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IHS : 35 Years of Serving Chronically Homeless People

The Institute for Human Services, Inc. IHS : 35 Years of Serving Chronically Homeless People. Definition & Diversity of Homeless Persons. Homeless definition has 4 categories: Literally homeless individuals/families Imminently at risk for homelessness

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IHS : 35 Years of Serving Chronically Homeless People

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  1. The Institute for Human Services, Inc IHS : 35 Years of Serving Chronically Homeless People

  2. Definition & Diversity of Homeless Persons Homeless definition has 4 categories: • Literally homeless individuals/families • Imminently at risk for homelessness • Unaccompanied youth or families with children/youth who meet the homeless defintion under another federal statute and 3 additional criteria • Imminently at risk for homelessness

  3. Homelessness = • A person or family who lacks fixed, regular , and adequate housing nighttime residence, meaning: • Sleeping in a place not designed for or ordinarily used for as a regular sleeping accommodation: car, park, abandoned building,bus/train station, airport, camping ground • Living in a shelter

  4. Chronically Homeless = • Homeless for 365 days or 4 episodes in the last 3 years AND • Have a disability that is expected to persist indefinitely

  5. Chronically Homeless Individual

  6. Just imagine… • You haven’t had a safe place to sleep in over a year. So your sleep is probably not very deep. How might your mood and ability to think be affected? • Would you remember how to take your medication as prescribed? • Might you be showing signs of grumpiness, distractability and forgetfulness?

  7. You don‘t have a home…. • How do you keep medications like insulin refrigerated ? • How do you secure your pain medications prescribed for chronic back pain that you’ve developed because you’re sleeping on the hard cement all the time? • How do you stay warm and dry in the pouring rain?

  8. Imagine… • You barely have enough resources to pay for food, transportation and maintaining your hygiene… • How would you do laundry? • How do you avoid getting an infection or allowing a small one to fester?

  9. IHS and Chronically Homeless Individuals • SAMHSA grant focused on helping chronically homeless individuals access needed treatment AND housing. • Systematically identifying and prioritizing those who are chronically homeless or vulnerable for intervention because… • Housing IS treatment.

  10. In 1st Year… • We served 367 chronically homeless persons through outreach (116) and inreach (251) • We placed 115 of them into housing • 57% of unsheltered outreached had health insurance benefits • 62% of sheltered had medical benefits at intake • 28 accessed substance abuse treatment • 88 accessed psychiatric evaluation or treatment

  11. Psychiatry-Assisted IHS Outreach • Project sought to demonstrate the impact of psychiatry assisted outreach • Compared homeless people who are geographically in the urban area (Downtown Honolulu, China town, Kalihi) and those how are in a rural area (North Shore - Wahiawa) • Triaging very ill persons and finding help for them

  12. Over 19 months...

  13. Challenges to Serving Chronically Homeless People • Approach to Healthcare: • Accessibility • Affordability • Appropriateness • Ability to engage in tx

  14. Confidentiality: Protection or Obstacle • Other current Health care providers • Past healthcare providers • Family • Homeless providers • Case managers • Neighbors & others concerned

  15. Medical Acuity of Homeless Persons • Increasing numbers coming to IHS with more serious medical problems • In calendar year Jan-Dec 2012, IHS fielded 434 referrals from hospitals • 109 New from hospital • 222 were returning guests • 13 were turned down due to their acuity required

  16. Who’s coming through the door? • Post surgery • Discharged from Psychiatric unit -SI • Post detox • Dying • Post partum • Cardiac conditions • Diabetes • Major infections

  17. What we do… • Making Connections • Emergency Room • Clinics • Mobile medical care • Screening to prevent • TB, Hansens Disease • Physical: Diabetes, hypertension, asthma, skin infections etc. • Onsite treatment or triage • Provide transportation – bus fare, taxi vouchers

  18. What do you do? • When you know a person is homeless, do you ask about their environment and resources? • Are you screening for behavioral health issues? • Do you ask about their practical support network? • When you give Rx, do you assess if the person has ability to fill it and follow through? • Do you take time to access information on the persons past success with treatment? • Or to assess motivation for treatment

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