Workshop Descriptions

View the electronic version of the full conference program.

2015 Conference Attendees

Pre-Conference Institutes | Wednesday, May 6

Medical Respite Pre-conference Institute

Each year, the Respite Care Providers’ Network (RCPN) Steering Committee plans a full-day institute to discuss trending issues related to medical respite care. This year’s institute will include panels, presentations, interactive discussion and role play and will be of interest to both clinicians and administrators engaged in the provision of medical respite care. Attendees who are new to medical respite care will participate in a breakout session in which panelists will share information about their program models, budgets, and partnerships with hospitals. Attendees who are more seasoned will be interested in a more advanced breakout session to discuss shifts in financing for medical respite care and the provision of end of life care in medical respite programs. To change things up, both beginners and advanced participants will come back together to participate in discussion and educational role play on pain management and milieu (group setting) management in the medical respite setting. Opportunities for networking will be incorporated throughout the day to facilitate information sharing among attendees.

PresentersPaul Gregerson, MD, MBA, Chief Medical Officer, JWCH, Inc., Los Angeles, CA; Sabrina Edgington, MSSW, Director of Special Projects, National Health Care for the Homeless Council, Nashville, TN; Jennifer Nelson-Seals, MSHRM, Executive Director, Interfaith House, Chicago, IL; Rhonda Hauff, BA, COO, Deputy CEO, Yakima Neighborhood Health Services, Yakima, WA; Brandon Clark, MBA, CEO, Circle the City, Phoenix, AZ; Ed Dwyer O’Connor, RN, BS, Manager of Downtown Programs, Harborview Medical Center, Seattle, WA; Paul Leon, RN, PHN, Founder and CEO, Illumination Foundation, Irvine, CA; Adele O’Sullivan, MD, Chief Medical Officer, Circle the City, Phoenix, AZ; Leslie Enzian, MD, Medical Director, Edward Thomas House, Seattle, WA; Adele O’Sullivan, MN, RN, Founder, Inland Northwest Transitional Respite Program, Spokane, WA; Chauna Brocht, LCSW-C, MA, Coordinator of Health Initiatives, Health Care for the Homeless, Baltimore;  Rebecca Doughty, MN, RN, Founder, Inland Northwest Transitional Respite Program, Spokane, Washington; Director of Medical Services, Catholic Charities of Eastern Washington; Brooks Ann McKinney, MSW, Director of Medical Respite and Safety Net Provider Relations, Mission Health and Hospitals, Asheville, NC; Kathleen Saunders, NP, Associate Medical Director, Barbara McInnis House, Boston Health Care for the Homeless Project, Boston, MA

ChicagoPoliciesConsolidated | Medical Respite PCI Agenda | PreConference Institute – Finance | Respite101 _ProgramModels | Respite101_Securing Hospital Funding | Respite301_MakingMedicalRespiteWork | Respite301_MCOCollaboration | Respite301_OSullivan | Respite301_RecuperativeCare | Respite301_Saunders | Standards 2 3 condensed | StandardsFieldTest_2015 Institute | MilieuManagement_Brocht

Cultural Humility and Vulnerable Populations

Understanding the cultural elements that influence an individual’s beliefs surrounding health, healing, wellness, illness, disease, and the delivery of health services is key to the provision of patient-centered care especially when working with vulnerable populations.  This full-day training is designed to help participants explore key principles of cultural humility and the concept of mutual respect in delivering health services to individuals experiencing homelessness. They will explore the principles of cultural humility and how it is different from cultural competency. Presentations will focus on subpopulations within the homeless community which include: LGBTQ youth and older adult populations. Special emphasis will be placed on developing skills through case studies, interactive activities, and small group discussions.

Presenters: Melanie TervalonMD, MPH, Consultant, San Francisco, CA; Jennifer Robinson, Community Health Worker, Lincoln Health Care for the Homeless Clinic, Durham, NC; Susan Childs, Community Health Worker, Duffy Health Center, Hyannis, MA; Diane Tanaka, MD, Medical Director, MyVoice Transition Clinic  and High Risk Youth Program, Division of Adolescent Medicine Children’s Hospital, Los Angeles, CA; Staci Hirsch, PsyD, Program Supervisor, Neighborhood Services Organization, Bridges Supportive Housing Program, Detroit, MI; Darlene Jenkins, DrPH, Senior Director of Programs, National Health Care for the Homeless Council, Nashville, TN

2015 CHW PCI Cultural Humility Handout Final | CULTURAL HUMILITY 2015 | Cultural Humility Power Point Final | TransitioningOurSheltersfortranspersons (2) | Working with LGBT Youth | Cultural Humility

From Health Care to Housing: Maximizing Medicaid for People Who Are Homeless

Medicaid expansion has brought many changes to homeless health care providers and those they serve. This pre-conference institute will feature in-depth discussions among federal officials, national partners and members of the HCH community to identify the opportunities presented by expansion (and how to maximize them) as well as to acknowledge the new challenges being created (and how to overcome them). Topics will include the advocacy needed to ensure all states expand Medicaid, the options states can adopt to add benefits or extend Medicaid into supportive housing and other care venues, the role of traditional safety net funding, and new care delivery systems that focus on new payment methodologies. Participants will gain a better understanding of the major issues facing providers and policymakers alike, identify priority areas for further attention, and inform the Council’s policy and advocacy agenda moving forward. Come to this session to raise issues and learn more about the many facets of Medicaid important to the HCH community.

This session will be a roundtable discussion among invited participants, with opportunities for Q&A and broader discussion with the audience.  Materials: Key points raised during this pre-conference institute.

Moderator: Barbara DiPietro, PhD, Director of Policy, National Health Care for the Homeless Council, Baltimore, MD

Self-Care is Quality Care

Helping professionals are at risk of experiencing issues that mirror those of the traumatized clients we serve. Research demonstrates the dangerous impact on physical and emotional health when exposure to trauma is combined with a stressful work environment. Knowledge is the best defense against burnout, vicarious trauma and compassion fatigue. This daylong training goes further than other self-care trainings by addressing the critical elements of health to enhance productivity and quality of work on both an individual and organizational level. Utilizing research in neurobiology, psychology and business, this training provides skills for those in direct care to be more effective and efficient at work, allowing for the highest level of services possible.

Presenter: Matthew Bennett, MBA, MA, Chief Innovations Officer, Coldspring Center, Nederland, CO

ProQOL_5_English_Self-Score_3-2012 | Self-care as Quality Care | Self-Care Presentation Handouts 2 | Self-Care Presentation Handouts

General Session | Thursday, May 7

Sylvia Mathews Burwell, Secretary, United States Department of Health and Human Services

As the Secretary of HHS, Ms. Burwell oversees more than 77,000 employees, in work that touches the lives of Americans at every age, from every background, in every part of our country. Her portfolio includes numerous programs that are critical to the health and well-being of people without homes, including the Health Center program with its 250+ Health Care for the Homeless Grants, SAMHSA’s homelessness programs, and Medicaid. Secretary Burwell is the Vice-Chair of the US Interagency Council on Homelessness.

Text of Secretary Burwell’s remarks

Susan L. Neibacher Address

The Susan L. Neibacher Address honors the memory of an early president of the National Health Care for the Homeless Council. Neibacher was a social worker who founded New York’s Care for the Homeless and worked to make systems-level advocacy an essential component of the HCH model of care.

T.R. Reid, author, lecturer, and documentary film maker.

A noted advocate himself, T.R. Reid’s book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care is an important contribution to understanding the single payer solution in a number of countries. Reid is one of the nation’s best-known reporters through his books and articles, his documentary films, his reporting for the Washington Post, and his light-hearted commentaries on NPR’s Morning Edition. His latest PBS film was U.S. Health Care: The Good News, which is being broadcast by PBS affiliates around the country.

Reid is a member of the boards of the Health Research and Education Trust, the Colorado Coalition for the Homeless (an HCH program), and other community and educational institutions. He is Chairman of the Colorado Foundation for Universal Health Care, the state-wide citizens’ campaign working to provide health care for every Coloradan.

Workshops 1 | Thursday, 10-11:30 a.m.

HRSA, SAMHSA, and CMS Update

In this session, administrators from the Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Medicare and Medicaid Services (CMS) will discuss funding opportunities and programs that affect HCH programs and their clients.

Presenters: Jim Macrae, MA, MPP, Acting Administrator, Health Resources and Services Administration, U.S. Department of Health and Human Services; Mary Fleming, Policy Director, Substance Abuse and Mental Health Services Administration; and Stephen Cha, MD, MHS, Chief Medical Officer, Centers for Medicare and Medicaid Services

Richard S. Cho, Senior Policy Director, United States Interagency Council on Homelessness

 

Effective and Sustainable Street Medicine: Backpack Homeless Healthcare Program in Santa Clara County, California

Unsheltered homeless persons have poorer health and lack access to health care. They have higher incidents of mental illness, drug and alcohol abuse, and chronic illness, and they tend remain chronically homeless. Meeting the health needs of this population is cost-effective, safe, and sustainable. Health care workers and providers are in a pivotal position to bring this marginalized population into holistic services that include medical care, mental health care, social services, and housing. The Backpack Homeless Healthcare Program of Santa Clara delivers health care to the streets, parks, railroads, and encampments sites. This workshop offers patient case studies and describes how the team provides reality-based, patient-centered health care to patients, packing medications and supplies in backpacks necessary to provide health care to patients where they are located.

PresentersMercy Egbujor, DNP, APRN, Family Nurse Practitioner, Santa Clara Valley Medical Center/Valley Homeless Healthcare Program, San Jose, CA; Mark Block, RN, Nurse Coordinator, Santa Clara Valley Medical Center/Valley Homeless Healthcare Program, San Jose, CA; Sergio Salazar, Public Health Community Specialist, Santa Clara Valley Medical Center/Valley Homeless Healthcare Program, San Jose, CA; Vanessa Beretta, Outreach Program Manager, HomeFirst Homeless Program, San Jose, CA

 

Focus Group Leader Training of Community Members: How to Use Cognitive Interviewing to Strengthen Outcomes

Focus groups are routinely used in community needs assessments. This method can provide important information that is not found in routine survey research. The ability of the participants to shape the conversation to address their concerns brings important information for any Healthcare for the Homeless agency. Our focus group training uses participatory techniques that include role-play using the survey and a discussion of how to revise or add to the questions. This introductory workshop will provide an overview of the use of focus groups in needs assessments, focus group leader training, and how to use cognitive interviewing to strengthen the survey and process.

Presenters: Christine Stevens, MPH, PhD, Associate Professor, University of Washington, Tacoma, WA; Joshua Church, Program Specialist, Outreach and Enrollment, MDC Healthcare for the Homeless, Tacoma, WA; Kim Morrison, Program Coordinator, MDC Healthcare for the Homeless, Tacoma, WA

 

Cultural Competency in a Homeless Services Environment

This workshop covers cultural competency, cultural literacy, empathy, and the essential need for constant self-reflection. Many direct care staff blindly enter a service program without a comprehensive understanding of who they are helping only to find their efforts rejected by or ineffective with consumers; not all people who are experiencing homelessness are alike. This workshop will help participants identify cultural nuances that will improve their ability to form connections with their consumers and increase the possibility of positive, sustainable outcomes. The workshop offers practical, easy-to-follow guidance that will allow participants to immediately integrate the new techniques into their daily practice.

Presenter: Staci Hirsch, PsyD, Program Supervisor, Neighborhood Service Organization, Detroit, MI

 

Shaping Public Opinion on Homelessness through Story, Media, and Public Policy

Words and photographs are powerful. One story or image can shape how we think and feel about an issue, whether it’s health care or climate change. Advocacy and social change would not be possible without thoughtful communications strategies and powerful personal stories. In this interactive workshop, participants will learn why sharing experience and expertise matters, how to powerfully share experiences and expertise, and how to plug into communications strategies for social change. This is an interactive workshop for front-line staff, consumers, and organizational leaders who are interested in sharing their experiences and expertise with a broader audience. Participants will gain insights on working with the media and will have the opportunity to practice public speaking skills in order to re-think how social media can advance social change. // Four themes dominated news coverage of homelessness in 2013: criminalization ordinances, hate crimes, tent cities and camping bans, and, federal budget cuts to homeless service programs. To what extent do news outlets shape public opinion, debate, and public policies – and how do political and financial forces shape news coverage? In this workshop, participants will examine the findings of a report that chronicles national news depiction of homeless topics from January 2013 through March 2015. Predominant themes, trends, and geographic distinctions will be discovered, and the tensions between new public-driven communication technologies and traditional news outlets will be considered. Through lecture, multi-media presentation, and facilitated group discussion, participants will explore how the interplay between news, politics, and public policy can inform their organizational decision-making related to advocacy techniques and program service delivery.

