Order #: 15120

Authors:

Health Care for the Homeless Clinicians' Network.

Title:

Integrating Primary & Behavioral Health Care for Homeless People.

Source:

Healing Hands 10(2): May, 2006. (Newsletter: 6 Pages)

Abstract:

Higher incidence, prevalence, and acuity of medical and behavioral problems among people who are homeless warrant the availability of comprehensive medical and behavioral health services. Limited access to mental health specialists, stigma associated with mental illness, and negative health outcomes related to undiagnosed or untreated behavioral disorders make it incumbent on primary care providers to address their patients' mental health needs. The following articles explore a variety of approaches used by Health Care for the Homeless providers to integrate primary and behavioral health care (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org.

Order #: 14500

Authors:

Buck, D.S., Monteiro, F.M., Kneuper, S., Rochon, D., Clark, D.L., Melillo, A., Volk, R.J.

Title:

Design and Validation of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI).

Source:

BMC Medical Education 5(2): 1-8, 2005. (Journal Article: 8 pages)

Abstract:

Recent literature has called for humanistic care of patients and for medical schools to begin incorporating humanism into medical education. To assess the attitudes of health-care professionals toward homeless patients and to demonstrate how those attitudes might impact optimal care, the authors developed and validated a new survey instrument, the Health Professional Attitudes Toward the Homeless Inventory (HPATHI). An instrument that measures providers' attitudes toward the homeless could offer meaningful information for the design and implementation of educational activities that foster more compassionate homeless health care. The HPATHI demonstrated strong reliability for the total scale and satisfactory test-retest reliability. Extreme group comparisons suggested that experience with the homeless rather than medical training itself could affect health-care professionals' attitudes toward the homeless. This could have implications for the evaluation of medical school curricula (authors). 

Order #: 14645

Authors:

Centers for Disease Control and Prevention.

Title:

Tuberculosis Transmission in a Homeless Shelter Population: New York, 2000-2003.

Source:

Atlanta, GA: Centers for Disease Control and Prevention, 2005. (Report: 5 Pages)

Abstract:

This report summarizes a recent outbreak of TB and highlights the challenges of preventing TB among homeless persons, particularly when multiple chains of transmission are occurring and multiple jurisdictions are involved. The findings underscore the complementary role of rapid DNA genotyping in the detection of possible TB transmission in homeless populations. To ensure early detection of unsuspected TB transmission in homeless populations, health department TB-control programs are encouraged to use CDC's universal Mycobacterium tuberculosis rapid genotyping system (authors). Available From: Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402, (202) 512-1800, www.cdc.gov/mmwr/preview/mmwrhtml/mm5406a4.htm

Order #: 14901

Authors:

Douaihy, A.B., Stowell, K.R., Bui, T., Daley, D., Salloum, I.

Title:

HIV/AIDS and Homelessness, Part 1: Background and Barriers to Care.

Source:

The AIDS Reader 15: 516-520, 527, 2005. (Journal Article: 6 Pages)

Abstract:

This article looks at how the co-occurrence of homelessness and HIV/AIDS poses a complex and multidimensional challenge to the health care provider’s clinical and system integration skills.  Existing data support the high prevalence of HIV/AIDS among homeless persons and a high percentage of persons living with HIV/AIDS being either homeless or at imminent risk for homelessness.  There are special considerations and challenges health care providers may face in caring for homeless persons with HIV/AIDS.  An integrated, flexible, interdisciplinary, community-based system of care addressing the full array of medical, psychiatric/substance abuse, and housing services would optimize clinical care for this population.  Areas that deserve particular attention include HIV/AIDS prevention, access to comprehensive HIV and health care, use of antiretroviral therapy, and adherence to treatment.  Research is needed to better understand the multifaceted needs of this population and to develop prevention and treatment strategies applicable to daily clinical care (authors). 

Order #: 14439

Authors:

Gundlapalli, A., Hanks, Monte, H., Stevens, S., Geroso, A.M., Viavant, C.R., McCall, Y., Lang, P, Bovos, M., Brasncomb, N.T., Ainsworth, A.D.

Title:

It Takes a Village: A Multidisciplinary Model for the Acute Illness Aftercare of Individuals Experiencing Homelessness.

Source:

Journal of Health Care for the Poor and Underserved 16: 257-272, 2005. (Journal Article: 13 Pages)

Abstract:

This article looks at The Fourth Street Clinic Respite Program, which was created to address the issue of uninsured homeless individuals needing to utilize acute health care services and experience longer hospitalizations than individuals who are housed.  Patients are referred to the program from local hospitals and other service providers.  Based on the acuity of illness and need for nursing care, patients are admitted to one of four programs: Shelter-Based Day Bed Program; Temporary Emergency Housing (Motel) Program; Tuberculosis Housing Program; or Nursing Home Program.  Aftercare patients receive medical, social, and behavioral health services and are discharged to local shelters when stable.  The aftercare program provides a safe refuge for recovery from acute illnesses for those experiencing homelessness (authors). 

Order #: 14489

Authors:

Haddad, M.B., Wilson, T.W., Ijaz, K., Marks, S.M., Moore, M.

Title:

Tuberculosis and Homelessness in the United States, 1994-2003.

Source:

The Journal of the American Medical Association 293(22): 2790-2793, 2005. (Journal Article: 3 Pages)

Abstract:

This study sought to describe homeless persons with tuberculosis (TB) and to compare risk factors and disease characteristics between homeless and nonhomeless persons with TB.  Of 185,870 cases of TB disease reported between 1994 and 2003, 11,369 were among persons classified as homeless during the 12 months before diagnosis. The annual proportion of cases associated with homelessness was stable.  Individual TB risk factors often overlap with risk factors for homelessness, and the social contexts in which TB occurs are often complex and important to consider in planning TB treatment. Nevertheless, given good case management, homeless persons with TB can achieve excellent treatment outcomes (authors). 

Order #: 14349

Authors:

Health Care for the Homeless Clinicians' Network.

Title:

Bugs That Bite: Helping Homeless People and Shelter Staff Cope.

Source:

Healing Hands 9(1): February, 2005. (Newsletter: 4 Pages)

Abstract:

This issue examines some of the more common problems that people who are homeless face because of their inability to escape bugs that bite. These include such parasites as lice and scabies, and common insects like mosquitoes, spiders, and ticks.  Environments like crowded shelters and outdoor camps, the inability to wash and change clothes regularly, and poor overall physical and mental health, place people who are homeless at risk for secondary infections and serious illnesses. This issue discusses ways in which HCH providers can help patients and shelter staff confront stigma and prevent outbreaks and serious complications (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org/Network/HealingHands/2005/Feb2005HealingHands.pdf

Order #: 14722

Authors:

Health Care for the Homeless Clinicians' Network.

Title:

Heart of the Matter: Managing and Preventing Cardiovascular Disease.

Source:

Healing Hands 9(4): August, 2005. (Newsletter: 6 Pages)

Abstract:

This issue of Healing Hands reports the prevalence of cardiovascular diseases among people who are homeless, explores special considerations for the treatment and self-management of those with chronic disease, and highlights strategies HCH providers use to help adults stop smoking and promote heart health in children. Heart disease is the number one killer of both men and women in the U.S. Poor diet, insufficient aerobic exercise, excessive use of drugs that elevate blood pressure and pulse rate (including nicotine and alcohol), highly stressful lives, and lack of regular preventive health care increase the risk for life-threatening diseases of the cardiovascular system. Homelessness compounds this risk, complicates treatment, and presents barriers to self-care (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org/Network/HealingHands/2005/Aug2005HealingHands.pdf

Order #: 14350

Authors:

Health Care for the Homeless Clinicians' Network.

Title:

Nurses: On the Front Lines of Health Care for Homeless People.

Source:

Healing Hands 9(1): April, 2005. (Newsletter: 4 pages)

Abstract:

This issue highlights the unique contributions that nurses make in working with people who are homeless. Nurses are on the front lines of providing health care to people who are homeless. The roles nurses play in HCH and similar projects are many and varied: they provide primary care, health education, and disease prevention; they act as social workers, therapists, and advocates; they work in clinics, shelters, and on the streets. This issue examines why nurses do this work, what makes them successful, and what they view as their greatest challenges and rewards (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org/Network/HealingHands/2005/Apr2005HealingHands.pdf

Order #: 14740

Authors:

Hwang, S.W., Svoboda, T.J., De Jong, I.J., Kabasele, K.J., Gogosis, E.

Title:

Bed Bug Infestations in an Urban Environment.

Source:

Emerging Infectious Diseases 11(4): 533-538, 2005. (Journal Article: 5 Pages)

Abstract:

This study determined the extent of reemerging bed bug infestations in homeless shelters and other locations in Toronto, Canada. Until recently, bed bugs have been considered uncommon in the industrialized world. Toronto Public Health documented complaints of bed bug infestations from 46 locations in 2003, most commonly apartments, shelters, and rooming houses. Pest control operators in Toronto reported treating bed bug infestations at 847 locations in 2003, most commonly single-family dwellings, apartments, and shelters. Bed bug infestations were reported at 20 of 65 homeless shelters. At 1 affected shelter, 4% of residents reported having bed bug bites. Bed bug infestations can have an adverse effect on health and quality of life in the general population, particularly among homeless persons living in shelters (authors). 

Order #: 14881

Authors:

Hwang, S.W., Tolomiczenko, G., Kouyoumdjian, F.G., Garner, R.E.

Title:

Interventions to Improve the Health of the Homeless: A Systematic Review.

Source:

American Journal of Preventive Medicine 29(4): 311-319, 2005. (Journal Article: 9 Pages)

Abstract:

This review's primary goal is to provide guidance in the development and organization of programs to improve the health of homeless people.  MEDLINE, CINAHL, HealthStar, PsycINFO, Sociological Abstracts, and Social Services Abstracts databases were searched from their inception through July 2004 using the following terms: homeless, homeless persons, and homelessness.  References of key articles were also searched.  4564 abstracts were screened, and 258 articles underwent full review.  Seventy-three studies conducted from 1988 to 2004 met inclusion criteria (use of an intervention, use of a comparison group, and the reporting of health-related outcomes).  Two authors independently abstracted data from studies and assigned quality ratings using explicit criteria.  Forty-five studies were rated good or fair quality.  For homeless people with mental illness, case management linked to other services was effective in improving psychiatric symptoms, and assertive case management was effective in decreasing psychiatric hospitalizations and increasing outpatient contacts.  For homeless people with substance abuse problems, case management resulted in greater decreases in substance use than did usual care.  For homeless people with latent tuberculosis, monetary incentives improved adherence rates.  Although a number of studies comparing an intervention to usual care were positive, studies comparing two interventions frequently found no significant difference in outcomes.  Coordinated treatment programs for homeless adults with mental illness or substance abuse usually result in better health outcomes than usual care.  Health care for homeless people should be provided through such programs whenever possible.  Research is lacking on interventions for youths, families, and conditions other than mental illness or substance abuse (authors). 

