1. The Institute for Human Services, Inc

2. Definition & Diversity of Homeless Persons Homeless definition has 4 categories:  Literally homeless individuals/families  Imminently at risk for homelessness  Unaccompanied youth or families with children/youth who meet the homeless defintion under another federal statute and 3 additional criteria  Imminently at risk for homelessness

3. Homelessness =  A person or family who lacks fixed, regular, and adequate housing nighttime residence, meaning:  Sleeping in a place not designed for or ordinarily used for as a regular sleeping accommodation: car, park, abandoned building,bus/train station, airport, camping ground  Living in a shelter

4. Chronically Homeless =  Homeless for 365 days or 4 episodes in the last 3 years AND  Have a disability that is expected to persist indefinitely

5. Chronically Homeless Individual

6. Just imagine…  You haven’t had a safe place to sleep in over a year. So your sleep is probably not very deep. How might your mood and ability to think be affected?  Would you remember how to take your medication as prescribed?  Might you be showing signs of grumpiness, distractability and forgetfulness?

7. You don‘t have a home….  How do you keep medications like insulin refrigerated ?  How do you secure your pain medications prescribed for chronic back pain that you’ve developed because you’re sleeping on the hard cement all the time?  How do you stay warm and dry in the pouring rain?

8. Imagine…  You barely have enough resources to pay for food, transportation and maintaining your hygiene…  How would you do laundry?  How do you avoid getting an infection or allowing a small one to fester?

9. IHS and Chronically Homeless Individuals  SAMHSA grant focused on helping chronically homeless individuals access needed treatment AND housing.  Systematically identifying and prioritizing those who are chronically homeless or vulnerable for intervention because…  Housing IS treatment.

10. In 1st Year…  We served 367 chronically homeless persons through outreach (116) and inreach (251)  We placed 115 of them into housing  57% of unsheltered outreached had health insurance benefits  62% of sheltered had medical benefits at intake  28 accessed substance abuse treatment  88 accessed psychiatric evaluation or treatment

11. Psychiatry-Assisted IHS Outreach  Project sought to demonstrate the impact of psychiatry assisted outreach  Compared homeless people who are geographically in the urban area (Downtown Honolulu, China town, Kalihi) and those how are in a rural area (North Shore - Wahiawa)  Triaging very ill persons and finding help for them

12. Over 19 months... 10/1/2011 to 4/30/13North ShoreUrban HonoluluTotal People Outreached143274417 Mental illness 43 (30%)143 (42%)186(45%) Chronic Homelessness(Time) 102 (71%)191 (70%)293 (70%) Disabiilty 78 (55%)207 (76%)285 (68%) CHRONICALLY HOMELESS 56 / 143 (39%)154 / 274 (56%)210/417 (50%) Mental Illness30/56 (54%)105/154 (68%)135/210 (64&)

13. Challenges to Serving Chronically Homeless People Approach to Healthcare: Accessibility Affordability Appropriateness Ability to engage in tx

14. Confidentiality: Protection or Obstacle  Other current Health care providers  Past healthcare providers  Family  Homeless providers  Case managers  Neighbors & others concerned

15. Medical Acuity of Homeless Persons  Increasing numbers coming to IHS with more serious medical problems  In calendar year Jan-Dec 2012, IHS fielded 434 referrals from hospitals  109 New from hospital  222 were returning guests  13 were turned down due to their acuity required

16. Who’s coming through the door?  Post surgery  Discharged from Psychiatric unit -SI  Post detox  Dying  Post partum  Cardiac conditions  Diabetes  Major infections

17. What we do…  Making Connections  Emergency Room  Clinics  Mobile medical care  Screening to prevent  TB, Hansens Disease  Physical: Diabetes, hypertension, asthma, skin infections etc.  Onsite treatment or triage  Provide transportation – bus fare, taxi vouchers

18. What do you do?  When you know a person is homeless, do you ask about their environment and resources?  Are you screening for behavioral health issues?  Do you ask about their practical support network?  When you give Rx, do you assess if the person has ability to fill it and follow through?  Do you take time to access information on the persons past success with treatment?  Or to assess motivation for treatment