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Su KY, Feldman BJ, Feldman CT, Saluja S, Coulourides Kogan AM, Cousineau MR. Behavioral Health Care Delivery Through Street Medicine Programs in California. Community Ment Health J 2024; 60:283-291. [PMID: 37526807 PMCID: PMC10822007 DOI: 10.1007/s10597-023-01169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
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.
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Affiliation(s)
- Kimberly Y Su
- Keck School of Medicine of USC, Los Angeles, CA, USA.
| | | | | | - Sonali Saluja
- Keck School of Medicine of USC, Los Angeles, CA, USA
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Sloan K, Kogan AC, Guller J, Feldman CT, Feldman BJ. Characteristics of Homeless Temporarily-Housed in Project RoomKey During the COVID-19 Pandemic. J Prim Care Community Health 2024; 15:21501319241234869. [PMID: 38491844 PMCID: PMC10943723 DOI: 10.1177/21501319241234869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION People experiencing unsheltered homelessness (PEUH) have higher disease burden yet limited access to healthcare. COVID-19 introduced even greater risk for PEUH aged 65+ years with an underlying chronic health condition and were temporarily housed in hotels/motels for Project RoomKey (PRK). This study aimed to characterize a PRK cohort who received primary care from a street medicine program. METHODS This observational case series study included a sample of 35 PRK participants receiving primary care from a street medicine team at a single site from July to September 2020. We used the HOUSED BEDS assessment tool for taking history on PEUH. RESULTS Participants were 63% male, 40% Hispanic/Latino/a, 40% white, 94% English-speaking, and 73% had chronic health conditions. Assessment revealed: average Homelessness (H) of 4 years; 76% had no prior social service Outreach (O); average Utilization (U) was 4 emergency department visits in prior 6-months; 68% received Salary (S) from government income; Food access or Eat (E) was commonly purchased (29%) or donated (26%); clean water to Drink (D) for 59% of participants; 86% had access to a Bathroom (B); Encampment (E) was varied and 38% reported safety concerns; Daily routine (D) showed 76% could access a telephone, 32% received social support from family; 79% reported past or current Substance use (S). No participants contracted COVID-19 during study period. CONCLUSIONS This study describes health and demographic characteristics of PRK participants in Southern California. Findings inform policies to continue PRK that includes onsite healthcare such as via street medicine.
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Affiliation(s)
- Kylie Sloan
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Jodie Guller
- University of Southern California, Alhambra, CA, USA
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Lowe E, Kogan AC, Feldman CT, Ma SB, Lie DA. Preceptors' preparedness to teach about substance and opioid use disorder: a qualitative study. BMC Med Educ 2022; 22:867. [PMID: 36517790 PMCID: PMC9749622 DOI: 10.1186/s12909-022-03922-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
STUDY AIM Little is known about preceptors' comfort and readiness to teach clinical students about the care of patients with substance and opioid use disorder (SUD/OUD). This study explores preceptors' views about caring for such patients, and their preparedness to teach about SUD/OUD management, to improve graduate competencies. METHODS Participants were recruited by convenience and snowball sampling. Semi-structured interviews were conducted with physician, physician assistant, and nurse practitioner preceptors who taught medical and physician assistant students. Interviews were conducted via Zoom® videoconferencing. Transcripts were generated and independently analyzed for themes by 4 experienced coders using constant comparison and a grounded theory approach. RESULTS Fifteen interviews were conducted to theme saturation. We identified 3 major themes and 10 subthemes supported by exemplar quotes. The major themes were: education about SUD/OUD in primary care (subthemes include need for longitudinal curriculum, redefining 'success' in treatment, and precepting challenges), treatment of SUD/OUD in primary care (need for systemic support and care continuity), and medication-assisted therapy (MAT) training as a tool for teaching (preceptors' own training, and need for clinical students to be trained). CONCLUSIONS Preceptors agreed that treatment of SUD/OUD belongs in primary care and students should learn about SUD/OUD from the start of their medical education. Data analysis enabled the construction of an emerging conceptual framework reflecting a diversity of experiences and opinions of preceptor comfort and preparedness to teach about SUD/OUD, associated with various barriers and motivators. This framework can guide future strategies to address facilitators and obstacles to advance and promote preceptor preparedness to teach students about the care and management of patients with SUD/OUD.
