Ch 41: Caring for Persons Who Are Homeless and Mentally Ill

b) Confidence in parenting and budgeting money Pg. 817 A living skills program typically includes content in nutrition, budgeting, parenting, household and family management, tenant responsibilities and rights, and employment readiness. The program can promote a feeling of camaraderie, self-confidence, trust in staff, and aspirations to independent living. The program does not focus on admission to college or arrangements to obtain a driver's license.

1. A nurse is discussing a "Living Skills Program" with a mother of a young child. Which is an outcome expected for the client after attending the program? a) Arrangements to obtain a driver's license b) Confidence in parenting and budgeting money c) Continue being a single parent without social support d) Ability to apply for college admission

a) The client may be embarrassed about their physical appearance Pg. 811-812 During the physical health assessment, the nurse needs to provide privacy and avoid being in a hurry. The client may be embarrassed about their physical appearance or hygiene. The nurse should explain their concern about the client's health status and provide a thorough assessment. The client does not have delusions or paranoia. The client does not feel the nurse cannot provide adequate care.

10. During an physical assessment of a homeless client, the client refuses to answer a few of the nurse's questions and states that they do not want the nurse to touch them. What may be the reason for this behavior? a) The client may be embarrassed about their physical appearance b) The client is feeling the nurse cannot provide adequate care c) The client is delusional and has paranoia d) The client is being stubborn

c) Concurrent drug or alcohol abuse Pg. 806-808 Risk factors for homelessness include presence of positive symptoms of schizophrenia, concurrent drug or alcohol abuse, presence of a personality disorder, lack of current family support, and high rate of disorganized family functioning from birth to age 18.

11. Which of the following is a risk factor for homelessness among persons with SPMI? a) Adequate family support b) Presence of a cognitive disorder c) Concurrent drug or alcohol abuse d) Presence of negative symptoms of schizophrenia

d) People who are homeless prefer being alone Pg. 817 Peer relations with trusted people are preferred and essential to survival and meeting needs. People who are homeless are from all walks of like. Most people are homeless for a relatively short time. People who are homeless must be creative to secure resources and constantly change life ways to survive.

12. Which of the following is a myth related to homeless people with psychiatric disorders? a) Most people are homeless for a relatively short time b) People who are homeless are from all walks of life c) People who are homeless must be creative to secure resources and constantly change life ways to survive d) People who are homeless prefer being alone

c) The client will need more intensive services Pg. 817 The structure of some day treatment programs follows the model of AA. Sobriety is the goal. No one is terminated for relapse; instead, patients who relapse are referred to more intensive services, including hospitalization if necessary. The other explanations are neither correct nor therapeutic.

13. A homeless client living in a shelter has alcoholism and is referred to a day treatment program that follows the 12 steps of Alcoholics Anonymous (AA). After being compliant for 2 weeks with the program, the client relapses and drinks a fifth of liquor purchased with money someone gave for food. What should the nurse tell this client will happen now? a) The client will never be totally sober b) The client will have to be hospitalized to stay in the program c) The client will need more intensive services d) The client will be terminated from the program because of the relapse

a) The nurse needs to become familiar with the person's street life due to misinterpretation of unusual behaviors Pg. 811 Nursing diagnoses must be formed cautiously after becoming familiar with the norms and necessities of street life because some unusual behaviors may be adaptive mechanisms. For example, clients may wear excessive clothing to prevent theft or to keep others from disturbing them. Likewise, they may consciously exhibit bizarre behaviors to keep others away.

