| Description |
Background: Rising unhoused rates among pregnant women limit access to adequate reproductive healthcare, increasing unintended pregnancies and poor maternal and neonatal outcomes. Available contraception to the unhoused often has higher failure rates - compounding risks. Systemic barriers like stigma and fragmented care further hinder support. This project highlights the need for improved strategies to support the unique needs of unhoused pregnant patients. Local Problem: Providers at an obstetrics and gynecology clinic (OB-GYN) in Utah report a growing number of unhoused patients but feel unprepared to meet their complex needs. Limited housing resources and fragmented support systems leave patients and providers without essential support. The clinic's lack of dedicated social workers or case managers further hinders efforts to provide comprehensive care. Methods: This project identified clinical challenges through interviews, expert input, and a presurvey, then implemented a toolkit with provider training and feedback check-ins. Usability, feasibility, and provider satisfaction were assessed via a post-survey. Descriptive statistics were used to analyze data from project manager site check-in visits, helping to identify response trends and operational challenges that may require adjustment. Interventions: The intervention included an initial interview with a Certified Nurse Midwife to identify care gaps for unhoused antepartum patients, followed by consultation with a state house and support services expert for individuals experiencing homelessness. A toolkit of state resources was developed through literature review and pre-survey feedback, then introduced via training and reinforced through ongoing check-ins. Toolkit implementation was evaluated through post-surveys and informal feedback to assess usability and guide real-time improvements. Results: Following toolkit implementation, an aggregate comparison of results revealed significant improvements in provider knowledge, responsibility, and confidence. Providers reported greater familiarity with resources and increased confidence in supporting unhoused patients. While the toolkit was well-received and easy to use, ongoing challenges included limited referrals made, communication barriers, and difficulties managing mental health and substance use. Conclusion: This project developed and implemented a Provider Toolkit to address gaps in provider awareness, resource accessibility, and care coordination for unhoused antepartum patients. While the toolkit improved resource access and support, its limitations include implementation in a single clinic, inconsistent patient encounters, and fluctuating resources. Despite these challenges, the findings emphasize the need for structured, provider-friendly resources to improve confidence in addressing social determinants of health. However, persistent barriers in case management and behavioral health highlight the need for ongoing refinement and additional support systems. |