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Affiliation(s)
- Enya Lowe
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
| | - Alexis Coulourides Kogan
- Family Medicine and Gerontology, Department of Family Medicine and Geriatrics, Keck School of Medicine of USC, University of Southern California, Alhambra, USA
| | - Corinne T. Feldman
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
| | - Sae Byul Ma
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
| | - Désirée A. Lie
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
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Ma SB, Feldman CT, D'Aquila M, Lowe E, Lie D. Addressing the Opioid Crisis: Medication-Assisted Therapy Waiver Training for Students. J Physician Assist Educ 2022; 33:122-126. [PMID: 35616689 DOI: 10.1097/jpa.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Physician assistant (PA) graduates should be prepared to care for patients with substance use disorders. Medication-assisted therapy (MAT) allows PA graduates to provide that care by becoming licensed to prescribe buprenorphine. However, it is unclear how feasible and effective it is to implement online MAT waiver training during PA school. This study examined student knowledge and attitudes after training to assess its impact and perceived value. METHODS We conducted a 15-question survey after one class of students completed training during clinical rotations. Students self-reported pre/post change in awareness, knowledge, interest, comfort and confidence, perceived usefulness to practice, and assessed quality using 5-point Likert scale (higher scores = more positive) and narrative responses. Data analysis was performed using the Wilcoxon signed rank test and descriptive statistics. Free text comments were analyzed for themes using constant comparison. RESULTS Fifty-five (100%) students completed training within 6 weeks. The survey response rate was 49/55 (89%). Pre-to-post score changes were significant (p < .05) from +0.39 to +1.35 with the greatest changes seen in knowledge (+1.35), comfort (+1.14), awareness (+1.06), and confidence (+1.08); the lowest change was in interest (score change +0.39). Students reported being satisfied with content organization and quality (mean 3.82) and recommended training to colleagues (3.98); 82% reported they would have preferred 3 months to complete training; 46% would have preferred training prior to the start of clinical rotations. Major themes indicated a desire for better preparation and flexibility of platform, with ambivalence about relevance to practice. CONCLUSION Online MAT waiver training is feasible and effective. However, students may not be convinced of its relevance to future practice. Faculty should offer adequate preparation and optimize integration into existing curricula.
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Affiliation(s)
- Sae Byul Ma
- Sae Byul (Sarah) Ma, PharmD , is interim associate program director, a clinical assistant professor, and director of research and scholarship for the Division of Physician Assistant Studies, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Corinne T. Feldman, MMS, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Mitzi D'Aquila, MACM, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Enya Lowe, MSc , is a project specialist for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Désirée A. Lie, MD, MSEd , is a clinical professor of family medicine for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
| | - Corinne T Feldman
- Sae Byul (Sarah) Ma, PharmD , is interim associate program director, a clinical assistant professor, and director of research and scholarship for the Division of Physician Assistant Studies, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Corinne T. Feldman, MMS, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Mitzi D'Aquila, MACM, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Enya Lowe, MSc , is a project specialist for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Désirée A. Lie, MD, MSEd , is a clinical professor of family medicine for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
| | - Mitzi D'Aquila
- Sae Byul (Sarah) Ma, PharmD , is interim associate program director, a clinical assistant professor, and director of research and scholarship for the Division of Physician Assistant Studies, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Corinne T. Feldman, MMS, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Mitzi D'Aquila, MACM, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Enya Lowe, MSc , is a project specialist for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Désirée A. Lie, MD, MSEd , is a clinical professor of family medicine for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
| | - Enya Lowe
- Sae Byul (Sarah) Ma, PharmD , is interim associate program director, a clinical assistant professor, and director of research and scholarship for the Division of Physician Assistant Studies, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Corinne T. Feldman, MMS, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Mitzi D'Aquila, MACM, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Enya Lowe, MSc , is a project specialist for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Désirée A. Lie, MD, MSEd , is a clinical professor of family medicine for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
| | - Désirée Lie
- Sae Byul (Sarah) Ma, PharmD , is interim associate program director, a clinical assistant professor, and director of research and scholarship for the Division of Physician Assistant Studies, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Corinne T. Feldman, MMS, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Mitzi D'Aquila, MACM, PA-C , is a clinical assistant professor for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Enya Lowe, MSc , is a project specialist for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
- Désirée A. Lie, MD, MSEd , is a clinical professor of family medicine for the Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine at the University of Southern California in Alhambra, California
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Ramos J, Feldman CT, Norman C. Exploring Social Determinants of Health Through Community Documentary-Making. J Physician Assist Educ 2021; 32:123-126. [PMID: 33935276 DOI: 10.1097/jpa.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jen Ramos
- Jen Ramos, MPAP, PA-C, ADE, is a clinical instructor of family medicine at the Keck School of Medicine, University of Southern California, Division of Physician Assistant Studies, Alhambra, California
- Corinne T. Feldman, MMS, PA-C, is director of didactic education for the Division of Physician Assistant Studies, Keck School of Medicine at the University of Southern California, Alhambra, California
- Claire Norman, MSJ, is a communications strategist for the Department of Family Medicine, Keck School of Medicine, University of Southern California, Division of Physician Assistant Studies, Alhambra, California
