Building for Homeless Health – LA Clinics Paving the Way for Innovative Solutions

Posted: July 16, 2018

CCALAC’s Member Clinics are leading efforts to address homelessness. Two clinics lend their perspective on how they are building sustainable solutions.
The Children’s Clinic – Providing Upstream, Actionable Answers to Address the Homeless Crisis

Contributed by Elisa Nicholas, MD, MSPH, Chief Executive Officer, The Children’s Clinic

The city of Long Beach is home to over 1,843 homeless individuals according to the 2017 Homeless Count. Additionally, 55% of the population in Long Beach is rent burdened. The Children’s Clinic, Serving Children & Their Families (TCC) served 1,336 homeless patients in 6,000 visits in 2017 through specialized sites for the homeless, a mobile clinic serving the homeless, and our ten other sites. These efforts are in collaboration with the City of Long each Department of Health and Human Services, Mental Health America, Century Villages of Cabrillo, and partner FQHC North East Valley Health Corporation, and many others.

TCC serves as a Patient Centered Medical Home for all ages focusing on moving further upstream with prevention and early intervention services to prevent health and psychosocial issues from becoming chronic health conditions that place individuals at risk for homelessness. TCC works to address issues and connect individuals and families experiencing risk of homelessness or homelessness to services and community resources to help them stabilize their lives.

We know many of the families we serve are at risk of homelessness and/or live in crowded and often unhealthy conditions. This is increasing on a daily basis as rents in Long Beach continue to rise. In our Selective Home Visiting program for at risk newborns, 13% of families referred with a newborn were homeless. In addition the most challenging issues our behavioral health and Medical Legal Partnership staff encounter are families facing homelessness, many of whom are pregnant, female victims of domestic violence, single mothers with young children, or mothers with multiple children with chronic illnesses/severe disabilities.

We know that for optimal child health and wellbeing, housing security is essential. For those children without stable housing, who frequently move, or who are homeless, this leads not only to psychosocial, developmental, and educational issues, but also to poor health outcomes in childhood and even into adulthood.

TCC is working with our many partners to address the continuum of care (COC) through our street outreach work with Mental Health America, our mobile family health center working with Long Beach Rescue Mission and Christian Outreach in Action, our clinic at the Long Beach Multi-Service Center for the Homeless and our clinic site at Century Villages of Cabrillo partners health care with permanent housing for the homeless.

In the building phase is a new clinic in Long Beach co-located with Mental Health America for severely mentally ill homeless and formerly homeless patients. Finally, we are in the planning phase of a clinic and wellness center in central Long Beach with affordable housing in partnership with BRIDGE Housing.

With increased rates and risk of acute and chronic health problems, prevalence and severity of asthma and skin conditions, abuse , exposure to violence and accidents, and emotional distress and developmental delay, corresponding with decreased academic achievement, this is a population that deserves to be served. We know we have a crisis and are fortunate to be a in a community that has recognized the issue and is working together to address it. We continue to educate and advocate for the needs of children, families, and the chronically homeless in our community.

Venice Family Clinic – Leader and Mentor in On-the-Ground Approaches to Homeless Health

Contributed by Coley King, DO, Director of Homeless Services, Venice Family Clinic

There is an acknowledged homeless problem in Los Angeles. Thousands live on the street and in unpermitted spaces, both in the city and in Los Angeles County. And thanks to the Homeless Initiative (a countywide movement to combat and prevent homelessness), we now have the funding to do something about it.

We know those on the street have a much higher burden of illness than the general population. Among them, the most at-risk are what we call “tri-morbid,” meaning they have co-occurring mental health issues, substance dependency and a major medical illness. There is a high medical need within this population.

Part of the Homeless Initiative is to provide outreach services to these patients across LA County. But the county’s efforts have to extend beyond simply sending social workers into the field. The teams going out must have a focus on street medicine.

Focus on the medicine

Through the efforts of the Community Clinic Association of Los Angeles County (CCALAC) and Venice Family Clinic, we’ve created multi-disciplinary teams by partnering a social service agency with a community health center. An agency provides social workers and case managers while we supply the provider—either a physician, a nurse practitioner, or a physician’s assistant—to deliver treatment in the field.

When we have these teams in place, we’ve seen a lot of success. Currently, we have medical providers on teams on the Westside and a few in Mid-City, too. In those areas, we are curing patients who have Hepatitis C. We’re making inroads in substance dependency through Medically-Assisted Treatment. But more importantly, our primary providers are extending beyond their previous comfort zones and doing much more mental health care if a psychiatrist isn’t available.

Bring psychiatry into the field

Another challenge is bringing a psychiatrist onto a multi-disciplinary team, either from a community health center or from the Los Angeles County Department of Mental Health. Psychiatrists are vital and are in shorter supply than the primary care providers.

We have two psychiatrists out there in the field. But when they’re not available, it’s up to the provider to deliver mental health care. If I’m out there as the street medicine provider and my patient is schizophrenic, then I’m the psychiatrist. No one will address their schizophrenia unless I do.

We give them an injectable treatment that’s long-acting, but only because we see a gap in care and are courageous enough to do something. The good news is we’ve had great success with long-acting, injectable psychiatric meds in the field.

The county is working on making psychiatrists available, but more needs to be done.

Housing is key

Of course, the primary goal for the patient is housing. Housing is the primary intervention.

When people become housed, we see an immediate boost in their health. But, along the way, we need to address their medical needs, improve their mental health status, have them on good psychiatric medications if necessary, and show some improvement in their addiction, if not full sobriety.

If we can do all that, then they’re going to be much more successful in housing. They’re going to be much happier. And then it becomes true, supportive housing.

I have one patient that we met in Malibu, where he’d been living up in a camp in the bushes for years. We housed him in senior housing in Claremont that has case management and supportive services. He takes a combination of buses and trains to get to our clinic. Yes, people will take three buses to come visit you if they consider you their medical home. And Venice Family Clinic is home for many.

We’re here to help

Over the last few years, outreach services have exploded, and all the agencies are hiring, trying to build teams. Here at Venice Family Clinic, we’re trying to mobilize community clinics to put providers in the field.

We’re here to help mentor these clinics in this process. We are a leader in homeless outreach and street medicine. In the past, we have mentored several agencies, including Northeast Valley Community Clinic, Saban Community Clinic, and Los Angeles Christian Health Centers. We openly invite providers to shadow us if they’re interested in learning about street medicine.

So, to all our fellow community health centers, join us. Spend two half-days riding along with us. See our best practices, how we partner with social service agencies.

The average age of morbidity from chronic homelessness is 48. The patients need us out there. The community expects us to be out there. It’s simply good medicine.

 

To learn more about how LA Clinics are serving this vulnerable population, check out CCALAC’s Network Adequacy Report prepared in partnership with Health Management Associates (HMA) and with support from L.A. Care Health Plan to benefit low-income and uninsured residents of Los Angeles County.

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