Clients in the Community: Chronic Illness, Homelessness and Special Needs of Infants, Children, and Adolescents Chapter 12, 14, 16 NUR 185

Social Justice Social justice is demonstrated by society seeing the health needs and health care issues of all people as having economic and social ramifications Cultural, racial, and socioeconomic differences are often turned into discrimination in health care services and policies

Definitions of Poverty and Homelessness Poor - people living below the government defined poverty threshold income level Extreme poor - people trying to survive on less than half the official poverty line Absolute poverty - not having enough money for shelter, clothing, and food Relative poverty - inability to afford goods and services that are considered necessities Homelessness- is lack of fixed, regular, and adequate nighttime residence (supervised shelter)

Some Causes of Homelessness Poverty and unavailable low-cost housing Battered women without resources Underinsured people who suffer severe physical or emotional illness Addictions cause disability support to be denied Economic, Social, Personal, Political

Health Effects and Homelessness Living outside results in exposure to assault and the weather Living in shelters results in exposure to violence and communicable diseases Basic activities of daily living are difficult, resulting in sleep deprivation, fear, hunger, inadequate hygiene, no privacy, no control Homelessness precipitates ill health, complicates treatment of ill health, and ill health causes homelessness

Interventions The Interagency Council on the Homeless coordinates federal homeless resources and is made up of the leaders of 16 federal agencies that have programs Health care programs for the homeless are limited and fragmented, with no continuity of care

Factors and Homelessness: The Barriers to Care Insensitivity and stereotyping on the part of providers Cultural barriers regarding health beliefs and behavior The homeless person’s first priority of food and shelter instead of health Breakdown in communication and fear of “the system” Lack of health insurance and bureaucratic paperwork to obtain services Lack of transportation to services Poor literacy skills and Language barriers Criminal records and Legal status Female-headed households, loss of government benefits, minimal wage jobs

CHN’s Role in Homelessness and Poverty Confronting poverty and caring for people who are poor require reflective assessment of one’s own assumptions and beliefs Serving as an advocate and bridge for families who need to gain access Intervening as a coach and guide, interpreting the system Acting as change agent to improve the system

Chronic Illness Is not curable by simple medical procedures or medical therapy Affects all age groups Occurs across all racial and ethnic groups Affects family and community as well as the client

Highest Prevalence Rates in U.S. Orthopedic impairments Arthritis High BP Hearing impairments Heart disease Respiratory Headaches

CHN’s Role in Chronic Diseases The emphasis is on preventing disease before it begins, rather than treating the disease after it occurs Primary Secondary Tertiary

Healthy People 2010 Targets Physical activity Obesity Tobacco and substance use Irresponsible sexual behavior Mental illness Injury and violence Poor environmental quality

CHN Impacting Infant Mortality Assess and counsel pregnant women Referral to prenatal resources Educate about health, nutrition, food allergies, immunizations, and injury prevention Monitor and refer infants to care when needed Educate parents about affordable nutrition Low birth weight and premature infants are at the highest risks to die within the first year Breastfeeding is still the best nutrition for NB, Need to take hT, WT,

CHN Impacts Immunizations Educate families regarding Side effects Access to care Knowledge about diseases vaccinated against Routine vaccinations of infants and children include: DPT<Oral polio, MMR, Influenza, Hep B.

Pediatric Health Problems Failure to thrive Exposure to tobacco smoke (direct and indirect) Unintentional injuries Lead poisoning Poverty and homelessness Child abuse and neglect

Adolescent Health Problems Tobacco use Alcohol consumption Use of illicit drugs Pregnancy STDs Violence Inadequate nutrition due to eating disorders, pregnancy, or illness