Community survey summary

The HCHN community survey was distributed widely among human and homeless service provider email lists, at homeless coalition meetings, at various homeless service agencies, and was available online on our website. Surveys were distributed beginning in late march 2004 and accepted until April 23 2004. In all, 145 surveys were returned, and one focus group was held by a group of 16 homeless and formerly homeless women at Mary's Place day center.

Method of completing/returning survey

Notes on analysis of the data

In addition to optional contact information and demographic information on the population served by each respondent, the survey consisted of the following 5 open-ended questions:

When you think about homeless people and their health—both physical and emotional—what issues concern you most?
What are the most important health problems that you think Health Care for the Homeless should focus on in the next 5 years?
What other issues or partnerships are most important for Health Care for the Homeless to focus on in the next 5 years?
Do you have any changes or improvements to recommend in the way Health Care for the Homeless program does business?
Do you have other comments or suggestions?

Because the questions were open-ended, we enjoyed a wealth of helpful and specific feedback that would not otherwise have been possible with a multiple choice survey. The challenge of this style, however, is to be able to adequately represent the feedback we received in a way that:

1.	Summarizes and interprets similar comments, allowing us to see the numbers of people who are concerned about each type of issue.
2.	Retains the flavor and uniqueness of the specifics of the comments that were made.

For this reason, the topic headings used in the data table were based on the comments received, and some topics headings contain subtopics to help illustrate the range of comments that were received. In this analysis we have tried to show both the commonalities among responses, in the graphs, as well as some of the specifics, by including several notes following each graph. In addition, a selection of comments taken directly from the survey responses is also available as a separate document (in Microsoft Word.)

In this summary, responses and comments were grouped into 3 areas:

1.	Physical & Emotional Health Issues
2.	Partnership Issues & Barriers to Accessing Healthcare
3.	Comments & Suggestions for Changes/Improvements

If you would like more information about the survey results, or are interested in a copy of the data table, the Mary's Place focus group notes, or the selected comments, contact Health Care for the Homeless Network at (206) 296-5091 or email Margery Muench at margery.muench@metrokc.gov

Top 10 Physical and Emotional Health Issues

* 10th & 11th were tied for # of respondents, so both are included

Notes

	The most common condition specifically mentioned among comments on mental illness was depression (11.7%)
	As part of the heading "drugs" many responses specifically mentioned: Substance abuse/Chemical Dependency/Treatment (60.7%), Alcoholism (17.2%), and Smoking (6.9%)
	37.9% of respondents form NE King County mentioned the need for more Dental/Oral healthcare.
	Of the homeless and formerly homeless survey respondents, 42.1% referred to the need for more medical respite, and 31.6% referred to the need for more safe places to rest and recuperate (non-medical respite).
	The chronic condition most frequently mentioned was Diabetes (14.5%). Asthma was also a common concern (7.6%)
	The communicable diseases most frequently mentioned were: TB (12.4%) and HIV/AIDS (9.0%)
	6.9% of survey respondents mentioned unhealthy food at shelters as an important health concern for homeless people.
	Domestic Violence (4.8%) and the need for more family support (5.5%) were the most frequent concerns related to safety, crisis, and violence.
	42.1% of homeless and formerly homeless survey respondents mentioned issues of safety, crisis, and violence as health issues, compared with 24.1% of all respondents.

Top 10 Partnership Issues and Barriers to Accessing Healthcare

Notes

	The top eligibility/access issue mentioned in the survey responses was access to adequate insurance/Medicaid/SSI (37.9%) and the gaps in these systems.
	Several other specific eligibility/access issues frequently mentioned were: the difficulty of navigating the complex bureaucracy of social and health services (20.7%) especially for clients with mental illness, the need for consumer education & assistance with application processes (27.6%), and availability/cost of obtaining medication (16.6%)
	Availability/cost of medication was mentioned disproportionately by King County respondents (N/E King County 24.1%, S King County 28.0%)
	The specific coordination of care issue mentioned most frequently was that of not separating mental health care from chemical dependency treatment (9.0%)
	Discharge planning was particularly mentioned with respect to jails (14.5%) and hospitals (13.8%)
	The top recommendations for partnerships and coordination were with church/community groups (3.4%), schools/childcare/youth programs (4.8%), and mental health services (3.4%)
	Homeless and formerly homeless respondents identified poverty/financial instability as a health access issue disproportionatey (36.8%) over other subgroups of respondents. This issue was also raised at a slightly higher rate among N/E and S King County respondents than among those from Seattle.
	Specific issues raised related to poverty/financial insecurity included inadequate wages/lack of benefits (11.7%) and need for job training/employment opportunities (13.8%)
	NE King County respondents reported need for culturally appropriate services at the highest rate of any subgroup (41.4%)
	The top issue identified in terms of culturally appropriate services was making services more "user friendly" for homeless people (25.5%) Other issues included culturally appropriate services for immigrants/refugees/illegal immigrants (6.2%), people of color (6.2%), sexual minorities (2.1%), hiring/retaining diverse staff (2.8%), and providing multilingual services/materials (2.8%)

Top 10 comments and suggestions for changes/improvements

Notes

	Concern for more regional planning & expansion of services to suburban areas was highest among S. King County respondents (32.0%) followed by N/E King County respondents (20.7%) Expanded needle exchange service was among the specific suggestions for expanded services in county areas.
	Expansion/concern for youth/young adults was highest in Seattle (25.0%) & N/E King County (24.1%)
	Expansion/concern for children and for families were highest among King County respondents over seattle respondents.
	Homeless and formerly homeless respondents reported concern for expanded services for youth/young adults and for pregnant women (15.8% each), followed by services for women and services in suburban areas (10.5% each).
	Among the top 10 comments/sugestions reported by homeless and formerly homeless respondents were: more holistic/alternative healthcare services (15.8%), 24-hour service/shelter (15.8%), and increasing the wider community's awareness/education/concern (21.1%). These were all mentioned at higher rates by this group than by any other subgroup of respondents.
	The most frequently mentioned advocacy issues was that of preventing program cuts, preventing loss of the social safety net, and restoring lost programs (7.6%). Several comments specifically mentioned the recent loss of the Safe Links program.

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