Thursday, 26 August 2010 Outstationed Eligibility Workers A panel discussion was held for outstationed eligibility workers and community outreach workers. Goal: Share best practices to find, enroll, and retain eligible homeless children and their families in Med-QUEST’s programs. Panelists Camille Mehau, Pahoa Family Health Center Garri Gorman, Wakiki Health Center Care-A-Van Jennifer Tehotu, Kalihi-Palama Health Care for the Homeless Tiffany Ahlo, Waianae Coast Comprehensive Health Center Moderator Lori Bianchin, Queen Emma Clinics Topic 1: How Does Each Location Conduct Outreach to Homeless Children and Families? Camille: Handles walk-ins. People find out through the coconut wireless and come by the community health center for help with applications and paperwork. Tiffany: Outreach from Kapolei to Makua Cave. Rotate beaches. After government sweeps, the outreach workers must find people at their new locations Garri: Care-A-Van goes to Wahiawä and Hale‘iwa areas. In Honolulu, outreach workers go to shelters such as Family Promise Program, Lighthouse Shelter, Institute for Human Services, and by Ala Moana Pier 1. Currently, there are not too many homeless on the beach. Jennifer: Case managers do home visits and location visits. Can refer clients to pubic housing and shelters. We also assist patients at shelter health clinics. Topic 2: Homeless Children: Who They Are and Why They Are Homeless? Jennifer: Some live with relatives but must move out because of family conflicts or overcrowding. The majority of homeless families with children are Micronesian. They often come to Hawai‘i without knowing it is difficult to find affordable housing or don’t mind living in parks or on the beach. Garri: There are many single moms with multiple kids. We try to have kids attend school, but lack of proper documents is an issue. Some Micronesian women come to Hawai‘i pregnant and give birth here which adds to the complexity of shelter placement. Families with children live at beach parks in the summer when school is out. During other months, the children often reside with family members in homes while the parents continue living on the beach. Homeless children can also be found with their mothers in domestic violence shelters. Tiffany: We know about 15-20 children and their families. Some parents do not have other choices so they keep their children with them at the beach. Camille: Hilo Area: Homeless teens are those who choose not to live with family members. In the summer, Hawai‘i County unlocks beaches for overnight camping so homeless parents stay with their parents. During other months, adults stay at the beach during the day and at night the families camp in people’s yards or find areas to park vehicles and sleep. Most homeless are single adults. Topic 3: Communication with Homeless Families Jennifer: Case managers do home visits and have cellphones for communication. Tiffany: Keep in contact through outreach, home visits, and health center visits. We also use cellphones. Garri: There is a mobile medical unit available at islandwide beaches (except the Waianae area which has its own health care services). Cases are managed for people not registered at Waikiki Health Center and their files can be transferred. Topic 4: Help with Citizenship Documents, Photo Identifications, and Mailing Addresses Camille: Outstationed eligibility workers go online to download birth certificate applications and also find ways to get photo identifications. Grant funds help pay for Hawai‘i State IDs. Clients sometimes call their families to have documents faxed or emailed. For mailing addresses, homeless people mostly use family and friends’ addresses. Some use P. O. Boxes and general delivery. Garri: Help with documents and photocopying and also use scanners. We keep document copies in case clients lose them. Hawai‘i State ID replacement not a problem, but for out-of-state you need a birth certificate. Federal office help is available for social security if no there is no identification. Mailing Addresses: assistance is provided to set up P. O. Boxes. Clients can also use the community health center as a mailing address and staff keeps binders with mail for clients to pick up. Norma (Waimanalo Health Center): Community health center has grant funds to help clients get birth certificates and photo identifications. Tiffany: Help homeless clients obtain required documents (e.g., photo identification, birth certificate, marriage license, divorce decree, death certificate) on our monthly document runs. Note: See details in Topic 5 (Transportation). Costs are paid by grants. If client needs an out-of-state certificate, we collaborate with Legal Aid Society of Hawaii. Jennifer: Health center uses grant funds as a last resort to pay for documents. Legal Aid Society of Hawai‘i (LASH) is also a resource to get documents. For mailing addresses, people an use office address if they do not have a P.O. Box or family residence. Connie (Legal Aid Society of Hawaii): Call John at our office (536-4302) to schedule notifications/notarized documents. Service is also available at Waianae Coast Comprehensive Health Center every Friday from 1:30–2:30 PM. Topic 5: Overcoming Clients’ Transportation Barriers Tiffany: Case Management Department transports homeless clients once a month to Honolulu to obtain documents. In special cases, workers escort clients and guide them through the process. We can also give them bus tickets to travel on their own. Garri: Community health center provides bus passes so clients can connect with our Kaimukï office for more services. Disabled bus passes are also available. Clients are personally escorted to alcohol and other drug detoxification programs (another major case management issue). Camille: Buses are free on the Big Island. Jennifer: Don’t usually transport clients. Advise them to get a disability bus pass if qualified. We also have one-way bus passes for specific purposes or can use taxi vouchers if it’s an emergency or they must get to appointments. Community clearinghouse has an emergency request program—clients can get vouchers for a monthly bus pass. Topic 6: Challenge of Mainland Transplants Camille: Most homeless people are mainland transients with medical issues. Topic 7: Verifying Homeless Jennifer: Verification letters are provided after one month of case management. Garri: Homeless verification done at Care-A-Van. If referred by another agency or housing office, need to qualify as a client by an outreach worker. Tiffany: Must encounter a client three times to provide a Homeless Verification Letter (HVL). During each encounter, we verify the campsite, assess the situation, and complete an intake. If everything is cleared, a case manager provides the client with a HVL and assists with a shelter application. Topic 8: Other Information Jennifer: Many homeless need adult mental health services. There is a “Shelter Plus” housing program for disabled people. Eligibility is homeless with documented disability. Clients can choose where they want to live for 30% of income. However, the program is currently closed because funding has been exceeded. A main focus is keeping contact with people who leave the shelters. Garri: Most walk-ins and single people apply for the General Assistance (GA) program. Tiffany: Pilot project using electronic Med-QUEST application. Program connects uninsured clients at satellite clinics with outstationed eligibility workers at the main community health center. It is a paperless program: documents are scanned and the file is faxed directly from a computer to Med-QUEST. Nurses go out on outreach once a month. If more health care services are needed beyond the nurses’ abilities, clients go to the Waianae Coast Comprehensive Health Center emergency room or clinic. Camille: Birth certificate or photo identification is required for shelters and people can only stay a maximum of 90 days Norma (Waimanalo Health Center): Audience Question: Does CPS take children away if the family is homeless? Norma: CPS is overwhelmed and there is a need for foster families. Shelters are at capacity so chances of children being taken away are slim unless there are concerns about abuse, drug use, or neglect. Community Health Centers: Use sliding-fee scale discounts to assist uninsured patients with health care costs. Charges are based on patient’s income. Nalani (Hui No Ke Ola Pono, Maui): Homeless come with major illnesses and resources are tight. Sometimes we lose contact with them and cannot follow-up. Med-QUEST Renewals: Many homeless people lose health insurance because they move around, don’t notify Med-QUEST, and the annual renewal letter is returned to the local Med-QUEST office. The Med-QUEST eligibility worker will try to call the customer, however often the phone number on file is disconnected therefore the case is closed due to “Whereabouts Unknown.”