The Housing Health Outreach Team (HHOT) provides outreach to low-income permanent supportive housing sites to assess the needs of residents in collaboration with other team members, including housing staff and chemical dependency counselors. Services target housing sites that serve chronically homeless persons, chronically homeless veterans, and that have high proportions of residents with compromised health. The HHOT RN works in partnership and joint accountability with other team members to achieve Neighborcare Health’s Mission, Guiding Principles, and Goals.
Services include health care triage, assessment, patient advocacy, referral/linkage to primary care, support for medication adherence, health education, support for chronic health conditions, and self-management goal setting and support.
Assure continuity of care through linkage to primary care, specialty care, dental care, mental health services, team chemical dependency services, and other health care services.
Facilitate access to care such as arranging transportation with building staff.
Participate with housing staff, Chemical Dependency staff and other team members in a formal communication system, including regularly scheduled meetings, to ensure coordination of care.
Serve as consultants to housing/case management staff to increase understanding of residents’ health needs and to incorporate health needs into care plan.
Offers in-services and/or health fairs to housing staff or residents as needed, to promote education and outreach.
Provide individual and group health education on issues of concern such as self-management of chronic health conditions, tobacco cessation, nutrition, dental care access, and proper use of health services.
Ability to relate respectfully and effectively to people of diverse racial, educational and socio-economic background; and homeless populations.
Bachelor degree in Nursing required. Masters in Nursing desired. Washington State Registered Nurse license required. 1 year experience in a primary care, hospital or home care setting, or comparable social service setting.
Experience working with a low-income, multi-ethnic patient population, and demonstrate an ability to relate respectfully and effectively to people of diverse racial, educational and socio-economic background; and homeless populations a plus.
Understanding of mental health and chemical dependency issues.
Experience with diabetes education and self-management, or with patient education and self-management of a comparable disease