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Safety net clinics for homeless women struggle to provide comprehensive care despite scarce resources

Over two-thirds of major sites treating homeless women in Los Angeles County are community or neighborhood clinics. These clinics treat 30 or more homeless women each month, the majority of whom are Hispanic. These safety net clinics struggle to provide comprehensive care amidst staff burnout, little specialized training for staff in caring for homeless women, and scarce resources. Less than one-quarter (22 percent) of these clinics have physicians who are women, less than 62 percent have medical staff who are proficient in Spanish, and less than two-thirds of the clinics have at least one clinician specially trained to provide care to people who are homeless.

Many of the sites, even the major providers, do not have the ability to provide comprehensive care, according to a study supported by the Agency for Healthcare Research and Quality (HS08323). The researchers found that only 31 percent of the clinics offered treatment for substance abuse, and only 56 percent could provide mental health services, despite the very high prevalence of these problems among homeless women. Also, less than one-fourth of the sites provided support services of great value to homeless women, such as emergency shelter, food and clothing, showers, or child care during medical exams. However, these sites enhanced access to care with evening and weekend hours, walk-in visits, proximity to public transportation, and by not requiring appointments.

Lillian Gelberg, M.D., M.S.P.H., of the University of California, Los Angeles School of Medicine, and her colleagues call for more resources to be invested in these poorly funded community clinics which, despite staff burnout, serve as a safety net for homeless women. They surveyed administrators and clinicians at 112 clinic sites that were actual or potential providers of primary health care to 95 percent of the homeless women in Los Angeles County; 73 completed surveys were received.

See "Providers of primary care to homeless women in Los Angeles County," by Jeff Luck, M.B.A., Ph.D., Ron Andersen, Ph.D., Suzanne Wenzel, Ph.D., and others, in the April 2002 Journal of Ambulatory Care Management, pp. 53-67.

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