Training Series
ZVMS Launches Series on Physicians Serving Patients Experiencing Homelessness
On any given night, there are almost 20,000 unhoused people in the state of Minnesota. Over the course of the year, over 50,000 in Minnesota experience homelessness at one point or another.(1) These numbers have not been helped by the current economic climate and are only expected to rise. ZVMS has created a series of trainings to help physicians and other health care providers to best serve patients experiencing homelessness.
You can learn more about homelessness in Minnesota, Olmsted County, and Rochester at the Wilder Foundation.
You can find additional information on Rochester and Olmsted County’s response to unsheltered individuals during COVID-19 here.
For a guide to resources and services in Olmsted County, see the 2021 Community Resource Guide, or “Green Book,” here.
We are grateful to our community partners for their willingness to share their insights and guidance.
Thank you to Mayo Clinic Alix School of Medicine students Grace Johnson and Derrick Lewis for leading the series.
Key Takeaways from the Series
(Click on each to expand)
- Too often, unsheltered patients face discrimination in healthcare settings. By recognizing our biases, putting aside preconceived notions, and asking trauma-informed, non-judgmental questions, we can make all patients feel welcome – regardless of housing status.
- Everyone has a story. Inviting patients to share their stories with us, including the circumstances that led to homelessness, allows for more tailored care.
- Earning the trust of our patients is essential. Homeless individuals may experience intense anxiety about seeking medical care. Taking time to build rapport by treating patients with respect and asking what they want, instead of telling them what to do, increases the likelihood that patients will follow through with recommendations and return visits.
- Patients experiencing homelessness face unique health risks such as exposure to extreme weather conditions, food scarcity, and limited access to sanitation facilities. These factors should be considered when devising treatment plans or discharge instructions.
- Simplifying medication regimens, minimizing specialty referrals when possible, and offering basic supplies (e.g., kits that include bandages, gauze, and personal hygiene products) can improve patient adherence to provider recommendations.
- Small steps in the right direction are a worthy goal. Patients may have medical conditions that are complicated by social circumstances and mental health challenges. It is important to meet patients where they are and focus on harm-reduction strategies when necessary.
- Collaborating with professionals in other sectors (e.g., social workers, mental health providers, and homelessness liaisons in schools) and staying informed about community resources help us connect patients to appropriate services upon leaving the clinic or hospital.
- In addition to serving individual patients, we can leverage our positions as medical providers to advocate for social change on a broader scale, including improved access to affordable healthcare, housing, and social support in our communities.
CULMINATING EVENT: STREET MEDICINE
The ZVMS training series on serving patients experiencing homelessness culminated on April 26, 2021,
with a presentation and discussion with Dr. Jim Withers, the founder of Street Medicine.
To learn more about the event, click on the “Learn More” button below.
Training 1
Overview
Mary O’Neil, Housing Stability Team Program Manager with the Olmsted County Housing Department, introduces ways in which we can best serve our patients experiencing homelessness. She provides strategies to gain trust, draw insights from the clinical record, find local community resources, and adjust clinical practice (e.g. prescribing for better medication adherence) in light of the unique challenges these patients face.
(October 22, 2020)
Key Takeaways from Mary O’Neil’s Presentation
- “Where did you stay last night?”
- “When was the last time you took your antibiotic?”
- “Can I see your medication bottle to see how many pills are still there?”
- Minimize dosing
- Be mindful of medications that must be taken with food
- Offer written instructions on a wallet-sized card
- Examples include bandages, gauze, and over-the-counter medications
- Consider having zip-lock bags available with socks, personal hygiene products, and bus passes for return visits
Training 2
Gaining Trust and Building Rapport
Dan Fifield, co-founder of The Landing MN, a non-profit that offers shelter, meals, and clothing to individuals in the Rochester area, discusses ways to gain trust and build rapport when working with patients who face housing insecurity.
(November 18, 2020)
Key Takeaways from Dan Fifield’s Presentation
- “Your ability to care for people is going to be greatly enhanced. A lot of the time, their stories are not much different than ours. They’ve just taken a different turn on that road.”
- “If we don’t listen, we don’t know what the problem is. It’s crucial to not try and tell people what to do, but to ask them what it is they want.”
- “We have to try and help people see that there is light at the end of that tunnel and a better life ahead.”
Training 3
Facing Homelessness:
A Personal Account
Karen Raisley (CiCi) is a Rochester resident who experienced 4 years of being homeless, 2 ½ of which were right here in Rochester. CiCi is a former professional ballet dancer and nurse who faced numerous obstacles and hardships that resulted in her becoming homeless. Her hope in sharing her experience is to help others develop a greater understanding of what it is like to be homeless and how as a community we can respond with empathy and compassion when addressing this problem.
(November 30, 2020)
Key Takeaways from Cici Raisley’s Presentation
- Consider your own biases and how your words or actions may be perceived as judgmental.
- “Homelessness should not be an embarrassment to the people who are experiencing it.”
- “I was treated with more empathy when I had an address.”
