Austin Health Care for the Homeless Project Background

Genesis

In 2004, The City of Austin Community Care Service Department (CCSD) successfully applied for a $650,000 per year federal grant to operate a Health Care for the Homeless Project. The application was prompted by data indicating that significant numbers of local homeless people were not accessing safety net primary health care resources and that many were utilizing local Emergency Room and inpatient resources when untreated chronic conditions or other illnesses resulted in an acute problem. Indigent Care Collaboration (ICC) ER utilization research also suggested that some homeless individuals and families use the ER as their regular primary care provider, often presenting at the ER for headaches, sinus infections, diarrhea, minor skin infections, etc. CCSD sought the federal grant to dramatically increase community health center resources dedicated to serving the homeless.

The U.S. Bureau of Primary Care awarded a Health Care for the Homeless (HCH) New Access Point grant to CCSD in the summer of 2004. The grant covers 100% of the operating costs of
• A 40-hour per week primary care clinic located within the Austin Resource Center for the Homeless (ARCH)
• An 8-hour per week primary care clinic at the SafePlace shelter for women and children who are victims of domestic violence
• An eight-hour per week primary care clinic at LifeWorks street outreach center for unaccompanied youth
• Twenty hours of homeless dental care provided on a CCSD dental van
• A four-hour per week vision care clinic staffed by volunteer optometrists.

These services complement CCSD's 40-hour per week primary care clinic at the downtown Salvation Army shelter, which is funded by the Travis County Hospital District.

Practice Model

The Austin HCH practice model is patterned on successful HCH Projects in other cities. Like these projects, ours acknowledges that homelessness in and of itself makes preventing, recovering from, and managing serious medical problems inherently challenging. It also acknowledges that unmanaged chronic medical conditions can create a barrier to overcoming homelessness. The project's practice model is thus designed not only to help patients establish a regular primary care home, but also to coordinate primary care with intensive case management to improve treatment compliance and facilitate access to non-medical resources patients can utilize to ultimately end their homelessness. To address the myriad psychological and social factors affecting the health of the homeless, the HCH clinical team employs a trans-disciplinary approach to care in which physicians, nurses, and case managers may each assess the patient's needs across a broad spectrum. Meeting these needs typically requires close coordination among clinical team members and often a referral to a co-located MHMR psychiatrist, substance abuse treatment program, housing resources, Legal Aid, and/or long-term case management programs associated with MHMR, Caritas, Front Steps, LifeWorks, and other homeless services agencies.

In addition, the HCH Project provides screening for communicable diseases such as TB, STIs, HIV, and Hepatitis as a routine part of patients' care. It also utilizes an outreach team to encourage homeless people throughout the city to utilize HCH services.

Current Status

The HCH Project is now fully implemented. From the October, 2004 start date to May 31, 2005, the grant-funded HCH sites provided 2,272 medical (physician) encounters to 840 unduplicated patients and 966 dental encounters to 538 unduplicated patients. An additional 1,984 homeless medical encounters were provided at the Salvation Army Clinic.

A significant portion of ARCH Clinic patients presents at the first clinic visit with complex and unmanaged chronic conditions, many of which are complicated by substance abuse and/or mental health issues. These complex patients have more often than not also been patients at Brackenridge Hospital, either in the ER or as inpatients. The HCH Project Director and medical providers have established open lines of communication with Brackenridge Hospital ER doctors, internal medicine program residents and faculty, and discharge staff. HCH medical providers regularly coordinate HCH patient care with Brackenridge providers and meet with them on a regular basis. Likewise, the HCH case management team has established close working relationships and referral protocols with Front Steps, the Salvation Army, Caritas, Trinity Center, MHMR-Access, and multiple other homeless services providers. The HCH Project Director is currently working with the City of Austin EMS Medical Director to identify ways that both agencies can reduce avoidable EMS calls for homeless people.

For more information on the Health Care for the Homeless Project, please contact John Gilvar, Project Director at 512-972-4006.