health <ul><li>Health problems cause homelessness </li></ul><ul><li>Homelessness causes health probl...
In other words… <ul><li>People in shelters/streets are more likely to get sick. </li></ul><ul><li>People in shelters/stree...
Impact of homelessness on health <ul><li>Individuals without a regular place to stay are far more likely than are those wi...
Homelessness and health care: fundamental issues <ul><li>Unstable housing </li></ul><ul><li>Limited access to nutritious f...
Homelessness and health care: fundamental issues (cont’d) <ul><li>Higher rates of abuse </li></ul><ul><li>Behavioral healt...
For many people… <ul><li>The emergency room  </li></ul><ul><li>is the  </li></ul><ul><li>primary care provider. </li></ul>
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Realitiesof Homelessness2007

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The three PowerPoint presentations provided below are from the HCH 101 Pre-conference Institute in June, 2006.

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  • Realitiesof Homelessness2007

    1. 1. Health Care for the Homeless 101 An orientation for clinicians, administrators, consumers, and board members National HCH Conference Washington, D.C. June 13, 2007
    2. 2. Sponsored by National HCH Council & HCH Clinicians’ Network
    3. 3. Overview <ul><li>Realities of homelessness </li></ul><ul><li>History and organization of HCH program </li></ul><ul><li>HCH approach to care </li></ul><ul><li>Resources </li></ul>
    4. 4. Realities of homelessness in the United States Homeless people are the sum total of our dreams, policies, intentions, errors, omissions, cruelties, and kindnesses as a society. Peter Marin, sociologist
    5. 5. Hunger and shelter requests <ul><li>In 23-city survey by U.S. Conf. of Mayors in 2006: </li></ul><ul><li>Requests for emergency food assistance increased 7% from previous year </li></ul><ul><li>Requests for emergency shelter increased by 9% </li></ul><ul><li>An average of 23% of all shelter requests went unmet </li></ul><ul><li>29% of shelter requests by homeless families went unmet </li></ul><ul><li>On average, people’s homelessness lasted eight months </li></ul><ul><li>U.S. Conference of Mayors’ Hunger and Homelessness Survey, December 2006 </li></ul>
    6. 6. Cost of housing <ul><li>The federal minimum wage has remained at $5.15 per hour for the past ten years (last raised in1997). </li></ul><ul><li>Nationally, the Housing Wage for a two-bedroom rental unit is $16.31 per hour – more than three times the federal minimum wage. </li></ul><ul><li>On average, 2.5 full time jobs per household are needed to afford a two bedroom unit at a fair market rental rate. </li></ul><ul><li>Minimum wage earners are not able to afford even a one-bedroom home anywhere in the U.S. </li></ul><ul><li>Out of Reach 2006, National Low Income Housing Coalition </li></ul>
    7. 7. Estimates of number of people experiencing homelessness <ul><li>More than 760,000 persons sleep on the streets or in shelters every night. </li></ul><ul><li>In the late 1990s, 3.5 million people were homeless at some time during an average year. </li></ul><ul><li>Approximately 12 million adults in the U.S. have experienced homelessness during their lifetime. </li></ul><ul><li>Urban Institute. What Will It Take to End Homelessness? 2001 </li></ul>
    8. 8. Single Women 17% Single Men 51% Families with Children 30% Unaccompanied Youth 2% A portrait of homelessness The US Conference of Mayors 23-City Survey: Hunger and Homelessness, December 2006
    9. 9. White 39% Native American 4% African- American 42% Asian 2% Hispanic 13% A portrait of homelessness The US Conference of Mayors 23-City Survey: Hunger and Homelessness, December 2006
    10. 10. Where do we find people who are homeless? Urban Institute, 1999
    11. 11. Emerging trends in homeless demographics: children and families <ul><li>Families with children are among fastest growing segments of people without housing </li></ul><ul><li>1.35 million children per year </li></ul><ul><li>2% of children in the U.S. </li></ul><ul><li>Urban Institute, 1999 </li></ul>