| | - Corinne T Feldman
- Jen Ramos, MPAP, PA-C, ADE, is a clinical instructor of family medicine at the Keck School of Medicine, University of Southern California, Division of Physician Assistant Studies, Alhambra, California
- Corinne T. Feldman, MMS, PA-C, is director of didactic education for the Division of Physician Assistant Studies, Keck School of Medicine at the University of Southern California, Alhambra, California
- Claire Norman, MSJ, is a communications strategist for the Department of Family Medicine, Keck School of Medicine, University of Southern California, Division of Physician Assistant Studies, Alhambra, California
| | - Claire Norman
- Jen Ramos, MPAP, PA-C, ADE, is a clinical instructor of family medicine at the Keck School of Medicine, University of Southern California, Division of Physician Assistant Studies, Alhambra, California
- Corinne T. Feldman, MMS, PA-C, is director of didactic education for the Division of Physician Assistant Studies, Keck School of Medicine at the University of Southern California, Alhambra, California
- Claire Norman, MSJ, is a communications strategist for the Department of Family Medicine, Keck School of Medicine, University of Southern California, Division of Physician Assistant Studies, Alhambra, California
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Feldman CT, Stevens GD, Lowe E, Lie DA. Inclusion of the homeless in health equity curricula: a needs assessment study. Med Educ Online 2020; 25:1777061. [PMID: 32573370 PMCID: PMC7482743 DOI: 10.1080/10872981.2020.1777061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
Exposure to homeless patients is a potential strategy to teach about social determinants of health and health inequities. Little is known about student attitudes and preferences for learning about the homeless in curricula addressing vulnerable populations. A needs assessment to determine student readiness may inform strategies for teaching. A mixed-methods study of one matriculating physician assistant student class, with a cross-sectional survey and 3 focus groups (FG). The validated 19-item Health Professionals' Attitudes Toward Homelessness inventory (HPATHI) and new 7-item Learning Attitudes scale were administered to explore perceptions and preferences about relevance of caring for the homeless to future practice. FGs were conducted to theme saturation. Verbatim transcripts were independently read and coded by 3 researchers using constant comparison. Survey response rate was 100% (N = 60). Overall HPATHI mean score was 3.97 ± 0.04 of 5, indicating positive attitudes toward the homeless. The highest mean score (4.26 ± 0.04) was for the social advocacy subscale; the lowest (3.02 ± 0.06) for personal advocacy. The Learning Attitude scale (Cronbach's alpha 0.89) mean score was 4.47 ± 0.07 out of 5, showing a positive attitude toward curricular exposure. Older students and those with prior experience with the homeless had higher HPATHI scores (p < 0.05). Four major themes emerged: vulnerable patients cannot advocate for themselves; learning about homelessness is relevant to future practice; preference for multiple teaching strategies and adequate preparation for street rotations; and anticipated anxiety about safety. Students recognize the value of learning from homeless patients as part of gaining skills in caring for vulnerable populations. Experiential learning opportunities focusing on this group are seen as an acceptable and valuable way to gain skills applicable to all vulnerable patients. Students express fear and anxiety around non-traditional settings such as the street. Their anxieties should be adequately addressed when designing clinical rotations.
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Affiliation(s)
- Corinne T. Feldman
- Keck School of Medicine, University of Southern California, Alhambra, CA, USA
| | - Gregory D. Stevens
- Keck School of Medicine, University of Southern California, Alhambra, CA, USA
| | - Enya Lowe
- Keck School of Medicine, University of Southern California, Alhambra, CA, USA
| | - Desiree A. Lie
- Keck School of Medicine, University of Southern California, Alhambra, CA, USA
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Feldman CT, Morici B, Goodrich S. Early Exposure to Underserved Patients and Its Impact on Initial Employment Decisions Regarding Physician Assistants. J Physician Assist Educ 2018; 29:144-149. [PMID: 30086119 DOI: 10.1097/jpa.0000000000000213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study explored the impact of early, repetitive, and required participation in a homeless shelter-based, student-run free clinic (SRC) on career choice in primary care, underserved medicine, and future volunteerism in physician assistants (PAs). The investigators hypothesized that students required to participate in the SRC would be more likely to select a career in primary care, be providers to underserved populations, and to volunteer. METHODS A 30-question online survey, which included open- and closed-ended questions, was administered to alumni of the DeSales University PA program from January 2015 to April 2015. Alumni who had and had not been exposed to the SRC were included in the sample. RESULTS Completed surveys were obtained from 43 graduates who attended the university before the opening of the SRC and from 114 graduates who were required to participate in the SRC, for an overall response rate of 31.2%. Graduates who were exposed to the SRC were significantly more likely to have an initial and current career in primary care. Furthermore, alumni who had worked in the SRC were more likely to report that they believed their DeSales University experience influenced their decision to enter primary care as compared to those who did not have exposure to the SRC. CONCLUSION This study provides initial evidence that early, repetitive, and required exposure to a student-run free clinic impacts graduates' decisions on career choice and volunteerism. The structure of this particular clinic and its location in a homeless shelter may have provided an opportunity for students to explore how social determinants affect health in an underserved population.
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Affiliation(s)
- Corinne T Feldman
- Corinne T. Feldman, MMS, PA-C, was the executive director/co-founder of the DeSales Free Clinic and is a clinical instructor of Family Medicine in the Primary Care Physician Assistant Program at the University of Southern California. Bobbie Morici, MSPAS, PA-C, is the director of Clinical Education and an assistant professor at the DeSales University Physician Assistant Program, Center Valley, Pennsylvania. Samantha Goodrich, PhD, is the manager of Health Systems Research and Evaluation for the Department of Community Health at Lehigh Valley Health Network, Allentown, Pennsylvania
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