Connecting Homeless Populations With Health Care

Homeless people are uniquely vulnerable, at risk of a variety of health problems, including chronic illness, hunger, pain, and infections. While resources exist to provide homeless populations with health insurance and care, those resources don’t always make their way to the people who need them.

Nurses Marcus Henderson and Ian McCurry, graduates of Penn’s School of Nursing, have committed themselves to changing that. Since winning the 2017 Penn President’s Engagement Prize for their project, “Homeless Health and Nursing: Building Community Partnerships for a Healthier Future,” McCurry and Henderson have had their heads down, working to connect homeless people in the shelter system of the non-profit Bethesda Project with health information and care.

As their efforts unfold and they bring knowledge and resources to Philadelphia’s homeless, they’ve found that their own education has continued in the shelters and on the streets of the city.

“One of the most rewarding aspects of our project is how much we are learning from this underserved population,” Henderson says. “Hearing their personal stories, interacting with them, we’re learning so much about them and the community.”

The President’s Engagement Prizes, awarded to Penn seniors annually since 2015 by President Amy Gutmann, are supported by Trustee Judith Bollinger and William G. Bollinger, Trustee Lee Spelman Doty and George E. Doty Jr., and Emeritus Trustee James S. Riepe and Gail Petty Riepe. Winners receive as much as $100,000 to implement the project, plus a $50,000 stipend for each team member.

Henderson and McCurry didn’t apply for the President’s Engagement Prize on a whim. Their proposal is the outgrowth of years of work in the area of increasing health equity and access to health care.

Both began working at Penn Nursing’s Center for Health Equity Research since their sophomore years, performing research and organizing training sessions in health disparities.

In addition, Henderson grew his understanding of public health and community work through an internship with the U.S. Department of Health and Human Services and during a placement as a school nurse in a Philadelphia high school. Meanwhile, McCurry delved deeper into the health-care-access needs of underserved populations though increasing responsibilities in the Old First Reformed Church’s homeless outreach ministry.

Together they developed the idea for their project, aiming to bridge the health-care gaps of homeless people using resources already available in the community. In addition to the Bethesda Project, they’ve enlisted partners including the National Nurse-led Care Consortium, the Greater Philadelphia Healthcare Partnership, and Temple University’s Community Health Worker Training Program. They received  funding to conduct a health-needs assessment in the shelters from Penn’s Office of Nursing Research and earned a spot in the competitive Philadelphia Social Innovations Lab to develop their skills in social entrepreneurship.

Key to the project’s implementation is a reliance on community health workers, who will interact dynamically and directly with the homeless individuals in a variety of supportive ways.

“These are the people in the community who are natural helpers,” McCurry says. “They’re the type of people you see at a church fair or bringing soup to a sick neighbor. [We’re training] them to navigate the health-care system so they can work with us to maximize health outcomes.”

“These individuals have shared life experiences with the people they’re working with,” Henderson adds. “They can have a deeper and more fruitful connection than any nurse going in and preaching about what to do is going to.”

The Penn team is drawing their community health workers from a program at Temple that identifies individuals from the community and trains them to advocate for others’ health care needs. Once the workers are selected, Henderson and McCurry will provide them with the connections, manuals, and procedures they need to work effectively and become embedded in the community, gaining trust and building a rapport with those they’re serving.​​​​​​​

In the meantime, Henderson and McCurry have conducted focus groups with residents of Our Brother’s Place, the busiest of Bethesda Project’s shelters.

“We had these hour-long conversations where we ask them, what is getting health care really like for them, what are the barriers to solving these problems,” says McCurry. “We pitch them our ideas but really want their feedback since they’re the ones who will be affected.”

The Penn grads plan to also offer seminars to staff at the Bethesda Project on subjects such as navigating the health-care system and supporting patients with chronic illnesses like diabetes or cardiovascular disease.

Henderson and McCurry have grand ambitions; their goals include enrolling at least 90 percent of Bethesda Project residents in health insurance plans, connecting at least 80 percent with primary-care providers, and at least 80 percent with mental-health-care providers. They’re also designing a model to ensure their efforts will be sustainable, even after their first year is completed.

“If this works for a year that’s good, but what have you really accomplished? So we’re working to be sure we can keep this going,” McCurry says.

They’re also hopeful that the basic structure of their project might serve as a model for others tackling health-care challenges in vulnerable groups.

“It’s a model we hope will translate well,” Henderson says. “I’m a product of the Philadelphia School District, and this is a model you could use in a public school setting to help students and their families thrive in the community.”​​​​​​​​​​​​​​

Both in preparing their application for the Prize and now as they enact it in the community, Henderson and McCurry have received mentoring from Terri Lipman, assistant dean for community engagement and the Miriam Stirl Endowed Term Professor of Nutrition in Penn Nursing, who herself has a long track record of leading community health programs.

Every couple of weeks, Lipman has met with the pair to help them navigate challenges and offer advice.

“She offers us very honest feedback,” McCurry says, “and has been helpful in guiding us to the right people and the right resources.”

Having worked with them and seen their proposal take shape over the last two and a half years, Lipman is convinced the work will have an impact.

“They’re an incredible team,” says Lipman. “I feel very honored to be their mentor and am thrilled for them and for the University. I'm confident that they will be successful and really improve the health care in this population in Philadelphia.”

When asked what advice they would offer to aspiring President’s Engagement Prize applicants, Henderson and McCurry both cite a need for a driving passion.

“The work that needs to go into these projects to be successful is intense,” McCurry says. “If you’re just doing this to be prestigious it’s not going to work. You have to be passionate about what you’re doing.”

Upcoming information sessions on the President’s Engagement Prize are scheduled for Nov. 2, 10, 14, and 29; information sessions for the President’s Innovation Prize are scheduled for Nov. 10, 13, and 16.

The application deadline for the 2018 President’s Engagement Prizes and President’s Innovation Prize is Friday, Jan. 19, 2018.

Photo: Both passionate about using their nursing knowledge to bolster vulnerable communities, McCurry and Henderson have set their sights on creating a programmatic structure that can be replicated in other environments.

McCurry and Henderson in clinic