jefferson county

Best Practices to Prevent and End Homelessness

In April 2013, John Andrew Young, a current Master of Public Health student at UAB, came to One Roof in search of a summer internship. John Andrew has a passion for policy and he wanted to help us achieve our mission by researching ways to effect positive and sustainable change for folks experiencing homelessness in our area. Under the direction of Michelle Farley, Executive Director of One Roof, and Valerie Bouriche, Administrative Coordinator of One Roof, John Andrew began a deeply involved project, researching and documenting nation- and world-wide best practices for preventing and ending homelessness.

At February’s monthly membership meeting, nearly a year after he began his project, John Andrew presented his research to our member agencies and we had a lively and thoughtful discussion about ways to maximize our resources to best serve folks experiencing homelessness in our area. We cannot thank John Andrew enough for his time, energy, and dedication to this project.

As you review these practices, we hope that you see how each is related to One Roof’s mission to prevent and end homelessness in our community. We understand that preventing and ending homelessness is different for each client–that each person experiencing homelessness in our area has an individual and complex set of circumstances that must be taken into account so that they receive the best and most appropriate care and services.

As recent Point in Time data indicates, the three largest subpopulations of folks experiencing homelessness in our area are folks who are chronically homeless, folks living with serious mental illnesses, and folks who chronically abuse substances. John Andrew’s presentation shows that many of the practices he researched are a proven method for preventing and ending homelessness for these particular groups in our country and other countries. We believe that these practices, while not appropriate for all clients or all service providers, can help eliminate barriers to housing for clients who are chronically homeless, severely mentally ill, or chronic substance abusers. Here are a few of these promising practices:

Housing First

Clients experiencing homelessness are quickly placed into a safe, decent, and affordable home, bypassing emergency shelters and transitional housing programs. This allows a client who was previously unstable to quickly gain stability. Clients are provided access to various services (mental health counseling, drug and alcohol treatment, healthcare, etc), but these services are not required. The main goal is taking vulnerable persons off the street and placing them into a safe, stable home. We believe that stability is paramount to personal growth and self-care. Stability allows clients to focus on underlying issues at the root of their prolonged instability.

SOAR

SSI/SSDI Outreach Access and Recovery (SOAR) is a national best practice aimed to increase SSI/SSDI benefits for persons living with a disabling condition and experiencing homelessness. These benefits provide a stable income, reduce economic insecurity for those who have a disabling condition and are unable to work, and allow access to health insurance and certain types of permanent housing. This practice also provides an immediate source of income for clients living with a disabling condition and reentering society after incarceration. Utilization of this practice prevents and ends homelessness for clients living with disabling conditions and experiencing homelessness / at-risk for experiencing homelessness. We believe that persons living with disabilities deserve stability and One Roof currently has a SOAR Specialist, Keyana Lewis, who assists clients applying for SSI/SSDI benefits. To read more about our SOAR program, click here.

Harm Reduction

Simply put, this practice reduces harm for clients who abuse substances. When a service provider practices harm reduction, clients are accepted as they are when they show up for services and they don’t have to fear expulsion due to their substance abuse. If a client shows up to a shelter or housing provider and is denied entry because they are under the influence, they may be forced to stay on the street. Staying on the street is unsafe for a person under the influence because they are more vulnerable and less able to perceive extreme temperatures and weather conditions. With a safe and warm place to sleep, potential harm is significantly reduced. Clients can be connected with appropriate supportive services which allow them to gain stability, minimize unhealthy outcomes due to their substance abuse, and work on underlying issues which might be causing them to abuse substances.

To read more about these practices and others, be sure to check out John Andrew’s presentation. One Roof is deeply committed to preventing and ending homelessness in our area through advocacy, education, and the coordination of services. While these practices may not be the solution for all clients or all housing providers, John Andrew’s research shows that these practices can allows us to successfully and strategically prevent and end homelessness; increase opportunities for housing, economic, and employment stability for community members; plan for more efficient use of community resources; and build a stronger community. We believe that all community members deserve safety, stability, and a decent and affordable home. To support One Roof’s efforts, click here.

 

Josh Helms is an AmeriCorps member serving at One Roof as the Capacity Building Assistant.

 

Why it should bother YOU that a person who is homeless cannot get medical care

A clinic waiting room is shown at Cooper Green Mercy Hospital in Birmingham, Ala., Friday, March 23, 2012. (The Birmingham News/Mark Almond)

Cooper Green has not left the headlines since Inpatient Care and the Emergency Room were closed last year. A large physician’s group is now speaking out about poor people not receiving medical services — a situation they say will raise medical costs for everyone.

