Agenda

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C.177

To:	Board of Supervisors
From:	William Walker, M.D., Health Services
Date:	January 8, 2013

Contra

Costa

County

Subject:

Health Care for the Homeless Project Update

APPROVE	OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR	RECOMMENDATION OF BOARD COMMITTEE

Action of Board On: 01/08/2013

APPROVED AS RECOMMENDED

OTHER

Clerks Notes:

VOTE OF SUPERVISORS

AYE:

John Gioia, District I Supervisor
Candace Andersen, District II Supervisor
Mary N. Piepho, District III Supervisor
Karen Mitchoff, District IV Supervisor
Federal D. Glover, District V Supervisor

Contact:

Rachael Birch, 925-313-6167

I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown.
ATTESTED: January 8, 2013
David Twa,

BY:	, Deputy

RECOMMENDATION(S):

ACCEPT the report from the Health Services Department regarding Health Care for the Homeless.

FISCAL IMPACT:

No impact. The HCH Project is funded through a Public Health Services Act Section 330(h) grant from the Health Resources Services Administration.

BACKGROUND:

Since 1990, the Health Care for the Homeless (HCH) Project has provided health care services to the homeless population through mobile clinics, as well as through the CCHS integrated ambulatory system of care, and the Behavioral Health departments. Primary health care services provided by the HCH Mobile Team include routine physical assessments, basic treatment of primary health problems such as minor wounds and skin conditions, respiratory problems, TB screening, acute communicable disease screening, and coordination and referrals for follow up treatment of identified health care needs. A significant portion of the homeless patients seen in the mobile clinics have chronic diseases, including asthma, hypertension, diabetes, and mental health/substance abuse issues.

BACKGROUND: (CONT'D)

The HCH mobile team is comprised of a Medical Director, Family Nurse Practitioners, Registered Nurses, Community Health Workers, Mental Health Specialist, and a Substance Abuse Counselor.

Homeless patients who receive care on one of the mobile clinics are referred into one of the CCHS ambulatory care health centers for primary and specialty care, into County mental health and substance abuse services and to Contra Costa Regional Medical Center for emergency, inpatient hospital, outpatient surgeries, laboratory and radiology. There are currently four ambulatory care clinics, located in San Pablo, Antioch and Concord, designated specifically for homeless patients to help them transition from the mobile clinic setting into the ambulatory care system. HCH mobile team members staff each of these clinics.

During 2011, CCHS treated 16,487 homeless patients who generated 104,910 visits. This is an increase from 2010, when CCHS saw 16,055 homeless patients who generated 102,367 visits. The increase is likely due in part to the declined economy which places further demand on the safety-net system, including CCHS, and partly due to the increase in the capacity of CCHS clinics. Data for 2012 will be available in late Spring 2013, and will be presented to the Family & Human Services committee.

New Actions

The following activities have occurred since the last briefing to the Board of Supervisors on HCH activities:

Homeless Respite Care and Shelter Clinic

The HCH Project continues to provide all medical and nursing care at the Philip Dorn Respite Center and continues to operate the licensed Respite clinic. The clinic serves homeless individuals staying at the Concord shelter and Respite, as well as all clients who meet the homeless criteria. Open four days (20 hours) per week, the clinic includes an RN, FNP and Community Health Worker.

Pro-Bono Dental Health Services for Homeless Clients

The Homeless Consumer Advisory Board and HCH launched a partnership with a small group of private dental providers who provide services free of charge to homeless individuals who do not qualify for dental coverage through other programs. The Advisory Board has been a strong advocate about the need for this free service given a lack of affordable dental services, and we are very pleased that a pilot program will address some of this unmet need. A sixth client will soon begin receiving services from Dr. Alijanian, DDS, of Walnut Creek. Dental services are essential to regaining employment and exiting homeless.

AB 109 Program

The HCH Project recently began providing medical services to the AB 109 Program parolees through referrals from the Program’s forensic team. This forensic team ensures that parolees have access to Behavioral, Health, Medical and Social services by linking them to County services.

Reentry Program for Individuals Exiting Incarceration

The HCH Project continues to provide staff at the PACT (Probation and Community Together) monthly meetings, providing parolees with assistance in entering our health care system.

Project Homeless Connect

The HCH Team participated in the annual Project Homeless Connect on June 14th in Concord, providing homeless individuals with health exams/screenings, immunizations and referrals to specialty care.

Breast Clinic

The HCH Program celebrated Breast Cancer Awareness Month by providing free breast exams to 14 uninsured women at the Philip Dorn Respite Center on October 25th.

New Clinics

The HCH Program added a 4-hour Homeless clinic at the newly opened West County Health Center in October. The HCH team now provides 8 hours of ambulatory care per week for homeless individuals at this health center.

New Program Manager

Kate Schwertscharf, HCH Program Manager for the past 6 years, accepted a position as the manager of the Public Health Nursing Adult unit in June. The new HCH Program Manager, Alvin Silva, has worked as a Registered Nurse on the HCH team for over five years.

New Electronic Health Record (ccLink)

Contra Costa Health Services implemented a certified Electronic Health Record (EHR) technology system, Epic on July 1, 2012. Implementing Epic will enable CCHS to provide a personal health record for each patient and will allow the sharing of clinical information with the major patient referral facilities in our area (Kaiser, Sutter, UCSF, UCD and Stanford). The EHR will aid the HCH Project in providing a continuum of care for our homeless patients by providing a shared health record, a streamlined referral process and an up-to-date medical record system for charting and data collection.

Summary

This has been an exciting and busy time of adjustment and growth for the HCH program in CCHS. We expect that our next report will have significant updates on the milestones achieved for these new projects, while we also work hard to sustain the ongoing work of the mobile clinic team and homeless ambulatory care clinics.

CONSEQUENCE OF NEGATIVE ACTION:

The Board will not be updated

CHILDREN'S IMPACT STATEMENT:

Not Applicable.