Remembering Who We Are: A Brief History of the HCH Clinicians' Network

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Within eternity, five years may seem a blink of an eye, but for an organization, it's a good vantage point from which to recall origins, reaffirm purposes and set future directions. As we celebrate the fifth anniversary of the Health Care for the Homeless Clinicians' Network, we take this opportunity to remind members why the Network exists, how it came to be and how far it has come. We invited several Network founders to share their recollections and their insights into current strengths and future challenges. Here's what they said.

 

PREPARING THE GROUND. In May 1993, the Network was just a twinkle in Joan Holloway's eye, then Director of the Division of Programs for Special Populations in the Bureau of Primary Health Care, when she agreed to fund a needs assessment of McKinney Act grantees. The resulting survey, designed and conducted by the National Health Care for the Homeless Council, was distributed to over 600 clinicians working in HCH projects around the country. Over half of the questionnaires were returned; this unusually high response rate indicated the need for an organization linking those who practice in the HCH setting.

 

Three-fourths of those taking part in the survey said that they were specifically interested in clinical issues -- screening, diagnosis and treatment -- as they relate to caring for those who are homeless. The survey revealed HCH clinicians' need for continuing education and peer support; they wanted to learn from and share with each other. They noted the importance of practice-based research and using research findings to influence or inform policy decisions.

 

In addition, these HCH clinicians sought a vehicle for reaching HCH Program administrators and shaping public policy affecting the delivery of services to the nation's homeless population. Most importantly, these clinicians gave a clear indication that if such an organization were to exist, they would participate.

 

From the Bureau's perspective, a clinical network could help advance HCH Program objectives by improving the delivery of care to homeless people while fostering recruitment and retention of the clinicians who serve them. Following the National Council's survey, events were quickly set in motion to hire a director and enlist volunteers who were willing to help establish this network. The Migrant Clinicians Network, serving clinicians in the field of migrant farm worker health, and the Clinical Directors Network of Region II, representing health centers' medical directors, were used as models.

 

SOWING SEEDS. The first step was to recruit leadership and chart a course for the new organization. After receiving financial backing from the Bureau of Primary Health Care, the National Council hired Brenda Proffitt, MHA, (Albuquerque) in April 1994 to direct the Network. In May, BPHC hosted an invitational meeting in Baltimore. During this meeting, ten clinicians agreed to serve on a Steering Committee, which would provide the needed clinical leadership for the HCH Clinicians' Network. To round out geographical and discipline diversity, nine additional clinicians were recruited and in August, the first Network Steering Committee¹ meeting was held in Boston.

 

 

Network founders formulate the Boston Principles, August 1994. Left to right: Brenda Proffitt, George Laven, Ken Kraybill, Clarence Taylor Photo by David Hildebrand

 

 

"Those two days in Boston were highly charged and energizing," recalls Laura Gillis, MS, RN (Baltimore). "We asked ourselves what makes working in health care for the homeless different from other practice settings. We brainstormed ideas for what we could accomplish if we were organized and unified." Out of these intense deliberations came a clear vision of the Network's purpose: to share information and experience; to provide peer support; to increase awareness of the interrelationship among homelessness, health and public policy; and to collaborate with like-minded organizations working with homeless people.

 

"Several important principles provide a compass for the Network. Foremost among these is the commitment to combat and prevent homelessness, and to improve the health and quality of life of homeless people." Brenda Proffitt, MHA

"It became clear that those sitting around the table shared a common belief that homelessness in the United States is intolerable," remembers Proffitt. "It was agreed that several important principles would provide a frame of reference or compass for the Network. Foremost among these was the commitment to combat and prevent homelessness, and to improve the health and quality of life of homeless people." These underlying principles have become affectionately known as the Boston Principles among those who took part in their crafting.

 

"Next, we set up working committees to reach our goals," adds Gillis. The original structure included the following committees: governance, education, membership/public relations, advocacy, and clinical-based research as well as an editorial board. Gillis chaired the governance committee, which immediately set about drafting bylaws.

 

In the fall of 1994, the Steering Committee met in Nashville and approved the Network's mission statement, established a fund-development committee, and agreed to open membership to clinicians working in PATH and ACCESS projects. "In addition," Proffitt notes, "the Steering Committee adopted pretty ambitious long-term goals: to become a free-standing organization [apart from the National Health Care for the Homeless Council]; have a membership of at least 500 clinicians by 1997; secure diversified funding; gain national recognition for our collective clinical expertise; and establish membership services and benefits."

 

"Another milestone in our history was when we agreed that we would use the consensus model of decision making," says Ken Kraybill, MSW (Seattle). "Consensus decision making can be both powerful and empowering," explains Kraybill, "and it seems to fit the Network's culture." Indeed, in December 1998 the Steering Committee received training in formal consensus to improve its skills in effective, unifying, democratic decision making. Kraybill chairs the nominating committee and sits on the executive committee as well.

