California has more than 160,000 people that are identified as homeless across 58 counties, and nationally has the highest rate of homelessness.
Some people lack trust in the health system, while others are fighting barriers that keep them from accessing treatment. Coordinated entry systems are deployed regionally to assist homeless people to secure transitional and permanent housing, and to establish linkages to other sources of assistance.
The State of California was approved through federal waivers to implement solutions across every county, and a variety of funding sources exist in the Medi-Cal managed care program.
Street medicine teams are an essential part of the public health system. Clinical and navigation teams are deployed to deliver wound care, assist with medication management, perform mental and physical health assessments, and transitional primary care or treatment of chronic conditions. Periodic testing and treatment for STIs, HIV, Hepatitis C, and COVID are performed in parks, encampments, safe RV parking sites, and under freeway overpasses. Overdose follow-up appointments, addiction treatments (low threshold buprenorphine) and referrals to substance use treatment facilities are common. Drug and alcohol counseling, substance use treatments, and low acuity mental health disorders are rendered to the patient. In certain areas, psychiatric care for people experience severe mental illness The Street Health teams arrange transportation to specialist appointments, coordinate food deliveries, and provide a wide array of services that address the social determinants of health. Many of these services are not reimbursed through the Medi-Cal system, however a statewide coalition has formed to change the way Street Medicine teams can increase revenues through grants and bundled payments.
Is your program funded adequately to serve the number of unhoused people in your community?
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Brett J. Feldman, MSPAS, PA-C, is the Director and co-Founder of Street Medicine at the USC Keck School of Medicine.