However, a recent scholarly article published in the Journal of Urban Health tells an equally frightening story….a story that has been going on for more than 10 years.  The following news articles are as recent as April 26, 2013:

The Journal of Urban Health tells us that in 2010, a group of researchers set out to understand more about a previous study showing that the homeless of our community have problems accessing medical care. The 2010 study showed:

  1. that the problems with getting care are real and that they remain severe

  2. that problems pertain to all types of health care, even the most basic general care that charity clinics and federally qualified health centers get funds, grants and donations to provide

  3. that the problems with getting care are especially difficult at the federally funded Birmingham Health Care, and at the primary care clinics at Cooper Green

The study shows that 15% of homeless people who went to Birmingham Health Care could not get care, and that, at the Cooper Green clinics, 13% could not get care. The study shows that, from 1995 to 2005, the percentage of homeless persons in Birmingham with unmet health care needs rose from 32% to 54%, meaning that on at least one occasion, these individuals were unable to access a form of health care they needed even though they tried.

Why should it bother YOU that a person who is homeless cannot get medical care? Well, first thing is that One Roof believes it is morally the right thing to do to see that basic medical care is provided for ALL citizens. Additionally, it is fairly disturbing that we live in one of the arguably greatest medical centers anywhere, and people who have lived here for their entire lives cannot access basic medical care.  However, if you don’t care about those reasons, let me share another reason:  money. The links below are just three short articles out of the hundreds of studies that show routine care for chronic conditions is far less expensive than emergency care.

The bottom line of all these studies is that medical costs incurred when getting routine medical care in a doctor’s office or clinic setting are much, much lower than going to the emergency room. Logically, a person who is unable to receive the needed routine care in a clinic is unlikely to be able to afford the emergency room care. If the emergency room care is not paid for by the patient, the unpaid cost will somehow be passed on to other hospital patients…that means you and me.

Ok, so non-emergency care is cheaper than emergency care. So why doesn’t everyone use the doctor’s office or clinic instead of going to the emergency room?  What if you can’t, as most homeless people can’t, afford that non-emergency care?  The safety net in place is a Federally Qualified Health Center or FQHC.

What is a FQHC? A FQHC serves as the medical home and family physician to 15 million people nationally. FQHC patients are among the nation’s most vulnerable populations with about half living in economically depressed inner city communities. Nearly 70% of FQHC patients have family incomes at or below poverty. Nationally, 40% of FQHC patients are uninsured and another 36% depend on Medicaid, much higher than the national rates of 12% and 15% for the nation’s population as a whole. Two-thirds of health center patients are members of racial and ethnic minorities.

Where are the FQHC’s for the majority of this area’s homeless population?

According to the U.S. Department of Health and Human Resources Health Resources and Service Administration, Birmingham Health Care is the FQHC for this area. But remember, the study published recently said that it has been increasingly difficult over the past few years for the homeless to access health care at Birmingham Health Care. If it is difficult for the homeless people to access health care at Birmingham Health Care and at Cooper Green, doesn’t it stand to reason that these sick people will probably end up in an emergency room? If asthma is not controlled with routine medications, permanently damaged lungs and frequent hospital visits can result. If high blood pressure is not controlled, congestive heart failure can be the expensive consequence. If an abscessed tooth is not removed, bacterial endocarditis (a heart infection) can happen. Let’s not even go into the myriad of problems that result from uncontrolled diabetes.

To add another layer to this complex problem, homeless people have more medical problems than housed people. Really?

Yes, really, according to the above studies and articles. It makes sense that the common cold is easier to treat in your own home, on your own couch, with your own chicken soup, than if you are under the interstate, on your own concrete, with nothing to eat.  It only stands to reason that asthma is easier to treat if you have your own home, with your own inhalers and an ability to close the windows to the dust and pollen, than if you are on the streets, with no medications, and no doors, windows or walls to close to anything. If homeless people have more medical problems than housed people, they will need more medical care (or we could just house them, but that is a whole other story).

Back to the headlines…reduced access to medical care for our homeless population. Let’s believe that people with understanding of medicine, poverty, business, and the intersection of the three will step up and figure out how to wisely use the resources of our community to provide the care that area citizens deserve…whether that care is seen as a moral obligation or a financial imperative.

For more information about area homelessness, please feel free to review previous articles on our blog or take a look at our Point in Time information.

 Michelle Farley, Executive Director
Volunteer Now to help end homelessness
Get help addressing a homeless situation

One Roof Events