2013 Conference Schedule and Workshop Descriptions

Plenary Sessions

Thursday, March 14, 2013

Introduction and Welcome

Presenter: John Lozier, MSSW; Executive Director, National Health Care for the Homeless Council

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. Susan was a social worker who founded Care for the Homeless in New York City and insisted that systems-level advocacy is an essential component of the HCH model of care.

Presenter: Bobby Watts, MPH, MS; President, National Health Care for the Homeless Council; Executive Director, Care for the Homeless

Ellen Dailey Award

Ellen Dailey was many things, including a person who experienced homelessness. Ellen used this experience to champion the unique voice of those experiencing homelessness and the right of all people to play a role in the decisions affecting their lives. The award bearing her name honors her memory and her efforts as an advocate for persons experiencing homelessness.

Ellen Dailey Award winners are people who have experienced homelessness and have found their own voice as advocates for others who experience homelessness. Award winners are driven by a passion for justice and a commitment to ending homelessness.

Presenters: Derek Winbush, Regional Representative; National Consumer Advisory Board, National Health Care for the Homeless Council

Recipient: Marianne Malott

Between the Feds, the States, and the Field: a Conversation on Medicaid Expansion

Conference attendees will hear from key stakeholders regarding the new rules, challenges, and opportunities that are transforming Medicaid programs across the country. While one aspect of the Affordable Care Act gives states the option to expand the program to most people earning at or below 133% federal poverty level, other parts of the law make mandatory improvements to the enrollment process for all states. As a result, state Medicaid programs are undergoing vast changes that will directly affect the health care for the homeless community. This plenary session features three perspectives that will highlight the major changes to come (beginning October 2013) and the role conference attendees play in effecting positive change.

Moderator: Barbara DiPietro, PhD; Policy Director, National Health Care for the Homeless Council

Panelists: Matt Salo, BA; Executive Director, National Association of Medicaid Directors; Jennifer Ryan; Acting Director for Policy of the Children and Adults Health Programs Group, Centers for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services; Greg Morris, PA-C; Program Director, Peak Vista Homeless Health Center, Colorado Springs, Colorado

Friday, March 15, 2013

Introduction and Welcome

Presenter: John Lozier, MSSW; Executive Director, National Health Care for the Homeless Council

A Whirlwind of Enrollment

Presentation Slides

Enroll America is dedicated to ensuring that all Americans are enrolled in and retain health coverage. Enroll America is a collaborative organization, working with partners that span the gamut of health coverage stakeholders—health insurers, hospitals, doctors, pharmaceutical companies, employers, consumer groups, faith-based organizations, civic organizations, and philanthropies—to engage many different voices in support of an easy, accessible, and widely available enrollment process. As Executive Director, Rachel Klein is focused on establishing a center of best practices related to enrollment, state-by-state resources, federal guidance, and other key information to maximize the collective work of a wide range of community partners, which includes the health care for the homeless community.

Presenter: Rachel Klein, MA; Executive Director, Enroll America

HCH Clinicians’ Network Outstanding Service Award

The Award for Outstanding Service honors a clinician working in health care for the homeless who has made a significant contribution to improving the health and quality of life of people experiencing homelessness. Recipients are hands-on caregivers who demonstrate vision and creativity in advancing the goals of ending and preventing homelessness.

Presenter: Mollie Bresnahan, MEd, LMHC; Health Care for the Homeless, Mercy Medical Center

Recipient: Rebecca Labovick, RN, BC; Director of Therapeutic Services, Community Health Services Corporation

Respite Care Providers’ Network Medical Respite Award for Excellence

The Medical Respite Award for Excellence is a new award that recognizes outstanding contribution to the field of medical respite care. Award recipients are individuals, teams, or agencies that promote access to medical respite care and quality services through innovative care, advocacy, collaboration building, and research, among other activities.

Presenter: Paul Gregerson, MD, MBA; Chief Medical Officer, John Wesley Community Health Institute, Inc.

Recipient: Center for Respite Care of Cincinnati, accepted on behalf of the agency by Mary Beth Meyer and Mildred Williams

A Changing Federal and Local Landscape

Nearly three years into Opening Doors, the federal strategic plan to prevent and end homelessness, progress is being made to change the federal paradigm on homelessness. New and stronger strategies to end homelessness among veterans and families have joined the ongoing challenge to end longer-term homelessness among those with serious health needs. A growing body of research documenting the impact of housing on health care, the changes brought by the Affordable Care Act, and new priorities for local continuums of care are galvanizing needed change at the federal, state, and local level. This plenary session will illustrate how the landscape is changing and how you can maximize change in your community.

Presenter: Jennifer Ho, Senior Advisor on Housing and Services; Office of the Secretary, Department of Housing and Urban Development

Announcement of Poster Contest Winner

Presenter: John Lozier, Executive Director, National Health Care for the Homeless Council

Pre-Conference Institutes

Behavioral Health Integration: Best Practices and Challenges from Theory to Practice

Presentation Slides Wismer     Presentation Slides Bascelli Colangelo     Presentation Slides Weinreb Centrone

Drawing on the experiences of health care for the homeless administrators and clinicians who have implemented or are in the process of integrating behavioral health care into their menu of services, this pre-conference institute aims to advance the goals of behavioral health integration for intermediate and advanced level administrators and clinicians across the country. Presenters will cover the latest theory about mental health services, the intersections of substance abuse and mental illness, and chronic pain management. This full-day program is intended to highlight emerging theories surrounding behavioral health integration but will largely deliver information about the most promising practices from the experiences of those who have or are currently in the process of integrating.

Presenters: Louis Cuoco, DSW, LCSW-R, ACSW; Director, Office of Managed Addiction Treatment Services, New York City Department of Health & Mental Hygiene; John McAteer, LCSW-R; Health Care Systems Coordinator, New York City Department of Health and Mental Hygiene; Brian Colangelo, LCSW; Clinical Social Worker, Project HOPE, Inc.; Linda Weinreb, MD; Professor, University of Massachusetts Medical School; Debbian Fletcher-Blake, APRN, FNP; Assistant Executive Director, Clinic Administrator, Care for the Homeless; Barry Zevin, MD; Physician Specialist, Tom Waddell Health Center; Wayne Centrone, NMD, MPH; Vice President, Design Lab, Center for Social Innovation

Room: Congressional A

Building a Comprehensive Care Model for Serving LGBTQ Populations in Homeless Health Centers

Presentation Slides Makadon Part One     Presentation Slides Makadon Part Two

This full-day pre-conference institute (PCI) will provide integrated discussions about how programs can meet the needs of LGBTQ young adults and youth experiencing homelessness. The PCI will provide an over-view of sexual and gender minority health needs, review the epidemiology, risk factors and care concerns for serving the target population and discuss ways that HCH programs can better integrate cultural and linguistic competency into their service delivery models. The PCI will focus on the incorporation of “best practices” into HCH services delivery. Through PowerPoint presentations, case based discussions and breakout “tracks” – the PCI will help HCH programs to better deliver culturally competent care as mandated by the ACA and meet the need for service integration. The PCI will help HCH programs operationalizing agency wide strategies around service the complex and diverse needs of LGBT youth and young adults experiencing homelessness.

Presenters: Harvey Makadon, MD; Director, National LGBT Health Education Center, The Fenway Institute; Wayne Centrone, NMD, MPH; Vice President, Design Lab, Center for Social Innovation; Rachael Kenney, MA; Associate, Center for Social Innovation; Tom Bardwell, MAEd; Senior Analyst, Center for Social Innovation; Commissioner, Massachusetts Commission on Gay, Lesbian, Bisexual, and Transgender Youth

Room: Congressional CD

Leadership for Changing Times: Beyond Health Care Reform

Presentation Slides Bennett     Presentation Slides Fadus     Presentation Slides Leon     Presentation Slides DiPietro

“Change is inevitable. Growth is optional.” – John Maxwell

As the world changes around us, our patients, staff, and communities need strong, visionary leaders to make sense of the environment and lead us into a better future. A day designed around research-based approaches and real-world best practices, this pre-conference institute will provide leaders with the tools and direction they need to thrive in a complex and dynamic health care environment. Through the pre-conference institute, presenters hope to provide the knowledge and momentum for attendees to implement and improve organizational, staff, and patient outcomes.

Chair of the Planning CommitteeHeidi Nelson, MHSA; CEO, Duffy Health Center

Key presenter and facilitator: Matt Bennett, MBA, MA; Diverse Management Solutions

Presenters: Barbara DiPietro, PhD; Director of Policy, National Health Care for the Homeless Council; Paul Leon, RN, PHN; President and CEO, Illumination Foundation; Doreen Fadus, MEd; Executive Director, Health Care for the Homeless, Mercy Medical Center; Bobby Watts, MPH, MS, CPH; Executive Director, Care for the Homeless; Parminder Bajwa, MD, MBA, DBA; Director of Medical Services, Columbus Neighborhood Health Center; Karen Batia, PhD; Executive Director, Heartland Health Outreach; Vice President, Heartland Alliance; Kevin Lindamood, MSW; President and CEO, Health Care for the Homeless of Maryland

Room: Congressional B

Opportunity Knocks: Opening Doorways to Medical Respite Care

Presentation Slides, Part One   Presentation Slides, Part Two   Presentation Slides, Part Three

Medical respite programs are frequently faced with complex dilemmas presented by patients, staff, hospitals, collaborators, funders, and the political system. The 2013 Medical Respite Pre-Conference Institute will use real case scenarios as a foundation to help participants think strategically and critically about how complex issues can be addressed from multiple perspectives (administrative, clinical, social service, policy, and advocacy). Along with in-depth discussions and activities around complex case scenarios, this year’s pre-conference institute will include a health reform update with a discussion of opportunities for medical respite programs to be engaged in local and state initiatives and planning conversations. This pre-conference institute will be of interest to administrators, clinicians, consumers, and advocates at every learning level. Those new to medical respite care will learn about real issues that are likely to arise in the medical respite setting and how these are addressed from various perspectives. More advanced learners will have an opportunity to discuss solution-based strategies to complex issues and how policy and advocacy can be integrated into everyday service.

