Women of Skid Row

- Lessons Learned -

Discussion

A majority of program participants presented with common comorbid health issues – including mental health and substance abuse/addiction – which increase the risk for chronic health conditions such as diabetes. Systemic barriers and accumulated stress from poverty and lack of sufficient housing and nutrition resources may also have contributed to these results. Demographic trends indicate that the number of homeless individuals vulnerable to the effects of heath inequities will continue to increase. In comparison to the housed population, homeless individuals face additional systemic barriers to achieving successful health outcomes. Food “deserts” encompassed by a lack of local and affordable grocery stores results in a scarcity of healthy foods available for the local population to purchase and consume. Although programs like the Walking Group expose participants to safe green spaces in the community, current statistics suggest that community safety for homeless women remains a serious public health issue. Program participants with a chronic disease such as diabetes may also present with additional social/psychological barriers such as trauma, mental health disorders, and substance abuse or addictions.

After surviving 15 years of homelessness and now managing multiple chronic health conditions as a result, I love providing outreach to other women to get them involved in the Women for Wellness program. If I can do it, so can they.

Nowhere else has there been a more robust and genuine example of a community of caring peers working on behalf of the community to improve health and well-being.

SCALE gave me the tools as an administrator to advance community advocacy around the topic of equity. Because of SCALE, our agency is better equipped to infuse equity efforts into our Strategic Plan and in our all of our policy and programming decisions. 
SCALE moved the needle for our community to help us meaningful incorporate stakeholder feedback on our path towards healthcare equity. 

- Steering Committee Members

Limitations

There are limitations with respect to the generalizability of the findings. Because only 50 women from one agency participated in the program, it is difficult to generalize the findings to the larger population of homeless women. Because some data was self-reported, misclassification and recall bias may have resulted. As another confounding factor, social desirability bias may have occurred. Attrition generally remains an issue for homeless healthcare programs. Chronically homeless individuals are less likely to complete a 1-year program as a population with multiple sociocultural, environmental, health, and safety barriers. There is generally a lack of reliable population data on homeless women with regards to chronic disease health programming.

Knowledge of each participant’s individual housing status, health barriers, and utilization rates of existing community resources can further inform future programming efforts. Moreover, dedication of additional staff resources to manage outreach and evaluation needs for health programming can increase capacity to successfully manage the program.