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Chapter 9: Integrated Health Care Five Year Strategies Topic 1 Outreach and Access to a Full Range of Care A key barrier to homeless people's access to health care of all types is the inability of the public health system to treat symptoms and problems related to co-existing disabilities, or to address the particular needs of homeless people. This inability is supported and maintained by departmental policies and funding streams which are based upon primary diagnoses rather than a whole person perspective. As a result, providers in these departments lack the knowledge and skills to address problems outside of their primary scope of practice, forcing homeless people with few resources to go from program to program to access a range of needed services. Many cannot do so, so they wait until their need become acute and then use the most costly transportation (ambulance) to travel to the most costly service sites (emergency rooms). Misconceptions and lack of information specific to disabilities can frame health policy, program development, and direct service attitudes. Because health systems are founded on medical models of treatment, where treatment providers are the experts, paternalistic perceptions still dominate. Thus, independent housing options for people with disabilities related to health, mental health and/or drug and alcohol problems are often viewed as unrealistic. Service and support dollars are directed toward more traditional single disability options and those choosing non-treatment-oriented housing options are forced to do so with little or no support. People with coexisting problems must travel from provider to provider to receive services as well as communicate and coordinate their own services and treatment. Currently, many homeless people with disabilities receive their primary care and services through the high cost acute medical or psychiatric treatment sites. Addressing presenting problems and overall health care issues holistically can potentially decrease the use of acute services as primary care sites, and thus reduce costs. Because integration of professional disciplines affects the labor force and changes the conditions of work, organized labor input is essential in the planning stages. Following is a plan to provide outreach to people with multiple health care needs and integrate these services. Alameda County-Wide Homeless Continuum of Care Plan: April 1997 115