Presenters: Bette Iacino, Vice President, Policy and Communications, Colorado Coalition for the Homeless, Denver, CO; Kenza Hadj-Moussa, MS, Director, Minnesota Coalition for the Homeless, St. Paul, MN

 

Overdose Education and Naloxone Prescribing/Distribution Programs: Nuts and Bolts of Implementation

Drug poisoning or overdose is the number-one cause of death among homeless individuals in some communities. As a result, certain communities have implemented overdose education and naloxone distribution (OEND) programs for people who may witness an overdose or people at risk for overdose. OEND programs educate people to prevent, recognize, and respond to an overdose and offer them naloxone, the antidote to an opioid overdose. Naloxone prescribing and distributing is expanding, yet organizations struggle to overcome hurdles and problems, wasting precious funding and time resources. This workshop will provide practical support for navigating the steps in establishing an OEND program and provide template documents and case studies that have been successfully implemented across the country. Participants should have a working knowledge of overdose education and naloxone-access initiatives and hope to gain implementation skills and strategies.

Presenters: James Kowalsky, BA, Engagement Services & Practice Enhancement Specialist, Heartland Health Outreach, Chicago, IL; Elizabeth Salisbury-Afshar, MD, MPH, Medical Director, Heartland Health Outreach, Chicago, IL; Maya Doe-Simkins, MPH, Training and Technical Assistance Manager Heartland Health Outreach and Prescribe to Prevent, Chicago, IL

Overdose Education and Naloxone Prescribing

When Training is Not Enough: Implementing Best Practices in HCH Programs

Ensuring that practitioners receive training in best practices is essential in carrying out the mission of health and human service organizations. Training itself, however, is not enough. While one-time training events may result in modest short-term changes in practice, they don’t always last. In this workshop, participants learn what the field of implementation science teaches about how to select staff, provide training with ongoing coaching and consultation, and assess performance.

Presenters: Ken Kraybill, MSW, Director of Training, t3 Center for Social Innovation, Needham, MA; Katherine T. Volk, MA, Managing Director, t3 Center for Social Innovation, Needham, MA

 

The Australian System of Universal Health Care and How Single-Payer Financing Could Transform U.S. Healthcare

The first part of the workshop will consider the moral, democratic, and economic imperatives driving the on-going struggle to establish in the United States a single standard of safe, therapeutic healthcare for all, with clear implications for covering people who are homeless. We will evaluate a single-payer system of financing, its impacts on patient care and strategies for getting to single-payer from our current system. The second part of the workshop will describe how a system of universal health care has operated in Australia for the past 40 years. While specific programs exist for psychiatric treatment of people who are homeless, physical health care for the homeless relies on the generic models of care available to the entire population. Difficulties for homeless people in accessing health care persist, indicating that specific programs remain essential for good outcomes regardless of funding models.

Presenter: Michael Lighty, MA, Director of Public Policy, California Nurses Association/National Nurses United, Silver Spring, MD; Julian Freidin, MBBS, MPM, FRANZCP, Psychiatrist, Homeless Outreach Psychiatric Service, Alfred Hospital, Australia

The Australian system of universal health care

Partnering with Hospitals: Community Health Workers and Care Coordination

Hospitals are seeing large numbers of individuals who frequent their emergency departments for chronic health issues (“high users”) that could be more appropriately addressed by the expertise of their local Health Care for the Homeless (HCH) clinic. Community Health Workers (CHWs) are known for their ability to connect with clients in ways that clinicians don’t always have the time or resources to do. This workshop will discuss the benefits of using a CHW as a liaison between an HCH clinic and hospital, developing relationships with hospitals, the CHW’s role in engaging high users, and the ability of CHWs to bridge the gap. This workshop will be facilitated by CHWs and a hospital social worker, both of whom are working across the country to reduce high users through engagement in HCH clinic services.

Presenters: Manuela Almaraz, Community Health Worker, Northeast Valley Health, San Fernando, CA; AJ Millet, Community Health Worker, Boston Health Care for the Homeless Program, Boston, MA; Rodney Dawkins, Community Health Worker; Jennifer Ethridge, Community Health Worker, Charles Drew Health Center, Omaha, Nebraska; Rosa Adams, LCSW, Director of Clinical Social Work, Department of Social Services, Olive View – UCLA Medical Center, San Fernando Valley, CA; Julia Dobbins, MSSW, Project Coordinator, National Health Care for the Homeless Council, Nashville, TN

 

Best Laid Plans…Strategic Planning and Implementation in Uncertain Environments to Drive Organizational Change Administration Introductory

HCH projects are required by HRSA to undergo routine strategic planning, and yet traditional planning models involving concrete goals and objectives over a three-to-five year period are insufficient for uncertain social, political, economic, and health care environments. Too many plans remain on shelves as agencies navigate unanticipated realities. HCH in Baltimore began a planning process in 2012, well before the Supreme Court determined the constitutionality of health reform. The resulting strategic narrative and the use of annual action plans in pursuit of goals has helped HCH transform its business model (moving from 30% to 90% insured), overhaul electronic systems, significantly grow staff and budget, achieve PCMH status, expand service sites, increase patient visits, and enhance consumer engagement, fundraising, and advocacy. Presenters will use story, theory, and facilitated discussion to teach use of an inclusive shared strategy to drive agency work, goals, and change.

Presenters: Keiren Havens, MTS, Chief Strategy Officer, Health Care for the Homeless, Baltimore, MD; Kevin Lindamood, MSW, President and CEO, Health Care for the Homeless, Baltimore, MD

Best Laid Plans

Health Care Coordination and Housing Case Management: What’s the Difference and How Can Providers Work Together?

Housing case management can leverage the long-term impact of medical care. Services aimed to help patients access and keep housing, seek employment, build parenting skills, find transportation to appointments, or engage in mental health or substance use treatment are often necessary to ensure adherence to medical advice and achieve health stability. Providers across the country are exploring ways to define care coordination and case management services so that those with appropriate expertise delivery each service. With clearer lines of communication and coordination, health services payers are able to determine when case management is essential for certain patients to achieve improved outcomes and whether the health system should pay social service agencies and housing providers for their expertise in delivering them. In this workshop, attendees will learn about the differences and overlaps between general health care coordination activities and housing case management, learn how health systems and housing entities are partnering to integrate care for patients and residents, and explore options for health system payers to pay for housing case management.

Presenters: Pascale Leone, Senior Program Manager, New York Program, CSH; Frances Isbell, CEO, Health Care for the Homeless, Houston, TX; Cathy Crouch, Executive Vice President, SEARCH Homeless Services, Houston, TX

Moderator: Peggy Bailey, Senior Policy Advisor, CSH (Moderator)

Health Care Coordination and Housing Case Management

 

Workshops 2 | Thursday, 1-2:30 p.m.

The Path to the 5%: Maximizing Patient Engagement with the Patient Portal

The patient is the most valuable yet underutilized resource in the health care system. Effectively designed and deployed patient portals can support patient engagement by providing secure electronic access to personal health information with patient-specific education content and resources for self-management. This session will focus on key requirements for patient portals, best practices to implement and incorporate patient portals and offer sample policies, and procedures and workflows to participants relevant to patient portals. The session will provide a brief review of Meaningful Use Stage 2 Requirements and outline strategic pre-work for implementation, including workflow optimization and development of policies and procedures. Essential functionality and usability features will be discussed and a sample project plan will be presented.

Presenters: Anna Gard FNP-BC, Health IT and Quality Consultant, DPM Health Care Consulting, Troy, MI; Debra McGrath, FNP, President, DPM Health Care Consulting, Troy, MI

The Path to the 5percent Patient Portal

Achieving PCMH Recognition Panel

Achieving recognition as a Patient-Centered Medical Home (PCMH) is a multi-layered, resource-intensive process which requires a review of everything from an organization’s mission and vision to the operational workflow of its clinics. The process can be especially challenging in a health care for the homeless environment when resources are scarce. This panel of representatives from the three major accreditation or recognition organizations – National Committee of Quality Assurance (NCQA), Accreditation Association for Ambulatory Health Care (AAAHC), and the Joint Commission – will address these special challenges. Participants in this workshop will have an opportunity to ask questions after brief presentations by the panelists.

Presenters: William (Bill) F. Tulloch, MS, Director, Government Recognition Initiatives, National Committee of Quality Assurance, Washington DC; Susan Griffin, Accreditation Surveyor, Accreditation Services, Accreditation Association for Ambulatory Health Care, Skokie, IL; Mona McSweeney, RN, BSN, Assistant Director, Accreditation Services, Accreditation Association for Ambulatory Health Care, Skokie, IL; Lon Berkeley, BA, MS, Co-Project Lead, Primary Care Medical Home Initiative & Project Director, Community Health Center Accreditation, The Joint Commission, Oakbrook Terrace, IL

Achieving PCMH Recognition Panel | AHC_PCMH_SAT effective July 2014 | Joint Commission’s Primary Care Medical Home | Most Challenging Primary Care Medical Home Requirements in 2011-2014 040115 | PCMH_QandA_Guide_110114 | What’s in Our Medical Home

Housing Choice: Innovations in Peer Delivered Housing for Those with Primary Substance Use Disorders

This workshop will communicate programmatic outcomes from a variety of communities successfully assisting those with both chronic and episodic homelessness along with criminal justice involvement to succeed in lasting recovery, community engagement, and economic self-sufficiency. Programmatic features include peer-based recovery housing, coordination with behavioral health and primary care, probation and parole, TANF, SNAP, and supported employment programs. Learn how to effectively serve the 20% not succeeding in Housing First programs.

Presenters: Rachel Post, LCSW, Public Policy Director, Central City Concern, Portland, OR; James Ginsburg, MNM, CAC III, Director of Veteran & Native American Services, Colorado Coalition for the Homeless, Denver, CO; Lori Criss, MSW, Associate Director, The Ohio Council of Behavioral Health & Family Services Providers, Columbus, OH; Sue Smith, MSW, Vice President, Residential and Homeless Services, Project HOME, Philadelphia, PA

Capitol A

Building Bridges: Care Transitions for People Experiencing Homelessness

Transitional care improves coordination and continuity of care as patients move across different providers and health care settings. Evidence-based care transition models have shown a positive impact on health outcomes and quality of care while reducing health care costs for many high-risk, high-cost patient populations. Participants will learn the fundamental elements of transitional care, the human and monetary costs of having transitional care disrupted by limited post-hospital discharge options, and the nuts and bolts of transitional care delivered as part of a shelter-based medical respite program. This workshop will be of interest to clinicians, administrators, consumers, and advocates looking to improve care transitions for patients experiencing homelessness.

Presenters: Donna J. Biederman, DrPH, MN, RN, Assistant Professor, Duke University School of Nursing, Durham, NC; Rebecca Doughty, MN, RN, PhD, Washington State University College of Nursing, Pullman, WA, Inland Northwest Transitional Respite Program, Spokane, WA; Sabrina Edgington, MSSW, Director of Special Projects, National Health Care for the Homeless Council, Nashville, TN

Building Bridges | Policy_Brief_Care_Transitions

Wound Care for the Homeless: A Workshop for Clinical Providers

This workshop will provide an opportunity to learn about and share expertise in wound care of skin conditions that disproportionately affect homeless individuals. Participants will break into small groups and work on cases to practice describing common wounds. The group will come back together and share different descriptions and discuss key wound description elements and how understanding these elements leads to a diagnosis and plan for wound care. Next, individuals will again break into small groups to discuss wound care plans for different cases and then come back together to share findings and ideas. There will also be a hands-on portion of the workshop in which attendees can feel and test bandages and practice wrapping techniques.