Presenters: Barbara DiPietro, PhD; Director of Policy, National Health Care for the Homeless Council; Adele O’Sullivan, MD; Medical Director, Circle the City; Jessie Gaeta, MD; Medical Director, Boston Health Care for the Homeless Program; Sarah CiambroneMS; Director, Barbara McInnis House; Michele Schneidermann, MD; Medical Director, San Francisco Medical Respite and Sobering Center; Karl Stokes; Medical Respite Alumnus, Baltimore HCH Convalescent Care Program

Room: Thornton

Workshops

Thursday, March 14, 2013

10 – 11:30 a.m.

Bridging the Gap: Care Transitions for Homeless Persons Leaving the Acute Care Hospitals

Presentation Slides     Presentation Handout One     Presentation Handout Two     Presentation Handout Three

This panel and facilitated discussion will address the timely issues of post-acute care for homeless patients. Homeless patients often have multiple psychological and social issues as well as chronic health conditions that make them a vulnerable population at risk of frequent readmissions. Coordinated care can be provided in the community with the help of all stakeholders, including homeless health care clinics, social services agencies, medical respite providers, and others. This presentation will demonstrate an innovative and successful collaboration in Santa Clara County, California, which focuses on the patient’s needs and meeting those needs effectively in the community with the support of both patients and hospitals. 

Presenters: Sherry Holm, LCSW; Director of Hospital Services, New Directions and Hospital Council; Charles Preston, PhD; Director of Psychological Services, Valley Homeless Healthcare Program; Malinda Mitchell, RN; Former CEO, Stanford Hospital

Room: Lexington

Clinical Challenges in Street Medicine: Five Case Studies in Context-Specific Care

Presentation Slides

This presentation will explore the emerging concepts of context-specific care and reality-based medicine as they relate to the care of persons experiencing chronic unsheltered homelessness. Disproportionate degrees of morbidity, mortality, and health care mis-utilization in this population present a variety of complex clinical and care delivery challenges for street medicine clinicians and other caregivers. Effective care in this resource-poor setting often requires creative, flexible, patient-centered approaches that respect and adapt to each individual’s unique circumstances, preferences, assets, and limitations. The presenters will discuss a series of clinical cases illustrating a variety of challenging scenarios commonly encountered by street medicine practitioners that highlight these concepts. The presentation format will be a guided, interactive clinical discussion with participants encouraged to share ideas and learn from one another as they work through the cases together.

Presenters: Patrick Perri, MD; Medical Director, Founder, Program for Homeless and Urban Poverty, Allegheny General Hospital; James Withers, MD; Medical Director and Founder, Operation Safety Net, Pittsburgh Mercy Health System

Room: Capitol A

Closing the Gaps and Strengthening Your Assets: Needs Assessment Models Worth Implementing

Presentation Slides

It is becoming widely recognized that the outputs of an organization are enhanced by assessing needs before planning, implementation, or quality improvement. When these needs are identified from the start in an inclusive and systematic manner, organizations are better positioned for sustainable, positive gains that target a community’s unique characteristics. To assist HCH grantees with making their needs assessments more effective, this workshop describes three different needs assessment models, the steps for conducting them, and common methods for data collection. This workshop also provides a resource guide on available data sources and tools, including a demonstration on Geographic Information Systems (GIS) mapping with UDS data. The content will provide attendees with the knowledge and skills necessary to identify and collect data using varied sources and conduct a needs assessment on the organizational and/or community level based on the specified mission of the organization.

Presenters: Patrina Twilley, MSW, Research Assistant; Sarah Knopf-Amelung, MA-R, Research Assistant; National Health Care for the Homeless Council

Room: Concord

Connecting Homeless Individuals to Medicaid and Health Care Services: Key Lessons from Administrators and Frontline Workers

Presentation Slides

A key goal of the Affordable Care Act is to reduce the number of uninsured through new coverage options for individuals and families. Beginning in 2014, states have the option to expand Medicaid to nearly all individuals with incomes up to 138% of the federal poverty level, which will greatly increase health care access to millions of low-income Americans. Given their high uninsured rate and limited access to care, individuals who are homeless are in a group that could significantly benefit from this expansion. This workshop features participants from a recent project between the National HCH Council and the Kaiser Commission on Medicaid and the Uninsured to highlight the experience of administrators and frontline workers serving those who are homeless. A panel discussion will identify key Medicaid enrollment and access barriers, successful strategies to overcome these barriers, and future considerations for implementing the Medicaid expansion under health reform. Time will be dedicated for questions and answers.

Presenters: Samantha Artiga, MHSA; Associate Director, Kaiser Commission on Medicaid and the Uninsured; Frances Isbell, MA; Director, Health Care for the Homeless Houston; Karen Batia, PhD; Executive Director, Heartland Health Outreach; Vice President, Heartland Alliance; Katie League, MSW, LCSW-C; Outreach Disability Specialist, Health Care for the Homeless of Maryland; Barbara DiPietro, PhD; Director of Policy, National Health Care for the Homeless Council

Room: Columbia C

Housing Is Not Enough: Social Inclusion as a Strategy to End Homelessness for Good

Housing is essential to end homelessness, but it is not enough. Likewise, health and social services are critical but cannot alone solve homelessness. Homelessness is about more than housing and complex clinical needs; it is also about a profound disconnection from family, friends, work, and community. Therefore, solutions to homelessness must focus on housing, services, and social connectedness. While many industrialized nations have developed sophisticated national strategies to promote social inclusion, the U.S. lags behind. This workshop will explore the differences among social connectedness, social capital, and social inclusion. It will highlight effective programs in the U.S. and internationally that promote social connectedness. Participants will explore strategies for increasing their agency and community focus on social inclusion strategies as a key element of their efforts to prevent and end homelessness.

Presenters: Jeffrey Olivet, MA, President and CEO; Livia Davis, MSW, Vice President, Organizational Culture and Development; Center for Social Innovation

Room: Bunker Hill

It Begins with a Connection: Communication with Patients Who Are Homeless with Community Voice Mail

Presentation Slides   Presentation Handout One   Presentation Handout Two

In 2012, Springwire and the National HCH Council collaborated on a national project aimed at improving the health of people with chronic health conditions who are homeless. Working with six HCH clinics, Springwire integrated its Community Voice Mail and Resource Broadcast programs into the way these clinics serve their hard-to-reach patients. Patients were given a reliable way to be contacted about individualized care and treatment regimens along with well-designed public health and social service information through voice mail broadcasts. This session will show how these two programs are beneficial to HCH clinic providers, staff, and patients and how they can help with PCMH and meaningful use standards by providing (1) a reliable way to reach patients for reminders about appointments and medication adherence related to their chronic condition; (2) greater continuity of care through consistent communication; and (3) an efficient way to broadcast information and resources that directly support improved health (i.e., employment, housing, immunizations, etc.). Staff from Springwire and partner clinics will demonstrate how these programs were implemented and share both successes and challenges learned. This is a one-hour session.

Presenter: Anna Landa, MPA; Program Director, Springwire; Tom Stubberud, MPH; Homeless and Mobile Medical Centers Manager, Family Health Centers of San Diego

Room: Thornton

National Health Service Corps: Supporting Recruitment and Retention of Primary Care Providers in Underserved Communities

Presentation Slides

The National Health Service Corps (NHSC) helps health care delivery sites recruit and retain qualified providers who care about patients living in communities with limited access to care and choose to work where they are needed most. Sites in communities designated as Health Professional Shortage Areas (HPSAs) may apply to be NHSC-approved and, upon approval, may offer eligible medical, dental, and mental health providers the opportunity to receive loan repayment of up to $60,000. The Corps is also dedicated to retaining NHSC members at their sites, providing educational and training resources to all NHSC members (clinicians and sites). This facilitated discussion session will include an overview of the National Health Service Corps; how the NHSC supports recruitment and retention of primary care providers dedicated to working with vulnerable populations; how to become an NHSC-approved site; and the educational loan repayment and scholarship programs available to health professionals.

Presenter: Kimberly Kleine, BA; Deputy Associate Administrator, Bureau of Clinician Recruitment and Service, HRSA

Room: Columbia A

The Neurobiology of Pain and the Homeless Patient

Presentation Slides

Recent research has discovered many interesting and surprising facts about the biological and neurological processes of chronic pain. This workshop will present an understandable review of these findings and then engage the group in a discussion of implications for practical bio-psycho-social-spiritual approaches to homeless individuals with multiple problems and chronic pain. Topics of discussion will include the common neurobiological pathways for pain and pleasure; chronic pain and substance dependence; lessons for rational prescribing; the neurobiological effects of successful psycho-social interventions; and spirituality and the brain. The presenters will facilitate a discussion of how this information can help us improve outcomes with our patients. The participant will be able to take home at least one idea for improving care in their community. Teaching techniques in this session will include lecture with visual aids and discussion-based learning.

Presenters: Barry Zevin, MD, Physician Specialist; Barbara Wismer, MD, Physician; Tom Waddell Health Center

Room: Columbia B

The Nuka Model at the Southcentral Foundation in Anchorage, Alaska

Presentation Slides

This workshop will examine five key content topics: (1) relationship as the key foundational element in all health care; (2) the relationship barriers resulting from trauma and loss; (3) the relationship barriers inherent in professional health care roles and health care environments; (4) the approach taken by the Southcentral Foundation (SCF) to address the above barriers and to become trauma informed systemwide; and (5) the approach taken by SCF to more effectively support the specific treatment and resolution of trauma and loss through FEEW and training and skill building in the positive utilization of the phenomenon of transference and counter-transference inherent in health care relationships, especially related to health care delivery to populations highly affected by trauma and loss, e.g. Alaska Native and homeless populations.

Presenters: KJ Worbey, MS, LPA, Clinical Director for Quality Assurance; Robert Heffle, Employee and Community Assistance Specialist; Southcentral Foundation

Room: Congressional A

Strategic Thinking and Successful Collaborations: Developing Your Federally Qualified Health Center

Collaborations between health centers and other area safety net and social service providers in the provision of services are an essential component of your health center. Fully understanding this health center requirement, especially while in the process of health center development, will increase the success of your health center. This session will discuss how to apply strategic thinking when developing successful collaborative relationships with other providers in the community. This session is designed for organizations developing health center initiatives, New Start projects, staff new to the health center program, and as a refresher for existing staff.

Presenter: Pamela Byrnes, PhD; Senior Consultant, John Snow, Inc.

