Providing Health Care to People Experiencing Homelessness: Strategies and Challenges for Cross-Sector Initiatives.

IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Michael J Yedidia, Joel C Cantor
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引用次数: 0

Abstract

Policy Points Initiatives that effectively bridge health care and housing sectors in serving people experiencing homelessness (PEH) shared four dimensions: success in matching client preferences with readily achievable options, maintaining intensive interaction, initiating outreach where clients are, and co-locating health and housing services. Analyses of accounts of those with firsthand experience implementing cross-sector programs yielded valuable guidance on strategies for incorporating these dimensions. Changes in policies associated with the new federal administration may pose new challenges but are unlikely to alter the relevance of accumulated experience in making use of available resources to effectively engage PEH in health care and housing services.

Context: Cross-sector collaborations among health care and housing services organizations promise more efficient use of resources and delivery of more coherent and effective services to people experiencing homelessness (PEH). This study analyzes challenges and strategies reported by those currently implementing cross-sector programs.

Methods: Data were collected through in-depth interviews with staff of health care and housing services at eight programs systematically selected to typify the scope and nature of cross-sector collaborations in New Jersey. Respondents included administrators (n = 14) and frontline providers (n = 10). Questions focused on motivations to collaborate, approaches to sustaining partnerships and managing operations, mechanisms for financing services across sectors, and strategies for effectively engaging PEH in health care services. Interviews were audio-recorded and inductively analyzed using standard qualitative techniques.

Findings: Collaborations were motivated by the impact of housing on health, the ineffectiveness and costs of attempting to address unmet health care needs in the absence of providing shelter, and the promise of harnessing resources from both sectors. Accounts of successful approaches for engaging PEH in health care services had four fundamentals in common: establishing rapport through matching client preferences with readily achievable options, maintaining intensive interaction, initiating outreach where clients are, and co-locating health and housing services. Favored policies for promoting effective implementation included financing case management services through contract or capitation arrangements, resolving ambiguities in licensing regulations and reimbursement practices that impede co-location of services, securing direct financing for delivery of nursing services at shelters, and providing greater support for frontline providers.

Conclusions: The programs' accumulated experiences in successfully implementing cross-sector programs yielded valuable insights for other organizations seeking to mount similar initiatives and for creating a more hospitable policy environment for programs to succeed. Policies of the new federal administration may raise new challenges but are unlikely to diminish the importance of lessons for achieving effective cross-sector collaboration.

向无家可归者提供保健:跨部门倡议的战略和挑战。
政策要点:在为无家可归者提供服务方面有效衔接保健和住房部门的举措共有四个方面:成功地将客户的偏好与容易实现的选择相匹配,保持密切的互动,在客户所在的地方开展外联活动,以及将保健和住房服务放在一起。对那些有实施跨部门项目的第一手经验的人的描述进行分析,为纳入这些方面的战略提供了宝贵的指导。与新的联邦行政当局有关的政策变化可能带来新的挑战,但不太可能改变在利用现有资源有效地使PEH参与保健和住房服务方面积累的经验的相关性。背景:保健和住房服务组织之间的跨部门合作有望更有效地利用资源,并向无家可归者提供更加连贯和有效的服务(PEH)。本研究分析了目前实施跨部门项目的机构报告的挑战和策略。方法:通过对八个项目的卫生保健和住房服务工作人员的深度访谈收集数据,这些项目系统地选择了新泽西州跨部门合作的范围和性质。受访者包括管理人员(n = 14)和一线提供者(n = 10)。问题集中在合作的动机、维持伙伴关系和管理业务的方法、跨部门服务融资机制以及有效地使公私健康参与卫生保健服务的战略等方面。访谈录音并使用标准定性技术进行归纳分析。调查结果:促进合作的原因是住房对健康的影响,在没有提供住房的情况下,试图解决未满足的保健需求的效率低下和成本高昂,以及有希望利用这两个部门的资源。将PEH纳入医疗保健服务的成功方法有四个共同的基本原则:通过将客户偏好与易于实现的选择相匹配来建立关系,保持密切的互动,在客户所在的地方开展外联活动,以及将医疗和住房服务放在一起。促进有效实施的有利政策包括:通过合同或人头安排为病例管理服务提供资金,解决许可条例和报销做法中阻碍服务集中的含糊之处,确保在收容所提供护理服务的直接融资,以及为一线提供者提供更多支持。结论:这些项目在成功实施跨部门项目方面积累的经验,为其他寻求发起类似倡议的组织提供了宝贵的见解,并为项目的成功创造了更友好的政策环境。新一届联邦政府的政策可能会带来新的挑战,但不太可能降低经验教训对实现有效的跨部门合作的重要性。
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来源期刊
Milbank Quarterly
Milbank Quarterly 医学-卫生保健
CiteScore
9.60
自引率
3.00%
发文量
37
审稿时长
>12 weeks
期刊介绍: The Milbank Quarterly is devoted to scholarly analysis of significant issues in health and health care policy. It presents original research, policy analysis, and commentary from academics, clinicians, and policymakers. The in-depth, multidisciplinary approach of the journal permits contributors to explore fully the social origins of health in our society and to examine in detail the implications of different health policies. Topics addressed in The Milbank Quarterly include the impact of social factors on health, prevention, allocation of health care resources, legal and ethical issues in health policy, health and health care administration, and the organization and financing of health care.
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