Alameda County Health Care for the Homeless Uses the StreetHealth Team to Treat SUD on the Street

HCH StreetHealth outreach worker Wilma Lozada and psychiatrist Aislinn Bird, MD, with a patient in a camp.Alameda County Health Care for the Homeless HRSA BPHC exit disclaimer in Oakland, CA, is a HRSA-funded health center and county health department-based network of providers. It is nationally recognized for providing patient-centered mobile and clinic-based homeless health care services. The health center observed an increase in the number of persons experiencing street homelessness and an increase of those persons experiencing mental health and substance use disorders (SUD).

In 2017, they developed the StreetHealth Team using HRSA funding, including Expanding Access to Quality Substance Use Disorder and Mental Health Services (SUD-MH) supplemental funding, Substance Abuse Service Expansion Supplement, and Access Increases in Mental Health and Substance Abuse Services (AIMS) supplemental funding. This multidisciplinary team works out of a small mobile unit led by a psychiatrist and includes a substance use-credentialed nurse and outreach workers. The StreetHealth Team has an emphasis on outreach team members developing trusting relationships with patients and connecting them to providers in the field and in clinics.

The team provides street-based harm reduction psychiatry, including psychiatric evaluation, assessment, and treatment with medications provided directly in the field. They also are the link to clinic-based psychiatric care and therapy. Substance use services are also provided, including psychiatrist- and nurse-provided street-based and clinic-based on-demand MAT (Medication-Assisted Therapy). The nurse and outreach worker also enable connections to detox/sobering and recovery services to residents on the street and in encampment settings, many of whom have PTSD and other mental health disorders. Outreach and nursing staff provide naloxone kits and training on naloxone use and safer injection and provide education and connection to clinic-based MAT at the nearby HCH TRUST Clinic and other HCH clinical locations. Patients are referred to a variety of trusted partners, from harm reduction programs to clinics, MAT services at the county hospital emergency department, and medical homes at HCH TRUST clinic.

To date, over 135 patients have been served in street and camp-based settings. Over 100 trainings and naloxone kits have been distributed, and five overdose reversals have been documented. Twelve patients have participated in street-based buprenorphine treatment to treat Opioid Use Disorder, and at least twenty patients have connected to MAT and other clinical services in the nearby HCH TRUST Clinic.

How to Implement

Alameda County Health Care for the Homeless took the following steps to implement this program:

  • Learned from other existing Street Psychiatry and Street Medicine providers with help from the National Health Care for Homeless Council HRSA BPHC exit disclaimer and Street Medicine Institute, especially in the development of staff and patient safety protocols.
  • Developed intensive system of evaluation and measures tracking, which after a year of testing is now being integrated into the program’s electronic records system.
  • Developed a consistent outreach schedule so patients know when to expect outreach visits.
  • Developed close partnerships with the county hospital’s emergency department and MAT clinic, and organizations which have similar philosophies regarding harm reduction and care for people experiencing homelessness. Lessons learned include the importance of investing time and energy to build relationships.
  • Focused on training patients on the use of naloxone and education around overdose prevention, which serves to build trust between patients and providers (and has saved lives).
  • Worked in partnership with a county pharmacist, TRUST clinic and a nearby contracted pharmacy to lower barriers to entry with flexible prescribing and program policies. This includes regular in-person visits and troubleshooting with contracting pharmacists.
  • Involved HCH patient advisory board in reviewing and editing StreetHealth flyers and outreach materials.
  • Acclimated clinician and treatment team to “at-home” inductions and treatment in the field with trainings and in-service presentations.
  • Developed additional funding from county/state mental health services fund to support non-billable services.
  • Worked with nonprofit and county benefits and legal advocates to ensure patient Medicaid enrollment and access to other benefits.
Date Last Reviewed:  April 2019

More Information

Health center's Uniform Data System (UDS) data

For more information about this promising practice, contact:
Dr. Aislinn Bird, Psychiatrist
Alameda County Health Care for the Homeless StreetHealth Team