14. Why would the psychiatric nurse need to be cautious about formulating nursing diagnoses quickly for a homeless person? a) The nurse needs to become familiar with the person's street life due to misinterpretation of unusual behaviors b) The nurse needs to spend more time in the homeless person's environment, even being on the street with the person, so he or she can more easily make judgments about the person's values and belief systems c) The homeless person is likely to be untrustworthy and may not provide accurate data d) The homeless person is often psychotic and cannot relate to the nurse

b) Client is in an unsheltered environment Pg. 806-807 Homeless individuals can live in either a sheltered (community/temporary) housing complex or in an unsheltered environment, such as a car, park, abandoned building, tent, or bus/train station. The priority action taken by the nurse would relate to potential safety exposure related to the unsheltered environment. Having minimal contact with family members or having few personal belongings is not the priority concern at this point.

15. A community clinic nurse is assessing a client who is homeless. Which finding requires a priority nursing action? a) Client states minimal contact with family members b) Client is in an unsheltered environment c) Client resides in a homeless shelter d) Client has few personal belongings

d) "Most people who are homeless require acute, inpatient psychiatric care" Pg. 816 Only about 5% to 7% of adults who are mentally ill and homeless need inpatient care. The other statements are true.

16. A nursing instructor is teaching about the homeless population with psychiatric disorders. Which of the following statements by a student represents a myth and indicates a need for further instruction? a) "Most people who are homeless recognize the need for help" b) "Many people who are homeless consider themselves well as long as they can get where they need to go" c) "The homeless person is likely to describe health and heath care needs in a holistic way" d) "Most people who are homeless require acute, inpatient psychiatric care"

c) McKinney-Vento Homeless Assistance Act Pg. 809 The McKinney-Vento Homeless Assistance Act provided the first comprehensive federal funding program targeted specifically to address the health, education, and welfare of the homeless population. The Shelter Plus Program allows for various housing choices and a range of supportive services funded by other sources. The Bringing Home America Act includes housing development, support for living income, rental assistance, job opportunities, civil rights protection for persons without housing, emergency funds to prevent homelessness, and increased access to health care for this population. The Affordable Care Act focuses on preventative care coverage.

17. Which of the following provided the first comprehensive federal funding program targeted specifically to address the health, education, and welfare of the homeless population? a) Bringing Home America Act b) Shelter Plus Care Program c) McKinney-Vento Homeless Assistance Act d) The Affordable Care Act

b) Diabetes d) Hypertension e) Dental caries Pg. 811-812 Common physical health problems include diabetes, hypertension, and dental caries. Guillain-Barré' and pulmonary embolism are relatively rare in this population and the general population.

18. Which of the following are common physical health problems experienced by homeless people? Select all that apply. a) Guillain-Barré syndrome b) Diabetes c) Pulmonary embolism d) Hypertension e) Dental caries

b) Away from creating emergency shelters to developing more permanent housing Pg. 815-816 The focus of attempts to address the problem of homelessness have shifted away from creating emergency shelters to developing more permanent housing. At the same time, housing assistance programs have become limited, rents have increased, and waiting lists for public housing have become longer.

19. A nurse working in an emergency shelter for the homeless tells a new colleague that there has been a change in the focus for homeless people in regards to housing. What is this shift? a) Away from having high rents to lower rents b) Away from creating emergency shelters to developing more permanent housing c) Away from using soup kitchens to instead having food voucher programs d) Away from having waiting lists for public housing

c) Independent d) Proud e) Resourceful Pg. 808-809 The experience of being homeless for a long time results in a sense of depersonalization and fragmented identity, loss of self-worth and self-efficacy, and a stigma of "being nothing," "a bum," "lazy," and "stupid." However, most people who are homeless describe themselves as resourceful, independent, proud, and survivors.

2. Most people who are homeless describe themselves as what? Select all that apply. a) Lazy b) Stupid c) Independent d) Proud e) Resourceful

a) Mental illness b) Lack of skills d) Unemployment e) Substance abuse Pg. 809 Many factors can contribute to homelessness including unemployment, lack of skills, mental illness, substance abuse, and domestic violence.

