Our program

Our foundation for care is built on the understanding that aspects of substance use and our society’s attitudes toward substance users can be destructive to an individual’s health, and broader social systems. Our program focuses on reducing the most severe harms, including fatal overdose, infectious diseases, neglect of overall health, needle waste in the street, and violence and crime. Our program is made up of 3 key component: Engage, Care, and Transition.

Engage​

Street Medicine Health Workers and community partners outreach, engage, and assess patients in targeted locations including streets, parks, encampments, sobering centers, harm reduction centers, navigation centers, or in open-access clinic spaces.

OUR APPROACH

Individuals are informed about San Francisco Department of Public Health efforts to reach and help active substance users who inject in public places. Our education and assistance focus on:

  • Referral to street medicine for assessment for low barrier buprenorphine start
  • Reducing syringe and needle waste left in public places
  • Facilitating access to treatment, including navigating to methadone treatment and residential or outpatient treatment programs for those who are appropriate and interested
  • Assistance to obtain Medi-Cal for those eligible
WHAT’S WORKING
  • Our team is mobile and assessments can be completed in the field
  • Using a flexible and harm reduction approach to rebuild the relationship between a patient and their desire to engage in care
  • Holding open access clinic hours in nontraditional sites where patients already feel comfortable
  • Hiring navigators and health workers with an authentic relationship to individuals and communities experiencing homelessness  

Care

We take a patient-centric approach that emphasizes flexibility and collaboration. Our goals are our patients’ goals whenever those goals are moving in the direction of health.

OUR APPROACH

The Street Medicine team physician or nurse practitioner with the Drug Addiction Treatment Act of 2000 (DATA 2000) waiver evaluates patients face-to-face. The following information is documented:

  • Diagnosis of moderate to severe opioid use disorder
  • Challenges to success of treatment including co-occurring disorders
  • Presence or absence of community support and stresses
  • Presence or absence of contraindications
  • Presence or absence of concerning activity on review of CURES (CA PDMP)
  • Consent to treatment
  • Patient goal and level of determination to engage in the program
WHAT’S WORKING
  • Supporting patients throughout their journey to wellness
  • Getting rid of appointments. Open-access allows patients to receive care on a schedule that works for them
  • Outreaching patients and staying connected. We visit patients in hospitals, jail, detox, and residential treatment facilities
  • Having a multidisciplinary team with unique skills to offer throughout a patient’s treatment experience
  • Welcoming return patients back into care and assessing how to improve care and connection moving forward
  • Patients who request re-prescription (re-engagement) after a period out of care, usually receive it

Transition

Transition is about easing a patient’s move from care with the Street Medicine Team to traditional primary care or other outpatient opioid treatment in the community. Additionally, transition may include supporting a patient in a move to reunite with family, obtain employment, or otherwise exit homelessness.

OUR APPROACH

Transition out of care with the Street Medicine Team is not a pivotal moment in the patient’s health journey. It’s one part of a voyage through a much larger ecosystem of services and programs that can and should be working towards a holistic approach to care for people experiencing homelessness.

WHAT’S WORKING
  • Preparing patients for common challenges of a traditional primary care clinic, including appointments, limited visit times, and waiting rooms. Where possible and desired, offering accompaniment to traditional primary care clinics
  • Connecting patients to harm reduction-oriented health providers and waiver programs in other cities
  • Keeping the door open. Care is not linear, and we welcome any past patients back into our clinic without judgment

How we got started