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Our Staff

The principal office of the National Health Care for the Homeless Council is in Nashville, Tennessee. Staff and contractors pursue our ambitious agenda in research, training, education, organizing, and advocacy from offices in various locations. Staff members include:

 

 

Bobby Watts

Bobby Watts, MPH, MS, CPH

Chief Executive Officer

G. Robert “Bobby” Watts is the chief executive officer of the National Health Care for the Homeless Council and oversees all aspects of the Council’s activity in advocacy, training, technical assistance, research, peer support, organizing, and fund development.

A nationally recognized advocate and leader in meeting the health needs of people without homes, he has more than 25 years of experience in administration, direct service, and implementation of homeless health services. He began his work with people experiencing homelessness as a live-in staff member of the New York City Rescue Mission in Manhattan. Learn more about Bobby.

Contact Information

Phone Number: (615) 226-2292 | Email Address: bwatts@nhchc.org

 

Hugo Aguas, MA

Research Associate

Hugo works with the research team to research health outcomes using data driven methodologies, Hugo collaborates with other community health partners throughout the country to develop educational materials pertaining to medical care for those experiencing homelessness. Hugo also disseminates data and provides ease-of-access to community partners throughout the nation, and assists in writing publications and scheduling educational seminars on public health amongst those experiencing homelessness.

Contact Information

Phone Number: (615) 226-2292 | Email Address: haguas@nhchc.org

 

Lauryn Berner, MSW, MPH

Research Manager

Lauryn works with the research team to support the Health Care for the Homeless field by developing and disseminating knowledge, increasing visibility of HCH-related research through publications and external collaborations, and providing data-driven support to inter-departmental teams and workgroups. Lauryn serves as the Council’s subject matter expert on housing and HIV, and her work has focused on the social determinants of health.

Contact Information

Phone Number: (615) 226-2292, Ext. 230 | Email Address: lberner@nhchc.org

 

 

Alaina Boyer, PhD

Director of Research

Alaina provides oversight and guidance for the research activities of the National Health Care for the Homeless Council, which include quality improvement projects and providing educational resources for health care clinics that serve individuals experiencing homelessness. She coordinates and facilitates the Research Committee and Practice Based Research Network initiatives, which are currently focused on improving health outcomes and providing quality care across systems for vulnerable populations.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 233 | Email Address: aboyer@nhchc.org 

 

Lily Catalano, BA

Clinical Manager

Lily coordinates the work of the Health Care for the Homeless Clinicians’ Network and develops resources to improve access to and quality of health care for people experiencing homelessness.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 231 | Email Address: lcatalano@nhchc.org

 

 

Katherine Cavanaugh, MSW

Consumer Advocate

Katherine staffs the National Consumer Advisory Board (NCAB), helps to coordinate consumer initiatives, and further develops Council relationships with local Consumer Advisory Boards (CABs).

Contact Information

Phone Number: (443) 703-1320 | Email Address: kcavanaugh@nhchc.org

 

Andrea Crowe, MA

Advancement Coordinator

Andrea maintains the Council's donor and membership database; manages fundraising lists of individuals, organizations, and foundations; and provides a range of administrative services in the areas of philanthropy and member relations.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 234 | Email Address: acrowe@nhchc.org

Brandon de la Cruz, MM

Media and Technology Manager

Brandon manages media-based communication activities for the Council -- including webinars, videography, photography, and music production -- and provides guidance and support for information technology services.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 249 | Email Address: bdelacruz@nhchc.org

Barbara DiPietro, PhD

Senior Director of Policy

Barbara directs the policy and advocacy activities for the National Health Care for the Homeless Council. This includes conducting policy analysis, providing educational materials and presentations to a broad range of policymakers and other stakeholders, coordinating the Council’s policy priorities with national partners, and organizing staff assistance to the Policy Committee and the National Consumer Advisory Board.

