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Introducing the Problem SolversBCM Responds to Community Needsby Ruth SoRelle
Healthcare for the Homeless - HoustonThe only thing necessary for the triumph of evil is for good men to do nothing. The needs of an urban population often seem overwhelming, but such challenges can bring out the best at Baylor College of Medicine, where outreach into the community is a major focus of the institution's mission. Beginning with its work in the city-county hospital in the early 1940s, BCM has always acknowledged that it owes a debt to the population that took it in and supported it for more than 50 years. How better to repay that debt than by providing care to those who are the most vulnerable and needy? From clinics that provide primary care for dental problems, mental health issues, infectious disease testing and vision assistance at the city's burgeoning homeless shelters to medical outreach on the streets themselves to the provision of medicines to an electronic medical record, Healthcare for the Homeless-Houston takes health care to the people who need it. Healthcare for the Homeless-Houston (HHH) originated from an initial partnership between Baylor College of Medicine and SEARCH Homeless Project. Today it is a consortium of agencies and educational institutions working under the umbrella of an independent nonprofit corporation. "A significant amount of its workforce is from Baylor College of Medicine," said Dr. David Buck, BCM associate professor of family and community medicine and HHH president and medical director. That enables the organization to minimize costs while using innovative measures to take care where it is needed most. "Who would have thought we would have a bus?" he said. Yet transportation is a major barrier to care for homeless people. Five days a week, at least eight hours a day, the bus ferries people to and from shelters, food pantries, soup kitchens, and hospitals such as the Michael E. DeBakey Veterans Affairs Medical Center and Ben Taub General Hospital, as well as HHH and Harris County Hospital District clinics - all stops identified from a survey of 550 homeless people themselves. "By providing health care, we are bridging a major gap in the safety net," said Buck. With many mentally ill patients, it is critical to provide them with the treatment they need that could, someday, enable them to take their medications regularly and ultimately live more normal lives. One of HHH's clinics is HOMES - Houston Outreach Medicine Education and Social Services-which seeks to provide quality, accessible free health care to homeless Houston residents in a learning environment that promotes the dignity of all participants. It is operated in part by students from Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHSC), as well as the UTHSC-Houston School of Public Health and University of Houston College of Pharmacy. "Working at this clinic trains students in an integrated program that allows them to learn about other disciplines and how to work together in a nurturing environment," said Buck. "We hope it will encourage more students to do this work." Watching the students learn to deal with homeless patients as people and equals is a formative process, said Buck. "Our students are so inspiring," he said. Medical care is "a vital component but not the only component of helping the homeless," said Buck. "We tend to medicalize homelessness." HHH seeks to do more than that, and in the process, save lives. People who live on the street for at least six months are four to 10 times more likely to die than people who have homes, he said. Texas Elder Abuse and Mistreatment Institute
Forging a bond with Texas Adult Protective Services and other local and state agencies, Dyer and her colleagues in a group called the Texas Elder Abuse and Mistreatment Institute (TEAM) band together to take the care and support these people need directly into their homes. "This was a match made in heaven," said Dyer. "We have a comprehensive geriatrics program that makes house calls and an agency that deals with frail elders in the community. We were fortunate that they saw the wisdom in what we are trying to do. All of these things melded together." When adult protective services makes her agency aware of a potential client, the group brings in a physician, a social worker and nurses who go to the home and do a full geriatric assessment of all aspects of the person's health and well-being. That includes a listing of medications, determination of the patient's mental and physical abilities and an assessment of the environment in which that person lives. Then the different groups sit down and come up with a plan to meet that person's needs. "It's not just their medical needs, but all of them," said Dyer. "Then we put a multifaceted plan in place." Involvement does not end there as members of the team continue to monitor the person's progress. "Sometimes all they need is a hand," she said. "Then they can remain in the community. Sometimes it's as simple as getting the family involved again. In other cases, it's more difficult." Last year, TEAM received a $1.7 million grant as part of the National Institutes of Health's Roadmap Initiative to begin the Consortium for Research in Elder Self-neglect of Texas (CREST) to encourage research across interdisciplinary and institutional lines. Other members of the group include the University of Houston School of Social Work, The UTHSCHouston Schools of Nursing and Public Health, The University of Texas Medical Branch at Galveston, Texas Adult Protective Services, the Harris County Hospital District, BCM and NASA. Recently, the U.S. Department of Justice awarded TEAM funding to replicate its model in two other states. In late February, representatives from Summa Health Care at the Northeastern Ohio School of Medicine and the Louisiana State University geriatrics program in New Orleans underwent a day and a half of training in how to provide care under the TEAM model. "Imitation is the greatest form of flattery," said Dyer. "We are thrilled that they like what we are doing." Giving Young Men a Chance
"Gradually, family planning clinic providers have realized that to be effective in reducing pregnancies as well as sexually transmitted infections, there is a need to include young men," said Ruth Buzi, an assistant professor at Baylor College of Medicine, who is also a leader in the Teen Health Clinics. Once a week, young men attend a special male clinic that provides a host of health services to a population that is often overlooked. "In addition, we have a component of health promotion," said Buzi. "We provide these young men with information about healthy practices such as avoiding drugs and cigarettes, and adopting a healthy lifestyle with exercise and proper nutrition. We also do a psychosocial assessment to identify mental health issues in young men." They even address unemployment with an AmeriCorps staff member onsite to provide job counseling. The young men are referred for legal or educational help when needed. "We connect the young men with a variety of employment services in the city," she said. "Our main issue is to address sexual health, advising them on avoiding risky behavior and discussing healthy sexuality such as respecting your partner and participating in family planning decisions." "...we provide these young men with information about healthy practices such as avoiding drugs and cigarettes, and adopting a healthy lifestyle with exercise and proper nutrition." "These young men don't have access to health care. They don't have insurance and cannot access services anywhere else," she said. "We have identified young men with hearing problems, skin conditions, asthma, diabetes, high blood pressure, seizure disorders, and a host of other problems." By identifying problems early, Buzi said the program hopes to provide help before a crisis situation occurs, which is when most of these young men seek treatment. "It is a lot less expensive and more effective to focus on prevention than to repond to crises," she said. |
Patient CareBaylor Clinic from the Inside Out Oil and Medicine: Profile on Dan Duncan ResearchEpilepsy: Seeking the Cause of a Lonely Disease Epilepsy: A history of stigma and superstition In for a Checkup? Check Out the Research Too EducationAll About the Education Evolution Revolution Community ServiceIntroducing the Problem Solvers College NewsRededication of a Monument to Medicine New BCM Logo Takes Center Stage The Perfect Fit: Putting the Pieces Together
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Volume 1, Issue 1, Spring 2005 |
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| Last modified: October 10, 2008 |
Dr. Carmel Bitondo Dyer, a BCM associate professor
of medicine and head of geriatrics at the Harris County
Hospital District, calls her patients "aged-in-place."
Often in their late 70s, living in middle- to low-income
neighborhoods in often-aging homes, they come from
all ethnic backgrounds. Their commonality is that they
can no longer keep up with their own basic needs.
They have no social support to make up for what they
cannot do.
A year ago, leaders of the Baylor
Teen Health Clinics turned their attention
to young men ages 17-25, a bold move for
a group that had long focused on young
women.