Order #: 14694

Authors:

Kaplan, G.A., Siefert, K., Ranjit, N., Raghunathan, T.E., Young, E.A., Tran, Diem, Danziger, S., Hudson, S., Lynch, J.W., Tolman, R.

Title:

The Health of Poor Women Under Welfare Reform.

Source:

American Journal of Public Health 95(7): 1252-1258, 2005. (Journal Article: 7 Pages)

Abstract:

This study compared the health of single mothers affected by welfare reform with the health of a nationally representative sample of women to document the prevalence of poor health as single mothers experience the effects of welfare reform.  Risk factors and measures of health among women randomly sampled from the welfare rolls were compared with similar data from a nationally representative sample of women.  Women in the welfare recipient sample had higher rates of elevated glycosylated hemoglobin, hypertension, high body mass index, and high-density lipoprotein cholesterol; lower peak expiratory flow; and less physical functioning.  Current smoking rates were higher, and smoking cessation rates were lower than in the national sample.  Current and former welfare recipients bear a substantial burden of illness.  Further studies are necessary to interpret the findings of worsened health in the wake of welfare reform (authors). 

Order #: 14925

Authors:

Kerker, B.

Title:

The Health of Homeless Adults in New York City: A Report from the New York City Departments of Health and Mental Hygiene and Homeless Services.

Source:

New York, NY: New York City Department of Homeless Services, 2005. (Report: 28 pages)

Abstract:

This study offers a first dramatic look at a hard-to-reach population with serious health needs. According to the report, homeless adults had a substantially higher death rate than the general NYC population. The leading killers were heart disease and cancer, the same as the overall population. However, substance abuse and HIV/AIDS accounted for nearly one-third of all deaths, compared with less than 5% in the general NYC adult population. People who are homeless also suffer from many conditions that diminish their health but are not necessarily fatal, creating higher rates of illness than in the non-homeless population (author). Available From: New York City Department of Homeless Services, 33 Beaver Street, 17th Floor, New York, NY 10004, (212) 361-7973, allena@dhs.nyc.gov, www.nyc.gov/html/doh/downloads/pdf/epi/epi-homeless-200512.pdf

Order #: 14754

Authors:

Kertesz, S.G., Larson, M.J., Horton, N.J., Winter, M., Saitz, R., Samet, J.H.

Title:

Homeless Chronicity and Health Related Quality of Life Trajectories Among Adults With Addictions.

Source:

Medical Care 43(6): 574-585, 2005. (Journal Article: 11 Pages)

Abstract:

This study used data from a 2-year cohort of addicted persons to test whether changes in mental and physical health-related quality of life (HRQOL) differed according to homeless chronicity. Using self-reported homelessness, this study classified subjects as chronically homeless, transitionally homeless, or as housed comparison subjects. New federal initiatives target funds toward chronically homeless as distinct from other homeless persons. Few data exist, however, to substantiate the implications of chronic homelessness for major health outcomes. The study concluded that chronic homelessness was associated with especially poor mental but not physical HRQOL over time. These findings reinforce a new typology of homelessness (authors). 

Order #: 15118

Authors:

Kraybill, K., Olivet, J.

Title:

Shelter Health: Essentials of Care for People Living in Shelter.

Source:

Nashville TN: National Health Care for the Homeless Council, 2005. (Report: 198 Pages)

Abstract:

This guide has been designed for communities where providers of shelter and other services can come together, learn about and discuss the issues, and plan individual and collaborative solutions. The guide is not intended to be a step-by-step "how-to" manual for setting up shelter services, but rather aims to provide tools and support to help shelter providers respond more effectively to the health needs of residents (author). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org.

Order #: 14580

Authors:

Lasser, K.E., Mintzer, I.L., Lambert, A., Cabral, H., Bor, D.H.

Title:

Missed Appointment Rates in Primary Care: The Importance of Site of Care.

Source:

Journal of Health Care for the Poor and Underserved 16(3): 475-486, 2005. (Journal Article: 12 pages)

Abstract:

This study's objective was to determine whether race, language, or gender concordance between primary care providers (PCPs) and patients is associated with lower missed appointment rates in neighborhood health centers.  An additional objective was to determine whether site of care is a determinant of missed appointment rates.  In analyses of 74,120 follow-up visits by 13,882 patients, odds ratios for missing an appointment for patients who had language, race, or gender concordance with their PCP were .90, .84, and 1.01 respectively, after adjustment for age, insurance, language, individual PCP open access, sessions per week PCP in practice, and health center.  Odds ratios for missing an appointment varied nearly three-fold, depending upon the particular site of care.  Race and language concordance between patients and PCPs has only a modest effect on missed appointment rates.  Receipt of primary care services at specific neighborhood health centers was the strongest predictor of missed appointment rates in this sample (authors). 

Order #: 14704

Authors:

Lee, T.C., Hanlon, J.G., Ben-David, J.

Title:

Risk Factors for Cardiovascular Disease in Homeless Adults.

Source:

Circulation 111(20): 2629-2635, 2005. (Journal Article: 6 Pages)

Abstract:

This study's objective was to examine cardiovascular risk factors in a representative sample of homeless adults and identify opportunities for improved risk factor modification. Homeless persons were randomly selected at shelters for single adults in Toronto. Participants underwent interviews, physical measurements, and blood sampling. The mean age of participants was 42 years, and 89% were men. The prevalence of smoking among homeless subjects was significantly higher than in the general population. Hypertension, high cholesterol, and diabetes were not more prevalent than in the general population but were often poorly controlled. Homeless men were significantly less likely to be overweight or obese than men in the general population. Cocaine use in the last year was reported by 29% of subjects. CVD was reported by 15% of subjects, fewer than one third of whom reported taking aspirin or cholesterol-lowering medication. According to multiple-risk-factor equations, the median estimated 10-year absolute risk of myocardial infarction or coronary death among homeless men aged 30 to 74 years was 5%. Cardiovascular risk factor modification is suboptimal among homeless adults in Toronto, despite universal health insurance. Multiple risk factor equations may underestimate true risk in this population because of inadequate accounting for factors such as cocaine use and heavy

smoking (authors). 

Order #: 14885

Authors:

McCary, J.M., O'Connell, J.J.

Title:

Health, Housing, and the Heart: Cardiovascular Disparities in Homeless People.

Source:

Circulation 111(20): 2555-2556, 2005. (Journal Article: 2 Pages)

Abstract:

This study not only exposes a resounding need for community-wide interventions to improve the cardiovascular health of homeless adults, but also underscores the vexing challenges confronting researchers investigating the health disparities attendant to homelessness. 

Order #: 14411

Authors:

Nakonezny, P.A., Ojeda, M.

Title:

Health Services Utilization Between Older and Younger Homeless Adults.

Source:

Gerontologist 45(2): 249-254, 2005. (Journal Article: 5 Pages)

Abstract:

The purpose of this study was to examine the relationship between health services utilization delivered by means of the Homeless Outreach Medical Services (HOMES) program and health services utilization delivered by means of the Parkland emergency room and inpatient units among a sample of older and younger homeless adults being served by the Parkland Health and Hospital System. Older homeless individuals utilized the HOMES more than inpatient services for substance abuse and musculoskeletal conditions, but they utilized inpatient services the most for psychiatric-related conditions. This level of inpatient utilization is perhaps a result of greater severity or progression of mental illness among older homeless adults. The level of outpatient utilization is probably because the HOMES program mitigates many of the barriers that prevent homeless individuals from obtaining primary medical care (authors). 

Order #: 14617

Authors:

National Health Care for the Homeless Council.

Title:

Comprehensive Services to Meet Complex Needs.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2005. (Brochure

 Conferen: 6 Pages)

Abstract:

The National Health Care for the Homeless Council provides a short brochure that succinctly describes the connection between homelessness and poor health, and explains how HCH projects are endeavoring to disrupt this terrible nexus. The brochure is designed to complement the booklet Every Success Story is a Great Story, but stands alone as an informative depiction of Health Care for the Homeless (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, council@nhchc.org, www.nhchc.org/HCHbrochure.html

Order #: 14883

Authors:

Norris, W.M., Nielsen, E.L., Engelberg, R.A., Curtis, J.R.

Title:

Treatment Preferences for Resuscitation and Critical Care Among Homeless Persons.

Source:

Chest 127(6): 2180-2187, 2005. (Journal Article: 8 Pages)

Abstract:

This study examined the treatment preferences of the homeless to guide surrogate decision makers in situations where people who are homeless are critically ill.  Participants were asked whether they would want intubation with mechanical ventilation or cardiopulmonary resuscitation in their current health, if they were in a permanent coma, if they had severe dementia, or if they were confined to bed and dependent on others for all care.  Homeless men were more likely to want resuscitation than homeless women in coma and dementia scenarios.  Homeless men and women were both more likely to want resuscitation in these scenarios than physicians.  Nonwhite homeless were more likely to want resuscitation than white homeless people, and both were more likely to want resuscitation than physicians.  Homeless are also more likely to want resuscitation than patients with COPD.  The majority of homeless who reported not having family or not wanting family to make medical decisions prefer a physician make decisions rather than a court-appointed guardian.  Homeless persons are more likely to prefer resuscitation than physicians and patients with severe COPD.  Since physicians may be in the position of making medical decisions for homeless patients and since physicians are influenced by their own preferences when making decisions for others, physicians should be aware that, on average, homeless persons prefer more aggressive care than physicians.  Hospitals serving homeless individuals should consider developing policies to address this issue (authors). 

Order #: 14902

Authors:

O’Connell, J.J., Mattison, S., Judge, C.M., Allen, J.S., Koh,. H.K.

Title:

A Public Health Approach to Reducing Morbidity and Mortality Among Homeless People in Boston.