 

"Consensus decision making can be both powerful and empowering, and it seems to fit the Network's culture."   Ken Kraybill, MSW

"By May 1995, we were ready to go public," recalls Proffitt. "We sponsored a membership table at the Sixth National Health Care for the Homeless Conference to spread the word about our organization and invite clinicians to join." The Steering Committee meeting held in conjunction with this conference was a memorable one. "Though noisy and confusing, it was electrifying, exciting and full of hope," recalls Linda Ruble, PA-C (Des Moines).

 

"After months of debate, revision and refinement, we adopted bylaws. We elected officers for the first time, and PATH and ACCESS representatives were welcomed to the Steering Committee." Ruble was the first Network chair, leading the organization from 1995 to 1996.

 

The highlight of the Steering Committee's meeting in September 1995 was learning that the Network had received a $10,000 contract through SAMHSA's Center for Mental Health Services to host a workshop on nonviolent crisis intervention. "This was exciting because it was our first funding from an agency other than the Bureau," adds Maggie Hobbs, MSW, (Washington, DC) "and it was our first opportunity to provide training to PATH, ACCESS and HCH clinicians." This hands-on training was held in Philadelphia in March 1996, and the Network produced a manual, Sample Safety Guidelines in Homeless Health Services Programs, to help HCH projects develop their own safety guidelines. Hobbs has chaired the communications committee for the past three years, and she is the Network's 1999 - 2000 chair-elect.

 

"At this point," explains John Lozier, MSSW, executive director of the National Health Care for the Homeless Council, "the Council's project support committee oversaw Network activities. During 1995, the Steering Committee came to realize that there was no pressing need for the Network to spin off from the Council, indeed there was much to gain from our continued close affiliation."

 

In September 1995, the Steering Committee executed a Memorandum of Agreement with the National Council. This MOA clarified the Network's relationship with the Council, making it clear that the Council's board of directors has legal and fiduciary responsibility for the Network. The Council gave full committee status to the Network Steering Committee and designated four seats on the board of directors for representatives of the Network.

 

"The Network nominating committee recommended that these three-year terms be filled by our chair, chair-elect and immediate past chair. The fourth seat is held by a Network member who is currently not on the Steering Committee. The Network chair also serves on the Council's executive committee," explains nominating committee member Matias Vega, MD (Albuquerque). Network leadership became part of the National Council's governing board in 1997.

 

FRUITS OF OUR LABOR. "By the end of that first year, we began to reap the rewards of our hard work," Proffitt comments. "Under the leadership of Suzanne Creary, CSW, (Peekskill) the membership committee established an annual awards program. In June 1996, we convened our first membership meeting and presented national awards to outstanding clinicians working in health care for the homeless. We were especially pleased to present Dr. Philip Brickner with a Distinguished Service Award in recognition of his significant contributions to our field." Since 1996 the Network has presented four awards for outstanding service and 16 local hero awards. Awards are presented annually at the membership meeting, which is held in conjunction with the national health care for the homeless conference.

 

 

1996 Award for Outstanding Service winner, Abby Lehrman, BS, outreach worker, San Francisco Community Clinic Consortium

 

"That first membership meeting has been a hard act to follow," according to Amalia Torrez, CDA (Albuquerque), current membership committee chair. "Our keynote speaker was Dr. Terry Tafoya, a psychologist and Native American storyteller from Taos Pueblo. Fortunately, we caught it all on videotape, thanks to financial and technical support from the Bureau of Primary Health Care." Tafoya's presentation, Blaze of Glory Should Not Equal Burnout: Caring for the Caregiver, is available from the National Clearinghouse for Primary Care; call toll-free 1-800-400-2742 to order.

 

From the beginning, the Network has had a regular column, "Network News," in Opening Doors, the quarterly newsletter produced by the Bureau of Primary Health Care for HCH grantees. This publication helps increase awareness of the Network and its activities. By the fall of 1996, however, the Network editorial board recommended that the organization needed more frequent and in-depth communication with Network members. In response, the Network developed and distributed its own newsletter, Healing Hands; the first issue went out in February 1997.

 

The newsletter has been well-received, and a 1998 member satisfaction survey found that 80 percent of members responding considered Healing Hands to be a very important benefit of belonging to the Network. Also in this survey, readers asked for in-depth articles, greater emphasis on clinical issues, and increased input from HCH clinicians themselves. In April 1998, the Network brought on an additional staff member, Pat Post, MPA, (Nashville) our current communications manager, to help meet these demands. Post writes and produces Healing Hands, maintains the Network Web site and staffs the communications committee.

 

PERENNIAL FAVORITES. "As early as 1994 we began working with the Bureau on planning the clinical track of the National Health Care for the Homeless Conference," explains Linda Dziobek, BA, RN (Providence). "One of the things we really pushed for was continuing medical education credit, advanced clinical topics for our more seasoned providers, and a poster session so we could learn from each other. Balancing the needs of the many clinical disciplines working in health care for the homeless continues to be a challenge for conference planners." The 1999 - 2000 Network chair, Dziobek chaired the education committee and served on the Bureau's conference planning committee from 1996 - 1999.

