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The Florida Department of Health works to protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts.

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Promoting Health in Homeless Shelters

Florida Department of Health - Hillsborough County

Program Rationale
According to the Centers for Disease Control and Prevention (CDC), the homeless population is at a higher risk of coming in contact with tuberculosis (TB) than the settled (housed) population.  The risk factors for the homeless population becoming infected with TB include residence in congregate settings (e.g. homeless shelters), access to health care, substance abuse, and HIV infection. The relationship between homelessness and TB infection is illustrated by long-lasting TB outbreaks seen in homeless populations over the past decade in various cities across the United States (e.g. Los Angeles, California; Kane County, Illinois; and Jacksonville, Florida).

Program Description
Due to the high risk of TB transmission in the homeless population, it is imperative to implement infection prevention and control protocols in homeless shelters by developing an infection prevention plan, increasing the amount of symptom screening and education provided to homeless individuals to reduce this risk, and educating shelter staff about TB.  Through coordination with the Tampa Hillsborough Homeless Initiative (THHI), the Promoting Health in Homeless Shelters (PHHS) workgroup was created for the Florida Department of Health in Hillsborough County (FDOH - Hillsborough), TB Center to work with both emergency shelter and transitional housing providers to complete the aforementioned tasks.  Shelters that adopt TB infection prevention policies and procedures (e.g., requiring annual TB testing and symptom screening for clients at intake) can identify clients with TB infection and/or disease and refer them to the FDOH-Hillsborough, TB Center, for evaluation. Incorporating these policies and procedures into the intake process can reduce the risk of TB transmission occurring within their facilities.

Once each organization has developed an infection prevention plan and undergo a TB education for staff, it can easily be expanded to cover the prevention of other communicable diseases.  Furthermore, additional health topics can be addressed outside of communicable diseases such as: nutrition/diabetes, access/linkage to healthcare, oral health, and mental health.  By covering topics such as these, this initiative can help address access to health care, substance abuse and HIV infection in order to tackle all of the major components that put the homeless population at increased risk of acquiring TB and other communicable diseases.

Infection Prevention Plan Template and Health Promotion Toolkit
In collaboration with local homeless service providers, the FDOH-Hillsborough developed an Infection Prevention Plan Template for agencies to adapt to their homeless shelters. The infection prevention plan includes: infection prevention guidelines; a sample TB symptom screening form; a referral letter from the agency to the FDOH-Hillsborough TB Center for TB testing, evaluation, and/or treatment; a cough/illness log; an annual health recommendations and shelter assessment form; and a health promotion toolkit.

The Health Promotion Toolkit for Homeless Shelters was developed in order to provide, facts, prevention measures, and resources for a variety of health topics that disparately affect the homeless population. This information can be utilized by shelters to provide health education to their clients in both formal (e.g. health education presentation/class) and informal (e.g. posting a “Cover Your Cough” poster on a bulletin board in a high-traffic area or a “Wash Your Hands” poster in the bathroom) settings to increase awareness and knowledge about various health topics.