Source:

Journal of Public Health Management Practice 11(4): 311-316, 2005. (Journal Article: 6 Pages)

Abstract:

This case study exemplifies a public health practice response to the vexing health care challenges confronting homeless people who must struggle to survive on the streets and in shelters.  Urban homeless populations suffer disproportionately high rates of premature death.  In response to a wave of highly publicized deaths on the streets of Boston during the winter of 1998-1999, the Massachusetts Department of Public Health (MDPH) convened a task force to investigate these deaths and implement an integrated response to this public health crisis.  Comprised of a broad coalition of public and private agencies as well as homeless persons and advocacy groups, the MDPH Task Force reviewed the circumstances surrounding the 13 deaths, monitored subsequent deaths among homeless persons in Boston, and implemented a comprehensive plan to address critical needs and prevent further deaths.  Contrary to the task force’s initial assumption, the 13 decedents had multiple contacts with the medical, psychiatric, and substance abuse systems.  In response to this finding, the MDPH Task Force sought to improve continuity of care and prevent future deaths among Boston’s street population.  Coordination of needed services was achieved through the creation of new, and often unconventional, partnerships (authors). 

Order #: 14378

Authors:

Post, P.A.

Title:

Developing Outcome Measures to Evaluate Health Care for the Homeless Services.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2005. (Report: 62 Pages)

Abstract:

This report examines difficulties and potential benefits that federally-funded Health Care for the Homeless (HCH) projects can expect as they engage in systematic program evaluation and use that information to improve quality of care and demonstrate the value of their work. This report summarizes recommendations by members of the HCH Outcomes Work Group, convened in 2004-2005 by the National Health Care for the Homeless Council to assess the feasibility of measuring HCH service outcomes in a more comprehensive fashion. The report also points out several factors that pose unique challenges in the field, including that standard clinical outcome measures are sometimes unrealistic for persons who are homeless. The outcomes work group took as its objectives identifying elements of HCH service models that should be assessed, specifying particular outcomes to be measured, determining levels of expertise required to develop effectiveness criteria and indicators, exploring data sources that might be used in tracking outcomes, suggesting data management processes and participants, and projecting the likely cost of meaningful outcomes measurement (author). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN, 37206, (615) 226-2292, www.nhchc.org/Publications/DevelopingHCHOutcomeMeasures.pdf

Order #: 14715

Authors:

Ruddy, G, Rhee, K.

Title:

Transdisciplinary Teams in Primary Care for the Underserved: A Literature Review.

Source:

Journal of Health Care for the Poor and Underserved 16(2): 248-256, 2005. (Journal Article: 9 Pages)

Abstract:

Order #: 15288

Authors:

Street Health.

Title:

Majority of Homeless People Have Serious Physical Health Conditions and Face Major Barriers to Health Care.

Source:

Street Health Research Bulletin, Fall 2005. (Bulletin: 4 Pages)

Abstract:

This bulletin points out that homelessness and poverty are key barriers to accessing health care, and that improved social programs and policies are needed to ensure access to adequate housing and incomes. Available From: Street Health, 228 Dundas Street East, Toronto, ON  M5A 2A1, (416) 921-8668.

Order #: 14714

Authors:

Stroebel, R.J., Gloor, B., Freytag, S., Riegert-Johnson, D., Smith, S.A., Huschka, T., Naessens, J., Kottke, T.E.

Title:

Adapting the Chronic Care Model to Treat Chronic Illness at a Free Medical Clinic.

Source:

Journal of Health Care for the Poor and Underserved 16(2): 286-296, 2005. (Journal Article: 11 Pages)

Abstract:

This project was designed to determine the feasibility and effectiveness of an adaptation of the chronic care model applied to uninsured patients in a free medical clinic staffed by volunteer physicians.  Of the 149 enrolled patients, 117 had hypertension, 91 had diabetes, and 51 had hyperlipidemia.  Patients were enrolled in a chronic disease registry from March 1, 2001 through September 30, 2002 at the Salvation Army Free Clinic (SAFC).  Two part-time registered nurses served as care managers providing disease-specific management using evidence-based guidelines.  Consistent specialty consultation was available via phone, e-mail, or physician visit.  Patient self-management was encouraged through collaborative goal setting.  There were 40 patients lost to follow-up; 109 completed the study.  A clinically significant improvement was obtained in at least one chronic disease for 79 patients.  The chronic care model was a useful template for the delivery of effective chronic disease care to a group of uninsured patients at a free medical clinic (authors). 

Order #: 14427

Authors:

Wilson, M.

Title:

Health-Promoting Behaviors of Sheltered Homeless Women.

Source:

Family and Community Health 51-63, 2005. (Journal Article: 13 Pages)

Abstract:

This study’s objective was to expand the body of knowledge and provide further insight into the complex area of homelessness and health.  Health practices of sheltered homeless women were investigated using a cross-sectional, descriptive, and non-experimental design using Pender’s Health Promotion Model as the theoretical framework.  The sample was well educated, mostly unemployed, primarily single, and homeless due to relationship problems/conflict per self-report.  Homeless women were noted to practice health-promoting behaviors in all areas but scored the lowest on physical activity and nutrition.  Significant findings reflected women’s personal strengths and resources in the areas of spiritual growth and interpersonal relations (authors). 

Order #: 15287

Authors:

Bazelon Center for Mental Health Law.

Title:

Get It Together: How to Integrate Physical and Mental Health Care for People With Serious Mental Disorders. Executive Summary.

Source:

 (Report: 10 Pages)

Abstract:

This report examines model programs for improving integration and coordination of behavioral health and primary health services for adults and children with serious mental disorders who rely on the public mental health system for their care.  It summarizes findings of a series of studies and offers recommendations for policymakers (authors). Available From: Bazelon Center for Mental Health Law, 1101 Fifteenth Street, NW, Suite 1212, Washington, DC 20005, (202) 467-5730, www.bazelon.org

Order #: 14927

Authors:

Buck, D.S., Rochon, D., Davidson, H., McCurdy, S.

Title:

Involving Homeless Persons in the Leadership of a Health Care Organization.

Source:

Qualitative Health Research 14(4): 513-525, 2004. (Journal Article: 12 Pages)

Abstract:

This article discusses consumer advisory boards (CABs) as a way of involving patients in their health care. To engage the homeless in the administration of a health care organization for the homeless, a service agency formed such a board comprising homeless and formerly homeless individuals. The purpose was to integrate experiences of homelessness into programmatic design and research efforts of the organization, and to promote participatory research among the homeless. A content analysis and member checking revealed four distinct themes relating to committee goals, identity definition, power, and issues and needs of the homeless. Findings indicate that participatory research provided a useful structure in which the CAB could improve self-sufficiency and self-efficacy, and contribute to the direction of the health care agency (authors). 

Order #: 13929

Authors:

Cashman, S., Savageau, J., Lemay, C., Ferguson, W.

Title:

Patient Health Status and Appointment Keeping in an Urban Community Health Center.

Source:

Journal of Health Care for the Poor and Underserved, 15(3):474-488, 2004. (Journal Article: 14 pages)

Abstract:

This study examines the relationship between patient health status and the likelihood of missing appointments in a community health center serving low-income patients. Medical records of 465 adult patients scheduled to be seen during one week in February 1999 were audited for an eighteen-month period. The authors state that seventy-three percent of patients failed to keep one or more appointments; forty-three percent missed one or two; thirty percent missed three or more. The authors also state that health status measures significantly associated with missing appointments included depression, anxiety/panic disorder, and using tobacco. The article asserts that the number of appointments scheduled and of diagnosed psychological conditions, as well as patient age were significant predictors of missed appointments. The authors conclude that patient appointment keeping is predictable; definable, measurable characteristics of patients can contribute to setting priorities for customizing interventions (authors). 

Order #: 13618

Authors:

Diamant, A., Hays, R., Morales, L., Ford, W., Calmes, D., Asch, S., Duan, N., Fielder, E., Kim, S., Fielding, J., Sumner, G., Shapiro, M., Hayes-Bautista, D., Gelberg, L.

Title:

Delays and Unmet Need for Health Care Among Adult and Primary Care Patients in a Restructured Urban Public Health System.

Source:

American Journal of Public Health 94(5): 783-789, 2004. (Journal Article: 7 pages)

Abstract:

In this article, the authors estimated the prevalence and determinants of delayed and unmet needs for medical care among patients in a restructured public health system.  The authors conducted a stratified cross-sectional probability sample of racially/ethnically diverse primary care patients in the Los Angeles County Department of Health Services.  According to the article, thirty-three percent reported delaying needed medical care during the preceding 12 months; 25% reported an unmet need for care because of competing priorities; and 46% had either delayed or gone without care.  The authors conclude that barriers to needed health care continue to exist among patients receiving care through a large safety net system, and that competing priorities for basic necessities and lack of insurance contribute importantly to unmet health care needs (authors). 

Order #: 13791

Authors:

Donohoe, M.

Title:

Homelessness in the United States: History, Epidemiology, Health Issues, Women, and Public Policy.

Source:

Medscape Ob/Gyn & Women's Health 9(2): 1-4, 2004. (Journal Article: 4 pages)

Abstract:

This article discusses the recent history and current etiologies of homelessness in the United States, presents information regarding homeless persons and their health problems, and describes steps healthcare providers can take to care for homeless patients and to try to overcome the social problem of homelessness. The author asserts that although most issues relevant to homelessness affect both men and women, homeless women's unique circumstances and health problems will be emphasized when relevant (author). 

Order #: 14706

Authors:

Gelberg, L., Browner, C.H., Lejano, E., Arangua, L.

Title:

Access to Women's Health Care: A Qualitative Study of Barriers Perceived by Homeless Women.

Source:

Women and Health 40(2): 87-100, 2004. (Journal Article: 14 Pages)

Abstract:

This study was conducted as the first stage of a qualitative/quantitative investigation of homeless women's access and barriers to family planning and women's health care. Homelessness is an escalating national problem and women are disproportionately affected. Nevertheless, few studies have focused on the special circumstances associated with being a homeless woman. For instance, while both genders experience serious barriers to obtaining health care, homeless women face an additional burden by virtue of their sexual and reproductive health needs. The authors interviewed 47 homeless women of diverse ages and ethnic backgrounds. A qualitative approach was initially taken to explore the factors homeless women themselves perceive as barriers to their use of birth control and women's health services, and factors they believe would facilitate their use. Key findings are that health is not a priority for homeless women, that transportation and scheduling can be particularly burdensome for homeless women, and that being homeless leads some to feel stigmatized by health care providers. Despite being homeless, having children was extremely important to the women in our study. At the same time, those interested in contraception confronted significant barriers in their efforts to prevent pregnancies. The authors conclude with suggested interventions that would make general, gynecological, and reproductive health care more accessible to homeless women (authors). 

Order #: 13678

Authors:

Geller, S., Taylor, B., Scott, H.

Title:

Free Clinics Helping to Patch the Safety Net.

