Caught in the Maze: Health Disparities for Homeless Women Wellness Foundation Conference September 25, 2013 Nancy Frappier Wellness Center Coordinator Homeless Prenatal Program San Francisco, CA
Agenda Overview Stories of Ashley and Carla Health Disparities for Homeless Women Pregnancy and Family Planning Substance Abuse, Mental Health and Violence Barriers to Care Remedies The Wellness Center at the Homeless Prenatal Program
Homeless Women 14% of the US population have been homeless at some point Women and families fastest growing segment 41% of the homeless population are families 84% of these families are headed by women 43% of the homeless population are women In 2008 there was a 9% increase in homeless families
Physical Health Disparities Homelessness in general increases risk of a variety health issues Tri morbidity: serious medical issue, substance abuse and mental health
Mental Health Disparities Abuse History Posttraumatic Stress Disorder (PTSD) Depression Anxiety Homelessness makes a person sick, scared, lonely, vulnerable to abuse and low selfesteem
Homelessness & Pregnancy Many homeless women want to be pregnant Pregnant homeless women more likely to have a low birth weight baby, preterm delivery, inadequate nutrition, anemia, bleeding disorders, fetal distress, inadequate weight gain and small for gestational age newborns Studies have found reduced utilization of prenatal care by homeless women Homeless women have less access to birth control
Pregnancy, Substance Abuse and Mental Health Pregnancy a motivation to stop using But strong fear of incarceration or involvement of child protective services or immigration Lack of mental health and substance abuse treatment for the mother increases risk to the children. Disorganization and chaos created by drug use makes it difficult for women to follow through on appointments, treatment, medications Substance use contributes to poor birth outcomes
Homeless Women & Violence Intimate Partner Violence leading cause of women and children becoming homeless Partner interfering with birth control; resistance, refusal, abuse, sabotage 56% were exposed to rape as compared with 16% 92% experienced severe physical or sexual abuse at some point in their life; 63% have experienced violence from an intimate partner Abuse and victimization can make a person sick, scared, lonely, and negatively impact self esteem
Barriers to Care Client provider issues Social Issues Logistical and Systems Issues
Access to services Lack of services was not the main barrier to care; obtaining food and shelter was much more important; not seeking care unless they had serious symptoms that interfered with these pursuits Most important factor is how women are treated Often rely on episodic provision of care in emergency rooms rather than regular care Importance of outreach, education, trust
Remedies ACOG statement of support for improved health care for homeless women Patient centered care Comprehensive and effective care Timeliness in providing primary care as well as improved coordination in providing ancillary and referral services. Equitable access to quality health care
Remedies Well being Committed care Trust Assumption free care Inclusionary care HPP what we have accomplished
Homeless Prenatal Program (HPP) Who we are Founded in 1989 Serving 4,000 families per year Diverse staff of 70 Education Work experience, Case management skill level What we do Case Management Substance Abuse Domestic Violence Child Welfare Housing Wellness Center In partnership with our families, break the cycle of childhood poverty
Primary Objectives Healthy Babies Safe, Nurturing Environments Where Children Thrive Economically Stable Families Breaking the Cycle of Childhood Poverty
The Wellness Center Mission: Support HPP s pregnant clients to have healthy pregnancies, healthy babies and supported postpartum periods through the provision of innovative prenatal and postpartum services. Goal: Reduce the incidence of child abuse and neglect, increase knowledge of child development and improve the bond between mother and child beginning in pregnancy
Wellness Center Services Prenatal and Post Partum Services Centering Pregnancy Prenatal Education Classes Prenatal and Baby Yoga Prenatal and Infant Massage Volunteer Doula Program Home Visits Parent Child Groups New Beginnings
Birth Outcomes Since 1992, nearly 3,000 babies were born to Homeless Prenatal Program clients. Of those, 90.1% were born at a normal weight and 98.7% were born drug free. In one year, 98% of Babies were born drug free 90% were born normal birth weight
Birth Outcomes The Wellness Center helped to reduce: Depression Stress levels Social isolation Perinatal substance use While increasing the mother s Connection to their babies and community Knowledge of resources Access to health care and alternative health modalities
Conclusion End poverty and homelessness! The provision of WC programs, referrals, support services and risk identification has improved the lives of an often neglected population. The important work done by the Wellness Center staff has had a tangible impact on the lives of it s clients, and should serve as a model for organizations around the country who seek to achieve true health equity. Imagine
Resources Homeless Prenatal Program: homelessprenatal.org Gelberg L., Andersen R.M., Leake B. (2000). The Behavior Model for Vulnerable Populations: Application to Medical Care Use and Outcomes for Homeless People, Health Services Research 34, 1273 1286. Semenyna M.L., Lane A. (2006). Prenatal Care Among Women Struggling with Poverty or Homelessness, Alberta RN, 62, 16 17. Lewis J.H., Andersen R.M., Gelberg L. (2003) Health Care for Homeless Women, Journal of General Internal Medicine, 18, 921 928. Ensign J., Panke A. (2002). Barriers and bridges to care: voices of homeless female adolescent youth in Seattle, Washington, USA, Journal of Advanced Nursing, 37, 166 172. Lewis J.H., Andersen R.M., Gelberg L. (2003) Health Care for Homeless Women, Journal of General Internal Medicine, 18, 921 928. Milligan R.,Wingrove B.K., Richards L., Rodan M., Monroe Lord L., Jackson V., Hatcher B., Harris C., Henderson C. and Johnson A.A. (2002). Perceptions about Prenatal Care: Views of Urban Vulnerable Groups, Bio Med Central Public Health, 2, 25. National Center for Family Homelessness, The Characteristics and Needs of Families Experiencing. Homelessness Retrieved March 26,2012 from www.familyhomelessness.org
Resources American College of Obstetricians and Gynecologists, Health Care for Homeless Women, No. 454, February 2010 Lisa Watson, removing the Barriers to Health Care Reform for Homeless Women, Huffington Post, 9/6/2013 National Healthcare for the Homeless Council, Decreasing Unintended Pregnancy among Women Experiencing Homelessness, Healing Hands, Vol 16, No. 4, Fall 2012 Teruya, C., et al, Health and Health Care Disparities among Homeless Women, Women Health, 2010 December; 50(8): 719 736 Access to Women's Health Care Gelberg et. al, 2004 Health, Access to Health Care and Health Care among homeless women with a history of intimate partner violence Vijayaraghavan et. al, 2011 Homeless Pts experience of Satisfaction with Care McCabe, Macnee and Anderson, 2001 Homelessness and Mental Illness... Bhui, Shanahan, and Harding, 2006 The link bw homeless women's mental health and service system use Tam, Zlotnick, and Bradley 2008