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National Health Care for the Homeless Council
Because Health Care is a Right, Not a Privilege
 Clinicians Network

Health Disparities Collaboratives

Content Manager: Sharon Morrison, RN, MAT

Since 1998, the Health Care for the Homeless Clinicians' Network has been one of three national clinical networks partnering with the Bureau of Primary Health Care in the Health Resources and Services Administration's Health Disparities Collaboratives. Health disparities are unfavorable differences in outcomes experienced by minority populations, poor people, and women. To eliminate health disparities and improve functional and clinical outcomes, health care organizations must change the way they deliver care. The Health Disparities Collaboratives call for such a change -- a transformation in the delivery of care.

The Health Disparities Collaboratives web site provides a centralized portal for communication as well as a forum for sharing the challenges, successes, tools of the trade and lessons learned. The web site has a community section where useful tools and documents are posted. The "library" is home to the joint e-newsletter of the Migrant Clinicians Network and the HCH Clinicians' Network, "Reaching the Underserved: Connecting Mobile and Homeless People to the Health Disparities Collaboratives." As a National Partner in the Collaboratives, the HCH Clinicians' Network's role is to:
  • increase the understanding of the special needs of homeless people,
  • partner with Collaboratives' staff at the national and regional levels,
  • serve as a resource and mentor to health center teams, and
  • serve as faculty at Learning Sessions.
HCH Clinicians’ Network Health Disparities Collaboratives Coordinator
The Health Disparities Collaboratives Coordinator for the HCH Clinicians’ Network is Sharon Morrison, RN, who may be reached at smorrison@nhchc.org. Sharon works at the national level to assure that the unique needs of homeless people are addressed within HRSA's Health Disparities Collaboratives. As faculty at Learning Sessions, she helps to increase awareness and understanding of homelessness, training clinicians to identify those who are homeless and to understand and meet these patients' unique needs. In order to measure outcomes, the Network urges all health centers to identify and track their homeless patients in the Collaboratives' registry. This national registry provides a special opportunity to compare health outcomes between our housed and homeless neighbors and the impact that the Collaboratives can make.

e-Newsletter
Reaching the Underserved: Connecting Mobile and Homeless People to the Health Disparities Collaboratives. This joint e-Newsletter of the Migrant Clinicians Network and HCH Clinicians’ Network focuses on the special needs of mobile and homeless populations and improving the health care services to the populations through the Health Disparities Collaboratives. The newsletter includes success stories, simple solutions, tools and resources in addition to a section for feedback from the field where providers can share opinions or ideas. Issues of Reaching the Underserved are available by clicking here.

Tools and Resources
Identifying Special Populations Within Health Centers’ Clientele Community Health Center's participating in HRSA'a Health Disparities Collaboratives often find it difficult to identify patients who are homeless or migrant within their populations. This PowerPoint presented at the Northeast Cluster’s Learning Session III, outlines HRSA's descriptions of both populations and gives examples of simple changes that CHC's can incorporate to include these vulnerable patients in the collaborative studies.

Connecting Special Populations to the Collaboratives (pdf). This PowerPoint presentation gives an overview of challenges to health care access faced by both migrant and homeless patients.  It outlines the Health Disparities Collaboratives model of care and provides clinicians with tips on how to adapt their practice to include these special populations.

Adapting Your Practice: Treatment and Recommendations for Homeless Patients
adapting your practiceClinicians who routinely care for homeless people recognize the need to take their patients' living situation and co-occurring disorders into consideration when developing a plan of care. Standard clinical practice guidelines fail to address the special challenges faced by homeless patients that may limit their ability to adhere to a plan of care. To fill this gap, the HCH Clinicians’ Network has developed adapted clinical practice guidelines for homeless patients.

Eight sets of Adapted Clinical Guidelines (discussing Diabetes Mellitus, Asthma, Chlamydial or Gonococcal Infections, Otitis Media, Reproductive Health Care, HIV/AIDS, Cardiovascular Diseases, and General Recommendations for the Care of HomelessPatients) are available
as PDF documents for purchase or download, through the National Guideline Clearinghouse, or formatted for PDAs.

Diabetes and Homelessness: Overcoming Barriers to Care. Diabetes and Homelessness: Overcoming Barriers to Care is a rich and varied collection of proven clinical tools, self-management and educational materials, outreach protocols, nutrition information, practice guidelines plus hundreds of resources and referrals pertinent to addressing diabetes mellitus in those who are homeless. The resource directory is designed to fit in a three-ring binder, which makes it easy to remove and copy patient handouts or samples of clinical tools.
Diabetes Personal Care Card
At the request of clinicians who work with homeless individuals with diabetes, the Network developed a portable medical record or diabetes personal care card.
diabetes card Diabetes and Homelessness includes a sample of the personal care card to help providers decide whether to order them for patients. The diabetes personal care cards are available in packets of 100 and come folded and shrink-wrapped; they are available at cost--$15 per 100--plus shipping.
Nylon Wallet wallet

Clinicians also recommend that clients be given a way to carry the care card. Recognizing that homeless people may have trouble keeping up with the card or that it may be lost or stolen, the Network sells small [4 1/2" x 5"] nylon wallets with two zippered pockets and a clear plastic sleeve. The wallet has a nylon cord so that it can be safely and discretely worn around the neck and under the person's shirt. The wallet with the visible personal care card stating "I Have Diabetes" has the additional benefit of identifying the person as having diabetes in an emergency. These wallets are navy with the Network logo in white and cost $2.50 each, shipping included; no minimum order is required.
Key Homeless Change Concepts for the Elements of the Care Model (November 2002)
The table below presents suggestions for changes that improve health outcomes for homeless people and outlines the six components of the Care Model.
Self Management Decision Support Clinical Information Systems Delivery System Design Organization of Health Care Community
Recognize patient priorities are meeting basic needs of food and shelter. Teach providers how to ask about housing status. Use registry for identifying and tracking homeless patients. Gather contact data from patient at each encounter. Educate staff about causes of homelessness and barriers to care. Increase public awareness and understanding of homelessness.
Set and document goals with patients collaboratively to support their independence. Educate providers about barriers to care for homeless patients. Enter contact data gathered at each encounter. Use case managers to link patients to entitlements/benefits. Furnish personal care items, snacks and socks. Recruit volunteer specialists in podiatry, nutrition, ophthalmology, nephrology, etc.
Adapt guidelines and treatment protocols Provide walk-in services and/or same day appointments. Train staff in methods to engage patients into care. Collaborate with homeless service providers, emergency dept. staff, criminal justice system and social service agencies.
Attempt to provide all services during a single visit.
  Create interdisciplinary teams.   Establish procedures to waive fees for homeless people who are unable to pay for services Recruit providers who embrace change and choose flexibility in the work environment. Collaborate with faith-based agencies to provide services.
  Cross train behavioral health and primary care providers.   Provide transportation: cab vouchers, bus tokens, van service.   Collaborate with homeless coalitions and advocacy groups.
  Educate inter-disciplinary team members about individual roles.   Determine outreach staffing mix and services based on a needs assessment   Solicit donations to help meet care needs for test strips, footwear, glasses, healthy food, etc.
      Conduct outreach where homeless people congregate.   Educate local businesses about homelessness.