Written by: Center for Care Innovations

Too often health providers confine their work to the four walls of a hospital or clinic, when some of the most needy patients are out on the street. Tri-City Health Center’s street medicine program and HOPE Project van highlight two ways to bring care to individuals experiencing homelessness. By providing basic services on the streets, they can bring these patients into the health system for clinic-based care.

Seeing the Problem

Individuals experiencing homelessness are often some of the most complex and costly patients to treat. In part this is because living on the streets, exposed to the elements and sometimes lacking proper nutrition, is taxing and compounds existing health problems. In part The unsteady lives of this population makes it difficult to integrate them into the health system. Many homeless patients do not feel comfortable visiting a clinic, or do not realize they qualify for Medicaid. They may avoid care until their symptoms become so dangerous or accute that they have to go to the emergency room, driving up costs. While providing housing can be a part of the solution, meeting homeless patients outside of the clinic can be a valuable tool for prevention and mitigating costs.

A Partnership to Reach Out

Since the late-90s, Tri-City Health Center in Alemeda County, CA, has partnered with Abode Services, a homeless housing organization, to provide care out of a mobile medical clinic van through their Homeless Outreach for People Empowerment (HOPE) Project. This RV-sized clinic travels throughout Southern and Eastern Alameda County cities, from Hayward to Livermore to Fremont, making stops each week where homeless patients can come and receive medical care. The van also provides a node for people to connect with social services and Abode’s housing services. The HOPE van operates 20 hours each week, seeing 352 visits from January to June 2016.

Shifts in the Landscape

The homelessness crisis in the Bay Area has gotten worse in recent years, and tent cities and other homeless encampments have grown. More recently cities, such as San Jose, have begun disbanding large homeless camps, scattering homeless individuals widely across the region, making it harder for providers, and efforts like the HOPE van, to find them to offer care. A new approach was needed to respond to this shifting landscape and better reach these patients.

Trying a New Approach

In October 2015 Tri-City added a new angle to their homeless care work: a “street medicine” program. In this effort, a single medical provider, equipped with a backpack of basic medical supplies, visits homeless encampments in remote areas to offer care to individuals who may not otherwise seek medical care. The medical provider often does a basic assessment, as well as address any open wounds or abressions. Theultimate goal of these interactionsis to allign these patients with a medical home, where they can seek more comprehensive care. By going to where these vulnerable patients are, the street medicine team can build relationships and establish trust, so the residents of the encampents can be comfortable coming to meet the provider in a clinic environment. From January to June 2016, the street medicine provider made 130 visits.

Part of a Larger Effort

Taking on homelessness requires a level of collaboration beyond what many health organizations are accustomed to. To support and better strategize their homeless services, Tri-City serves on a homelessness task force, along with Abode Servicesand the local fire and police departments and the City of Fremont’s staff. In the winter months they also visit a warming center in Fremont, where they can often reconnect with patients they have lost touch with.

Lessons Learned

  • Be consistent! In a practice that aligns with their patient-centered medical home teamlet model, Tri-City has learned that it is especially important to use the same providers and medical assistants when patients experiencing homelessness come into the clinic.
  • Similarly, the street medicine program program and the HOPE van do not have rotating staff. The street medicine program is practiced by a single provider with a passion for homeless outreach, for whom being on the streets is her main role.
  • These programs have found that the morning and the middle of the day are the most effective time to reach homeless patients. Tri-City tries to connect with patients at night via Fremont’s warming center.

Learn More

Tri-City Health Center serves patients in Southern Alameda County with a wide spectrum of services, including primary care, behavioral health, dental, vision, health education and connection to other social service agencies. Visit their website: tricityhealth.org



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