Coastal Street Medicine

Introduction

“Howdy.  How can we help you today?” Every Wednesday morning, in a comfortable room at the Mendocino Coast Hospitality Center (MCHC) in Fort Bragg, staff are waiting to greet the homeless patients who come to the Street Medicine clinic. The tools of the trade – stethoscope, blood pressure cuff, etc. and lots of supplies (including wound care materials, over-the-counter pain relief, socks and toothbrushes) – are ready. 

Bill, RN, works at the Mendocino Coast Clinics (MCC). He and Ana (the scribe), who also works at MCC, start their Wednesdays at the Street Medicine Clinic. Janette and Cathy, who work as case managers at MCHC, join them. The staff provide health checks, wound care, take vital signs, help with ailments such as colds, fevers, headaches, backaches, provide health education and make and facilitate referrals to mental health, dental care or medical care. Faith is the clinical coordinator (she is the FNP at the local rural health center) and she often sees patients and provides clinical and logistical support. I’m the coordinator, the person in the background coordinating all the pieces.

Street Medicine – A Unique Model

Many patients who are homeless have difficulty accessing and maintaining health care because of their lifestyle. Traditionally primary care requires patients to arrive at an appointed time and to present a chief complaint. For the homeless population this is often difficult. Folks are often on foot or using public transportation; their lives may be disconnected and disorganized and are frequently affected by daily inconveniences; they carry their belongings with them or have them all in a bag or case; they may have a companion dog who cannot enter the medical clinic; and their list of medical and mental issues can be substantial.

To address these issues, our project combines three components - walk-in clinics, case management and inter-agency collaboration.

Lucresha Renteria, Executive Director of MCC, and the medical staff started two walk-in sessions a week. These four-hour sessions are run by one of MCC’s experienced physicians who has taken on primary care for these complex, high need patients. This unique model of primary care fits the needs of the homeless population well and addresses the issues raised above. The MCC staff who work at the street medicine clinics also work at the walk-in clinics to provide continuity and trust-building.

Carla Harris, the Executive Director of MCHC has supported incorporating the MCHC case managers or wellness coaches into Street Medicine; they provide a supportive wrap-around service to its patients by assisting them with appointments (including mental health) and interpreting the information provided. They also address health insurance issues and help patients apply for economic and support programs for which they are eligible. 

The project is a unique collaboration between MCHC, MCC and Adventist Health. The three organizations provide services, space, supplies and financial support (Adventist Health). Each patient signs a consent form that allows the staff to treat them and to collect basic information in a cloud-based, HIPAA-compliant computer application called Vertical Change. Communication among the organizations, with appropriate patient confidentiality, contributes to coordinated care for the patient.

“For me Street Medicine has been an opportunity to get to know the individuals who are unsheltered in our community. Everyone has their own story and way of dealing with what has happened in their lives. Our clients are no different from ourselves. Bad luck, circumstances outside of our control, medical issues, job losses, adverse childhood experiences, maybe some bad choices - all influence our present circumstances. Connecting our clients with primary care is a first step in helping people get back on their feet.”  Faith Simon, FNP

How Are We Doing So Far?

We started the project in May 2018 at MCHC and in October 2018 we added on a monthly clinic at the Mendocino Presbyterian Church. The church offers a weekly program on Tuesday afternoons that includes showers, a clothes pantry and a full mid-day meal served in their dining room. Street Medicine is there on the last Tuesday of each month. Again, the collaboration and working together is efficient and helps patients.

Since we started, we have enrolled 102 patients and have had over 310 patient visits.  We estimate that we are seeing about 56% of the homeless population on the coast.  

According to the 2017 Point In Time counts, Mendocino County had the highest per-capita homelessness rate in our country, and it is of the utmost importance that we face this head-on.

Any urgent or seriously acute issues are referred to the MCDH emergency department (ED).  We call ahead to provide advanced notice. At present, we are working directly with the staff and providers of the ED to identify patients who may not have primary care or who are using the ED for their primary health care. The goal is to engage patients in primary care that meets their needs so that ED visits become less frequent. At present, many homeless individuals (between 25-30 a month) visit the ED for medical issues that could be addressed in a primary care setting.

The Future

The plans for the future include hiring a Street Medicine case manager; locating a vehicle that would allow the team to go out to encampments or other locations where homeless individuals stay; recruiting additional medical providers who can provide “backpack” medicine; adding one additional location in Fort Bragg to provide this service; and working with other community members to address the shelter and housing issues in our community.

For additional information, please contact coastalstreetmedicine@gmail.com

“Street medicine is serving the underserved. We are a community that cares for each other including the homeless and less fortunate.”  Shelley Ware, RN, MCDH

Street Medicine also operates in Ukiah and was the first program of its kind in Mendocino County. It is supported by Adventist Health Ukiah Valley. At this time, it is looking for a new location. A COMPASS clinic, an outpatient/outreach program, operates out of Plowshares every Thursday during the 11:30 lunch time and at the Center for Hope on Luce Ave. every Tuesday at 8:00 am. They will also be at the new Day Center run by Redwood Community Services on S. State once it opens. They offer health screenings and case management services.

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Linda Jo Stern, MPH is an experienced and seasoned manager with a lifetime of experience in domestic and international public health. She presently works as the part-time coordinator of the Coastal Street Medicine in Fort Bragg, CA, working with the dedicated staff from the Mendocino Coast Hospitality Center, the Mendocino Coast Clinics and the Fort Bragg Rural Health Center. Just recently she completed her assignment as the interim Executive Director of Safe Passage Family Resource Center in Fort Bragg and for the previous thirty-seven years managed primary care clinics and international and domestic community health programs. She also serves as a chaplain at the local hospital and for law enforcement.