Original Publication
Open Access

Caring With Compassion, Domain 2: Bio-Psychosocial Care of Uninsured, Homeless, Underserved, and At-Risk Populations

Published: April 10, 2014 | 10.15766/mep_2374-8265.9755

Included in this publication:

  • 1.Biomedical.docx
  • 1.Biomedical Test.docx
  • 1.Biomedical Answers.docx
  • 2.SDH.docx
  • 2.SDH Test.docx
  • 2.SDH Answers.docx
  • 3.Bio-psychosocial Model.docx
  • 3.Bio-psychosocial Model Test.docx
  • 3.Bio-psychosocial Model Answers.docx
  • 4.Team Care.docx
  • 4.Team Care Test.docx
  • 4.Team Care Answers.docx
  • Domain2.Suggested Links.docx
  • Presentation Guide.pdf
  • Milestone Assessment Tool.pdf

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: The Caring with Compassion series provides core background information to support bio-psychosocial clinical care for homeless, underserved, uninsured, and at-risk populations. At the University of Michigan Medical School, this content serves as a core resource for a fourth-year medical student clinical elective regarding care of the underserved. At the University of Michigan School of Nursing, it is a core resource for advance nurse practitioner clinical rotations in underserved settings. For graduate medical learners, the content is available as an independent learning resource. This resource is the second domain in a two-domain series. The first domain provides an overview of US public health care systems, while this domain presents the bio-psychosocial model of health care and special care needs of underserved populations. Methods: In this module, case-based materials are provided to address the topics of biomedical conditions among the homeless, social determinants of health, the biopsychosocial model of health, and interdisciplinary team care. A multiple-choice test and answer key are provided for each topic. Results: Nationally, over 300 learners from multiple medical and nursing training programs have registered as learners, and feedback has been highly positive. Through the use of t tests, preliminary quantitative outcome data demonstrated significant improvement in multiple-choice examination scores following exposure to the modules for all assessed content areas: epidemiology of populations in need (n = 42, pretest = 49%, posttest = 81%, p < .0001); health care delivery systems knowledge (n = 19, pretest = 53%, posttest = 67%, p < .002); homelessness and disease (n = 20, pretest = 59%, posttest = 82%, p < .0001); public health insurance (n = 30, pretest = 52%, posttest = 80%, p < .0001); team care (n = 14, pretest = 45%, posttest = 64%, p < .001); social determinants (n = 29, pretest = 51%, posttest = 56%, p = .022). Additionally, comments from users included: “This is incredible and I am going through it slowly – realize how much I need to learn,” “A great tool for everyone not only to raise awareness but hopefully inspire people to take an active role in the care of the underserved.” Discussion: Most training programs find it easiest to utilize this resource then encourage application in clinical settings. For programs with residents providing continuity care in federally qualified health care centers, the content may be used for ambulatory case conference discussions.

Educational Objectives

By completion of the instructional content by topic, learners will be able to:
Topic 1: Biomedical Conditions Among the Homeless

  1. Recognize the type and prevalence of conditions more common among homeless persons.
  2. Recognize the prevalence of tobacco use and substance abuse in the homeless population.
  3. Identify examples of biomedical complications of food scarcity and malnutrition.
  4. Recognize common skin conditions of the homeless and treatment options.
  5. Recognize exposure-related conditions seen in cold conditions (i.e., frostbite, trench foot, hypothermia).
  6. Acknowledge challenges to chronic disease management imposed by homelessness, precarious housing, and food scarcity.

Topic 2: Social Determinants of Health

  1. Define health disparities and health care disparities in the context of two moral frameworks—social justice and compassion.
  2. Identify major classes of social determinants of health (i.e., race/ethnicity, socioeconomic status, environment, behavioral factors, and health system characteristics).
  3. Give examples of negative health consequences of uninsured status.

Topic 3: Biopsychosocial Model of Health and Health Care

  1. Identify major classes of psychosocial and behavioral determinants of health (i.e., mental health conditions, behavioral disorders and social support, cultural influences, local environment).
  2. Recognize type and prevalence of mental health disorders common among homeless persons.
  3. Recognize increased medical morbidity and decreased life expectancy associated with chronic mental illness in the public mental health sector.
  4. List diagnostic criteria for major common addictive substance disorders.
  5. Identify major features of traditional addictive substance treatment programs.
  6. Identify major features of recovery oriented and harm reduction substance abuse services.
  7. Relate components of the readiness-for-change and self-efficacy models of health behaviors, and their application among homeless patients.

Topic 4: Interdisciplinary Team Care

  1. Recall training, licensure, and scope of practice of nurse practitioners, physician assistants, and pharmacists, social workers, and case managers.
  2. Recall scope of practice of addiction counselors and mental health providers.
  3. Describe outreach and team-based health care delivery models of demonstrated effectiveness among homeless persons.
  4. Identify specific team skills and communication approaches essential to high-functioning, interdisciplinary care teams.

Author Information

  • Davoren Chick, MD: University of Michigan Medical School
  • April Bigelow: University of Michigan School of Nursing
  • Frank Jacob Seagull: University of Michigan Medical School
  • Heather Rye: University of Michigan Medical School
  • Pamela Davis: University of Michigan Medical School
  • Brent Williams: University of Michigan Medical School

None to report.

None to report.


Chick D, Bigelow A, Seagull F, Rye H, Davis P, Williams B. Caring with compassion, domain 2: bio-psychosocial care of uninsured, homeless, underserved, and at-risk populations. MedEdPORTAL. 2014;10:9755. https://doi.org/10.15766/mep_2374-8265.9755