Table Of ContentShelter Health:
Essentials of Care for /eople
+iving in Shelter
*en *raybill, MSW
)eff .livet, MA
-ational Health Care for the Homeless Council
www.nhchc.org
Shelter Health:
Essentials of Care for /eople +iving in Shelter
The 'ational Health are for the Homeless ouncil
The -ational Health Care for the Homeless Council began as an element of the -proEect
HCH demonstration program of the Robert Wood )ohnson Foundation and the /ew
Memorial Trust. We are now over .rganiUational Members and over 00 individuals who
provide care for homeless people throughout the country. .ur .rganiUational members
include grantees and subcontractors in the federal Health Care for the Homeless funding
stream, members of the Respite Care /roviders -etwork, and others. Homeless and
formerly homeless people who formally advise local HCH proEects comprise the -ational
Consumer Advisory !oard and participate in the governance of the -ational Council.
,tatement of )rinciples
We recogniUe and believe that:
homelessness is unacceptable
every person has the right to adequate food, housing, clothing and health care
all people have the right to participate in the decisions affecting their lives
contemporary homelessness is the product of conscious social and economic policy
decisions that have retreated from a commitment to insuring basic life necessities for
all people
the struggle to end homelessness and alleviate its consequences takes many forms
including efforts to insure adequate housing, health care, and access to meaningful
work.
&ission ,tatement
The mission of the -ational Council is to help bring about reform of the health care system
to best serve the needs of people who are homeless, to work in alliance with others whose
broader purpose is to eliminate homelessness, and to provide support to Council members.
Consistent with our Mission Statement, we:
Advocate for universal health care and for the improvement of current systems
intended to serve people who are poor and homeless
Research critical issues
Train and organiUe health care providers, service agencies, and homeless people
themselves to improve care
/ublish newsletters, monographs, action alerts, policy statements, training videos and
books
Collaborate with a broad range of public and private entities interested in the
problems of health care and homelessness.
-ational Health Care for the Homeless Council 2
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Shelter Health:
Essentials of Care for /eople +iving in Shelter
c=nowledgments
This proEect was developed with the support of the Health Resources and Services
Administration. The views expressed in this document do not necessarily reflect the views
of HRSA.
The development of the proEect was guided by the Shelter Health Advisory Committee,
consisting of Edward !onin, Sharon !rammer, )ohn &ilvar, Amy &rassette, +inda .livet,
Alina /ereU-Stable, *aren Rotondo, Marion Scott, and Allan Ainsworth.
Also indispensable to this proEect have been Heather !arr, !eth Miller *raybill, Sharon
Morrison, Hannah !ouldin .livet, /at /ost, and Marcia Stone.
As always, )ohn +oUier has provided great vision and support.
This guide draws extensively on Marsha McMurray-Avila’s book OrganiJing Health Care for
Homeless People, *en *raybill’s Outreach to People Hperiencing Homelessness, and The Health Care
of Homeless Persons: A $anual of Communica2le iseases and Common Pro2lems in Shelters on the
Streets, )im .’Connell, editor. The Health Care of Homeless Persons was published by the !oston
Health Care for the Homeless /rogram and generously shared with the -ational Council for
this and other purposes. Homeless Health Care +os Angeles and the Seattle-*ing County
Health Care for the Homeless -etwork have also done pioneering work in the area of
training shelter providers, and we have utiliUed and adapted their materials for this &uide.
Additionally, we have drawn from the work of many other organiUations for this &uide, and
we have tried diligently to give proper attribution. We are deeply appreciative of all the work
that has given us a foundation for this publication.
Drawing on the wisdom of many, we have attempted to create a document that will be
useful to many. /lease feel free to duplicate and adapt these materials for your own training
and operational purposes attribution as to source will be appreciated. Reproduction or sale
of these materials for profit is prohibited.
