Factors limiting evaluation of health care programs for the homeless

The problem of homelessness and the need for health care by homeless people does not seem to be subsiding. All indications are that current legislation to implement dramatic welfare reform will eventually increase the number of homeless persons. Evaluation to guide, monitor, and select the most effective approaches in the provision of health care will remain a key element in health care delivery. Although barriers regarding evaluation of homeless health care have been reported by previous researchers as similar, the results in this study document findings elicited from administrators in the field. The administrators have the expertise to address some of the more common barriers and reduce them. Ways to approach this endeavor and to support staff in participating in and successfully integrating evaluation activities into health care provision will require attention of funding agencies, program administrators, and inclusion of staff and clients in planning. As the era of managed care becomes the focus of how health care is delivered, evaluation of existing programs will be essential to their survival. The descriptive information obtained in this exploratory study provides useful instruction for considering issues that need to be addressed in planning and implementing evaluation of health care to homeless persons.