Mobile health clinics bring care to California's unhoused

Street medicine is key for building trust

For many patients, getting to improved health outcomes means meeting them where they're at. After all, patient trust is elusive among traditionally underserved populations, particularly folks who have been let down before and who have serious mental and physical health diagnoses.

That's where street medicine comes in.

HIA employs a multidisciplinary team who focuses on holistic, patient-centered care, Kaska said. As a PA, he particularly focuses on clinical services, which are an important aspect of being ready for stable housing.

Better clinical outcomes start by having the right tools on board, Kaska added. HIA's van is outfitted with a range of mobile medical devices, turning it essentially into a primary care office on wheels. Having those point-of-care capabilities, plus telehealth-enabled e-consults, lets Kaska and his team spearhead patient care, keep patients in a setting where they're comfortable and familiar and deliver trauma-informed care.

"We don't try to get our patients into brick-and-mortar care until it's the right moment," he noted.

The fact of the matter is that not every patient is going to thrive in a traditional, brick-and-mortar medical setting, even if it's a safety net clinic, Kaska said. They have not gotten enough of their needs -- mental health, physical health needs or social determinants of health -- met to be able to thrive in that setting. Kaska said his team does not want that to cause a bad or traumatic experience.

Instead, fulfilling as many medical needs as possible in the patient's preferred environment and moving that patient to a more stable health status is paramount. It's at that point that the patient becomes ready to engage more deeply with the traditional healthcare setting.

But even then, it's incumbent upon HIA clinicians to set up a smooth transition. Kaska creates dossiers on each patient he transitions to brick-and-mortar care to outline the patient's personal and health history.

"That way, the patient has a positive experience and doesn't need to get retraumatized," Kaska said.

Tapping the right team member for the right role

Street medicine is not a job clinicians can do alone, Kaska insists.

In fact, PAs and physicians are not the service leads for this population. It's the peer navigators.

"They are usually a non-licensed person who is our patient's best friend, confidant, liaison, support system -- everything," Kaska explained. "We traditionally hire people with lived experience."

That lived experience is the bedrock of the trust HIA builds with its patients and, in many cases, is the reason why a patient agrees to work with the organization in the first place. Unhoused patients are more likely to trust someone who's lived through something similar.

In that way, HIA's model turns the paternalistic medicine paradigm on its head. Kaska and his clinician peers really need to lean on peer navigators to keep clinical operations going for patients, he stated.

"I like our program because it's the exact opposite," of paternalistic medicine, Kaska said. "We have an army of peer navigators, and they're the ones who are going out and providing the social services to the patients. They're the ones who take them to the DMV to get their license. They take them to the courthouse to get their warrants expunged or their bench warrants reduced. They're the search party, the welcoming committee and the party planners."

At HIA, it is actually the role of the clinicians to fill the needs of the peer navigators, Kaska continued. If a peer navigator notes that a person has a medical need, they will bring them to Kaska -- not the other way around.

Again, this is all about making sure HIA is using the right tools and the right people to solve the problem at hand. Kaska and the rest of the clinical team is absolutely equipped to handle medical needs. But when it comes to social services, HIA turns to the expertise of the peer navigators. It's that philosophy that makes the whole operation work.

"We as clinicians are there to treat the underlying causes of the health conditions that drive their homelessness, but we're not in control," Kaska said. "It's the peer navigators and the patients that plan their path and we're there to support."

In the next part of this two-part series, we will cover the health technologies and medical devices that support HIA's mission.

Sara Heath has reported news related to patient engagement and health equity since 2015.