Room: Congressional CD

Through the Lens: Using Photovoice as a Vehicle for Change Presentation Slides Part 1     Presentation Slides Part 2     Presentation Slides Part 3     Presentation Slides Part 4

This workshop will focus on how consumers and others can be actively involved in advocacy and policy change by using Photovoice, which is often described as “lending voice to power”. The presenters will facilitate an interactive discussion on how this methodology can be used by organizational staff and consumers to plan and evaluate programs at their local agencies. The presenters will also share the Visions of Voices project to demonstrate how the methodology has been successfully used at an HCH site to expand HIV programs and services. Guidance will be given to attendees on how to identify an issue of interest and develop a plan of action to use Photovoice at their respective organizations or in their communities to advocate for change.

Presenter: Darlene Jenkins, DrPH, MPH, CHES; Director of Research and Evaluation, National Health Care for the Homeless Council; Sabine Eustache, DrPH, MBA, MPH; Assistant Professor, Nova Southeastern University College of Osteopathic Medicine; Andrea J. Brooks; Performance Improvement Manager, Broward Community and Family Health Center, Inc.

Room: Yellowstone/Everglades

Trauma-Informed Care for Women Veterans Experiencing Homelessness

This session will highlight the prevalence and impact of trauma in the lives of women veterans experiencing homelessness and offer participants concrete tools and strategies for adopting a trauma-informed approach to working with this population. This workshop will include information about rates of traumatic stress among women veterans, the impact of trauma, and what it means to provide “trauma-informed” care. The session will introduce participants to a “trauma guide” that includes concrete, trauma-informed strategies that can be adopted within community-based organizations serving women veterans. Workshop will include lecture and facilitated discussion with participants.

Presenters: Kathleen Guarino, LMHC; Director of Training, National Center on Family Homelessness; Tarsha Cavanaugh, PhD, MSW, LGSW; Senior Public Health Analyst, HRSA Office of Women’s Health

Room: Congressional B

An Update from the Centers for Medicare & Medicaid Services

Presentation Slides

The Centers for Medicare & Medicaid Services provides health coverage for 100 million Americans. Come hear from the Director of the CMS Centers for Medicaid and CHIP Services about upcoming changes and initiatives. This is a 45-minute presentation.

Presenter: Cindy Mann, JD; Director of the CMS Centers for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services

Room: Capitol B

12 a.m. – 1 p.m.

Council Presidents’ Luncheon: Succession Planning for Your Organization and Your Future

Three experienced senior HCH program directors, current and former Presidents of the Board of the National Health Care for the Homeless Council, will share their journey in considering long-term planning for their personal lives and for future leadership of their respective organizations. The portion of the presentation on retirement will include suggestions for how to determine when the time is right to begin life’s next chapter and how to anticipate the financial, interpersonal, and mental health impacts of this decision. The discussion of succession planning will include suggestions for how and when to being to plan for succession (TODAY!) and the value to the organization of a seamless and well-executed transition. There is no “right way” to approach these topics, and the panelists will be candid in sharing their lessons learned. The discussion will be in a facilitated panel format with opportunities for participant questions and comments.

Facilitator: Jean Hochron, MPH; Senior Administrator, Montgomery County, Maryland DHHS

Panelists: Bobby Watts, MPH, MS; Executive Director, Care for the Homeless, New York; Bob Donovan, MD; Physician, Cincinnati Health Network, Inc.; Bob Taube, PhD, MPH; Executive Director, Boston Health Care for the Homeless Program

Room: Thornton

1 – 2:30 p.m.

Adverse Child Experiences and Provider Trust: Research Supporting the Need for Trauma Informed Primary Care

Presentation Slides

This workshop will focus on community engaged action research to develop a trauma informed primary care model for people experiencing homelessness. A multidisciplinary team of medicine, social work, and pharmacy will didactically present data captured through a partnership with an outreach agency to sample homeless youths using the Adverse Childhood Experiences (ACE) Scale, the Adult Attachment (AA) Scale, and the Physicians Trust (PT) Scale. Results show high ACE scores among homeless youth and a negative correlation between ACE scores and the PT Scale, with lower levels of physician trust also correlated with insecure attachment scores on the AA scale. Presenters will discuss how the data supports the need for trauma informed primary care models for the homeless. The workshop will conclude with a World Café, a discussion method that includes appreciative inquiry to assist participants in developing trauma informed primary care models for their unique communities for use in an era of health care reform.

Presenters: Mark Fox, PhD, MD, MPH; Associate Dean for Community Health and Research Development, University of Oklahoma School of Community Medicine; Ricky Munoz, JD, MSW; Assistant Clinical Professor of Social Work, University of Oklahoma School of Medicine; Nancy Brahm, PharmD, MS, BCPP, CGP; Clinical Professor, University of Oklahoma College of Pharmacy

Room: Columbia A

Applying the Health Home Model to Homeless High Users of Emergency Services

Presentation Slides

Project 25 is a collaboration, lead by St. Vincent de Paul Village, serving homeless high users of emergency services. It uses a housing first model, a medical home with psychiatric care, and case management. The goals are to reduce costs to the community, reduce homelessness, and improve quality of life. Participants were identified using data from 9-1-1, hospitals, jails, and the county. Thirty-five people have been enrolled to date; all are housed. Demographic and clinical data will be presented as will data on baseline utilization of health care, jails, and shelters. This data will also be presented for the first 12 months of enrollment. Challenges include developing the initial list of participants, getting data from hospitals, ongoing substance use in participants, and maintaining housing. In conclusion, Project 25 is showing promising results in its first 18 months and offers the possibility of helping the most hard to treat chronically homeless people while also reducing costs.

Presenters: David Folsom, MD, MPH, Medical Director; Marc Stevenson, MSW, Director, Project 25; Kris Kuntz, MA, Data Analyst, Project 25; St. Vincent de Paul

Room: Bunker Hill

At Home: A Randomized, Controlled Trial of Housing First for Homeless People with Mental Illness

The At Home study is a randomized controlled trial of Housing First for people who are homeless and living with mental illness. The study has 2,210 participants in five Canadian cities (1,240 participants receiving Housing First with Assertive Community Treatment or Intensive Case Management, and 970 participants receiving usual care). Primary outcomes are housing stability, social functioning, quality of life, health care utilization, and justice system involvement. Through short interactive presentations and facilitated discussions, the presenters will discuss program adaptations of Housing First in Toronto, describe 12-month outcomes and preliminary cost analyses, and review policy implications for ending chronic homelessness. This workshop will appeal to researchers, policy makers, and service providers who are interested in clinical innovation, informing policy through research, and identifying policies and programs to better serve homeless people with mental illness.

Presenters: Stephen Hwang, MD, MPH; Research Scientist, Centre for Research on Inner City Health; Staff Physician, St. Michael’s Hospital; Vicky Stergiopoulos, MD, MHSc; Research Scientist, Centre for Research on Inner City Health; Psychiatrist-in-Chief, St. Michael’s Hospital

Room: Congressional B

Care Transitions: Don’t Lose Your Patients

Presentation Slides     Handout One     Handout Two

The Affordable Care Act emphasizes the importance of effective care transitions in initiatives such as health homes, the Medicare Share Savings Program, and quality and performance reporting. Effective care transitions reduce hospital readmissions by ensuring patients’ primary care providers are aware of acute care hospital visits, their medications are reconciled, and patients are able to follow through with discharge instructions. Care transition models offer simple protocols that can be adopted at each setting as well as standards for accountability and templates for information exchange. Attendees of this workshop will learn about care transition models and discuss promising practices for addressing barriers in transitional care for people experiencing homelessness. Discussion will also address the role of medical respite programs in transitional care.

Presenters: Sabrina Edgington, MSSW; Program and Policy Specialist, National Health Care for the Homeless Council; Michelle Schneidermann, MD; Medical Director, San Francisco Medical Respite and Sobering Center; Rebecca Doughty, MN, RN; Washington State University College of Nursing

Room: Lexington

The Clinical Benefits of Advocacy: Beyond Just Social Change

Presentation Slides

Advocacy and social action are effective not only for promoting positive systems change but also for providing clinical benefits to those who advocate. Drawing on individual strengths, advocacy and social action can provide meaning and purpose, build support systems and positive social connections, and enhance communication and interpersonal skills. This panel presentation will describe the basic elements of advocacy and social action, will use real-life examples of ongoing initiatives, and will highlight the positive clinical benefits using the results of a recent research study at an HCH project. Members of the panel will include a member of the study’s research team, an HCH consumer board member, and two HCH staff members who support the policy and advocacy agenda. Presenters will facilitate open discussion with attendees to brainstorm possible ways to replicate such initiatives in their communities, and additional resources for further learning will be provided.

Presenters: Adam Schneider, MSW, Community Relations Coordinator; Elizabeth Coleclough, MPH, Johns Hopkins University; Mark Schumann, HCH Board Member; Vanessa Borotz, HCH Volunteer

Room: Capitol A

Health and Homelessness among Veterans: A Needs Assessment of HCH Grantees

Presentation Slides   Presentation Handout

This presentation will present the findings of a mixed-methods study on unstably housed veterans who received services from HCH grantees in 2012. This topic lacks prior research, as most literature  has focused on care in the VA setting. In 2010, however, 23,119 veterans used HCH services, demonstrating the significance and need to further explore this population so that grantees can provide appropriate care (Uniform Data System, 2010). The presentation will present the key findings from expert interviews, focus groups, and a needs assessment. Topics will include (a) the demographics, health statuses, service utilization, and unmet health needs of unstably housed veterans who received care from HCH grantees; (b) how HCH grantees identified and provided services to veterans; (c) how HCH grantees collaborated with local VA Medical Centers; and (d) the training needs that were identified.

Presenter: Sarah Knopf-Amelung, MA-R; Research Assistant, National Health Care for the Homeless Council

Room: Concord

Integrating HIV Prevention and Care into Primary Care in Community Health Centers

Presentation Slides Makadon

Like many aspects of health care, the provision of HIV/AIDS prevention and care has often been fragmented among multiple organizations. Many have seen this as critical in limiting the over-medicalization of an illness that was poorly understood. Health care reform is pushing the pieces together, raising concerns that established patterns of care will be disrupted. While integration of HIV care with primary care will lead to change for many, some practices have already spent years forging innovative systems that integrate HIV prevention within care settings. Case studies from three such organizations—Boston Health Care for the Homeless, Fenway Health, and Beth Israel Deaconess Medical Center—will focus on challenges and opportunities. As the U.S. looks into the eyes of health care reform, a key question will be how this experience has led to a greater understanding of how to accommodate the needs of populations in settings that look remarkably like patient-centered medical homes.

