Building Bridges that Matter: How Two Students Are Tackling the Social Determinants of Health at HOMES Clinic
Written by Colton Andrews & Panayiotis (Panos) Kontoyiannis with original contributions & editorial assistance from Nick Peoples
Living on the streets is one of the hardest jobs in the world. How does one get off the streets and get a home?
Well, “get a job” is the typical response. But how do you compete for a job in today’s high inflation, layoff-heavy economy with rapidly rising housing cost when you’re sick, tired, and hungry? Or when you don’t have clean clothes or a shower?
“Stop doing drugs” is what usually comes next – despite that only 25-40% of people experiencing homelessness have a substance use problem (1) (meaning that 60-75% do not). It’s further worth considering that many developed those issues after becoming homeless, as a direct result of it.
“It’s a mental health issue.” Yes, it can be. Just read this gripping firsthand account of bipolar disorder and homelessness written by a former HOMES patient. And yet, only 25% of people with unstable housing have a mental disorder1 (translation: a whopping 75% do not). And again, it’s a chicken and the egg scenario: did the mental disorder cause the homelessness, or did the terrors and indignities of living on the streets cause the mental disorder?
Let’s ask a more practical question: how do you stop being sick when you don’t have healthcare? Or how do you keep your immune system strong when you don’t know where your next meal is coming from? How do you claw your way back from diabetes if you don’t have a refrigerator to store your insulin? As community health worker Joe Benson, formerly homeless himself, has pointed out: “Having healthcare and no transportation to get to that healthcare is the same thing as not having healthcare at all.”
So, there are a million pieces to the puzzle of getting off the streets. And they all more or less have to happen together, or else the ground gives out and you’re back to square one.
Now forget jobs for a moment. How do you even survive when you’re stuck outside and the earth is so hot the temperatures are lethal?
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The vision statement of HOMES Clinic, which was drafted and ratified by the executive board in July 2022, affirms our pursuit of
A world without homelessness, where all individuals have access to housing, social services, and high-quality, patient-centered healthcare.
And… we’re getting there. Nearly every Sunday for the past 23 years, HOMES Clinic, under the umbrella of Healthcare for the Homeless – Houston (HHH), has provided free, accessible, and quality healthcare for Houstonians who are experiencing homelessness. We see patients, host health fairs and vaccine drives, and publish peer-reviewed research on best practices. But is this enough to realize such a bold vision?
A recurring theme in our work, both as volunteers and as members of the executive board, has been seeing our patients encounter barrier after barrier outside the clinic. The Health Advocate program provided an innovative solution to help bridge these gaps and facilitate linkages to desperately needed social resources (2). And our parent organization, Healthcare for the Homeless-Houston, eventually even decided to adopt our Social Resource Guide for their own clinics and social workers across the city. However, we still felt like something was missing.
During the summer of 2022, Panos worked with several clients across multiple weekends and tracked their progress for getting healthcare and housing. He quickly realized that the referrals that HOMES sent out were not always well received. For instance, after meeting a patient who was new to the Houston area and had several urgent social concerns, Panos and the clinic team referred them to a high-quality clinic and a caseworker fluent in Spanish. The following week Panos incidentally ran into the same person at The Beacon and asked if he had been accommodated, only to hear a disappointing, “No.” This was not the first time a patient relayed frustrations of not being able to be seen at the organizations we had referred them to. This raised the essential question: “How many of the people we refer to various social resources are actually able to access them?”
These concerns were reinforced by another interaction with a client who was waiting for housing. We asked if he had heard any updates since we last saw him. Again, this client expressed his frustration of no updates. Panos began to think that better methods could be put in place to advocate for our clients and ensure that the recommendations we made were materializing into real progress.
It was about this time that we discovered our mutual interest in tackling these challenges. Separately, I had also recognized the limitations of the Health Advocate program. Information sharing was a critical first step, but how could we further expand our capabilities to be more directly involved with helping clients access social resources? Could we train volunteers to help clients fill out applications or communicate directly with other social resource organizations in the Greater Houston area to facilitate access to their resources for clients?
Through a fellow board member, we learned about the Patient Care Intervention Center (PCIC). PCIC is a software designed for multi-organizational collaboration to facilitate the delivery of available social resources in the Greater Houston Area. In other words, a “Street EMR.” With easy, up-to-date directories, rapid communication avenues, and capabilities to support the needs of social workers, PCIC helps Houstonian organizations better connect and serve the unhoused population. The social resource directory closely paralleled the Social Resource Guide our Health Advocates use, but with additional functionality that promised to mitigated many of the challenges we observed. Could HOMES Clinic be connected into PCIC to expand our student’s capabilities to learn about and better help our patients?
Well, it was worth a shot. But we needed funding. We had both heard about the Albert Schweitzer Fellowship (ASF) through multiple avenues. Coincidentally, the Directors of HOMES Clinic at the time, Nick Peoples and Thomas Gebert, had just succeeded in establishing HOMES Clinic as a host organization for ASF fellows. The stars could not have aligned more clearly. We felt the mission of ASF aligned well with our emerging goals. Moreover, having a structured approach with accountability and network of experts for support would significantly increase the likelihood of success.
Thus, this project was born from us bringing together multiple organizations to achieve a shared vision of better care coordination for people with unstable housing. Our project goal is to integrate PCIC services into the Health Advocate role to better serve clients at The Beacon and patients at HOMES Clinic. Health advocate volunteers will help clients set up profiles in PCIC, develop individualized goals, and then leverage the referral and communication networks set up by PCIC to connect patients to the right personnel. Health Advocates will help monitor weekly progress and be a mediator between clients and social organizations, taking a more active role to make sure the right resources end up with the right clients.
We are fortunate to have the help of many individuals for this project. Dr. Dana Clark, our faculty advisor for HOMES Clinic and a longtime advocate for the unhoused population, is supporting us with her vast clinical experience. Dr. Andrea Link and Carol Jacob, the Executive Director and Program Director of our ASF chapter, respectively, are providing the framework for success and sharing their network to ensure we get the right inputs from the right people as a guide for our project. Viraj Pawa, a developer at PCIC, is guiding us through our education on PCIC as well as catering the capabilities of PCIC to our needs at HOMES Clinic to create a portal where our Health Advocates can easily and efficiently work to help deliver resources to clients. Lastly, we have the support of the Board of Directors at HOMES Clinic to provide feedback throughout our project to ensure the new capabilities are student-friendly and provide a mutual educational experience.
We are looking forward to what our year as Albert Schweitzer Fellows brings as we tackle this project as well as to working with and helping individuals of the unhoused population reach their full potential.
If you would like to get involved in supporting the mission of HOMES Clinic or have ideas you think we should hear about, reach out to our leadership here or make a life-changing donation here.
References
Colburn G, Aldern CP. Homelessness is a housing problem: How structural factors explain US patterns. Univ of California Press; 2022 Mar 15.
Peoples N, Fang M, Kontoyiannis P, Andrews C, Clark D. Development of a User-Informed Social Resource Guide to Improve Identification and Management of Psychosocial Concerns: A Model for the Free Clinic Setting. Journal of Student-Run Clinics. 2023 Jun 5;9(1).
Special thanks to Nicholas Peoples, Mary Fang, and Dr. Dana Clark for their early support of the project; to the Albert Schweitzer Fellowship for their generous support; to the Patient Care Intervention Center for their generous donation of time and resources; and to our parent organization, Healthcare for the Homeless-Houston, for their unparalleled support of HOMES Clinic.