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D Site V;s'ts and Meetings with Local Providers of Serv;ees to the Homeless As part of the research plan for this study, members of the committee and members of the study staff conducted site visits to various programs serving the homeless in 1 1 cities: Boston; Chicago; Kansas City; Lex- ington; Los Angeles; Milwaukee; Nashville; San Diego; San Francisco; St. Louis; and Washington, D.C. In addition, site visits to observe the problems of homeless people in rural areas were conducted under special funding from the U.S. Department of Health and Human Services in Alabama, Minnesota, Mississippi, and North Dakota. In those cities that received grants from the Health Care for the Homeless program jointly funded by the Robert Wood Johnson Foundation and the Pew Memorial Trust (Johnson-Pew HCH), the sites visited were primarily those con- nected with this program. The following sites were visited: The Cardinal Medeiros Day Center of the Kit Clarke Senior House (Boston): A day program for the elderly homeless that operates an outreach van throughout Boston; in addition to serving food to the elderly homeless, the van is staffed by a nurse who visually observes the homeless people for signs of illness or medical problems. Christ Church (St. Louis): A shelter for homeless adults and homeless families located in a church-owned building; the shelter provides health evaluation and education through the services of a public health nurse. Christ House (Washington, D.C.~: A 34-bed convalescent center for homeless people with medical problems; located in a restored apartment building, this facility includes a full medical and nursing clinic and on-site living quarters for the medical staff. City Union Mission (Kansas City): A shelter, a transitional living program, and 218

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APPENDIX D 219 an alcohol detoxification program for homeless men; the facility has an on-site . . . nursing c. .lnlc. Cook County Jail (Chicago): A prison with a highly regarded medical program; since some homeless people receive medical care only if they are incarcerated, this facility was toured to observe the quality of such care. Cooper's Place (Chicago): A drop-in center for homeless men; health screening services are provided by the Chicago Johnson-Pew Health Care for the Homeless project. Downtown Clinic (Nashville): A central clinic operated under the Nashville Johnson-Pew HCH project; this is the first HCH project to be incorporated into an existing governmental structure and is now operating as a public clinic of the city and county health department. Emergency Lodge (Kansas City): A shelter operated by the Salvation Army that serves both individual adults and homeless families; this program also has a transitional living apartment project for homeless families. Emergency Lodge (Milwaukee): Also operated by the Salvation Army; this program for individual adults and families receives health screening services from the Milwaukee Johnson-Pew HCH project and health care services from a nearby community health center. Emergency Lodge (St. Louis): Operated by the Salvation Army, this shelter serves homeless families; its program includes a day care center for children so that their parents can search for employment or vocational training during the day. Family Crisis Center (Milwaukee): A shelter for single-parent families that provides a broad spectrum of social service programs; it receives health care services from the Milwaukee Johnson-Pew HCH project. Firehouse Annex (Chicago): A day center and transitional living program for homeless women; it receives health screening services from the Chicago Johnson- Pew HCH project. Folsom Street Hotel (San Francisco): The site of a supportive living program for homeless people with acquired immune deficiency syndrome (AIDS) admin- istered by Catholic Charities. Guest House (Milwaukee): A shelter for individual adults with a high prevalence of mental illness among its client population; it receives health care services from the Milwaukee Johnson-Pew HCH project and mental health assessments from the county hospital. Harbor House (St. Louis): A three-stage (detoxification, maintenance of sobri- ety, and reintegration into the community) alcohol rehabilitation program for homeless men; along with Harbor Light, a shelter for homeless men located adjacent to it, this program is operated by the Salvation Army. Horizon Center for the Homeless (Lexington): A day center for homeless adults with a nursing clinic operated in conjunction with the College of Nursing of the University of Kentucky. Hospitality House (St. Louis): A shelter for homeless adults, primarily women; it receives health care services from a public health nurse and a nearby health |. . clinic.

