PROJECT HOPE: AN INNOVATIVE APPROACH TO HOMELESS HEALTH CARE EDUCATION

Morris Auditorium

Objective. · To explore alternative ways of adapting medical student clerkships in response to precepting physician shortages and limited placement opportunities within healthcare for the homeless projects. · To demonstrate educational techniques toward improving the identification and subsequent provision of care to individuals experiencing instability of housing. · To discuss how to integrate medical students in the outreach team, with an understanding of barriers to care and the effects that external factors can have upon street outreach as well as solutions to overcome these barriers. Background. Project HOPE - Homelessness in Osteopathic Pre-doctoral Education began within Nova Southeastern University's College of Medicine as a primary care initiative in 2010 funded through a HRSA pre-doctoral training grant (Federal Grant Identifying Number: D56HP20778.) This initiative was created due to a lack of formal curricula and training for medical students relevant to the needs of those experiencing homelessness. New challenges and needs have been recognized: 1) there are insufficient HCH sites with capacity to supervise medical students; and 2) as instability in housing is increasingly common second to the economic downturn, it is increasingly essential to assess the housing status of individuals across medical service points and beyond. Innovation demonstrated by Project HOPE relates to a focus on the individual rather than service setting so that medical student training can more broadly address all populations and their unique needs irrespective of clerkship rotation or setting. As a model that is collaborative and integrated by design, curriculum and project advances are informed through focus groups with students, faculty, clinicians and most importantly through the direct involvement of homeless health care consumers. The culmination of these efforts is reflected through 27 curricular hours that are integrated across all years of medical school. Included are concepts related to varying definitions of street outreach and the rationale for conducting outreach; with techniques such as motivational interviewing and an understanding of trauma informed care are key components to service delivery. In addition to evaluating change in attitudes and knowledge based upon didactic curricula and direct experience, the project seeks to disseminate curricula, research and lessons learned such that other programs within the health professions could easily replicate and implement this type of a training initiative. Methods. As part of this model, housing intake forms became a requirement of all monthly rotation logs to both emphasize that those experiencing instability in housing do not solely present at Health Care for the Homeless centers, and that housing status is irrefutably connected to a competent patient care plan. This was launched within rural / underserved rotations in March, 2012 and in July, 2012 for other rotations. Accordingly, all medical students' experiences in primary health care delivery to the homeless will continue to be expanded. Results. Data from 2284 completed logs since March, 2012, revealed a 6.9% encounter rate with individuals experiencing homelessness across all rotations, with an average of 11 patients encountered per student. Conclusion. As Medicaid expansion ensues, it is critical that students and professionals across the health professions are competently trained with a skill-set conducive to working with a diverse population inclusive of diverse needs. The project continues to gain momentum through student-led initiatives to provide health screenings and education within homeless shelters and safety-net programs, and in expanding curriculum to also engage professionals in the field within limited resources and trainings on emergent themes and issues (i.e. street outreach for those unaccustomed to the practice, STI prevention and treatment, allhazards preparedness for those without stable housing, etc.) Grants. HRSA