20. When teaching about vulnerable populations, the nursing instructor lists the homeless as an example. What are some risk factors known to lead to homelessness? Select all that apply. a) Mental illness b) Lack of skills c) Multiple children in family d) Unemployment e) Substance abuse f) Part-time work

a) Developmental delays and learning difficulties Pg. 810 Homeless children commonly experience developmental delays, depression, anxiety, and learning difficulties. Their homelessness may be a source of shame. They also may demonstrate resiliency to their multiple stressors.

21. Homelessness can cause a multitude of problems for children, some of which include... a) Developmental delays and learning difficulties b) Depression and suicidality c) Anxiety and lack of concentration d) Aggression and depression

b) A psychosocial assessment is conducted by the provider using observation and listening to the client Pg. 812 The psychosocial assessment is a behavioral assessment to gain insight into a client's life and mental health issues. Much of the assessment is conducted through observation and listening to the client's explanation of events. The physical assessment is a head to toe assessment by the provider.

22. An psychosocial assessment of a homeless client is different from a physical assessment. Which best describes the difference? a) A psychosocial assessment is a head-to-toe assessment by a provider b) A psychosocial assessment is conducted by the provider using observation and listening to the client c) A physical assessment uses questions to assess, and documentation focuses on the client's responses d) A physical assessment focuses on the client's observed behaviors and how the provider interprets the interaction

d) Verbalizes the necessity to return regularly to the clinic for monitoring and obtaining prescribed medicines to control symptoms Pg. 816-817 Case management encompasses health teaching, crisis intervention, symptom monitoring, assistance with federal or local entitlements, assistance with transportation, teaching about money management, and consumer advocacy.

23. The nurse evaluates case management to have been effective if the homeless client with schizophrenia... a) Indicates he or she can take care of meeting his or her daily living needs and will no longer need further referrals b) States that he or she is free of symptoms and does not need to take prescribed medicines until symptoms reappear c) Introduces the nurse to a new friend from whom necessary transportation services will be provided d) Verbalizes the necessity to return regularly to the clinic for monitoring and obtaining prescribed medicines to control symptoms

a) Accessing emergency services Pg. 815-816 Homeless clients need information to promote health and to use pertinent health care resources. Client education may include topics such as personal hygiene, recognizing and treating infestation, thermoregulatory disorders, tuberculosis screening, respiratory problems, sexually transmitted infections, signs of domestic violence, emergency services, and substance abuse issues. The nurse also educates clients about the nature of mental illness; symptoms to expect; side effects, risks, and benefits of prescribed medications; and ways to negotiate the complexities of the mental health system.

24. A community-based clinic is offering education classes at a local shelter. The nurse performs a needs assessment on which topics might be most important for the clients at the shelter. After analyzing the data, the nurse would likely plan a session on which of the following topics? a) Accessing emergency services b) Signs of developing diabetes c) How to file insurance claims d) Eating a balanced diet

a) The nurse is focused on documentation and avoids eye contact with the client Pg. 806-807 Each client (whether homeless or not) should be afforded respect and courtesy. Myths associated with people experiencing psychiatric disorders include but are not limited to that they choose to be homeless and/or they aren't smart enough to succeed. The nurse, by focusing on the health record and avoiding eye contact with the client, is not being respectful. It is important for health care professionals to provide equitable care to all populations.

25. A client who is homeless and diagnosed with bipolar disorder presents to the clinic for a follow-up visit and a nurse begins the assessment. Which observation by the nurse manager warrants immediate intervention? a) The nurse is focused on documentation and avoids eye contact with the client b) The nurse addresses the client by their name c) The nurse asks additional questions to clarify the client's responses d) The nurse focuses on the client's answers before asking additional questions

a) Something as simple as not having an address may prevent the client from receiving care Pg. 817 Barriers to the homeless receiving care include lack of insurance; lack of transportation; eligibility criteria, which may require an address; loss of identification (a frequent requirement for accessing services); lack of knowledge of available services; fear of having to leave, and possibly lose, possessions by attending clinic appointments; concern over missing meals or a place in line for a shelter bed; and fear of scrutiny by caregivers.

