The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people

Objectives. (1) To present the Behavioral Model for Vulnerable Populations, a major revision of a leading model of access to care that is particularly applicable to vulnerable populations; and (2) to test the model in a prosp ective study designed to define and determine predictors of the course of h ealth services utilization and physical health outcomes within one vulnerab le population: homeless adults. We paid particular attention to the effects of mental health, substance use, residential history, competing needs, and victimization. Methods. A community-based probability sample of 363 homeless individuals w as interviewed and examined for four study conditions (high blood pressure, functional vision impairment, skin/leg/foot problems, and tuberculosis ski n test positivity). Persons with at least one study condition were followed longitudinally for up to eight months. Principal Findings. Homeless adults had high rates of functional vision imp airment (37 percent), skin/leg/foot problems (36 percent), and TB skin test positivity (31 percent), but a rate of high blood pressure similar to that of the general population (14 percent). Utilization was high for high bloo d pressure (81 percent) and TB skin test positivity (78 percent), but lower for vision impairment (33 percent) and skin/leg/foot problems (44 percent) . Health status for high blood pressure, vision impairment, and skin/leg/fo ot problems improved over time. In general, more severe homeless status, me ntal health problems, and substance abuse did not deter homeless individual s from obtaining care. Better health outcomes were predicted by a variety o f variables, most notably having a community clinic or private physician as a regular source of care. Generally, use of currently available services d id not affect health outcomes. Conclusions. Homeless persons are willing to obtain care if they believe it is important. Our findings suggest that case identification and referral f or physical health care can be successfully accomplished among homeless per sons and can occur concurrently with successful efforts to help them find p ermanent housing, alleviate their mental illness, and abstain from substanc e abuse.