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Women's Health/Children's Health

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More assertive outreach programs may be needed to link homeless women to case managers and a broader range of services

Over half (56 percent) of nearly 1,000 homeless women interviewed in Los Angeles County in 1997 had case managers to help them find and obtain care. Women with case managers were nearly twice as likely as those without case managers to use food stamps and more than twice as likely to have found shelter without difficulty in the previous month. However, having a case manager did not increase their likelihood of using the Supplemental Nutrition Program for Women, Infants, and Children (WIC) or meeting their needs for medical care, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08323).

This is important, since homeless women and their children typically have inadequate dietary intake and are poor enough to be eligible for these programs. However, applications for WIC are available only at municipal health department clinics and not at shelters, meal programs, or other places that homeless women often visit. Also, there is a 10-page application form for the food stamp program, and both programs require extensive documentation of finances. These are the types of administrative and logistical barriers that case managers have traditionally been charged with reducing, explains Lillian Gelberg, M.D., M.S.P.H., of the University of California, Los Angeles.

Case managers need to step up efforts to help homeless women apply for WIC, refer women to appropriate sources of medical care, and link homeless women to public health insurance programs and a regular source of care. Using shelters and meal programs to enroll women in these programs and more assertive forms of outreach in the streets are ways to boost services to homeless women without case workers, says Dr. Gelberg. Dr. Gelberg and her colleagues measured the association of case management with access to shelter, food stamps, WIC, and medical care for a sample of 974 homeless women of reproductive age whom they interviewed in 1997.

See "Case management and access to services for homeless women," by Kevin C. Heslin, Ph.D., Ronald M. Andersen, Ph.D., and Dr. Gelberg, in the Journal of Health Care for the Poor and Underserved 14(1), pp. 34-51, 2003.

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