Topic #6 Homelessness and Social Determinats of Health

[M Rauf]

Please complete CWC Module 6: PSYCHOSOCIAL AND BEHAVIORAL DETERMINANTS OF HEALTH AND HEALTH CARE, Case 2:

A 52-year-old man at a homeless shelter has hypertension, diabetes, and asthma. He has been homeless for over ten years. On exam he is pleasant and somewhat talkative. He answers all questions directly and fairly succinctly.

1.How likely is this patient to suffer from severe mental illness? ◦>80%
◦61-80%
◦41-60%
◦21-40%
◦<20%

Reflection Blog assignment:

1. Watch this 10mins video: https://www.youtube.com/watch?v=hzdT390OCz4&feature=share

Just focus on the stats and stories of the video and ignore any political bias or commentary in the comment section.

2. Reflect and write about: What does homelessness mean to me ? Using the biopsychosocial model I learned about last clinic week, how can I better serve my homeless patients? How can I and my program better collaborate with the homeless community agencies I learned about? (name them).

[M Rauf]

Homelessness means the same thing it did last year to me. Probably by referring patient to resources, and by acknowledging the challenges that the patient may face due to being homeless. Plan a trip to Detroit Rescue Mission, NSO, etc. during clinic week during SDH time. If somebody is not able to come we should excuse them. Residents are busy people.

[Scott Smith]

Homelessness can be difficult to define, for some it may mean living on the streets, but others may define it as not having permanent housing of their own, and living with a series of family members, both of which can make it more difficult for them to establish permanent housing. Contributing problems to the homeless population include reduced income potential, development of mental health disease, further exacerbating the issue. Many homeless children later become chronically homeless adults, creating a cyclical problem, without an obvious solution. Any sudden loss of liquid assets can lead to homelessness, including job loss, medical bills, foreclosure, bankruptcy. Solutions we can provide are limited, but there are many free resources a person can use if they are homeless. Things I recommend to my patients include: obtaining a free google voice phone number if they have a cell phone, as they work in wifi and can be used as a contact number; Getting a cell phone if they do not have one, The Michigan department of health and Human services often will provide vouchers and funds to obtain a phone if eligible for the benefits; Finding a church or other building which could be used as a temporary address for mail, this can help in social security correspondence and in looking for a job.

[Hibah Ismail]

We attempt to help our patients medically during our everyday practice. However many times we fail to address underlying factors that will affect their healthcare in multiple ways. Many of the patients we see in clinic have told us that they live in shelters and we have treated multiple patients for frostbites injuries secondary to being out in the cold weather during the winter months with nowhere to go. Many of our social workers are able to help us find some solutions to our patient’s living conditions, however there are many underlying factors that need to be taken into account, including availability of jobs to afford permanent housing, mental health, social support and others. In the meantime, it is crucial that we know the available resources present in our community to help our pateints in the best way possible.

[Brett Trzcinski]

There is a very timely piece in this week’s JAMA (https://jamanetwork.com/journals/jama/fullarticle/2725151) that summarizes a number of attempts to address the impact of homelessness on health. One study highlighted was pilot study at the University of Illinois – Chicago where selected patient’s who were high utilizers of the hospital as well as being without homes were provided with housing (the hospital worked in collaboration with local housing non-profits) with a goal of reducing ED visits and inpatient admissions. I strive to improve my knowledge of what resources are available locally to refer patients to and incorporate social workers sooner to facilitate connecting patients with housing and supportive services.

[Hamza Salam]

This week’s discussion on homelessness and its effects on patient care including but not limited to access to medications, being able to carry out lifestyle modifications and management of chronic medical conditions. Homelessness also had a psychological effect on the patient’s mental health and patient’s who are homeless for long durations of time have been linked to higher mental health issues. As physicians, we need to understand the effect homeslessness has on our patients and we should tailor are treatment and counselling accordingly.

