Heartland Health Outreach

1. Heartland Health Outreach Health Care for the Homeless Oral Health Program Mona Van Kanegan, Dental Director Heidi Nelson, Executive Director

2. Heartland Health OutreachHealth Care for the Homeless Oral Health Program Session Objectives: • HCH Oral Health Program development • How Oral health Program functions in partnership • Plans for Growth Heartland Alliance for Human Needs & Human Rights

3. HEARTLAND ALLIANCEwho we are: a 117-year-old service-based human rights organization providing paths from harm to hope for the most poor and vulnerable. Heartland Alliance for Human Needs & Human Rights

4. HEARTLAND ALLIANCEwho we are: our human rights work is based on promoting three freedoms: • FREEDOM FROM WANT: providing the opportunity to work and enjoy a decent standard of living (and ensuring a safety net for those who can’t work due to crisis, disability, or age); • FREEDOM FROM FEAR: ensuring that everyone has a safe home and a safe community—free of violence or persecution; • FREEDOM FROM INJUSTICE: promoting equality, civil liberties, and the rule of law. Heartland Alliance for Human Needs & Human Rights

5. HEARTLAND ALLIANCEwho we are: our comprehensive approach includes: • ­ Opportunities for work and well being for the poor and homeless • ­ Safe and affordable housing and related support services • ­ Health care systems—medical, mental health, and dental • ­ Protective and resettlement services for people in crisis or danger • ­ Legal remedies for those being treated unjustly • ­ Crafting solutions to poverty, homelessness, migration, and situations of vulnerability Heartland Alliance for Human Needs & Human Rights

6. Heartland Health Outreach • Primary Care Services • RWCA, HCH and CHC services • Cross Cultural Interpreting Service • Kovler Center for Survivors of Torture • Mental Health and Addiction Services • Homeless Mental Health • Residential Mental Health • Pathways Home • Oral Health Services • RWCA, HCH and CHC services Heartland Alliance for Human Needs & Human Rights

7. 2003 Program Summary • Income/Insurance: • 95% of Users below 100% FPL • 77% of Users are uninsured • 19% of Users have Medicaid • Racial Breakdown: • 53% African American • 24% white non-Hispanic • 23% Hispanic Heartland Alliance for Human Needs & Human Rights

8. Spang Center Clinics Heartland Alliance for Human Needs & Human Rights

9. Heartland Health Outreach Spang Center Program With the assistance from city, state and federal governments and private foundations, HHO started its oral health program in 1992 • Dr. Larry Spang • Chicago Department of Public Health (CDPH) • CDPH Uptown Neighborhood Health Center Heartland Alliance for Human Needs & Human Rights

10. Program Growth • Initially oral health services were available for HIV persons in Uptown and later expanded to West Town and Englewood Neighborhoods • 1998-2001:Collected data to document local need in other populations (HCH and CHC) to expand programs Heartland Alliance for Human Needs & Human Rights

11. Needs Assessment – HCH Oral Health Up to 80,000 homeless people per year • Regional Continuum of Care Roundtable (2001) • 30% of persons needing dental services could not get them • Circle Family Care (2001) • 36% program participants had no access to dental services Heartland Alliance for Human Needs & Human Rights

12. Needs Assessment – HCH Oral Health • CDHS (2002) • 41% substance abuse issues • 9% severe mental illness • 2.4% HIV/AIDS • 7.5% physical disability or chronic condition • Diverse population, high percent of foreign born persons • Strong primary care program (HHO) more than 10,000 HCH patients Heartland Alliance for Human Needs & Human Rights

13. Community Responsiveness • Armed with needs and clinical assessments of oral health in Chicago, HHO as the HCH grantee applied for and received oral health funding in 2002 Heartland Alliance for Human Needs & Human Rights

14. Implementation Objective I • To provide homeless services in or near communities where homeless persons were known to reside and within easy access to public transportation • HHO had three clinics that were located in high homeless areas • These also were within easy access to public transportation, in CDPH buildings • Challenge: limited hours of operation for the HCH program, from 8 to 16 hrs/week each Heartland Alliance for Human Needs & Human Rights

15. Implementation Objective II • To provide culturally and linguistically competent comprehensive treatment • A sister program at HHO provides health care interpreting service for program participants that covers almost 40 languages Heartland Alliance for Human Needs & Human Rights