Presenters: Alexandra Molnar, MD, Clinical Assistant Professor and Attending Physician, Pioneer Square Clinic, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA; Yvonne Marquis, MSN, ARNP, Primary Care and Woundcare Provider, Pioneer Square Clinic, Harborview Medical Center and Robert Clewis Needle Exchange Center, King County Dept of Public Health, Seattle, WA

Columbia C

Making the Case for TB Continuity of Care Planning for Homeless Patients

Systems that address the unique health problems suffered by individuals without stable housing are ill prepared to provide continuity of care. These systems need strategies to properly follow patients living on the streets or in temporary or transitional housing while receiving treatment. Individuals without stable housing are at high risk for TB because of previous exposure in high-risk settings and stressed immune systems. Indeed there are a number of persistent outbreaks in these populations throughout the US. Exposure to TB does not assure the onset of disease, but 10% of those exposed and who become infected with the TB bacteria will convert to active disease, with 50% of those cases emerging in the two years after exposure, others may develop TB infection. TB infection (LTBI) and pan-sensitive TB disease require six-to-nine months of treatment that can be successful if given without interruption. Incomplete treatment can result in reactivation, drug-resistant disease, and even death. Health Network, an innovative approach to care continuity and management in mobile patients, provides a clear example of how TB control can be successfully and cost-effectively accomplished in mobile populations.

Presenters: Edward Zuroweste, MD, Chief Medical Officer, Migrant Clinicians Network, Austin, TX; Cynthia Tschampl, PhD, Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA

Making the Case for TB Continuity of Care Planning for Homeless Patients

SPEAK UP! SPEAK OUT! A Workshop for Straight White Men (and others)

This workshop will examine the need for people of privilege—often heterosexual white males—to engage in the fight for racial justice, gender equality, and gay rights. Some of the most successful historic social achievements have been achieved by people working together—homeless and housed, women and men, gay and straight, white and black. If we expect to achieve any meaningful social change in the complex modern world, we must forge partnerships that include those with power and those who currently lack a seat at the table. This workshop will explore strategies that participants can apply in their local settings as they work to end homelessness, support LGBTQ youth, ensure access to healthcare, and speak out for racial and economic justice.

Presenter: Jeff Olivet, MA, President/CEO, Center for Social Innovation, Needham, MA

 

Criminalization of Homelessness, Constructive Alternatives, and Protecting the Human Rights of Homeless Persons

Imagine a world where it is illegal to sit down, fall asleep, to store your belongings, use the bathroom, or even stand still. In communities across the nation, these harmless, unavoidable behaviors are treated as criminal activity for persons experiencing homelessness. This forces them into health-threatening situations to avoid detection and creates arrest records that put further barriers between these individuals and the access to housing and services they need. Criminalization has been condemned by international human rights monitors and domestic courts, and the federal government and a number of communities have demonstrated success in promoting and utilizing constructive alternatives approaches. In this workshop, victims will share personal stories of how criminalization affected them, and experts will discuss negative legal and policy aspects of criminalization, share positive examples of alternatives, and provide specific steps participants can use to identify and address criminalization in their home communities.

Presenters: Eric Tars, JD, Senior Attorney, National Law Center on Homelessness & Poverty, Washington, D.C.; Bobby Watts, MPH, MS, Executive Director, Care for the Homeless, New York, NY; Raymond West, Secretary, Consumer Advisory Board, Care for the Homeless, New York, NY; Anthony Williams, Member, Consumer Advisory Board, Care for the Homeless, New York, NY

Criminalization of Homelessness

Homelessness in Health Education: A Training Template for the Health Professions

Project HOPE – Homelessness in Osteopathic Pre-doctoral Education—began in Nova Southeastern University’s College of Osteopathic Medicine as a primary care initiative in 2010 funded through a HRSA training award. This initiative was created due to a lack of formal training for medical students relevant to the needs of those experiencing homelessness and fails to encourage graduates from the health professions to serve homeless populations with which they may feel discomfort or inability to provide competent care. Now in its final year, the project is poised to provide data on student attitudes, techniques for assessing housing at intake, and a template curriculum that could be implemented within any health professions training program. This session will provide an overview of the project findings and will provide a template for educators and administrators on how to implement a training program in homeless health care education that can be implemented within existing programs.

Presenters: Elliot Sklar, MS, PhD, Project Director, Project HOPE, Assistant Director, Master of Public Health Program, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL; Kristi Messer, MSW, MPH, Executive Project Director, Project HOPE, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL; Devra Cohen, MPH, Coordinator of Interprofessional Research and Outcomes Assessment, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL; Anna Johnson, BA, Administrative Project Coordinator, Nova Southeastern University, College of Osteopathic Medicine, Fort Lauderdale, FL

Project HOPE Homelessness in Osteopathic Pre-doctoral Education

Research You Can Do: The Health Care for Homeless Practice-Based Research Network (PBRN)

The Health Care for the Homeless (HCH) Practice-Based Research Network facilitates the involvement of HCH grantees and other homeless service agencies in collaborative research on a national level. Studies focus on the primary health care needs of persons experiencing homelessness with the end goal to improve health care practice and policy. Experiences of participating in a PBRN study, methods, and preliminary findings will be shared from two current projects. The first, an NIAAA funded study led by University of Massachusetts investigators, aims to identify health care needs and barriers among women with substance use issues. Data collection methods include a survey of 750 women and medical record reviews in 11 HCH clinical sites across nine states. The second study examines the feasibility of hosting Nicotine Anonymous (twelve-step, peer support smoking cessation meetings) at two HCH grantee sites. This study is unfunded and was initiated by the HCH PBRN and its advising Research Committee.

Presenters: Barbara Wismer, MD, MPH, Physician, Internal and Preventive Medicine, Tom Waddell Clinic, San Francisco, CA; Carole Upshur, EdD, Professor and Research Psychologist, University of Massachusetts Medical School, Worcester, MA; Linda Weinreb, MD, Professor and Vice Chair of Research, University of Massachusetts Medical School, Worcester, MA; Jane de Groot MPA, Director of Program Resources at Duffy Health Center, Hyannis, MA; Susan Moore MPA, MHA, Director of Homeless & Public Housing Health Clinics at Charles Drew Health Center, Omaha, NE; Molly Meinbresse, MPH, Director of Research, National Health Care for the Homeless Council, Nashville, TN

PBRN workshop_FINAL

Integration of Addiction Informed Pain Management into Primary Care

Many Health Care for the Homeless providers are grappling with the scope of prescription drug abuse among patients with histories of chronic substance abuse. An evidence based approach to pain management can help manage a population with complaints of chronic pain who also have complex substance use, medical and mental health disorders. Brightpoint Health successfully hired and credentialed a pain management specialist, and added this service to our HRSA scope. The workshop will present the lessons learned in the credentialing and HRSA Scope process, and share strategies for successfully integrating pain management in the primary care setting.

PresentersJonathan Zellan, MD, Regional Medical Director, Pain Management Program, Brightpoint Health, New York, NY; Carol Murphy, MHA, RNC, NHA, Chief Operating Officer, Brightpoint Health, New York, NY

 

 

Workshops 3 | Thursday, 3-4:30 p.m.

Adapting Your Practice: Anticipatory Guidance for Infants and Toddlers Experiencing Homelessness 

Children experiencing homelessness are significantly more likely to have acute and chronic illnesses and have much higher rates of emotional and behavior problems and developmental delays than housed children. In this workshop we will discuss strategies from a forthcoming Council resource, Adapted Anticipatory Guidance for Infants and Toddlers Experiencing Homelessness, which adapts standard guidance for the condition of homelessness and aims to improve social, development, and health outcomes for homeless children.

Presenters: Dana Basara, MSN,  Nurse Faculty, Penn Valley Community College, Kansa City, MO; Lynda Bascelli, MD, Medical Director, Project Hope, Inc., Camden, NJ

2015 Anticipatory Guidance for web

Increasing Security Literacy: Supporting Your Staff in Understanding their Role in HIPAA HITECH Compliance

Meaningful Use and HIPAA HITECH require adoption of EHRs, but health centers are overwhelmed by the burden of assessing, managing, and monitoring data security and privacy, especially with mobile devices. Some unintended risks of health IT include being hacked, infected with malware, and vulnerability to unauthorized access. The greatest risk to security and privacy of patient health information (PHI) is employee negligence including use of unsecure mobile devices, accessing unsecure networks, lack of encryption for files, email, and text, and theft of hardware. This is especially true in small-to-medium sized health centers in under-served rural and urban communities where physical, technical and personnel resources are limited. Some of these practices may have had a security risk assessment performed but don’t have the technical and personnel resources to move forward with remediation. This lecture will provide inexpensive strategies and resources for privacy and security literacy.

PresentersAnna Gard, FNP-BC, Health IT and Quality Consultant, AMG Consulting, LLC, Sherman Oaks, CA; Robert Zimmerman, Founder and Director, QiP Solutions, Rockville, MD; Kathy Foy, MSW, Director of Compliance and Consumer Risk – Total Quality Management Department, Public Health Management Corporation, Philadelphia, PA

Increasing Security Literacy-Supporting Staff HIPAA

Trauma Informed Leadership in HCH Settings

The Trauma Informed Excellence Leadership (TIE: Leadership) presentation is designed to give leaders the skills and knowledge to propel their community health centers towards excellence. This workshop provides a practical model designed to enhance staff health, while maximizing clinical and organizational outcomes. Learners will leave this presentation with a new paradigm of leadership, along with a set of skills to implement in supervision of staff and management of programs. Designed with an interactive and experiential format, this workshop challenges leaders to look at job responsibilities, staff, systems and agency through the Trauma Informed paradigm. This powerful experience provides approaches and strategies that can transform individuals, systems, and the overall approach to helping others heal and grow.

Presenter: Matthew Bennett, MBA, MA, Chief Innovations Officer, Coldspring Center, Nederland, CO

Trauma Informed Leadership in HCH Settings

Are We Doing Enough? A Thoughtful Discussion about the Work of Ending Homelessness

A flurry of stories has recently hit the press proclaiming giant strides in ending homelessness. The 100,000 Homes Campaign marked a historic milestone in 2014 and met their organizational goal of housing thousands of people. Communities around the country are promoting a message of “ending homelessness.” Yet walking in many of the urban communities around this country gives indication that homelessness is a growing issue. In the 2013 U.S. Conference of Mayors report on hunger and homelessness, the total number of persons experiencing homelessness increased in 52% of the survey cities responding. This workshop will focus on helping HCH programs sort through the press and information and determine critical paths for advocacy.

Presenters: Barbara DiPietro, PhD, Policy Director, National Health Care for the Homeless Council, Baltimore, MD; Jeff Olivet, MA, CEO/President Center for Social Innovation, Needham, MA; Kevin Lindamood, MSW, LCSW, President and CEO, Health Care for the Homeless, Baltimore, MD; James O’Connell, MD, President, Boston Health Care for the Homeless Program, Boston, MA

Moderator: Wayne Centrone, Center for Social Innovation, Needham, MA

 

The HOT Project: A Shelter-Based Mental Health Clinic for Homeless Adults

Many individuals experiencing homelessness struggle with mental health problems but find it difficult to successfully access and engage in traditional psychiatric services. This workshop provides an overview of the the HOT Project, a shelter-based mental health clinic for homeless adults in North Carolina that aims to reduce barriers to care and provides clients with no-cost psychiatric services at a local shelter/soup kitchen. The program includes a comprehensive assessment of clients’ mental health and substance use, individual psychotherapy, psychiatric evaluation and medication management, and case management and referral for additional services, including health care, substance abuse treatment, and housing assistance. The workshop will include data on mental health, substance use, and treatment utilization among the population; and recommendations for those interested in starting a similar program in their local communities.