 

Contact Information

Phone Number: (443) 703-1346 | Email Address: bdipietro@nhchc.org

 

 

Jennifer Dix, BBA

Communications Coordinator

Jenn provides assistance with the Council’s marketing and branding efforts. This includes supporting effective communication strategies via email communications, newsletters, marketing materials, website content, and social media.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 225 | Email Address: jdix@nhchc.org

 

 

Julia Dobbins, MSW

Director of Medical Respite Care

Julia joined the Council in 2012 and leads our work on medical respite care. She provides guidance and oversight for medical respite activities including training, technical assistance, and resource and program development. Additionally, she is the staff liaison to the Respite Care Providers’ Network (RCPN) and coordinates and facilitates the activities of the RCPN steering committee.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 232 | Email Address: jdobbins@nhchc.org

 

D. Michael Durham, MTS

Community Engagement Manager

Michael is responsible for strategic relationship-building and increasing representation of marginalized communities in all of the Council’s work. Leaning on these relationships, he coordinates the Council’s largely peer-to-peer technical assistance program, which provides support to health centers and other organizations serving people experiencing homelessness. He also supports the CEO in certain racial equity initiatives.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 246 | Email Address: mdurham@nhchc.org

 

 

Dorothy (Dott) Freeman, PhD

Senior Director of Advancement

Dott is the Council's Senior Director of Advancement and has more than 25 years of fundraising experience in a variety of areas, including service-oriented nonprofits, health care, and education. Heading the Council's Advancement Team, she leads our philanthropy, communications, membership, media, and technology initiatives.

 

Contact Information

Phone Number: (207) 333-8877 | Email Address: dfreeman@nhchc.org

 

 

Melanie Harper, BA, LSSGB

Director of Finance & Administration

Melanie is responsible for oversight of all the financial and administrative functions of the Council and staffs the Finance & Personnel Committee.

Contact Information

Phone Number: (615) 226-2292, Ext. 229 | Email Address: mharper@nhchc.org

 

 

Darlene Jenkins, DrPH

Senior Director of Programs

Darlene oversees the work of the Education and Research Teams.

Contact Information

Phone Number: (615) 226-2292, Ext. 228 | Email Address: djenkins@nhchc.org

 

 

Joseph Kenkel, BS

Research Assistant

Joey works with the research team to support the Health Care for the Homeless field by developing and disseminating information, increasing visibility of HCH-related research through publications and external collaborations, and improving the HCH field and community’s capacity for quality improvement and engagement in research. Joey also performs activities aimed to increase the knowledge base, skill set, and resources of health center staff engaged in supportive housing initiatives in partnership with the Corporation for Supportive Housing (CSH).

Contact Information

Phone Number: (615) 226-2292, Ext. 226 | Email Address: jkenkel@nhchc.org

 

Kelli Klein, BA

Behavioral Health Coordinator

Kelli provides technical assistance and supports the Council’s work on behavioral health and homelessness, focusing on the integration of behavioral health into primary care settings. She works specifically on the Health Resources and Services Administration’s Center of Excellence (CoE) for Behavioral Health Technical Assistance (BHTA), which includes the development and execution of webinars and peer learning opportunities through communities of practice.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 247 | Email Address: kklein@nhchc.org

 

Katie League, LCSW-C

COVID-19 Project Manager (Policy Team)

Katie works with the policy team to support the Council’s efforts surrounding the COVID-19 global pandemic. She works to identify and promote promising practices, common challenges, and key policy issues faced by the HCH community. 

 

Contact Information

Phone Number: (615) 226-2292 | Email Address: kleague@nhchc.org

Cindy Manginelli, BS

Director of Community Engagement

Cindy directs the Council’s efforts to engage and create a diverse community of individuals, coalitions, and programs that directly address issues at the intersection of homelessness and health care. She also manages the Council’s ongoing work to promote diversity, equity, and inclusion within the community of those who experience and address homelessness.  

