Integrating Service Needs for Homeless Children in a Medical Home

1. Integrating Service Needs for Homeless Children in a Medical Home Christine Achre, MA, LCPC

2. Key objectives of presentation • Describe service needs of homeless children • Provide an Overview of the Medical Home for Homeless Kids Project • Describe preliminary outcomes of the project • Discuss lessons learned from coordinating this project

4. Beacon Therapeutic Diagnostic and Treatment Center • Brief agency overview • History of delivering services to homeless families • Day School Services • Broader Shelter Outreach Services • Specialized TOTS program

5. Needs of homeless children • Demographics of homeless children • 20% of children ages 3-5 have diagnosable mental health disorders • Sicker than housed children • Social and emotional delays at higher rates than housed children • Developmental delays at higher rates than housed children with a higher socioeconomic level • Exposed to multiple transitions • Despite the high needs for services, less than 50% of children will get the help they need Source: National Center on Family Homelessness

6. Needs of homeless children • Seminal study by the National Center on Family Homelessness (formerly known as the Better Homes Fund) identified four key areas of a child’s life affected by homelessness • Emotional development • Physical Illness • Family Stability • Education

7. Needs of homeless children • Emotional needs • Mental health characteristics and needs • Higher rate of emotional and behavioral problems • Less likely to receive necessary professional care.

8. Needs of homeless children • Physical Illness • Physical health characteristics and needs • Higher rate of acute/chronic illness • Lack of access to services

9. Needs of homeless children Family stability Most, but not all homeless families are headed by a single mother Reasons for becoming homeless represent economic, emotional and environmental hardships Homeless mothers often represent with significant challenges Involvement in foster care Homeless as children Mental health concerns including post-traumatic stress, depressive and anxiety disorders Source: National Center on Family Homelessness

10. Needs of homeless children • Education • Characteristic needs of young homeless children • Increased rate of developmental delay and learning disability • System issues that inadvertently contribute to the needs • Lack of access for routine immunizations, dental care

11. Needs of homeless children Despite the enormous needs of homeless children, the system had been fragmented and disconnected

12. Medical Home for Homeless Kids Project • Background of the Medical Home Model • Partnership between Beacon Therapeutic and University of Chicago Comer Children’s Hospital • About University of Chicago Comer Children’s Hospital

13. What is a Medical Home? • Key components • Accessible • Family Centered • Coordinated • Comprehensive • Continuous • Compassionate • Culturally Competent Source: AAP Policy Statement: The Medical Home

14. Medical Home for Homeless Kids Project Goals of the project Identify and fill an access need to ensure that physical health needs of homeless children are met Identify and provide specialized developmental services to ensure that homeless children can succeed in their kindergarten placement

15. Medical Home for Homeless Kids Project • Key Service Components • Specialized developmental screening • Well-child physical health care • Access to dental care • Psychiatric and psychological support on-site as well as in the shelter setting • Recreational therapist focusing on children’s motor skills • Educational linkage and advocacy

16. Medical Home for Homeless Kids Project • Project receives funding support from • Illinois Department of Human Services • In-kind services from University of Chicago • United Way Pilot Funding • United Way Partner Agency funding • Housing and Urban Development (HUD)

17. Medical Home for Homeless Kids Project • Initial Outcome • Children and their parents are made aware of the resources offered by the Medical Home program • Indicator: • 100% of parents will consent to participation in TOTS/Medical Home Program • Initial outcomes revealed – 100% consented to participation in the program

18. Medical Home for Homeless Kids Project • Initial Outcome • Kids enhance their positive life-skills • Indicator • 100% of children referred will follow up on development and/or physical health screenings • Initial outcomes revealed100% consented to one or both areas of screenings

19. Medical Home for Homeless Kids Project • Intermediate Outcomes • 90% of children will exhibit improvement in their overall functioning including physical, emotional, behavioral and developmental • Initial outcomes revealed 89% of children exhibited improvement

20. Medical Home for Homeless Kids Project • Long-Term Outcome: Children will successfully transition to their kindergarten placement having stabilized all identified need areas • Indicator: 90% of children who complete treatment will successfully transition to kindergarten • Initial outcomes revealed – 100% of children who left the program were transitioned to their kindergarten placement

21. Medical Home for Homeless Kids Project • Strategies and Clinical Tools Used • Behavior Monitoring Form • Child Behavior Checklist • Kindergarten Readiness Form • Children’s Global Assessment Scale • Parent Stress Index (PSI) • Trauma Symptoms Checklist for Young Children (TSCYC)

22. Medical Home for Homeless Kids Project • Lessons Learned • Parents must be partners • Transient nature of this population • Transportation logistics • Health Information and follow-up for parents • Time and coordination among partners

23. Medical Home for Homeless Kids Project • Conclusion • We believe that the medical home program reflects an integrated, multi-disciplinary service delivery model