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National Health Care for the Homeless Council
Health Care and Housing Are Human Rights
 Clinicians Network

Health Disparities
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.
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.

TOOLS AND RESOURCES
HRSA Knowledge Gateway The Gateway is an online tool that facilitates rapid dissemination of evidenced-based information, resources, videos and tools. The online Library function allows documentation and indexing of best practices for participating health care organizations, peers in the field, researchers and the lay public. The results-sharing portions of the Gateway provide a snapshot of organizational and community of practice performance on key measures of health care delivery. The Gateway enables frontline caregivers in the field, who learn and know the most about providing and improving health care, to share, codify and rapidly extend their knowledge and evolving practices.
Contact: Fred Butler Jr. | HRSA Office of the Administrator | Center for Quality | fbutler@hrsa.gov

Introduction to Healthcare Disparities  This online course covers evidence, significance, race and ethnicity, causes and response to healthcare disparities. Talaria, Inc. 2007

Healthcare Disparities: An e-learning course for physicians Evidence suggests that unconscious physician bias may be a contributing factor in healthcare disparities. At the same time, physicians are less likely than the general public to recognize the existence of healthcare disparities. This paper presents highlights from an evidence-based e-learning course for physicians that seeks to raise awareness of healthcare disparities and motivate interest in further education and behavior change. American Public Health Association. 2008

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.

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.