 

Contact Information

Phone Number: (615) 226-2292, Ext. 239 | Email Address: cmanginelli@nhchc.org

 

Julia Nettles-Clemons, BA 

Administrative Coordinator

Julia has a variety of responsibilities in the areas of finance and administration that include accounts receivable and accounts payable, office maintenance,  clerical work, operations, and database support.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 221| Email Address: jnettles@nhchc.org

Courtney Pladsen, DNP, FNP-BC, RN

Director of Clinical and Quality Improvement

Courtney leads initiatives to improve the delivery of primary care, substance use treatment, and mental health care nationally. She directs training and quality improvement initiatives, and contributes to research and policy recommendations on emerging clinical issues affecting people experiencing homelessness.

 

Contact Information

Phone Number: (615) 226-2292 | Email Address: cpladsen@nhchc.org

 

 

Brett W. PoeBrett Poe, BS

Research Associate

Brett works with the research team to support the Health Care for the Homeless field by developing and disseminating information, increasing visibility of HCH-related research through publications and external collaborations, and providing data-driven support to inter-departmental teams and workgroups.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 242 | Email Address: bpoe@nhchc.org

 

 

Regina ReedRegina Reed, MPH

Health Policy Manager

Regina is responsible for representing the interests of the Council to policymakers and organizational partners in Washington, D.C., working with the Policy Committee to advance the Council’s advocacy agenda, developing policy positions and analyses, and mobilizing member organizations, service providers, and other advocates to end poverty and homelessness.

 

Contact Information

Phone Number: (443) 703-1337 | Email Address: rreed@nhchc.org

 

 

Caitlin Synovec, OTD, OTR/L, BCMH

Medical Respite Manager

Caitlin is an occupational therapist with clinical experience working with adults experiencing homelessness to improve quality of life and engagement in their preferred communities. As the Medical Respite Manager, she works with the Director of Medical Respite on projects of the National Institute for Medical Respite Care (NIMRC) and the Respite Care Providers’ Network (RCPN).

 

Contact Information

Phone Number: (615) 226-2292 | Email Address: csynovec@nhchc.org

 

Cecilia Willoughby, BA

Training and Meetings Coordinator

Cecilia manages logistics and educational content for the Council’s major training events, including our annual National Health Care for the Homeless Conference and Policy Symposium, Regional Training, and Governing Membership Meeting. She serves as the point person for these major training events working in concert with the Director of Finance and Administration, Administrators Committee, other staff members, and other stakeholders.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 241 | Email Address: cwilloughby@nhchc.org

Cecilia Willoughby, BA

Training and Meetings Coordinator

Cecilia manages logistics and educational content for the Council’s major training events, including our annual National Health Care for the Homeless Conference and Policy Symposium, Regional Training, and Governing Membership Meeting. She serves as the point person for these major training events working in concert with the Director of Finance and Administration, Administrators Committee, other staff members, and other stakeholders.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 241 | Email Address: cwilloughby@nhchc.org

Terri Woodmore, MS

Communications Manager

As part of the advancement team, Terri develops and coordinates ongoing communications and media strategies, and maintains high-quality communications including mass emails, newsletters, marketing materials, website design and content, social media, and audio/video packages.

 

Contact Information

Phone Number: (615) 226-2292, Ext. 245 | Email Address: twoodmore@nhchc.org

 

Brenda Wright

Executive Assistant

Brenda serves as Executive Assistant to the CEO and is responsible for Board meeting preparation, special projects, and administrative support including scheduling, preparing executive documents and correspondence, managing travel itineraries, maintaining files, and other administrative duties.

Contact Information

Phone Number: (615) 226-2292, Ext. 251 | Email Address: bwright@nhchc.org

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Core Competencies Curriculum

Disclaimer: The following is a compendium of resources in support of ten core competencies in delivering health care to people experiencing homelessness. These ten components emerged from a dedicated committee composed of experienced professionals, which concluded its work in 2012. However, the Council is due to return to what we consider “core competencies” in HCH and update the accompanying resources. Until we have the opportunity to do so, we retain this webpage with the caveat that some information is outdated. 