Presenters: James O’Connell, MD; President, Boston Health Care for the Homeless Program; Carole Hohl, MHS, PA-C; Director of HIV Services, Boston Health Care for the Homeless Program; Harvey Makadon, MD; Director, National LGBT Education Center, The Fenway Institute

Room: Capitol B

Preparing for Health Reform: Educate, Engage, and Excel

Presentation Slides

The Affordable Care Act is prompting numerous changes in the way health care is financed, organized, and delivered. Many of these changes will increase access to health insurance and health care services but also pose new opportunities to meet and challenges to overcome. Barbara DiPietro will detail the priority areas of the ACA that affect the HCH community, the related decisions to be made at the state level that require active engagement, and the successful strategies for ensuring the needs of homeless populations will be included in decision making. Kevin Lindamood will outline the role of HCH leadership both internally to prepare an organization for the changes to come and externally in state-level advocacy and education to ensure broader system changes reflect the needs of safety net providers and their most vulnerable clients.

Presenters: Barbara DiPietro, PhD; Director of Policy, National Health Care for the Homeless Council and Health Care for the Homeless of Maryland; Kevin Lindamood, MSW; President and CEO, Health Care for the Homeless of Maryland

Room: Thornton

Preventing and Responding to Workplace Violence in an HCH Setting

Presentation Slides

Workplace violence is part of working with traumatized populations. This workshop presents a trauma-informed approach to understanding, preventing, and working with escalating clients and patients. Participants will learn strategies for each phase in escalation with a goal to help prevent and minimize situations from becoming dangerous. This presentation will include strategies to de-escalate clients and patients who have become dangerous and keep everyone involved as safe as possible. Finally, this workshop will examine approaches to reconnect with clients after violence has occurred and find opportunities to reestablish trust and safety.

Presenter: Matt Bennett, MBA; Diverse Management Solutions

Room: Columbia B

Serving Mental Health Clients in Respite Care: Challenges in Demonstrating Cost-Effectiveness

Presentation Slides

A common question respite programs face from hospitals is “Will this save us money?” While there are many non-financial reasons to participate in respite programs, a financial incentive can ensure hospitals’ long-term participation. Respite programs have developed several formulas for calculating the cost-savings of participating hospitals. One relies on calculating avoided bed days as a result of referral to respite. Another focuses on the average reduction in hospital or emergency room usage among respite patients. While both are generally effective in demonstrating cost savings, they are less useful when mental health patients are included. The issue presented by a mental health patient is that psychiatric diagnoses do not reliably predict the patient’s length of care, so it is impossible to define the baseline cost of hospital care to compare the cost of respite stays. Using the Contra Costa County Respite Center as an example, this workshop will discuss how to address and overcome such challenges.

Presenters: Jay Lee, JD; Staff Attorney, HomeBase; Amanda Stempson, JD; Staff Lawyer, HomeBase; Nishant Shah, MD, MPH; Medical Director, Contra Costa County Health Care for the Homeless Project

Room: Congressional A

What Does ALGEE Have to Do with Mental Health? An Introduction to Mental Health First Aid

Most people know how to do the Heimlich maneuver and CPR but never put these skills to use. Most people encounter individuals who are experiencing mental health problems every day, especially when working with individuals who are experiencing homelessness, but may not have training in how to help. The National Council for Community Behavioral Healthcare developed Mental Health First Aid to provide these skills. MHFA is based on the premise that it is possible to provide first aid for someone who is developing a mental health problem or in a mental health crisis. The National Council for Community Behavioral Healthcare trains and certifies trainers around the country, who then train all kinds of people, from cab drivers to human service professionals to police officers. This session will introduce the concept of Mental Health First Aid, discuss the Mental Health First Aid Action Plan, and explore ways that service providers can train the community.

Presenters: Rachael Kenney, MA, Associate, Center for Social Innovation; Pat Mosby, The Institute for Innovation and Implementation University of Maryland, Baltimore School of Social Work

Room: Congressional CD

3 – 4:30 p.m.

Clinical Review of Contraceptive Methods

The prevalence of unintended pregnancy among homeless women is twice or more than that of housed women and their pregnancy outcomes are worse, with homeless women experiencing over twice the national rate of having a low-birth weight infant. In 2008, the National HCH Council’s Practice-Based Research Network conducted a survey of HCH providers on contraceptive services for homeless women. The study found a major barrier to be lack of provider training, particularly in providing implants and IUDs, the two most effective long-term, reversible methods. This intensive training will cover a range of contraceptive methods, their associated risks and benefits, and how to comfortably discuss birth control options with clients. The session will examine common myths and attitudes about contraceptives, unplanned pregnancies and options, permanent methods, and emergency birth control. Presenters will employ case-based studies and facilitated group discussions along with lecture and hands-on demonstrations.

Presenters: Marji Gold, MD; Professor of Family and Social Medicine, Einstein College of Medicine; Andrea Littleton, MD; Assistant Professor of Family Medicine, Einstein College of Medicine; Clinician, Care for the Homeless; Medical Director, BronxWorks

Room: Columbia A

Cultivating Peer Health Partners

The most powerful voices changing health-related behavior are not content experts. Individuals who are similar to current patients and who are managing chronic illness well are the most effective motivators. Peer health partners (PHP) demonstrate that it is possible to make changes in diet, exercise, and medication adherence even within the instability of their lives.

This workshop will identify the qualities of PHP, the key elements of training for PHP, defining what resources are needed to create and measure the value of a successful peer health educators program. Representatives from the Peer Health Partners program at N Street Village will be present, and evidence from research on peer health promotion efforts elsewhere will be presented as well.

Presenters: Janaina Stanley, BA; Manager Education and Employment Center; Sharon Watkins MA, BSN, RN; Manager Wellness Services; N Street Village

Room: Columbia C

Emerging Challenges in Defining Homelessness in Health Care

Presentation Slides

In 2010, Nova Southeastern University’s College of Osteopathic Medicine received a Pre-doctoral Primary Care Training grant from HRSA. This initiative was created due to a lack of formal curricula and training for medical students relevant to the needs of those experiencing homelessness. As the project is underway, two new challenges and needs have been recognized: (1) there are insufficient HCH sites with capacity to supervise medical students and (2) as instability in housing is increasingly common secondary to the economic downturn, it is increasingly essential to assess the housing status of individuals across medical service points. The lack of information concerning housing status among patients is problematic as one’s housing status is irrefutably linked to health status and can complicate a provider’s ability to address core medical issues. A lecture and discussion of the changing portrait of homelessness and its implications in health and social service delivery will be addressed.

Presenters: Elliot Sklar, PhD, MS; Project Director, Project HOPE; Assistant Professor, Nova Southeastern University College of Osteopathic Medicine; Kristi Messer, MPH, MSW; Executive Director, Project HOPE; Assistant Professor, Nova Southeastern University College of Osteopathic Medicine

Room: Lexington

Going beyond Income: Case Studies Demonstrating the Importance of Disability Benefits

Presentation Slides

This workshop will identify the common barriers individuals experience in accessing income and how these create unnecessary, expensive, and painful consequences on a variety of levels. Once the barriers have been identified, some key tools to overcome those barriers will be examined. Then, the presentation will focus on the positive, qualitative aspects of benefits acquisition. Testimonials of clients who have been assisted through this process will be provided and insights into the multiple successes that can stem from accessing income will be discussed. From this, participants will receive the qualitative perspective of accessing disability benefits and the connection to other treatment sources and services.

Presenters: Margaret Flanagan, LGSW; Disability Assistance Project Manager, Health Care for the Homeless Maryland; Caroline Bolas, MSW; SOAR Data Consultant, Level Headed, Inc.

Room: Congressional CD

Housing Choice: One Size Does Not Fit All

Presentation Slides

This workshop will use a combination of lecture and facilitated discussion to review the latest knowledge about the importance of housing choice in fully ending homelessness for diverse subpopulations including those with serious mental health conditions, primary addiction disorders, or multiple morbidities, and those who are youths, victims of domestic violence, or exiting incarceration. Housing First’s permanent supportive housing model is currently held as a national standard for ending homelessness, influencing federal policy and local efforts, while alternatives are often viewed as inferior. Learn how communities are using both permanent supportive housing and transitional supportive housing to assist in stabilization and placement into permanent unsubsidized housing while reducing costs to emergency service and corrections systems and reserving permanent supported housing stock, subsidy, and services for those with permanent disabling conditions. Programmatic outcomes related to housing tenure, lasting recovery, health, and employment will be reviewed.

Presenters: James Ginsburg, MNM, CAC III; Director of Housing First, Colorado Coalition for the Homeless; Ed Blackburn, MA; Executive Director, Central City Concern; Rachel Post, MSSW, LCSW; Public Policy Analyst, Central City Concern

Room: Concord

Risk, Reward, and Reinvention: A Candid Conversation about the Successes and Failures of Homeless Health Services in the District

Partnership, coordinated care, and outreach strategies are needed to provide quality services to homeless people in concurrent periods of health systems transformation and economic turbulence. This workshop will include a lecture and panel on the successes and failures of homeless health care in the District of Columbia. The workshop will offer a candid glimpse into the issues that plagued the District in the past, the challenges that still remain today, and the current initiatives that show the greatest promise to affect the future. Specifically, the workshop will address four key areas:

  • PAST: A brief history of homeless services in the District
  • PRESENT: Without Walls: Grassroots partnerships to touch hard to reach residents
  • PRESENT: Positive Pathways to reach people living with HIV with Community Health Workers
  • FUTURE: ER Diversion: How collaboration between a funder, Medicaid MCO, and a homeless health provider may pave the way to reduced unnecessary ER utilization

Presenters: Vincent Keane, MDiv, President and CEO; Catherine Crosland, MD, Medical Director, Homeless Outreach Services; Sharon Winget, LICSW, Director of Social Services; Unity Health Care

Room: Capitol B

So You Want to Start a Medical Respite Program? Here’s How!