Source:

Journal of Health Care for the Poor and Underserved 15:42-51, 2004. (Journal Article: 10 pages)

Abstract:

This article describes the results of a survey of free clinics in seven Midwestern states: Illinois, Indiana, Iowa, Michigan, Minnesota, Ohio, and Wisconsin. Findings from this survey show that, in a single year, these 106 clinics provided medical, dental, and pharmaceutical services to over 200,000 patients, suggesting that free clinics nationwide are caring for a substantial number of the country's uninsured.  The authors discuss the populations these clinics serve, and the services provided.  The article concludes that given the lack of options for the uninsured and underinsured, free clinics deserve continued recognition, support, and assistance from policy makers, health care providers and the philanthropic community (authors). 

Order #: 13789

Authors:

Health Care for the Homeless Clinician's Network.

Title:

Wound Care Difficult for Homeless Patients and Providers.

Source:

Healing Hands 8(3): 1-4, 2004. (Newsletter: 4 pages)

Abstract:

The articles in this issue examine risk factors, wound types, treatment options, and strategies for patient self-care.  The authors also highlight resources where the reader can find more information (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org

Order #: 13525

Authors:

Health Care for the Homeless Clinicians' Network.

Title:

Adapting Your Practice: General Recommendations for the Care of Homeless Patients.

Source:

Nashville, TN: Health Care for the Homeless Clinicians' Network, 2004. (Report: 32 pages)

Abstract:

This guide was developed to assist clinicians that provide health care to individuals who are homeless or at risk of becoming homeless. The authors assert that these simple clinical practice adaptations will increase opportunities for homeless patients to receive the optimum standard of care and ultimately reduce their higher morbidity and mortality risks (authors). Available From: Health Care for the Homeless Clinicians' Network, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org.

Order #: 13428

Authors:

Health Care for the Homeless Clinicians' Network.

Title:

Adapting Your Practice: Treatment and Recommendations for Homeless Patients With Cardiovascular Diseases: Hypertension, Hyperlipidemia and Heart Failure.

Source:

Nashville, TN: Health Care for the Homeless Clinicians' Network, 2004. (Report: 43 pages)

Abstract:

This report discusses the gap between standard clinical guidelines and clinical practices used by health care providers experienced in the care of individuals who are homeless.  Drawing from their own experience and from that of their colleagues in Health Care for the Homeless projects across the United States, the authors created adaptations that reflect their collective experience in serving people who are homeless with hypertension, hyperlipidemia, and/or heart failure.  The report provides helpful guidance to primary care providers serving individuals who are homeless, and contributes to increased improvements in both quality of care and quality of life for patients (authors). Available From: Health Care for the Homeless Clinicians' Network, P.O Box 60427, Nashville, TN 37206, (615) 226.2292, www.nhchc.org/clinical/2.28.04CVDguide.pdf.

Order #: 14025

Authors:

Health Care for the Homeless Clinicians' Network.

Title:

Pain Management: Reducing Disparities for Homeless Patients.

Source:

Healing Hands 8(5): October, 2004. (Newsletter: 6 Pages)

Abstract:

This issue of Healing Hands explores some of the reasons why pain suffered by individuals who are homeless is often under-treated. Articles focus on pain assessment techniques, recommended treatment modalities to alleviate acute and chronic pain, and therapeutic challenges presented by patients who self-medicate with alcohol or illicit drugs to cope with unrelieved pain (authors). Available From: HCH Clinicians' Network, P.O. Box 60427, Nashville, TN, 37206, (615) 226-2292, www.nhchc.org/Network/HealingHands/2004/Oct2004HealingHands.pdf

Order #: 13628

Authors:

Health Care for the Homeless Clinicians' Network.

Title:

Rx for Homeless Patients Present Financial, Medical Challenges.

Source:

Healing Hands 8(2): 1-6, 2004. (Newsletter: 6 pages)

Abstract:

In this issue of Healing Hands, the authors discuss some ways in which Health Care for the Homeless projects address the complex and critical issue of access to pharmaceuticals.  The authors also specify prescribing practices that providers recommend for the most effective care of homeless patients (authors). Available From: National Health Care for the Homeless Council, HCH Clinicians' Network, P.O. Box 60427,(615) 226-2292, Nashville, TN 37206, www.nhchc.org.

Order #: 14377

Authors:

Hearne, K.

Title:

Respite Care for Homeless Persons: Descriptions of Respite Care Programs in the United States.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2004. (Program Descriptions: 64 Pages)

Abstract:

These descriptions of respite care programs for people who are homeless in the United States were compiled for the National Gathering of Respite Care Providers in Indianapolis, Indiana. All twenty-nine descriptions provide detailed contact information, a program description, and a program profile (author). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN, 37206, (615) 226-2292, www.nhchc.org.

Order #: 13317

Authors:

Holzwarth, J.

Title:

Providing Care to People Experiencing Homelessness.

Source:

Nashville, TN: National Health Care for the Homeless Council, Inc., 2004. (Presentation: 62 slides)

Abstract:

This PowerPoint presentation is designed to help Health Care for the Homeless projects actively encourage students in the health and social service fields to consider work and training opportunities in homeless health care.  The author discusses topics including the realities of homelessness in the United States, the challenges and rewards of working with people experiencing homelessness, successful approaches to providing services to homeless people, compelling reasons to work in homeless health care, and a discussion of ways students can make a difference in the lives of homeless people. This presentation is intended to be used at local schools of medicine, nursing, or social work, or to orient new students doing a rotation or internship in your project. This presentation was designed to be used as a template to be tailored by the presenter according to the needs of the audience (author). Available From: National Health Care for the Homeless Council,  P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org/Training/HCHRecruitmentSlides_files/frame.htm

Order #: 14430

Authors:

Macnee, C.L., McCabe, S.

Title:

Satisfaction With Care Among Homeless Patients: Developments and Testing of a Measure.

Source:

Journal of Community Health Nursing 21(3): 167-178, 2004. (Journal Article: 12 Pages)

Abstract:

This study’s purpose was to establish the reliability and validity of the Homeless Satisfaction With Care Scale, a measure of satisfaction with care among homeless clients; and to examine selected predictors of satisfaction with care.  A descriptive cross-sectional study was conducted comparing an inductively developed measure of satisfaction with 2 established satisfaction measures in a sample of 168 homeless clients who used a rural or an urban clinic.  The inductively developed satisfaction scale had good internal consistency reliability and was significantly related to the established measures of satisfaction, supporting its construct validity.  Generally, patient characteristics were not associated with satisfaction level.  However, black clients had significantly lower satisfaction levels than white clients; satisfaction differed between the rural and urban sites.  Race and clinical site explained 7% of variance in satisfaction.  The inductively developed measure provides a salient and appropriate measure of satisfaction with care for future studies with the unique population of homeless (authors). 

Order #: 14841

Authors:

Masson, C.L., Sorensen, J.L., Phibbs, C.S., Okin, R.L.

Title:

Predictors of Medical Service Utilization Among Individuals with Co-Occurring HIV Infection and Substance Abuse Disorders.

Source:

AIDS Care 16(6): 744-755, 2004. (Journal Article: 11 Pages)

Abstract:

This study examined factors affecting medical service use among HIV-infected persons with a substance abuse disorder. The sample comprised 190 participants enrolled in a randomized trial of a case management intervention. Participants were interviewed about their backgrounds, housing status, income, alcohol and drug use problems, health status and depressive symptoms at study entry. Electronic medical records were used to assess medical service use. Poisson regression models were tested to determine the effects of need, enabling and predisposing factors on the dependent variables of emergency department visits, inpatient admissions and ambulatory care visits. During a two-year period, 71% were treated in the emergency department, 64% had been hospitalized and the sample averaged 12.9 ambulatory care visits. Homelessness was associated with higher utilization of emergency department and inpatient services; drug use severity was associated with higher inpatient and ambulatory care service use; and alcohol use severity was associated with greater use of emergency medical services. Homelessness and substance abuse exacerbate the health care needs of HIV-infected persons and result in increased use of emergency department and inpatient services. Interventions are needed that target HIV-infected persons with substance abuse disorders, particularly those that increase entry and retention in outpatient health care and thus decrease reliance on acute hospital-based services (authors). 

Order #: 13582

Authors:

Meharry Medical College

Title:

Journal of Health Care for the Poor and Underserved.

Source:

Journal of Health Care for the Poor and Underserved 15(2): 149-308, 2004. (Journal:Entire Issue: 159 pages)

Abstract:

This journal discusses topics including the health issues of Native American tribes, access to Hepatitis B vaccinations among Korean American children in immigrant families, and Helicobacter pylori in a Haitian population.  This issue also includes articles on low-income women's use of substance abuse and mental health services, influenza vaccination by race among disabled community-dwelling older women, and the impact of acculturation on smoking in Asian American homes. The exploration of patients' trust in physicians in training, characteristics associated with nursing home residents, and nationwide survey of dentist recruitment and salaries in community health centers are also discussed (authors). 

Order #: 13426

Authors:

Meharry Medical College.

Title:

Journal of Health Care for the Poor and Underserved.

Source:

Journal of Health Care for the Poor and Underserved 15(1): 1-144, 2004. (Journal:Entire Issue: 145 pages)

Abstract:

This issue focuses on Medicaid benefits and care for minority groups.  Some of the articles contained in this issue include: Churning Medicaid Managed Care and Its Effects in Accountability; Full Disclosure of Financial Costs and Options to Patients: The Roles of Race, Age, Health Insurance and Usual Source of Care; Do Medicaid Out-of-Pocket Expenses Thrust Families into Poverty; and Improving the Immunization and Health Status of Children in the Women, Infants, and Children (WIC) Program (authors). 

Order #: 13865

Authors:

Meharry Medical College.

Title:

Journal of Health Care for the Poor and Underserved.

Source:

Baltimore, MD: Johns Hopkins University Press, 2004. (Journal:Entire Issue: 186 pages)

Abstract:

This issue addresses topics including: structural violence and racial disparity in HIV transmission; medical debt and consumer credit counseling services; health risk and promotion behaviors in refugee populations; Medicaid participation in Ohio; patterns of hospital-based pediatric care across diverse ethnicities and breast and cervical cancer screening among Mississippi Delta women.  This issue also addresses: mammography rescreening among women of diverse ethnicities; availability of and access to medical services among HIV-infected inmates; perinatal health service use by women release from jail; transition to adult care for adolescents with Sickle Cell disease and patient health status and appointment-keeping in an urban community center (authors). Available From: Johns Hopkins University Press, 2515 North Charles Street, Baltimore, MD 21218, (800) 548-1784, www.press.jhu.edu.