Table of Contents

  1. Health Care for the Homeless 101
  2. High Priority Clinical Issues
  3. Substance Abuse, Mental Health Disorders and Cognitive Impairments
  4. Trauma-Informed Care
  5. Complex Co-Morbidities
  6. Developing Relevant, Patient-Centered Treatment Plans
  7. Outreach
  8. Motivational Interviewing
  9. Care Coordination
  10. Self Care

Acknowledgements

Special thanks to the Core Competencies Work Group:

Heather Barr, BSN, RN, King County Dept. Public Health, Seattle, WA

Mollie Bresnahan, MEd, LMHC , Health Care for the Homeless/Mercy Medical Center, Springfield, MA

Jan Caughlan, MSW, LCSW-C, Health Care for the Homeless, Inc., Baltimore, MD

Brian Colangelo, LCSW, Project H.O.P.E , Camden, NJ

Bernadette Creaven, MN, RN, Carolyn Downs Family Medical Center, Seattle, WA

Darlene Jenkins, DrPH, CHES, National Health Care for the Homeless Council, Nashville, TN

Alona Koehler, Healthpoint Community Health Clinic, Renton, WA

Greg Morris, PA-C, Peak Vista Community Health Centers, Inc., Colorado Springs, CO

Marcia Stone, MPH, RN, King County Dept. Public Health, Seattle, WA

Additional thanks to the following individuals for their contributions:

Melissa DaSilva, MS, RN, National Health Care for the Homeless Council, Nashville, TN

Victoria Raschke, MA, National Health Care for the Homeless Council, Nashville, TN

Introduction

Addressing the challenges of healthcare delivery to persons experiencing homelessness requires a commitment to client-centered care, infused with compassion and a creative drive to re-design the service delivery systems for health care and housing. Preparing health care professionals in the HCH setting to take on these tasks requires orientation to the fundamentals of the HCH model of Care and ongoing mentoring and professional development in effectively addressing the needs of vulnerable populations.  The Core Competencies Work Group of the Clinicians’ Network recognized the importance of preparing new staff to be effective in the HCH setting and thus endeavored to package the most pertinent training materials and resources in this guide for administrators.

We look forward to your comments.

1. Health Care for the Homeless 101

Description:

HCH 101 is a 7-hour training which provides an introduction to the realities of homelessness, the methods of providing health care for this special population, and the large community of HCH consumers, providers, and advocates. The history of HCH is reviewed, the characteristics of the HCH Model of Care are defined, and resources, including those for self-care and team-care, are explored. HCH 101 is beneficial for those new to the health care for the homeless field as well as volunteers and advocates looking for refreshers. HCH 101 presents the basics of homeless health care services including information on outreach and clinic encounters and the implementation of evidence-based methods and techniques that help to foster consistent follow- for persons experiencing homelessness. Motivational Interviewing, Trauma Informed Care, and Provider Self-care are just a few of the cornerstone methods and techniques employed in the HCH setting. HCH 101 includes information from the perspective of the outreach worker, healthcare provider, and persons experiencing homelessness. HCH 101 provides a foundation on which to build new staff orientation and ongoing training to be effective in the HCH setting.

Learning Objectives:

  • Staff will be able to list three hallmarks of the HCH Model of Care.
  • Staff will be able to list three resources for HCH providers.

