San Francisco Community Clinic Consortium's Quarterly Newsletter
From the CEO
I started my career as a probation officer working with juvenile and adult offenders. I planned to help each person I worked with to change their behavior and become model citizens. Many times I heard, “If only…” If only I had not been drinking, taking drugs, neglected my child, if only I had worked harder. My next job was as a mental health social worker in an alternative school for teens. Once again, I heard, “if only…” Wanting to make a difference, I became Executive Director of a health center, with the aims of changing people’s lives and changing the health care delivery system. Meeting with other health care leaders, once again I heard “if only”… we had more money, acted faster, knew more about the future. Today, nearly three decades later, (I celebrated 25 years at SFCCC on October 15) I still hear “if only…” from our patients, our Member Health Centers, and our community leaders. In all my years of service, I never knew a person who started out to be a drug user or alcoholic. I never met anyone who planned to be homeless someday.
SOS, Vet SOS, and our Member Health Centers and other partners offer a wide array of services to break the cycle of homelessness. Please read on and see how SFCCC is making a difference to prevent having to say “if only…”
SFCCC Health Care for the Homeless Program
Determining the number of homeless in San Francisco is a challenge. The point-in-time count of the number of homeless individuals in January, 2015, including a supplemental youth count, was 7,539, a 2% increase from the 2013 count and a 7% increase over the last 10 years. Since this is only a one-night count, this is a severe undercount of those who are eligible for Health Care for the Homeless services, which includes those who are precariously housed. The SF Ten Year Plan to Abolish Chronic Homelessness estimated the number of homeless to be 15,000. San Francisco is estimated to have the highest proportion of unsheltered homeless in the nation, with 511 people on the streets for every 100,000 residents. The 2015 point-in-time count identified the extent of various health conditions for people experiencing chronic homelessness in San Francisco:
Since 1988, SFCCC has led the SF Health Care for the Homeless Program, with the goal of addressing the health-related needs of homeless people and linking them to ongoing care and services. The SFHCH Program, funded in part by the U.S. Health Resources and Services Administration Bureau of Primary Health Care, is a collaborative network providing services at 48 sites in San Francisco and includes Street Outreach Services (SOS), our mobile outreach van. In addition to SOS (described further in this newsletter), our primary partner clinics include:
- HealthRIGHT 360, with sites at the former Haight Ashbury Free Clinic, Integrated Care Center, Lyon-Martin Health Services, and Tenderloin Health Services (formerly Glide Health Services and now a program/site of HR360)
- Mission Neighborhood Health Center, including the Mission Neighborhood Resource Center focused solely on serving homeless people
- North East Medical Services
- St. Anthony’s Medical Clinic
- SFDPH’s Tom Waddell Urban Health Center, Castro Mission Health Center, and Curry Senior Center
- South of Market Health Center.
Meet “Street Outreach Services (SOS)”
“The thing that lies at the foundation of positive change is service to a fellow human being.” -Lech Walesa
SOS is the mobile outreach component of SFCCC’s Health Care for the Homeless (HCH) program. Since 1988, SOS has provided high-quality, nonjudgmental health services directly to homeless individuals. Through our Vet SOS project, we also offer free veterinary care to the companion animals of homeless San Franciscans as a demonstrated highly effective method for linking their human guardians with health care services.
Traveling in two specially equipped vans to sites throughout San Francisco, the dedicated SOS team creates “clinics without walls” at soup kitchens, on city streets, under freeway overpasses, and in parks. By going directly to homeless people, the SOS team builds relationships of trust and breaks down the barriers that keep homeless people and their companion animals from the care they need and deserve.
Each year over 1,000 homeless San Franciscans receive direct services, with most also getting connected to primary care and other ongoing assistance such as mental health and substance abuse services, MediCal enrollment, shelter referrals, and other support services.
Each year over 800 homeless individuals’ companion animals receive care, while their guardians get comfort from knowing the being most important to them is taken care of, and often then become motivated to take care of their own health needs.
