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In their Commentary in a recent issue of European Journal of Public Health, the authors provide an excellent overview of the challenges in providing integrated care for the homeless in Europe and the United States. They discuss some of the successful meetings in the United States and Europe, as well as the work of European Federation of National Organisations (FEANTSA) and European Network of Homeless Health Workers (ENHW). The authors state that the greatest challenge in providing appropriate homeless care is that "the amount of attention paid to homelessness and health in practice, academic centres and research institutes can be considered as marginalized as the attention paid to homeless people in general. Consequently, among service providers, homeless health workers are the homeless professionals in highest need for support. Our situation mirrors that of our homeless patients. For re-socialization and recognition, we ourselves are in need for an identification card, benefits and health insurance, in order to deliver state of the art integrated care". The authors postulate and elaborate on five questions that need to be addressed to improve integrated care for the homeless: (1) What do we need to know to find people in highest need?; (2) What knowledge and experience do we need once we find people in highest need?; (3) How do we organize care?; (4) How can social and medical outcomes be measured?; and (5) How much do poor and homeless people cost? The authors point out that "In daily practice we are confronted with homeless people in extremely ill health who are in need of two sorts of care. These are social care for housing, income and activities, and medical care for addiction, mental and physical health problems. These six problem areas are to be addressed simultaneously, while making rules and infrastructure for integrated care for those in highest need". The authors conclude with their mission "to improve the social and medical condition of people with none or insufficient social and medical basic needs provided", a mission based in the authors' practice-based evidence from seeking out the homeless internationally and providing outreach care to the homeless for over a dozen years in Amsterdam and Pittsburgh. |