 

 

"As early as 1994 we began working with the Bureau of Primary Health Care on planning the clinical track of the National Health Care for the Homeless Conference." Linda Dziobek, BA, RN

The education committee began planning its own workshop, HCH 101, in January 1997. The idea was to provide a comprehensive, three-hour orientation to clinicians new to the HCH practice setting. A detailed case study was developed, handouts and a recommended reading list compiled, and small group leaders recruited and trained. This workshop was presented for the first time in June at the Eighth National Health Care for the Homeless Conference. The training included an overview of the HCH Program, an introduction to interdisciplinary teams, and small group work organized by clinical discipline. The workshop has proven very popular and has been presented four times; a similar session may be developed for HCH administrative staff.

 

FROM LITTLE ACORNS. "A unique opportunity came our way when researcher Ellen Bassuk, MD, asked to meet with HCH clinicians during a small breakfast meeting in June 1997," comments Karen Rotondo, BSN, RN (Springfield, Massachusetts). "Bassuk was keen to discuss her research findings with clinicians in the field. She and her colleagues had just completed a study on homeless women and children, and they were intrigued by the high incidence of traumatic violence and its sequela in this population." This stimulating breakfast conversation led to the Network's collaboration with The Better Homes Fund on a project related to homeless women and posttraumatic stress disorder.

 

Between 1997 and 1999, the Network research committee helped TBHF develop and validate a screening tool to detect PTSD in homeless women. BPHC provided financial support for the project, and the resulting screening tool and accompanying manual will be distributed to HCH projects nationally this summer.

 

 

"The Network's mission is not only to provide peer support, but to encourage research that enhances clinical practice." Karen Rotondo, BSN, RN

"The Network's mission is not only to provide peer support, but to encourage research that enhances clinical practice," Rotondo states. "Working with TBHF on this project helped us to fulfill this aspect of our mission, and collaborations with other researchers are underway." Rotondo has chaired the research committee since August 1998, and she was the 1997 - 1998 Network chair.

 

STOP AND SMELL THE ROSES. The HCH Clinicians' Network has grown from 194 members in 1995 to over 400 in 1999. Among the Network's achievements are the publication of triage and safety guidelines, a work on disability determination, and collaborative efforts to develop appropriate standards of care for homeless persons with HIV/AIDS.

 

"More and more, the Bureau and other agencies have turned to Network members for their unique expertise," observes Ardyce Ridolfo, MSN, FNP (Chattanooga). "In 1996, we worked with the Bureau to develop clinical outcome measures for the HCH Program, and in 1997 we submitted comments on draft Medicaid HEDIS measures. We were asked to comment on OSHA's draft regulations on preventing the spread of tuberculosis in shelters. During 1998 and '99, we've participated in HRSA's Health Status and Performance Improvement Collaborative on diabetes mellitus, and we are active in the National Clinicians' Forum. Our dream to share information based on our clinical experience is becoming a reality." A member of the Network Steering Committee, Ridolfo just completed her term as 1998 - 1999 chair.

 

"Our challenge is to be careful stewards of the passion that brought us together." Linda Ruble, PA-C

As gardeners know, growing something beautiful requires time and patience, knowledge and skill, a good plan and ample luck. These ingredients are also essential when cultivating a successful organization. "As the Network has matured, it has grown more practical and realistic with more of a clinical focus," states Ruble. "Our challenge is to be careful stewards of the passion that brought us together."

 

 

1999 Network Steering Committee members (top to bottom, left to right): Jim White, Ken Kraybill, Ed Farrell, Mary Beth Herner, Amalia Torrez, Linda Dziobek, Linda Ruble, Brenda Proffitt, Adele O'Sullivan, Ardyce Ridolfo, Karen Holman, Maggie Hobbs.  Not pictured: Sharon Brammer, Elizabeth DelaTorres, James Dixon, Karen Rotondo, Peter Sherman and Aaron Strelow Photo by Scott Orman

¹ Original 19-member Steering Committee: Jerry Anooshian, MSW (Boise); Debra Bond, PhD (Hartford); Silvia Corral, MD, MPH (Salt Lake City); Suzanne Creary, CSW (Peekskill); Linda Dziobek, BA, RN (Providence); Laura Gillis, MS, RN (Baltimore); Mary Beth Herner (San Francisco); Ken Kraybill, MSW (Seattle); George Laven, MD (Lamont, CA); Reginald Mebane, PhD (Memphis); Tony Nieto, DMD (Albuquerque); Cavaille Osson-Fox, RN (New York); Karen Rotondo, BSN, RN (Springfield, MA); Linda Ruble, PA-C (Des Moines); Clarence Taylor, MD (Cleveland); Matias Vega, MD (formerly Indianapolis; currently Albuquerque); C. C. Williams, BSW (Boston); Mel Wilson, LCSW (Washington, DC); and Leona Woods, MPA, NP (Los Angeles)

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