Presenter: Elizabeth Arnold, PhD, LCSW, Associate Professor of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC

 

Research in 30 Minutes

1. Inconsistently Wrong: Point-in-Time Homeless Counts in the United States

Since the U.S. Census’s sole publication of homeless counts in 1990, the responsibility to enumerate the homeless has fallen to local jurisdictions, referred to as continuums of care (CoC). Analysis of data from 2007-2013 reveals an inexplicably wide range of change within-CoC homeless estimates (0% to 71,641% cumulative change). This is likely due to inconsistent measurements of homeless counts due to changes in methodology. The HUD guidelines for the CoC counts are vague, leaving counting methods unstandardized both within and across CoCs. The homeless suffer from disproportionate rates of health issues that have an impact on the broader society, and reliable estimates are necessary to ensure we are effectively improving the health of our communities.

Presenter: Jemma Alarcon, BA, Medical Student, University of California, Irvine, CA

2. ER Diversion and Linkages to Primary, Specialty, and Behavioral Health Services Among Individuals Experiencing Homelessness

This workshop will include information about the purpose and major components of ER diversion programs; the importance of and challenges associated with linking clients enrolled in ER diversion programs to outpatient services; the factors associated with successful linkages to outpatient primary, specialty, and behavioral health services based on interviews with providers and clients at an HCH-run ER diversion program in Baltimore, MD; and the ways providers can take these findings into consideration when developing similar ER diversion programs.

Presenter: Julia Zur, PhD, Julio Bellber Postdoctoral Fellow in Community Health Policy Research, George Washington University, Washington, D.C.

Research in 30_Emergency Room Diversion and Linkages

3. Using Peers to Re-Engage and Retain HIV-positive Minority Patients in HIV Care

This workshop will describe the methods and results of the Re-Engagement and Retention of HIV-positive Minorities HRSA Initiative conducted at three clinic sites in Miami FL, Brooklyn, NY, and San Juan, PR. This is the only randomized control study to date of a peer intervention targeted to minority HIV patients with mental health, substance abuse and housing issues who had fallen out of HIV care. Both the products and results from this initiative are relevant to the current movement of incorporating community health workers and peers into clinical teams to engage and retain vulnerable patients with co-morbidities into primary and HIV care. Products to be highlighted include a peer training curriculum, a training curriculum for supervisors and an intervention manual (all are available in both English and Spanish). In addition, digital stories have been created to document the impact of peers on the clinic setting and on the lives of patients.

Presenter: Jane Fox, MPH, Project Director, Health and Disability Working Group, Boston University School of Public Health, Boston, MA

Research in 30_Using Peers to Re-Engage and Retain HIV-positive Minority Patients in HIV Care

Supporting Cancer Care, Palliative and End of Life Planning in Medical Respite

Respite care varies across the country and finding ways to serve patients with cancer and end-of-life needs who are struggling with homelessness is extremely challenging. From July 1, 2013 to June 30, 2014, the Phillip Dorn Medical Respite admitted 177 patients. Twenty patients (11%) admitted had a cancer diagnosis and seven patients (4%) were primarily admitted to support chemotherapy and radiation treatment. Cancer care requires complex coordination of care, including diagnostic workups, complicated treatment regimens, symptom management, palliative care, and end of life planning. It is important to create a knowledge base within a respite team to address the needs of cancer patients by engaging staff in shelters on the appropriateness of length of stay, housing options, and social support systems and respite facilities on hospice care, death and dying, and how to support self-care for staff witnessing the end of life process.

Presenters: Sue Dickerson, RN, Respite Nurse, Contra Costa Healthcare for the Homeless, Martinez, CA; Nishant Shah, MD, MPH, Public Health Outpatient Family Medicine, Contra Costa Health Services, Martinez, CA

Cancer Referral Work Sheet (Autosaved) | Nursing Evaluation for Cancer Care in Respite | Supporting  Cancer Care Presentation

A Collaborative Approach to Chronic Disease Management in Persons in Permanent Supportive Housing

Permanent supportive housing is a combination of housing, supportive services, and health care that address the complex conditions of chronically homeless individuals, many of whom are disabled. Integrating services with behavioral health and consumers is critical to the sustainability of this model. When encountering consumers as mentors during the transition to permanent supportive housing, individuals are more inclined to remain in permanent supportive housing with an improved quality of life. Chronic diseases are endemic in the homeless community, and without housing these individuals experience frequent exacerbations of their diseases and costly hospitalizations. Life on the streets perpetuates conditions that could be stabilized with adequate housing and support services.

Presenters: Pia Valvassori, PhD, ARNP, Clinician/Professor, Health Care Center for the Homeless, Orlando, FL; Amy Grassette, Consumer/Staff, Health Care for the Homeless, Worcester, MA

A Collaborative Approach to Chronic Disease Management PSH

Opening Doors Through Patient-Generated Performance: Healing Through Engagement

This workshop demonstrates The Daily Planet’s unique blend of consumer engagement, performing arts, and organizational storytelling. By giving consumers the resources and support to write and perform their own stories in a public setting, this HCH health center harnesses the therapeutic value of creative expression wherein consumers have a strong voice and the mission of the organization is communicated through their performances. Participants in the workshop learn hands-on skills for engaging consumers in this kind of theatrical activity and how such work can create community, combat provider burnout, and serve as an inspiration to both consumers and the broader community. Through role-play and a consumer’s own presentation, participants see how creative performance can put a healthcare center’s mission into action and become a vibrant part of individual healing.

PresenterMarc Taylor, LPC, The Daily Planet, Richmond, VA; Maureen Neal, CFRE, The Daily Planet, Richmond, VA; Krista Graves, Consumer Board Member, The Daily Planet, Richmond, VA

 

Common Denominators: Serving Migrant and Homeless Special Populations

For migrant and homeless populations, the delivery of health care is very similar. Farmworkers experience many of the same challenges accessing healthcare as homeless individuals. Substandard, unstable, and sometimes non-existent housing in farmworker communities meets the technical definition of “homelessness” and contributes to negative health outcomes. Presenters will provide an overview of these populations, their housing conditions, and health-related implications. Those who operate Migrant and/or homeless health centers are likewise challenged in meeting both the needs of their populations and HRSA Program Requirements in unique service delivery modalities. Health disparities that exist among both populations often complicate a patient’s ability to access care, follow through with providers’ orders and health center performance improvement. The workshop will include a facilitated discussion designed to identify mutually helpful solutions and explore how collaboration can promote best practices for delivering health care to these populations.

Presenter: Virginia Ruiz, Director of Occupational and Environmental Health, Farmworker Justice, Washington, D.C.; Rhonda Hauff, BA, Chief Operating Officer/Deputy CEO, Yakima Neighborhood Health, Yakima, WA

Intro to Migrant Health | YNHS Migrant and Homeless

Using an Integrated Care Team to Improve Treatment Adherence in a Substance-Using Population

Integration of specialties ensures successful treatment of the complex patient. Since 2011, HELP/PSI has added co-located specialties (behavioral health, case management, pain management, podiatry, and dental) that comprehensively meet our patients’ needs. The interdisciplinary and integrated care team takes responsibility for all aspects of a patient’s needs. A shared electronic health record also helps keep all providers informed about all aspects of the patient’s care. High-risk patients with a medical and co-occurring mental health and substance abuse diagnoses have experienced adherence to their medical appointments over the last three years since this multi-specialty care team has been in place.

Presenters: Jonathan Zellan, MD, Regional Medical Director – Pain Management Program, Brightpoint Health, New York, NY; Carol Murphy, MHA, RNC, Chief Operating Officer, Brightpoint Health, New York, NY

Film: Transgender Tuesdays

To get a copy of the 30-minute “brown bag” version of the film, please email Mark Freeman. To purchase the full-length film for a library or academic institution visit the Transgender Tuesdays website.

General Session Friday, May 8

Jama Shelton, LMSW, PhD, Deputy Executive Director of the True Colors Fund

For more than a decade, Jama Shelton has worked in the field of lesbian, gay, bisexual, and transgender youth homelessness. After receiving an MSW in 2004, Shelton began a 9-year stint at the Ali Forney Center, an organization that provides housing and supportive services for gay and transgender youth experiencing homelessness. During her tenure she played an integral role in the building of the most expansive housing program in the nation for gay and transgender youth. Having worked in various roles – first as a direct service provider, then developing and directing the expansion of their housing program, and finally as a researcher, program evaluator and trainer – Jama brings a comprehensive understanding of the issues facing both homeless gay and transgender youth and the service providers with whom they work.

NHCHC_Shelton

Tom Andrews, President/CEO of Saint Joseph’s Health System and President of Mercy Care

Tom Andrews was named President/CEO of Saint Joseph’s Health System in April, 2012 and President of Mercy Care in September, 2003. Mercy Care is a Federally Qualified Health Center in Atlanta, Georgia specifically funded to serve the homeless population. The agency operates twelve medical clinics, two dental clinics and offers a variety of other services including behavioral health, mental health case management, respite care, vision, diagnostics, health education, residential support services and homeless outreach. In 2013, Mercy Care provided services to over 12,796 patients.

Tom was the President of the Board for the National Health Care for the Homeless Council in 2010-11. Tom has an extensive background in health care management and administration including business development, process improvement, strategic planning and financial management. He has served in leadership roles with a variety of non-profit and for-profit health care organizations. Prior to joining Saint Joseph’s Health System, Tom was the president of Independent Physician Strategies, a physician practice support consulting firm for large oncology, surgery and urology practices. Tom also served as the Executive Director of the Georgia Society of Clinical Oncology and was Vice President of Contracting for Promina Health System. Tom also served as the Director of Managed Care for Saint Joseph’s Hospital from 1989 to 1994.

Field of Light video

Workshops 4 | Friday, 10-11:30 a.m.

Speaking Outside the Box: Raising Critical Consciousness through Storytelling

This panel will not only discuss the societal failures that cause homelessness, but also focus on using effective sharing and storytelling in order to be more effective advocates. When re-telling personal stories of homelessness, it is important to remove self-degradation and stay away from rote, date-based timelines. Small-group discussions will allow participants to talk about the areas where a better connection to societal structures and personal struggles could be added. This workshop will personalize the political and help people to connect aspects of personal stories to external systemic issues. Finding ways to connect some of those “it’s my fault” statements to systemic issues helps rebuild lost self-esteem and creates the structural framework to challenge internalized oppression.

Presenters: Damien Haussling, BS, Coordinator/Speaker, Faces of Homelessness Speakers’ Bureau, Health Care for the Homeless, Baltimore, MD, John Gaither, Jr., Speaker, Faces of Homelessness Speakers’ Bureau, Health Care for the Homeless, Baltimore, MD; Dwayne “Tony” Simmons, Speaker, Faces of Homelessness Speakers’ Bureau, Health Care for the Homeless, Baltimore, MD

Speaking Outside the Box

Sexual History, Effective HIV and STI Prevention, and the use of HIV Pre-Exposure Prophylaxis (PrEP) in High Risk Populations

Studies indicate that most patients want to discuss issues of sexual health with their providers, and that this discussion is an essential part of a patient’s comprehensive history during an annual prevention visit. In reality, however, busy providers often skip the sexual history unless a patient is demonstrating signs or symptoms of an STD. This contributes to missing opportunities to effectively address HIV where knowing patients and closely following them is critical. The challenges of doing so are heightened for providers of health care to the homeless. This session addresses the challenge of routinely collecting information on every patient’s sexual history by providing a “roadmap” that includes setting up systems to support all members of the clinical care team and how to utilize universal screening and the HIV treatment cascade as a guide for developing systems for both prevention with an emphasis on PrEP and linkage to, engagement in, and retention in care.

