Women of Means aims to reduce all barriers to health care for the women we serve and to educate our peers and health policy experts on the methods and approaches that improve access to care.
Some of our projects are:
1. “Shelter-based Health Care for Impoverished Women in Boston” :
Design: Cross-sectional survey of underserved women, utilizing structured interviews.
Setting & Participants: Fifty women, aged 29-67, who sought medical care repeatedly at two daytime shelters in Boston, Massachusetts since program inception in 1999.
Main Outcome Measures: Survey measures included self-reported questions about socio-demographics, physical and mental health co-morbidities, health care needs, health care utilization patterns, and perceived barriers to care.
Main Results: The response rate was 74%. The average age of respondents was 52.4 years. All women had health insurance. 70% reported stable housing—84% of whom had been housed for >1 year. 94% reported multiple medical problems—the most common diagnosis was depression (70%). 89% reported having a primary care provider, but only one respondent had been with the same provider over the past five years. Subjects preferred obtaining medical services through our organization, citing preference for providers who understand their issues (88%), ability to obtain over-the-counter medicines and medical supplies (85%), and assistance with accessing traditional healthcare delivery systems (82%).
Conclusions: Impoverished women continue to access medical services at day shelters even after obtaining housing, health insurance, and primary care providers. Our model of care is one applicable approach to overcome perceived barriers to accessing the traditional healthcare system.
Keywords: Homeless Shelter, Women, Healthcare, Traumatic Brain Injury
2. PCP identification project—Determined where our patients have their established primary care providers. Data shows (of 1349 women with PCP documented ) 12% BHCHP (Boston Health Care for the Homeless), 28% CHC (Community Health Centers), 43% AMC (Academic Medical Centers) and another 16% “other” including private practice, Harvard Vanguard, unidentifiable, and out of state physicians.
3. Aging in Shelters Collaborative, data collection—chart review of 1800 women completed to determine age distribution in our single adult women’s shelters. Found 54% of the women we serve in our Wellness Centers are >50 years of age, 8% of the women are >70 years old.
4. Homeless Women Care About Their Health—review of clinical records over two years showed documented instances that we consider “valuable alternative outcomes” that demonstrate the impact of our constant and familiar presence in improving health outcomes. We call them “intention to self heal behaviors”:
- Came to us instead of using an emergency room inappropriately
- Followed up with one of our clinicians when advised
- Saw one of the volunteer physician specialists (Psychiatry, Dermatology, Foot care) when advised
- Obtained a T-Pass or a Medical Alert bracelet
- Agreed to accept care previously refused
- Took medicines as prescribed by one of us
- Improved blood sugars through education
- Asked for a detoxification referral
- Worked with volunteer psychiatrist until could establish ongoing relationship with own psychiatrist
- Followed up with one of us for a treated condition to tell us how it worked
- Came to us for a flu vaccine or TB test, including returning for the TB test reading 2 days later
- Went with one of the Women of Means nurses to interview for housing
- Worked with one of us to get eyeglasses or dental care
COLLABORATIVE WORK/PUBLIC HEALTH
1. Aging in Shelter Collaborative— The Aging in Shelters Collaborative (ASC) Program provides support, education and increased access to services for 100 women who are among the most medically needy and least connected to mainstream primary care. The long term goal of the program is to build a sustainable collaborative structure to effectively serve the housing, health and social service needs of the broader population of aging chronically homeless women in Boston. The services provided to the women participating through the ASC Program include home visiting and case management.
2. The Second Step—Educational collaboration to design a healthcare checklist that can be used with a pilot group of victims of domestic violence served by The Second Step’s mentoring group. In addition, as part of the same grant, will work to create staff training modules to assist Second Step’s lay staff in health care discussions with the women they serve. In addition, one of our nurses visits the houses to provide clinical care and participates in the design of the educational modules.
3. Traumatic Brain Injury in Domestic Violence Survivors–in collaboration with Dr. Eve Valera of MGH, an MRI study that looked for underlying physical damage to white matter tracts related to DV, possibly accounting for cognitive and executive function in survivors. Study is complete, data analysis ongoing.
