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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
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.
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.
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.
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.
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