This workshop will present a compact review of the evolution and history of medical respite care, models of care, funding challenges, scope of practice, and the significance of medical respite care to accountable care organizations and hospitals. Then the workshop will divide participants into small groups, each focused on defining a task essential to the development of a model, e.g. (a) selecting and rationalizing a model for a small city where the HCH has a relationship with a teaching hospital; (b) defining scope of care and developing admission criteria for a shelter based model; and (c) developing a staffing model for a 20-bed stand alone respite program or a shelter-based 15-bed model.

In addition, each participant will ask one question related to developing a model, and over the course of the workshop, all questions will be answered and illustrated by experience or case studies.

Presenters: Sarah Ciambrone, MS; Director, Barbara McInnis House; Leslie Enzian, MD; Medical Director, Harborview Medical Center

Room: Thornton

Spare Some Social Change? Integrating Service and Advocacy

Presentation Slides

HCH staff and consumers possess significant experience with the successes and failures of the homeless services system. This expertise is invaluable in the struggle to improve the public policies that can ultimately prevent and end homelessness. This workshop will explain the connection between public policy and homelessness and will explore strategies to integrate direct service and policy advocacy at the project level. Overcoming barriers to policy advocacy, specific action steps to encourage the integration of service and advocacy, and strategies for successful advocacy campaigns will all be discussed. Additionally, one clinician will highlight her own process of overcoming personal uncertainty to achieve a significant advocacy victory. This policy change was commended by the White House and could be replicated. This clinician’s work on external coalitions, facilitating consumer involvement, and communicating with the state legislature will all be discussed.

Presenters: Dan Rabbitt, MSW; Health Policy Organizer, National Health Care for the Homeless Council; Lisa Stambolis, NP; Director of Pediatrics, Health Care for the Homeless, Inc.

Room: Bunker Hill

Treating Opioid Addiction Using Suboxone within an Integrated Group Medical Visit

Facing the national increase in opioid addiction and deaths along with limited access to treatment, Suboxone is a safe alternative to methadone or other treatments that can be prescribed from a primary care site. There are some challenges in treating opioid addiction. We have found that using a group model of treatment has positively affected both our providers and our clients. An integrated group medical visit brings together many providers in one room focused on the treatment of opioid addiction. Up to eight patients’ may be seen during a one-hour group. Medication adjustments are made by the physicians, while social workers aid with housing, school, and entitlements. Psychologists help activate patients self-management behaviors and provide techniques for managing the overwhelming feelings that come with recovery. Patients report feeling helped and supported. Providers feel less stressed and better able to provide more comprehensive care.

Presenters: Charles Preston, PhD, Director Psychology Services; Sara Doorley, MD, Medical Director; Elizabeth Echeverria, LCSW; Deborah Oduma, RN; Valley Homeless Healthcare Program

Room: Capitol A

Undocumented Cognitive Impairment and TBI in the HCH Setting

Presentation Slides

This presentation will explain how cognitive impairment and traumatic brain injury are the missing links in many supplemental security income claims and how TBI awareness can explain behaviors of patients in the shelter setting and open doors to treatment. In Raleigh, there have been a high number of chronically homeless patients with IQs of less than 70 undocumented for many years. This research and a new protocol have significantly changed how patients are screened and how their lives are changed. The presentation will discuss research from the Raleigh HCH site and the SOAR data proving the high number of undocumented cases as well as how, once aware, SSI cases were approved quickly and allowed access to insurance and income to improve patients’ well being and quality of life. The workshop will also include a case study discussion and question and answer time.

Presenters: Brooks Ann McKinney, MSW; Director of Medical Respite and Safety Net Providers, Mission Health and Hospitals; Alexandra Hartfield, BSW; SOAR Outreach Specialist, Capitol Care Collaborative, Wake County Medical Society

Room: Columbia B

Friday, March 15, 2013

10 – 11:30 a.m.

Best Practices in the Homeless Health Clinic

Presentation Slides

This presentation will demonstrate many of the common health problems that social workers encounter on a regular basis and what they need to know when working in homeless clinics associated with the VA. For example, if a client enters a social worker’s office for help and midway thru the interview the social worker thinks the person has pink eye, what should they do? Would the social worker know how to disinfect the office? Other examples include lice, scabies, cold/flu, incontinence, diabetes, and dementia; each has specific information that would be helpful for a social worker to know. This presentation will include information on how the Homeless Clinic at the Nashville VA utilizes the Nurse Practitioner for compensated work therapy consults, urine drug screens, and TB surveillance.

Presenter: Holly Gillon, EdS, MSN, FNP; Nurse Practitioner Tennessee Valley Health Care System, Nashville HCHV

Room: Thornton

Caring for Homeless Sex Offenders in the Community Setting: A Collaborative Approach

Presentation Slides   Presentation Handouts

In the health care for the homeless setting, providers offer medical and behavioral health care to many individuals with sex offender status. HCH clinicians can surely provide more effective care if they have a better understanding of the issues facing these clients. In this workshop, the presenters will highlight the ways in which the criminal justice and the health care systems treat these individuals differently. This workshop will discuss the varying levels of offense and registration within the legal system along with the behavioral health status of these individuals. This presentation will conclude with challenges of treating these individuals from the perspective of the provider as well as the challenges stemming from collaborating agencies and the legal system.

Presenters: Ivan Wolfson, MD; Assistant Clinical Professor of Family Medicine, Alpert School of Medicine, Brown University; Medical Director, Providence Community Health Center at Crossroads; Catherine Margaret May, RN; Family Nurse Practitioner, Providence Community Health Centers at Crossroads

Room: Congressional A

Going beyond the Basics

Presentation Slides

This workshop will use a combination of lecture and facilitated discussion to examine the unique and complex diagnosis that can exist within the homeless population. Examples of how motivational interviewing is used to enable patients to determine how they would like to pursue potential health care and mental health issues. An integrative health care concept will be discussed which will show how it empowers the health care providers and enhances the patients overall health care experience. The use of screening tools for diagnosis will be discussed for overall care. An example of one to two case studies will be discussed along with a brief look at how the neurotransmitters are affected by antidepressants and antipsychotic medications. By the end of the workshop, practitioners should have added insight and an increased comfort level in going beyond the basics in treating patients who have a mental health diagnosis.

Presenters: James Williamson, PA-C; Physicians Assistant, Corner of Hope Homeless Clinic; Mia Quaglia-Oswald, MSW, ASW; Behavioral Health Clinician, Addiction Counseling; Vikram Khanna, MD; Physician, Corner of Hope Homeless Clinic

Room: Columbia A

Homelessness, Racism, and Social Justice

Homelessness in the U.S. disproportionately affects people of color. While this is often attributed simply to extreme poverty, recent research demonstrates that high rates of minority homelessness go well beyond poverty. In other words, even when poverty rates are considered across races, poor people of color are still more likely to become homeless than poor white people. Many factors contribute to this: housing discrimination, lack of affordable housing stock in communities of color, income disparities, lack of access to primary care and behavioral health care, and others. In communities across the country—north and south, east and west, urban, suburban, and rural—overt and subtle forms of racism contribute to racial inequality in homelessness. This workshop will use lecture, facilitated discussion, and small groups to explore issues of race and homelessness, including policy changes that would lay the groundwork for racial justice in the fight to end homelessness.

Presenter: Jeffrey Olivet, MA; President and CEO, Center for Social Innovation

Room: Concord

The Implications of Integrating a Street Outreach Curriculum for Medical Students

Presentation Slides

The intent of this discussion is to highlight the components of a street outreach curriculum for medical students. Included in this teaching module are concepts related to varying definitions of street outreach and engagement and the rationale for conducting outreach. Techniques such as motivational interviewing and an understanding of trauma informed care are key components to service delivery.

The composition of a typical outreach team and the role of consumers on any given team will be discussed. Most importantly, the role of medical students and the means of integrating them into a team will be elaborated upon. Identifying client needs and the countless barriers to care that this population are confronted with are essential to understanding the unique nature of this work.

Formalizing students’ understanding of street outreach will empower them, dismiss misconceptions, and sensitize them to the circumstances in which homeless clients are confronted with.

Presenters: Pia Valvassori, PhD, Assistant Clinical Professor, Nova Southeastern University College of Osteopathic Medicine; Elliot Sklar, PhD, MS; Project Director, Project HOPE; Assistant Professor, Nova Southeastern University College of Osteopathic Medicine; Amy Grassette; former Chair, National Consumer Advisory Board, National Health Care for the Homeless Council

Room: Bunker Hill

Interagency Inter-Professional Treatment Teams

Presentation Recording, Part One   Presentation Recording, Part Two

This presentation will describe patient-centered care that increases clients’ readiness to change health behaviors related to metabolic syndrome, and any secondary risk factors of mental illness or substance abuse, through education and support groups. In this model, student nurses and social workers as well as peer educators who have previously experienced homelessness will provide education and facilitate support groups. Students and peer educators have been supported by University of South Alabama faculty, Our Neighborhood Healthcare Clinic at 15 Place, Alta Pointe, and Health Care for the Homeless, Housing First. A 50% increase in readiness to change before participating in the inter-professional interagency treatment team is anticipated with an increase of 50% in health-seeking behaviors.

Presenters: Sharon Brammer, CRNP; Program Manager, Birmingham Health Care, Inc.; Margaret Moore-Nadler, DNP, RN; Assistant Professor, University of South Alabama College of Nursing

Room: Columbia B

Leadership Strategies for Patient-Centered Medical Home Transformation in the HCH Setting

Building a patient-centered medical home for mobile, medically complex patients experiencing homelessness requires significant strategy and resources for practice transformation. This workshop will address the key elements for PCMH transformation in the HCH setting and practical ways in which health centers can incorporate homeless patients into the medical home model.

Presenters: Anna Gard, FNP-BC; Health Disparities Consultant, Association of Clinicians for the Underserved; Kristy Chambers, CPA; CEO, Fourth Street Clinic, Wasatch Homeless Health Care, Inc.; Nicole Van Borkulo, MEd; Practice Transformation Program Manager, Safety Net Medical Home; Senior Consultant, Qualis Health

Room: Congressional CD

Partnership Strategies to Expand Health Care for the Homeless to Residents of Public Housing

Presentation Slides

This presentation will highlight the experience of Genesee County Community Mental Health/Genesee Community Health Center’s HCH and PHPC program in Flint, Michigan. The program, a 2012 New Access Point, is a unique public entity model that has developed many effective partnerships within the community to overcome barriers to care. The presenters will discuss how, as a longstanding provider of behavioral health care, GCCMH/GCHC has leveraged its experience and community partnerships in working toward a fully integrated PCMH model of care. Presenters will also discuss both shared issues among homeless and public housing individuals and the challenges unique to each as well as national trends. Additional information will include opportunities for health centers to serve public housing residents through federal investments and partnerships with housing authorities.

