1. Health Care for the Homeless and Hepatitis National Hepatitis Coordinators' Conference January 27, 2003
Presented by:
Amy M. Taylor, MD, MHS
Deputy Chief, Health Care for the Homeless Branch
Division of Programs for Special Populations
Bureau of Primary Health Care/HRSA

2. Objectives
To provide an overview of HRSA's Health Care for the Homeless program.
To provide an overview of health issues faced by homeless people.
To discuss the barriers to care for homeless individuals.
To review the risk factors of hepatitis among homeless individuals.

3. Homelessness in America
estimated 600, ,000 homeless persons on any given night
up to 2 million persons are homeless within a one-year period
12 million persons in the U.S. have been homeless at some point in their lives

4. Homelessness in America
35% are children and families
30% are veterans
estimated 200,000 persons are chronically homeless

5. Homelessness in America
Homeless people have extensive medical needs and
disabilities
30% have a serious mental illness
50% have substance abuse issues
homeless people have high rates of infectious diseases (including HIV/AIDS), chronic illnesses and exposure-related illnesses

6. The Federal Response
Stewart B. McKinney Homeless Assistance Act was passed in 1987
established targeted programs throughout the Federal system
housing
health care
income supports and job training
veterans programs.

7. The Federal Response
Targeted health programs in Department of Health and Human Services
Health Care for the Homeless (HRSA)
primary care and substance abuse services, begun 1988, reauthorized as part of the Health Centers Consolidation Act in 1996

8. The Federal Response
Targeted health programs in Department of Health and Human Services
Projects for Assistance in Transition from Homelessness (SAMHSA)
outreach and case management of homeless persons with serious mental illnesses, begun in its current form in 1990

9. The Federal Response
Targeted health programs in Department of Health and Human Services
Addictions Treatment for Homeless Persons (SAMHSA)
begun 2001

10. Consolidated Health Center Program
Community Health Centers
Migrant Health Centers
Health Care for the Homeless
School-Based Health Centers
Public Housing Primary Care

11. Consolidated Health Center Program
provides services to meet the primary health care needs of low-income and underserved individuals and families
closely linked to the communities they serve

12. Health Care for the Homeless
Currently 154 grantees
Grantee Sponsorship
49% (75) community health centers
16% (25) public health departments
7% (11) hospitals
28% (43) other community-based organizations

13. Health Care for the Homeless
Clients
approximately 515,000 persons seen in Calendar Year 2001
63% are persons of color
18% are under age 20, including 35,000 adolescents

14. Health Care for the Homeless
Clients
92% are below 100% of the Federal Poverty Level
74% are uninsured; 19% are enrolled in Medicaid

15. Health Care for the Homeless
Service settings - diverse to meet client’s needs
stable clinic sites
mobile vans
shelter and street-based care

16. Health Care for the Homeless
Services offered
primary care
substance abuse services
mental health services
oral health services

17. Health Care for the Homeless
Services offered
extensive outreach and engagement
extensive case management services
assistance with accessing public benefits, housing, job training, etc.

18. Health Issues Physical Health
Acute illnesses such as respiratory infections, trauma, minor skin ailments
Chronic conditions such as hypertension, diabetes, arthritis, COPD

19. Health Issues Physical Health
Oral health problems such as missing teeth, tooth decay, oral cancer
Infectious diseases such as STDs, HIV/AIDS, hepatitis, TB

20. Health Issues Behavioral Health
serious mental illness such as schizophrenia, bipolar disease and major depression
substance abuse disorders
approximately 40% of homeless drug users have a co-occurring mental illness

21. Barriers to Care circumstances of homelessness
lack of financial resources and health insurance
lack of documentation
language and cultural barriers

22. Barriers to Care attitudes of providers scheduling difficulties
lack of transportation
fear and distrust of institutions

23. Risk Factors for Hepatitis
low socioeconomic status
crowded living conditions
dumpster diving
immigrant status

24. Risk Factors for Hepatitis
injection drug use
sexual behaviors
alcohol abuse

25. Contact Information
Amy M. Taylor
(301)