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220 APPENDIX D House of Ruth (Washington, D.C.~: A multisite program for homeless women, including shelters for battered women and homeless women who are pregnant; it receives health care services from the Washington Johnson-Pew HCH project. Larkin Street Youth Center (San Francisco): A day center for homeless runaway and throwaway youths; the center has a health clinic, a group counseling program, and an aggressive AIDS prevention education program. Lemuel Shattuck Hospital (Jamaica Plains, Mass.~: The site of a 20-bed convalescent program located within a municipal shelter that is part of a state health care facility, but funded by the Boston Johnson-Pew HCH project. Life Ministries (San Diego): A mission shelter for homeless men that operates an on-site all-volunteer medical and nursing clinic in the evenings. Long Island Shelter (Boston): A municipal shelter for the homeless with an on- site nursing clinic. Meharry Community Mental Health Center (Nashville): A community mental health center that provides mental health workers to the Nashville Johnson-Pew HCH project to conduct street outreach to the homeless mentally ill. Near North Health Center Outpost Clinic (Chicago): A community health center that serves as one of the sites for the Chicago Johnson-Pew HCH project's mobile team. Oakland Independence Support Center (Oakland, Calif.~: A self-help day program operated by and for people with histories of psychiatric hospitalization; the center provides assistance in locating affordable housing for members who are or may become homeless. Pilgrim House (Kansas City): A shelter for homeless families operated as part of the City Union Mission; Pilgrim House receives health and social services from the Kansas City project for health care for homeless people, which was developed as a result of public and private effort when Kansas City did not receive one of the Johnson-Pew HCH project grants. Pine Street Inn (Boston): One of the oldest shelters for homeless men in the United States; the Inn has its own medical and nursing clinic, as well as a separate clinic operated by the Boston Johnson-Pew HCH project. Project Hope (Boston): A shelter for homeless families that receives health services from the Boston Johnson-Pew HCH prefects family health team. Restart, Inc. (Kansas City): An interfaith transitional living program (which also provides emergency shelter during periods of weather extremes); this program places a heavy emphasis on vocational and social services, including a revolving fund to provide financial assistance to homeless people starting their own businesses. So Others Might Eat (SOME) (Washington, D.C.~: A soup kitchen that also provides an array of medical, dental, and support services to homeless people. Shamrock Club (St. Louis): A membership day center for mentally ill homeless adults; receives health care services from a nearby health clinic. St. Anthony's Clinic (San Francisco): One of the oldest health care programs serving homeless people in the United States; the clinic is divided into two halves, one serving individual adults and the other serving families.

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APPENDIX D 221 St. Benedict's Meal Site (Milwaukee): An evening meal program that serves between 500 and 700 meals per night; an on-site clinic is operated by the Milwaukee Johnson-Pew HCH project 2 nights per week. St. Francis House (Boston): A multiservice center for homeless adult men and women; it has a health clinic (partly funded by the Boston Johnson-Pew HCH project) and mental health and vocational training programs. Union Rescue Mission (Los Angeles): A shelter for homeless men located in the skid row section of Los Angeles; it is the site for a nursing clinic funded by the Los Angeles Johnson-Pew HCH project. Union Rescue Mission (Nashville): A large shelter for homeless men with its own medical and dental clinics primarily staffed by volunteer doctors and dentists and students from Meharry Medical School and Meharry College of Dentistry. Valley Shelter, Inc. (Los Angeles): A shelter for homeless adults and families located in a former motel in the San Fernando Valley section of Los Angeles County; it receives health, mental health, and social services from the Los Angeles Johnson-Pew HCH project. Venice Family Clinic (Los Angeles): A free clinic founded in the 1960s; it receives funding from the Los Angeles Johnson-Pew ITCH project to provide health care to homeless families in the Venice Beach/Santa Monica area. Veterans Administration Community Residence Program (Lexington): One of many such programs operated by the U.S. Veterans Administration, this program places physically and/or mentally disabled veterans into residential programs at the time of their discharge from a VA medical center as a means of preventing them from becoming homeless. Veterans Administration Outreach Program (St. Louis): One of several programs initiated as a result of legislative action in the winter of 198~1987; this program sends outreach workers onto the streets to identify homeless veterans in an attempt to bring them into the VA system for services. YWCA (San DiegoJ: A program to provide temporary housing to chronically ill homeless women via contract with the Division of Mental Health Services of the San Diego County Department of Health Services. In addition to these sites that were visited, members of the committee and the study staff met with the following groups of local officials and . . service prove ers: Congressman Bill Boner (now mayor of Nashville, Tennessee), April 20, 1987. Kansas City Health Care for the Homeless People staff, April 30, 1987. Lexington, Kentucky, city officials and not-for-profit service provid- ers, April 21, 1987. Los Angeles County Department of Health, May 6, 1987. Los Angeles County Department of Mental Health, May 6, 1987. Los Angeles Health Care for the Homeless Project Governance Committee, May 5, 1987.

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222 APPENDIX D National Street Outreach Conference, Milwaukee, April 28, 1987. San Diego (City) director of Community Services, May 4, 1987. San Diego (County) Department of Health Services, May 4, 1987. San Diego (County) Department of Health Service, Division of Mental Health Services, Central Region, May 4, 1987. San Francisco AIDS Advisory Committee, May 8, 1987. San Francisco City/County Human Rights Commission AIDS dis- crimination specialist, May 8, 1987. San Francisco Homeless Service Providers' Coalition, May 7, 1987. San Francisco Joint Task Force on Homeless Veterans, May 8, 1987. St. Louis Health Care for the Homeless Coalition, May 1, 1987. St. Thomas Hospital, Nashville, Tennessee, April 20, 1987. Tennessee Association of Primary Care Centers, Nashville, Tennes- see, April 20, 1987.