Presenters: Honor Potvin, MPH; Associate Director, Health Project Research and Development, Genesee Community Mental Health; William A. Doub, MAUP; Supervisor, Community Housing, Genesee Community Mental Health; Alex Lehr O’Connell, MPH, CPH; Director, Community Health Partners for Sustainability

Room: Capitol B

Strategic Partnerships that Maximize Access to Health Insurance and Disability Income for Homeless Individuals with Severe Disabilities

Presentation Slides Peters   Presentation Slides Elder

SOAR (SSI/SSDI Outreach, Access, and Recovery), a national project funded by SAMHSA, has been recognized as an effective way to fast-track homeless men and women with severe disabilities for mainstream benefits. In 2011, the approval rate for SOAR-assisted applications was 71% in an average of 101 days. For persons who are homeless who do not receive assistance to apply, the approval rate is estimated at 10-15%. In 2011 alone, SSI/SSDI brought over $85 million into the state and local economies of participating states.

SOAR works. However, the question is how to scale the effort to meet the need in the community and how to sustain the work. This panel discussion will focus on how to maximize the effect of SOAR projects in your state. It will highlight effective, replicable models and ways to sustain the work. One partnership alone resulted in over $2 million per year recovered from Medicaid for hospital charges that had been written off as uncollectible.

Presenters: Barbara Peters, MS; President and CEO, First Step;  Protip Biswas; Vice President, United Way of Metropolitan Atlanta, Commission on Regional Homelessness; Jen Elder, MSc; Senior Project Associate, Policy Research Associates, Inc.

Room: Congressional B

Tools You Can Use!

The National HCH Council’s website has a wealth of information and tools for providers, advocates, and consumers. Melissa DaSilva will walk participants through the navigation system, highlight some of the more popular tools and pages, and take questions from participants. This is a 45-minute session for information on locating resources on the Council’s new website.

Presenter: Melissa DaSilva, MS, RN; Deputy Director, National Health Care for the Homeless Council

Room: Columbia C

An Update from the Health Resources & Services Administration 

The Health Resources & Services Administration (HRSA) provides major support to health care for the homeless projects and other health centers, and HRSA’s policies affect much that is done within HCH. Come learn from the Deputy Associate Administrator for the Bureau of Primary Health Care about the agency’s latest policy directions and funding plans.

Presenter: Tonya Bowers, MHS; Deputy Associate Administrator, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services

Room: Capitol A

1 – 2:30 p.m.

Forming and Maintaining a Consumer Advisory Board

Presentation Slides

This workshop focuses on how a consumer advisory board (CAB) can enhance consumer involvement in governance while advocating on behalf of consumers of an HCH project and in the community. Different models for CABs will be discussed, including real-life challenges and achievements. Audience members involved with governance will have an opportunity to share their unique experiences with developing and maintaining CABs at their local projects.

Presenters: Rodney Dawkins, Steering Committee Member; Willie Joe Mackey, Regional Representative; Tom Rossi, BA, MDiv, Co-chair; National Consumer Advisory Board, National Health Care for the Homeless Council

Room: Congressional CD

Health Village Collaborative

Presentation Slides

The Southern Arizona Health Village for the Homeless program was created by collaborative partners to provide medical services for people who are experiencing homelessness. The program components include a mobile clinic, primary care, behavioral health assessments, a post-hospital program, social services, telemedicine, and hospital navigators. The workshop will feature an interactive presentation and a group discussion. Topics will include program initiation and design, funding, leveraging of assets, combining activities to achieve economies of scale, and operations.

Presenters: Kathy Hall, GCPH; Manager, SAHVH, Carondelet Health Network; Tara Radke, MPH; Director, Special Populations, el Rio Community Health Center

Room: Columbia A

Improving Quality and Safety with Meaningful Use of the Electronic Health Record in the Health Care for Homeless Setting

Presentation Slides Fader     Presentation Slides Larsen     Presentation Slides Anthony

Health information technology facilitates strategy for quality improvement, and meaningful use is the bridge between quality improvement and information technology. Meaningful use of electronic health records supports the ability to capture data to identify risk and improve safety and quality of health care through evidence-based clinical decision support, performance measurement and improvement, and enhanced patient communication and engagement.

Presenters: Anna Gard, FNP-BC; Health Disparities Consultant, Association of Clinicians for the Underserved; Henry Fader, JD; Of Counsel, Pepper Hamilton LLP; Kevin Larsen, MD; Medical Director of Meaningful Use, Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services; Rob Anthony; Health Specialist, Office of E-Health Standards and Services, Centers for Medicare and Medicaid Services

Room: Concord

Innovative Coordinated Care Models for People Experiencing Homelessness

Presentation Slides Batia   Presentation Slides Engstom

Together4Health responds to the newly eligible people through Medicaid expansion in Illinois. Heartland Health Outreach, a lead agency in the Coordinated Care Entity, has used its experience as an innovative provider of primary care, oral health, mental health, and substance use services to people who fall through the holes in the safety net to create a regional community health home network for those living with chronic illness, in poverty, and experiencing homelessness. Central City Concern is a founding member of Health Share Oregon, the coordinated care organization covering the Portland Metro Area which includes five hospitals, three counties, and the largest Medicaid MCO in the region. CCC operates an integrated health care for the homeless clinic, supported housing, and employment program that serves 13,000 individuals a year. CCC is lending its expertise on the social determinants of health and programming to support Oregon’s health transformation efforts.

Presenters: Karen Batia, PhD; Executive Director, Heartland Health Outreach; Todd Engstrom, MD; Old Town Clinic Medical Director, Central City Concern; Ed Blackburn, MA; Executive Director, Central City Concern

Room: Congressional B

Primary Care Medical Training in Health Care for the Homeless

Presentation Slides

Project HOPE (Homelessness in Pre-doctoral Osteopathic Education) responds to a curricular deficit in the education of medical students toward the health care needs of the homeless. This project aims to expand acceptance of the federal (HRSA) definition of homelessness to include the hidden homeless and unstably housed, who are becoming increasingly prevalent. Perceptions of homelessness do not permit for breadth in identifying and providing appropriate medical care. This project works to educate medical students to provide them with the knowledge and skills to become well-prepared primary care practitioners both through didactic curriculum and applied practical experiences. The project also examines the malleability of medical student attitudes concerning work with those experiencing homelessness. A lecture highlighting cumulative project findings and discussion of theory, curriculum, and practice will be facilitated by core project researchers, educators, and supervising clinicians.

Presenters: Elliot Sklar, PhD, MS; Project Director, Project HOPE; Assistant Professor, Nova Southeastern University College of Osteopathic Medicine; Kristi Messer, MPH, MSW; Executive Director, Project HOPE; Assistant Professor, Nova Southeastern University College of Osteopathic Medicine; Pia Valvassori, PhD; Assistant Clinical Professor, Nova Southeastern University College of Osteopathic Medicine

Room: Lexington

Quality Improvement for All

QI for All Wismer

Everyone wants to do the best they can in their work. Quality improvement (QI) is a proven way to assess operations, generate and test ideas for improvement, and spread changes that work. In the era of the patient-centered medical home, there is a movement toward more team-based care. It is becoming increasingly important for staff of all types and work teams to be involved in QI. In this workshop, participants will learn how to develop a QI project from idea to result, including how to define and measure data, how to make an AIM statement, how to test an idea for change, and how to communicate QI and change management effectively with staff. This workshop will include lecture and examples from the field while offering attendees the time to work in small groups to develop their own ideas into projects to take back to their programs.

Presenters: Barbara Wismer, MD, MPH; Physician, Tom Waddell Health Center; Deborah Borne, MD, MSW; Medical Director, SF Department of Public Health

Room: Capitol A

The Role of Health Care for the Homeless Clinics in Ending Homelessness in the United States

Presentation Slides

Progress is being made to end homelessness across the United States. In some cities, the reduction in the total number of homeless people is on track to end homelessness before 2015. Communities that are making considerable progress have a high level of integration of housing services with primary care, support services, and consistency in philosophy of care based on housing first principles. Using these “positive outliers” as an indication of best practice, there is opportunity for all health care for the homeless providers to both participate in and provide leadership to reduce the number of homeless people in their communities and strive towards achieving the goal of ending chronic homelessness and homelessness for veterans by 2015.

Presenter: Joshua Bamberger, MD, MPH; Director of Housing and Urban Health, San Francisco Department of Public Health

Room: Capitol B

Sleep, Disease, and Homelessness: Seeking a Connection

One of the many challenges faced by people who are homeless is where to sleep. This workshop will present information to help those working in the homeless community have a better understanding of the nature of sleep and its significance to maintaining health. It will also review the major types of sleep disorders, particularly sleep apnea. The workshop will provide strategies and identify resources for addressing sleep concerns that can help improve the sleep of your patients and maybe even yourself.

Presenter: Edward Grandi, Executive Director, American Sleep Apnea Association

Room: Columbia B

Wedded Bliss: Marrying Medicaid Health Homes and Permanent Supportive Housing

Considering opportunities created by the Affordable Care Act, the AIDS Foundation of Chicago (AFC) and the Center for Housing and Health (CHH) designed a permanent supportive housing program connected with a health home to serve homeless, high users of Medicaid. The project partnered with the health care for the homeless provider in Chicago to develop the health home and contracted housing case management staff from the organization.

Through collaboration with Illinois’s Medicaid office, AFC and CHH accessed health information for program participants. Analysis of service usage patterns, health conditions, and overall spending provided valuable information on enhancing patient-centered care. Informed by this data, the project developed innovative strategies to assimilate housing case managers into a care coordination team at the health home.

Teaching techniques include panel presentations. Understanding permanent supportive housing programs would be beneficial for attendees.

Presenters: Arturo Bendixen, MSW, Vice President of Housing Partnerships; Peter Toepfer, BA, Housing Manager; AIDS Foundation of Chicago

Room: Congressional A

3 – 4:30 p.m.