Order #: 14027

Authors:

Meharry Medical College.

Title:

Journal of Health Care for the Poor and Underserved.

Source:

Journal of Health Care for the Poor and Underserved 15(4): 501-720, 2004. (Journal:Entire Issue: 210 Pages)

Abstract:

The journal has as its goal the dissemination of information on the health of, and health care for, low income and other medically underserved communities to health care practitioners, policy makers, and community leaders who are in a position to effect meaningful change. Issues dealt with include access to, quality of, and cost of health care (authors). 

Order #: 14100

Authors:

O’Connell, J., Quick, P., Zevin, B., Post, P.

Title:

Documenting Disability: Simple Strategies for Medical Providers.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2004. (Report: 48 Pages)

Abstract:

This paper explains how medical providers can most efficiently and effectively document their patients’ impairments in support of SSI or SSDI disability benefit applications.  It provides practical, experience-based advice that is grounded in use of the Social Security Administration’s Listing of Impairments. This paper is intended to improve access to Federal disability benefits for eligible persons, including chronically homeless persons, who by definition are disabled.  Obtaining health insurance and monthly incomes through the SSI and SSDI programs can help many people escape the terrible trap of homelessness (authors). Available From: National Health Care for the Homeless Council, PO Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org.

Order #: 13586

Authors:

O'Connell, J.

Title:

The Health Care of Homeless Persons: A Manual of Communicable Diseases and Common Problems in Shelters and on the Streets.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2004. (Manual: 345 pages)

Abstract:

This manual discusses the health care issues affecting people who are homeless.  The manual is divided into seven parts.  The first contains discussions of twenty-eight communicable diseases and three infections seen frequently among homeless populations.  The second discusses survival on the streets, and the conditions that arise from this exposure, such as hypothermia, frostbite and heat stroke.  Part three attempts to respond to an array of future and present challenges in shelter and street medicine.  Part four addresses the management of chronic illness in a population without housing or a safe place to heal and store medications.  In part five, the authors detail the immunization schedules for children and adults, as well as some of the illnesses rendered rare by widespread vaccination programs such as polio, mumps, rubella and tetanus.  Part six examines food management in shelters and soup kitchens, including suggestions for proper handling, storage and preparation of food in those settings.  Part seven is comprised of fact sheets for shelter guests.  Suggestions and recommendations are given throughout (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org. (COST: $15.00)

Order #: 14067

Authors:

O'Connell, J.J.

Title:

Dying in the Shadows: The Challenge of Providing Health Care for Homeless People.

Source:

Canadian Medical Association Journal 170(8): 1251-1252, 2004. (Journal Article: 2 Pages)

Abstract:

The medical care of homeless individuals and families poses a vexing challenge for traditional health care delivery models. The relentless immediacy of the daily struggle for safe shelter and a warm meal relegates health needs to a distant priority. Common illnesses progress and injuries fester, leading to increased numbers of emergency department visits and acute care hospital admissions. Impoverished women and men without homes bear an undue and unacceptable burden of illness and are dying prematurely in the streets, in the very shadows of towering health care institutions. The ultimate solution to homelessness will require change in many sectors. This public health crisis will not be ameliorated until housing and health care become a fundamental right for every human being (author). 

Order #: 14786

Authors:

O'Connell, J.J., Roncarati, J.S., Reilly, E.C., Kane, C.A., Morrison, S.K., Swain, S.E., Allen, J.S., Jones, K.

Title:

Old and Sleeping Rough: Elderly Homeless Persons on the Streets of Boston.

Source:

Care Management Journals 5(2):101-106, 2004. (Journal Article: 5 Pages)

Abstract:

Older individuals living on the streets of our urban cities are a unique sub-group of the homeless population. No studies have been published about these elderly "rough sleepers" who face daunting obstacles to health care while facing a litany of health risks on the streets that are magnified by the physical and mental limitations of advancing years. To improve understanding of this itinerant group, the Street Team of the Boston Health Care for the Homeless Program prospectively followed 30 individuals aged 60 or older living on Boston's streets for the four-year period from 2000 through 2003. This cohort included 8 (27%) women and 22 (73%) men ranging in age from 60 to 82 years. The average age was 67 years old. At the end of the four year study period, 9 (30%) had died and 6 (20%) were in nursing homes. Despite intense efforts, only 5 (17%) found housing. Seven (23%) were still on Boston's streets after four years, and one was lost to follow-up. Authors concluded that elderly rough sleepers have high morbidity and mortality and pose significant challenges to programs seeking to provide housing and supportive health care services for this vulnerable sub-group of elderly homeless persons. New and creative housing options are needed, and the delicate issues of competency and guardianship must be addressed (authors). 

Order #: 14007

Authors:

Rich, J.D., McKenzie, M., Macalino, G.E., Taylor, L.E., Sanford-Colby, S., Wolf, F., McNamara, S., Mehrotra, M., Stein, M.D.

Title:

A Syringe Prescription Program to Prevent Infectious Disease and Improve Health of Injection Drug Users.

Source:

Journal of Urban Health 81(1): 122-134, 2004. (Journal Article: 13 Pages)

Abstract:

This article discusses the fact that injection drug users (IDUs) are at increased risk for many health problems, including acquisition of human immunodeficiency virus (HIV) and hepatitis B and C. These risks are compounded by barriers in obtaining legal, sterile syringes and in accessing necessary medical care. In 1999, the authors established the first-ever syringe prescription program in Providence, RI, to provide legal access to sterile syringes, reduce HIV risk behaviors, and encourage entry into medical care. Physicians provided free medical care, counseling, disease testing, vaccination, community referrals, and prescriptions for sterile syringes for patients who were not ready to stop injecting. Enrolled participants had limited stable contact with the health care system at baseline; 45% were homeless, 59% were uninsured, and 63% did not have a primary care physician. Many reported high-risk injection behaviors such as sharing syringes , reusing syringes, and obtaining syringes from unreliable sources. This program demonstrates the feasibility, acceptability, and unique features of syringe prescription for IDUs. The fact that drug use is acknowledged allows an open and frank discussion of risk behaviors and other issues often not disclosed to physicians. The syringe prescription program in Providence represents a promising and innovative approach to disease prevention and treatment for IDUs (authors). 

Order #: 14049

Authors:

Solliday-McRoy, C., Campbell, T.C., Melchert, T.P., Young, T.J., Cisler, R.A.

Title:

Neuropsychological Functioning of Homeless Men.

Source:

Journal of Nervous and Mental Disease 192(7): 471-478, 2004. (Journal Article: 7 Pages)

Abstract:

This study explored the neuropsychological functioning of 90 homeless men. Numerous biological and psychological factors associated with impaired neurological functioning have been identified as common among the homeless, but there has been relatively little systematic examination of the cognitive functioning of homeless people. There was great variability in their test scores, but the presence of possible cognitive impairment was detected in 80% of the sample. Average general intellectual functioning and reading abilities were found to be relatively low, and the incidence of impairments in reading, new verbal learning, memory, and attention and concentration was high. These findings suggest that the homeless men in this study had considerable assessment and treatment needs that were not being met by most of the health and social services offered to them (authors). 

Order #: 13605

Authors:

Van Ness, P., Davis, W., Johnson, B.

Title:

Socioeconomic Marginality and Health Services Utilization Among Central Harlem Substance Users.

Source:

Substance Use & Misuse 39(1): 61-85, 2004. (Journal Article: 24 pages)

Abstract:

The article examines whether decrements in socioeconomic measures in a poor, substance using population predict changes in health services utilization. The authors analyzed a sample, consisted of 658 "hard drug" (crack, powder cocaine, and heroin) users drawn from Central Harlem in New York City during 1998 and 1999, and was stratified according to operational measures indicating socioeconomic marginality.  The authors assert that in this sample socioeconomic marginality reflected by low levels of income, education, and employment sometimes predicts greater rates of health services utilization and, in other cases, it predicts lower rates. The authors also state that when the sample is stratified according to an operational measure of homelessness, the gradient of greater utilization and self-reported morbidity for the homeless is more marked and consistent. The article concludes that results are supportive of a public health model of drug user treatment that recommends that it occur as part of an integrated strategy addressing poverty, homelessness, violence, and related social problems (authors). 

Order #: 13214

Authors:

Wehler, C., Weintreb, L., Huntington, N., Scott, R., Hosmer, D., Fletcher, K., Goldberg, R., Gundersen, C.

Title:

Risk and Protective Factors for Adult and Child Hunger Among Low-Income Housed and Homeless Female-Headed Families.

Source:

American Journal of Public Health 94(1): 109-115, 2004. (Journal Article: 9 pages)

Abstract:

In this article, the authors sought to identify factors associated with adult or child hunger.  Mothers who were low-income housed and homeless were interviewed about socioeconomic, psychosocial, health, and food sufficiency information. Multinomial logistic regression produced models predicting adult or child hunger. According to the article, predictors of adult hunger included mothers’ childhood sexual molestation and current parenting difficulties, or "hassles." The authors assert that risk factors for child hunger included mothers’ childhood sexual molestation, housing subsidies, brief local residence, having more or older children, and substandard housing. This study found that the odds of hunger, although affected by resource constraints in low-income female-headed families, were also worsened by mothers’ poor physical and mental health. Eliminating hunger thus may require broader interventions than food programs (authors). 

Order #: 14429

Authors:

Zugazaga, C.

Title:

Stressful Life Event Experiences of Homeless Adults: A Comparison of Single Men, Single Women, and Women With Children.

Source:

Journal of Community Psychology 32(6): 643-654, 2004. (Journal Article: 12 Pages)

Abstract:

This article describes stressful life events experienced by a multi-shelter sample of 162 homeless adults in the Central Florida area.  Participants included homeless single men, homeless single women, and homeless women with children.  Subjects were interviewed, and findings indicated that the two groups of women were more likely to have been both physically and sexually abused as children than single men.  Single women were more likely to have experienced sexual violence over the age of 18, experienced domestic violence, and been hospitalized in a psychiatric facility.  Single men were more likely to have abused drugs and alcohol, and to have been incarcerated.  Women with children were more likely to have lived in foster care.  Overall, single women experienced significantly more stressful life events than single men and women with children.  These findings suggest that the three groups are unique and would benefit from prevention and/or treatment approaches developed for the specific subgroup (authors). 

Order #: 14073

Authors:

Clark, D.L., Melillo, A., Wallace, D., Pierrel, S., Buck, D.S.

Title:

A Multidisciplinary, Learner-Centered, Student-Run Clinic for the Homeless.

