1. Nurse Managed 12 week Latent Tuberculosis Infection Treatment
Contra CostA county Health care for Homeless
Jo Elliff, FNP
Rose Vigil, RN

2. HCH Mission statement
Our mission is to reach out and serve homeless adults, children and families of Contra Costa County by providing accessible, culturally sensitive services in order to promote wellness, prevent illness and to provide care when needed so that ultimately, we may improve the health status of this vulnerable population.

3. Who Qualifies as Homeless?
Lacking a fixed, regular, adequate nighttime residence
Primary night-time residence in a shelter, welfare hotel, transitional housing or street
“Doubled-up” without name on a lease, couch surfing, etc.

4. Funding for hch services
Section 330(h) Public Health Services Act Health Care for the Homeless grant from the Federal Government
(Health Resources and Services Administration, HRSA)

5. HCH Types of services HCH Ambulatory Clinics HCH Mobile Clinics
Respite Care
HCH Behavioral Health Services
HCH Dental Clinics
Medical Outreach Team
Eligibility Services
Linkages to Care (Specialty services, establishing a medical home, PCP)

6. HCH Team Medical Director Program Manager
Family Nurse Practitioners (FNP)
Registered Nurses (RN)
Community Health Workers (CHW)
Certified Enrollment Counselors
Consumer Liaison
Senior Health Education Specialist
Mental Health Specialist
Licensed Clinical Social Worker (LCSW)
Dentist
Registered Dental Assistant

7. Homeless population served
The number of homeless patients served by Contra Costa Health Services in 2015
31, 093 Unduplicated Homeless Patients
Medical Visits: 100,532
Dental Visits:4,058
Mental Health Visits: 33,321
Substance Abuse Visits: 11,623

10. Patients completed treatment

11. Entry into rehabilitation centers Foreign born General health screen
Who gets tested?
Entry into shelters
Entry into rehabilitation centers
Foreign born
General health screen

12. If initial screening is positive:
Testing process
Health Screen
Initial testing
TST (Tuberculosis Skin Test)
QFT (Quantiferon)
If initial screening is positive:
 chest x-ray
 if chest x-ray negative and patient is asymptomatic = consider LTBI treatment

13. Result Follow up Discuss diagnosis Discuss treatment options
Discuss the risks/benefits of treatments
Physical evaluation
Importance of medication adherence
Asses adherence to treatment plan
Provider order medications
Schedule follow up with RN for 12 week nurse managed LTBI treatment

14. nurse managed ltbi treatment Directly observed treatment
Starting Treatment
Discuss possible side-effects to treatment resistance
Weekly symptom screen
Positive symptom screen follow protocol
Reinforce importance of medication adherence
Identify potential barrier to adherence
Establish plan to ensure adherence

15. Challenges of medication adherence
Lack of access to health care
Co-existing medical conditions
Unstable housing
Require weekly visits
Low health literacy
Alcohol/substance use
High number of life stressors
Language barrier

16. Why it works Initial testing to follow up  1 week
Shorter duration of treatment
Extended shelter stay
Part of comprehensive care
Mobile
Provide transportation vouchers (i.e. bus tickets)
No cost medication
Medications kept centralized
Spanish speaking providers
Core Outreach team
PHN referral

17. Lost to follow up – moved out of area Hospitalizations
On going challenges
Lost to care – jail
Lost to follow up – moved out of area
Hospitalizations
Non – compliance
Transportation