Broadlawns Medical Center
1801 Hickman Road
Des Moines, Iowa 50314
Contact: Linda Ruble, PA/C
Phone: (515) 282-2200
Key words: outreach; mental and physical
health; SF-12
The purpose of this study was to explore
the effect(s) of outreach workers on the
physical and mental health of homeless
clients while testing the reliability
and validity of established measurement
tools for homeless clients.
METHODS
At the start of this study, research staff
(hired by program staff as consultants)
intended to use the SF-36, and later the
Dartmouth Co-op charting system, as their
research tool to obtain relevant health
information on clients for their dual
research objective. However, research
staff encountered difficulties, primarily
with respect a lack of applicability in
the questions asked, when they attempted
to use these tools. As a result, the SF-12
was used to obtain health information
from clients. The non-random sample for
this study (n=261) came from the sheltered
and unsheltered homeless population within
the catchment area of the Broadlawns Outreach
Project (BOP). The final sample for the
study consisted of 144 homeless individuals.
Eighty-five individuals who used any of
the seven outreach medical sites run by
BOP, had an assigned outreach worker,
and had provided complete information
on an SF-12 (physical and mental health
inventory) were chosen as the test or
experimental group. The comparison group
(n=59) was obtained through shelter sites
in the city where clinics were not located
and whose clientele did not have an assigned
outreach worker from BOP. Comparison group
members also completed the SF-12. Of the
85 individuals in the treatment group,
62 were males and 23 were females. The
mean age for males was 38.3 years, while
for females it was 28.9 years. Data on
race was rather imprecise for both groups;
for the treatment group, 77.4 percent
of the males and 69.6 percent of the females
were classified as White; 12.9 percent
of the males and 13.0 percent of the females
were categorized as non-White, with the
remainder being classified as _other/missing._
The comparison group (n=59) consisted
of 36 males and 23 females. Seventyseven
percent of the males and 56.5 percent
of the females in this group were classified
as White; 11.1 percent of the males and
13.0 percent of the females were categorized
as non-White, with the remainder being
classified as _other/missing._ Data was
collected from February through July 1997
at all BOP sites, which rotated among
various shelters throughout the city.
The physical and mental health status
of clients was determined using the SF-12,
which was translated into Spanish as needed.
Additional information collected on clients
included that related to educational background;
family demographics; prescription and
nonprescription drug history; employment
status; income level; veteran status;
experience with outreach workers; and
causes of homelessness. All outreach clinic
patients were asked to participate in
the study and willing participants were
asked to fill in the questionnaire while
they waited to be seen by a health care
provider. Clinic staff forwarded the completed
questionnaires along with intake logs
to project researchers affiliated with
Iowa State University. Questionnaire responses
were entered into a database, cleaned,
and analyzed using an SAS program.
The overall mean score on the PCS-12 (physical
component of the SF-12) for the total
population sampled (n=144) was 46.32 (s.d.
9.79), with scores ranging from 20 to
64 . The general population mean is 50.12
(s.d. 9.45). Therefore the sample was
4 points (0.4 of 1 standard deviation)
below the general population norms. The
mean score for this sample on the MCS-12
(mental component of the SF-12) was 40.83
(s.d. 13.18), with scores ranging from
9 to 65. The mean score for the general
population is 50.04 (s.d. 9.59); therefore
this sample was 9.21 points (0.9 s.d.)
below the general population mean. Using
raw scores, which were derived from the
computed, standardized PCS-12 and MCS-12
scores, which were multiplied by the predetermined
negative coefficient calculated from the
population norms, data were examined for
significant differences among genders,
age groups, and educational levels, based
upon group assignment. With the exception
of scores on the PCS-12 for age group
32-41, no significant differences were
found.
Data were also examined for differences
between gender groups and no significant
differences were found on the PCS-12 or
the MCS-12.
Research staff faced a number of challenges
before and during the course of this study
that have undoubtedly impacted the findings.
In addition to the difficulty experienced
by researchers in identifying an appropriate
health assessment tool, data collection
was also inhibited somewhat because research
staff (who were affiliated with a state
university) were not permitted by their
own internal research reviewing body to
use client medical records to supplement
the clients_ self-reported information
without first getting the consent of individual
clients. Therefore, in the many instances
in which data responses were unclear or
missing altogether, there was no mechanism
for supplementing the information. Data
collection difficulties and resource limitations
(i.e., staff and money) also negatively
impacted the study design and sampling.
The sample obtained was deficient in several
demographic categories (e.g., race/ethnicity,
gender, age). In addition, the study design
did not allow control or measurement of
type, intensity, and duration of outreach
services provided as well as more detailed
information on clients history of homelessness.
Although the results
of this study do not show significant
differences between the treatment and
comparison groups with regard to physical
and mental health as measured by the SF-12,
it is clearly not justifiable to conclude
that outreach workers have no effect on
the physical or mental health of homeless
clients. Further study is definitely needed;
future considerations should include special
attention to population sample characteristics.
In addition to the problems encountered
with data collection and study design,
it is also possible that because the efforts
of outreach workers are so interwoven
with the primary care and related support
services provided to clients, the benefit
they provide to clients will not be necessarily
detectable through the types of measures
researched in this study. Therefore, a
literature review on the evaluation of
outreach workers to help with the identification
of possible measures should be completed
as well.