Source:

Journal of Family Medicine 35(6): 394-397, 2003. (Journal Article: 4 Pages)

Abstract:

This article discusses Houston Outreach Medicine Education and Social Services, which teaches students, in multidisciplinary teams using the learner-centered model, to provide primary health care to the homeless. The founding and operational aspects of this educational intervention are presented. Student response to this service-learning program is assessed in terms of educational value using a survey and an analysis of student reflections. Clinical service activities are measured to demonstrate program efficacy. Student participants, especially basic science medical students, value the program due to its contributions to their professional and personal education, as well as their increased understanding of biopsychosocial issues. Learners develop empathy, compassion, and heightened social awareness (authors). 

Order #: 12071

Authors:

Cohen, D.A., Mason, K., Bedimo, A., Scribner, R., Basolo, V., Farley, T.A.

Title:

Neighborhood Physical Conditions and Health.

Source:

American Journal of Public Health 93(3): 467-471, 2003. (Journal Article: 5 pages)

Abstract:

This article explores the relationship between boarded-up housing and rates of gonorrhea and premature mortality, and is based on an ecological study done of 107 US cities.  Controlling race, poverty, education, population change, and health insurance coverage, the authors developed several models predicting rates of gonorrhea and premature death before age 65 from all causes and from specific causes.   The article states that boarded up housing remained a predictor of gonorrhea rates, all causes premature mortality and premature morality due to the malignant neoplasms, diabetes, homicide and suicide after control for socioeconomical factors.  The authors assert that boarded-up housing may be related to mortality risk because of its potential adverse impact on social relationships and opportunities to engage in healthful behaviors.  Neighborhood physical conditions deserve further consideration as a potential global factor influencing health and well-being (authors). 

Order #: 12358

Authors:

Drury, L.

Title:

Community Care for People Who are Homeless and Mentally Ill.

Source:

Journal of Health Care for the Poor and Underserved 14(2): 194-207, 2003. (Journal Article: 14 pages)

Abstract:

This study documents the experiences of 60 people who are homeless and mentally ill from their state mental hospital discharge through their first two years in community housing.  This article also explores the personal, cultural, and environmental contexts of life for adults who are homeless and mentally ill and examines the interaction between an individual's needs and community resources.  The research identifies forces that perpetuate homelessness and traces the struggles that people who are homeless and mentally ill encounter during the transition from the streets to stable housing.  The findings describe a culturally based pattern of mutual avoidance between homeless mentally ill clients and caregivers, which limits delivery of services to the population.  The author recommend development of alternative systems of care delivery, expansion of educational experiences with underserved populations, and increased funding for service or research with people who are homeless and mentally ill (author). 

Order #: 12540

Authors:

Fitzpatrick, K.M., La Gory, M.E., Ritchey, F.J.

Title:

Factors Associated with Health-Compromising Behavior Among the Homeless.

Source:

Journal of Health Care for the Poor and Underserved 14(1): 70-86, 2003. (Journal Article: 16 pages)

Abstract:

This exploratory study examined a set of sociodemographic, risk, and protective factors associated with health-compromising behavior among the homeless. One hundred and sixty-one homeless adults living in a midsize, southern metropolitan area were surveyed. Information was collected using structured in-depth interviews that assessed residential and event histories, life circumstances, mental and physical health symptoms, and health-related risk behaviors (drug and alcohol use, risky sexual practices, sleeping outdoors, aggressive behavior, and weapon possession). Descriptive results showed differences in health-compromising behavior for ascribed characteristics such as age, race, and gender. Younger people, nonwhites, and men took more risks. Multivariate results indicated that while sociodemographic risk factors were important predictors of health-compromising behavior for people who are homeless, other variables, including childhood memories, victimization, and local nativism, were also significant. The implications of these findings are explored in the larger context of a social policy framework (authors). 

Order #: 12008

Authors:

Gray, E.M.

Title:

HCH UDS Pilot Project 2001-2002:  A Technical Assistance Publication.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2003. (Report: 30 pages)

Abstract:

The HCH Uniform Data System (USD) Pilot Project was initiated in 2000 by a group of Health Care for the Homeless (HCH) project representatives in Public Health Service Region IX.  This initiative was motivated by a desire to increase the capacity of the Bureau of Primary Health Care's current UDS to reflect the complexity and intensity of HCH services delivered to homeless individuals.  This technical assistance publication describes the rationale for the collection of additional data by HCH projects for inclusion in their annual USD reports, and proposes data collection tools for this purpose that were developed and pilot tested by the HCH UDS Work Group in 2001-2002.  This document reports benefits to HCH projects that use these tools, and identifies the technical and financial resources that are required to adapt HCH information systems and data collection processes to include these additional data elements.  The proposed data collection tools, appended to this report, include new measures to assess different levels of care in five categories of service that are considered intrinsic to the HCH model of care:  case management, substance abuse, health education, medical, nursing and outreach services (author). Available From: National Health Care for the Homeless Council, P.O Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhcnc.org.

Order #: 12539

Authors:

Han B., Wells, B.L., Taylor, A.M.

Title:

Use of the Health Care for the Homeless Program Services and Other Health Care Services by Homeless Adults.

Source:

Journal of Health Care for the Poor and Underserved 14(1): 87-99, 2003. (Journal Article: 12 pages)

Abstract:

This study examined factors associated with the use of the Health Care for the Homeless Program and other health care services by homeless adults. A total of 941 homeless adults were identified in 52 soup kitchens in U.S. communities. Descriptive statistics and logistic regression models were applied. Among homeless adults, having dental problems was the most robust factor associated with their use of Health Care for the Homeless Program services. Among homeless adults who did not visit Health Care for the Homeless Program services during last six months, the number of emergency room visits was the most powerful factor associated with their use of other health care services. The results of the study can help health care providers better serve homeless adults to meet their health needs (authors). 

Order #: 14077

Authors:

Johnson L.J., McCool, A.C.

Title:

Dietary Intake and Nutritional Status of Older Adult Homeless Women: A Pilot Study.

Source:

Journal of Nutrition for the Elderly 23(1): 1-21, 2003. (Journal Article: 20 Pages)

Abstract:

This study examined the relationship between shelter use and risk of death using longitudinal data in a cohort of 8,769 homeless men in Toronto, Ontario. Homeless people suffer from high levels of morbidity and mortality, but there is surprisingly little empiric evidence that homelessness has a direct adverse effect on health.  Among men, periods of homeless shelter use are associated with higher mortality. There are three reasons why this finding does not necessarily mean that homelessness itself increases the risk of death. First, the hazard of death associated with shelter use compared to non-shelter use may be significantly different from that associated with homelessness compared to non-homelessness. Second, the association between shelter use and risk of death may be confounded by other variables such as alcohol and drug use. Finally, because the mechanism and time-course of the putative effect of homelessness on health is uncertain, appropriate modeling of the time-dependent covariate is difficult to ensure. Further research into the possible adverse effects of homelessness on health is needed and would have important implications for public policy (author). 

Order #: 13097

Authors:

Lewis, J., Andersen, R., Gelberg, L.

Title:

Health Care for Homeless Women:  Unmet Needs and Barriers to Care.

Source:

Journal of General Internal Medicine 18(11): 921-928, 2003. (Journal Article: 8 pages)

Abstract:

This study determines how much perceived unmet need for medical care there is among homeless women, what homeless women perceive to be barriers to health care, and how barriers and other factors are associated with unmet needs.  Based on a cross-sectional study of homeless women by the authors, utilizing structured interviews, the authors evaluate the perceived unmet need for medical care in the past 60 days, the relationship between unmet need and demographic variables, place of stay, source of health care, insurance, and perceived barriers to care.  Of the 974 women, 37 percent reported unmet need for medical care. Controlling for other factors, the odds of unmet need were lower among those with a regular source of care,  while having health insurance was not significantly associated. The odds of unmet need were higher among those who experienced the barriers: not knowing where to go, long office waiting times and being too sick to seek care.  The authors conclude that there is significant unmet need for medical care among homeless women. Homeless women must be educated regarding sources of care, and clinics serving the homeless must decrease waiting times (authors). 

Order #: 12505

Authors:

Minnesota Primary Care Association.

Title:

Health Care and the Homeless.

Source:

Health Care and the Homeless 3(7): July, 2003. (Fact Sheet: 1 page)

Abstract:

This is a monthly fact sheet sent out by the Minnesota Primary Care Association. This resource is a great example of how PCAs and PCOs can share important information with health centers, community partners, and state lawmakers in a compact, easy-to-read format.  This issue also has interesting information about national and state-level developments in primary health care and welfare trends. Available From: Minnesota Primary Care Association, 1113 E. Franklin Avenue, Suite 211, Minneapolis, MN 55404, (612) 253-4715, tony.wijesinha@mnpca.org, http://www.mnpca.nonprofitoffice.com

Order #: 12768

Authors:

Nadkarni, M., Philbrick, J.

Title:

Free Clinics and the Uninsured: The Increasing Demands of Chronic Illness.

Source:

Journal of Health Care for the Poor and Underserved 14(2): 165-175, 2003. (Journal Article: 10 pages)

Abstract:

This article discusses the safety net needed for the uninsured, such as community health centers, public hospitals, and academic health centers.  Despite the fact that there are three hundred forty five free clinics in the United States, there is very little information published about them.  This article provides detailed descriptions of demographic and clinical characteristics of free clinic patients.  The authors assert that this information is vital for clinic management as well as broader public policy concerns, and describe the experience from the first five years of operation of the Charlottesville Free Clinic in Charlottesville, Virginia (authors). 

Order #: 13255

Authors:

National Coalition for the Homeless.

Title:

People Need Health Care.

Source:

Washington, DC: National Coalition for the Homeless, 2003. (Fact Sheet: 1 page)

Abstract:

This fact sheet discusses the difficulties people who are homeless face in receiving health care.  The authors discuss the effects poverty, unemployment and a lack of housing have on the health and well-being of adults and children (authors). Available From: National Coalition for the Homeless, 1012 Fourteenth Street, NW, #600, Washington, DC 20005, (202) 737-6444, www.nationalhomeless.org.

Order #: 12998

Authors:

National Health Care for the Homeless Council.

Title:

Mainstreaming Health Care for Homeless People.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2003. (Report: 6 pages)

Abstract:

Mass homelessness signifies the failure of numerous systems, and the eradication of homelessness will require significant adjustments to many mainstream public programs, particularly in the areas of health care, housing and income support.  This paper very briefly examines the interaction of the health care system with homelessness, and describes an effective approach to mainstreaming in health care that can help to prevent and end homelessness (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville TN 37206, (615) 226-2292, www.nhchc.org.

