Unhoused Individuals and Access to Healthcare Introduction & Background: The unhoused, identified as those in shelters, transitional housing, and those who sleep in unhabitable places are prone to exposure to issues such as diabetes complications, tuberculosis, and lack of insurance. This U.S. population of over 560,000 may not prioritize health due to their focus on survival. Purpose Statement & Research Question: The purpose of researching homelessness is to determine if the unhoused population who use community health resources has a better quality of life than the unhoused who do not utilize resources. Literature Review: The literature review included search terms such as unhoused, hospital admissions, homeless programs, and scientific nursing research. A broad inclusion criterion with a focus on the use of local resources within the population was utilized. The CINAHL database was searched. Each source is peer reviewed, less than 5 years old, and authored by at least one registered nurse. Findings: Findings indicate that current systems and tools for the unhoused within healthcare facilities are deficient regarding patient-centered care. Over 50% of unhoused people are male, and 60% of the unhoused seek shelter in some capacity. Trends include region, climate, and available resources. Interviews yield that the unhoused have issues seeking proper care due to a lack of understanding of healthcare systems or referral pathways. Difficulties with transportation, insurance, or perceived negative authority from providers affect this population. Conclusions & Nursing Implications: Professional hypotheses and methodology are portrayed in the viewed research. Different identification strategies and accessible health programs are necessary for this population to improve the well-being of the unhoused and the efficiency of health facilities.

My findings imply that homeless LGBTQ young adults are very limited in where they can go to find LGBTQ-accepting services. Even though all the shelters that were interviewed claimed they did not discriminate against LGBTQ persons, they do not provide and are not affiliated with services or programs that are considered to be LGBTQ- accepting. Based on the research, shelters would rather have clients conform to their pre-existing structure rather than the shelters conforming to the specific needs of the clients.; The goal of this research is to explore what programs and services are being provided at various homeless shelters in the South Florida area that would appeal to homeless clients who self-identify as a member of the lesbian, gay, bisexual, transgender or queer/questioning (LGBTQ) community, if staff and faculty are trained on how to better address LGBTQ specific issues, how often staff receive LGBTQ sensitivity training, what demographic information is being recorded upon client intake and whether or not homeless LGBTQ young adults would feel safe using their facility when receiving social services. Data for this research was collected through brief, confidential telephone interviews with staff members at twenty-five various social service providers throughout the Palm Beach, Broward and Miami-Dade Counties of South Florida. Short interviews were also conducted with two major LGBTQ advocacy groups in Broward and Miami-Dade County. As a result of completing my research, I have found that no shelters in Palm Beach, Broward and Miami-Dade County provide programs or services that are identified as LGBTQ-friendly. There are a few shelters that are affiliated with the local LGBTQ advocacy groups and will refer LGBTQ clients to these groups for services. Training on cultural diversity is required of all staff members of each social service provider, however in these cultural diversity training sessions, LGBTQ issues are just reviewed and not the main focus of the sessions. In addition to a lack of direct focus on LGBTQ specific issues, these training sessions are infrequent. This research also shows that social services are taking into account demographic information such as race and sex but not really focusing on sexual orientation or gender identity, leaving us with a severe lack of data on where this specific population is going to receive social services.

There is a specific need for occupational therapy programs to provide education about culturally responsive care. Evidence suggests that occupational therapists often feel unprepared in the practice setting to fulfill the role of service provider for persons experiencing homelessness (Lauckner et al., 2006). Occupational therapists are uniquely equipped to address the needs of homeless clients in community health settings and decrease barriers to participation for homeless individuals. With additional education about culturally responsive care for this target population, occupational therapists will feel more prepared to provide for homeless clients and develop client trust. The Student-Homeless Health Partnership (SHHP) is an evidence-based, theory-driven program that utilizes multimodal approaches of instruction with occupational therapy students to provide culturally responsive care for homeless individuals. Through the program, students will develop a client-centered, occupation-based approach to caring for individuals experiencing homelessness through direct engagement. The goal and outcome of the program is to change occupational therapy students’ social beliefs and attitudes tied to adults who are homeless and ultimately, provide effective and culturally responsive care for these individuals. Positive program evaluation findings of SHHP will highlight occupational therapy’s distinct value in community health programs and reinforce the expansion of the SHHP model to occupational therapy programs outside of the San Francisco Bay Area.

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