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Health Providers Take to the Streets to Help the Homeless

Street Pulse Interviews Coordinator of Madison Street Medicine Initiative (MSMI)
by Henry Solotaroff-Webber, Street Pulse Writer, Features Editor of Badger Herald

Roaming the streets of Madison, healthcare volunteers of the Madison Street Medicine Initiative (MSMI) seek to bring medical care and expertise to people experiencing homelessness.

Funded by a two-year UW Baldwin Idea Grant, the service is a collaboration between the UW School of Medicine and Public Health’s Department of Medicine and Madison Area Care for the Homeless (MACH) OneHealth (the group that initiated monthly Foot Care Clinic services at First United Methodist Church). The service has been developing since last summer and just began sending out teams of volunteers on March 22.

After the team’s first outing, Street Pulse was able to exchange emails with Bootsy Harden, the project’s coordinator, about how the first outing went, the challenges the team experienced, and Harden’s hopes for the future of the initiative.

The following interview has been edited for style and clarity.

Street Pulse: What is MSMI’s overall purpose and mission? How has it changed since Dr. Ann Catlett, a physician at UW Hospital and leader of the effort, was interviewed by Channel 3000 last year? (Read the interview with Catlett at https://bit.ly/2K2HAL6)

Bootsy Harden: MACH OneHealth's mission is to provide and coordinate compassionate, holistic healthcare for housing-insecure individuals in the Madison Area. That hasn't changed. The goal of the MACH OneHealth Street Health Teams is to meet people experiencing homelessness where they're at and offer free direct medical services and care coordination. The direct medical services is our starting point. Our scope of care is limited (for example, we can offer care for some wounds, some skin conditions, and some simple infections).

For health conditions beyond our scope, we work to help people get the care they need. We are interested in linking people to physical and mental healthcare resources in the community. Eventually, we aim to even offer to accompany people to doctor's appointments (if they'd like us to) to serve as an ally and advocate on that journey. That accompaniment phase will start later, in our second year.

SP: How did the first round of caregiving go? Were there any success stories? Things that need to be immediately improved upon?

BH: During our first care-giving rounds, we had some enlightening exchanges with people we met. We had a few people share their health concerns with us after we introduced ourselves. On that first night, we ended up not providing any treatments, but we did make some referrals to local clinics. Whether those referrals could be considered successful or not remains to be seen. I hope we can reconnect with those individuals to learn whether or not they were able to get their needs met. If we discover that people had obstacles to acting on a referral that we made, we'll want to troubleshoot and see what we can do to smooth the path.

Bottom line, sometimes we'll encounter people who have health needs that we're equipped to take care of on the street. Other times, we may best serve people by linking them to services with other health or social service agencies. More than one person told us that what they really need is housing. We believe that "housing is healthcare" and for this reason, a MACH Street Health Team representative regularly attends meetings of the Homeless Services Consortium's outreach group at The Beacon. We see this contact with HSC as a way for us to link patients we meet to a case manager who can assess their situations and get them on the list for housing if that's what people want.

SP: How do volunteer caregivers balance providing care and establishing trust with getting people to clinics or hospitals if need be. It almost seems as if volunteers are both caregivers and ambassadors to the medical community at large.

BH: I agree that our volunteers are both caregivers and ambassadors. We recognize that some health conditions can't be properly managed on the street. We hope that by meeting people where they're at, with unconditional positive regard, we can get to know people on a personal level and learn what their goals are. Then we can brainstorm and troubleshoot about how we can work with them to help them achieve their goals. It would be great if all healthcare encounters could to that!

MACH OneHealth conducted a survey a while back, which revealed that mistrust of healthcare providers is one of the many barriers people face in getting their health needs met. And while some folks we encountered were open to talking with us after we identified team members as "doctors and nurses," one individual was definitely not interested in conversing with us after that disclosure. We aim to engage people we meet with respect and compassion, without judgment. By exercising these values, we can demonstrate that healthcare providers truly care for folks as fellow humans on this earth. Our hope is that as we move into the accompaniment phase of our work we could model those values to healthcare providers in clinic and hospital settings.

