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APHA Scientific Session and Event Listing

Roseanna H. Means, MD MSc, Department of Medicine, Brigham and Women's Hospital, Women of Means, Inc., 148 Linden St., Wellesley, MA 02482, 781-239-0290, RMeans@womenofmeans.org

Women living on the streets or in homeless shelters face multiple barriers in accessing medical care. Challenges of homelessness and survival needs make it hard to focus, organize, and follow through on primary and preventive health care. Isolation, poverty, shame, humiliation, mental and cognitive impairment are only some of the many barriers that get in the way of asking for and receiving help. Women of Means (WOM) is a grassroots non-profit organization of volunteer doctors and paid nurse case managers that visit homeless shelters in Boston to provide free and unencumbered medical care. WOM sees the women for episodic care and provides clinical support supplemented by individual nursing case management and outreach to help the women remain clinically stable and get or stay connected with their own PCPs. Individual trusting relationships are built by our consistent and reliable presence. WOM rewards women with praise when they complete “non-traditional outcomes” such as showing up to meet with a psychiatrist, choosing to sleep in a shelter rather than the street, asking for antibiotics for bronchitis instead of using an ER, or following up for housing appointments or PPD readings. Praise for small steps can lead to more positive steps. Our approach led to 35% enrollment in health insurance for previously uninsured women in 2005. We suggest that such “alternative outcomes” are worthy intentional steps toward improved health of extremely vulnerable persons and ought to be included as legitimate outcomes measures in addition to or instead of procedure-based quality assurance indicators.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Articulate the rationale for offering unencumbered health care in locations where homeless women feel safest.
• Define “non-traditional” health outcomes.
• Recognize the importance and impact of life context on health outcomes as compared with traditional Quality Assurance measures that are procedure-based.
• Apply variables of functional, emotional, financial, cognitive, and mental health to a better understanding of what constitute successful health outcomes.

Keywords: Access to Health Care, Women

Presenting author's disclosure statement:

Not Answered