Interprofessional Educational Opportunity and
Community Engagement While Serving Those That Are Homeless
Jean Irion PT, EdD, SCS, ATC
Joseph M. Day PT, Ph.D., OCS, CIMT
Margaret Moore-Nadler, DNP, RN
NEXT Conference: June 6, 2016
Description
This session will provide information on how to develop and organize an interprofessional health
screening, education and resource identification service project associated with a city/countywide Homeless Connect event. The unique health-related needs of individuals who are homeless
and factors that might influence individuals who are homeless to seek health related services will
also be discussed. Also included in this session are the learning activities to prepare students and
faculty for such an event, particularly related to the medical and psychosocial needs of the
population served and student perceptions of their profession and other professions related to
interprofessional practice. Two additional components of this presentation will include other city
and county-wide resources provided at this event as well as “lessons learned” to modify this
event for the future.
Objectives
1. Apply the current literature regarding individuals who are homeless and the health care
system to interprofessional practice.
2. Summarize the evidence on the effectiveness of interprofessional service opportunities on
student learning.
3. Implement an interprofessional student and faculty-led health-screening and education
project during a Homeless Connect event.
4. Determine ancillary and health resources provided to the underserviced guests during the
Homeless Connect event to ensure an opportunity for ongoing care, resources and followup intervention.
Definition of Homelessness (HUD) in:
• an emergency shelter or
• transitional housing program (including safe havens) or
• a place not meant for human habitation (car, abandoned building, or on the streets)
National Estimates on Homeless in the U.S.
• January 2014 point-in-time count- Last 10 days in January
Statistics on those that are Homeless
• State of Homelessness in America (2015) by the National Alliance to End Homelessness
• Changes in Overall Homelessness from 2013-2014 to 2015: Overall decrease by 2.3% in
homelessness
• Single Night in January 2014: 578,424 people experienced homelessness
• National Rate: 18.3/10,000 people
o Range 120/10,000 (Washington, DCà 7/10,000 (MS)
• Highest sub-population: Veterans at 10.5%
• Federal Funding for those that are homeless: 4.5 billion
Populations at Rick of Homelessness
• Unemployed
• Those living in poverty (4.8 million)
• People living doubled up with family and friends
o Last living situation before coming homeless
• Poor renter households with severe housing cost burdens (pay more than 50% of their
income to housing) (6.4 million in 2013; down 2.8% since 2013)
• Veterans
• Those with mental illness
• Those with substance abuse
• Unaccompanied children and youth
Healthcare for those that are Homeless
• Co-morbid conditions and several barriers to accessing health care
• Need services even mores if chronically homeless
• In those with diabetes, it is important to involvement of patients, medical and social
service providers must be emergent and responsive to changing needs
• Need to overcome “underground resourcefulness”
• Need to gain transportation
• Hierarchy of needs have many things above health care needs
• How to improve it
o Increase interdisciplinary communication
o Referrals to homeless services
o Increase availability of services
o Provide medical respite (post-hospitalization transitional care)
Perceptions of Healthcare services by those that are homeless
• Those that are homeless
o Usually based on past experiences
o Feeling unwelcome
o Treated with prejudice
o Received substandard care
o A non-system for healthcare for the homeless
o Treated with disrespect
o Feeling invisible; ignoring their needs; loose their identity
o Not getting the treatment they needed and being discharged prematurely
o Marginalized from the health care system and society
o Discriminatory treatment
o “Unwelcomeness”
• People who are homeless and mentally ill
o Mismatch between expectations and provision
o Inadequacy and complexity of services
o Mistrust and stigmatized
o Dissatisfaction with the last of choice and say in their care
o Suspicion about intentions of health care providers
•
Positive feeling towards health care providers
o Most likely to be achieved in a welcoming environment created by all
professionals in contact with the patients
Perception by healthcare providers and students of those that are homeless
• denial of proper care and negative attitudes
• positive change in attitudes after an experience in an homeless outpatient clinic (HOC)
• lack of understanding of the barriers to healthcare
• previous negative perceptions can be changed when students meet their patients on a
person-to-person level
• intense emotions while in the situation that are hard to express
• families that are homeless are both different and similar to families who have housing
• experience had a positive impact on perceived willingness to treat in the future
Interprofessional Education and Collaborative Practice
• Collaborative or interprofessional practice occurs when “multiple health workers from
different professional backgrounds provide comprehensive services by working with
patients, their families, caregivers, and communities to deliver the highest quality of
care.”
