Clin/comm & diversity and Homelessness Flashcards
be aware of things to consider/ask when taking a hx or assessing capacity from a person who is homeless also who have language barrier and are talking about embarrassing/sensitive issue
What are the different types of homeless?
unintentionally homeless and in priority need e.g. pregnant, disaster victims, dependents, children
intentionally homeless (spent rent money elsewhere) in priority need
homeless but not in priority need
local connection? - work, life, family
hidden homeless (over occupancy)
What are the institutional needs of healthcare r.e. homelessness?
institutional needs
- free up beds –> need to be effective with those who are homeless to be efficient otherwise:
delayed discharge, other patients and staff safety
What are the homeless patients needs?
Physical social psychological emotional/mental health risk assessment practical
what are the physical needs of a homeless person?
they need a good handover - paramedics often know locals/regulars
dx and referral
access to medicine and med needs
- withdrawal symptoms (50% and 70% are alcohol and drug used respective)
- Infestation e.g. head lice - often the homeless dont have a place to shower or look after basic hygeine
What are the social needs of a homeless person?
where do they sleep?
who/what is their community?
significant relationship? animals?
What are the psychological needs of a homeless person?
anger - ?PTSD patients ability to communicate pts priorities? previous bad experiences talking to a dr? 54% special needs inc illiteracy
what are the emotional/mental health needs of a homeless person?
35x more likely to attempt suicide 2x levels of common mental health problems than in the community 4-15x more prone to psychosis (psych risk assesment) ASK ABOUT MOOD? SELF HARM? TRIED TO TAKE YOUR OWN LIFE?
SEE/OR HEAR STRANGE THINGS?
What is in a homeless persons risk assessment?
Regarding quitting addiction or their healthcare practice in general:
what has worked before?
what has FAILED before?
how frequent/severe/recent are risk behaviours (drinking/psychosis/etc) and in what context? (social/psych etc)
What are the services available to homeless peopls?
DALTS
homeless persons unit (garatt lane)
GP/clinics/dual dx workshop
patient street community
area outreach - street reach (phone reporting vulnerable adults)
hostel or day centre [ace of clubs, clapham - spires, tooting bec; these are 3rd sector - st mungos][NB: in hostels they could feel vulnerable from drug dealers etc]
social services
NB: brixton hill = red light district- addiction
What tips are there regarding communicating with a homeless person (clin/comm & diversity)
- listen and react appropriately
- use a natural curiosity to find out more about the persons life & fill in the blanks - theres a lot of info normally so summarise and be curious
if they want to discharge themselves -why?
- ?bad experiences with a doctor
- ?where discharging to
- ?where are their belongings
- ?explore ASDA for any habits/addictions
- ?feels constrained/uncomfortable
Follow up!
Psychosocial and identify problems r.e. diet, heatlh access e.g. Gp or see nurse at spires - access to transport etc
What are tips regarding sensitive/embarassing problems?
OSCE station: “gather PC and address any concerns”
(clin/comm & diversity)
- give time to respond r/e sensitive/embarrassing problems
- “not here to judge”
- CONFIDENTIALITY
normalise - “here for your wellbeing and health”
LISTEN, EMPATHISE, CLARIFY and UNDERSTAND - confident questions = confident answers
- “sexual activity with others?”
–> did you use protetction? kind of sex? - signpost though
NB: you wont break confidentiality after 1 session - takes time and follow up appointments - will tell them and why breaking confidentiality over time - you need strong legal defence/resoning why you broke it
what are tips regarding english not being a patients first language (clin/comm & diversity)
?language line
?interpreter
gague language ability initially, speak clear and slowish
- be nice and try not to get frustrated
- try and get consent (otherwise eventually for a conversations its implied) - say student doctor though and will see doctor after
- Ask questions open to closed (not mid) can get to Y/N questions - but let try and talk first and summarise back
- point to things
- short sentences
- confidentiality - reassure here for you and wellbeing
- ask if worried? sad? (if they seem it: keep words simple)