Presenters:  Andrew Desruisseau, MD, MSc, Infectious Diseases Physician, Healthright360, San Francisco, CA

Sexual History, Effective HIV and STI Prevention

 

Unaccompanied Homeless Youth, the ACA, and Future Steps States Must Take to Ensure Access

In 2014, a provision of the Affordable Care Act (ACA) took effect that requires states to put into place outreach programs so that unaccompanied youth can obtain health insurance. This important new provision will have limited impact on youth unless legal and health care advocates and professionals support and monitor its implementation and state laws empower minors to consent for their own health care. Currently, twenty states do not have laws allowing unaccompanied youth to consent to general medical and dental care, effectively preventing them access to health care. Targeted law reform is necessary to keep youth healthy and make the ACA meaningful to them. // Many unaccompanied homeless youth nearing adulthood find themselves stuck in a legal gap that leaves them unable to access necessary health care services until they turn eighteen. This is because healthcare providers are usually required to ask for consent from a minor’s parents or guardians, who—for many homeless youth—are frequently absent, unreachable, or uncooperative. This workshop will discuss successful advocacy strategies in Maryland and Illinois to pass state laws granting unaccompanied minors the ability to consent to health care services on their own behalf. The presenters will focus on collaborations between health care service providers and advocates to eliminate this barrier to accessing health care, including tips for engaging legislators and non-traditional allies and ending with an open-ended discussion among participants about other ways health care providers and advocates can collaborate to address barriers to accessing health care.

Presenters: Amy Louttit, JD, Public Policy Associate, National Network for Youth, Washington, D.C.; Graham Bowman, JD, Equal Justice Works Fellow, The Law Project of the Chicago Coalition for the Homeless, Chicago, IL; Lisa Stambolis, RN, CPNP, Director of Pediatric and Adolescent Health, Health Care for the Homeless, Baltimore, MD; Jennifer Cushman, MSW, Policy Specialist, The Chicago Coalition for the Homeless, Chicago, IL

Unaccompanied Homeless Youth Model Minor Consent Law

We Are Trauma Informed, Aren’t We? Using Assessment to Get Under the Surface of Clinic Policy and Practice

Adopting agency-wide Trauma-Informed Care (TIC) practices and policies is crucial to providing quality care to people experiencing homelessness. This workshop will detail how an interdisciplinary, staff-led Health Equity Committee collaborated with student researchers from Johns Hopkins University to develop and conduct an agency-wide TIC assessment with staff and clients. We will review the assessment’s six domains, share research tools, discuss recruitment strategies, and share results and lessons learned through the assessment process. We will discuss the utility of in-person interviews and focus groups and, specifically, the richness of data obtained through this process. Through a small group activity, participants will be able to operationalize data-driven clinical and policy implications.

Presenters: Lawanda Williams, LCSW-C, DrPH(c), Coordinator of Connect Project, Health Care for the Homeless, Baltimore, MD; Annick Barker, LCSW-C, Mental Health Therapist, Health Care for the Homeless, Baltimore, MD; Liz Coleclough, MPH, PhD(c), Johns Hopkins Bloomberg School of Public Health, Health Care for the Homeless, Baltimore, MD

Client Interview Guide | Informed Consent – Staff | Staff – Interviews, Focus Groups

Looking for Resources? How Hospital Community Benefit Programs Might Help

The Affordable Care Act (ACA) mandates that nonprofit hospitals conduct Community Health Needs Assessments and Implementation Plans targeting Community Benefit (CB) investment. This workshop will assist administrative and clinical staff in understanding the history of hospital community benefit programs and the current mandates for non-profit hospital systems. Participants will learn what qualifies as a community benefit and identify avenues for inclusion in this hospital process. The discussion will share principles of CB along with new and exciting opportunities for HCH programs to collaborate with hospitals on strategic planning and resource expansion for the homeless including care coordination. National innovations from Catholic Health East/Trinity Health System will be presented, along with a successful HCH and hospital collaborative CB process example. This workshop will identify a replicable hospital model that embraces an HCH program.

Presenters: Doreen Fadus, MEd, Executive Director, Community Benefit and Health, Mercy Medical Center, Springfield, MA; Vondie Woodbury, MPA, Vice President, Community Benefit Catholic Health East/Trinity Health System, Cincinnati, OH

How Hospital Community Benefit Programs Might Help

Technology-Enhanced Health Navigation and Coaching for Tenants in Permanent Supportive Housing

mCHAT, an 1115 Medicaid Waiver project in Texas, is a technology-enhanced health navigation program for residents of Permanent Supportive Housing. The project draws on brief health navigation systems that utilize motivational interviewing and wellness incentives to target health conditions faced by this high-risk population, many of whom are dually diagnosed. The mCHAT model includes six main features: monthly home visits; technology enhanced decision-making using a web-based interface that visually displays consumers’ individual data; collaborative goal setting around six quality-of-life domains, including the ability to set reminders pushed to a smart phone; wellness incentive accounts (CHAT bucks) that can be used to purchase items to help support health goals; health tips that are available on program smart phones, and, linkage to community resources and support systems. This workshop will report on lessons learned during implementation.

Presenters: Emily Spence-Almguer, MSW, PhD, Associate Professor, Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, TX; Scott Walters, PhD, Professor, Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, TX; Whitney Hill, MPH, CPH, mCHAT Project Coordinator, University of North Texas Health Science Center

 

Data, Data, Everywhere, but Not a Drop to Measure: Quenching Your Thirst for Clinical Quality Information Administration Introductory

Every day, we capture a raging river of data: thousands of clinical drops that are poured into our electronic medical record (EMR) systems. But when we crave information about the work we do and the populations we serve, we often find nothing to drink. This panel will explore ways to quench your thirst for meaningful reports. Quality leaders from four HCH projects will explain the differences between an EMR and a clinical quality reporting system, and discuss how the latter can help with Patient-Centered Medical Home (PCMH) certification, HRSA’s 19 requirements, and more. Participants will learn about the strengths and weaknesses of vendored systems (such as Azara DRVS or i2i Tracks), HRSA-funded Health Center Controlled Networks (such as Alliance of Chicago), and in-house development by a center’s own IT team. Finally, participants will learn how to determine which solutions are best for their project. Together, we’ll turn those rivers of data into pools of knowledge.

Presenters: Chuck Amos, MBA, Director of Performance Improvement, Health Care for the Homeless, Baltimore, MD; Pooja Bhalla, MSN, RN, Chief Operating Officer, Boston Health Care for the Homeless Program, Boston, MA; Chris Espersen, MSPH, Quality Director, Primary Health Care, Urbandale, IA; Stephanie Luther, MD, Chief Medical Officer, Heartland Health Outreach, Chicago, IL

Data Data Everywhere

Can We Have An Impact? Interventions and Quality Improvement for Substance Use Disorders (SUD) in HCH Primary Care Settings

Among people experiencing homelessness, SUD is highly prevalent and substance-attributable mortality is disproportionately high. Yet, clinical interventions for SUD are often not considered within the scope of primary care practice. As the care model within HCH settings shifts to become more integrated, we must consider clinical interventions for SUD appropriate for HCH settings and aim to measure their impact. Evidence behind interventions for Alcohol Use Disorder and Opioid Use Disorder will be reviewed. Innovative approaches to SUD in HCH programs will be shared through facilitated discussion. In an effort to promote high-quality care for SUD, the workshop will analyze potential quality metrics that may be appropriate for measuring the impact of interventions specifically within primary care settings, as well as discussing methods of population health management targeted to HCH patients with SUD.

Presenters: Jessie Gaeta, MD, Chief Medical Officer, Boston Health Care for the Homeless Program, Boston, MA; Barbara Wismer, MD, MPH, Physician, Internal and Preventive Medicine, Tom Waddell Urban Health Clinic/San Francisco Department of Public Health, San Francisco, CA

Can We Have An Impact?

 

HIV and Hep C Care Wherever You Are: Expanding Access in the Healthcare for the Homeless Setting

The workshop presents information on the history and implementation of Project ECHO along with video interviews of patients who are the recipients of care based on two years of enhancing the services by presenting cases to an experienced faculty via telehealth and using their recommendations to treat patients for HIV and Hep C. These patients would ordinarily have had to travel great distances to see specialists, and as a result would have historically fallen through the cracks. The workshop will offer first-hand learning experiences about the benefits of participation in Project ECHO, including the reduction of isolation, continuing education, and peer support. Project ECHO is an innovative model of care that uses technology to increase the number of providers able to provide HIV and Hep C care and the number of patients able to receive care.

Presenters: Kasey Harding-Wheeler, BAS, Program Director, Integrated Care for Special Populations (ICSP), Community Health Center, Middletown, CT; Elizabeth Scott, APRN, Provider, Community Health Center, Middletown, CT

 

Intimate Partner Violence and Homelessness: The Dilemma of Providing Services to the Couple in Conflict

Poverty, substance abuse, and childhood trauma are all associated with increased risk for intimate partner violence (IPV), and it is not uncommon for Healthcare for the Homeless (HCH) programs to encounter both those who abuse and are abused. While the safety and support of the victim of IPV remains the most important focus, issues of housing and substance abuse treatment often require advocacy for the couple—as a couple. This workshop will explore treatment dilemmas and strategies along with staff safety and secondary trauma posed by IPV in the HCH setting. Discussion will focus on case examples offered by HCH clinicians and administrators. The workshop clearly addresses an issue from the difficult and unique perspective of advocacy for both the victim and perpetrator of IPV, as this is a common dilemma faced by all HCH programs that provide housing and substance abuse care.

Presenters: Erik Garcia, MD, Medical Director, Community Healthlink, Worcester, MA; Tammy Brisebois, BS, Suboxone Case Manager, Community Healthlink, Worcester, MA; Brian Bickford, MA/LMHC, Director, Homeless Outreach and Advocacy Program, Community Healthlink, Worcester, MA; Lina Gonzalez-Dufresne, MSW/LICSW, Behavioral Health Program Manager, Community Healthlink, Worcester, MA

Intimate Partner Violence and Homelessness ppt v8

Managing Multiple Cardiac Risk Factors in High-Risk, Low-Income Patients: An Integrated, Effective, Cost-Conscious Approach

Based on principles of adult learning theory, this workshop utilizes individual and small group “readiness assessments” to review key concepts from various clinical practice guidelines. In small groups, participants will discuss approaches to clinical management with respect to clinical practice guidelines. In a large group setting, participants will review key principles from relevant clinical practice guidelines, and integrated algorithms for clinical management will be presented. Small group work will allow participants to apply the algorithms in a case-based format. Evidence of successful implementation and improved outcomes will be presented in a review of the Heart Improvement Project, a comprehensive cardiovascular risk reduction program for high-risk uninsured patients, which has been in operation for six years. The evolution of the program design and critical threats and success factors will be reviewed briefly.

Presenters: Mark Fox, MD, PhD, MPH, Associate Dean for Community Health and Research Development, University of Oklahoma School of Community Medicine, Norman, OK; Heather Chancellor, MS, Project Coordinator, Heart Improvement Project, University of Oklahoma School of Community Medicine, Norman, OK

 

Motivational Interviewing with a Twist: Facilitating Communication and Change with Policymakers

Would you like to see the system work better but are uncomfortable or just frustrated with the idea of talking to legislators and other policymakers? Are you familiar with the core principles of Motivational Interviewing (MI), and have you been able to incorporate this approach into your clinical work? If so, this workshop will combine two mainstays of the annual HCH Conference: Motivational Interviewing and the Integration of Service and Advocacy with an emphasis on talking with policymakers about the solutions needed prevent and end homelessness. MI gives us strategies for structuring discussions about change and is effective for defusing tension, identifying mutual goals and working with a wide range of beliefs. Reframing resistance as ambivalence can work well in both the public policy and clinical arenas. If ever there was a time your skills were needed in the public policy discussion, it is now. This workshop will demonstrate how you can use MI to be an effective advocate in your community.

Presenters: Matthew Bennett MBA, MA, Chief Innovation Officer, Coldspring Center for Social & Health Innovation, Nederland, CO; Barbara DiPietro, PhD, Director of Policy, National Health Care for the Homeless Council, Baltimore, MD

 

 

Workshop Session 5 | Friday, 1-2:30 p.m.

Implementing Trauma-Informed Practices in Healthcare Settings

“Trauma-informed care” has become a buzzword in the HCH field, and it is an important one. We know that the people involved in our programs have experienced often-intense, prolonged trauma and we recognize that it is important to tailor our approach to services accordingly. But where do we begin? This highly interactive workshop will discuss the five domains of trauma-informed practice: training and education, trusting relationships, safe and supportive environment, organizational services, and policies and procedures. Using case studies and examples from participants, we will discuss ways to implement trauma-informed practices in various parts of community-based organizations.

