Shelter Health:
Essentials of Care for People Living in Shelter

Serious health problems are common among homeless persons, and shelter settings involve particular health risks for residents and service providers, as well as opportunities for important health care interventions. This Shelter Health 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. Click on the summary or detailed Tables of Contents below to download sections of the Guide; the Tool Kits associated with each section may be accessed by clicking here. A full, printed version containing a CD with the Tool Kits, may be ordered here.

This guide has been designed as part of a larger training effort, and is most effective when used in conjunction with a formal training of its contents. The PowerPoint presentation used by our trainers in these sessions is available here. Click here for information about trainings available from the National Health Care for the Homeless Council.

This project is supported by a grant from the Health Resources and Services Administration. The views expressed are not necessarily those of HRSA.
Summary Table of Contents
Acknowledgements
Why This Guide? Why Now?
What You Need to Know:
Environmental Health and Safety, Part I
Environmental Health and Safety, Part II
Mental Illness and Substance Use Disorders
Taking Care: Coping with Grief and Loss
Communication and Connection
Sustaining Community Dialogue and Response
OK, Now What? Next Steps
More Resources
Tool Kits
Detailed Table of Contents
Acknowledgements
Why This Guide? Why Now?
The Tool Kits
A Guide for Shelter Providers
Ways to Use This Guide
The Causes and Conditions of Homelessness
Homelessness and Health Care: Fundamental Issues
Understanding the Connections Between Poor Health And Homelessness
Human Rights, Shelter, and Health Care
Thinking of Hosting a Homeless Shelter

What You Need to Know

Bringing Health Care into the Shelter
The Tool Kits
The Facts on Common Health Conditions
The Facts of Lice
Intake, Showers, and Clean Sheets: Heading Off Infestations In Homeless Shelters
The Top 4: Asthma, Diabetes, Cardiovascular Disease, and Seizures
About Asthma
About Diabetes
About Cardiovascular Disease
What To Do If Someone is Having a Seizure
Health Promotion
Health Promotion in Shelters
Homeless Family Facility Nutrition Guidelines
Why Dental Care Matters to Homeless People

Environmental Health and Safety, Part I
The Tool Kits
Hand Washing
Guidelines for Environmental Safety in Shelter
Guidelines for the Control of Communicable Disease in Shelter
Standard Precautions in Shelters
Sample Shelter Policies
Environmental Health and Safety, Part II
Environmental Health is Not Just About Control of Disease
Safety Manual
For the Women of Katrina and Other Disasters
Making Shelters Safe for Transgender Evacuees
A Word About Animals and Environmental Health

Mental Illness and Substance Use Disorders
The Tool Kits
Effective Approaches
What Works
Suggestions for Relating to a Person Experiencing Mental Illness
Suggestions for Relating to a Person Who is Intoxicated
Understanding Addiction
Principles of Effective Drug Addiction Treatment
Suicide
Suicide Myths and Facts
Signs of Depression and Possible Suicide Risk
P.L.A.I.D. P.A.L.S.
Glossary of Common Mental Health Terms
Glossary of Selected Terms Related to Substance Use Disorders, Treatment, and Recovery

Taking Care: Coping with Grief and Loss
The Tool Kits
When the Hurricane Hits
Care for the Caregiver
Common Causes of Stress in Homeless Services
Signs and Symptoms of Secondary Traumatic Stress
Self-Assessment Tool: Self-Care
Finding Resiliency and Renewal in Our Work
Caring for Your Self, Your Soul, Your Sanity
Mindfulness and Self-Care for Shelter Providers
Helping Others Cope with Grief and Loss
Reactions to Loss
Keys to Understanding and Accepting the Grief Process
Some Suggestions to Help Grieving People
Recovering From the Aftermath of a Disaster

Communication and Connection
The Tool Kits
Common Human Needs: The Basis for Outreach
Seven Human Needs
Frameworks of Engagement
Purpose and Principles of Outreach
Where Outreach Happens
Services Provided Through Outreach and Case Management
Good Communication
OARS: Open Questions
OARS: Affirmations
OARS: Reflective Listening
OARS: Summaries
Creating a Listening Environment

