A Comparison of Recommended Practice
Guidelines for Health Care of the Homeless
and the Current Health Status of Homeless
Individuals and Families in an Urban
Community as Assessed Through the Use of
Photovoice Methodology
Identified Problem: Homelessness and Health
Care Challenges
•
Nationally, 3.5 million people experience homelessness within a
given year.
•
Thirty seven percent of the homeless populations are families,
and the numbers are growing.
•
There are approximately 9,300 people who experience
homelessness on a given night in Minnesota, with the majority of
them within the metro area of St. Paul and Minneapolis.
•
Inaccessibility to health care can be related to financial issues,
lack of resources and personal issues.
Purpose of Project
•
Increase awareness of health care needs of
homeless families within the community
•
Comparison of National Guidelines for delivery
of care to the homeless
•
Empowerment of the participants
•
Promote dialogue; involving local leaders,
policy makers and the community that may lead
to improvement of delivery of services to the
homeless
Clinical Question
“Does a community forum increase community
member awareness of service gaps through a
comparison of practice guidelines and the actual
experience of health care services of homeless families
in St. Paul, Minnesota?”
National Guidelines for Care of the
Homeless
•
Adapting Your Practice: General Recommendations for the Care
of Homeless Patients
(Bonin et al., 2010)
•
Compared Guideline recommendations with the current health care
experience of homeless adult family members within the city of St.
Paul, Minnesota (Photovoice Assessment)
•
Three areas of Guideline were addressed:
•
Access and continuity of health care (including barriers and
services)
•
Basic needs (food, shelter, and safety)
Methods
Subjects: After Institutional Review Board Approval through the Minnesota State
University, Mankato, 15 subjects were recruited to take part in the assessment. The
subjects were homeless care providers of at least one child and were between the ages
of 18 and 45 years old. Thirteen participants completed the assessment.
Assessment: Through a photovoice assessment, participants were directed to take
photographs of things that affect their health in relationship to the areas that are
addressed in the Guideline. Three main areas of the Guideline were the focus of the
project. These areas included: (a) access and continuity of health care (including
barriers and services), (b) basic needs (food, shelter, safety), and (c) social support
systems.
Analysis: A comparative analysis was completed on the identified health care
experiences as expressed through the photovoice assessment of the participants and
the recommendations for delivery of care of the national Guideline.
Intervention: A community forum was presented to share results of assessment
and analysis, increase awareness, promote dialogue, and encourage change.
Method for Evaluation: Likert Scale questionnaire given at Forum to
determine intervention effectiveness.
Theoretical Framework
Modeling and Role Modeling Theory (Erickson, 2006):
•
Identifies the integration of the clients’ view of their world and the
community where they live. The community surrounds the homeless
client; it is the context of the client’s world.
•
An assessment process (Photovoice) helps to identify health needs
and barriers experienced by the client.
The Community Engagement Model: (International Association for
Public Participation, 2005):
•
Recognizes the importance of community partnerships.
•
Health needs are identified and shared, empowering the community
through the process of informing, consulting, involving, and
collaborating.
Photovoice
Photovoice Methodology:
•
Dr. Carolyn Wang
•
Participatory Research method
•
Elicits in-depth descriptions of a person’s realities through
pictures
Intended Outcomes of Photovoice:
•
Empowerment of Participants
•
Increase community awareness
•
Promote dialogue to bring about change
Photovoice Assessment and Results
•
13 adult homeless care providers utilizing services in St. Paul
•
4 Males, 9 Females, 22-42 years old
•
1 Caucasian, 1 Hispanic, 11 Black
•
Total of 24 children
•
Met with participants 3 times
•
Results (Guideline areas)
•
Health Care Access
-11 of 13 participants had insurance
•
Barriers included co-pays, transportation, follow-up, primary care
•
Food
- All 13 participants had access to food
•
at least 2 meals/day
•
lack of nutritional choices
•
Safety
- 7 discussed concerns of safety for self and belongings
•
Support
- All stated they had good support systems when initially homeless (‘Used up’
support system and resources over time)
•
Shelter
- Of the 13 participants, only one family spent one night together on the street
(homeless time period-1 month to 10 years)
Intervention: Community Forum-Results
•
Approximately 120 people attended the Community
Forum.
•
83 completed the likert questionnaire-(69%)
•
Of those who completed the questionnaire:
o
92% agreed or strongly agreed that the Forum increased their
awareness of homeless individuals and family’s needs
o
89% of those who completed the questionnaire agreed or
strongly agreed that the Forum increased their awareness of
the National Guidelines for the homeless in delivery of
healthcare and services.
o
92% of those who completed the questionnaire agreed or
strongly agreed the forum encouraged them to talk to their
policy makers and leaders regarding the needs of those who
are experiencing homelessness.
Recommendations for Community related to Guideline,
input from Community (focus groups), and input from
Photovoice Assessment Participants
Housing/Shelter:
•
Easier access to housing that is available.
•
More affordable housing opportunities.
•
Address ‘spend down’ issue in relationship to housing opportunities.
Safety:
•
Address resources needed to keep families safe and make sure information and
resources are available to homeless families.
Food/Nutrition:
•
Make more nutritious food choices available for families experiencing homelessness.
•
Educate both community and those experiencing homelessness on nutritional needs.
•
Encourage communities to meet needs.
Resources/Support:
•
Centralize resources, have all in one place.
•
Do more outreach, awareness and education within community to address the needs.
•
Coordinate services and referrals.
Health Care Access/Concerns:
•
Offer integrated, interdisciplinary services at multiple points accessible to the homeless
Clinical Practice Implications
•
Improved delivery of services through
application of guidelines. (Written
recommendations share with local
healthcare and service providers)
•
Community partnerships.
•
Future plan- replicate
project in other
communities to promote better health
outcomes for the homeless.
Slide Show
The Face of Homelessness Within our own
Community
Acknowledgements
•
Thank you to the participants for sharing their
photographs and stories.
•
Thank you to the Wellness Center and the community for
offering support and resources for the families and
individuals who are experiencing homelessness.
•
Thank you to Dr. Marcia Stevens, Dr. Sue Ellen Bell, and
Dr. Marjorie Schaffer for their support during this DNP
project.
•
Financial support: The Becky Taylor Scholarship,
Minnesota State University, Mankato.
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