Presenter: Katie Volk MA, Managing Director, t3, Austin, TX

 

Being Brave in a New World: “Must Haves” in Managed Care Contracting

With new coverage of many HCH patients through Medicaid expansion, and with increasing reliance by states on managed care arrangements, HCH grantees are increasingly required to contract with Managed Care Organizations (MCOs) and Accountable Care Organizations (ACOs). This workshop will explain the basic business arrangements that are coming to dominate health care financing and care delivery. Not all MCOs/ACOs understand what is necessary to provide effective, quality care to people without homes, and in the contracting process HCH providers must diligently protect their interests and those of their patients. The session will help participants understand the real dangers and the exciting possibilities that contract negotiations entail.
PresentersJennifer Nolty, Director, Innovative Primary Care, PCA & Network Relations, National Association of Community Health Centers; Ted Amman, MPH, RN, Director of Health System Development, Central City Concern, Portland OR
Being Brave in a New World

The Art and Science of Providing Nursing Care to the Homeless Population: An Evolution of Nursing Practice at Boston Health Care for the Homeless Program (BHCHP) Using a Multidisciplinary Approach

Nurses are invaluable members of multidisciplinary teams providing important relationship-building and health services. This workshop focuses on how nurses working with the homeless use both art and science to provide quality care. The session will review how nursing practice at Boston Health Care for the Homeless Program has evolved to meet the ongoing complex needs of our patients in the current ACA health care environment. Our nurses and clinicians, working together in multidisciplinary teams, provide comprehensive primary and episodic care. This collaboration across disciplines – along with the seamless integration of hospital, shelter, respite and street clinics – creates the foundation for BHCHP’s model of care. Through a combination of presentation, cases, and facilitated discussion by seasoned HCH nurses, this workshop will provide participants with knowledge, tools, and inspiration to create a successful nursing environment that can lead to improved patient outcomes.

Presenters: Terri LaCoursiere Zucchero, PhD, RN, FNP-BC, Assistant Professor, Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, and Nurse Practitioner, Boston Health Care for the Homeless Program, Boston, MA; Pooja Bhalla MSN, RN, Chief Operating Officer, Boston Health Care for the Homeless Program, Boston, MA; Barbara Giles, MSN, RN, Program Director of Nursing/Nurse Educator, Boston Health Care for the Homeless Program, Boston, MA

 

Under One Roof: A Housing and Healthcare Partnership

This workshop will highlight the client-centered collaborative approach used at the Canadian Mental Health Association (CMHA) Ottawa Branch to assist people with serious mental illness and addictions find safe, stable, and affordable housing. With the use of client scenarios and discussion, this workshop will present the more than ten years of experience CMHA Ottawa has with providing services and housing to the homeless. This will include a discussion about the Housing First Model, integrated services offered at CMHA Ottawa, and the community and partnerships that have been created. The presentation will highlight the successes and examine the challenges of providing rent supplements to clients, working with private and public housing providers, and client stigma, and also feature our unique partnership with a local community health center in providing housing and services to clients with complex substance use disorders. Participants will learn how CMHA has innovatively responded to the needs of the homeless population in Ottawa Ontario.

Presenters: Teresa Meulensteen, MSW, Housing Program Manager, Canadian Mental Health Association, Ottawa, ON; Michael McGee, BA, Housing Coordinator, Canadian Mental Health Association, Ottawa, ON; Corry Comeau, BA, Housing Coordinator, Canadian Mental Health Association, Ottawa, ON

Under One Roof (CMHA)

Making the Business Case for Integrated Community Health Outreach Programs Administration

Community health outreach programs play a critical role in facilitating access to primary care and establishing a medical home for individuals from underserved populations. However, the impact of outreach on health center revenues is not well documented or understood, making these programs susceptible to limited funding and budget cuts. Health Outreach Partners has developed a strategic framework and corresponding toolkit aimed at assisting Community Health Center (CHC) administrators in determining the business value of an integrated community health outreach program. The toolkit includes calculators and other tools to assist health center decision makers in assessing the potential financial impact of sustained investments in outreach. During this 90-minute workshop, facilitators will describe the elements of a fully integrated health outreach program and will provide an overview of the framework and toolkit.

Presenters: Oscar Gomez, CEO, Health Outreach Partners, Oakland, CA; Liam Spurgeon, Associate Project Manager at Health Outreach Partners

 

Utilizing the Behavioral Health Integration (BHI) model in the Health Care for the Homeless (HCH) Setting from a Team Approach

This comprehensive presentation will give an overview of integrated care and the benefits of its use. It will educate professionals about Behavioral Health Integration (BHI) and equipthem with concrete strategies to begin applying BHI in their respective practices.  An overview of the BHI continuum will be will be outlined and participants will be encouraged to consider how this applies to their own practice settings.  Techniques including service integration, communication, care delivery, consumer involvement, and patient tracking will be discussed.  Presenters from various disciplines will discuss application of BHI in their respective roles.  Participants in this workshop will  develop a thorough understanding of BHI and will be prepared to apply these techniques to their practice setting.

Presenters: Quinnette Jones, PA-C, LCSW, Clinic Manager, Lincoln Community Health Center, Healthcare for the Homeless Clinic, Durham, NC; Charita McCollers, MSW, LCSWA, Social Worker/Case Manager, Lincoln Community Health Center, Healthcare for the Homeless Clinic, Durham, NC; Serena Wilson, BA, Intern, Lincoln Community Health Center, Healthcare for the Homeless Clinic, Durham, NC; Jennifer Robinson, BA, Community Health Worker, Lincoln Community Health Center, Healthcare for the Homeless Clinic, Durham, NC

Using the BHI model in the Health Care for the Homeless Clinic

An Advanced Model to Routinize Hepatitis C Testing and Linkage to Care for Homeless Patients in Philadelphia, Pennsylvania

From 2010 to 2019, direct costs of Hepatitis C Virus (HCV) are likely to surpass $10.7 billion and indirect costs are projected to reach $54.2 billion. Certain sub-populations are disproportionately impacted by the disease, such as those experiencing homelessness. With the advent of new treatment options, and more coming soon, it is an important time to integrate HCV testing as part of routine care at health centers that serve the homeless. In this interactive workshop we will present a successful model of routine HCV testing and linkage to care from Mary Howard Health Center, a federally qualified health center in Philadelphia, Pennsylvania, that treats an entirely adult homeless population. We will look at epidemiology, the benefits of universal testing and proven models of linkage and engagement to specialist care. There will be discussion about successes, barriers, and lessons learned while implementing testing. By the end of the workshop, participants will be able to replicate the model in their own healthcare setting.

Presenter: Catelyn Coyle, MPH, MEd, Public Health Project Manager, National Nursing Centers Consortium, Philadelphia, PA

 

Engaging Native Americans through the Talking Circle

Native Americans experiencing homelessness suffer from layers of personal traumatic events as well as historical and intergenerational trauma. Cultural, spiritual, and traditional beliefs and practices linked to ancestry have provided the mainstay of strength in identity and survival. Historically, the Talking Circle was practiced by many Native nations to assist in making important and delicate decisions in a highly respectful and diplomatic manner. The Talking Circle begins with an invocation and reminder of how all of creation is connected and that the circle has no beginning and no end, therefore we are all related. The Colorado Coalition for the Homeless (CCH) hosts Talking Circles weekly to engage Native American clients, a unique model that is both ritualistic and pragmatic. CCH’s Talking Circles are popular, engaging 60 individuals over four different groups weekly. This workshop will provide an interactive presentation of the Talking Circle a modality of Native American engagement.

Presenters: Petra Ulrych, MA, LPC, Program Manager, Native American and Veteran Services, Colorado Coalition for the Homeless, Denver, CO; RoSean Howard, BA, Women’s/Ethnic Studies Patient Navigation/Case Manager, Colorado Coalition for the Homeless, Denver, CO

 

The Activist Consumer Advisory Board: Using the Consumer Advisory Board (CAB) as a Tool for Policy Advocacy, Health Education, and Social Change

This workshop discusses the unique role that CABs can play in policy advocacy and consumer health education by highlighting the work of “activist” CABs in Miami, Atlanta, and Boston, where CAB members engage with municipal, state, and federal regulators and policymakers to advocate on matters such as alternatives to homelessness criminalization, Medicaid expansion, community health fairs, consumer focus groups, and facilitation of meetings with HRSA Project Officers. These CABs also disseminate health information on matters like chronic diseases that disproportionately affect consumers and the homeless population. Key content topics include navigating legal and institutional barriers to effective advocacy and tying health education to clinical quality indicators. This workshop provides instruction to empower CABs nationwide to take leadership roles in advocacy and education.

Presenters: David Peery, JD, CAB Chairperson, Camillus Health Concern, Miami, FL; Tina Hayes, CAB Chair, NCAB Co-Chair, Mercy Care Services, Atlanta, GA; Derek Winbush, CAB Chair, NCAB Member-at-Large, Boston Health Care for the Homeless Program, Boston, MA

 

Forget About the Patient Centered Medical Home: I Need a Damn Medical Neighborhood!

This workshop will utilize a case-based, pragmatic, facilitated, small-group approach to address gaps in seamless integrated care in the homeless clinic by exploring the model used at Healthright360, one that incorporates psychiatric care, addiction treatment, and specialty infectious diseases care into the patient-centered medical home, thereby creating more of a medical “neighborhood.” This workshop is intended to help those who want to work towards creating a more integrated health care delivery model by exploring creative solutions to common obstacles.

Presenters: Andrew Desruisseau, MD, MSc, Infectious Diseases Physician, Healthright360, San Francisco, CA; Ako Jacintho, MD, Family Practitioner, Healthright360, San Francisco, CA; Harun Evcimen, MD, Psychiatrist, Healthright360, San Francisco, CA

Forget About the Patient Centered Medical Home

 

Supportive Housing is Healthcare: Operationalizing the Rhetoric through Supportive Housing and Health Center Partnerships

Patients who are frequent users of emergency health services are often vulnerable and unstably housed. Innovative new programs across the country are realizing the benefits of health centers and supportive housing providers’ partnerships. These programs improve services and housing for vulnerable, frequent user patients, which results in improved outcomes and lower costs to the health care system. Moreover, these innovations show how health centers can access housing units by engaging with the broader housing community rather than having to operate housing themselves. During this workshop, attendees will learn about housing and health partnerships, understand the administrative components for formalizing partnerships, and learn how these partnerships can advance HRSA Program requirements.

Presenters: Cheryl Winter, Director of Quality improvement and Health Integration, Pathways to Housing, Washington, D.C.; Catherine Crosland, MD, Medical Director, Unity Health Care, Washington, D.C.; Jim O’Connell, MD, President, Boston Health Care for the Homeless Program, Boston, MA

Moderator: Jane Bilger, Senior Program Manager, CSH

 

Workshops 6 | Friday, 3-4:30 p.m.

Hospitals, Community Care Teams, and Recuperation: Statewide Coordination to Identify, Monitor, and Care for the Homeless

This workshop highlights statewide efforts to standardize identification and track of people experiencing homelessness within hospitals, improve discharge planning, build and strengthen Community Care Teams, and utilize our experience to bolster state policy/advocacy efforts. Participants will hear examples of progress and impact in two of the regions in the project. The workshop presents lessons learned and the potential that this initiative holds to bolster an advocacy initiative with state government. Participants will learn about the method of securing resources and support with which to sustain Community Care Teams (CCTs) so as to initiate and expand medical respite and recuperative care programs for people who are homeless. Participants will hear how data tracking has set a path for the state to provide support for CCTs. Lastly, attendees will learn how embedding hospital screening and data measures into ongoing operations can impact ED/inpatient utilization by the homeless

Presenters: Alicia Woodsby, MSW, Executive Director, Partnership for Strong Communities, Hartford, CT; Terri DiPietro, MBA, OTR/L, Director, Outpatient Behavioral Health, Middlesex Hospital, Middletown, CT; Carl Schiessl, JD, Director, Regulatory Advocacy, Connecticut Hospital Association, Wallingford, CT; Michael Ferry, LCSW, Social Work Lead, Yale-New Haven Hospital, New Haven, CT; Alison Cunningham, MDiv, Executive Director, Columbus House, New Haven, CT

Hospitals, Community Care Teams, and Recuperation

Clinical and Ethical Challenges of Permanent Supportive Housing

Permanent Supportive Housing (PSH) can be a difficult, messy process fraught with ethical pitfalls. How do we support our clients when their decisions can put them and their neighbors at risk? How do we balance over-helping without risking under-helping? How do we acknowledge failures with dignity? This workshop features experienced PSH clinicians from two HCH projects who will use case-study examples and facilitated discussion to address the thorny aspects of working with challenging clients to improve health and housing stability. This panel will also feature a property manager who will illustrate how partnerships with health teams can yield more successful outcomes for all involved. Topics covered will include client education, teaching negotiation skills and preventing burnout and compassion fatigue among PSH team members. This workshop will leave PSH providers feeling better supported, with new ideas for navigating difficult circumstances.