26. When planning care for a homeless person, the nurse must build into the plan the fact that... a) Something as simple as not having an address may prevent the client from receiving care b) Clients have knowledge and access to public health services c) The client can easily access adequate public transportation d) Their belongings will be safe while they are receiving care at a clinic

a) Legal protection b) Rehabilitation from drug and alcohol abuse d) Case management services e) Housing options Pg. 815 Stable shelters or residences, often referred as Safe Havens, offer essential components for the homeless and those experiencing psychiatric disorders. These include accessible outreach, integrated case management, accessible and affordable housing options, treatment and rehabilitation service, general health care services, vocational training and assistance with employment, income support, and legal protection. Transportation services are not provided.

27. A client who is homeless and bipolar discloses to the nurse that they have been living in a stable shelter called Safe Haven. What services do stable shelters provide? Select all that apply. a) Legal protection b) Rehabilitation from drug and alcohol abuse c) Transportation options d) Case management services e) Housing options

a) Foot screening b) Height measurement c) Blood pressure d) Scoliosis e) Hearing test Pg. 811-812 Common physical health problems for the homeless population include but are not limited to hypertension, impaired hearing, and/or foot injuries (blister/callus/infection). Height measurement by itself would not reveal any significant information. Screening for scoliosis is not necessary for this population.

28. A group of nurses are preparing a community health fair to help screen for health care services needed by the homeless population in the community. What type(s) of screenings should the nurses provide? Select all that apply. a) Foot screening b) Height measurement c) Blood pressure d) Scoliosis e) Hearing test

b) Resilience Pg. 806-808 Homeless mothers and children have great resilience. Homeless mothers are not necessarily depressed, nor do they have inadequate coping skills. Many of them, having made the decision to free themselves of a noxious relationship, are competent and resilient.

29. A nurse is reading an article about different risk factors for homelessness. The article describes a situation in which a woman with two children leaves her husband because of domestic violence and becomes homeless. The nurse interprets this action as the woman exhibiting which characteristic? a) Lack of coping skills b) Resilience c) Depression d) Incompetence

c) Make sure that case management has been contacted Pg. 816 The importance of verifying that case management has been contacted to participate in discharge planning of a client who is homeless represents a priority nursing action. The other options may be needed but they are not the priority, because without case management, there is no coordination of care on discharge.

3. A client who is homeless is being discharged from the hospital. Which is the priority action the nurse should implement? a) Refer to a health care provider in the community b) Schedule a follow-up appointment at the local clinic c) Make sure that case management has been contacted d) Provide the client with prescriptions

b) Homelessness but coping by living in a shelter Pg. 812 The client is experiencing homelessness is using resources available to cope with the issue. The client is not experiencing mental fatigue, nor a negative relationship or an exacerbation of mental illness. All homeless clients should have a psychological assessment to determine if they have a mental illness.

30. When performing a health history on a client, the client states that they have been living in a shelter for 2 months. What should the nurse determine the client is experiencing? a) Exacerbation of depression with admission to a treatment facility b) Homelessness but coping by living in a shelter c) Mental fatigue and needs rest d) Negative relationship with family with no social support network

c) Placement in a shelter Pg. 814-815 Prioritization of needs for the homeless according to Maslow focus on basic needs, such as food and shelter; therefore, the priority goal is to place individuals in a safe environment. Obtaining medication, referral to a health care provider for oral care, and compliance with therapy are all areas that can be eventually addressed but they are not the priority concern.

31. A nurse is working with a group of clients who are homeless. Based on Maslow's hierarchy of needs, what should the nurse anticipate as a priority goal? a) Obtaining medications b) Referral to a health care provider for oral care c) Placement in a shelter d) Compliance with therapy

b) The screening requires little time e) It provides a screening, brief interventions, and referral to treatment Pg. 811 Screening, brief interventions, and referral to treatement (SBIRT) integrate initial screening with brief interventions or referral to treatment for clients who have substance use disorders, mental disorders, and homelessness. It does not provide a treatment regime for hospitalized clients, aid in the diagnosis of cardiovascular disease, or identify basic needs of housing or food. The screening requires little time; 5 minutes to screen and 10 minutes to provide interventions.

32. A nurse is completing a physical examination of a homeless client who reveals they have depression. What are the reasons a nurse would perform an SBIRT on the client? Select all that apply. a) It is a part of the treatment regime for any hospitalized client b) The screening requires little time c) The tool identifies basic needs, including housing and food d) The tool is helpful for diagnosis of cardiovascular disease e) It provides a screening, brief interventions, and referral to treatment

a) Prison release c) Domestic violence d) Veteran status Pg. 809-810 General causes of homelessness include veteran status, domestic violence, prison release, and poverty. Having adequate coping skills and employment are not general causes of homelessness.

33. A nurse is preparing a presentation for a local community group about homelessness. Which information would the nurse most likely identify as a general cause of homelessness? Select all that apply. a) Prison release b) Adequate coping skills c) Domestic violence d) Veteran status e) Employment

b) Daily skill training c) Peer support d) Psychosocial rehabilitation e) Vocational training Pg. 812-813 Providing housing alone does not significantly alter the prognosis of the homeless for persons with mental illness. Psychosocial rehabilitaiton, peer support, vocational training, and daily living skills are all important components for decreasing the homeless population and improving quality of life. Once the client feels he or she belongs to the community, the client may decide to volunteer time as a peer for other homeless.

34. The nurse is taking care of a homeless client who suffers from PTSD. There are several barriers to effective treatment for the homeless. The nurse understands that housing alone will not promote health for the client. Which additional strategies should the nurse include? Select all that apply. a) Volunteer hours b) Daily skill training c) Peer support d) Psychosocial rehabilitation e) Vocational training

a) Developmental delays and learning difficulties Pg. 810 Homeless children commonly experience developmental delays, depression, anxiety, and learning difficulties. Their homelessness may be a source of shame. They also may demonstrate resiliency to their multiple stressors.

35. The school nurse is monitoring Austin, a third grader whose family is experiencing a multitude of financial problems. His father was laid off at his manufacturing job, causing the family to have to sell their house immediately in efforts to downsize expenses. They have yet to locate affordable housing so the family is temporarily living in a subsidized motel facility. The nurse is especially alert for Austin to display which of the following responses related to this crisis? a) Developmental delays and learning difficulties b) Headaches and fatigue c) Lack of concentration and disinterest in activities d) Aggression and impulsiveness

b) "I don't want to discuss my family" Pg. 806-807 Discussing the social support system of a homeless client allows for a more comprehensive assessment of people or services used in the past. The statement that the client does not want to discuss their family is a statement that identifies challenges. "Not agreeing with the parents' choices" or "discussing a long history" identifies the willingness of the client to discuss the social support system of the family.

36. A nurse asks a homeless client about their family. Which statement indicates challenges the client has experienced with their family? a) "Why do you want to know about my family?" b) "I don't want to discuss my family" c) "I don't agree with my parents' choices" d) "My family has a long list of issues" e) "My family has a long history of crazy behaviors"

b) Poverty c) Inadequate housing d) Deficient mental health care system e) Substance abuse Pg. 806-808 Common societal factors have helped to foster conditions that have led to increased homelessness. Examples include a deficient mental health care system, the disabling functional deficits of mental illness, substance abuse, the effects of poverty, inadequate housing, and mobility.

37. A nursing instructor is teaching about homelessness and the many societal factors that contribute to this problem. Which of the following contributing factors would the instructor identify? Select all that apply. a) Support from family b) Poverty c) Inadequate housing d) Deficient mental health care system e) Substance abuse

b) Use observation first and engage the client in conversation prior to performing any tactile assessments Pg. 811-812 The physical examination of an individual who is homeless should incorporate the elements of look, touch, palpate, and auscultate, with the nurse being mindful of not being intrusive, which could result in the client feeling apprehensive and/or leaving the exam room environment. Therefore, it is important to first use observation and engage the client in conversation prior to performing any tactile assessments. Having the client remove all of their clothes may lead to feelings of apprehension. Asking specific questions may also lead to apprehension, avoid unnecessary directness or probing.

38. A nurse is getting ready to perform a physical assessment on a client who is homeless who presented to the clinic. Which nursing action represents the best approach? a) Ask specific questions to obtain information related to the physical exam b) Use observation first and engage the client in conversation prior to performing any tactile assessments c) Inspect, palpate, and percuss as needed to elicit physical examination information d) Have the client remove all of their clothes, provide an examination gown, and leave the room to provide privacy

a) Transformation of old buildings into modern condominiums Pg. 809-810 Gentrification is the upgrading of inner-city property so that it is affordable only to people who have the resources of upper-middle or upper economic levels. Abandoned or substandard buildings are demolished to build modern condominiums or "lofts". Modernization or updating homes for affordable housing or repair of elderly homes are not examples of gentrification.

39. What is an example of gentrification? a) Transformation of old buildings into modern condominiums b) Updating abandoned homes for affordable housing c) Modernization of existing apartments d) Allocating state or local funds to repair elderly homes

a) "I will be able to get assistance coping with my addiction" Pg. 816 Participation in structured day treatment programs provides emotional and practical support for the client with an drug and alcohol addiction as well as mental illness. Sobriety or harm reduction is the goal; the client attends daily meetings, receives necessary psychiatric and medical treatment, and participates in all the other activities and services available at the day treatment program. Food is not usually provided.

4. A nurse explains to a homeless client about a day treatment program available to assist with the client's addiction to alcohol. Which statement by the client indicates the teaching was effective? a) "I will be able to get assistance coping with my addiction" b) "I need to go every other day to the day program" c) "I will be able to get three full meals while attending the program" d) "I will be the only person there for alcohol addiction"

b) Clothing c) Shelter e) Food Pg. 811 The priority for homeless people is meeting basic needs: food, shelter, clothing, etc. Care for the mental illness is secondary. The nurses should use Maslow's hierarchy as the guiding framework when planning interventions.

40. A nurse working in a homeless shelter identifies which of the following as priorities for the homeless population? Select all that apply. a) Health care b) Clothing c) Shelter d) Prescriptions e) Food

d) Cardiovascular and pulmonary systems Pg. 811-812 People with SPMI die an average of 25 years earlier than the general population and about 60% of these premature deaths are linked to natural causes, such as cardiovascular and pulmonary disease.

41. The psychiatric nurse assesses a client with a history of a severe persistent mental illness for indications of medical conditions, especially involving the client's... a) Endocrine and sensory systems b) Integumentary and musculoskeletal systems c) Gastrointestinal and renal systems d) Cardiovascular and pulmonary systems

c) The responses are common to this client Pg. 812 Symptoms of schizophrenia may be difficult to differentiate from emotional responses to the stressors of a homeless lifestyle. Blunted affect, lack of communication, loose associations, ambivalence, isolation, and uncertainty may be the result of life on the streets and living in various places. Such symptoms or behaviors may be part of the homeless experience and reflect healthy coping mechanisms and creative survival techniques rather than pathology. Calling another nurse or a provider is not necessary.

42. A nurse is conducting a health history of a homeless client. The client has a history of schizophrenia. The nurse notices that the client is not answering some of the questions appropriately, does not smile or maintain eye contact, and is evasive in the responses. What is the nurse's best assessment of this behavior? a) The nurse should ask another nurse to assist b) The actions require immediate hospitalization c) The responses are common to this client d) These responses warrant additional information related to medication adherence

a) Prepare the client for involuntary hospitalization Pg. 811 Safety needs are always a priority. If an individual is a threat to others or self, safety interventions should be implemented. The client may be involuntarily hospitalized for stabilization of symptoms. Calling the prescriber is not warranted at this time. Putting a client in a locked room will not deescalate the feelings. Probing the client is not appropriate at this time. The client has already expressed wanting to hurt their mother. The nurse has to prepare to keep the client safe.