Sustaining Community Dialogue and Response
The Tool Kits
Working Effectively in the Community
Checklist for Making Successful Referrals
Everyone Hates Meetings
Meetings Stink
Ten Tips for Effective Meetings
Guiding Principles and Shelter Standards
Disaster Planning
When Disaster Strikes, Health Care for the Homeless Takes to the Streets

OK, Now What? Next Steps
Next Steps
Tips for Trainers
Lessons Learned

More Resources
List of Organizations
List of Acronyms
Further Reading

The Tool Kits
Each section of the Shelter Health guide refers to tool kits that will be helpful for anyone involved with health care issues in shelters. There are not links to these resources in the pdf sections of the Shelter Health Guide accessible above, but each Tool Kit resource is provided through the following links, organized according to the sections of the Shelter Health guide.

Tool Kit A: General Information
A-1 “Why Are People Homeless?” A fact sheet from the National Coalition for the Homeless
A-2 “Homeless Children: America’s New Outcasts” from the National Center on Family Homelessness
A-3 “Internally Displaced Persons”
A-4 “Right to Health”
A-5 “Right to Housing”

Tool Kit B: Bringing Health Care into the Shelter
B-1 Adapting Your Practice: General Recommendations for the Care of Homeless Patients (HCH Clinicians’ Network)
B-2 CDC handout: Controlling the Spread of Infections
B-3 CDC handout: Diabetes Flyer
B-4 CDC handout: Keep It With You Medical Info Form
B-5 CDC handout: Cover Cough (English)
B-6 CDC handout: Cover Cough (Spanish)
B-7 MCN handout: Daily Foot Care
B-8 MCN handout: Depression and Healthy Living
B-9 MCN handout: Healthy Foods
B-10 MCN handout: Small Changes
B-11 “Healing Hands” February 2005: Bugs That Bite
B-12 “Symptoms of Diabetes”
B-13 Fact Sheets from The Health Care of Homeless Persons (English and Spanish)

Tool Kit C: Environmental Health and Safety
C-1 Hand washing Flyer
C-2 Food Prep brochure on food-borne bacteria
C-3 Food Prep—Chill
C-4 Food Prep—Clean
C-5 Food Prep—Cook
C-6 Food Prep—Separate
C-7 “Healthy Shelter Living”
C-8 Standard Precautions Policy
C-9 Fluid Clean-up Policy
C-10 Fluid Exposure Policy
C-11 Laundry Hygeine Policy
C-12 Wasatch HHC Program Safety Manual
C-13 Seattle Guidelines
C-14 “For the Women of Katrina: Protection from Violence Against Women and Children”
C-15 “Violence and Disasters”
C-16 “Preventing Violence After a Natural Disaster”
C-17 Animals in Shelters

Tool Kit D: Mental Illness and Substance Use Disorders
D-1 Mental Illness and Homelessness—Healing Hands
D-2 Mental Illness and Homelessness Facts
D-3 Borderline Personality Disorders—Healing Hands
D-4 “Relating to a Person with Mental Illness”
D-5 Substance Abuse and Homelessness—Healing Hands
D-6 Addiction Disorders and Homelessness Facts
D-7 “Blueprint for Change: Ending Chronic Homelessness"
D-8 “Interacting with Intoxicated Persons”
D-9 Suicide Myths and Facts
D-10 Signs of Possible Suicide Risks
D-11 “PLAID PALS”

Tool Kit E: Taking Care—Coping with Grief and Loss
E-1 CDC handout: Coping with a Traumatic Event
E-2 “Homeless Families and Trauma”
E-3 Self-Care Self-Assessment Tool
E-4 “Healing Hands” February 2002: Resiliency and Renewal
E-5 “Healing Hands” April 1999: Trauma and Homelessness
E-6 Facts on Trauma and Homeless Children
E-7 “For the Women of Katrina”

Tool Kit F: Communication and Connection
F-1 Basics of Good Communication Skills
F-2 Listening Well
F-3 Six Habits of Highly Ineffective Listeners
F-4 Cultural Competence Checklist
F-5 Chinese Folk Tale

Tool Kit G: Sustaining Community Dialogue and Response
G-1 Checklist for Making Successful Referrals
G-2 Norfolk Shelter Standards
G-3 Ohio Basic Shelter Standards
G-4 Seattle Guidelines
G-5 Toronto Shelter Guiding Principles
G-6 “Healing Hands” August 2004: Disaster Planning