As the San Francisco Area Health Education Center (AHEC), each year over 50 medical residents, medical students, and nursing students receive hands-on training from our skilled multidisciplinary team, helping to develop and inspire future clinicians to practice community-based health care. In addition, their and our volunteer providers’ in-kind services make SOS an extremely cost-effective program.
For more information about SOS and Vet SOS, visit our website: http://www.sfccc.org/street-outreach-services and http://www.sfccc.org/veterinary-street-outreach-services-vetsos
It Takes A (Pop-Up Care) Village
Our SOS program is a key partner in San Francisco’s new “Pop-Up Care Village”. Launched in the spring of this year by Lava Mae, organizers aimed for the Village to “bring access to more services and collective impact to more people on the streets where they're at.” And that’s exactly what we are doing! Turns out the pop-up model is so successful that we’ve added it to our regular repertoire of outreach services. SOS provides medical visits, hygiene kits, and over-the-counter medications to Village guests on a monthly basis while other service providers offer haircuts, showers, clothing, and more. Come see us on the last Tuesday of each month in front of the main branch of San Francisco Public Library!
A Day with the SOS Team
9:00 am: Outreach team members meet to discuss the clients they haven’t seen in a while. A few are doing well and have moved off the street, into shelters, treatment programs or with friends. Many are still struggling with homelessness, addiction, mental illness, and/or isolation. There’s lots of work to be done!
9:30 am: SOS is open for business! Loaded with staff and supplies, the SOS van hits the streets, targeting neighborhoods with high concentrations of homeless people and low concentrations of service providers. Two outreach workers leave the van to canvas nearby parks and freeway overpasses, while two team members, including a medical provider, wait in the van for clients who need help.
9:45 am: The first of several clients boards the van. She’s been sleeping outdoors for 20 years and has a long history of trauma, leading to poly-substance abuse and serial violent relationships. She has poorly managed asthma and is not connected to primary care, instead using the public emergency room when crises arise. The outreach staff provides her with non-judgmental and compassionate care and, then with her consent, connects her to a primary care clinic and drug treatment services. All SOS services are free of charge, and we ensure that the other places where we connect our clients are free for homeless individuals also.
10:00 am: The client agrees to see the SOS doctor, so she’s escorted into the van’s private exam room, which is a regular doctor’s office with an exam table, medical equipment, and a small dispensary. A USF nursing student takes the client’s vitals. The doctor examines the client, reviews her medical history, and provides her with an albuterol inhaler to use while waiting for a primary care appointment in a few days. The client smiles!
10:15-11:45 am: Staff sees 3 more clients for medical visits. Each client is connected to resources, and a medical visit, and each leaves with a bag of health and hygiene supplies which may include toothbrushes, tampons, sunscreen, drinking water, protein bars, and vitamins. Clients tell us that these “little” things make a huge difference in their lives. Each client will later receive appointment reminder calls or texts from SOS, and will be offered transportation assistance so that they can actually make it to their appointments.
12:00 pm: Staff enters their interactions into SOS’ new electronic health record (EHR) system to support continuity of care across all SOS locations and providers. (SOS was selected by our EHR vendor to receive free use of their cloud-based system, including training and on-going support! Yes, free—yet another example of our program’s cost-effectiveness!).
12:30 pm: Staff grabs a quick lunch on the road. Burritos, anyone?
1:00 pm: A UCSF medical resident meets the SOS van for the afternoon shift. As a program of the SF AHEC, SOS works closely with several academic institutions to train the future health care workforce. Yay for teamwork!
“Working with SOS has taught me so many invaluable things – not only have I developed hands-on experience and vital skills for my future career as a physician, but I’ve also learned the importance of serving the community and treating all individuals with respect and dignity." -SOS resident
1:30 pm: The van moves to a grassy hill where several homeless people are enjoying a bit of respite in the sun. Some are playing instruments or eating sandwiches, while others play with their dogs or sleep. SOS team members take the opportunity to distribute fliers about our monthly pop-up Vet SOS clinics, where homeless guardians’ pets can receive free veterinary wellness exams, vaccines and pet supplies. Oh yeah, and we always sneak in some human health referrals, too!
