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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
 
4207.0: Tuesday, December 13, 2005 - 3:30 PM

Abstract #108261

Traumatic brain injury in the homeless: Impact on access to quality healthcare

Carol Waldmann, MD, Boston Healthcare for the Homeless Program, 729 Massachusetts Ave, Boston, MA 02118, 781 221-6565, cwaldmann@bhchp.org and Jill Roncarati, PA-C, Boston Health Care for the Homeless Program, 729 Massachusetts Avenue, Boston, MA 02118.

Traumatic brain injury is common in the general population and is particularly common within the homeless population. Many homeless are at risk of brain injury because of their daily exposure to violence on the streets, the high incidence of trauma and accidents, and the prevalence of substance abuse within this population. Many persons become homeless after suffering neuro-psychiatric and behavioral deterioration following TBI. Alcoholism, very common in the homeless population, decreases the brain's ability to heal and increases the risk of neuro-psychiatric and physical sequelae of brain injury. People with multiple diagnosis including mental illness, substance abuse and traumatic brain injury often find it difficult to access appropriate services. These individuals may have trouble negotiating complex systems due to cognitive or behavioral problems. Even with help, barriers exist. Each discipline has diagnosis specific assistance. The multiply diagnosed are often unable to get assistance because of their co-morbid diagnosis. When a multiply diagnosed patient is homeless these barriers are magnified. Many healthcare providers and support staff are under educated on the complexities, barriers to care and opportunities for intervention for this group of patients. In my presentation I plan to elucidate the potential sequelae of TBI and discuss how the neuro-psychiatric and behavioral difficulties can handicap patients ability to care for themselves or access assistance. Through case discussion I hope to show potential approaches that can lead to success in this complicated group. Cases will be drawn from my urban homeless primary care practice with Boston Healthcare for the Homeless Program.

Learning Objectives: After the session the learner should be able to