Behavioral Health Care Delivery Through Street Medicine Programs in California

Su, Kuan‐Pin; Feldman, Brett; Feldman, Corinne; Saluja, Sonali; Kogan, Alexis Coulourides; Cousineau, Michael R.

doi:10.1007/s10597-023-01169-z

Cited by 7 publications

(9 citation statements)

References 35 publications

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“…People experiencing homelessness are more likely than people who are housed to have mental illness, childhood trauma, decreased access to health care services, and substance use disorders, all of which are associated with suicide and substance use disorder risk. [43][44][45][46] In line with other studies, [47][48][49] ED visits for patients with housing insecurity or homelessness were more likely to include a chief concern and primary diagnosis related to suicide, intoxication, or trauma. Discharge was more likely to be to psychiatric care for those who screened positive than for those who screened negative.…”

Section: Chief Concerns and Diagnosessupporting

confidence: 75%

“…Overall, these findings point to a need for more comprehensive psychiatric care, including suicide prevention and support for treating substance use disorders for patients experiencing homelessness as well as additional community support and bolstered coordination between EDs and mental health care facilities. Finally, continued efforts should be made to maintain resources overnight and bring mental health care directly to the street …”

Section: Discussionsupporting

confidence: 54%

“…Finally, there was concordance between presenting chief concern and primary diagnosis, suggesting that homeless individuals are not at increased odds of malingering or fabricating symptoms to get food or shelter, as has been suggested by some prior studies. 46 , 50 The proportion of visits with positive screening results at night suggests the continued need for support and homeless preparedness in EDs overnight.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, continued efforts should be made to maintain resources overnight and bring mental health care directly to the street. 46 …”

Section: Discussionmentioning

confidence: 99%

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Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

Ball,

Sack,

Druffner

et al. 2024

JAMA Netw Open

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ImportanceUnstable housing and homelessness can exacerbate adverse health outcomes leading to increased risk of chronic disease, injury, and disability. However, emergency departments (EDs) have no universal method to identify those at risk of or currently experiencing homelessness.ObjectiveTo describe the extent of housing insecurity among patients who seek care in an urban ED, including chief concerns, demographics, and patterns of health care utilization.Design, Setting, and ParticipantsThis cross-sectional study included all adult patients presenting to the ED at Vanderbilt University Medical Center (VUMC), an urban tertiary care, level I trauma center in the Southeast US, from January 5 to May 16, 2023.Main Outcomes and MeasuresThe primary outcome was the proportion of ED visits at which patients screened positive for housing insecurity. Secondary outcomes included prevalence of insecurity by chief concerns, demographics, and patterns of health care utilization.ResultsOf all 23 795 VUMC ED visits with screenings for housing insecurity (12 465 visits among women [52%]; median age, 47 years [IQR, 32-48 years]), in 1185 (5%), patients screened positive for current homelessness or housing insecurity (660 unique patients); at 22 610 visits (95%), the screening result was negative. Of visits with positive results, the median age of patients was 46 years (IQR, 36-55 years) and 829 (70%) were among male patients. Suicide and intoxication were more common chief concerns among visits at which patients screened positive (132 [11%] and 118 [10%], respectively) than among those at which patients screened negative (220 [1%] and 335 [2%], respectively). Visits with positive results were more likely to be among patients who were uninsured (395 [33%] vs 2272 [10%]) and had multiple visits during the study period. A higher proportion of positive screening results occurred between 8 pm and 6 am. The social work team assessed patients at 919 visits (78%) with positive screening results.Conclusions and RelevanceIn this cross-sectional study of 23 795 ED visits, at 5% of visits, patients screened positive for housing insecurity and were more likely to present with a chief concern of suicide, to be uninsured, and to have multiple visits during the study period. This analysis provides a call for other institutions to introduce screening and create tailored care plans for patients experiencing housing insecurity to achieve equitable health care.

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Section: Chief Concerns and Diagnosessupporting

confidence: 75%

Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

“…Finally, continued efforts should be made to maintain resources overnight and bring mental health care directly to the street. 46 …”

Section: Discussionmentioning

confidence: 99%

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Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

Ball,

Sack,

Druffner

et al. 2024

JAMA Netw Open

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“…Many mobile programs deliver behavioral health services for PEH. In California, 25 street medicine programs provided behavioral health services, serving 9682 unique patients in 2021 alone [ 30 ]. An individual mobile clinic in Massachusetts (UMass Memorial Medical Center) has cared for 1121 individuals, with over 4567 encounters [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review

Kaufman,

Mallick,

Louis

et al. 2024

IJERPH

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Introduction: An estimated 5800 to 46,500 lives are lost due to homelessness each year. Experiencing homelessness and poor health are cyclically related, with one reinforcing the other. Mobile programs, which include vehicles that travel to deliver care, and street medicine, the act of bringing care to spaces where PEH live, may play a role in alleviating this burden by providing trusted, affordable, and accessible care to this community. Methods: We conducted a scoping review of peer-reviewed literature on the role of mobile clinics and street medicine in providing care for PEH by searching PubMed, Embase, and Web of Science on 10 August 2023. Articles from 2013 to 2023 specific to programs in the United States were included. The protocol was developed following the PRISMA-ScR guidelines. The primary outcome was the role of mobile programs for persons experiencing homelessness. Results: A total of 15 articles were included in this review. The descriptive findings emphasized that street medicine and mobile clinics provide primary care, behavioral health, and social services. The utilization findings indicate that street medicine programs positively impact the health system through their ability to defer emergency department and hospital visits, providing financial benefits. The comparative findings between mobile programs and office-based programs indicate current successes and areas for improvement. Discussion: Mobile clinics and street medicine programs that serve PEH provide a wide range of services. While more significant structural change is needed to address healthcare costs and housing policies in the United States, mobile clinics and street medicine teams can improve healthcare access and the healthcare system.

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Prehospital Care for Persons Experiencing Homelessness: A Cross-Sectional Survey of the Challenges, Experiences, and Perspectives of Operational EMS Agency Medical Directors

Abramson,

Burner,

Arora

et al. 2024

Prehospital Emergency Care

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Behavioral Health Care Delivery Through Street Medicine Programs in California

Cited by 7 publications

References 35 publications

Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review

Prehospital Care for Persons Experiencing Homelessness: A Cross-Sectional Survey of the Challenges, Experiences, and Perspectives of Operational EMS Agency Medical Directors

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