The U.S. Department of Housing and Urban Development (HUD, 2018) defines an individual or family as homeless, as someone who lacks “fixed, regular, and adequate nighttime residence”. As of January 2020, there were an estimated 11,751 individuals experiencing homelessness in Seattle/King County (King County Regional Homelessness Authority, 2020). National Alliance to End Homelessness (2020) explains that health and homelessness are inextricably linked, where an acute physical or behavioral health crisis or any long-term disabling condition may lead to homelessness; homelessness itself can exacerbate chronic medical conditions. To reduce the number of homeless families on the streets in King County, Mary’s Place offers a safe inclusive shelter to support women, children, and families on their journey out of homelessness. Mary’s Place believes that no one’s child should sleep outside. They aim to keep families together and safe when they have no place else to go, by providing resources, housing and employment services, community, and hope. In 2020, Mary’s Place had served 586 families and 1,225 children across Seattle, Northshore, White Center, Burien, Auburn, and South Lake Union. Our project’s focus location is at Family Center in The Regrade, downtown Seattle. The goal of our project is to provide a health resource binder which has useful, easy to use health information that is relevant, up to date, accessible, holistic, inclusive, organized, and tailored to Mary’s Place clientele.
Based on the latest survey conducted by the King County Regional Homelessness Authority (RHA) (2020), individuals in family households make up a total of 3,743 adults and children, or 32% of the total homeless population in Seattle/King County in 2020. This was the first increase seen in the past four years (unsheltered homelessness from 3% in 2017 to 2019, to 29% in 2020). The top three most used services by individuals in family households are emergency shelters (58%) followed by bus passes (51%) and free meals (44%). The most commonly cited challenges when trying to access services are lack of transportation (35%), not knowing where to go for help (30%), not hearing back after applying for services (25%) and didn’t qualify for service (18%). These statistics support our agency liaison’s request to collate a resource binder with information related to transportation, healthcare, wellbeing improvements, and specifically where to go for help if they need affordable, free or Medicare/Medicaid accepting facilities. Our project’s goal is to address the clients’ deficient access to resources directed at healthcare needs, promote optimum family well-being and enhance their overall wellness. We formulated our nursing diagnosis as follows: Readiness for enhanced knowledge and family coping related to health management and improvement as evidenced by reports from Mary’s Place liaison about the client’s deficient access to resources.
Activities and Methods
Our project framework is based on Pender’s Health promotion model (HPM), which focuses on helping clients achieve higher levels of well-being and identifies background factors that influence health behaviors (Khoshnood et al., 2020). In consistent with operationalizing HPM, we structured our project activities by conducting nursing assessment, diagnosis, and interventions (Khoshnood et al., 2020). The HPM provides a framework for our project to provide accessible health resources to help clients locate affordable or free healthcare services and pursue better health outcomes through preventive healthcare and pursue overall wellness.
We commenced our fact finding by conducting a windshield survey and toured Mary’s Place where we were briefed on the facilities provided to the clients. Our project activities include gathering existing resources from Mary’s Place and updating it with added information on healthcare facilities that provide free/affordable services. Related health literature was reviewed for evidence-based resources and had weekly meetings with our agency liaison to ensure that we are delivering the final product as per expectations. We tracked our specific tasks assignments and project deliverables via a Gantt chart. The logic model outlined our project goal, inputs, activities, outputs, outcomes and impact of our deliverables to Mary’s Place clientele. We agreed with our agency liaison on the final deliverable, which is the health resource binder that can be accessible by all clients and staff at Mary’s Place.
In addressing the most cited challenges based on the survey by RHA (2020), our team researched and collated information on the following: transportation options (i.e., bus routes, Orca cards, Hope Link, etc.), healthcare services that provide free or affordable medical, dental, and mental health services, family planning and women’s health, nutrition (e.g., food pantry, SNAP benefits), and children and teens health. For each of the categories, we included the following details for each of the facilities: name, address, phone number, website, operating hours, services provided, and types of payment or eligibility (i.e., Medicaid, uninsured, undocumented). In a study conducted by Ramsay et al. (2019), lack of transportation was a significant barrier for individuals experiencing homelessness, as they were unable to attend appointments or travel to laboratories and imaging facilities, which significantly impacted their ability to access care. inability to find a physician that was able or willing to accept them as patients was another barrier to accessing health care (Ramsay et al., 2019). Hence, this further supported the agency’s need to have the health resource binder on hand to enable easy navigation for their clientele.