- When working with unsheltered patients, inquire about the details of their situations. Cici suggests asking, “What are the circumstances that brought you there?”
- Curiosity allows for more tailored care: “The more you find out, the more you’re going to be able to help that individual.”
- Consider patients’ circumstances after they leave the hospital. Provide information about local shelters and other resources.
- “It’s very important for the medical community to be informed” so that patients can be informed.
Read the transcript here
Training 4
Law Enforcement
Officer Doug Remling with the Rochester Police Department’s Community Action Team discusses the role of law enforcement in addressing homelessness and how physicians can work together with law enforcement to serve unsheltered patients.
(January 11, 2021)
Key Takeaways from Officer Remling’s Presentation
- Officers trained in crisis intervention use active listening and other interaction skills when working with homeless individuals to help diagnose problems.
- “We will try to get to know them. We’ll ask them what their story is. We try to educate on what resources are available to them.”
- It is essential for medical professionals to collaborate with officers who bring homeless patients to the hospital.
- “We might be able to tell you the circumstance the patient was found in, what we observed at the scene, what we know about the individual. We accomplish more when we are able to work together.”
- Fires under bridges can cause carbon monoxide poisoning.
- Lack of access to restroom facilities can pose sanitation risks.
Read the transcript here
Training 5
Housing Policies and Programs
Commisioner Sheila Kiscaden of the Olmsted County Board of Commissioners, a former Minnesota state senator, discussed policies and programs in Olmsted County to address housing and homelessness.
To learn more about several of the initiatives and programs Commissioner Kiscaden discussed in her presentation, see:
- Destination Medical Center
- Olmsted County housing strategies
- Coalition for Rochester Area Housing
- Dorothy Day Hospitality House
- Damascus Way
(January 20, 2021)
Key Takeaways from Commissioner Kiscaden’s Presentation
- “I just really want you to understand this, that community members raising issues gets government action, maybe not quickly, but it does.”
- “…there are so many particular needs. People who end up homeless, sometimes it’s more than just a place to live. It’s the services that they need to be able to stay stable. This is particularly true for those young parents, or the mentally ill with serious and persistent mental illness or strong substance abuse; they need other kinds of supports.”
- “We need housing that people who earn very little can afford to live in. We need more single-room occupancy housing. We need housing that has subsidies for families who need the subsidy to live in the housing . . . We need to build the supply of housing in our community, and we need to build it for all income levels”
Read the transcript here
Training 6
Youth and Families
Melissa Brandt, Transitions and Fostering Connections Coordinator, Rochester Public Schools, discussed the “invisible” homelessness among youth.
Melissa Brandt referenced the following resources:
(February 2, 2021)
Key Takeaways from Melissa Brandt’s Presentation
- “46% of Minnesota’s homeless in the Wilder study were 21 years of age or younger. If you bump that number up to 24, it’s 52% of Minnesota’s identified homeless. And, that is not including families who are doubled up or living with other families. The majority of Minnesota’s homeless are youth, children, and young adults. That’s often a big reset for people. The average age of a homeless student in Minnesota is seven [years old].”
- “I always embody [respect] before it’s expected, because a lot of times when families come to me, they’re very deregulated because they’re probably upset about something happening at home and that sort of thing. I always say: ‘I can tell that you care about your children as much as I care about them. Let’s figure this out.’ When you embody that respect, that respect is returned to you.”
- “We get so afraid of breaking a rule or doing something wrong that I think is to the detriment of families. If I could encourage anything, I would say if you’re going into the field of pediatrics, be connected to the schools. Legally, every single public school system has a homeless liaison. It’s federal law. We are in every single public school district and we’re a connection for tons of resources for physicians.”
Training 7
Providing Support
Sheryl Block and Sean Haggerty Jr, from the Zumbro Valley Health Center, a private, non-profit organization that provides mental health, substance use disorder, primary care, and community-based services to twelve counties in SE Minnesota, talked about caring for unsheltered patients.
(March 2, 2021)
Key Takeaways from Sheryl Block and Sean Haggerty’s Presentation
- “The other thing I would really touch on is just continuing of care. Really important is having that long-term relationship. I know you all work in medicine so sometimes that doesn’t always work out. What I would suggest, especially in that scope, even if you’ve met with this person a couple of times but you have to transfer them for whatever reason, do that warm handoff, even be involved in that, too. That will really help build that relationship.”
- “…in our approach, we use harm reduction. That seems to work the best. The beauty of that is we meet people where they’re at, especially in their addiction or even in their mental health. I’ve come across a few folks that don’t even want to acknowledge that they have mental health issues . . . so again I really focus on just building that relationship, building that rapport, and taking it kind of slow with them, too.”
- “Everybody wants to be treated with respect. These are folks like anyone else. Treat the person and not the disease, or leave the judgement behind. Even the littlest disrespect, and it could be the way you ask a question, it could be the way you look at them; clients pick up on that. It really affects them and their willingness to come back.”
Read the transcript here