Order #: 14078

Authors:

Penson, R.T., Fergus, L.A., Haston, R.J., Clark, J.R., Demotses, A., O'Connell, J.J., Chabner, B.A., Lynch, T.J.

Title:

The Kenneth B. Schwartz Center at Massachusetts General Hospital Hematology-Oncology Department: Hope for the Homeless.

Source:

The Oncologist 8(5): 488-495, 2003. (Journal Article: 7 Pages)

Abstract:

This article discusses issues of access to cancer care, and the special problems presented by homeless patients. Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded the Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum during which caregivers discuss a specific cancer patient, reflect on the important psychological issues faced by patients, their families, and their caregivers, and gain insight and support from their fellow staff members. A homeless man with head and neck cancer presents to the emergency room: a sad and familiar story. But this story is redeemed by his 35-year friendship with a priest, a man whose unconditional love and support became critical to the patient's care and treatment. The patient had lived for 30 years in homeless shelters, had problems with alcohol abuse, and was notoriously noncompliant with medical caregivers. He could not speak due to his disease, was illiterate with limited intellectual capacity, and had neither a job nor a family. Despite huge and apparently insurmountable problems for the patient, the oncology team was able to carve out a package of care, successfully communicate, and mobilize a support network to allow successful completion of chemoradiation therapy. The team developed a strong commitment to his care and an affectionate bond, which very positively affected all of those involved (authors). 

Order #: 14079

Authors:

Shoenberger, J.M., Houpt, J.C., Swadron, S.P.

Title:

Occult Trauma in High-Risk Populations.

Source:

Emergency Medical Clinics of North America 21(4): 1145-1163, 2003. (Journal Article: 18 Pages)

Abstract:

This review highlights commonly missed traumatic injuries in adult patients. Several groups of patients are at increased risk for traumatic injury that is occult, or not apparent on initial presentation. Perhaps the most notorious are those who abuse alcohol, but other groups include the elderly, coagulopathic, those with neurological disease, and the mentally ill. Moreover, traumatic injury can coexist with (or be masked by) medical pathology, resulting in the disposition of injured patients to nonsurgical services where surveillance for traumatic injury diminishes. Because delays or failures in diagnosis might result in unnecessary pain, morbidity, and mortality, it is important for the emergency physician to identify occult presentations of trauma before disposition (authors). 

Order #: 13475

Authors:

Stratigos, A.J., Katsambas, A.D.

Title:

Medical and Cutaneous Disorders Associated With Homelessness.

Source:

SKINmed 2(3):168-174, 2003. (Journal Article: 7 pages)

Abstract:

Homelessness is a rising problem with socioeconomic roots that affects millions of people around the world. Homeless people suffer from a wide range of health problems and, consequently, have high rates of morbidity and mortality. Various infectious and noninfectious skin conditions have been described among the homeless, with trauma, superficial fungal infections, and foot problems being the most prevalent. Poor hygiene conditions, exposure to harmful environmental agents, and impaired access to health care may further exacerbate these skin diseases and lead to serious and occasionally life-threatening situations. As an integral part of the medical care for the homeless, dermatologic care is essential in diagnosing and managing their skin diseases, in preventing more serious complications and in improving the overall health status of the homeless population (authors). 

Order #: 12544

Authors:

Beauchamp, T.L., Jennings, B., Kinney, E.D., Levine, R.J.

Title:

Pharmaceutical Research Involving the Homeless.

Source:

Journal of Medicine and Philosophy 27(5): 547-564, 2002. (Journal Article: 17 pages)

Abstract:

This article states that discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature (authors). 

Order #: 13520

Authors:

Butler, J., Okuyemi, K., Jean, S., Nazir, N., Ahluwalia, J., Resnicow, K.

Title:

Smoking Characteristics of a Homeless Population.

Source:

Substance Abuse 23(4): 223-31, 2002. (Journal Article: 8 pages)

Abstract:

This article examines the smoking characteristics of a homeless population.  The authors compared homeless smokers to nonhomeless smokers on sociodemographics, smoking characteristics, motivation to quit, and smoking cessation experiences. According to the article, results showed that homeless smokers were more likely to be white, smoke more cigarettes per day, initiate smoking at a younger age, and have a longer smoking history. The authors assert that knowledge about the risks of smoking and the benefits of quitting were equally high in both groups, and that homeless smokers were less likely to be preparing to quit smoking compared to nonhomeless smokers. The article concludes that these factors place homeless smokers at increased risk of tobacco-related diseases. The authors suggest that programs are needed to design and test effective cessation interventions for homeless smokers (authors). 

Order #: 11806

Authors:

Central City Association of Los Angeles.

Title:

Downtown's Human Tragedy: It's Not Acceptable Anymore: A Public Health and Safety Plan.

Source:

Los Angeles, CA: Institute for the Study of Homelessness and Poverty at the Weingart Center, 2002. (Report: 11 pages)

Abstract:

This report describes homelessness in Downtown Los Angeles and proposes a 14-point plan to address issues of public health and safety.  It addresses the public health, safety and economic crises, and pinpoints target populations effected.  The report's recommendations focus on service resistant addicted, mentally ill, panhandlers, parolees, drug dealers and other criminals (authors). Available From: Institute for the Study of Homelessness and Poverty, Weingart Center, 566 South San Pedro Street, Los Angeles, CA 90012, (212) 689-2280, www.weingart.org/institute/index.cfm.

Order #: 11783

Authors:

Chau, S., Chin, M., Chang, J., Luecha, A., Cheng, E., Schlesinger, J., Veena, R., Huang, D., Maxwell, A.E., Usatine, R., Bastani, R., Gelberg, L.

Title:

Cancer Risk Behaviors and Screening Rates Among Homeless Adults in Los Angeles County.

Source:

Cancer Epidemiology, Biomakers & Prevention 11 (5): 431-438, 2002. (Journal Article: 8 pages)

Abstract:

This article examines the many barriers to health care and preventive services facing people who are homeless, despite the fact that they have an increased prevalence of most risk factors for cancer.  A group of adults who are homeless, at nine different locations within Los Angeles County were surveyed during the summers of 1998 and 1999.  The majority of this population had not been to cancer screening exams, however, their risk factors make them more likely to develop cancer.  The authors assert that given the lower cancer screening rates compounded by higher cancer risk factors, populations of homeless adults need increased access to cancer screening, and education on the availability of free services.  Also, the authors suggest that facilities for people who are homeless and their staff should reinforce the purposes of cancer screening, provide more screening services, and implement institutional efforts to reduce high-risk behaviors (authors). 

Order #: 11781

Authors:

Connor, S.E., Cook, R.L., Herbert, M.I., Neal, S.M., Williams, J.T.

Title:

Smoking Cessation in a Homeless Population: There is a Will, but is There a Way?

Source:

Journal of General Internal Medicine 17 (5): 369-372, 2002. (Journal Article: 4 pages)

Abstract:

In this article, the authors seek to determine the prevalence of smoking, interest in smoking, cessation, and preferences for smoking cessation treatment among a diverse sample of 236 adults who are homeless.  The authors also determine how readiness to quit smoking might vary according to living situation, demographic factors, and current participation in a substance abuse treatment program.  The findings suggest an urgent need to develop and implement smoking cessation programs for people who are homeless (authors). 

Order #: 14080

Authors:

Hwang, S.W.

Title:

Is Homelessness Hazardous to Your Health? Obstacles to the Demonstration of a Causal Relationship.

Source:

Canadian Journal of Public Health 93(6): 407-410, 2002. (Journal Article: 4 Pages)

Abstract:

This study examined the relationship between shelter use and risk of death using longitudinal data in a cohort of 8,769 homeless men in Toronto, Ontario. Homeless people suffer from high levels of morbidity and mortality, but there is surprisingly little empiric evidence that homelessness has a direct adverse effect on health.  Among men, periods of homeless shelter use are associated with higher mortality. There are three reasons why this finding does not necessarily mean that homelessness itself increases the risk of death. First, the hazard of death associated with shelter use compared to non-shelter use may be significantly different from that associated with homelessness compared to non-homelessness. Second, the association between shelter use and risk of death may be confounded by other variables such as alcohol and drug use. Finally, because the mechanism and time-course of the putative effect of homelessness on health is uncertain, appropriate modeling of the time-dependent covariate is difficult to ensure. Further research into the possible adverse effects of homelessness on health is needed and would have important implications for public policy (author). 

Order #: 14086

Authors:

National Clearinghouse for Primary Care Information.

Title:

Primary Care Programs Directory 2002: The People We Serve...The People We Are.

Source:

Vienna, VA: National Clearinghouse for Primary Care Information, 2002. (Directory: 697 Pages)

Abstract:

This 16th edition directory provides detailed information on 10 Federal programs that provide support for primary health care services to medically underserved, disadvantaged, and high-risk populations in the U.S. and its Territories. It lists satellite clinics affiliated with each Grantee and includes an index of each clinic by State. The directory provides contact information for additional Bureau of Primary Health Care-supported primary care delivery programs. Available From: National Clearinghouse for Primary Care Information, 2070 Chain Bridge Road, Suite 450, Vienna, VA 22182, (800) 400-2742, www.bphc.hrsa.dhhs.gov.

Order #: 11492

Authors:

National Health Care for the Homeless Council Clinicians' Network.

Title:

Adapting Your Practice: Treatment and Recommendations for Homeless Patients with Diabetes Mellitus.

Source:

Nashville, TN: National Health Care for the Homeless Council Clinicians' Network, 2002. (Report: 12 pages)

Abstract:

Clinical practice guidelines for people who have diabetes mellitus and are homeless are the same as for the general population.  Primary care providers who routinely care for people who are homeless, however, recognize the need to take patient's living situation and co-occurring disorders into consideration when developing a plan of care.  These simple adaptations of established guidelines might improve treatment adherence and patient outcomes.  The treatment recommendations in this guide were compiled in order to assist providers who care for homeless adults with diabetes.  The American Diabetes Association's Standards of Medical Care for Patients with Diabetes Mellitus is the source document for these adaptations.  Recommendations found in the ADA diabetes guidelines are not restated in this document except to clarify a particular adaptation (author). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN, 37206, (615) 226-2292, www.nhchc.org.

Order #: 11780

Authors:

O'Toole, T.P., Gibbon, J.L., Seltzer, D., Hanusa, B.H., Fine, M.J.

