Practice Adaptations

ADAPTED CLINICAL GUIDELINES
Adapting Your Practice: Treatment and Recommendations for Homeless Patients. Standard clinical practice guidelines often fail to address the special challenges faced by homeless patients that may limit their ability to adhere to a plan of care. To fill this gap, the HCH Clinicians’ Network developed a series of adapted clinical guidelines covering:

These homeless-specific practice recommendations may be downloaded free from this website or ordered using our Publications Order Form.

The Homeless in America: Adapting Your Practice by Susan L. Montauk, MD, appears in the October 2006 issue of American Family Physician along with a related editorial by Bechara Choucair, MD. The article defines homelessness, includes key recommendations for practice, examines determinants of general care adherence in the homeless and offers potential enhancements, and lists resources for caring for homeless individuals and families. The piece references the Network's eight guidelines listed above and sites more recent literature when available. The online version includes supplemental content and links to the editorial and a PDF version of the article for download. Dr. Montauk is a staff physician on the Cincinnati Health Care for the Homeless Mobile Van.

Source: Am Fam Physician 2006;74:1132-8. Copyright © 2006 American Academy of Family Physicians

ABBREVIATED RECOMMENDATIONS
Abstracts posted on the National Guideline Clearinghouse website: Search for a specific guideline or for "homeless" to see abstracts of all adapted clinical guidelines developed by the HCH Clinicians' Network.  Abstracts were prepared by the Agency for Healthcare Research and Quality's (AHRQ’s) National Guideline Clearinghouse (NGC) in collaboration with the Network. You may download the abstract to your PDA from the NGC website by selecting the abstract and clicking Palm Download under Summary for Instructions. You may download the abstract to a handheld computer (PDA, Palm, etc.) from the NGC website by selecting the abstract and clicking the link to Palm Download under the Summary menu. Additional information about the availability of guidelines in downloadable versions for handheld computers is on the NGC Resources page.

Clinical Tool Card/PDA download: Outlines of the main points contained in the following recommended clinical practice adaptations are also available for download to hand-held devices: CLINICAL PRACTICE OVERVIEW
Balancing Act: Clinical Practices that Respond to the Needs of Homeless People by Marsha McMurray-Avila, MCRP; Lillian Gelberg, MD, MSPH; and William R. Breakey, MD; 1998 National Symposium on Homelessness Research. This paper describes special adaptations to clinical practice necessary for addressing the most common health problems of homeless individuals and families. Based on the complexity of multiple interrelated health problems seen, a case is made for the integration of primary care, mental health and substance abuse services as the preferred approach. The nature of the homeless condition also calls for special adaptations to clinical practice in the areas of intake and assessment, clinical preventive services, diagnosis, follow-up, referrals to specialty care and linkages to other services. Specific adaptations for treatment of physical and mental illnesses are presented, with discussion of primary care, treatment services for substance use disorders, treatment services for serious and persistent mental illnesses, and special services for homeless people with dual diagnoses.