Health care for the homeless in a national health program

To assess the impact of adoption of a national health program on homeless care in the United States, care for this group in Britain's National Health Service (NHS) was evaluated. Although hospital and medication charges are eliminated, primary care for the homeless lacks central government directive, suffers from overlap of statutory agencies and mechanistic biases, is disproportionately delivered in emergency rooms, and has relied on advocacy by the non-profit sector. Disadvantages of this void in NHS provision are marginalization of the homeless and continuation of a two-class care system. Removal of financial barriers to care by enactment of a national health program in the US would not solve all issues related to delivery of quality care for the homeless unless its structure addressed the special needs of disenfranchised groups.     

Involving users in health care

The publication of Caring for People, The NHS and Community Care Act 1990, and The Patient's Charter, placed involving users at the forefront of discussions concerning the future organisation and management of health and social care services. Ray Higgins describes the evaluation of an advocacy project and the challenges for managers it presented.     

Modeling the mental health effects of victimization among homeless persons

Homeless persons are victims of violent and non-violent crime at higher rates than housed populations. While studies have suggested that victimization can induce or exacerbate mental health problems, there is very little known about factors that may buffer the effects of victimization. This cross-sectional study examined the influence of victimization on depressive symptoms in over 9600 homeless and mentally ill adults participating in the Access to Community Care and Effective Services and Supports study (ACCESS) conducted in multiple cities across the USA relationships between victimization, depressive symptoms, and perceived safety were tested within a structural equation modeling framework using data collected at the baseline interview. The overall model exhibited a good fit with the data. Non-physical victimization was associated with higher levels of depressive symptoms, and physical victimization was associated with lower levels of perceived safety. As hypothesized, perceived safety was a significant partial mediator of depressive symptoms. These results underscore the complexity of the relationships between victimization and depression in homeless adults and the importance of addressing different types of victimization in homeless and mentally ill adults.     

Shared care model in a federally qualified health care center for the homeless

Shared Care Model at The Daily Planet, is a nonprofit, 501(c)3 charitable organization that was started in 1969 as a case management organization and evolved into a comprehensive health services center for those at risk of or experiencing homelessness.     

The Allegheny initiative for mental health integration for the homeless: integrating heterogeneous health services for homeless persons

The Allegheny Initiative for Mental Health Integration for the Homeless (AIM-HIGH) was a 3-year urban initiative in Pennsylvania that sought to enhance integration and coordination of medical and behavioral services for homeless persons through system-, provider-, and client-level interventions. On a system level, AIM-HIGH established partnerships between several key medical and behavioral health agencies. On a provider level, AIM-HIGH conducted 5 county-wide conferences regarding homeless integration, attended by 637 attendees from 72 agencies. On a client level, 5 colocated medical and behavioral health care clinics provided care to 1986 homeless patients in 4084 encounters, generating 1917 referrals for care. For a modest investment, AIM-HIGH demonstrated that integration of medical and behavioral health services for homeless persons can occur in a large urban environment.     

A review of physical and mental health in homeless persons.

OBJECTIVE: To review the physical and mental status in homeless people. DATA SOURCES: A MEDLINE database search covering 5 decades was supplemented by tracing back through references from existing review work. Over 200 articles were extracted, and 106 were selected for review. MAIN FINDINGS: Homeless persons suffer frequently from physical health problems like tuberculosis, asthma, bronchitis, HIV infection, and as a consequence, they run an increased risk for premature mortality. The prevalence of mental disorders among homeless individuals varies from 80-95% in the USA, Australia, Canada, Norway, and Germany to 25-33% in Ireland and Spain. The most prominent mental disorders among the homeless, which vary from country to country, are depression, affective disorders, substance abuse, psychotic disorders, schizophrenia, and personality disorders. CONCLUSION: Homelessness is a major public health problem that should have our special interest.     

Transformational leadership in health care today

Management in nursing is in a state of revolution based on positive transformational changes. Effective leadership on individual nursing units directly affects nursing staff satisfaction. Employees are interested in managers who can lead in a positive and encouraging manner. Nurses who are content in their positions correlate to a reduction in staff turnover and improve retention. When the nursing staff are satisfied with their employment, patient satisfaction rises. Health care organizations can see this trickle-down effect through increases in patient satisfaction scores over time. The promotion of effective communication and positive attitudes enhances a healthy environment for all employees and staff. Health care organizations should evaluate individual nurse managers on units to promote transformational leadership qualities; this will directly result in staff satisfaction, staff retention, and patient satisfaction.     

The diversity of case management needs for the care of homeless persons

Health care providers have been attempting to meet the special needs of homeless people on a national level since 1984. The need to implement strategies specific to serving the diversity of services required by homeless people has been apparent. To devise appropriate strategies, clinical information was drawn from the Health Resources and Services Administration-Health Care for the Homeless (HRSA-HCH) projects, which were created in 1987 primarily to fill such a need. In addition, data gathered by the HCH projects (1984-87) funded by the Robert Wood Johnson and Pew Memorial Trust were used. It is suggested that the past mode of providing health care for the homeless has been found to be inadequate when confronting the complex problems of the homeless person of today. In general, health care providers need to focus more on case management activities, which may include activities not necessarily associated with the provision of health care services (for example, finding and providing food, clothing, shelter, and assessing entitlement eligibility) to achieve the ultimate goal--stabilization--and when possible, reintegration of the homeless person back into society.     

