Agenda

Return

C. 97

To:	Board of Supervisors
From:	William Walker, M.D., Health Services Director
Date:	December 13, 2011

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: 12/13/2011

APPROVED AS RECOMMENDED

OTHER

Clerks Notes:

VOTE OF SUPERVISORS

AYE:

John Gioia, District I Supervisor
Gayle B. Uilkema, District II Supervisor
Mary N. Piepho, District III Supervisor
Karen Mitchoff, District IV Supervisor
Federal D. Glover, District V Supervisor

Contact:	William Walker, MD, 957-5403
cc:	Demetria Gary Tasha Scott Rachael Birch

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: December 13, 2011
David Twa,

BY:	, Deputy

RECOMMENDATION(S):

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

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 Departments of Mental Health and Alcohol and Other Drugs. 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 mobile team is comprised of a Medical Director, Family Nurse Practitioners, Public Health Nurses, Nurses, Community Health Workers, Financial Counselor, 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 three ambulatory care clinics, located throughout the County, designated specifically for homeless patients to help them transition from the mobile clinic setting into the ambulatory care system. HCH staff members are present at each of these clinics.

During 2010, CCHS treated 16,055 homeless patients who generated 102,367 visits. This is an increase from 2009, when CCHS saw 15,094 homeless patients who generated 96,572 visits. The increase is likely due in part to the economic recession, which placed further demand on the safety-net system, including CCHS, and partly to the addition of three Community Practice Clinics in Concord, Antioch and San Pablo. Data for 2011 will be available in late Spring 2012, and will be presented to the Family & Human Services committee.

Table 1 (below) indicates the Board of Supervisor’s District where homeless patients reside. If no residential zip code data are available, the zip code where a patient received care is used.

Table 1: Percent of Homeless Patients by Supervisorial District, 2010

District 1- Supervisor Gioia 33%
District 2- Supervisor Uilkema 20%
District 3- Supervisor Piepho 2%
District 4- Supervisor Bonilla 23%
District 5- Supervisor Glover 22%

New Actions

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

American Recovery and Reinvestment Act Funding

In July 2009, the HCH Project received a Capital Improvement Project award to replace the Martinez Family Practice Site (Building 2 on the CCRMC Campus). This project will modernize the clinic and streamline clinic flow for maximum efficiency. The new unit will enhance the effectiveness and efficiency of providing clinical services to patients through reduced waiting times for clinic appointments at the Martinez site and throughout the CCHS system. A homeless-specific clinic will be offered at this site upon its opening. Funding for this project was calculated on a formula basis at $683,000. During the past year, CCHS devoted time to meeting all conditions associated with the grant award prior to beginning construction, including extensive environmental assessments.
The new clinic will have both medical and mental health components. Its design has been completed and is currently under review by the Department of Community Development.
In December 2009, CCHS received $12 Million in ARRA funds for the construction of a new West County health center, to replace the Richmond Health Center. Construction is well under way on the 50,000 square foot, two story clinic. It will house a comprehensive array of outpatient medical services and support functions. The goal is to have the building achieve LEED certification for environmental quality.

In May 2009, the HCH Project was awarded an additional $220,000 in stimulus funds to address the “Increased Demand for Services.” This amount of funding was calculated by a formula based on the number of homeless patients served by the HCH Program. This funding has been incorporated into our HCH base grant, increasing our annual amount to $958,795

Affordable Care Act

In August 2011, the HCH Project received a New Access Point (NAP) grant from HRSA for $649,185 per year. The funding will help pay for a team of HCH staff to operate a homeless clinic in Concord, at 3024 Willow Pass Rd., Concord. This team will include one RN, one PHN, one Community Health Worker, one Medical Doctor, one Care Coordinator, one Mental Health Specialist, one Substance Abuse Specialist and one Registration Clerk. This funding will be incorporated into our HCH base grant, increasing the annual amount to $1,607,977.

Integrated Primary Care Clinic in Concord

The HCH Project will soon be opening an integrated primary care (IPC) clinic at Concord Mental Health. The proposed site will provide primary health care with specialty referral and coordination to adults with serious mental illness (and co-occurring substance abuse) and will be located at 1420 Willow Pass Road, Concord, CA. Referrals will initially come from enrolled consumers within Concord Mental Health, where it is estimated that at least 50% of the actively enrolled consumers do not have regular access to primary care and 70% are homeless.

Homeless Respite Care and Shelter Clinic

The HCH Project opened a licensed ambulatory care clinic at the Concord shelter in May 2011. 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.

The HCH Project continues to provide all medical and nursing care at the Philip Dorn Respite Center.

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 second client recently received free treatment and a complete set of dentures, at no cost, courtesy of the generous care from Dr. Alijanian, DDS, of Walnut Creek. A third client will soon begin receiving services from Dr. Michael Tobian. Dental services are essential to regaining employment and exiting homeless.

Rentry Program for Individuals Exiting Incarceration

The HCH Project continues to provide staff at the PACT (Probation and Community Together) meetings, providing parolees with assistance in entering our health care system. Kate Schwertscharf, HCH Public Health Nurse Program Manager, receives phone calls and referrals from the San Quentin Medical Project, Richmond Parole Office and the West County Detention Facility, assisting clients in accessing health services.

New Medical Director

The HCH’s Medical Director, Dr. Kate Colwell, retired after 24 years with CCHS. A new Medical Director, Dr. Nishant Shah, M.D., M.P.H. was identified from within the organization and was oriented by the previous, Dr. Kate Colwell.

Summary

This has been an exciting and busy time of growth and planning 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:

Not applicable.

CHILDREN'S IMPACT STATEMENT:

Not applicable.