Presenters: Joshua Bamberger MD, MPH, Medical Consultant, Housing and Urban Health, San Francisco Department of Public Health, San Francisco, CA; Jan Caughlan, MSW, LCSW-C, Director of Housing and Health Initiatives, Health Care for the Homeless, Baltimore, MD; Lauren Hall, BA, Director, Delivering Innovation in Supportive Housing, San Francisco, CA; Amy Noack, MD, Medical Director, San Fransisco VA, Downtown Homeless Center, San Francisco, CA

Clinical and Ethical Challenges of Permanent Supportive Housing

Oh, The Places We Go! Outreach with Rural Folk Experiencing Homelessness

During the first open enrollment period, many outreach and enrollment programs were focused on meeting the high demand for application assistance. During the second open enrollment period, it was important to develop more targeted strategies to reach particular populations. While homelessness is often thought of as an urban problem, many individuals in rural areas experience marginal and unstable housing. Those living in rural areas experiencing homelessness have unique characteristics and barriers to accessing both enrollment assistance and health care. Using lecture and facilitated discussion, this session will provide an overview of outreach and enrollment strategies in Kentucky, then focus on Grace Community Health Center (a Federally Qualified Health Center in Appalachian Kentucky) as a model for reaching individuals experiencing homelessness in rural areas.

Presenters: Lindsay Nelson, MSW, Kentucky Primary Care Association, Frankfort, KY; Phyllis Platt, MSW, PhD, Grace Community Health Center, Gray, KY

Oh the Places We Go!

Integration of Outreach and Clinical Services with a Nursing Care Coordination Model

The development of the nursing care coordination model is a recent development in healthcare that has been applied most effectively in “hot-spotting” or targeting high utilizers of emergency services. This presentation will argue that nursing care management is a model that can provide increased access and utilization of primary care services for high risk adult populations experiencing homelessness and present a model based on the experience of a Federally Qualified Health Center (FQHC) embedded within an established comprehensive outreach, housing, and advocacy program for the homeless in Philadelphia.

Presenters: Lucy Kibe, MS, MHS, DrPH, PA-C, Director of Clinical and Wellness Services, Project HOME, Philadelphia, PA; Lisa Greenspan, RN, Nurse Care Manager, Project HOME, Philadelphia, PA; Samantha Baker-Evans, RN, BSN, Nurse Care Manager, Project HOME, Philadelphia, PA; Mudit Gilotra, Project HOME, Philadelphia, PA

 

Navigating Systems Change Making Opportunities for Improvement, Growth, and Sustainability in the Midst of Chaos

This workshop begins with a recounting of the overnight transfer of a large and long-lived Health Care for the Homeless program from one comprehensive healthcare system to another. Five years later, the HCH program (Lutheran Family Health Centers’ Community Medicine Program, formerly operated by St. Vincent’s Catholic Medical Centers) is strong and sustainable. Key lessons will be extracted and shared, and there will be ample time for questions and examination of how those lessons can be applied to other programs and organizations in flux and/or distress. Conversation will center on the essential aspects of success in transition, including: seamless provision of care, retention and rapid transfer of personnel, HIM/IT transition, maintenance of patient and staff satisfaction, continuity of funding streams, regulatory challenges, communications (internal and external), and geography and organizational culture, or how to give a scattered-site program a new home.

Presenters: Aaron Felder, AVP for Special Populations, Lutheran Family Health Centers, Brooklyn, NY; Barbara Conanan, RN, MS, Program Director, Community Medicine, Lutheran Family Health Centers, Brooklyn, NY

Navigating Systems Change

Research in 30 Minutes

1. Who Is High Cost? Rethinking Frequent Emergency Department Use with Implications for Health Care Reform

This presentation demonstrates that frequent users of emergency departments are not necessarily high-cost patients. In fact, only a small number of frequent users are in the top cost decile. Our research pinpoints characteristics for identifying high cost frequent users with greater accuracy. This has clear implications for developing cost-saving interventions—accurately identifying the highest cost patients enables the development of more efficient interventions in the context of limited resources.

Presenters: Matthew Mitchell, MTS, Emergency Room High User Program Coordinator, Boston Health Care for the Homeless Program Boston, MA; Casey Leon, MPH, Research Manager, Boston Health Care for the Homeless Program Boston, MA

2. The “Treatment” Effect of Illicit Drugs on Anxiety Reduction for Homeless Individuals Experiencing PTSD

This workshop discusses the role illicit drug usage plays in reducing anxiety for those experiencing PTSD. Participants will have the opportunity to share their experiences of working with homeless individuals to reduce their illicit drug usage and the difficulties they have encountered in doing so. The emphasis will be on the psychological value of drug “abuse” in reducing anxiety and the difficulties that presents in reducing drug usage.

Presenters: Ricky T. Munoz, JD, MSW, Assistant Clinical Professor of Social Work, University of Oklahoma, Tulsa, OK; Mark D. Fox, MD, PhD, MPH, Director, OU Street Outreach Clinical, Tulsa, OK; Nancy Brahm, PharmD, MS, BCPP, CGP, Clinical Professor, University of Oklahoma, Tulsa, OK; Heather Chancellor, MS, Research Coordinator, Center for Clinical and Translational Research, University of Oklahoma, Tulsa, OK

3. The Experiences, Meanings, and Needs of Urban Appalachian Mothers Transitioning from Homelessness

This workshop highlights findings from an ethnographic study of urban Appalachian mothers and their children transitioning into housing from a Midwestern family shelter. Participants will discuss study findings related to barriers and facilitators of healthy transition experiences through large and small group dialogue related to development of culturally informed strategies for supporting families transitioning from homelessness. As society becomes increasingly diverse, it is important to understanding the need to culturally tailor homeless services and transition experiences.

Presenter: Rebecca Lee, PhD, RN, PHCNS-BC, CTN-A, Associate Professor, University of Cincinnati College of Nursing, Cincinnati, OH

 

Will Work for Social Change: Integrating Public Policy Advocacy into Your HCH Project Policy and Advocacy Introductory

We cannot end homelessness without changing the public policies that perpetuate homelessness. Changing these policies will be challenging, but it is essential to the HCH mission. Thankfully, HCH staff and consumers make fantastic advocates and have the direct experience with homelessness and homeless services needed to understand what must change. This workshop will describe how HCH staff and consumers can efficiently integrate policy advocacy into their work and how projects can support their advocacy involvement. Needed training and resources, potential barriers to advocacy, and examples of advocacy strategies will all be provided. In addition, examples of the integration of advocacy at Central City Concern in Portland, Oregon, and Care for the Homeless in New York City will be provided. These projects have engaged in numerous policy efforts from Medicaid redesign to new affordable housing and have provided the training and support for staff and consumers to play a huge role.

Presenters: Adam Schneider, MSW, Director of Community Relations, Health Care for the Homeless, Baltimore, MD; Gary Cobb, Advocacy Associate, Central City Concern, Portland, OR; Jeff Foreman, JD, Policy Director, Care for the Homeless, New York, NY

 

Trans in the Tenderloin: A Story of Community Resilience

Gender specialist and psychotherapist Robyn L. Stukalin, MS, LCSW will be joined by Amber Gray, Kandi Patterson and Conrad Wenzel, MSW, who are trans* identified peer and staff activists to discuss the effects that trauma and discrimination have on the lives of trans* and gender non-conforming people and the resilience shown by members of the transgender community. The presentation will combine excerpts from interviews done with members of the trans* community and relevant research findings on the impact of discrimination with Ms. Stukalin’s insight after decades of clinical experience working with members of the trans* community. In their panel Ms. Gray, Ms. Patterson and Mr. Wenzel they will explore what trans* people need to be healthy, the impact of the intersection of racism, sexism, homophobia and transphobia and the factors that they have found that contribute to the resilience of the trans* community.

Presenter: Robyn Stukalin, MS, LCSW, Psychotherapist/Clinician, Tom Waddell Clinic, Trans Access, San Francisco, CA

 

Starting at Your Base: A Primer on Developing and Maintaining a Highly Effective and Inclusive Non-Profit Board

Boards play a crucial role in the success (or failure) of any organization, but their functions and responsibilities are often not well understood. A thoughtfully and intentionally conceived board structure and membership that is inclusive of many perspectives, including those of consumers, enhances organizational effectiveness and program outcomes. This presentation will help guide your board to its full potential, examining how to create, maintain and empower a board of directors that will in turn support and thoughtfully guide your agency.

Presenters: Paul Leon, RN, CEO, Founder, The Illumination Foundation, Irvine, CA; Jenny Metzler, MPH, Executive Director, Albuquerque Health Care for the Homeless, Albuquerque, NM

Starting At Your Base Handout Packet | Starting At Your Base

Combining Medicaid with Permanent Supportive Housing: Policy and Payment Options and Current Practices in the Field

Medicaid is a flexible program and states have numerous options for expanding benefit packages beyond the minimum required by law. New priorities to place the most vulnerable homeless clients in permanent supportive housing (PSH) bring a renewed focus to using Medicaid benefits, which can be tailored based on specific needs, to pay for PSH services. Intended to complement new resources on Medicaid and PSH from the U.S. Department of Health and Human Services, experts on this panel workshop will explain the options available; describe how they can be adopted and implemented; illustrate how to use Medicaid to cover integrated primary care, behavioral health, and health home services; and highlight lessons learned from states and communities that are using such options to pay for services for PSH clients.

Presenters: Carol Wilkins, MPP, Consultant, Abt Associates, Cambridge, MA; Brenda Goldstein, Psychosocial Services Director, LifeLong Administrative Offices, Berkeley, CA; Karen Batia, PhD, Principal, Health Management Associates and Chief Excellence and Innovations Officer, Aunt Martha’s Youth Service Center, Olympia Fields, IL

Moderator: Emily Rosenoff, MPA, Senior Policy Analyst, Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (HHS)Washington, D.C.

CombiningMedicaid-PSH quick-guide | Medicaid-PSH-slides | Wilkins-background-slides

The Homeless Outreach, Management and Empowerment (HOME) Program: Making Managed Care Work for Homeless People

Medicaid expansions enrolled many homeless people in managed care plans, which require individuals to understand and navigate complex systems. Clinic staff face new administrative burdens, including counseling and educating clients about managed care. These increased responsibilities can decrease productivity and increase staffing costs. Amida Care, a Medicaid Special Needs Plan for PLWHA, has improved outcomes and contained costs. Recently, uninfected homeless people became eligible for the SNPs. The SNPs offer enhanced benefits and programs to improve retention in care, and re-engage people who fall out of care. A requirement to foster housing stability was made possible with the cooperation of NYC DHS. This workshop will examine the impact and limitations of governing rules and processes, benefit design, conceptualizing a homeless-friendly managed care program and creating a housing history system, payment and risk adjustment, pitfalls of implementation, and transferability.

Presenters: Douglas Berman, MA, MSJ, Director of Special Populations, Amida Care, New York, NY; Kevin Steffens, RN, MBA, Senior Director of Health Services Operations, Amida Care, New York, NY

 

 

Learning Labs | Saturday, May 9, 9:00 a.m.-2:30 p.m.

