Shelter Health: Leveraging Partnerships to Improve Access and Build a Healthier Shelter Environment

Shelter Health: Leveraging

Partnerships to Improve Access and Build a Healthier Shelter Environment 2024

During the height of the COVID-19 pandemic, Health Care for the Homeless health centers collaborated with homeless shelters to mitigate COVID-19 transmission. This experience revealed that health centers and shelters can successfully collaborate to create a continuum of care that is better equipped to increase access to care and improve health outcomes for patients/residents, than if one organization attempts to implement changes/practices alone.

Shelter health is a broad term that encompasses both the health of the individuals residing in that shelter as well as the environmental factors that contribute to the health and well-being of those who reside and work there. Improving shelter health requires increasing residents access to health care services - medical, mental health, and substance use - while also planning for and responding to events that impact the overall health of everyone in the facility. These impacts could be disease related (e.g. infectious diseases that are transmittable from person to person, such as TB, COVID, C-Diff, etc.) or environmental (e.g. worsening air quality, natural disasters, etc.) and could happen acutely or be an on-going issue that shelters must adapt to.

Health Centers, especially health care for the homeless providers, are uniquely positioned to engage with shelters to provide care for their residents and to develop procedures, policies, and response plans to expected and unforeseen health concerns. This toolkit contains resources health centers and shelters may use to improve access to primary care for people experiencing homelessness and identify strategies to create strong partnerships between shelters, health centers and local health departments.

Section 1: Strengthening Partnerships Between Shelters & Health Centers

Strengthening Partnerships for Better Health Outcomes During COVID-19 (2021)

• Description: This brief was created to improve health care quality and outcomes for people experiencing homelessness during the COVID-19 pandemic by strengthening partnerships between homeless response systems and health care providers. It includes descriptions of three communities Atlanta, Chicago, and the State of Connecticut that built strong and constructive partnerships.

Making the Connection: Improving the Relationship Between Shelters and Health Centers (2018)

• Description: With a multitude of case management obligations, constant staff turnover, and an important emphasis on housing first – it can be difficult for emergency shelter staff to prioritize the health care of their clients. The National Health Care for the Homeless Council’s TennCare Shelter Enrollment Project has developed ways of reaching out to emergency shelters and bridging the gap between shelter and clinic for both staff and residents. From regional training to Medicaid enrollment, learn effective strategies to strengthen your relationship with those who provide direct service to the homeless community in your region.

Shelter-Based Care for Homeless Populations [Healing Hands] (2018)

• Description: This issue of Healing Hands focuses on innovative shelter-based health care programs that provide low-barrier health care to people living in shelter settings, showing that reducing barriers to care not only leads to improvement in individuals’ health, but also to population health. This edition also examines the types of health care that can be provided in a shelter-based setting, as well as best practices and lessons learned for collaborating effectively with shelter staff and for providing person-centered, trauma-informed health care in a shelter.

Key Elements of Integrated Care for Persons Experiencing Homelessness: A Guide for Health Care for the Homeless Providers (2011)

• Description: This document examines integrated care from the perspective of the key elements of the Health Care for the Homeless (HCH) model, with program examples drawn from interviews with a variety of HCH providers, representing urban and rural, small and large, newly funded or with long histories of service delivery, and varying organizational structures. This resource aims to provide information that will facilitate a greater understanding of integration of care, the HCH model, and the alignment between that model and the Patient Centered Medical Home.

On page 21, there is a short paragraph about the partnership between health centers and shelters and then a brief "Examples from the Field" section, which provides a few sentences on 4 different health center/shelter partnerships.

Section2: ShelterHealth

Improving Indoor Air Quality in Homeless Shelters and Service Sites (2023)

• Description: This toolkit was created by the Alameda County Health Care Services Agency’s Health Care for the Homeless (ACHCH) program and Alameda County Community Development Agency’s Healthy Homes Department for program managers, direct care staff, volunteers, and others who operate homeless shelters, housing, or services in congregate settings. It offers strategies that can help reduce the spread of airborne diseases, such as COVID19 and asthma triggers.

Infection control and winter planning series (2023)

• Description: This Department of Housing and Urban Development (HUD) webinar series is a resource designed with HUD recipients as the target audience and goes over general infection control, best practices for cleaning in congregate settings, and isolation and operational considerations.

Overview of Infectious Disease (2022)

• Description: These slides are from a National Health Care for the Homeless Council training focused on infectious disease. The slides contain information about the basics of infectious disease as well as information about the role outreach workers play with regard to infectious disease management and providing health services to people experiencing homelessness.

Assessment of Health Needs and Identifying Emergencies (2022)

• Description: These slides are from a National Health Care for the Homeless Council training that provides information, strategies, and practices that assist with evaluating clients' health needs and with assessing what is and what is not a health emergency.