43. A nurse is completing a health history on a client who reports wanting to injure and hurt their mother. What action is the priority for the nurse? a) Prepare the client for involuntary hospitalization b) Probe the client to obtain more details c) Call a prescriber for medications d) Place the client in a locked room

a) Find a shelter to accommodate the family Pg. 810 Family homelessness has a adverse effect on children. The nurse should assist the social worker to find placement for the entire family. The family should be kept together to minimize trauma to the children. Hospitalizing the father can separate the children. The nurse should work together with the social worker.

5. A nurse is working with a social worker to find a homeless shelter for a man and two young daughters. What is the priority for shelter placement for this family? a) Find a shelter to accommodate the family b) Hospitalize the father for an acute problem to keep the family together c) Allow the social worker to find placement for the family d) Separate the father and children into two shelters

d) Institutional to community orientation Pg. 811 The current mental health care system has shifted from an institutional to a community orientation. Resulting gaps in care have contributed to increased rates of homelessness. The system has not adequately addressed the comorbidity of mental illness or substance abuse.

6. A nurse tells a new graduate that a shift in the mental health care system contributed greatly to increased rates of homelessness. To what change is the nurse referring? a) Focus on the comorbidity of substance abuse b) Community to institutional orientation c) Focus on the comorbidity of mental illness d) Institutional to community orientation

a) "Nothing matters" d) "I am overwhelmed and do not care about anything" Pg. 809 Persons who have been or are homeless and have mental illnesses have typically have endured and coped with constraints or problems with extremes stressors or catastrophes and negative life events. The nurse needs to recognize how the client is feeling and attempt to instill a sense of hope and recovery from homelessness and mental illness. "I am overwhelmed" and "nothing matters" are statements that the client has had extreme stressors affecting coping. The nurse should recognize these as challenges.

7. A nurse is providing care to a client who has a history of homelessness. Which statements by the client identify stressors that affect homelessness? Select all that apply. a) "Nothing matters" b) "Do you think you can help me?" c) "I am trying to change things" d) "I am overwhelmed and do not care about anything"

a) The client will use available community resources Pg. 810 Treatment goals for a homeless mentally ill person may include the following: The client will satisfy physical needs and remain safe; the client will understand the symptoms of his or her mental illness; the client will build a therapeutic alliance with providers; and the client will identify and use psychosocial supports.

8. Which of the following represents a realistic goal when planning care for a homeless client with mental illness? a) The client will use available community resources b) The client will maintain a home in a subsidized housing facility c) The client will gain insight into the causes of his mental illness d) The client will resume previous level of functioning

e) Outreach and engagement Pg. 810 The nurse understands the client is developing a trust and supportive relationship and is ready to change their behavior. Outreach and engagement is the first step in the process and involves facilitation on the individual into behavior changes. Transition to intensive care occurs when individuals agree to accept health and/or financial benefits, substance abuse/mental health treatment. Intensive care phase emphasizes the person participation in defining and managing their own goals. Transition from intensive care to ongoing rehabilitation is preparation for sustaining the process of recover. Ongoing rehabilitation is an open-ended phase in which people gradually establish an identity as no longer homeless.

9. A nurse is discussing with a homeless client about moving into sheltered housing. The client acknowledges the care and understanding of the nurse and states, "Okay, I am ready to go there." The nurse is able to recognize that the client is in which stage of the homeless rehabilitation process? a) Transition to intensive care b) Intensive care c) Ongoing rehabilitation d) Transition from intensive care to ongoing rehabilitation e) Outreach and engagement