SP: How can people who are experiencing homelessness identify who the caregivers are and know when to be where to receive care or advice?

BH: Great question! Currently, we are going on rounds of the State Street corridor and Capitol Square once a week on Thursday evenings from 6-9pm. We travel on foot in a group of 4-5 people. A few of us will be wearing a green glowing light. We also wear t-shirts and name badges with the MACH OneHealth logo. When it warms up a little more, the logos won't be covered by our coats! If people find our services to be helpful, we hope to expand to do rounds at more frequent intervals, and also to have the flexibility to check on people living in remote campsites, under bridges, or in parked vehicles.

SP: What are some challenges that remain for MSMI and its volunteers as the operation continues to unfold and evolve?

BH: Another great question! Currently, we are primarily volunteer-driven. We do not have a full-time paid staff person, so we don't have the capacity to be as responsive to new and established patients as we'd like. It would be great if we had someone available 40+ hours a week to answer a MACH phone to take referrals. We're not there yet.

We'd like to be able to have a brick-and-mortar clinic site where we could follow up with patients after seeing them on rounds. It's difficult to offer someone a medical evaluation without having a private space for examination and confidential conversation. It would be awesome if we had a specially-outfitted medical van for this, especially in the colder months.

In addition to the dream of an awesome van, we have identified a growing number of items that would help us with our mission, but which we don't have in our budget (examples include: funds to help defray the cost of medications, funds to help patients with pharmacy co-payments, funds to cover the cost of bus passes or cab fare for patients to travel to/from clinic appointments, funds to cover the cost of malpractice insurance for our clinical volunteers). MACH OneHealth could really use help with fundraising, grant-writing, and development.

SP: What other organizations or initiatives is MSMI working with at this time?

BH: Glad you asked! MACH OneHealth's Street Health Teams are collaborating with a number of other organizations. Our model for outreach is to have an experienced homeless outreach guide accompany our teams. We already have outreach people from Operation Welcome Home and Friends of the State Street Family on our schedule. We are in discussion with Porchlight, Inc. about this as well. We are in regular communication with Karen Andro of Hope's Home at First United Methodist Church (she is on the MACH OneHealth Board of Directors).

We've tapped the expertise of people from a number of amazing organizations as we developed training for our clinical volunteers, including Operation Welcome Home, Friends of the State Street Family, Porchlight, Inc., Briarpatch Youth Services, and the William S. Middleton Memorial VA Medical Center's Homeless Program Office. The Salvation Army was kind enough to offer us meeting space earlier this year. The Beacon is an amazing resource that we hope to collaborate with as well. If someone experiencing housing insecurity has a pet that needs veterinary attention, we reach out to our sister organization, WisCARES (Wisconsin Companion Animal Resources, Education, and Social Services).

We are extremely fortunate to be partnered with UW Health and the UW School of Medicine and Public Health. In addition to facilitating the efforts of their licensed clinicians to volunteer on our teams, they have provided us with guidance on some complex legal and patient privacy issues involved with street medicine. We are especially excited that UW Health has assembled a team of health information specialists who will volunteer their time and expertise to create a mobile electronic health record system for us.

SP: Is MSMI still in search of volunteers? Is there any area of health that could be better covered?

BH: Thank you for the opportunity to put in a plug for volunteers! We have just recruited and trained our first round of volunteers and are now creating a list of interested licensed clinicians for our next wave of growth. We expect to expand our services beyond this small walking route and beyond one night per week. We also hope to develop a formal process for connecting people with other services, be they related to physical health, mental health, treatment for addiction, housing, or other services. Licensed clinical professionals (including physicians, nurses, nurse practitioners, physician assistants, pharmacists, social workers and mental health/AODA specialists) can contact me at charden@wisc.edu to indicate their interest. It's not clear when we'll have the capacity to expand our services, but we hope it will happen within a couple of months!