Week 14: Assessing the Homeless Pt

Question 1

Definitions of homelessness

Answer 1

Terms:
1. CHRONICALLY homeless: Someone who has been homeless for at least 1 yr. OR has had four episodes in a 3-yr. period WITH a chronic, disabling condition

2. INTERMITTENTLY homeless: Someone who has had multiple, short, self-limited episodes of homelessness
3. IN-CRISIS homeless: Someone who has had one episode of homelessness brought by a major crisis – economic, health or environmental-related (i.e. Fire, earthquake)
4. UNACCOMPANIED YOUTH: Adolescents or young adults <25 yrs. old, living on their own without parents

Question 2

Causes of homelessness

Answer 2

Caused by:
1. Personal vulnerabilities – mental health, substance use

2. Structural factors – poverty, lack of affordable housing

Question 3

Addressing the homeless population

Answer 3

Approach:
1. Be nonjudgmental

2. Be sensitive to the reality of homeless situation
3. Focus on immediate problems
4. Use event markers for time
5. Schedule appointments early in the day
6. Explain accurately and simply the reason information is needed

Question 4

History

Answer 4

Biographical – where are you staying?

Current – any injuries?

PMHX – diseases? hospitalizations?

FHX – may not wish to discuss

Psychosocial

Question 5

Review of systems

Answer 5

Skin – lesions, scabies, lice

HEENT – ear/eye/dental problems

Respiratory – URI, TB

CV – HTN

GI – nutrition, alcohol

GU – STDs

MS/Neurologic – neurologic/psychiatric problems

Hematologic/Immune/Endocrine – anemia, HIV, DM

Question 6

Psychosocial data

Answer 6

Health patterns – barriers to healthcare

Typical day – finding shelter

Activity/Exercise – basic needs

Sleep – priority finding a safe place

Personal habits – smoke, alcohol, drugs

Occupational health – may be employed

Socioeconomic status – homelessness implies low socioeconomic status; check if veteran (resources available)

Environmental – thermoregulation problem due to exposure and increased risk for victim of crime

Self-concept – low self-esteem, anxiety, and depression are common

Cultural influence – may be of undocumented status; language barriers

Religious influence – faith-based organizations often service providers

Sexuality – may be sexually active; may be victim of abuse

Question 7

Physical Exam

Answer 7

Work head-to-toe, paying close attention to feet; may have all possessions on person and reluctant to remove clothes

GE – poor hygiene, unusual odors

VS – hyper/hypothermia

Integumentary – lice, scabies from crowded living, skin lesions (DM common), poor wound healing

HEENT – dental problems

Respiratory – URI, TB

CV – PVD, HTN common

GI – GI problems often related to inadequate food source; cirrhosis, pancreatitis

GU – high risk for rape and STDs

MS – trauma

Neurologic – head trauma, substance abuse, seizures, psychiatric problems

Question 8

Follow up

Answer 8

Be realistic

Address immediate needs, and make referrals as needed

Question 9

Health promotion and disease prevention

Answer 9

Annual PPD testing

Pap smears and STI testing per recommendations

Vaccinations – influenza, pneumovax, hepatitis A and B, and tetanus vaccine

Contraception