[Ali Saker]

In spit of the fact that Michigan’s homeless population had a significant decline during the last year, homelessness remains a challenge for use as a major social determinant of health . It’s important to have a screening strategy for patient’s who are not willing to admit it, in a non-judgmental, caring, compassionate way in order to achieve a better practice.

[Aamer Javed]

Homelessness to me means not having permanent housing options available, sense of safety and privacy. As the video states there are over half a million homeless Americans, many of who are veterans. As a physician I need to be more cognizant of identifying those patients who are homeless by asking pertinent questions. As a program we need to have a list of available shelters and temporary housing facilities that are easily accessible for our patients. These facilities should also be specific for women who are victims of abuse to cater to their needs.

[Amjad Kanj]

As physicians we need to be aware that the health care of the homeless is different than that of other patients. Homeless live under tough circumstances, posing a particular problem when developing a treatment plan. Transportation and access to medications are two major obstacles in the care of this population. As such, the patient’s best interest should be carefully considered in every step of the plan. A crucial element in caring for homeless is to understand their living conditions by visiting them in the streets and shelters.

[Arslan Mahmood]

For some Homelessness means living on the streets, for others it can be sharing a home with other people. It affects patients mental health. We need to address this issue along with their medical problems during the clinic visits. We should give them resources like informing them about nearby churches, the national helpline 211 and registering at the local library

[Nabeel Rizvi]

Often times as clinicians we put more emphasis on addressing medical issues and can tend to overlook a patient’s social status or mental health concerns. Last clinic week we learned about identifying key components of a patient’s psychosocial network. Learning about the 5-domain model was an excellent method to use to help manage the complete health of our patients. This week we discussed the meaning of homelessness. Press TV really did a wonderful job on opening our eyes to the statistics behind the homeless population in our country. I found these numbers to be astonishing. Each homeless person has a different story. Homelessness is formally defined by the United States government as when a person “lacks a fixed, regular, and adequate nighttime residence, and if they sleep in a shelter designated for temporary living accommodations or in places not designated for human habitation.” For those homeless this could mean walking miles to every meal, having little or no privacy, receiving rejection and hostility from most people, having possessions stolen or ruined on a regular basis, or simply needing money for ones needs. During our discussion, I learned about the different types of resources that I could provide to the patient including calling “211”. An outreach initiative our program can take to collaborate with the Detroit community is to volunteer time either at the Detroit Rescue Mission, Covenant House of Michigan, or Gleaners Community Food Bank. As physicians, we need to be aware of the prevalence of homelessness and the effects it has on our patients. As a program we need to have a list of available shelters and temporary housing facilities that is easily accessible to these patients. If we identify a homeless patient, we should tailor our medical treatment and be able to find the proper resources to better serve them.

[Amir Laktineh]

This week our discussion was a bout homelessness and the role of the physician in the acknowledgement first and addressing this issue.

Main causes for homelessness would be Causes of homelessness in the United States include lack of affordable housing, divorce, lawful eviction, PTSD, mental illness, physical disability, having no family or supportive relatives, substance abuse.

Efforts to assist the homeless include federal legislation, non-profit efforts, increased access to healthcare services, supportive housing, and affordable housing.As a primary care physician, obtaining the right info on why and how patients became homeless and providing resources and access to the main places for shelter and food would help our patients.

[asil daoud]

Homelessness can be one of the biggest challenges in all nations, as the larger the population, the harder is to give help and provide support. Causes of homelessness can be very variable and depends on the places, culture and population. Causes of homelessness in the United States include; no or inadequate income sources (such as Social Security, stock dividends, or annuity), poverty (no net worth), unemployment, and low-paying jobs. Homelessness in the United States affects many segments of the population, including families, children, domestic violence victims, ex-convicts, veterans, and the aged. Efforts to assist the homeless include federal legislation, non-profit efforts, increased access to healthcare services, supportive housing, and affordable housing.

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