Resources:

  • HCH 101 Online Self-Paced Course –  The National Healthcare for the Homeless Council has developed an online training tool for those new to the HCH setting as a means of learning the basics of HCH proficiency from the view of the homeless person, advocate, and practitioner.  It consists of a pre- and post-test [in redevelopment]. Modules are dedicated to specific topics important in establishing a foundation for new and prospective HCH staff.  Viewpoints are presented from the people experiencing homelessness, outreach workers, and practitioners to help ensure success and longevity in the field of Homeless Healthcare.
  • www.CaringwithCompassion.org – An online curriculum developed by University of Michigan that consists of didactic content divided into modules (complete with pre- and post-testing) as well as a low-risk game in which providers can interact with a “patient” in order to drive home the importance of assessing psychosocial factors, working with patients who are under-insured, and inclusion of the patient in creation of treatment plans.  There is also a resource section which has links to different organizations as well as a pocket tri-fold which were developed for providers/students to guide them in terms of care and documentation.

2. High Priority Clinical Issues

Description:

High priority clinical issues in the HCH setting include housing and employment as well as medical conditions found in the general population. Further, HCH providers must be alert to emerging and urgent clinical situations such as outbreaks of infectious disease, injury related to environmental conditions, and demographic shifts among those experiencing homelessness, such as and increase in families experiencing homelessness. Developing this core competency in no way differs from what is expected by any other specialty healthcare practice or professional healthcare associations. It is the responsibility of the homeless provider to dedicate the time and effort to obtain this information for use in their Healthcare for the Homeless setting. Keeping abreast of the latest news in the HCH field can be daunting. Start by signing up for free subscriptions to newsletters and updates from the NHCHC, CDC, your State Department of Health and your professional organization (AMA, ANA, NASW, among others).

Learning Objectives:

  • Staff will be able to list three common diagnoses among HCH clients.
  • Staff will be able to list three resources for more information on frequently encountered clinical issues in the HCH setting.

Resources:

  • Healing Hands – Healing Hands is a quarterly newsletter produced by the Communications Committee of the HCH Clinicians’ Network. You can view the archives in both chronological and subject order on the website. CEUs are available for the current year’s issues.
  • Adapting Your Practice Guidelines – Adapted clinical guidelines have been developed on a number of clinical topics, including  asthma, diabetes and chronic pain management.
  • National Health Care for the Homeless Council Webinars – All Council webinars are archived on the site and new webinars are delivered monthly.

3. Managing Substance Abuse, Mental Health Disorders and Cognitive Impairments

Description:

Substance Abuse: A common stereotype of the homeless population is that they are all alcoholics or drug abusers. The truth is that a high percentage of homeless people do struggle with substance abuse, but addictions should be viewed as illnesses and require a great deal of treatment, counseling and support to overcome. Substance abuse is both a cause and a result of homelessness, often arising after people lose their housing.

Although obtaining an accurate, recent count is difficult, the Substance Abuse and Mental Health Services Administration (2003) estimates, 38% of people experiencing homelessness were dependent on alcohol and 26% abused other drugs. Alcohol abuse is more common in older generations, while drug abuse is more common among youth and young adults (Didenko and Pankratz, 2007). Substance abuse is much more common among people experiencing homelessness than in the general population. According to the 2006 National Household Survey on Drug Use and Health (NSDUH), 15% of people about the age of 12 reported using drugs within the last year and only 8% reported using drugs within the past month.

Mental Health: Approximately 20-25% of the single adult homeless population suffers from some form of severe and persistent mental illness (National Resource and Training Center on Homelessness and Mental Illness, 2003). While 22% of the American population as a whole suffers from mental illness, a small percentage of the 44 million people who have a serious mental illness are homeless at any given point in time (National Institute of Mental Health, 2005)

Cognitive Impairments: Cognitive disabilities are functional impairments associated with disorders of the brain, resulting from trauma, mental illness, chronic substance abuse, developmental disabilities, diseases, or toxic agents that affect the central nervous system.

