Enhancing perinatal outcome in homeless women: the challenge of providing comprehensive health care.

Homeless women who are pregnant present a number of challenge to health care providers. As a group, they are at risk for a variety of illnesses that could affect their pregnancies, including sexually transmitted diseases and substance abuse. Poor access to health care, inadequate prenatal care, poor nutrition, and poor housing cause these women to suffer poor birth outcomes. They are more likely to deliver low birth weight infants and have higher rates of infant mortality. It should be understood that homeless pregnant women are a heterogenous group. Generally, they are pregnant adolescents and women in homeless families. Additionally, there are differences within these two groups. The causes of homelessness for these women vary as do their needs during pregnancy. Any provider of health care to the homeless must understand the different situations of these women to deliver directed, effective care.

The Homeless Child Health Care Inventory: assessing the efficacy of linkages to primary care.

Each year, the New York City homeless family shelter system provides transitional housing for nearly 20,000 homeless children. While the health care needs of these children are substantial, there is currently no system-wide mechanism for ensuring that they have access to appropriate medical care. This report analyzes information from the Homeless Child Health Care Inventory, a survey conducted by Montefiore Medical Center's Division of Community Pediatrics, to examine the adequacy of health care resources available to the homeless children in New York City. Results showed that available health care resources varied considerably throughout the shelter system and that nearly 50% of homeless children in New York City did not have access to appropriate medical care.

Overcoming barriers to health care access for medically underserved children.

The NYCHP was designed to serve the special needs of medically underserved, extremely disadvantaged children in New York City. As a model, and as the flagship program of a national network, the NYCHP demonstrates that it is possible to provide a medical home for children in a variety of challenging situations where access to traditional providers is limited. It is clear, however, that mobile units or other creative ways to overcome barriers to access to care are an insufficient long-term answer. Ultimately, the public sector must take steps to ensure that all American children have regular access to a true medical home regardless of their social or economic situation. In the interim, special initiatives such as the NYCHP must continue to fill the gap.