Individuals at risk of poor health and healthcare disparities are normally regarded as being vulnerable. For homeless persons and other socially marginalized populations, an effective healthcare system is always not within their reach. Moreover, other social determinants of health, such as income, housing, and social support are often not present. No clear approach to healthcare delivery for homeless persons and other vulnerable people has been defined. Vulnerability, which is likelihood to harm, emanates from an interaction among various factors, including an individual, society, and prevailing life challenges encountered. Notably, vulnerable people experience extremely high rates of acute and chronic behavioral health disorders and physical conditions and injuries than the general population. Usually, these conditions remain unmet medical needs. Further, competing interests, such as housing and food, implies that vulnerable people may not always prioritize health needs. Most of them are uninsured and often seek care in emergency departments (EDs) when unmanaged symptoms lead to hospitalization.
Project Description and Overall Goal(s)
The practicum, “Improving the Overall Health of Hope House Residents in Middletown, Ohio”, seeks to improve health of homeless individuals. The program will target homeless residents aged between 18 and 75. The overall objective of the project will be to ensure that those who reside in the shelter are encouraged to take care of their own health through access to the necessary knowledge.
This project will be implemented in Hope House Mission, a faith-based shelter for the homeless. Its mission is to provide a wide of range of programs and services designed to achieve long-term, sustainable life transformation for homeless children, men, and women. Homeless persons usually have perceived unmet health needs, and they use high-levels of healthcare, usually in costly emergency departments or acute care settings (O’Toole, Johnson, Aiello, Kane, & Pape, 2016). Thus, the practicum, which is a holistic in approach to public health, will ensure that Hope House Mission and homeless persons have enhanced capacity to address healthcare needs they experience.
The practicum is expected to run for about 24 weeks (six months), and will be performed via lectures and discussion modes. Having identified the health needs that continue to affect the residents of Hope House, the project leader developed several topics that will be used to improve the overall health of people at the facility. These topics will aim not only to empower the residents with the knowledge on how to deal with common health issues, but also to underscore the importance of self-worth and self-esteem in managing challenging conditions. Some of the topics that will be addressed in this project are medication management, diabetes and hepatitis C management, self-neglect, oral health management, and vision management. Classes and group discussions will be held on a weekly basis with the residents of the Hope House, who will be encouraged to attend to ensure they gain useful knowledge on how they can deal with common health issues.
The objectives of this practicum address multiple areas of public health improvement among homeless persons in Hope House. The objectives include:
- Increase awareness in homeless people about the significance of overall health and well-being
- Increase acceptance and usability of effective preventive interventions and treatments in homeless persons at Hope House
- Promote educational interventions to lessen healthcare problems in homeless shelters
- Enhance the capacity of homeless shelter programs to offer preventive health services to homeless persons at homeless shelters
These objectives are designed in line with the overall goal of the practicum. Thus, at the end of the practicum, noticeable changes in knowledge, awareness, and practices would be expected in homeless persons at Hope House.
A holistic approach to public health will be used to ensure that the project helps develop all aspects of peoples’ lives that are critical to improving the overall health of the targeted population. The approach is based on the realization that most residents of Hope House face different health challenges and, thus, a holistic perspective is needed to ensure that the project will have an impact on physical, emotional, mental, and spiritual needs of the residents. The justification for using this perspective is due to difficulties to improve the overall health and well-being of the targeted population without adopting such a perspective. The integrated educational package would ensure a holistic approach to improve health and well-being of homeless persons while addressing care and underlying health challenges leading to emergency department use (O’Toole et al., 2016).
This practicum containing educational programs prepared by the presenter will be presented to homeless persons through face-to-face using oral PowerPoint presentation and brochures. These learning materials will be kept in a binder to be used as toolkits and references to ensure the continuity of the project even in the absence of the main implementer and for educating new residents. The toolkits will contain information and resources to assist the homeless people residing in the shelter in improving their overall health on different levels – physical, emotional, mental, and spiritual.
The project will target 40 homeless individuals at Hope House. One general approach to assess learning in the educational package will be to administer a pre-test and a post-test examination (Boston University, 2013). The pre-test will be administered at the start of the instruction to assess pre-existing knowledge of the content program, including medication management, diabetes and hepatitis C management, self-neglect, oral health management, and vision management. Later on at the end of every instruction program involving oral presentations and group discussions, a post-test assessment will be administered in an effort to show measurable achievements in homeless persons’ knowledge. The entire practicum will last 24 weeks (see the table below).
Impact evaluation will be used at the end of the interventional educational program to determine the degree to which the practicum would meet its main goal of knowledge acquisition in homeless persons at Hope House. It is an important instrument to improve the quality of program and improve the outcomes. In this case, pre-test and post-test assignments would be used for the practicum evaluation.
Collected data would be analyzed using frequencies and percentage to determine changes in knowledge following implementation of the project for homeless persons. Changes in percentage prior to and following the practicum will determine potential new knowledge acquired.
Sufficient resources, such as time, funds, instructional materials, and others, will be provided to facilitate the implementation of this practicum. The overall interventional educational practicum will address the following topics: medication management, diabetes and hepatitis C management, self-neglect, oral health management, and vision management within 24 weeks. The topics have been divided into different weeks to facilitate the implementation of the practicum through oral PowerPoint presentation, group discussions, pre-tests, post-tests, and brochures to reinforce learning.
|Table 1 |
The Practicum Implementation Schedule
|Programs||Medication management |
Pre-test and post-test
|Diabetes and hepatitis C management |
Pre-test and post-test
|Self-neglect and oral health management |
Pre-test and post-test
|Vision management |
Pre-test and post-test
Homeless persons are considered vulnerable, and vulnerability, as previously noted, emanates from multiple sources (Grabovschi, Loignon, & Fortin, 2013; Culo, 2011). For homeless persons, the rate of healthcare challenges are higher compared to the general population (Lin, Bharel, Zhang, O’Connell, & Clark, 2015). For medication management, it is shown that vulnerable people are at greater risks because of limited abilities to manage a complicated medication regimen based on multiple conditions they may experience. Non-adherence to medication, therefore, is a primary contributing factor for poor healthcare outcomes in vulnerable people. As such, interventions, such as education, that help such individuals to manage their medication could assist in avoiding needless, costly emergency department visits, admission, and hospitalization, as well as help in improving quality of life (Knowlton, Nguyen, Robinson, Harrell, & Mitchell, 2015).
Diabetes and hepatitis C virus are two health problems considered as chronic. Studies have demonstrated a significant relationship between diabetes and hepatitis C virus (Ba-Essa, Mobarak, & Al-Daghri, 2016). Notably, patients who share personal items, occupational exposure to blood or its related products, tattooing items, increased transaminases and risk practices were most likely to have both conditions leading to frequencies of hospital admission (Ba-Essa, Mobarak, & Al-Daghri, 2016). These results underscore the need for educational intervention for vulnerable persons.
From a broader perspective, self-neglect is a growing condition that is poorly understood social and medical challenge. Self-neglect is a multifactorial behavioral issue that accounts for an individual’s inability or a rejection to attend to own health, personal hygiene, and personal and environmental needs (Culo, 2011). Self-neglect is the chief reason for “referral to adult protection services” (Culo, 2011, p. 421). In this case, unsafe behaviors expose individuals to self-endangerment, which is an isolated risk factor for death and institutionalization. Vulnerable persons, especially older adults, who demonstrate self-neglect tendencies, usually live in situations of greater isolation, squalor, and foulness. Such individuals may refuse any help because they do not see anything amiss in their conditions. However, they present safety hazard and health risks to self and others. It is imperative to understand that such cases are controversial and, thus, care providers often argue whether the condition is social or medical, especially when mental conditions are absent (Culo, 2011). In the end, the issue of self-neglect comes to semantics. Nevertheless, individuals who neglect themselves are incapable and sick, and care providers should not ignore them (Culo, 2011). This explains why the practicum will adopt a holistic approach to address overall health and well-being of homeless persons.
Not much is known about the ocular condition of homeless persons (Noel et al., 2015). Visual acuity is significantly associated with reduced overall well-being. Thus, it is a critical educational program for homeless shelters, which host majorities with such complications. The training program will explore factors related to visual impairment and demonstrate the relevance of constant visual screening programs and treatment for homeless persons, especially where free eye clinics are found to help address this unmet health need.
Poor oral health based on all measurement indicators, such as decayed teeth, missing teeth, and oral pain, have been found among homeless persons (Costa et al., 2012). The educational program will cover causes, symptoms, diets, and offer a list of physicians who accept Medicaid and Medicare.
This project lies squarely on the public health domain as it aims to protect the safety and improve health of the homeless members of the Hope House community through education. Rather than seeking to provide diagnostic interventions for the health problems affecting the homeless, the project aims to create awareness and empower the homeless on how to manage these issues through education. Additionally, this project is in the public health realm because the feedback received from the intervention could be employed to develop policies and processes in order to ensure the safety and health improvement of the homeless members of the community. Overall, the project’s focus on improving the overall health of Hope House residents makes it a public health issue as the main goal of public health interventions is to safeguard improve health of different community members through education, policy making, and research on disease and injury prevention.
Ba-Essa, E. M., Mobarak, E. I., & Al-Daghri, N. M. (2016). Hepatitis C virus infection among patients with diabetes mellitus in Dammam, Saudi Arabia. BMC Health Services Research, 16, 313. Web.
Boston University. (2013). Choosing the right assessment method: Pre-test/post-test evaluation. Web.
Costa, S. M., Martins, C. C., de Lourdes, C. B., Zina, L. G., Paiva, S. M., Pordeus, I. A., & Abreu, M. H. (2012). A systematic review of socioeconomic indicators and dental caries in adults. International Journal of Environmental Research and Public Health, 9(10), 3540–3574. Web.
Culo, S. (2011). Risk assessment and intervention for vulnerable older adults. British Columbia Medical Journal, 53(8), 421-425.
Grabovschi, C., Loignon, C., & Fortin, M. (2013). Mapping the concept of vulnerability related to health care disparities: a scoping review. BMC Health Services Research, 13, 94. Web.
Knowlton, A. R., Nguyen, T. Q., Robinson, A. C., Harrell, P. T., & Mitchell, M. M. (2015). Pain symptoms associated with opioid use among vulnerable persons with HIV: An exploratory study with implications for palliative care and opioid abuse prevention. Journal of Palliative Care, 31(4), 228–233.
Lin, W.-C., Bharel, M., Zhang, J., O’Connell, E., & Clark, R. E. (2015). Frequent emergency department visits and hospitalizations among homeless people with Medicaid: Implications for Medicaid expansion. American Journal of Public Health, 105(S5), S716-S722. Web.
Noel, C. W., Fung, H., Srivastava, R., Lebovic, G., Hwang, S. W., Berger, A., & Lichter, M. (2015). Visual impairment and unmet eye care needs among homeless adults in a Canadian City. JAMA Ophthalmology, 133(4), 455-460. Web.
O’Toole, T. P., Johnson, E. E., Aiello, R., Kane, V., & Pape, L. (2016). Tailoring care to vulnerable populations by incorporating social determinants of health: The Veterans health administration’s “homeless patient aligned care team” program. Preventing Chronic Disease, 13, E44. Web.