Adapting your Practice: General Recommendations for the Care of Homeless Patients

This resource was selected by SMI Adviser content partners and approved by the SMI Adviser clinical expert team for inclusion in the knowledge base.

This guide was developed with support from the Bureau of Primary Health Care, Health Resources and Services Administration, and the U.S. Department of Health and Human Services. Clinicians with extensive experience caring for homeless individuals are adept in adapting their clinical care in order to promote good outcomes for homeless individuals. This set of guidelines and recommendations is intended for health care professionals, students, and ancillary personnel who have relatively less experience working with this population and may not realize that some of their patients are in fact homeless.

The comprehensive set of recommendations in this document represent what experienced clinicians know works best for patients experiencing homelessness with the realistic understanding that limited resources, challenged health care delivery systems, and loss to follow-up often compromise adherence to optimal clinical practices. This document offers an excellent overview and a set of detailed recommendations for the psychiatric and medical care of homeless individuals. The sections of this resource describe fundamental issues in providing health care for the homeless such as proper diagnosis and evaluation, how to create a plan for the management of care, various models of care and service delivery, and suggestions for outreach and engagement.

Topics covered in some detail include living conditions, history of homelessness, acute/chronic illness issues, medications, history of mental illness, cognitive deficits, and developmental/behavioral problems. In addition, there is a good deal of information about important areas that need to evaluated by healthcare providers such as use or abuse of alcohol/nicotine/other drug use, existence of health insurance, history and risk of physical and/or sexual abuse, legal problems, violent behavior, work history, educational level, literacy, nutrition/hydration, and cultural heritage/affiliations/supports and personal strengths. Also included are several case studies of homeless adults, adolescents, and children. Finally, a set of additional resources are provided for health care professionals who work with homeless individuals.

The authors hope that these recommendations in this document will provide helpful guidance to health care professionals who work with individuals who are homeless or at risk of homelessness and that these guidelines will contribute to improvements in both quality of care and quality of life for these patients.


View more practice guidelines from the National Health Care for the Homeless Council (NHCHC).

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