Barriers to Access/Hard to Reach Groups

Providers frequently mentioned the lack of transportation as a barrier to accessing care and services. A provider was frustrated when explaining the situation of some of the clients "who are paying out half of what they earn working, just for somebody to pick 'em up. Where's the incentive [for health care]? Why bother?"

Outreach and scheduling for those who work during the day is a barrier for the service providers to meet the needs of the working homeless. Trusting the "system" was also mentioned as being a significant barrier and concern for some who are chronically and mentally ill, and for others who simply do not feel comfortable within the bounds of a facility or do not wish to wait in the waiting room. Another barrier to accessing services mentioned was pride, and the difficulty in asking for help. One informant said, "I think the only barriers are the ones created in the minds of the people who may be asking for help … I just have to give him the time to find enough courage to ask for help."

Lack of insurance also poses a big problem. One informant pointed out that their is minimal low-cost treatment available for conditions requiring surgery, adequate treatment for burn victims and ongoing care for persons with heart problems. They don't have access to rehabilitation services and are discharged from research hospitals to recuperate at the shelter. There were also cases mentioned where clients were turned away because the agency did not serve people on Medicaid. While the number of the uninsured increases, hospitals are unwilling to increase the amount of care they offer to those with low income. Other services seen as inadequate for meeting the needs of homeless people included: substance abuse treatment, mental health treatment, and more access to emergency beds. One informant also commented on the need for better facilities and environment at the shelters in general and especially for women and children, "because the shelter is a chaotic, dangerous place where everyone lives right on top of each other. Mothers scream at their children constantly and…frequently hit them." Some good-willed but under-staffed and under-resourced services just end up "retracting into a state of learned-helplessness."

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Interactions Between Cultural/Ethnic Groups