Practice Transformation: Improving Access to Care and Quality of Care for Unstably Housed Transgender and Gender Non-Conforming Persons

Frequently grouped together with lesbian, gay, bisexual, and sometimes queer/questioning individuals, transgender and gender non-conforming (TGNC) persons are often considered to be a marginalized part of society. Despite having limited research specifically addressing unstably housed transgender and gender non-conforming individuals, it is clear that a number of persistent service access barriers contribute to a disproportionate risk of housing instability and inequities in health. One of the most prominent issues is cultural sensitivity amongst service providers with transgender and gender-nonconforming clients, staff and peers.

This training session will build on cultural capacity, awareness, and skills of service providers through interactive and hands-on activities. It was adapted from the “Moving Margins: Training Curriculum for Child Welfare Services with LGBT Youth in Out-of-Home Care,” developed by the National Association of Social Workers and the Lambda Legal Defense & Education.

Presenters: Pamela Klein RN MSN ACRN, Boston Health care for the Homeless Program, Conrad Wenzel MSW, Transgender Health Services, San Francisco Department of Public Health, Seth Ammerman MD, Stanford University/Lucile Packard Children’s Hospital Stanford; Mark Aytch, PA-C, Medical Director – Homeless Services, NeighborCare, Seattle, WA

Practice Transformation

Consumer Empowerment: a Voice on Advisory and Governing Boards and throughout the Community

Consumer Empowerment: A Voice on Advisory and Governing Boards and throughout the Community

Consumers have a unique space in governance and advocacy as they can provide their real-life experience to guide policy and practices at health centers and in the larger community. Health centers can be critical access points for consumer engagement as they are required to engage consumers in governance, either through participation on Boards of Directors or outreach that solicits contributions such as focus groups, surveys, or Consumer Advisory Boards. This Learning Lab will identify best practices in fulfilling this responsibility, including both structural considerations (e.g., how consumers’ advice is gathered and incorporated into agency decision-making) and practical tips for participating in formal decision-making processes (e.g., how to conduct a meeting and consensus decision making). To maximize the quality of this input, consumers must develop leadership skills including advocacy and communication. As the sharing of a consumer’s experiences can be a significant contribution to this work, this workshop will describe how to express stories effectively.

PresentersWillie Joe Mackey, Santa Clara County Valley Health and Hospital System, San Jose, CA; Reginald O. Hamilton, JD, Advantage Health Centers, Detroit, MI; Rodney Dawkins, Heartland Health Alliance, Chicago IL; Tina Hayes, Mercy Care, Atlanta, GA; Amy Grassette, Community Healthlink, Worcester, MA; Katherine Cavanaugh, MSW, Consumer Advocate, National Health Care for the Homeless Council, Baltimore, MD; Paula Lomazzi,Sacramento County HCH, Sacramento, CA

Consumer Governance – Conference | Leadership Development – Conference | NCAB Learning Lab CPO 2015

Diagnosing and Engaging Patients with Traumatic Brain Injury

Traumatic Brain Injury (TBI) is a significant public health problem in the United States, common in the general population, and particularly common in the homeless population. This interactive lab with case studies will feature two notable experts in the field of brain injury who will present an overview of TBI, describe the clinical manifestation of TBI, and highlight a range of screening and assessment tools for diagnosing TBI. In addition, a therapist at Albuquerque Healthcare for the Homeless will provide practical application and information on how to conduct outreach and engage clients with TBI.  Attendees will have the opportunity to share their experiences when dealing with patients with TBI and cognitive impairment. The presenters will offer application of information to setting, and provide insight into adjustments health centers and staff can make to accommodate patients diagnosed with TBI or suspected of having TBI.

PresentersAngela Colantonio, PhD, MSc, BScOT, Senior Scientist, Toronto Rehabilitation Institute; Carolyn Lemsky, PhD, CPsych, Neuropsychologist, Community Head Injury Resource Services, Toronto Canada; Ryan Porter, LMSW, Albuquerque Healthcare for the Homeless

TBI HomelessnessColantonio

Mastering UDS: Implementing New Measures and Improving Your Outcomes

The Uniform Data System is a core set of information collected to evaluate health center performance. This in-depth Learning Lab will introduce the Uniform Data System and dive deeply into the UDS clinical measures. The session will also address changes to specific clinical reports for the 2015 calendar year. The training will feature best-practices from Community Health Center, Inc. This training will be highly interactive. Participants will have opportunities to share ideas, experiences and wisdom regarding UDS measures and reporting. Participants can expect to leave the session with best practices and innovative ideas for meeting and reporting UDS measures.

PresentersDanielle Oryn, DO, MPH, Chief Medical Informatics Officer, Petaluma Health Center; Elizabeth Scott, APRN, Community Health Center, Inc. – Wherever You Are – Health Care for the Homeless; Bernie Delgado, RN, Community Health Center, Inc. – Wherever You Are – Health Care for the Homeless

MasteringUDS

Workshops 7 | Saturday

As Medicaid Expansion Progresses: New Opportunities and Challenges Connecting Homeless Clients to Coverage and Care

For most people who are homeless, expanded Medicaid eligibility has brought a new focus on outreach, enrollment, access to care, and increasing revenue for the HCH community. At the same time, new challenges have developed as more clients access insurance (many for the first time) and HCH projects become more deeply involved with Medicaid managed care. This panel discussion will focus on the benefits and opportunities that enrollment has brought, as well as the new challenges and priorities that are emerging. Intended to complement a recent report from the Kaiser Family Foundation on homelessness and Medicaid, this workshop will include facilitated discussion with attendees. Anyone working in a Medicaid expansion state (or one that will be expanding soon) will benefit from learning what three HCHs are experiencing and how they are changing their approaches accordingly.

Matias Vega, MD, Medical Director, Albuquerque Health Care for the Homeless, Albuquerque, NM; Sheena Ward, BA, Benefits and Entitlements Supervisor, Heartland Health Outreach, Chicago, IL; Kevin Lindamood MSW, President and CEO, Health Care for the Homeless, Baltimore, MD; Barbara DiPietro, PhD, Director of Policy, National Health Care for the Homeless Council, Baltimore, MD

As Medicaid Expansion Progresses

Hospital Collaboration in a Non Expansion State: Implementation of the FUSE model and Development of a Permanent Supportive Housing (PSH) Project in Asheville, North Carolina

This presentation will begin with a local newspaper article about the criminalization of homeless in Asheville, NC, that sparked the city council and city government to fund an 80-unit PSH project, which will break ground later this year. Participants will discuss the FUSE model and how stakeholders can work with local hospitals to target high utilizers of the system to make the case to fund other projects, such as medical respite. The presentation will include a consumer story as well as examples of steps to take as an outside agency to work with the CoC and hospitals to gather data and facilitate discussions with a system perspective. This will lead to ways to advocate policy wise in a non-expansion state, including examples of how to gather financial data to show why HCH programs are a smart investment.

Presenter: Brooks Ann McKinney, MSW, Mission Health and Hospitals, Asheville, NC

 

Testing Assumptions about Medicaid Expansion and Access to Care for Previously Uninsured Homeless Patients with Complex Needs

For uninsured single homeless adults historically shut out of the mainstream health care system, has eligibility for expanded Medicaid been the game-changer that expansion advocates had hoped? Or, for those with urgent needs for chronic disease management assistance, specialty care, and behavioral health services, do communities need to make further investments to help patients connect the dots? Using case studies and Medicaid enrollment and health system utilization data, this session will explore the successes and challenges of an outreach-based, mobile health care provider with a primary focus on enrolling unsheltered and other high needs homeless individuals in insurance and linking them to mainstream health care. The workshop will focus on strategies used to promote enrollment in the new Medicaid, lessons learned in linking clients to non-HCH community health clinics, and the strides clients have made within the mainstream system with comprehensive coverage when linked with new providers.

Presenters: Whitney Walker, BS, BA, Client Services Representative, HealthPoint, Renton, WA; John Gilvar, MA, Program Manager, Mobile Medical Program & High Risk Populations Planning,  Public Health – Seattle and King County, Seattle, WA; Josh Hoke, Outreach Specialist Public Health, Seattle and King County, Seattle, WA; Sarah Vanston, MD, Staff Physician, Public Health – Seattle and King County, Seattle, WA

 

Homeless Deaths Studies: An Advocacy Tool

This workshop will present the findings and recommendations of the Sacramento County Homeless Deaths Report: 2002 -2013 & a 2014 Update and the City of Philadelphia Homeless Death Review Report 2011-2012, along with comparison of these findings to other cities, including Los Angeles, Denver, New York, Portland, and Philadelphia.

Topics will include demographics (age, gender, ethnicity, veteran, and marital status), seasonal and day of the week distribution of deaths, geographic distribution, manner and cause(s) of death, use of homeless services (including homeless healthcare clinic and programs identified by HMIS), interaction with law enforcement, comparison of homeless population to general population- mortality, suicide and homicide rates, policy recommendations, and the impact of the report on policymakers.

Presenters: Bob Erlenbusch, PhD, Executive Director, Sacramento Regional Coalition to End Homelessness, Sacramento, CA; Roberta Cancellier, MSW, Deputy Director, Office of Supportive Housing, City of Philadelphia, Continuum of Care, Philadelphia, PA

Homeless Death Studies

Expanding Street Medicine: The Use of Telemedicine in Street Outreach

The Mercy Care Street Medicine team is launching a unique program to bring telemedicine to Atlanta’s unsheltered homeless. The team currently provides integrated physical and mental health care, but through the use of telemedicine, the team will be able to provide subspecialty care, such as dermatology, on the streets and expand the reach of the existing program. During this presentation, team members will discuss the nuts and bolts of telemedicine implementation on street rounds, the successes and challenges the program, and data on the quality of care and consumer satisfaction. The team’s outreach guide—a formerly homeless individual—will discuss engagement and building trust while using telemedicine on the streets. The team will present in a lecture format, then facilitate a discussion designed to help attendees brainstorm about using telemedicine in their own street outreach.

Presenters: Liz Frye, MD, MPH, Mercy Care Services, Atlanta, GA; Ricky Alexander, Certified Peer Specialist, Mercy Care Services, Atlanta, GA

 

Older Homeless Adults: Report Back from the HOPE HOME COHORT

The HOPE HOME COHORT is a population-based cohort of homeless individuals aged 50 and older in Oakland, CA (N= 350). In this interactive workshop we will present key learning points from three research areas collected from this longitudinal cohort. 1) We will describe our findings at baseline including age at first homelessness, precipitants of homelessness, and chronicity, as well as homelessness exits at cohort 6-month follow-up. 2) We will present the frequency, severity, and factors associated with cognitive and functional impairment. 3) We will present baseline data on the prevalence, severity, and factors associated with geriatric syndromes observed in this cohort. Each research topic will be followed by a brief question and answer session. The session will conclude with a small group discussion period to explore implications for geriatric screening, healthcare delivery, and homelessness prevention and rehousing.

Presenters: Margot Kushel, MD, Professor of Medicine, PI of HOPE HOME Study, University of California, San Francisco, CA; Emily Hurstak, MD, MPH, Fellow, University of California San Francisco Primary Care Research, San Francisco, CA

 

Shelter-Based Primary Care for Families

Because of the current crisis in family homelessness with record numbers of homeless families and families homeless for longer and longer periods of time, Boston Health Care for the Homeless Program has been shifting its model to provide team-based primary care in family shelters and hotels. The workshop reviews the theoretical framework for shelter-based primary care based on current guidelines, and explores the multiple barriers to care and specific issues that homeless families face in accessing medical care. Participants learn how to create shelter-based primary care that is tailored to alleviating these specific barriers and issues related to homeless families. The workshop provides concrete and practical information on how to create high-quality, trauma-informed primary care services for families experiencing homelessness on site to reduce the difficulty and stress of accessing medical care while in the shelter system.

Presenters: Summer Bartholomew, MD, Family Team Medical Director, Boston Health Care for the Homeless Program, Boston, MA; Toni Williams, RN, Family Team RN, Boston Health Care for the Homeless Program, Boston, MA; Juanita Martinez, Consumer, Boston Health Care for the Homeless Program, Boston, MA