a book by McMurray-Avila... I feel like I am in college again. On one of my first days of work, I was handed this book and told to read it. Here's what it says about my job...
[Issues of substance use and mental illness] were common problems for people being seen [at clinics] and were often the underlying cause of physical health complaints.
In response to the growing awareness of the problem of homlessness, Congress passed the Stewart B. McKinney Homeless Assistance Act on July 22, 1987 to provide "urgently needed assistance to protect and improve the lives and safety of the homeless." The McKinney Act (McKinney-Vento Act) provided for a wide range of programs for people who are homeless including emergency food and shelter, transitional and long-term housing, primary health care, mental health care, mental health services, education and job training.
Specifically, HCH programs:
-provide for primary health care and substance abuse services at locations accessible to homeless people;
-provide for emergency care with referrals to hospitals for in-patient care services and/or to needed mental health services; and
-provide for outreach services to access difficult to reach homeless persons, and for aid in establishing eligibility for entitlement programs and housing
*most of my job is the third point
HCH projects are unique in that they directly attack the access barriers by taking the services out to where homeless people are found, at times that make the most sense.
HCH projects are known for their hallmark approach to aggressive outreach.
HCH staff make sure that their clients do not face additional obstacles to getting what they need.
*another very noticeable point of my job
A final aspect of improving accessibility is perhaps one of the simplest, but most essential -- providing services without regard to ability to pay. Given that homelessness represents the lowest end of the poverty spectrum, most HCH clients recieve their care at no charge. When Medicaid reimbursement is available, HCH projects bill the Medicaid agency for payment. HCH staff also work to assure that any homeless person who is eligible for Medicaid has access to this valuable resource for recieving medical care.
Effective implementation of this approach depends upon the attitude of those involved in the work itself. It is the philosophy of HCH projects that people who are homeless deserve to be treated with dignity and respect, and with sensitivity to cultural and ethnic diversity. Another common theme running through all aspects of HCH services is an understanding of homelessness as a social, political and economic phenomenon, and not simply the result of people making mistakes in their lives.
What makes HCH projects more than just "clinics that serve homeless people" is the philosophy that their ultimate goal is to help people escape homelessness. This means collaborating with others in the movement to change the policies, circumstances, and attitudes that cause homelessness in the first place. It also requires intensive work with coalitions dedicated to coordinating and expanding the continuum of services available for people experiencing homelessness.
Sometimes the needed resources do not exist, while those that do exist are rarely coordinated sufficiently to consitute an understandable and easily accessible continuum of care.
Barriers are:
lack of awareness of available services
lack of financial resources or health insurance
lack of documentation
language and cultural barriers
attitude of providers
scheduling difficulties
lack of transportation
fear or distrust of large institutions
lack of comprehensive services
Case management is distinguished from other health care activities in that it addressess the well-being and quality of life of the client as that person defines it, not as defined by diagnostic categories chosen by health care providers. Seen in this light, any improvement in the quality of life of a person who is homeless is a move toward health. In this process the person's own perception of what consititutes health plays a major role. The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Case management is a tool to achieve that state of health.
Hope is to shape the nature of healthcare systems so that they become more responsive and relevant.
Case management has potential to become a source of human support for those who have none.
Hopefully this gives you a bit more of an educated idea of what it's like to be a social work case manager within health care for the homeless. The toughest part thus far has been becoming acquainted with all the opportunities in pittsburgh. No wonder nobody knows about services-- its hard for even social workers to keep up with all of them!! Continue to pray for me as I am adjusting to this job. Continue to pray for the homeless.
