Assessment and Intake

Health Management Toolkit

Introduction: What is health management? Health management is an essential task for maintaining a person’s overall health and well-being, particularly for people experiencing homelessness who have increased prevalence and higher onset of chronic health conditions (Gutman et al., 2018b). Health management is defined as “activities related to developing, managing, and maintaining health and wellness routines, […]

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Cluster Care: Providing Support to High-Needs Clients in Transitional Housing

The organization recognized a need to provide specialized support to high-needs residents in NYC Safe Haven transitional housing for individuals who previously experienced street homelessness. Due to systemic constraints that do not allow for long-term Home Health Aide Services onsite, a needs assessment was conducted to learn the scale and scope of the need among

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Using CalAIM to Make Strategic Investments that Uplift the Experience of Unhoused Members

Learn about a Medi-Cal plan’s approach to centering the experience of its members experiencing homelessness through strategic investments and program implementation in partnership with the local continuum of care and community-based organizations. Learn how these investments increase opportunities for unhoused members to provide feedback on programs and receive a variety of new services to support

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Nurse Call Line Pilot in Homeless Shelters in NYC: Experiences, Barriers, and Facilitators

The Nurse Call Line (NCL) is a 24/7 telephone-based triage service intended to connect New York City shelter residents with appropriate health care. The study team conducted a qualitative assessment of the NCL to ascertain perceptions, experiences, and interactions with the program, as well as barriers and facilitators to use and implementation. This presentation will

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Protocol for Responding to And Assessing Patients’ Assets, Risks, and Experiences (PRAPARE)

Nationally standardized and stakeholder-driven, the Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences (PRAPARE) is designed to equip healthcare and their community partners to better understand and act on individuals’ social drivers of health (SDOH). PRAPARE, when paired with the Implementation and Action Toolkit, empowers users to leverage data to improve health

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Rebuilding Systems: Adapting Housing Assessments to Prioritize Health, Equity, and Belonging

The need for housing prioritization results from a lack of affordable housing. Existing tools have been applied universally and have resulted in further inequity. This toolkit is intended to help communities create a process that centers equity and community-specific needs. Download the fact sheet, Rebuilding Systems: Adapting Housing Assessments to Prioritize Health, Equity, and Belonging,

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