  • Screen and Assessment
    • Validated tools and measures: DAST, MAST, SBIRT, CAGE/UNCOPE, AUDIT, URICA, NMASSIST, PHQ9, GAD7, SIGECAPS, MMSE, RBANS, MOCA, OSU TBI-ID
    • Documentation
    • Sign and symptoms
    • Risk factors
  • Treatment
    • Knowledge of various modalities
    • Psychopharmacology, Addiction pharmacology
    • Behavioral interventions
        • Harm reduction
        • 12-step model
        • Recovery model
        • CBT
    • Case management
    • Coordination of Care in the HCH setting
  • Sensitivity
    • Stereotypes
    • Personal bias
  • For possible discussion: Prevention

Learning Objectives:

  • Staff will be able to describe the prevalence of substance use and mental health conditions among HCH clients.
  • Staff will be able to list up to three tools and measures for screening and assessment.

Resources:

4. Providing Trauma-Informed Care

Description:

Many individuals seeking homeless services are trauma survivors [citation forthcoming].  Homelessness itself is a traumatic experience and being homeless often increases the risk of further victimization and retraumatization.

Traumas can include: interpersonal violence (both experienced or witnessed), physical, sexual and institutional abuse or neglect, intergenerational trauma, and war, terrorism, and natural disasters that induce powerlessness, fear, recurrent hopelessness, and hypervigilance.

Traumatic experiences may impact an individual’s ability to seek medical and behavioral health services as well as impact an individual’s ability to leave homelessness and remain in stable housing.

The goal of trauma informed care is to avoid retraumatization and exacerbation of trauma symptoms in patients who have experienced trauma in their lives.  Becoming trauma informed means implementing and adopting a holistic view of care and recognizing the connections between housing, employment, mental and physical health, substance abuse and trauma history.  Trauma informed services “create an environment that acknowledges the impact of trauma and tries to create a sense of safety.” Grant (2010).

The core principles of a trauma informed culture include: safety, trustworthiness, choice collaboration and empowerment.

  • Safety – ensuring physical and emotional safety
  • Trustworthiness – maximizing trustworthiness, making tasks clear, maintaining appropriate boundaries.
  • Choice – prioritizing consumer choice and control over recovery.
  • Collaboration – maximizing collaboration and sharing power with consumers
  • Empowerment – identifying what patients are able to do for themselves; prioritizing building skills that promote recovery; helping consumer find inner strengths needed to heal. Beyer (2010)

Learning Objectives:

  • Staff will be able to identify techniques for delivering trauma informed services to clients.
  • Staff will gain familiarity with techniques for creating a safe environment for clients that acknowledges the impact of trauma in their lives.

Resources:

  • Beyer, L.L., and Blake,M. (2010).  Trauma-informed care: Building partnerships and peer supports in supportive housing settings[PowerPoint slides]. Presentation at Services in Supportive Housing Annual Grantee Meeting.  Washington, DC.  Retrieved from http://www.samhsa-ssh-meeting.net/assets/documents/trauma_informed_care.pdf
  • Grant, G. (2010).  Truly trauma-informed: Assessing the agency through the trauma lens [PowerPoint slides].  Presentation at Practice in Progress: Expanding Skills in Trauma Work.  Second Annual Trauma Conference.  South San Francisco, CA.  Retrieved from http://smchealth.org/sites/default/files/docs/TraumaConf_Grant.pdf
  • Healing Hands, Delivering Trauma-Informed Services (Dec 2010)
  • SAMHSA Homelessness Resource Center. Trauma Informed Care 101. Kathleen Guarino

5. Managing Complex Multiple Morbidities

Description:

Multiple morbidities are commonly encountered among persons experiencing homelessness. Having to manage multiple morbidities in the homeless population is an integral part, if not a standard of care, for anyone providing healthcare in this setting. There is much information (online and in prominent periodicals) on the definition of co-morbidities and models of care that are broader than the focus considered necessary in the Homeless Healthcare setting.