16. Implementation Objective III • Extend HHO’s holistic approach to health care to increase access to care • Treatment/Intervention- oral health education including oral disease and trauma prevention; provide direct service: treatment for dental caries, periodontal disease, edentulism, cancer exam and emergency services Heartland Alliance for Human Needs & Human Rights

17. Implementation Objective III Continued… • Extend HHO’s holistic approach to health care to increase access to care • Advocacy/Public Policy- HHO works with the Chicago Continuum of Care and Health Care for the Homeless Roundtable to educate and inform; Member of ISDS Access to Care Committee Heartland Alliance for Human Needs & Human Rights

18. Implementation Objective III Continued… • Extend HHO’s holistic approach to health care in addressing lack of access • Affect Education Systems- HHO has agreements with UIC and UCSF Schools of Dentistry to provide clinical dental education at the Spang Center sites students treat HIV, community and HCH patients of the clinic Provides an opportunity to witness, first hand the community health care system, population and how they can interact Heartland Alliance for Human Needs & Human Rights

19. Critical Partners: Collaboration/Integration • Referral agencies • University partners • Chicago Department of Public Health • Goldie’s Place, a north side Homeless Service Agency Heartland Alliance for Human Needs & Human Rights

20. Goldie’s Place • 4 hour/month/one chair volunteer dental program • Common mission with HHO: to provide dental care, support and job training opportunities for the area homeless population • Soon to move to a larger location Heartland Alliance for Human Needs & Human Rights

21. Heartland Spang Center for Oral Health Edgewater Collaboration • With a joint service plan, Goldie’s Place was able to leverage local foundation support to build out and equip with one dental chair and some small equipment • A dentist was hired for 32 hours week, second chair and remaining dental equipment were funded by HCH grant funds through HHO Heartland Alliance for Human Needs & Human Rights

22. Heartland Spang Center for Oral Health Edgewater Collaboration • Permanent dental clinic for both agencies with reliable equipment • Volunteer program has grown to 6 hrs/week and a Dental Assistant Job Training program • HHO pays a prorated share of market rate rent and receptionist (previous Goldie’s participant) salary Heartland Alliance for Human Needs & Human Rights

23. Heartland Spang Center for Oral Health Edgewater Collaboration • Goldie’s Place uses rent funds to support its Job Training, dental treatment and other programs • Goldie’s place has access to HHO’s dentist for emergency coverage of patients • HHO accepts Goldie’s patients for rehabilitative portion of dental treatment plan Heartland Alliance for Human Needs & Human Rights

24. Heartland Spang Center for Oral Health Edgewater Collaboration • Year to Year contract, considered by HHO as a interim space • Strive for good communication, trust and mutual respect • Each party functions as its own center responsible for supplies and on going expenses • Major equipment is shared, upkeep costs are prorated Heartland Alliance for Human Needs & Human Rights

25. HCH Oral Health: Third Expansion Cycle • Outgrown Goldie’s Place (in the second expansion cycle) • Planning a move to a 160 unit low income residential building, where 30% of the units will be occupied by a transitional housing program • Seven chair clinic on the ground floor Heartland Alliance for Human Needs & Human Rights

26. Innovation • HHO works with many homeless service agencies, shelters, transitional housing locations~ large referral base of patients • Many different people referring into oral health program • High failure rate of first dental appointment dental clinic overbookingunpredictable schedule Heartland Alliance for Human Needs & Human Rights

27. Innovation- Intensive case management • In house primary and mental health patients • Case manager is housed at the primary care site, explains the dental program and makes a dental appointment at the primary care visit • Additional Case manager’s duties: refer and follow HCH patients, make appointments, help fill out paperwork, arrange for transportation and interpreter • Streamlined and coordinated referral and follow up • Decreased failure rate to 25-30% Heartland Alliance for Human Needs & Human Rights

28. Quality Measures & Outcomes • Quarterly: Next Available Appointment Access Measure • Annual: Patient Satisfaction Survey and Focus Group • Annual: Peer Chart Review • Annual: Healthy Teeth Indicator Heartland Alliance for Human Needs & Human Rights

29. Replication • Oral Health Program has grown “organically” • Used unconventional, less that ideal opportunities to develop a comprehensive oral health program • Leveraged unused resources (space) • Took risks: part of pilot for student training, opening small clinics • Value development of equal partnerships and joint programs to share resources Heartland Alliance for Human Needs & Human Rights

30. Long Term Goal: To strategically develop larger capacity clinics for HIV, Community and HCH programs in Chicago

31. Heartland Alliance for Human Needs & Human Rights