Big Ideas in Small Centers: Adopting Public Health Initiatives into Your Health Center

Presentation Slides

Some of the most prominent initiatives in public health (meaningful use, patient-centered medical home, and quality improvement) were designed with marginal consideration of how small health centers and those serving special populations will achieve these benchmarks. This workshop will be a lecture and facilitated discussion of how small centers with special populations can use existing resources and use their size as an advantage in achieving these public health goals through the experiences and best practices of one of New Jersey’s smallest community health centers. The workshop will balance the views and experiences of both clinical management and administration, providing insight that can be used by all staff members, from the receptionist’s front desk to the CEO’s office.

Presenters: Joshua Myers, MA, Manager of Development and Information Technology; Lynda Bascelli, MD, Chief Medical Officer; Project HOPE, Inc.

Room: Capitol A

Designing Your Health Center for Maximum Patient-Centered Integrated Health Care

Presentation Slides

Using the examples of four health care for the homeless programs, this workshop will examine both the physical and programmatic elements of a patient-centered health care home for homeless and vulnerable populations. Best practice examples of health center design promoting integration of primary care, mental health, substance treatment, oral health, and enabling services will be presented. Capital financing sources will also be explored. Presenters will share their experience of recently completed and currently developing projects currently in development.

Presenters: John Parvensky, JD; President, Colorado Coalition for the Homeless; Robert Taube, PhD, MPH; CEO, Boston HCH; Ed Blackburn, MA; CEO, President, Central City Concern; Kevin Lindamood, MSW; President and CEO, Health Care for the Homeless of Maryland

Room: Columbia B

Developing an Integrated Treatment Team to Address Common Medical and Psychosocial Problems among Newly Housed Persons

This workshop will present information on an integrated, multidisciplinary group designed to help newly housed clients negotiate the physical and psychosocial difficulties associated with becoming housed. When clients are housed, they are often motivated to treat their physical illnesses. Also, clients often have a sense of fear when they are first left alone in their new homes. They may need to learn how to budget their income, deal with utility companies, or even how to cook for themselves. Clients have also reported feeling guilty over those that they left behind on the street. This group has helped our clients become more independent and has helped complex clients maintain their housing and health. Besides presenting this model, this workshop will help participants to design and implement their own groups.

Presenters: Charles Preston, PhD; Director of Psychological Services, Valley Homeless Healthcare Program; Sara Doorley, MD; Medical Director, Valley Homeless Healthcare Program; Kate Kreil, MSW; Social Worker, New Directions

Room: Concord

National Health Foundation’s Recuperative Care 2012 Summary Report: Lessons Learned from an Evidence-Based Program

The workshop will include the highlights from National Health Foundation’s Recuperative Care 2012 Summary Report. After two years of operations, National Health Foundation has compiled a 40-page report on the challenges, successes, and lessons learned from the development of the Recuperative Care Center. The presentation will inform participants on key lessons and recommendations formulated from this evidence-based program. An overview will be provided on the implementation and the operation of two self-sustaining sites (Los Angeles County and Orange County) as replicable programs, NHF’s collaborative role with over 50 private hospitals on a safe and appropriate discharge option for homeless patients, and outcome data from the program.

Presenters: Kelly Bruno, MSW, Chief Operating Officer; Elizabeth Yang, MA, Director of Recuperative Care Center; National Health Foundation

Room: Congressional CD

“Need Money? I Can Help!” Using Benefits to Engage in Services

Presentation Slides

This presentation will include multiple interactive methods including videos of client testimonials, handouts, and an interactive presentation. Presenters will provide background information on the SSI/SSDI Outreach Access and Recovery Initiative (SOAR) in Maryland and demonstrate how it has successfully used benefits to engage individuals who have difficulties connecting with services. The presenters will share information about the types of assessments and methods that can be used on outreach when discussing disability benefits. The presentation will discuss using the SOAR process as both a long- and short-term engagement strategy on outreach including how to facilitate access to more avenues of care. Focus will be given to the importance of collaboration with other service providers and outreach teams to connect with health care, housing, and other vital services.

Presenters: Katie League, MSW, LCSW-C, Outreach Disability Specialist; Margaret Flanagan, LCSW, Disability Assistance Project Manager; Health Care for the Homeless Maryland

Room: Capitol B

Operation CHOICES: Evaluation of Obesity Prevention Programming for Families in Emergency Housing

Presentation Slides

For the past three years, a pediatric health outreach program has delivered an obesity prevention program to women and children living in shelter. Participants in this workshop will learn about the challenges of evaluating an obesity prevention program based on the Transtheoretical Model of Change, including how to capture a transient population with little control over their food and activity choices. Rather than assess Body Mass Index (BMI), program leadership chose to measure families’ readiness to change behavior related to nutrition and fitness. This interactive presentation will combine didactics and facilitated discussion to describe the implementation of the program, the evaluation tool used, and the outcomes.

Presenters: Melissa Berrios, MSW, Social Work Trainer; Michelle Katzow, MD, Pediatric Resident, PL-3, The Children’s Hospital of Philadelphia

Room: Congressional A

A Psychiatrist, a Social Worker, and a Consumer Walk into a Library

Presentation Slides

The San Francisco Public Library approached the Department of Public Health for advice on how to serve homeless and mentally ill patrons. This presentation will focus on the evolution of this collaboration, which included needs assessment surveys, collaborations with the police department, engagement of library staff, placement of a social worker at the main branch, and the adoption of a vocational rehabilitation component which trained homeless library patrons to assist other individuals in similar situations.

Presenters: Rajesh Parekh, MD, Clinical Director and Community Liaison; Leah Esguerra, LMFT, Psychiatric Social Worker; Kathleen Lee, Health and Safety Associate; San Francisco Fully-Integrated Recovery Services Team, San Francisco Department of Public Health

Room: Columbia A

Rapid Deployment of a Dental Program without Building a Clinic: Make the Most of the Smallest Financial Resources to Meet Patient/Consumer Needs without Service Provider Competition for Funds

Program Slides and Handouts

A Continuum of Care lead agency will show a short video of the dramatic impact of the homeless dental program developed in 2011. The presenter will walk attendees through the development process, collaboration process, and sample contracts used to implement the program. Through either real-time Internet access or screen shots, the presenter will walk through each step of the program from case manager referral, approval, billing, and ACH payment. The presenter will detail performance measures and how the system is used by case managers through a motivational interviewing, incentive, and accountability model. The presenter will detail spin-off applications of this Direct Client Service Fund that has closed the gap on client needs from pharmaceutical, transportation, critical documents, and education needs. Development and marketing strategies will be shared on how the CoC is acquiring donations to keep the fund growing.

Presenter: Cindy Crain, MPA; Executive Director, Tarrant County Homeless Coalition

Room: Columbia C

Using Existing Networks to Educate the HCH Community on Health Reform

Presentation Slides Rabbitt     Presentation Slides Navarro     Presentation Slides Brownlow

Beginning in 2014 (or earlier in some states), the Affordable Care Act expands Medicaid health coverage to all individuals making 138% of the Federal Poverty Level or less. Efforts to educate and enroll individuals experiencing homelessness will be needed, especially considering the barriers to enrollment many face. Few additional resources are available, so HCH projects must be creative in using existing networks and community partners to establish trust and educate homeless persons on the new benefits. This workshop will highlight two unique examples of such strategies: the Health Care Ambassador Program of the California PCA and the Community Educator Program of St. Stephens Human Services in Minnesota. These programs’ use of provider and consumer networks to connect with and educate the community on the ACA and other policy topics will be discussed as well as lessons learned from their states’ early Medicaid Expansions and suggestions for replicating similar programs.

Presenters: Dan Rabbitt, MSW; Health Policy Organizer, National Health Care for the Homeless Council; Aracely Navarro; Regional Advocate, California PCA; Tonya Brownlow, MSW; Assistant Director of Ending Long Term Homelessness, St. Stephen’s Human Services

Room: Lexington

Saturday, March 16, 2013

9 – 10:30 a.m.

Enhancing Benefits Acquisition Efforts through Collaboration

Presentation Slides

This workshop will cover ways in which HCH projects have been able to implement mainstream benefits acquisition programs (using the SOAR model). The panel will discuss why it is important for HCH projects to focus on building community collaborations to support those efforts both systemically and financially. Access to SSI/SSDI income will remain essential with the full implementation of health care reform and the Medicaid expansion. The panel will discuss ways to incorporate benefits acquisition into heath care reform efforts. At the conclusion of the panel presentations, a facilitated discussion will be held with the panel and the audience. The audience will be able to ask specific questions about the model programs and next steps for implementing a SOAR benefits acquisition effort in their HCH project. Participants will be provided post-workshop support and technical assistance from the national SAMHSA SOAR Technical Assistance Center.

Presenters: Jen Elder, MSc; Senior Project Associate, Policy Research Associates, Inc.; Marian Bland, LCSW-C; Director, Office of Special Needs Populations, Maryland Mental Hygiene Administration; Nancy Vasquez; California Institute for Mental Health

Room: Columbia A

Investigating Patient Attitudes toward Hepatitis C to Guide Implementation of Primary Care-Based HCV Treatment

Presentation Slides

Nearly one-third of homeless adults are infected with the Hepatitis C virus (HCV). With new and more efficacious treatments and changing guidelines for early detection and treatment, it is critical to improve access to HCV services in populations at the highest risk for infection. Coordinating HCV services through a primary care initiative best addresses this need. This lecture outlines the process of starting a multidisciplinary, harm reduction-oriented HCV education and support group affiliated with an urban clinic caring for homeless patients and those living in supportive housing. Along with the weekly group, twelve participants were individually interviewed regarding their knowledge and beliefs about HCV and to assess treatment readiness. The interview data is currently being used to guide development of an interdisciplinary treatment program at this clinic that serves patients with high rates of concurrent substance abuse, mental illness, and other chronic diseases.

Presenters: Kelly Eagen, MD, Physician; Laura Starbird, RN, MS, Health Education Nurse & Research Assistant; San Francisco Department of Public Health

Room: Congressional CD

Promoting Healthy Habits: Innovative Nutrition Education Programs for Homeless Children and Families

Presentation Slides   Presentation Handout

To address issues of accessing healthy food and venues for physical activity, the New York Children’s Health Project conducts CHEFF’s and Microwave Cooking classes, aimed at increasing nutrition-related knowledge and skills in the context of limited resources. Workshop attendees will learn techniques used in teaching homeless mothers to shop on a budget, cook nutritious food, and encourage healthy eating habits while also engaging in an abbreviated version of the Microwave Cooking Class. A presentation of CHEFF’s, the nutrition education and physical activity program for children ages 6-14, including curriculum, evaluation tools, methods, and results, will follow. Participants will discover ways to address obesity prevention, promote healthy habits, and overcome challenges inherent in working in homeless shelter settings. The rewards of delivering programs that foster social support and improve quality of life among shelter residents will be highlighted as well.