Standards for Shelter-Based Health Care (2020)

• Description: This guide was developed by the Chicago Homelessness and Health Response Group for Equity to support primary health care teams going into shelters to provide care. The guide offers information on topics including the benefits of shelter-based health care, guiding principles for shelter-based health care, key components of partnerships between health care providers and

shelter, providing care and COVID-19, key components of shelter health and outreach and engagement, and providing trauma-informed care.

Infectious Disease Toolkit (2020)

• Description: This Department of Housing and Urban Development (HUD) toolkit is intended to support Continuums of Care (CoC) with responding to infectious diseases (outbreaks and regular seasonal illnesses) and focuses on the need to develop partnerships with health care providers - specifically Health Care for the Homeless organizations.

Shelter Health: Opportunities for Health Care for the Homeless Projects (2016)

• Description: Health centers can play a key role in improving shelter health for individuals and families experiencing homelessness. In addition to screening and treating conditions that arise in the shelter setting, health centers can work with local shelters and public health departments to mitigate health risks by developing strategies to prevent, identify, and resolve drivers of poor health. This issue brief identifies certain health issues that can be particularly affected by shelter conditions, identifies opportunities for health centers to be engaged in local efforts to improve shelter health, and describes environmental health services supported by the federal Health Center Program.

Pandemic Influenza Guidance for Homeless Shelters & Homeless Services Providers (2009)

• Description: This practical manual is for homeless shelters and other service providers as they plan for and respond to the special needs of people experiencing homelessness during the influenza season. Different facilities will need to tailor the guidance to meet the specific needs of their staff and the people they serve. The manual consolidates a number of materials developed by credible authorities.

Shelter Health: Essentials of Care for People Living in Shelter (2006)

• Description: Serious health problems are common among people experiencing homelessness, and shelter settings may pose or exacerbate particular health risks for residents and service providers, as well as opportunities for important health care interventions. This guide has been designed for communities where providers of shelter and other services can come together, learn about and discuss the issues, and plan individual and collaborative solutions. The guide is not intended to be a step-by-step “how-to” manual for setting up shelter services, but rather aims to provide tools and support to help shelter providers respond more effectively to the health needs of residents.

Shelter Health and COVID-19

• Description: Alameda County Health Care for the Homeless (ACHCH) web page that provides a list of a variety of Shelter Health and COVID-19 resources.

This toolkit was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,788,315 with 0% percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

StaffBridge

BacktoClinic

Outreachworkers peers and communityhealthworkersserveas liaisonstoconnectclientswithcare Supportwithaccessingcareatthe healthcenter includingwarmhand offstoproviders

MobileClinic ComestoShelter

Cliniconwheels allowsfor consistentclinicalservicesnot contingentuponspaceavailability insidetheshelter

Mobilecliniccanquicklyrespondto differentshelterlocationsasneeded Mobileclinicisjustoutsideshelter doors

Shelter healthteam: Composition servicesoffered, etc

HealthCenter ServesAs On-CallProvider forShelter

Telehealthcanbeused Healthcenterstaffcanhelpshelter stafftriageneedsoftheclientto determineamedicalcareplan

MedicalProvider DoesOutreach toShelter

Similartoa backpackmodel whereprovidersseeclientsinthe exactspottheyare Confidentialitycanbe challenging

Shelter HealthModels

Shelterhealthlooksdifferentineach communityandisdeterminedbytheneeds ofthepopulation,space,andtheresources available Noonemodelisinnatelybetter andoftenusingmultiplemodelsinconjunction canmeettheneedsoftheshelterresidents moreeffectively.Allmodelsare bestimplementedwhencombinedwith client-centered,traumainformed, harmreductionapproaches toengagementandcare

Medically DesignatedSpace

Spacewithinafacilityisdesignated forclientswhorequireadditional medicalsupport HealthCenterstaffprovidecarein thatspaceforclientswhoarethere Rules/Policiesfortheseclientsmay needtobedifferentbasedontheir abilitytoambulate etc

Embedded Clinic

CouldbebroughtundertheHRSA scopeofhealthcenterasa satellite site”sothatthespaceisfullystaffed andoperatedbythehealthcenter Ifthisisdone,thespacecannotbe usedbyotherorganizationswithout agreementfromthehealthcenter Hoursaresetbyhealthcenter

HealthCenter Provides CrisisSupport

Couldbemedicalorbehavioral healthteams(orboth)

Healthcenterstaffprovidesondemandcrisisassessmentand support

MedicalTriage

Usedtodetermineadmittance intoashelter Maybeamethodof storing/managingmedication

Considerations for All Models of Shelter Health

Hoursof operation

Space opportunities andlimitations

Client communication: Howwillpeople knowyou’re there?

Clientflow: Howwill clients beseen byproviders?

Medication: Whatwillbe available?How willclientsget medications?Where willtheybestored?

Confidentiality: Howprograms willtalktoone anotherabout sharedclients?