• Interprofessional education “occurs when two or more health and social care professions
are interactively learning about, from, and with each other.”
Importance of Interprofessional Practice/Collaboration for the Underserved
• Many members of the homeless population have co-morbid/chronic conditions and
several barriers to accessing necessary healthcare to restore health.
• Because those who are homeless lack access to healthcare, an increase in disease burden
and morbidity exists.
• Persons living with multiple chronic conditions experience many challenges managing
health needs and rely on a healthcare system not designed to adequately assess and meet
complex needs
• To Address these concerns, the US Department of Health and Human Services has
released Strategic Framework on Multiple Chronic Conditions
§ “foster interprofessional collaboration and team-based care in health care
curriculum
Interprofessional Practice: Importance for Student Learning
• Domain 1: Values and Ethics
• Domain 2: Roles and Responsibilities
• Domain 3: Interprofessional Communication
• Domain 4: Teams and Teamwork
Interprofessional Education Collaborative, May 2011
From Importance to Student Perception: What does the literature say about student
perceptions?
• Positive
o Interprofessional practice provides an environment that reflects learning and
application outside the classroom in real-world situations.
•
o Students report improved patient communication and procedural skills when
involved with interprofessional collaboration.
Constructive Feedback
o Short-term interprofessional collaboration, such as a single meeting, received
negative feedback from students, but if the collaboration was an extended time
throughout the curriculum, the views and feedback were more positive.
o These students believed that they lacked real world practical experience in
working collaboratively and having good relations among professionals.
o concern was indicated with the scenarios being too simplistic and not allowing for
meaningful problem-solving and interaction among health professions.
o professional students do not have “time to partake in additional interprofessional
education (IPE) experiences as their timetables were already crowded with
profession-specific coursework and extracurricular activities
Perceptions of Students: Take Away Points for the Future
• Generally the experience is positive
• Students seem to realize that they have much less understanding of IP practice after an
experience
o this may prompt them to seek out information.
• Small group settings seems to work best
• Should be integrated into the Existing Curriculum
Perceptions of Students: Pearls to consider for Interprofessional Collaboration during
Homeless Connect
• More than one session together
• Small groups
• Real work experience
History of Homeless Connect on a National Level
• The first Project Homeless Connect was held October 2004 in San Francisco
• The event in San Francisco is now held bi-monthly and is a major component of the
advocacy effort to end homelessness there.
Origins of Homeless Connect in Mobile, AL
• Housing First in Mobile, AL: Mission
o It is the mission of Housing First, Inc. to secure resources and assets, which lead
to community planning to end homelessness through advocacy and community
collaboration. It is our vision that every man, woman, and child will have the
opportunity to have suitable, safe, and adequate housing.
• History of Housing First in Mobile
o 1992- Church And Business Leaders Met in Downtown
o 1994 Homeless Task Force was Created to Collected More Data
o 1996 Homeless Collation of Mobile becomes official Nonprofit organization of
the state
o 2004, Named Housing First of Mobile
Structure of Housing First in Mobile, AL
• Housing First
o Community Housing
o Homeless Prevention
o Other Services
Community and Education Partners That Came Together
• Housing First, Inc.