Presenters: Jacqueline Rodriguez, MPH, AE-C, Health Educator; Cara Stephenson-Hunter, MPsy, Administrative Coordinator; Community Pediatric Programs Montefiore Medical Center

Room: Lexington

Quality Improvement Initiatives for Homeless Patients: A Multidisciplinary Approach

Presentation Slides

Quality improvement efforts are an important component of health care reform efforts. Much attention is now being placed on value-based health care with enhanced quality and lower costs. Health care for the homeless programs have a particular challenge of improving these quality metrics in the face of the many obstacles to care that our patients face. Improved chronic disease management and preventive health screening remain of paramount concern, yet the challenges of achieving these remain high.

A lecture and facilitated discussion will frame the current quality environment, including the emphasis on the Institute of Medicine recommendations. Discussion will then focus on the evolution of Boston Heath Care for the Homeless Program’s quality improvement plan and share some successes and pitfalls. Discussions will include use of a multidisciplinary or patient-centered approach, point of care techniques, transparent reporting, EMR tools, and quality reporting. This will be followed by a facilitated discussion with audience participation.

Presenters: Monica Bharel, MD, MPH, Chief Medical Officer; Pooja Bhalla, RN, Director of Nursing; Boston Health Care for the Homeless Program

Room: Columbia C

Strategic Sharing

Presentation Slides

This workshop will be part lecture and part interactive session, during which presenters will cover opportunities for consumers to tell their stories and the ideas of choosing, connecting, and claiming those stories. This workshop will also address credibility, opening the floor to an audience discussion of what can damage a speaker’s credibility. Then, in small groups, consumers will be given an opportunity to practice and receive structured feedback on their ability to choose, connect, and claim their stories in a way that maximizes credibility.

Presenters: Amy Grassette, former Chair; Joseph Benson, Chair; Tom Rossi, Co-Chair; National Consumer Advisory Board, National Health Care for the Homeless Council

Room: Columbia B

Supporting Homeless Families: A Study in Unique Systems and Policy Collaboration to Promote Health Care Coordination

Presentation Slides

The circumstances of homeless children and families are not always in the forefront of policy and systems considerations related to health care delivery. Workshop presenters have collaborated on policy and systems changes and enhancements to ensure that homeless children benefit from health care coordination. Presenters will introduce techniques for coalition building and share information about the experience and lessons learned for successfully bringing together unlikely leaders from a range of systems that affect and serve, or desire to serve, the health care needs of homeless families and children. Some strategies to be discussed include using coalition building to engage unlikely partners, aligning and connecting cross-systems initiatives, targeted training and technical assistance, and advocacy. A facilitated discussion will engage participants to brainstorm about integrating the strategies presented into their unique environments.

Presenters: Juanona Brewster, MDiv, MTS, MJ; Director of Early Childhood Development, Illinois Chapter, American Academy of Pediatrics; Carie Bires, MSW; Systems Integration Manager, Heartland Center for Systems Change

Room: Bunker Hill

11 a.m. – 12:30 p.m.

The ABCs of PCMH: Steps to NCQA Recognition for your HCH Program

According to the Agency for Healthcare Research and Quality, the patient-centered medical home model is a way to improve America’s health care by transforming how primary care is organized and delivered. PCMH health care settings aim to ensure quality care that is accessible, timely, comprehensive, and evidence-based. Health care for the homeless projects deliver more enabling services and care coordination than some traditional primary care providers. HCHs should apply for PCMH recognition to show they can deliver quality care to all, regardless of their housing status or insurance coverage. This workshop is a step-by-step guide to assist practices with the process of applying to and obtaining recognition as a medical home through the National Committee for Quality Assurance (NCQA). The learning process will be encouraged by interactive team-based exercises and question and answer sessions. No prior knowledge is required before attendance. Medical homes are rapidly becoming an expectation in the U.S. health care delivery system, and it is important that HCH centers not be left behind.

Presenters: Kelechi Uduhiri, MD, MPH; Medical Director, Health Care for the Homeless, Baltimore County; Viviana Cuberos-Orozco, MD; Attending Physician, Family Health Centers of SouthWest Florida

Room: Congressional CD

Effective Collaboration between Social Service Providers and Law Enforcement Using a Harm Reduction Approach

Presentation Slides

Can law enforcement and social workers possibly collaborate on harm reduction when working with drug offenders and street based sex workers?

The answer is “yes,” and this workshop will present an innovative program joining public defenders, prosecutors, law enforcement, and social service providers in the first pilot of its kind in the U.S.

Due to the criminalization of homelessness and addiction, the legal system greatly affects how individuals access services. Yet provider relationships with law enforcement are rife with ethical challenges and conflicts of interest. This workshop will use case examples and discussions to illuminate the common ground between providers and law enforcement and describe how to build sound collaborations. It will include

  • an examination of the strengths and challenges of partnerships between law enforcement and homeless providers;
  • the principles underlying public health-focused collaboration between law enforcement and providers; and
  • effective harm reduction in the criminal justice system.

Presenters: Chloe Gayle, MSW; REACH Program Co-Director, Evergreen Treatment Services; Kris Nyrop; Harm Reduction Trainer, Program Director, Racial Disparity Project, The Defender Association; Cathy Speelmon, CDP; LEAD Program Manager, Evergreen Treatment Services

Room: Yellowstone/Everglades

The Hub of Hope: Delivering Health Care and Building Community

Presentation Slides

The Hub of Hope is an innovative public and private partnership to provide medical, psychiatric, and housing placement services in Philadelphia’s subway and train concourse, a place where many people who are homeless reside in winter. The Hub ran for three months (winter only) and had terrific outcomes, and the group is evaluating changes to make in time for next year. Because ending street homelessness is a priority of most cities and the federal government, the Hub believes its combined health care and housing placement approach is an important tool to consider.

Attendees will gain insight into how to set up similar programs and be provided the opportunity to learn from successes and mistakes. With an interactive presentation and other materials (including a short video), the workshop will address the services provided, the participants served, health service report, shelter or treatment placements, SREHUP overview, positive outcomes, lessons learned, the challenges, and the impact of project.

Presenter: Lisa Greenspan, RN, Jefferson Nurse Care Manager; Monica Medina McCurdy, PA-C, Vice-president of Health Services; Project HOME

Room: Congressional B

The Missing Links

Presentation Slides

Despite Kansas City’s network of strong homeless services, emergency providers saw a surge in homeless cases from 2006 to 2009. Many cases were not emergencies. When Saint Luke’s Hospital called on emergency and homeless services to address the issue, they also asked people experiencing homelessness who to invite. The result was an innovative, client-driven program that utilized collective impact principles to maximize collaboration. The program filled gaps, connected people and agencies, and facilitated the process for people to get off the street. Working with two dozen hospitals and most homeless services, the project, in just over two years, saved over $3,000,000 in emergency service fees ($5+ savings for each $1 spent). More importantly, it helped the people without homes, homeless service agencies, emergency providers, and the general community.

This lecture and facilitated discussion explores this case study to identify and share concepts and techniques applicable in other settings.

Presenters: Kar Woo, BA; President, Artists Helping the Homeless, Inc.; Elizabeth Cessor, Vice President, Mission & Community Services, Saint Luke’s Health System

Room: Columbia C

The Reliability and Validity of the Vulnerability Index and a Community-Based Revised Version

Presentation Slides

This workshop will present information on a grassroots effort to revise the Vulnerability Index (VI) as a tool to prioritize scarce housing resources in Fort Worth, Texas. The focus of the presentation will be on (1) the concept of vulnerability; (2) the comparative reliability and validity of the VI and the revised tool, the Fort Worth Vulnerability Assessment (FWVAS); and (3) the implications of using vulnerability assessments as a housing prioritization tool. This presentation is particularly unique and timely in that it is one of the first empirical reports of the VI. While 62 communities nationwide are using the VI, no psychometric or other research studies have been published on it. This workshop will utilize small group discussion formats to facilitate dialogue regarding conceptions of vulnerability and to highlight the variability across communities in how vulnerability is perceived and used to allocate housing resources.

Presenters: Emily Spence-Almaguer, MSW, PhD; Associate Professor, School of Public Health; Courtney Cronley, MSW, PhD; Assistant Professor, School of Social Work, Univ. of Texas Arlington; James Petrovitch, MSSW, PhD; Assistant Professor, School of Social Work, Texas Christian University

Room: Lexington

Talking about Hepatitis C: How to Give Accurate, Clear, Up-to-Date Information to Clients and Coworkers

Presentation Slides

An estimated 25% of homeless people have Hepatitis C, and the information about this disease is often confusing and contradictory. This workshop will review basic information about Hepatitis C and develop concrete, clear, and evidence-based messages about this disease. Participants, from peer educators to health care providers to consumers to program staff, will discuss the most up-to-date answers to frequent questions about Hepatitis C. These questions include “Who should get tested?”, “What are the treatment options?”, and “If I can’t get treatment, what can I do to stay healthy?” In small groups, the audience will practice applying harm reduction and trauma-informed approaches to discussions about Hep C.

Presenter: Eowyn Rieke, MD, MPH; Clinician, Outside In

Room: Thornton

Trauma, Attachment, and Chronic Homelessness: A Model for a New Care Strategy

Presentation Slides     Handout

Attendees will leave this workshop having learned the following:

  • How attachment and trust are important to effective functioning in the community
  • How trauma impairs and distorts normal attachment development
  • How to the use motivational interviewing to effectively prompt early steps in social engagement
  • How to use introductory dialectical behavioral therapy to teach social skills and emotional regulation
  • How to translate other trauma-informed clinical techniques into care coordination
  • How to address common roadblocks through the effective use of peers

Presenter: Staci Hirsch, PsyD; Program Supervisor, Bridges Supportive Housing Program, Neighborhood Service Organization

Room: Columbia A