Our project’s goal is to equip the clients with relevant and useful health information to develop the client’s individual plans to meet their respective healthcare needs/goals, optimize wellness, and enable the families to meet their needs during this relocation transition. This binder should be able to provide the families with a sense of self-efficacy, normalize self-care, and encourage the family’s health-seeking behaviors. In addition, the ease of accessibility and availability of the information should help save time for the clients, families, as well as the agency. To ensure that we were working towards delivering the critical resources for their clients, we had frequent meetings with our liaison to discuss any roadblocks and ensure that we continued to deliver the expected outcomes. The final presentation of our resource binder to our agency liaison, and her team at the end of the project will enable us to perform a preliminary assessment of the appropriateness, and usefulness of the health resource binder. Due to time limitations, we are not able to evaluate the effectiveness of the resource binder or dedicate time at Mary’s Place in-person, to gather feedback from the clients regarding the effectiveness of the resource binder. It is our recommendation to have the staff at Mary’s Place evaluate the effectiveness of the resource binder and eventually expand the binder to be available for all Mary’s Place locations. Again, due to the duration of our project, the project limitations include the ability to assess and evaluate the long-term healthcare impacts, and effectiveness on the clients, families, and staff at Mary’s Place. This would serve as an opportunity for future projects to assess and evaluate the effectiveness of these resources, and to better enhance the information based on the feedback from the agency and the clients to further improve the health and wellbeing of clients at Mary’s Place.
Our long-term goal and objectives for the health resource binder is to improve the overall wellbeing of Mary’s Place clientele, by reducing illness through preventative healthcare, reducing number homelessness due to less medical bankruptcy, increase work productivity, and independence of the clients. Hence accessibility to obtaining appropriate ambulatory care, improving the long-term management of physical and mental illnesses, and addressing structural factors such as transportation can help achieve our long-term goals and objectives (Hwang et al. 2013). We are hopeful that this resource binder will help serve the purpose it was intended for and positively impact the clients at Mary’s Place.
Hwang, S. W., Chambers, C., Chiu, S., Katic, M., Kiss, A., Redelmeier, D. A., & Levinson, W. (2013). A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance. American Journal of Public Health, 103(Suppl 2), S294–S301. doi:10.2105/AJPH.2013.301369
Khoshnood, Z., Rayyani, M., & Tirgari, B. (2020). Theory analysis for Pender’s health promotion model (HPM) by Barnum’s criteria: A critical perspective. International Journal of Adolescent Medicine and Health, 32(4). https://doi.org/10.1515/ijamh-2017-0160
King County Regional Homelessness Authority (RHA, 2020). Seattle/King County point-in-time count of individuals experiencing homelessness 2020. https://kcrha.org/king-county-point-in-time-count/
Mary’s Place (2020). 2020 Gratitude report. https://static1.squarespace.com/static/5b8989d231d4df1bccd7bcc7/t/60721c9c6b0134353fb33bc3/1618091166064/MP+2020+Gratitude+Report.pdf
National Alliance to End Homelessness (2020). Health. https://endhomelessness.org/homelessness-in-america/what-causes-homelessness/health/
Ramsay, N., Hossain, R., Moore, M., Milo, M., & Brown, A. (2019). Health care while homeless: Barriers, facilitators, and the lived experiences of homeless individuals accessing health care in a Canadian regional municipality. Qualitative Health Research, 29(13), 1839-1849. Doi: https://doi-org.ezproxy.spu.edu/10.1177/1049732319829434
U.S. Department of Housing and Urban Development (HUD, 2018). Key federal terms and definitions of homelessness. https://www.usich.gov/resources/uploads/asset_library/Federal-Definitions-of-Youth-Homelessness.pdf
Gilman, Haylee R.; Carrasco Flores, Lucy; Haack, Keenan; Liew, Hui Jean; and Abrha, Gebrehiwot, "Promoting Health Independence Through Accessible Health Resources" (2021). Nursing Leadership in Community Engagement Projects. 3.
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