Heslin KC, Andersen RM, Gelberg L; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 5.
Department of Health Services, UCLA, Room 31-245a Center for Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90024, Phone: (310) 313-0413, Fax: (310) 825-3317, E-mail: heslin@ucla.edu
RESEARCH OBJECTIVE: The challenges of securing basic forms of subsistence such as food and shelter may cause the homeless to delay or completely forego seeking needed health and social services. Case management has been promoted as a mechanism for addressing this problem. Although there is a substantial literature on case management for the homeless, the emphasis on the severely mentally ill has precluded evaluation of outcomes that are crucial for women of reproductive age, such as those related to nutritional intake. This study presents estimates of the proportion of homeless women with case managers, and the associations of case management with access to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), food stamps, and medical care, and with difficulty finding shelter.STUDY DESIGN: Respondents to this cross-sectional survey were sampled from 102 Los Angeles County homeless shelters and meal programs using a multi-stage probabilistic approach. Face-to-face interviews were conducted between January and October 1997. Respondents were asked if they had a case manager. They were also asked whether they used WIC services or food stamps, or had difficulty finding shelter for the night, in the previous 30 days, or had unmet need for medical care in the previous 60 days. The association of case management with access to the four types of services was estimated with separate multivariate logistic regression analyses. Analysis weights were set inversely proportional to the selection probabilities for respondents, based on data on the frequencies with which respondents reported using the shelters and meal programs that served as sampling sites. Odds ratios (ORs) and 95-percent confidence intervals (CIs) were calculated.POPULATION STUDIED: 974 homeless women of reproductive age.PRINCIPAL FINDINGS: Many homeless women are not receiving key health and social services. Only 35 and 53 percent of program-eligible respondents, respectively, are accessing WIC and food stamps. Approximately 37 percent of homeless women report unmet needs for medical care, and 30 percent report difficulty finding adequate shelter. Approximately 56 percent of respondents have case managers. Multivariate analyses show that having a case manager is associated with increased odds of obtaining shelter without difficulty (OR=1.98; 95% CI=1.26, 3.11) and food stamps (OR=1.78; 95% CI=1.08, 2.95), but not WIC or medical care.CONCLUSIONS: Despite the difficulties of addressing their great needs for assistance in a complex and nonintegrated service system, nearly 45 percent of homeless women do not have case managers. Further, the effectiveness of case management in improving access to medical care appears limited.IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: More assertive forms of case management may be necessary to reach homeless women. Increased administrative support may help inform case managers about the range of programs and other resources available to their clients.PRIMARY FUNDING SOURCE: Agency for Health Care Policy and Research
Publication Types:
Keywords:
- Case Management
- Child
- Cross-Sectional Studies
- Female
- Health Services
- Health Services Accessibility
- Health Services Needs and Demand
- Health Services Research
- Housing
- Humans
- Infant
- Interviews as Topic
- Los Angeles
- Managed Care Programs
- Social Welfare
- Social Work
- economics
- hsrmtgs
Other ID:
UI: 102273145
From Meeting Abstracts