Community Health CenterÕs Outreach Program to Homeless Population

The health concern:Over the course of a year, approximately 15,000 people are homeless in Washington, DC. Among single adults who are homeless, approximately two-thirds have special health care needs due to HIV/AIDS, mental illness, substance abuse, and serious physical health problems. Individuals who are homeless lack permanent shelter, transportation, and telephone services, which makes health care access and use a significant barrier. The challenge for health care providers is to ensure that these patients make their doctor appointments and adhere to medication regimens.

The strategy: Unity Health Care, Inc., a federally qualified community health center in DC, knew that in order to provide primary care services to the homeless community, it would need to bring services to the locations where individuals who are homeless gather. As cultural brokers, providers and outreach workers at Unity built on their expertise in providing health care to the homeless: Before becoming a federally qualified health center, Unity was known as Health Care for the Homeless. Many of the staff who work at UnityÑwhich also provides health care to other underserved communitiesÑknew that in order to respond to the culture of persons without shelter, services would need to be delivered in a safe and familiar environment.

The action: Unity Health Care provides services to the homeless population in several ways. Clinicians travel weekly in vans, to certain areas throughout the city, to provide primary care services to the most hard-to-reach individuals who are homeless. Project Orion targets only those individuals who are drug users and are most at risk of HIV/AIDS. Individuals who are homeless receive free, confidential services including education, counseling, and testing for HIV/AIDS, sexually transmitted diseases, hepatitis B and C and tuberculosis, and medical and case management services. Project Orion staff also return to sites to distribute test results.

Project Orion outreach workers function as cultural brokers and work diligently to get to know individuals who are at highest risk. Over time the outreach workers have become familiar with needle usage patterns among these individuals and the ÒstreetÓ jargon they use. As cultural brokers, the outreach workers have created a regular source of health for the individuals who are homeless and most at risk.

Why it works: According to Sister Eileen Reid, R.N., a shelter-based health center manager, the outreach workers serve as cultural brokers for individuals who are homeless receiving services through the mobile clinics. Cultural brokering involves the outreach workersÕ knowledge and expertise in the delivery of a complex array of health care and mental health services and supports to the homeless population. It also involves the creation of a comfortable and safe environment.