Model of Care

Service Delivery Design  TOP

• Flexible service system – “One size-fits all” system of care is inadequate to meet the complex needs of homeless people. Identify and resolve system barriers that impede access to care, recognize that some barriers are not within the patient’s capacity to control. Don’t focus on what the patient is not doing; instead focus on what service providers can offer to enable homeless patients to obtain effective treatment such as assuring service flexibility and providing appropriate medical assistance to anyone who walks into the clinic. Be creative!
• Integrated, interdisciplinary model of care – Successful initiation and maintenance of HIV therapy requires a holistic approach to care provided by an interdisciplinary clinical team. The patient is an essential member of this team. Optimally, medical and psychosocial services should be easily accessible at the same location; fragmented service systems do not work for homeless people. Coordinate medical and psychosocial services across multiple disciplines.
• Access to mainstream health system – Full collaboration between primary care providers and specialists is the only effective treatment and management strategy. Problems that distinguish homeless HIV patients from others are primarily system and provider access problems, rather than client problems or differences in intent or desire to adhere to plan of care.