1. Providence Veterans Affairs Homeless Clinic: Caring for your feet Brittany Condon Henry, RN NU-387 July 2015

2. Homeless Veterans Approximately 610,042 people reported homelessness in 2013 Of those, 57,849 were homeless Veterans This makes up 12% of the entire homeless population. Approximately 60% of homeless Veterans stay in shelters or safe havens, while the remaining 40% remained unsheltered. Homeless Veterans are younger on average than the general Veteran population 9% between the ages of 18-30 41% between the ages of 31-50 The number of young homeless Veterans who have served in Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND) are increasing.

3. Homeless Veterans Identification of the Population: Homeless Patient Aligned Care Team (HPACT) Clinic Diabetic homeless population Need for education regarding diabetic and general foot care. Many comorbidities

4. Health Status The most common diagnoses in this population are Alcohol/Drug abuse (71.7%) Mood Disorder (47.1%) Orthopedic Problems (43.2%) Adjustment Disorder (36.9%) Hypertension (28.6%) One in four men and women Veterans have diabetes. Related factors: Obesity, elderly, lower incomes, limited access to healthy foods, and social disparities. Type I Type II

5. Health Promotion Needs “At-risk” status Any homeless Veteran who may have limited or lack of access to clean water, soap, proper fitting shoes, socks, and/or the physical ability to care for their feet. Education on foot care for the general homeless population and the diabetic homeless population was greatly needed.

6. Poster Presentation

7. Most appropriate for population. Educational Sessions For Homeless Veterans For HPACT Staff Evaluation of Poster Veteran Surveys Veteran Suggestions Replicability of Project

8. Poster Presentation In order to fully understand the requirements of this project, I first had to investigate the homeless Veteran population and their health concerns. Working with my preceptor, we were able to identify a problem, develop a plan, execute and evaluate our interventions. Over the next few months, my preceptor and I will continue working together to determine the long term effects of our project on the homeless Veteran population receiving treatment at the HPACT clinic.

9. Evaluation Homeless Veterans HPACT Clinic Public Health RN Health Technicians Social Workers MD’s Providence VA Medical Center Education Committee

10. What to Change? Given more time, I would have liked to put together a hand out for patients regarding daily and/or diabetic foot care. We are currently awaiting approval from the PVAMC education committee on brochures stating the same education presented in the poster. We would have liked to make a business card with the signs and symptoms of infection and when to call or see a provider. In the future: The poster will be presented at the Operation Stand Down RI Weekend this September. Podiatry Service will be present at OSDRI Weekend. Kevin will contact other HPACT clinics in our VISN (the Northeast region) and disseminate this poster and information. Poster to be replicated and presented on inpatient units, in- service with staff and patients.

11. References Wahowiak, L. (2014). Veterans and Diabetes. Retrieved from: http://www.diabetesforecast.org/2014/12-dec/veterans-and-diabetes.html Goldstein, G. Luther, J.F. Haas, G. L. Appelt, C.J. Gordon, A.J. (2010). Factor Structure and Risk Factors for the Health Status of Homeless Veterans. Psychiatr Q. 81: 311-323. National Coalition for Homeless Veterans. (2013). Background and Statistics. Retrieved from: http://nchv.org/index.php/news/media/background_and_statistics/ The U.S. Department of Housing and Urban Development. (2013). The 2013 Annual Homeless Assessment Report (AHAR) to Congress. Retrieved from: https://www.hudexchange.info/resources/documents/AHAR-2013-Part1.pdf My HealtheVet: Veterans Health Library. (2015). Retrieved from: http://www.veteranshealthlibrary.org/RelatedItems/142,82130_VA My HealtheVet: Veterans Health Library. (2015). Retrieved from: http://www.veteranshealthlibrary.org/RelatedItems/142,82128_VA WebMD. (2015). Slideshow of Common Foot Problems. Retrieved from: http://www.webmd.com/skin-problems-and-treatments/ss/slideshow-common- foot-problems