Consumer Participation Outreach
The National Consumer Advisory Board regularly conducts Consumer Participation Outreach (CPO) surveys to increase the capacity of CABs and other consumer groups to participate effectively in the governance of Health Care for the Homeless projects. These surveys are developed by NCAB, with the support of the National Council staff, and conducted by consumers across the United States to develop research led by people with the experience of homelessness.
In the initial outreach effort, HCH Consumer Advisory Boards and HCH projects across the country used the same outreach questions to engage in conversations with homeless persons and ask questions about health care. This resulted in a report and recommendations. Later CPO surveys asked about chronic homelessness and access to services, further explored the relationships between health and homelessness, and examined the experiences of violence while homeless.
Reports & Recommendations
COVID-19 has had a significant impact on people’s well-being and mental health, with folks enduring a variety of stress responses. At the same time, support systems and service provision were disrupted, and people had to find new ways to take care of themselves and their communities. Thus, this CPO focused on understanding how COVID-19 impacted people’s behavioral health and access to behavioral health services, the impact of systemic racism and other discrimination on well-being, and ways to improve access to behavioral health services during the pandemic and recovery.
Feeling safe is a complicated experience. “Safety” involves not only the physical environment, but also emotional and psychological well-being. Due to high rates of experiences with violence, trauma, and disenfranchisement, safety is particularly important for people experiencing homelessness. In order for health care providers to deliver meaningful, comprehensive care they must consider how their service sites are providing for these needs to increase access and engagement in care that can lead to better health outcomes and higher patient satisfaction. This CPO demonstrates the complexity of what makes people feel safe, and considerations that sites focused on open access and harm reduction must face in creating these safe spaces.
A quick Overview of the results and recommendations of this CPO is also available.
Based on the findings of this survey, NCAB worked with clinicians and administrators to develop a quick guide on Creating a Culture of Safety at Health Centers. This quick guide discusses recommendations for developing physical spaces that promote well-being, considerations for vulnerable populations, and strategies for providing for staff support.
This Consumer Participation Outreach study examines the role of enabling services in overcoming the barriers to accessing appropriate health care services encountered by people without homes. The research looks at enabling services that HCH projects and other health centers are required to offer, and at other non-required services that are supportive in the health care context. The CPO reveals that the services most commonly received by people experiencing homelessness are food, clothing, shower, and laundry services, but case management, housing, and transportation were the most needed. This information should guide funders and program managers to offer or expand these types of services that generally support stable housing and improved health.
The most vulnerable individuals experiencing homelessness have often spent many years on the street and are suspicious of traditional homeless service providers and programs, which have likely failed them numerous times; rebuilding the trust needed to engage in services is a nuanced, time-consuming endeavor that requires specific skills and attitudes. Furthermore, this subset of the homeless population generally experiences a variety of mental health and/or substance abuse disorders, leading to difficulty navigating the relatively complex homeless services system. There are also multiple logistical hurdles to jump to effectively apply and qualify for benefit programs and services.
Developing effective, person-centered outreach and enrollment strategies is critical in order to serve the hardest-to-reach. This survey attempted to target those individuals who were hard-to-reach and less engaged homeless who were more likely to remain unenrolled in Medicaid in order to arrive at best outreach practices for this population.
Individuals experiencing homelessness in the United States suffer from similar diseases and disorders as the general population but oftentimes at significantly higher rates and with poorer control. In addition to an increased medical vulnerability, homeless individuals have an increased risk of mortality. The experience of violence while homeless is one factor contributing to the increased vulnerability to illness and mortality. Physical assault on individuals experiencing homelessness has the potential to cause serious physical and psychological injuries, extend homelessness, and result in expensive medical bills. This study explored the experience, both as witness and as victim, of violence, by individuals experiencing homelessness. Read the article: Exploring the Experiences of Violence Among Individuals Who Are Homeless Using a Consumer-Led Approach (Violence and Victims, Volume 29, Number 1, 2014).
Crime Victims Fund Fact Sheet: While doing this survey we discovered that a number of our subjects were unaware of the national Crime Victim Compensation Fund, which aims to cover certain expenses resulting from a violent crime. The program is useful in alleviating additional stress caused by the financial burden of victimization; yet this program does have limitations for people experiencing homelessness, which we explore as well as opportunities for overcoming these challenges.
Questions were designed to evaluate consumer opinion and experience on access to health care, the relationship between health and homelessness, and solutions for ending homelessness. The study examined access to health care: lack of insurance, inability to pay and under-insurance were reported as the top three barriers to health care. The experience of homelessness was also recognized as a cause of poor health. Participants also indicated making housing available and health care accessible were the most important solutions to ending homelessness.
In late 2006, CPO surveyors sought to learn from individuals experiencing homelessness how to prioritize resources. The majority of individuals surveyed reported experiencing chronic homelessness and believed those experiencing chronic homelessness should receive first priority. Women and children experiencing homelessness were also identified as a priority group. Survey participants identified housing as the most needed resource, in addition to several others. Finally, participants prioritized issues for NHCHC advocacy. Health care, employment, and housing were the top three.
The second CPO project sought feedback on the accessibility of healthcare services and opinions on the functionality of the healthcare system in the United States. Many respondents reported facing barriers to health care, including the inability to pay, bureaucratic issues (eligibility, application processes), and lack of transportation. Also apparent, health care issues served as a barrier to housing. Finally, most individuals surveyed believed health care should be paid for by the government and that health care access should be universal.
In early 2005, the National Health Care for the Homeless Council launched a project to “increase the capacity of HCH consumer bodies to effectively determine and represent to HCH project administrators and policy makers the health care needs of homeless persons.” A pilot program of outreach to Health Care for the Homeless clients in six cities indicated a high level of satisfaction with HCH services, demonstrated a significant base of support for enhanced consumer involvement in HCH, and provided an initial model for increasing consumer involvement.
This report recommends continuing the program of outreach and incorporating its findings into HCH practice at local and national levels, and clarifying and strengthening the role of Consumer Advisory Boards and/or other mechanisms for consumer involvement in HCH governance.