Title:

Urban Homelessness and Poverty During Economic Prosperity and Welfare Reform: Changes in Self-Reported Comorbidities, Insurance, and Sources for Usual Care, 1995 - 1997.

Source:

Journal of Urban Health 79 (2): 200-210, 2002. (Journal Article: 11 pages)

Abstract:

In this article, the authors report findings from two cross-sectional, community-based surveys of homeless and urban poor adults in Pittsburgh, PA.  The authors assess changes in demographic composition, source for usual care, self-reported comorbidities, and issues of subsistence between samples of adults who were homeless in 1995 and 1997.  The changes noted are discussed in the context of the relative economic prosperity in the region at the time and its effect on homelessness, as well as the structural supports for health care to urban poor during the shift to Medicaid managed-care coverage and eligibility restrictions (authors). 

Order #: 11136

Authors:

Post, P.A.

Title:

Hard to Reach: Rural Homelessness and Health Care.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2002. (Literature Review: 29 pages)

Abstract:

This report examines obstacles to health care encountered by people who experience homelessness in small communities and remote rural areas of the United States.  Information presented here was obtained from the research literature and from 32 service providers and others who are knowledgeable about rural poverty and homelessness in 17 states.  The document summarizes what is known about the causes of rural homelessness, and how unstably housed people living in rural areas differ from their urban counterparts.  In addition, it describes health problems often experienced by rural homeless clients, highlights strategies that homeless service providers are using to meet the challenges these clients present, and lists their recommendations for policy and practice to improve service access and reduce the incidence of rural homelessness.  Sources cited in this report and additional resources about rural homelessness in particular states are included in the bibliography (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org.

Order #: 12546

Authors:

Rew, L.

Title:

Characteristics and Health Care Needs of Homeless Adolescents.

Source:

Nursing Clinics of North America 37(3): 423-431, 2002. (Journal Article: 8 pages)

Abstract:

This article discusses the significant and growing number of adolescents who separate early from their families and become homeless. These youths are heterogeneous in terms of gender, race, ethnicity, and socioeconomic status, but the majority come from families that have been disruptive or dysfunctional in some way. Homeless adolescents are vulnerable to a variety of physical and psychological problems related not only to their family histories but to the stressful environments in which they try to survive. Although numerous federal, state, and local programs have been developed to meet their needs for shelter, health care, and education, much remains to be done to ensure their healthy development and to prepare them for responsible life in the larger society (author). 

Order #: 12571

Authors:

Smith, H., Reporter, R., Rood, M., Linscott, A., Mascola, L., Hogrefe, W., Purcell, R.

Title:

Prevalence Study of Antibody to Ratborne Pathogens and other Agents among Patients Using a Free Clinic in Downtown Los Angeles.

Source:

Journal of Infectious Diseases 186(11): 1673-1676, 2002. (Journal Article: 4 pages)

Abstract:

In this article, the authors discuss the risk levels for various microbes of people who are homeless, and have contact with rats.  According to the authors, the Los Angeles County Department of Health Services initiated a seroepidemiologic study among patients who used a free clinic in downtown Los Angeles; 200 serum specimens obtained for other routine assays were tested for antibodies to ratborne pathogens and other agents.  The authors state that the seroprevalence of antibody to hepatitis E virus in this population was 13.6 percent; to Bartonella elizabethai, 12.5 percent; to B. quintana, 9.5 percent; to B. henselae, 3.5 percent; to Seoul virus, 0.5 percent.  The article states that patients and locally trapped rats had antibodies to some of the same agents (authors). 

Order #: 14081

Authors:

Szerlip, M.I., Szerlip, H.M.

Title:

Identification of Cardiovascular Risk Factors in Homeless Adults.

Source:

The American Journal of the Medical Sciences 324(5): 243-246, 2002. (Journal Article: 3 Pages)

Abstract:

This study was undertaken to identify the reversible cardiovascular risks present in the homeless. Cardiovascular disease is an important health problem among homeless adults; however, the common cardiac risk factors present in this population are unknown. A retrospective chart review was performed randomly on 100 patients who were seen at a homeless clinic in New Orleans, LA. These patients were compared with 200 matched nonhomeless patients who attended an inner-city primary care clinic. Each chart from the 2 groups was reviewed for the presence of hypertension, diabetes mellitus type 2, cigarette smoking, and hypercholesterolemia. Statistical comparisons were made between the homeless and the control subjects. There was no difference in the prevalence of diabetes or total cholesterol. Compared with national data hypertension, smoking and diabetes seem to be represented excessively in the homeless population. Smoking and hypertension are significantly more prevalent in the homeless population than in a matched cohort. Educational and preventive programs are needed to reduce the prevalence of cardiovascular disease and reduce the overutilization of expensive healthcare resources (authors). 

Order #: 13456

Authors:

Zerger, S.

Title:

A Preliminary Review of Literature: Chronic Medical Illness and Homeless Individuals.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2002. (Literature Review: 39 pages)

Abstract:

In this literature review, the author compiles relevant resources that address the relationship between chronic medical conditions and homelessness.  This review summarizes these sources, which include published research and evaluations as well as renegade sources.  As a preliminary literature review, the author provides an introductory assessment of the general topics covered in the available resources, their primary messages, and access to additional resources which may be useful. The author asserts that a special attempt was made to focus on any available cost-benefit analyses of services, particularly housing, provided for homeless persons with chronic medical illness (author). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org/ Publications/literaturereview_chronicillness.pdf.

Order #: 12764

Authors:

Zerger, S.

Title:

Learning About Homelessness and Health in Your Community: A Data Resource Guide.

Source:

Nashville, TN: National Health Care for the Homeless Council, 2002. (Resource Guide: 13 pages)

Abstract:

This publication contains helpful resources for service providers, researchers and advocates seeking data about homelessness and health.  The data resource guide will be particularly useful to those who are preparing funding applications for the federal Health Care for the Homeless or other Consolidated Health Center programs.  Data resources cited in this document are available free-of-charge via the Internet.  Information available from these resources includes national, state and local statistics on poverty, employment patterns, housing, health status indicators, and health risk factors that may have an impact on the homeless population.  Listings of health, housing and homeless services and resources that are available at state and local levels are also included (authors). Available From: National Health Care for the Homeless Council, P.O Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org.

Order #: 13420

Authors:

Bassuk, E., Dawson, R., Perloff, J., Weinreb, L.

Title:

Post-Traumatic Stress Disorder in Extremely Poor Women: Implications for Health Care Clinicians.

Source:

JAMWA 56(2): 79-85, 2001. (Journal Article: 7 pages)

Abstract:

This article identifies childhood antecedents for lifetime post-traumatic stress disorder (PTSD) and determines how this diagnosis relates to health and service use among extremely poor women. The authors found that extremely poor women with lifetime PTSD were more likely to have grown up in family environments of violence, threat, and anger than those without PTSD.  The authors also assert that the strongest risk factor for PTSD was childhood sexual abuse with threat, and that women with PTSD experienced more chronic health conditions and had more problematic relationships with their health care providers and perceived more barriers to care.  The article concludes that many low-income women have difficulty using medical care appropriately because of childhood histories of physical and sexual abuse, the subsequent development of post-trauma responses, and structural barriers to care.  The authors suggest that health care clinicians routinely screen for histories of violence and PTSD and develop treatment plans that ensure safety, link current symptoms with prior experiences, and provide support as necessary (authors). 

Order #: 10935

Authors:

D'Amore, J., Hung, O., Chiang, W., Goldfrank, L.

Title:

The Epidemiology of the Homeless Population and Its Impact on an Urban Emergency Department.

Source:

Academic Emergency Medicine 8(11): 1051-1055, 2001. (Journal Article: 5 pages)

Abstract:

The aim of this study was to characterize the homeless adult population of an urban emergency department (ED) and study the medical, psychiatric, and social factors that contribute to homelessness. Methods included a prospective, case-control survey of all homeless adult patients presenting to an urban, tertiary care ED and a random set of non-homeless controls over an eight-week period during summer 1999. Research assistants administered a 50-item questionnaire and were trained in assessing dentition and triceps skin-fold thickness. Inclusion criteria: all homeless adults who consented to participate. Homelessness was defined as being any person not residing at a private address, group home, or drug treatment program. Randomly selected controls were concurrently enrolled with a 3:1 homeless: control rate. Exclusion criteria: critically ill, injured, or incapacitated patients, or patients less than 21 years of age. Univariate analysis with appropriate statistical tests was used.  The Mantel-Haenszel test was used to adjust for population differences. Two hundred fifty-two homeless subjects and 88 controls were enrolled. Data are presented for homeless vs control patients:  mean age = 42 vs 48; male gender 95% vs 54%; history of tuberculosis 49% vs 15%; history of HIV infection 35% vs 13%; history of penetrating trauma 62% vs 16%; history of depression 70% vs 15%; history of schizophrenia 27% vs 7%; history of alcoholism 81% vs 15%; significant tooth loss 43% vs 18%; percentage of body fat 16.5% vs 19.7%; history of social isolation (no weekly social contacts) 81% vs 11%; mean number of ED visits/year 6.0 vs 1.6. In the study population homelessness was associated with a history of significantly higher rates of infectious disease, ethanol and substance use, psychiatric illness, social isolation, and rates of ED utilization. 

Order #: 14083

Authors:

Elliott, B.A., Beattie, M.K., Kaitfors, S.E.

Title:

Health Needs of People Living Below Poverty Level.

Source:

Family Medicine Journal 33(5): 361-366, 2001. (Journal Article: 5 Pages)

Abstract:

This study was conducted to better understand the health care needs and behaviors of people living in poverty. Low-income populations, especially persons without health insurance, suffer disproportionately with a variety of chronic ailments, postpone getting medical care, and have shorter life spans.  Participants for the study were recruited through agencies serving low-income and homeless people, neighborhood businesses, churches, and subsidized housing units. All participants were adults who had incomes below 200% of the federal poverty level. Subjects completed face-to-face interviews to answer questions about demographics and their concerns about health care. Quantitative and qualitative analyses were performed.  A total of 750 people were interviewed, with 729 providing usable data. Thirty-seven percent of subjects reported spending at least part of the previous year without health insurance. Fifty-six percent of these individuals were persons who were employed but whose employers did not provide health insurance. Reported health concerns were access to care, costs of care, and ability to purchase medications. Forty-five percent of subjects reported receiving mental health services; these subjects were concerned about their ability to continue receiving care and to afford medications. The portion of the low-income population that is uninsured for part or all of a year is greater than in published reports. The health behaviors of this group are easily understood when coverage (if any), level of income, age, and health care needs are considered (authors). 

Order #: 8935