Adapted Clinical Guidelines

Adapting Your Practice: Treatment and Recommendations for Homeless Patients

Standard clinical practice guidelines often fail to address the special challenges faced by homeless patients that may limit their ability to adhere to a plan of care. To fill this gap, the HCH Clinicians’ Network developed a series of adapted clinical guidelines covering the following:

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

Abbreviated Recommendations

In the abstracts posted on the National Guideline Clearinghouse website, you can search for a specific guideline or for “homeless” to see abstracts of all adapted clinical guidelines developed by the HCH Clinicians’ Network. Abstracts were prepared by the Agency for Healthcare Research and Quality’s (AHRQ’s) National Guideline Clearinghouse (NGC) in collaboration with the Clinicians’ Network. The availability of downloadable guidelines for handheld computers is on the NGC Resources page.

The Clinical Tool Card outlines of the main points contained in the following recommended clinical practice adaptations are also available for download to handheld devices:

Clinical Practice Overview

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