Health literacy is a vital component of building a successful health care delivery system. For medical clients, health literacy means their ability to follow a doctor's instructions after a visit, to manage a chronic illness, and/or to take medication properly. For health care providers, health literacy means clear, concise communication with patients. It means treating patients with a patient-focused approach to healing. All the rules for effective communication among diverse groups exist for health literacy-from the ability to communicate (cultural, socio-economic, education, geographical differences), to the physician-patient relationship, to less visible barriers (patient confidence, shame, fear). It means that the words used, the directions given, and the materials presented depend on the ability of the patient to understand them. Only when they do will they be empowered to act on the information imparted and manage their health.

As the principles of health literacy/communication have become more defined, and as the needs of homeless clients have changed, Care for the Homeless' goal has remained providing health information to homeless clients in a clear, concise, culturally competent way that promotes understanding, adherence, and empowerment. With this in mind, Care for the Homeless has created the ACCESS (Applying Clear Communication to Empower HomeleSS People) project to proactively address our ability to communicate with our clients in a clear and positive way.

The ACCESS project takes the health literacy concept a step beyond health care. We apply the principles of health literacy to the provision of all services, including social services and health education. The Care for the Homeless ACCESS project works to provide all information, including case management and health education, to homeless clients in a clear, concise, culturally competent way that promotes understanding, adherence, and empowerment.

In 2001, Care for the Homeless staff participated in a Health Literacy Institute training at AHEC Health Literacy Center at the University of New England. This led us to formalize the principles of health literacy that we have informally used since 1985. For example, we now use the Fry Readability Formula to assess all client materials. In addition, we developed a formal reporting process titled Easy To Read in consultation with Sue Stableford, MPH, MSB, Director of the AHEC Health Literacy Center at the University of New England. Care for the Homeless has been consulted for help by other organizations in the creation of materials that are easy to read. For example, we contributed to the creation of the Gay Men's Health Crisis' SNiP TIPS, a guidebook to help New York City Medicaid beneficiaries living with HIV/AIDS deal with the Medicaid managed care system.