Catholic Medical Center - Health Care for the Homeless Program

Overview

Catholic Medical Center’s Health Care for the Homeless (HCH) Program/Mobile Community Health Team Project is a “clinic without walls” that provides primary medical care, mental health care, nursing case management, addiction counseling, social services, and health education to homeless individuals and families, onsite at clinics located in shelters and transitional housing programs in Manchester. The clinical team consists of two physicians, two family nurse practitioners, one psychiatric nurse practitioner, four nurses, one social worker/mental health counselor, one community health worker/patient navigator, and three program assistants. Outreach medicine – bringing hospital care out to the people in the community – is central to HCH program philosophy and practice. HCH clinics are in session daily at New Hampshire’s largest homeless shelter; and thrice weekly at New Hampshire’s largest transitional housing program for homeless families.

The HCH program of Catholic Medical Center was established in 1988, based upon the model created in 1969 by Philip W. Brickner, MD, at St. Vincent’s Hospital (SVH) in New York City. In 1985, the Robert Wood Johnson and Pew Charitable Trust foundations funded a four-year demonstration project in 19 cities across the country, modeled to replicate the program at SVH. Today, there are more than 200 HCH programs nationwide that provide comprehensive health care to people who are homeless. For more information, visit the web site of National Health Care for the Homeless Council www.nhchc.org.

Impact

The HCH team collaborates with local health care providers and human service agencies to ensure access to health care for more than 1,000 individuals and family members who are homeless in Manchester. Of these patients, 85 percent do not have health insurance of any kind, and 90 percent struggle with incomes below the 100 percent federal poverty line.

Challenges/success factors

Caring for people who are homeless is clinically complex. Many patients present with tri-morbid and co-occurring conditions of medical/mental health/and addiction disorders. In addition, patients struggle with learning disabilities and cognitive impairment. They are often estranged from their own families and support networks. To ensure best outcomes, the HCH team engenders trust and ensures continuity of care to all patients. At HCH, homeless patients know that they will be helped and not judged. A team approach ensures that comprehensive medical/psycho-social care is coordinated, and that housing needs are addressed.

Future direction/sustainability

Hospital leaders plan to continue and grow all components of the HCH program. To raise participation rates and find patients in need, the HCH street outreach nurse and the HCH community health worker tour the streets, visit smaller shelters, and frequent the ED to encourage homeless individuals to enroll in primary care at HCH and its shelter-based clinics. In addition, Health Education is conducted weekly, covering topics such as addiction recovery, relapse prevention, parenting skills, smoking cessation, nutrition, obesity, and fitness training. HCH Health Education is another venue where patients are newly enrolled in HCH primary care.

Advice to others

HCH clinicians need to have a sense of creativity with a “MASH-unit/can-do” attitude, understanding that health care can be offered on a street corner; and that while there, important connections to those in need can begin. Staff should be experienced providers with exceptional clinical skills. Staff should also be team players who are curious, non-judgmental, and unafraid to “ask that next question” to address the root cause of homelessness and to appreciate the unique context of each person's struggle.

Contact: Marianne Savarese
Project Director, Health Care for the Homeless Program
Telephone: 603-663-8716
E-mail: msavarese@cmc-nh.org