About This Series
This series focuses on the challenges of addressing the health and health care needs, both related and unrelated to the pandemic, of people who are homeless, and spotlights emerging care innovations, partnerships, and practices across the state. See the full Homelessness and COVID-19 series.
Within California, 70% of the approximately 150,000 people experiencing homelessness are living unsheltered, according to the Annual Homeless Assessment Report developed by the US Department of Housing and Urban Development. Street medicine is the practice of providing basic medical care to people experiencing homelessness and living on the street. What began in the early 1990s with the recognition that meeting unsheltered people where they are both reduces barriers to care and builds trust has proved to be essential in mitigating the impact of COVID-19 among this high-risk population. They have a higher mortality rate than those who are sheltered or housed, are more at risk for adverse outcomes due to COVID-19 based on their higher rates of chronic conditions, and experience environmental factors that put them at greater risk of infection, such as lack of access to hygiene resources. Street medicine providers are the front line of defense against these inequities by working to decrease the spread and negative impacts of COVID-19, such as worsening mental health, increases in substance use disorders, and delays in health care for the unsheltered population.
Background on Street Medicine
According to the Street Medicine Institute, street medicine is the provision of health care directly to those living and sleeping on the streets — the unsheltered or ‘rough sleeper’ homeless — through mobile services such as walking teams, medical vans, and outdoor clinics. Street medicine programs focus on health care for unsheltered people as opposed to those residing in shelters. These programs, which emerged in the 1990s in California, are quickly gaining popularity, with over 60 programs across the US and growing. Using tailored outreach and engagement strategies, street medicine programs can help link people to brick-and-mortar primary care sites and housing while providing essential services in the field to people who have not sought, and sometimes do not want to seek, care in traditional settings.
The Center for Health Care Strategies (CHCS) recently spoke with Lisa Abdishoo, MD, president and CEO, and Shannon Fernando, FNP-C chief innovation officer, at Los Angeles Christian Health Centers (LACHC), a Federally Qualified Health Center (FQHC) with multiple locations and street outreach teams, including one on LA’s Skid Row, a 54-block area of downtown LA associated with poverty and homelessness. CHCS also spoke with Danielle Williams, MD, a street medicine provider with the Street Team Outreach Medical Program (STOMP), at the Roots Community Health Center in Oakland, to learn more about how their existing street medicine programs are adapting to meet patients’ needs amid the pandemic.