Thanks to you all,
*en *raybill and )eff .livet
May 200
-ational Health Care for the Homeless Council 3
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Shelter Health:
Essentials of Care for /eople +iving in Shelter
Table of ontents
". Why This uide? Why 'ow?
The Tool *its
A &uide for Shelter /roviders
Ways to Use This &uide 0
The Causes and Conditions of Homelessness
Homelessness and Health Care: Fundamental (ssues 3
Understanding the Connections !etween /oor Health
And Homelessness
Human Rights, Shelter, and Health Care
Thinking of Hosting a Homeless Shelter
"". What You 'eed to $now
ringing Health are into the ,helter
The Tool *its 2
The Facts on Common Health Conditions 2
The Facts of +ice 4
(ntake, Showers, and Clean Sheets: Heading .ff (nfestations
(n Homeless Shelters 4
The Top 4: Asthma, Diabetes, Cardiovascular Disease, and SeiUures 4
About Asthma 4
About Diabetes 0
About Cardiovascular Disease 3
What To Do (f Someone is Having a SeiUure
Health /romotion
Health /romotion in Shelters
Homeless Family Facility -utrition &uidelines
Why Dental Care Matters to Homeless /eople 2
Environmental Health and ,afety
The Tool *its
Hand Washing
&uidelines for Environmental Safety in Shelter
&uidelines for the Control of Communicable Disease in Shelter
Standard /recautions in Shelters
Sample Shelter /olicies 2
Environmental Health is -ot )ust About Control of Disease 0
Safety Manual
-ational Health Care for the Homeless Council 4
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Shelter Health:
Essentials of Care for /eople +iving in Shelter
For the Women of *atrina and .ther Disasters
Making Shelters Safe for Transgender Evacuees
A Word About Animals and Environmental Health 0
&ental "llness and ,ubstance Use Disorders
The Tool *its
Effective Approaches
What Works
Suggestions for Relating to a /erson Experiencing Mental (llness 00
Suggestions for Relating to a /erson Experiencing (ntoxication 0
Understanding Addiction 02
/rinciples of Effective Drug Addiction Treatment 03
Suicide 0
Suicide Myths and Facts 0
Signs of Depression and /ossible Suicide Risk 0
/.+.A.(.D. /.A.+.S. 0
&lossary of Common Mental Health Terms 0
&lossary of Selected Terms Related to Substance Use Disorders,
Treatment, and Recovery 4
Ta=ing are: oping with rief and %oss
The Tool *its 22
When the Hurricane Hits 23
Care for the Caregiver 2
Common Causes of Stress in Homeless Services 2
Signs and Symptoms of Secondary Traumatic Stress 2
Self-Assessment Tool: Self-Care 2
Finding Resiliency and Renewal in .ur Work 30
Caring for Your Self, Your Soul, Your Sanity 32
Mindfulness and Self-Care for Shelter /roviders 33
Helping .thers Cope with &rief and +oss 3
Reactions to +oss 3
*eys to Understanding and Accepting the &rief /rocess 3
Some Suggestions to Help &rieving /eople 3
Recovering From the Aftermath of a Disaster 3
ommunication and onnection
The Tool *its 42
Common Human -eeds: The !asis for .utreach 43
Seven Human -eeds 44
Frameworks of Engagement 4
/urpose and /rinciples of .utreach 4
Where .utreach Happens 4
-ational Health Care for the Homeless Council
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Shelter Health:
Essentials of Care for /eople +iving in Shelter
Services /rovided Through .utreach and Case Management 0
&ood Communication
.ARS: .pen 0uestions 2
.ARS: Affirmations 3
.ARS: Reflective +istening 4
.ARS: Summaries
Creating a +istening Environment
,ustaining ommunity Dialogue and Response
The Tool *its
Working Effectively in the Community
Checklist for Making Successful Referrals 0
Everyone Hates Meetings
Meetings Stink 2
Ten Tips for Effective Meetings 4
&uiding /rinciples and Shelter Standards
Disaster /lanning 2
When Disaster Strikes, Health Care for the Homeless
Takes to the Streets
""". ($, 'ow What? 'ext ,teps
-ext Steps
Tips for Trainers 2
+essons +earned
"/. &ore Resources
+ist of .rganiUations
+ist of Acronyms
Further Reading
-ational Health Care for the Homeless Council
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Shelter Health:
Essentials of Care for /eople +iving in Shelter
Why This &uide
Why -ow
-ational Health Care for the Homeless Council
www.nhchc.org
Shelter Health:
Essentials of Care for /eople +iving in Shelter
The Tool $its
At the beginning of each section of this &uide, readers will find lists that outline the
contents of the Tool *its that can be found in electronic form on the CD that accompanies
this &uide. While some of the tools and handouts are found both in the &uide and in the
Tool *its, most of the items listed below are only found in the Tool *its. They are to be
used to supplement the material in the &uide and to provide shelter providers with day-to-
day tools for use in the shelters.
