At A Glance
When people have one place to coordinate care for their health problems, they have better health outcomes and health care costs are reduced. With that in mind, The Wellness Coalition took steps to offer homeless people in Montgomery, Alabama, increased access to community health workers (CHWs) at the coalition’s Friendship Mission West and North homeless shelters. During 2015–2016, the nonprofit trained four CHWs, who linked 170 homeless people to primary care, free or low-cost medicines, and education on self-managing chronic diseases.
Public Health Challenge
About 1,733 homeless people, including women and children, visited shelters across Montgomery at least one night during 2015–2016. Another 144 were living on the streets, according to the Mid-Alabama Coalition for the Homeless. Being homeless can lead to serious health problems because of lack of proper nutrition, shelter, financial resources, and basic self-care skills. The Centers for Disease Control and Prevention (CDC) notes that homeless people are more likely to develop infectious diseases and chronic illnesses than the general population. Problems can include tuberculosis, HIV/AIDS, heart and lung disease, diabetes, poor mental health, and addiction. Homeless people often turn to the emergency room (ER) for medical needs because ERs do not require upfront payment. Lack of health insurance and an inability to pay medical bills contributes to rising national health care costs.
Find Out More
The use of CHWs is a proven public health practice that supports and strengthens links between clinical services and the community. CHWs help increase health knowledge and improve access to services through outreach, community education, and informal counseling. If your organization is interested in training CHWs through The Wellness Coalition visit http://www.thewellnesscoalition.org. This project is supported by CDC’s Racial and Ethnic Approaches to Community Health cooperative agreement.
Initially, we were only providing food, shelter, and limited case management. CHW training has opened our eyes to health-related needs of the people experiencing homelessness. This program better equips us and our clients.
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Tammy Middleton, Executive Shelter Director
Approach
The Wellness Coalition in Montgomery set up CHW training in 2011 to reduce the use of ERs for routine medical problems and to link local residents in need with primary care and referrals to community resources. With funding from CDC, the nonprofit expanded the program in 2015 and trained four CHWs at Friendship Mission West and North homeless shelters. CHWs learned how to help people living in the shelters set up and get to appointments with primary care doctors, get free or low-cost medicines, enroll in health insurance, and keep their chronic conditions under control.
What's Next
By changing the way it served its clients, Friendship Mission improved the connections between the local homeless population and primary care providers in Montgomery. Instead of providing transportation to the ER for nonemergency visits, shelter staff are now working to help homeless people find a regular source of care, get free or low-cost medicines, and learn how to control their chronic conditions. The Wellness Coalition will continue to help the shelters meet these goals by providing refresher training for CHWs and additional training for new employees as an ongoing service. This support ensures that Friendship Mission will be able to provide CHW services for years to come.
Results
During 2015–2016, CHWs at Friendship Mission West and North shelters helped 170 homeless people in Montgomery with their medical needs. For example, instead of providing transportation to ERs, they helped 76 people set up and get to primary care appointments. This change reduced the number of nonemergency ER visits and the cost of medical services for this population. CHWs also taught clients how to manage chronic conditions like diabetes, obesity, and high blood pressure and provided 476 follow-up services for treatment of health conditions. In addition, they helped more than 60 homeless people get free or low-cost medicines from community groups, local Federally Qualified Health Centers, free clinics, and pharmaceutical company patient-assistance programs.