It is very difficult to treat a homeless person with increasing multiple health issues in which external variables often determine the efficacy in producing good clinical outcomes. These factors include a coexisting mental health disorder, lack of resources, different set of priorities influencing the ability to maintain tight controls for certain health issues as determined by professional medical societies, research, or UDS guidelines. There is information on complex co-morbidities within multiple documents, or case studies within the Councils resources achieves.  There is an effort now to provide a resource to guide clinicians in the effort to manage multi-morbidities in this difficult population.

Learning Objectives:

  • Staff will be able to identify three external variables that often determine the efficacy of producing good clinical outcomes for people experiencing homelessness.
  • Staff will be able to identify three resources on how to manage patients with complex co-morbidities.

Resources:

[forthcoming]

6. Developing Relevant, Patient-Centered Treatment Plans

Description:

A Treatment Plan should provide all of the information necessary for a conscientious person to deliver the correct treatment procedures, at the correct times, and with sufficient consistency to produce the changes in behavior that are described in the Plan — reducing or eliminating undesirable behavior and increasing or improving desired behavior, while providing a means to monitor progress on an ongoing basis that informs the process of treatment.

Treatment plans are strategies designed to guide health care professionals involved with patient care. Such plans are patient specific and are meant to address the total status of the patient. Care plans are intended to ensure optimal outcomes for patients during the course of their care.

  1. Stay focused on the person not the problems
  2. Transformation through relationships, not paperwork
  3. Legal compliance
  4. Components to include:
    • A prioritized list of main concerns/goals with
    • The current clinical/educational/social information pertinent to the concern/goal.
    • The current plan/intervention for that concern/goal
    • The person(s) responsible for that intervention
    • The due date for the intervention
  5. Realistic expectations of both patient and medical provider
  6. Assess motivational readiness
  7. Patient-Centered Medical Home Compliance
  8. Interdisciplinary approach – Medical, nursing, social work, psychiatrist, outreach
    • Assignment of responsibilities
    • Ability to collaborate and work as a team
  9. Provider skills
    • Communication
    • Patient engagement
    • Obtaining patient “buy-in”
    • Providing Education

Learning Objectives:

  • Staff will be able to list up to three components of a treatment plan.

Resources

7. Outreach

Description:

Among the many core competencies of service to individuals experiencing homelessness is the competency in the field of conducting outreach and engaging clients. Outreach is defined as moving health services beyond the walls of traditional medical institutions and into the community, streets, soup kitchens, shelters, bridges, and locations where the most underserved are to be found. Health services that are delivered in outreach settings include medical health, mental health, and social services such as health insurance enrollment and benefits enrollment (Social Security).

By breaking down psychological and systematic barriers to care, individuals experiencing homelessness are provided care through the creative and nontraditional means of delivery.  Vital to the core of outreach are the following elements: rapport and relationship building, disseminating information and services (medical, mental health and case management) in a flexible manner and in the location where the patient is most comfortable, patience in motivating clients and the use of a multidisciplinary team.

Learning Objectives:

  • Staff will be able to describe outreach as a healthcare strategy.
  • Staff will be able to identify three resources that provide more information on outreach.

Resources:

  • Outreach Resources Page, National Health Care for the Homeless Council
  • Outreach to People Experiencing Homelessness: A Curriculum for Training Health Care for the Homeless Outreach Workers (2005) National Health Care for the Homeless Council – The purpose of this curriculum, developed by Ken Kraybill, is to provide a comprehensive overview of the principles, knowledge and issues relevant to doing outreach in the Health Care for the Homeless context. It is intended to serve as a guide for anyone involved in facilitating training for outreach workers in Health Care for the Homeless settings and other outreach programs.
  • Mobile Medical Outreach: A Commitment to Service (2009) –  This homeless health care case report, developed by the HCH Clinicians’ Network, elucidates components of mobile medical outreach treatment, highlighting best practices and evidence-based primary care. The report presents a compelling case submitted by Outside In Community Medical Outreach in Portland. Oregon. It discusses engagement, continuity of care, social service advocacy, supportive housing, the use of Model for End-Stage Liver Disease (MELD) scoring and the Short Alcohol Dependence Data Questionnaire (SADD).
  • Mobile Health Care for Homeless People: Using Vehicles to Extend Care (2007) – This report describes the experiences of 33 HCH projects that use outreach vehicles, ranging from passenger vans to custom-designed clinics on wheels, to provide a variety of health services to people without stable housing. Topics discussed include the rationale for mobile health outreach to homeless populations, services provided and staffing models, types and designs of mobile units, financing and administration of mobile health programs, obstacles encountered and strategies used to address them, and factors to which HCH providers attribute the success of these mobile outreach efforts.
  • Organizing Health Services for Homeless People: A Practical Guide (Second edition),  Marsha McMurray-Avila (2001) – See Part 4: Service Delivery Strategies; F: Outreach. Available from Amazon.com.
  • Healing Hands, Keeping Homeless People Out of the Justice System: The HCH Role (Dec 2004)
  • Healing Hands, Hard to Reach: Rural Homelessness & Health Care (Oct 2001)
  • Healing Hands, Operation Safety Net: Outreach to Unsheltered Homeless People (Nov 1998)

8. Motivational Interviewing

Description:

Developed by Professors William R. Miller and Stephen Rollnick, Motivational Interviewing is used extensively by Health Care for the Homeless providers. It is semi-directive, client-centered counseling style for eliciting behavioral change. It helps clients explore and resolve ambivalence in order to elicit behavioral change. The resolution of ambivalence is a central concept. It was originally developed to assist people with alcohol dependence. Motivational Interviewing is supportive, not argumentative, nonjudgemental and non-confrontational.

The basic principles of Motivational Interviewing include:

  • Expressing empathy through reflective listening
  • Developing and exploring discrepancy between clients’ current behaviors and their goals or values
  • Avoiding confrontation and argument with the client
  • Adjusting or rolling with client resistance
  • Supporting self-efficacy and optimism

Motivational Interviewing assists in increasing the client’s awareness of the risks and consequences of their behavior and possible benefits of change. It helps motivate the client to make a change that is consistent with their values or goals.

Learning Objectives:

  • Staff will be able to list up to three principles of Motivational Interviewing.
  • Staff will be able to identify three resources on additional information pertaining to Motivational Interviewing.

Resources:

9. Principles of Care Coordination

Description:

Persons experiencing homelessness burdened with complex commorbidities, often require a good deal of care coordination.  Care coordination is defined by NCQA as:

  • A function that supports information-sharing across providers, patients, and types and levels of service, sites and time frames.
  • The goal of coordination is to ensure that patient’s needs and preferences are achieved and that care is efficient and of high quality.
  • Care coordination is most needed by persons who have multiple needs that cannot be met by a single clinician or by a single clinical organization, and which are ongoing, with their mix and intensity subject to change over time.

Providing holistic care to individuals with complex medical and behavioral diagnoses adds a layer of complexity to care coordination, particularly when there is controversy over treatment approaches.  Disagreements over treatment approaches are common, inclusive of both perceived priorities as well as treatment approaches.  Communication skills are primary and woven throughout the entire process.  Additionally, care coordination is enhanced when providers are skilled in 2 specific areas:

  • Referral Capacity
  • Negotiation
  • Good listening skills
  • Ability to appreciate the values or experiences expressed in the opposing view
  • Knowing which conflicts to resolve
  • Validated knowledge of the treatments being negotiated.
  • Having good working relationships with one’s colleagues

Learning to be a good negotiator is something that gets better with practice.  Being able to resolve treatment conflicts between providers allow the team and the client work out the best plan of care.

Learning Objectives:

  • Staff will be able to identify the definition of :Care Coordination: as defined by the National Committee of Quality Assurance (NCQA).
  • Staff will be able to identify additional resources on care coordination.

Resources:

10. Self Care

Resources:

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