Santa Barbara County Health Care Services Public Health Programs 345 Camino del Remedio

Santa Barbara, California 93110
Contact: Natlee Hapeman
Phone: (805) 681-4750
(alternate: Pam Stowe, (805) 681-5465)
Key words: utilization of services; patient profiles; data base

OBJECTIVE

The purpose of this study was to analyze demographic data that had been collected over a 2_ year period from patient encounter forms to assist program staff with efforts to provide the most appropriate services to clients.

METHODS
The study population includes those homeless clients that are seen by four community clinics; five Santa Barbara County Health Care Services clinics; and two public health nurses. The data for this pilot project was collected from January 1, 1997 through June 30, 1997. A random sample of revised intake patient encounter forms was evaluated to assess the following variables: area, sex, age, housing, outcomes and referrals. For the January 1 to June 30, 1997, data collection period, there were a total of 4,000 encounters, including 3,000 encounters seen by public health nurses. A systematic random sample (10 percent) was chosen from all areas to represent the homeless population for this data collection period. There were 376 charts chosen: 77 from Lompoc, 150 from Santa Barbara, and 149 from Santa Maria.

The following univariate analyses describe the variables and population sample.
Age:

Age groups	Frequenc y	Percent
less than 1	1	0.3
1 - 4	2	0.5
5 - 12	4	1.1
13 - 14	0	0.0
15 - 19	16	4.3
20 - 24	22	5.9
25 - 44	244	64.9
45 - 64	80	21.3
65 - 74	4	1.1
75 - 84	2	0.5
85 and older	1	0.3
Total	376

Gender:

Gender	Frequenc y	Percent
Male	234	62.2
Female	142	37.8
Total	376

Housing:

Housing	Frequenc y	Percent
Shelter	134	35.6
Transition	22	5.9
Doubling up	30	8.0
Street	118	31.4
Other	57	15.2
Unknown	15	4.0
Total	376

Measures:

Measures	Frequency
Continued Compliance/ Health Maintenance	202
Current Health Status Improved	58
Current Health Status Deteriorated	136
Lost to Follow-up	53
Referred to another district/county/state	20
Goal met	30
Refused service	9
Child under 2 yrs fully immunized	1
Kindergartners fully	3
immunized

Status-all Public Health Programs

Public Health Programs	Frequency
Domestic violence risk	26
Child abuse risk	14

Status-Maternal/Child Health Programs users:

Maternal Child Health	Frequency
Mother enrolled in OB Program	12
Teen mother (current pregnancy) <18 yrs	1
Newborn low birth weight <2400 grams	0
Child in need/referred to California Children's Services(CCS)	1
Child in need/referred to Child Health and Disability Prevention(CHDP) Program	0
not applicable	363

This study expanded traditional indicators measured by theprogram to include infant and child health needs. The following variables were added to the existing measures: early access to prenatal care; well-child physical to screen for treatable illnesses; complete immunizations to decrease preventable childhood diseases; and early referral to specialty providers or programs. The Homeless Health Care Project Patient Intake Form was modified to reflect these changes. A data base was also created in Access to allow for ongoing data collection.

RESULTS

The following are some of the analyses produced from questions about associations and relationships among the variables chosen. These associations were analyzed by using crosstabulation and Chi Square analyses, rejection at p-values < 0.05.

An association between area and housing was found, Chi Square=129.22, p-value < 0.001. In the Lompoc and Santa Maria areas, housing for clients is most likely to be shelters, whereas in Santa Barbara clients are most likely to live on the streets.

There also appeared to be a relationship between gender and housing, Chi Square=32.99, p-value < 0.001; this indicates that females are more likely to be in shelters and have other housing and males are more likely to live in shelters and on the street.

An association between gender and area also appeared, Chi Square=19.01, p-value < 0.001. Males seem to be more likely to be homeless in Santa Barbara, while females were more likely to be homeless in Santa Maria. There appear to be approximately an equal amount of males and females who are homeless in Lompoc.

During the 6 month study, there were 202 individuals who continued compliance; 58 whose current health status improved; 136 whose current health status deteriorated; 53 who were lost to follow-up; 20 who were referred to another district; 30 who had a goal met; and nine who refused service. There was 1 child under 2 years of age fully immunized, and 3 kindergartners fully immunized. Twenty-six individuals were found to be at risk for domestic violence, and 14 children were found to be at risk for child abuse. As part of the overall assessment for clients who had multiple visits during the study period, the following information was found: 1) regarding all males (234), most 102 (43.6 percent) seemed to have deteriorated (more than females 34 of 142 or 23.9 percent); 2) of those who were continually compliant (130), there was almost an equal split between males (68 or 52.3 percent) and females (62 or 47.7 percent); 3) of those living in a shelter (134), most (51 or 38.1 percent) had continued compliance/health maintenance, 30 (22.4 percent) deteriorated, and 16 (11.9 percent) improved; and 4) of those who lived on the street (118), most (68 or 57.6 percent) deteriorated, 39 (24.6 percent) continued compliance/health maintenance, and only 7 (5.9 percent) improved.

DISCUSSION

The collection of this data provides a useful information baseline that will be helpful for future studies. The revised intake form appears to be requesting the most appropriate and useful information necessary for ongoing evaluation. This data confirmed the belief that most Lompoc and Santa Maria clients live in shelters while most Santa Barbara clients live on the street. Also, this data confirmed the thought that females are more likely to live in shelters or other housing, unlike males who are more likely to live on the street. In addition, males are more likely to be seen in Santa Barbara and females in Santa Maria. Prior to the study, these trends were suspected by the public health nurses, but had not been confirmed. It was interesting, yet almost predictable, to confirm that those who live in shelters have the greatest continued compliance and that those that live on the street show the greatest deterioration. By obtaining this data, it was discovered that 12 women were referred to obstetrical care, 1 of whom was less than 18 years of age. Twenty-six individuals at risk of domestic violence and 14 children at risk for child abuse were identified. Having this information is extremely important to allow for the best and most appropriate care and social support of these mothers, infants, and children. Regarding limitations of the study and the data collected, those which were strongest include the following: 1) the study population is well defined by area, thus comparisons between areas may not be appropriate in some cases; 2) related to the first limitation, some of the study population is also rather transient; 3) data collection through a systematic randomized chart review may not allow for obtaining enough information about mothers, infants and children in particular; and 4) there is a slight statistical chance that individuals were not chosen for the random sample.

CONCLUSION

The major benefits that have come about from this study included the following: the development and improvement of a patient data base; a revised and improved Homeless Health Care Project Patient Intake Form; and perhaps most important, valuable client profile information that will help this program to better meet the needs of its clients.