There are also management issues related to how the Milwaukee agency is administered according to the policies and procedures promulgated by the national organization. For example, in order to provide more one-on-one contact with clinicians who have expertise in homelessness, the HCH Network also identifies clinicians from each of the five Clusters to work with the health center team in Milwaukee. This Network representative serves on the national organization's Cluster's Steering Committee; in this capacity, the primary responsibility of the Network representative is to share specific expertise and knowledge about providing primary health care to homeless people. This ongoing initiative is intended to help ensure that the unique needs of homeless people are addressed by the HCH Collaborative (Health Disparities Collaboratives, 2005).

There are also management issues related to the allocation of resources to target specific population groups in the Milwaukee PMSA. For example, Baumohl (1996) reports that children who are forced to live in shelters may experience poor health as a result of poor nutrition, communicable diseases that spread in congregate living environments, inadequate sanitary facilities, and to noise and light that disrupt sleep. "Shelters in many cities require families to leave during the day," he says, "making it difficult for young children to nap or for sick children to recuperate. Homeless children who live in cars, abandoned buildings, or in the open may suffer from exposure to the elements and are even less likely than shelter children to have adequate nutrition, sanitary facilities, and places to sleep" (p. 119). In many areas of the country, health care for such homeless children is provided by special programs operated by Health Care for the Homeless; however, in other parts of the country, access to timely care and a consistent health care provider may be difficult or impossible (Baumohl, 1996).

Money. Because resources are by definition scarce, it is critical that HCH remain a careful manager of the funds that come into its care. In this regard, the following tables provide financial statement data from 2004 for HCH. As can be seen in Table 2 below, at first glance, it would seem that HCH enjoyed a solid financial basis at the end of last year:

Table 2. Revenue and net worth for Health Care for the Homeless, Milwaukee, WI, 2004.

Revenue and Net Worth

Amount

Contributions

Other revenue

Total revenue

Beginning year net worth

Net worth changes

Year end net worth

Source: Wisconsin Department of Regulation & Licensing, 2005.

As can be seen from the "bottom-line" in Table 3, though, HCH incurred a $292,362 deficit in 2004.

Table 3. Health Care for the Homeless, Milwaukee, WI, financial information for fiscal year 2004.

Expenses

Amount

Percentage of total expenses

Other percentages

Program services

102.76% of total revenue

Management and general

Fund raising

0.00% of contributions

Payment to affiliates

Total expenses

Excess deficit

4.50% of revenue

Source: Wisconsin Department of Regulation & Licensing, 2005.

Constructive criticism and/or recommendations for future strategies and directions.

Concern for the homeless and their need for quality health care is nothing new; however, more attention is still needed. St. Martin (1996) advises that, "The new focus on quality does indeed represent a paradigm shift in the most fundamental sense from a concentration on assessment and monitoring... And from a provider and process orientation, to a customer and outcome orientation" (p. 84).

1. Establish an Internet present using a free hosting service. Even though a so-called "digital divide" exists between the information "haves" and the "have-nots," the U.S. has more than 15,700 public libraries that are helping to close this "digital gap" by providing free Internet access to numerous rural and impoverished areas where citizens frequently lack any alternative methods of online access (Semitsu, 2000). Therefore, projecting an Internet presence to help advertise the availability...

Furthermore, there are a number of Web hosts, such as 50megs.com, that provide advertising-supported Web sites free of charge. Given the altruistic nature of the mission of HCH, it is also reasonable to assume that superior Web hosting services could be secured, also free of charge, perhaps from the City of Milwaukee or by including a segment on HCH on existing municipal sites.
2. Become more aggressive in grant-seeking by using technical assistance grants to pay for assistance from professional grant-writing agencies. The recent success of the HCH in securing a SAMHSA grant suggests that more effort should be directed towards this avenue of funding. In this regard, technical assistance grants, or TAGs, are designed to help nonprofit organizations such as HCH provide grant-makers with the information and background they need to make informed decisions; TAGs have been used successfully by a wide range of NPOs that seek to expand their operations or extend their services to additional clientele (Nosek & Swedlund, 2000). Technical assistance grants provide funding for professional grant-writing services to prepare a comprehensive grant package that stands a better chance of being approved, and the costs of the TAG are frequently included in the total grant, making such services virtually free to the requesting agency (Satterthwaite, 2005).

3. Establish a permanent medical record for the homeless. Targeted medical services offered by Health Care for the Homeless projects have significantly improved access to badly needed health care services for many homeless; however, efforts must be made to ensure that such services do not become fragmented. Based on the mobility of most homeless families, Baumohl (1996) recommends that HCH adopt a policy to encourage families to maintain a "medical home" to promote educational services and health care.