Homeless Initiative Brings Medical Care to Children in Tarrant County Shelters

As the mother of three boys under the age of 5, and all capable of impressive tantrums, Dana Brown-Bonner thought she knew what it meant to be challenged and live in chaos. But that was before an unexpected life event put her resiliency to the test.

In 2018, she and her family joined the often overlooked but growing homeless population in Fort Worth. When Dana and her husband became unemployed and could no longer afford to put a roof over their heads, they turned to the Union Gospel Mission shelter for help. It was there that they were introduced to a program called the Homeless Initiative, which aims to provide a medical home for children experiencing homelessness in Tarrant County, a population of roughly 15,000.

“The Homeless Initiative program provides medical care, actually any service that Cook Children’s can offer, to the children who reside in the three shelters in Tarrant County: Presbyterian Night Shelter, Union Gospel Mission and Arlington Life Shelter,” said Pat Ballard, an RN at Cook Children’s and one of the two case managers for the Homeless Initiative. “We do well checks, sick visits, TB testing, we have a flu clinic, we get them up-to-date on vaccines, any specialty doctors that they need, dentists, dental care, dental surgery, we schedule it all.”

The Homeless Initiative began in 2008 as a collaboration between Cook Children’s and former Fort Worth Mayor Mike Moncrief. The goal was to provide a path to medical care for this vulnerable population of children who, too often, were only seen by emergency room physicians.

“Back in 2008, about 98% of homeless children in Tarrant County were using ERs for primary care issues,” said Ballard. “That’s a huge burden for any ER and it puts stress on the whole system.”

The initial goal of the program was to make sure children had a primary care physician through Cook Children’s Neighborhood Clinics. These doctors would provide appointments for things like well checks, ear infections and upper respiratory conditions. It didn’t take long, however, for organizers to realize the need for mental health services and trauma-informed care, which takes a person’s traumatic experiences into account and promotes environments of healing.

“I don’t think we fully understood the problem in the beginning,” explained Denise Coover, LCSW, trauma informed care specialist at Cook Children’s. “Many of these kids have been through a lot of trauma. The more questions we asked, the more we learned.”

Coover joined the program in 2013 and provides on-site behavioral health assessments of children in the three shelters where the Homeless Initiative operates. Many of the questions in her assessment gauge what children have witnessed or endured such as physical and emotional abuse. She adds that being able to talk to the children themselves is key because often, parents don’t know the extent of what their children have been through, especially if they’ve been separated due to time in jail or foster care.

“A lot of our children have witnessed domestic violence. We have a lot of children who make disclosures of sexual assault, physical abuse, neglect and sex trafficking,” Coover said. “When we think about trauma, we have to remember the true definition is an event, or the threat of an event, that overwhelms someone’s ability to cope. If you can think of something that would overwhelm your ability to cope, our children are dealing with that.”

According to the National Center on Family Homelessness, children experiencing homelessness get sick twice as often as other children. They also suffer from more mental health issues such as anxiety, depression and withdrawal.

“We know while these children are in the shelter, this is our opportunity to intervene with them and provide them help,” Coover said. “They can’t wait six weeks, 12 weeks on a waiting list. They need intervention and they need it now.”

To make sure children experiencing homelessness in Tarrant County get the care they need quickly, Cook Children’s provides free transportation to the program’s families.

“We have a 16 passenger shuttle with a full-time, dedicated driver that delivers our kids to every appointment that we make,” Ballard explained. “That means picking up the parent at the shelter, going to school and getting the child, bringing them back to the clinic, whatever we have to do to get that child to an appointment we do.”

And if an appointment interferes with a family’s ability to eat lunch, the driver will make a special stop to make sure parents and children don’t miss a meal.

Another major goal for the Homeless Initiative is to make sure families transitioning out of homelessness have everything they need to succeed. Cynthia Thomas, LMSW, another case manager for the program, spearheads this mission. She says her job is to support and empower families experiencing homelessness.

“I provide strollers, car seats, anything a parent would need. They may need assistance in the education system, or school supplies. My role is to find out what non-health resources are necessary for them to be successful,” expressed Thomas, who works for The Women’s Center of Tarrant County.

While such supplies are necessary for success, Thomas’ main goal is to cultivate life skills families can take with them when they leave the shelters. To foster these skills, she organizes parenting classes several times a week at all three shelters. Thomas works with community volunteers and organizations across Tarrant County to create educational presentations meant to equip parents for raising children and teens.

“When they leave the shelter, we want them to feel empowered and we also want them to be able to speak for themselves,” said Thomas.

Some families need a little extra help with this, especially those who have children with special needs. Thomas often acts as a mentor and spokesperson for these parents who may have trouble navigating the special education system.

“A lot of times, the parent doesn’t understand the verbiage of the special education program, so I will go through it with them so they understand it better,” said Thomas. “One of the most rewarding parts of my job is seeing parents gain confidence and feel empowered. One mother was too afraid to say anything during meetings we had with the school. I was able to watch her learn how the system works, become comfortable and lose that fear.”

It’s been 11 years since the Homeless Initiative began and the impact is visible. As of December 2018, nearly 16,000 children and their families had been transported to medical appointments through the effort. Forty-five percent of those children returned to a neighborhood clinic after leaving the shelters, meaning they were no longer using emergency rooms as their medical home.

“I can go in the clinic two, three years later and I’ll see a mom sitting in the clinic with her kids,” said Ballard. “That’s really nice to see that you’ve made a difference in their medical care.”

The program isn’t intended to be just an appointment at a doctor’s office. Cook Children’s hopes it will be a support system when families need it most.

“It’s a chaotic world right now, but this is one of the things we don’t have to stress about,” said Brown-Bonner. “When I forget something, I get a reminder. They go above and beyond to make sure you’re comfortable and that things are taken care of. I’m very grateful and I know that there are other parents that are as well.”

For the Homeless Initiative team, the work seems never ending, but they know their efforts have a higher purpose.

“We know the outcomes for these children are not good if there’s no intervention medically and emotionally,” said Coover. “But the thing about resilience, that is the ability to bounce back from difficult life experiences, is it just takes one person believing in a child to build the resiliency they will need to succeed.”