    12. 12. Homeless youth <ul><li>730,000 to 1.3 million nationally on annual basis </li></ul><ul><li>50% run away secondary to abuse </li></ul><ul><li>50% involved with survival sex increasing the likelihood of STD’s and unintended pregnancies </li></ul><ul><li>50% use alcohol; 80% use street drugs, 35% intravenous drug users </li></ul><ul><li>Noell J et al. Childhood sexual abuse, adolescent sexual coercion and sexually transmitted infection acquisition among homeless female adolescents; Child Abuse and Neglect; 25(1): 137–48, Jan 2001 </li></ul>
    13. 13. Adverse childhood experiences reported by homeless clients <ul><li>27% history of foster care, group home or other institutional setting - </li></ul><ul><li>25% history of childhood physical or sexual abuse </li></ul><ul><li>21% history of childhood homelessness </li></ul><ul><li>33% ran away from home </li></ul><ul><li>22% forced to leave home </li></ul><ul><li>Self-report data from Interagency Council on Homelessness, 1999 </li></ul>
    14. 14. Victimization and violence <ul><li>In a study of homeless and poor housed women, 67% reported severe physical violence by a childhood caretaker; </li></ul><ul><li>43% reported childhood sexual molestation; </li></ul><ul><li>and 63% reported severe violence by a male partner. </li></ul><ul><li>Browne A and Bassuk SS. Intimate violence in the lives of homeless and poor housed women; Am J Orthopsychiatry 67(2): 261–278, 1997. </li></ul>
    15. 15. Severe mental illness <ul><li>It is estimated that 25 percent of homeless people have at some time experienced severe mental illness such as schizophrenia or a major mood disorder. </li></ul><ul><li>P. Koegel, M.A. Burnam and J. Baumohl. The Causes of Homelessness. Phoenix: Oryx, 1996, p. 31. </li></ul>
    16. 16. Co-occurring disorders <ul><li>Some studies suggest that as many as half of homeless adults with severe mental illness also have a co-occurring substance use disorder. </li></ul><ul><li>D.L. Dennis, I.S. Levine and F.C. Osher. The Physical and Mental Health Status of Homeless Adults , a paper presented at the Fannie Mae Housing Conference, Washington, DC, 1991 p.9. As cited in Organizing Health Services for Homeless People . McMurray-Avila. M. 2001. </li></ul>
    17. 17. Homelessness and poor health <ul><li>Health problems cause homelessness </li></ul><ul><li>Homelessness causes health problems </li></ul><ul><li>Homelessness complicates efforts to </li></ul><ul><li>treat health problems </li></ul>
    18. 18. In other words… <ul><li>People in shelters/streets are more likely to get sick. </li></ul><ul><li>People in shelters/streets have a tougher time getting well. </li></ul>
    19. 19. Impact of homelessness on health <ul><li>Individuals without a regular place to stay are far more likely than are those with stable housing to suffer from chronic medical conditions such as diabetes, cardiovascular disease, and asthma. </li></ul><ul><li>Institute on Medicine, Homelessness, Health and Human Needs , 1988 </li></ul>
    20. 20. Homelessness and health care: fundamental issues <ul><li>Unstable housing </li></ul><ul><li>Limited access to nutritious food and water </li></ul><ul><li>Higher rates of communicable disease </li></ul><ul><li>Serious and complex medical conditions </li></ul><ul><li>Lack of health insurance/resources </li></ul><ul><li>Lack of transportation </li></ul><ul><li>Discontinuous/inaccessible health care </li></ul><ul><li>Chronic stress </li></ul><ul><li>Developmental discrepancies </li></ul>
    21. 21. Homelessness and health care: fundamental issues (cont’d) <ul><li>Higher rates of abuse </li></ul><ul><li>Behavioral health problems </li></ul><ul><li>Physical/cognitive impairments </li></ul><ul><li>Barriers to disability assistance </li></ul><ul><li>Cultural/linguistic barriers </li></ul><ul><li>Limited education/literacy </li></ul><ul><li>Lack of social supports </li></ul><ul><li>Criminalization of homelessness </li></ul><ul><li>From Adapting Your Practice: General Recommendations for the Care of Homeless Patients Health Care for the Homeless Clinicians’ Network. Available at http://www.nhchc.org/Publications/6.1.04GenHomelessRecsFINAL.pdf </li></ul>
    22. 22. For many people… <ul><li>The emergency room </li></ul><ul><li>is the </li></ul><ul><li>primary care provider. </li></ul>

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