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Healthcare for homeless and marginalized youth can easily get lost in the shuffle. But in Sacramento, "Health Shack," a Web-based system that stores personal health records for young people in the foster care system, or who are emancipated or homeless, aims to change that.
Through the joint work of dedicated youth services in the area, university pediatrics specialists and public health nurses, this new initiative harnesses the power of the Internet to take on a unique public health challenge. In the process, it offers health and hope to a population often ignored, and presents a new healthcare career option for individuals interested in public health nursing.
Home for Health
The Health Shack project began with a Web-based records platform for an entirely different yet similar population. "MiVia" was an initiative by software company Follow Me Inc., designed to provide a central health repository for migrant workers in California who had disjointed, incomplete records and little continuity from healthcare providers. The project was greeted with skepticism by some, but became immensely popular and well-used. It didn't take long to envision the possibilities for similar systems for other populations.
"The company approached me 2 years ago knowing my experience with homeless and marginalized youth, and asked if this type of system would be useful," said Elizabeth Miller, MD, assistant professor in pediatrics, UC Davis School of Medicine, Sacramento. "It was a natural fit because our youth experience such fragmented care, and a centralized place for important information would be extremely helpful. From there we received pilot money from the Sierra Health Foundation and started working with youth to see how this platform might fit their needs and life experiences."
The result became the Health Shack, a secure spot for youth and their care providers to store and access important health information. To use the system, each enrolled individual receives a log-in name and password. Each participant, along with their care providers, can enter and easily access information as needed. Health Shack members also receive an emergency identification card that lists emergency contacts, medical conditions, and other information about medications and allergies.
Initial participants in the Sacramento area are those utilizing WIND Youth Services, a program for homeless and marginalized youth, and Linkage to Education, serving youth in foster care and on probation. In collaboration with these two programs and Sierra Health Foundation, physicians and nurses from the UC Davis Children's Hospital and California State University Sacramento public health nursing are working to build and develop the program and establish the baseline health records.
New View of Public Health
The nurse's role in this new venture has proved essential to Health Shack's development and adoption.
"We had a nurse who was also a public health student interested in volunteering for the project," Miller said. "Her initial role was to help the kids put their information into the system. What we found, however, is that, through the nurse, the youth became more interested, shared more about their health history and became eager to participate. That was our 'Eureka!' moment: We need the public health nurse connection."
Today, two public health nurses work as volunteers with WIND Youth Services and Linkage to Education, introducing the program to each participant and helping create the beginnings of a comprehensive health record. The nurses walk each young person through a medical history, identifying gaps and questions, tracking down records, and filling out incidents and updates. They serve as trusted resources and care coordinators, educating and guiding the teens through the often-confusing world of healthcare and pointing them toward the best care when they need it most.
Miller said public health nurses are so integral to the project that additional funding is being sought for more. They're also looking to set up the project as a formal public health nurse training site.
"This program reaches a marginalized population that others may have given up on," Miller said. "This population experiences the most repeat pregnancies, as well as the highest rates of HIV and hepatitis infection, and our Band-Aid approach is no longer working. This innovative approach may not drive down infection rates, but it offers an opportunity to empower youth to take control over their health and their life, which directly impacts public health."
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