Behavioral Health Care Delivery Through Street Medicine Programs in California

Mental health and substance use disorders are prevalent among people experiencing homelessness. Street Medicine can reach unhoused people who face barriers to accessing healthcare in more traditional medical settings including shelter-based clinics. However, there is little guidance on best practices for mental health and substance use treatment through Street Medicine. The aim of the study was to describe behavioral health care through Street Medicine by analyzing data from the California Street Medicine Landscape survey and follow-up qualitative interviews. Most street medicine programs utilize non-psychiatrists to diagnose and treat mental health and substance use disorders, though the capacity to provide the level of care needed varies. There is a lack of street-based psychiatric clinicians and programs have difficulty making referrals to mental health and addiction services. This report shows that Street Medicine could serve as a strategy to expand access to behavioral health care for the unhoused.

DEVELOPMENT AND PILOT TESTING OF THE END-OF-LIFE READINESS ASSESSMENT (ERA) SURVEY

An emerging conceptual framework on the relationship between serious and sensitive end-of-life (EOL) discussions and patient hope points to the mediating role that patient readiness may play. Additional research has also found that among some patients, engaging in and EOL conversation before they are ready may actually cause harm. Presently, health practitioners do not have a way to measure patient readiness. Therefore, the purpose of this study was to develop a survey assessment tool, rooted in research, to measure patient readiness to engage in an EOL discussion. The 16-item survey was initially developed by a gerontological researcher and clinical oncologist, and tested for face reliability and appropriateness among a geriatrician and three patients with chronic illness. In May 2018, the final version of the survey was pilot tested among 168 patients attending their regularly scheduled oncology appointment. On average, most participants identified as Caucasian (74%) females (61%) in partnerships (58%) and having a cancer diagnosis (64%). Bivariate analyses revealed that older age (60+, p=0.008), Caucasian race (p=0.04), and reported greater knowledge of community and supportive services (p=0.049) was significantly associated with increased readiness to engage in an EOL discussion. Additionally, a higher score on the Advance Care Planning Engagement Survey was significantly associated with increased readiness (p<0.001). Findings reveal patient groups that might be more appropriate targets for interventions, education, and resources and highlight the role of interprofessionals in outpatient health settings to “prime the pump” for these types of conversations.