• Alabama Cares
• University of South Alabama
o College of Nursing
o College of Allied Health
o College of Medicine
o Biomedical Library staff
o Social Work faculty and students
• Providence Hospital Diabetes Educators
• Mobile Infirmary Cardiovascular nurses
• Alta Pointe Health Systems (mental health)
• Mobile County Health Department
• Franklin Dental Clinic
• Lion’s Club
• Ozanam Charitable Pharmacy
History of Homeless Connect in Mobile, AL
• Year 1: 2014
o Initiated by Dr. Margaret Moore-Nadler (USA CON faculty member) with
Housing First and other entities; modeled after National Homeless Connect events
§ Became initially involved because of her work with 15 Place in Mobile
§ Approached by Housing First to become involved
§ Invited other disciplines from the U of South AL (USA) to participate
o In addition to above also participation by various undergrad students from USA
for set-up and break down
o Education only on serving those that are homeless; done in a group in person
o Used the Mobile Civic Center
o Ice storm the evening before- had to change the entrance location
o Small square footage for healthcare screening and other healthcare services
o More students than needed and somewhat disorganized with assignment for
students
§ Students were frustrated at times
§ OT “games and activities moved several times”
o Some disorganization regarding the roles of various healthcare professionals and
the expectations at each station/area
o Disconnect between the Mobile County Health Dept. Van and other medical
services
o “Physical Therapy Screening” and problems with this
•
•
§ frustration observed in some quests
§ no structured or formatted handouts/information to provide
§ no rehab service location to refer for follow-up
§ Social work faculty did assist as they could
o No data collected from a research standpoint
o Most of the guests seemed appreciative of what was being provided
o Free lunch was at a church- guests were bussed there and back
o Overall the students enjoyed the experience, especially if they were “escorts” and
provided good feedback to make modifications for the following year
Year 2: 2015
o More interprofessional experience and training prior to Homeless Connect 2015
via Cathedral Place involvement with the Colleges of Nursing, AHP, and
Medicine
o Online training on serving the homeless
o Moved to the Mobile City Fairgrounds
o Much larger area for health care screening and services
o Added additional education tables
§ Students designed “PT handouts” for guests on topics of greatest interest
based on the year before
o Continued issues with attempts at interprofessional practice
§ PA and MD students online in Triage screening area (even though there
were numerous medical musculoskeletal complaints)
o Bussing of the guests was more challenging
o Follow-up “Physical Therapy Services”
§ PT faculty provided pro-bono services
o Data was collected as part of a student research project supervised by faculty
o Data will be provided towards the end of this presentation
Year 3: 2016
o Online training again on serving the homeless
o Continued at Mobile City Fairgrounds
o PT students (year 2) in triage area called in for consult exam and sent to “Physical
Therapy station”
o Referral for PT services
§ Healthcare for the Homeless with the Franklin Clinic
o Other activities very similar to the year prior
Learning Activities to Prepare Students and Healthcare Providers to serve those that are
Homeless
• 2014: 1 hour session in person on what to expect when working with those that are
homeless
• 2015 and 2015: online training modules
o Introduction to Homelessness
o Navigator Orientation (Escort Training)
o Faculty Student Overview
§ Student/Guest Flow
§ Registration information
§ NEXTSTEPS
§ Some information on interprofessional practice and coordination
o Videos and pictures of the previous year’s events to view
Ancillary Services Provided to Guests:
Over 25 service providers including, but not limited to:
• Laundry
• Lunch
• Delta Bike Project
• Legal Aid
• Housing
• Identification services
• Veterans’ services
• Employment services
• Pet care
• Haircuts
Health Services Provided to the Guests
• Biometric Stations
• Blood Glucose
• Mental Health Screening
• Triage Central (Assessment Rooms)
• Psychiatrist: Alta Pointe
• Social Worker Stations
• Hepatitis C Screening
• Dental Screening
• Vision Screening
• Emergency Response Team
• Medication Management
• Health Literacy
• Clinical Services
• Educational Services
Specialty Clinics
• Community Resource Center- Social Work Interns
o Empowering change
o Listening to guest concerns
o Guiding guest to community resources
• Diabetes Center
o Support to Assessment rooms collecting blood
o Education
o Resources
o Supplies
• Respiratory Therapy Center
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•
•
•
•
•
•
•
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o Smoking Cessation Class registration
o Guidance for free patches
o Guidance for smoking cessation
o Asthma education
Cardiovascular
o Signs and symptoms of stroke
o Prevention
Physical Therapy
o Foot Clinic
o Education
o Prevention
Occupational Therapy
o Education
o Health and Wellness Activities
Outdoor Living
o Prevention
o Guidance
o Safety
Eye Clinic
o Screening
o Certificate for free glasses
Immunizations
o Depending on funding
