YWCA Passage Point Health Coordination

Grantee: YWCA
Timeframe: July 2016 – June 2018 | Total Amount: $144,164

Year 1: July 2016 – June 2017. Amount: $70,918
Year 2: July 2017 – June 2018. Amount: $73,246

The Passage Point Health Coordination program, a component of the Health Access Department, will serve persons facing homelessness working to regain custody of their children upon exiting the corrections system. The program’s mission is to increase effective access to health care services and promote management of individual and family health needs. The program will achieve this mission through health care navigation, utilization, education about health conditions, harm reduction skill building and individualized health case management. Through this project, they will provide on-site, tailored, flexible and client-driven health services for residents who would otherwise not be connected to a health system to manage their own health and support optimal health for their children. The YWCA will hire an on-site Health Coordinator who will become an integrated member of the Passage Point Resident Services Team. The Health Coordinator will increase effective access to health care services and promote management of individual and family health needs for Passage Point residents by providing: health insurance enrollment and problem solving, advocacy and multisystem health navigation support, chronic disease management, children’s health and development education, harm reduction education, and individualized health case management. These interventions will be provided through one-on-one coaching and advocacy interactions. All residents will be able to schedule appointments with the Health Coordinator, drop-in during office hours and participate in group classes. In-kind childcare will be provided to residents as needed to reduce barriers to participation. During the initial outreach phase of the program, the Health Coordinator will attend resident meetings and gatherings to build relationships with the residents. Building trust will be an essential component of service delivery, as health needs are very private and residents will be understandably wary about sharing health information that they may perceive to impact their ability to regain custody of their children or their ability to meet the conditions of their parole.

As with all Health Access programming, participation in the Health Coordination program is completely voluntary and is a client-driven methodology which allows the residents to define and prioritize their health goals. In partnership with the Health Coordinator, residents will establish health goals for themselves, and, where applicable, their children. Since the number and complexity of goals will vary by resident, the duration and intensity of interventions provided to the residents will also vary. For residents with chronic health conditions, the Health Coordinator will assess their familiarity with the condition, and current disease management and behaviors that impact their condition. Then, through a harm reduction lens, a framework designed to reduce the harmful consequences associated with various human behaviors rather than providing abstinence only options, the resident and Health Coordinator will identify steps towards achieving those goals. The Health Coordinator will support residents in accessing affordable, culturally competent and stigma-free health care services. The Health Coordinator will be a trained In Person Assister and will be able to enroll, re-enroll and troubleshoot health insurance challenges. The Health Coordinator will provide guidance on the importance of regular preventative care, including medical and dental visits, and will provide coaching to overcome concerns preventing them from seeking care. Residents seeking offsite health services will receive van transportation assistance to the nearest public transportation hub and bus tickets if needed. The Health Coordinator will work closely with residents to plan out appointments, ensuring adequate travel time and establishing a clear understanding of routes and locations.