Meeting People Where They Are: HCH’s Street Medicine Program
Dr. Jason Reinking and Roots Community Health Center’s Oakland STOMP team established a relationship with the patient over visits on consecutive days at her encampment in West Oakland. Because trust developed, the team, which includes Dr. Reinking, two outreach workers, and a medical assistant, was able to bring the patient to see an opthamologist in Alameda. Surgery will likely restore her eyesight.
“Serving patients where they are and addressing all of their needs is the cornerstone of our model of care,” says Suzanne Warner, Deputy Director of Alameda County’s Health Care for the Homeless (HCH) program, which partners with Roots Community Health Center and Tri-City Health Center to provide street medicine services.
“Our clients are often unsheltered or in temporary housing,” says Warner. “Street medicine allows us to engage people where they are and to offer opportunities to connect to a permanent health home, financial benefits, permanent housing, and other services.”
The Roots program, known as ‘Oakland STOMP,’ started in July 2015. Between the program launch and June 30, 2016, the program had seen 279 patients in 512 face-to-face primary care encounters. As of September 30, 2016, Tri-City Health Center’s HOPE Project Mobile Medical Clinic, which started in December 2015, had made 384 visits to encampments in Hayward, Fremont, and Livermore and seen 180 clients in 264 primary care encounters. Tri-City carries out its program in partnership with Abode Services.
This year, HCH opened the Trust Health Center in downtown Oakland, offering under one roof a full range of physical and behavioral health services along with case management, financial benefits counseling, and linkages to permanent housing. The Trust Health Center serves disabled adult residents of Alameda County who receive County General Assistance or have income lower than the GA amount and who are homeless or at risk of homelessness.
Wilma Lozada conducts outreach for HCH, often following up with people Dr. Reinking identifies as eligible for services at the Trust Health Center and ready to get into permanent housing.
“After Dr. Jay refers someone to me,” says Lozada, “I confirm their eligibility and then drive to where they are. I might need to meet with clients several times at their encampments before they are comfortable coming in,” she says. “When they’re ready, I’ll drive them where they need to go.”
Not infrequently, Lozada’s outreach reestablishes an existing connection. “One gentleman I met in his late forties or early fifties said he’d been homeless for a month and needed help with housing and managing his disability payments. I started asking him questions and then he remembered that he’d had a place he was staying. I showed him some pictures and started calling around. I reached a facility and said, ‘I have someone here who might live at your place.’ They said ‘Yes, where is he? We lost him.’ All his stuff was there. He had been incarcerated in Santa Rita for a month and didn’t have his medication when he got out and didn’t remember where he had been staying. He was so happy to be out of the rain. It was as simple as showing interest and taking the time to figure out where his home was.”
Street medicine can provide a link to permanent housing for people with the highest needs. “We work with people who are too sick or too mentally unwell to move through a long and difficult housing process,” says Dr. Reinking. “We advocate for them and prioritize them to receive housing early.” This saves money, as these are the same persons who are often using a lot of resources.
“This is a change in how the county houses people experiencing homelessness,” says HCH Deputy Director Warner. “In the past, mostly just those people with the highest levels of functioning and the greatest determination were able to navigate the complex process of finding housing. Working with our street medicine partners, we are able to identify and house people with the greatest needs.”
Just this year, 10 Roots clients have been housed in partnership with HCH. HCH, in partnership with EveryOne Home and Alameda County’s Housing Services Office in Behavioral Health Care also manages the county’s new Home Stretch program, which prioritizes chronically homeless, high need individuals.
Many of HCH’s street medicine clients have complex conditions that cannot be managed adequately outside. “We see a lot of hypertension, diabetes, Hepatitis C, abscesses, congestive heart failure, COPD, and kidney failure,” says Susan Doughty, a nurse practitioner who delivers care for Tri-City’s street medicine project. “I have two people who are supposed to be on oxygen but there’s no place to plug in a compressor. It’s ridiculous.” According to Doughty, 80 to 90 percent of her clients have conditions that could be managed well with appropriate supports.
Street medicine provides a bridge to connection. “As people fall through the ranks of society to end up living on the street, they inevitably develop a very real distrust of society, whom they feel have turned their backs on them,” says Dr. Reinking. “There’s also a distrust of assistance programs, so the population can be very hard to engage meaningfully, to bring back into mainstream society.”
“Our clients often experience a knowledge gap about their conditions,” says Reinking. “Frequently, no one has ever taken the time to explain to them what’s going on. On top of that, clients have had a lot of negative experiences, and that can frustrate and anger them."
Meeting basic needs is a starting point. “We provide hygiene kits, food, water, condoms and overdose kits in order to engage people wherever they are at and start a relationship, because trust is everything in this kind of work. Once we have a trusting relationship with people, and we find ourselves on the same level, speaking the same language, we have a better chance to make meaningful change in their lives.”
Doughty tells the story of a man in his mid-fifties who used to sleep outdoors in Fremont. He had repeated emergency room admissions and would leave with prescriptions, but he wouldn’t take his medicines regularly. “He ended up with a broken hip and living in a long-term care facility,” she says. “We got him back on his medicines, got him a bed in a shelter, and then checked in on him twice a week. He’s doing much better now. He just really needed to feel that there were people on his side, that this wasn’t just our job, but that we do this work because we care.”