Alta Pointe Health Systems
o Mental Health Check
o Appointments/referrals
Franklin Heal Care Systems
o Health Care for the Homeless: appointments and referrals
o Dental Van
Ozanam Charitable Pharmacy
o Medication education
o Assistance with application
o No Rx filled at the event
Health Services Education Booths
• Outdoor Living Safety & Heat Stroke
• Stress/Coping/Resilience
• Stoke/Heart Attacks
• Diabetic/Nutrition/Diet
• Sexual Transmitted Diseases & Safe Sex
• Posture & Body Mechanics & Maneuvers
• Communicable Disease
• Smoking/Alcohol/Drugs
• Health/Illness/Hygiene
•
•
•
Foot Care Education
Health Care Resources
USA Student-Run Free Clinic
Set-up and Flow of Healthcare Services
• Biometrics/Vitals
• Triage
• Specialties, testing and education
• Exit Interview
Referral Resources Provided to Guests for Sustainability
• USA Student Run Clinic
• Franklin Primary (Healthcare for the Homeless)
o general, specialty, and rehabilitation services
• 15 Place
o Health and Wellness Education
o Mental Health and Wellness Screenings – Alta Point
• Mobile Health Department
o Dentistry
o Some additional services
Integration of Ancillary and Health Services
• Bike Fitting in collaboration with physical therapy
Integrating Scholarly Activities into an Interprofessional Community Service Opportunity
Perceptions of People who are Homeless and Perceptions of Students Engaged in
Interprofessional Practice atProject Homeless Connect
2014-2015 Academic Year
Michael Ard, Meagan Jackson, Callie Lyon, Allison MacKay
Dr. Matt Day, Dr. Jean Irion
Purpose of the Student Run-Faculty Led Research Project
• For Students:
o Gain feedback regarding perceptions of people who are homeless and interactions
with this population at Project Homeless Connect
o Gain feedback regarding interprofessional collaboration at Project Homeless
Connect
• For those who are homeless
o Analyze perceptions regarding healthcare providers and services
o Receive feedback regarding quality of care provided during Project Homeless
Connect
• Results of the Student Research Project from Homeless Connect 2015
o Perceptions of those that are homeless of the health care services provided at the
Homeless Connect event
o Perceptions of students regarding interprofessional practice during a Homeless
Connect event
Hypotheses for Research Study:
• Students’ perceptions of those who are homeless will be favorable after Project Homeless
Connect.
• After exposure to interprofessional collaboration, students’ perceptions of
interprofessional practice will be positive.
• Those who are homeless will have favorable perceptions of healthcare providers
regardless of preconceived notions.
Methods
• For Students:
o Pre-survey and post-survey of:
§ Perceptions of interprofessional collaboration and of those that are
homeless
§ Used survey monkey: www.surveymonkey.com
o References for these instruments:
§ Readiness for Interprofessional Learning Scale Questionnaire.
Institute for Healthcare Improvement website.
http://www.ihi.org/education/ihiopenschool/Chapters/Documents/riplsque
stionnaire19.pdf. Published August 2009. Accessed April 12, 2015.
§ Interdisciplinary Education Perception Scale. National Center for
Interprofessional Practice and Education website.
https://nexusiperesourceexchange.s3.amazonaws.com/Tool.Interdisciplina
ry-Education-Perception-Scale-IEPS.pdf. Published 1990. Accessed April
12, 2015.
• For those that are Homeless (our guests)
o Post health-screening survey at Project Homeless Connect
§ Perceptions of healthcare provider and level of satisfaction with services
provided at Homeless Connect event
§ Data gathered using www.surveymonkey.com and option to complete the
survey manually
Data Analysis
• Qualitative
o Feedback was collected from those who are homeless and from students
• Quantitative
o Descriptive data
§ Frequency of attendance of each booth by the guests
§ Frequency of student participation by profession
o Results from IPE pre- and post-surveys for students were analyzed applying a
Mann Whitney U Test
Results
• The majority of student perceptions of the clients, other professions, and their own
professions were initially positive, but became significantly less positive when comparing
pre- to post-surveys (p < 0.01)
• Examples of qualitative data collected from the guests:
o Question to Client: What was the best thing that happened to you at Project
Homeless Connect?
§ Answer: “The fact of understanding that so many care about our well
being. That [there are] so many resources available.”
o Question to Client: Please give us comments or suggestions for the next Project
Homeless Connect
§ Answer: “Get the word out more about it so that more people know about
what is provided.”
Conclusion
• Clients reported positive experiences at the event and favorable perceptions of healthcare
providers prior to the event.
• Students may feel inadequately prepared to participate in interprofessional collaboration
• Limitations
What Should be Changed in the Future? Where do we go from Here?
• How can we enhance a true interprofessional set up?
• How can we better design are services for sustainability?
• How can we modify the process to allow physical therapist full treatment access to our
clients?
• Are the students benefitting long term from this experience?
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