Unique health care utilization patterns in a homeless population in Ghent

Background  

Existing studies concerning the health care use of homeless people describe higher utilisation rates for hospital-based care and emergency care, and lower rates for primary care by homeless people compared to the general population. Homeless people are importantly hindered and/or steered in their health care use by barriers directly related to the organisation of care. Our goal is to describe the accessibility of primary health care services, secondary care and emergency care for homeless people living in an area with a universal primary health care system and active guidance towards this unique system.     

Clinical leadership in health care: a position statement

PURPOSE: This paper aims to briefly review leadership within the contemporary UK National Health Services (NHS) including Department of Health and Royal College of Nursing (RCN) initiatives. DESIGN/METHODOLOGY/APPROACH: It is argued that the concept of clinical leadership is a viable and important one, and is theoretically consistent with the contemporary social psychological literature on the importance of "local" leadership to effective organizational functioning. Field theory proposes that local influences (e.g. local management) on attitudes and behaviour will to a large extent mediate the impact of the organization (e.g. organisational structure and values) on (in this instance) health care delivery. FINDINGS: The reality of clinical leadership must involve a judicious blend effective management in the conventional sense with skill in transformational change in order to make real difference to the care delivery process. PRACTICAL IMPLICATIONS: For leadership initiatives to become truly culturally embedded into the "way we do things around here", they require more than just individual training and development. ORIGINALITY/VALUE: A view is offered for the practical interpretation of the clinical leadership concept in relationship terms. This will involve management of the relationship between health care professionals, between health care professionals and the "organizations" to which they are accountable and between health care professionals and service users.     

Leadership in health care and the leadership literature

Crossing the Quality Chasm, the Institute of Medicine's recently issued report on the quality of health care in America, is a call to arms for the urgent redesign of the U.S. health care system. The big question confronting health care organizations is how to mount new strategies that will enhance organizational effectiveness and reduce system failures as well as individual errors. Redesign implies organizational restructuring and engineering as well as serious steps in organizational development, with the emphasis on leadership enhancement strategies focused on performance excellence. This article addresses the state of the leadership literature and concludes that massive new investments will have to be made to tackle the issues of leadership training and accountability.     

Systemization of leadership for the systemization health care of health care: the unaddressed issue in health care reform

The case literature strongly suggests that both in England and in Australia health care reforms have had very little impact in terms of "improved performance". It is in the context of a perceived failure in the implementation of the reforms that an interest has arisen in leadership at the level of individual clinical units (e.g an orthopaedics unit or birth unit), as the possible "fix" for bridging the promise-performance gap. Drawing upon extensive case studies that highlight the problem and context for appropriate forms of leadership, this paper argues that the appropriate discourse, in terms of leadership in health reform, needs to focus upon the issue of authorization. In making this argument, addresses the current conceptions of leadership that have been advanced in the discourse before offering some case study material that is suggestive of why attention should be focused on the issue of authorization. Illustrates how and why the processes of leading, central to implementing reform, cannot be construed as socially disembodied processes. Rather, leading and following are partial and partisan processes whose potential is circumscribed by participants' position-takings and what is authorized in the institutional settings in which they are located Argues that the "following" that clinical unit managers could command was shaped by the sub-cultures and "regulatory ideals" with which staff of each profession are involved In the interests of reform, policy players in health should not be focusing attention solely upon the performative qualities and potential leadership abilities of middle level management, but also on their own performance. They should consider how their actions affect what is authorized institutionally and which sets the scope and limits of the leadership-followership dialectic in clinical settings.     

Use of the SF-12 instrument for measuring the health of homeless persons

OBJECTIVE: To evaluate the construct validity of the Short Form 12-item Survey (SF-12) among users of a homeless day shelter. Adding brief health assessments has potential to provide information regarding the effect that programs have upon the health status and functioning of homeless persons. STUDY SETTING: A convenience sample of 145 homeless persons at a day shelter in an urban setting. STUDY DESIGN: Participants were verbally administered the SF-12 that provides information on mental and physical health status and the Dartmouth Improve Your Medical Care Survey (IYMC) that provides information on functional health, clinical symptoms, medical conditions, and health risk. The IYMC survey system has been widely used in clinical settings to assess health status and the outcomes of care. DATA COLLECTION/EXTRACTION METHODS: Construct validity was assessed by the following approaches: (a) the method of extreme groups was used where multivariate analysis of variance determined if SF-12 summary scores varied for individuals who differed in self-reported clinical symptoms and medical conditions, and (b) convergent validity was assessed by correlating SF-12 summary scores with the subscales. PRINCIPAL FINDINGS: Four to 10 point differences in physical health (PCS12) and 5-11 point differences in mental health (MCS12) were found between those who reported acute symptoms and medical conditions and those who did not. A 13-point difference in PCS12 scores and a 7-16-point difference in MCS12 scores were found for those who reported none or few to several symptoms or conditions. The summary scores and subscales yielded satisfactory convergent validity coefficients that ranged from 0.62 to 0.88 with one exception. CONCLUSIONS: The SF-12 shows promise as a valid outcome indicator for assessing and monitoring health status among the homeless. Its strengths include brevity and availability of norms for specific medical conditions.     

Involving consumers in health care decision making

This paper considers ways of involving consumers in decisions regarding the allocation of scarce health service resources. Specifically, two levels of consumer participation are highlighted and discussed. These are: (1) at the level of deciding whether or not a particular service should be introduced or its scale changed; and (2) at the level of deciding how best to provide a service once it has been decided that the servicewill be provided. The limitations of the current methods of involving consumers are outlined and two alternative approaches discussed. These are willingness to pay and conjoint analysis.