Tool $it : eneral "nformation
A- “Why Are /eople Homeless” A fact sheet from the -ational Coalition for the
Homeless
A-2 “Homeless Children: America’s -ew .utcasts” from the -ational Center on
Family Homelessness
A-3 “(nternally Displaced /ersons”
A-4 “Right to Health”
A- “Right to Housing”
-ational Health Care for the Homeless Council
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Shelter Health:
Essentials of Care for /eople +iving in Shelter
uide for ,helter )roviders
The -ational Health Care for the Homeless Council provides publications and trainings on
providing effective health care for homeless persons. (n late 200 and early 200, we have
chosen to focus our efforts on shelters that have been created to house persons displaced by
the recent hurricanes, and on pre-existing shelters that have absorbed other refugees from
those storms.
Serious health problems are common among homeless persons, and shelter settings may
pose or exacerbate particular health risks for residents and service providers, as well as
opportunities for important health care interventions. This guide will familiariUe shelter
providers and others who provide services in shelters with topics such as:
RecogniUing common health risks and conditions of homeless persons
.rganiUing health screenings and on-site clinics
Making effective referrals to community health care providers
/recautions to prevent the spread of infectious diseases
Responding to substance abuse, mental health problems and /TSD
Safety concerns for residents and providers
Coping with grief and loss
-utrition and food handling
This guide has been designed for communities where providers of shelter and other services
can come together, learn about and discuss the issues, and plan individual and collaborative
solutions. The guide is not intended to be a step-by-step “how-to” manual for setting up
shelter services, but rather aims to provide tools and support to help shelter providers
respond more effectively to the health needs of residents.
This guide has been designed as part of a larger training effort, and is most effective when
used in conEunction with a formal training of its contents. These trainings are available from
the -ational Health Care for the Homeless Council.
The -ational Health Care for the Homeless Council is a twenty-year-old organiUation of
local health agencies, individual clinicians, respite care providers and people who have
experienced homelessness. To learn more about the -ational Council’s work, please visit
www.nhchc.org.
-ational Health Care for the Homeless Council
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Shelter Health:
Essentials of Care for /eople +iving in Shelter
Ways to Use This uide
To orient and train new shelter workers and volunteers
To provide a resource for in-servicecontinuing education sessions within an agency
To bring together shelter workers from various community organiUations for
ongoing training and networking
To use the resources and handouts to create or contribute to a “health library” in the
agency
To provide a resource for local government, civic leaders, and advocacy groups to
plan and develop services for homeless people
To aid shelter boards, directors, and managers to develop additional programs and
services in the shelter
To develop shelter policies and procedures
To serve as a reference for shelter residents and other homelessformerly homeless
people to advocate for needed programs and services
To use selected hand-outs taped on refrigerators, doors, walls as reminders for
workers and residents
To “train trainers” in using the guide to teach others about health issues in shelters
To use for writing grants and position papers
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