1:45 pm: The team greets a previous client, Al, and his puppy, Trinity. Al says if it weren’t for SOS and our Vet SOS project, he doesn’t know where he would get care for himself or Trinity. The outreach team high fives each other and smiles big (seriously).
2:00 pm: A new client boards the van. He says that he lived in a house in San Francisco for many years but when his mental illness became more severe, he began spending most nights camping alone in local parks. Staff assists the client to complete registration paperwork and talk to him about his most pressing needs. The client says that he hasn’t seen his psychiatrist in 3 months and is out of medication. The staff notice a troubling head wound and the client reports he was assaulted while sleeping last night. An outreach staff member phones the client’s clinic to schedule a same-day appointment with his psychiatrist and coordinates transport. The SOS doctor treats the patient’s head wound and dispenses antibiotics.
2:30-4:00 pm: Staff sees 3 more clients for medical visits. Each receives customized referrals; one client needs a shower, another a family shelter for her and her son, and another a pair of reading glasses.
4:15 pm: The outreach team completes their charting, then heads back to home base, where the van is filled with gas, parked, cleaned, and re-stocked for tomorrow. Fliers are replenished, new cases of water and snacks are transported from the storage unit, vaccines are re-refrigerated, portable electronics are charged, and trash is emptied.
4:45 pm: Staff arrive back in the office, where they review upcoming plans for collaborations in San Francisco’s monthly Pop-Up Care Villages and quarterly Project Homeless Connect events. SOS is all about collaborating to best meet the needs of homeless San Franciscans!
5:00 pm: Time to go home and rest for another day on the streets. Great work, SOS.
Meet SOS Patient Advocate, John Sorensen
John has been receiving services from SOS since 2002. He says, “The SOS program takes care of people without judgment or bias about what people are dealing with in their life. Those interactions really make a difference.”
Since John moved off the street and into a residential substance abuse treatment facility, he now serves as a patient representative to SFCCC’s Consumer Advisory Panel (CAP). The CAP is comprised of patients who represent the clinics where SFCCC’s Health Care for the Homeless (and Ryan White Part C HIV/AIDS) services are provided. The purpose of the CAP is to offer suggestions for the improvement of SFCCC’s members’ clinical services, by people directly impacted.
Of his service with CAP, John declares,
“I want to give homeless people a voice. I want to stand up for services that have been critical to me. To help the next person that really needs it. SOS services gave me empathy and compassion when I was down on my luck.”
Way to go and thank you for your commitment, John!
Meet SOS MD, Linette Martinez
Dr. Martinez has been working as a physician in SFCCC’s SOS program for 17 years!
She has wanted to help other people ever since she was a child. Dr. Martinez values being able to take extra time to really engage with SOS patients in the field and appreciates working as part of a team to share the follow up responsibilities.
When asked about her most memorable patient care experience, she told us: “I once took care of a man who was struggling so much with alcoholism that we would often find him lying on the sidewalk and barely moving. One day he said that he had a lot of dental pain and when I examined him, I saw that he had a life threatening dental abscess. He declined transport to the emergency room, so I gave him antibiotics and SOS kept checking back with him. Eventually, we were able to admit him to the hospital. He later told me; “Your antibiotics saved my life” He later went into recovery.
Help us address the health-related needs of homeless individuals and their companion animals! Donate to Street Outreach Services and Veterinary Street Outreach Services today:
Every donation makes a difference!
$ 10.00: Provides fuel for our outreach van
$ 25.00: Pays for preventative vaccines
$ 50.00: Supplies vitamins and toiletries to a homeless person for a week, or ensures that a companion animal will receive a microchip
$ 75.00: Helps distribute clothing, raingear and blankets to homeless people, or underwrites flea and heartworm preventative for companion animals
$100.00: Provides antibiotics and other urgently needed medications
$250.00: Helps underwrite life-saving urgent care services for a homeless person, or life-saving emergency care for a companion animal
Learn more about SOS and Vet SOS and view our institutional supporters: