There are a lot of barriers to overcome when running a family practice for the homeless population, says Greg Morris. But, he says, there’s also a lot of opportunity to make a difference.
Greg is the Program Director of Peak Vista’s Homeless Health Center, which serves roughly 3,500 people in Colorado Springs, Colorado. As a family practice, its patients run the gamut from pediatric care to geriatrics. And because the population served by the clinic has often been marginalized from health care and other services, he says what’s different about his patients is not so much the types of diagnoses, but rather, the complexity of diagnoses. He describes it as the “orange juice concentrate of health problems.”
“Instead of just blood pressure issues, for example, [there are] multiple issues combined in one individual,” Greg says. “It makes each encounter very complex, but you provide the best services you can because it might be the one opportunity for them to take an interest in their health.”
Understanding the competing issues faced by people experiencing homelessness has helped him provide this care. Greg’s patients might forgo health care in order to buy food, or because they need time to travel across town to get disability services or find a place to sleep that night. The fact that health care providers and patients experiencing homelessness have different sets of priorities can make the process very slow, he says.
But it doesn’t mean that the process doesn’t work, Greg adds. Sometimes it just requires a lot of patience. He recalls one patient, Frank*, who came to see him with serious liver disease caused by excessive alcohol use. “We were able to start slow, and that’s where our training in Motivational Interviewing and Trauma-Informed Care came in,” says Greg. “We saw him on his time frame, at his comfort level, and we were able to help him stop using alcohol and start taking medicine.” Frank got into a shelter, went on to earn a Medical Assistant technical degree, and is now working in a local hospital.
Greg says he believes his patients are doing the best they can. He says that even those who are in completely desperate situations often go out of their way to do something nice for him in return for his services, recalling one patient who brought him his favorite soda, for instance. And Greg doesn’t lose heart. “You can make a difference as people transition out of homelessness,” Greg says. “It happens more than you think—just not as often as you’d like.”
The Homeless Health Center is a Federally Qualified Health Center that is connected to the main Peak Vista Health Clinic. As a separate program with its own funding stream, the clinic has learned how to run an effective homeless medical program with very limited resources.
One of the biggest obstacles comes from its fixed funding amounts, which limit the clinic’s hours and the number of clinicians it employs. Greg is the primary provider at the clinic, with only two medical assistants who alternate shifts. The clinic sees about 10 to 12 patients during each half day it is open.
One strategy the clinic employs to address its limited resources is to connect its patients with other local providers, either through the specialty clinic at Peak Vista or the local network of mental health care providers. The Homeless Health Center also meets patients where they are, taking their medical and mental health mobile outreach van to gathering places like soup kitchens, transitional care facilities, and rural areas where access to health care is extremely limited. “[The mobile medical van] was born out of the street outreach approach,” says Greg. “Providers know how important direct outreach is [with people experiencing homelessness].”
Greg says he used to feel very isolated because there weren’t many local colleagues available to discuss providing better homeless services. He says that’s why he finds it so important to stay connected with larger networks of homeless service providers. He is involved with the National Homeless Council, the Homeless Clinicians’ Network, and respite networks, for example.
Not only has this helped him access trainings in evidence-based practices—like Motivational Interviewing and Trauma-Informed Care — but it has also allowed him to meet a community of his peers at regional and National meetings. He says being able to pick up the phone and call a colleague from across the country to talk through a struggle has helped him to feel like part of a supportive peer learning community.
But if you ask Greg, taking good care of people experiencing homelessness really starts with taking good care of yourself. A few years ago, he realized that it had been five full years since he had taken a real vacation. Burnout had started to set in, and he began having negative thoughts about the people he was serving, even though he knew that they were doing the best they could.
“[Burnout] can really sneak up on you,” he says, adding that it’s hard for the work not to affect providers emotionally when they spend each day listening to difficult and sometimes disturbing stories from their clients.
“So that’s when I made the effort to take a substantial vacation, and to step away and cleanse so I could be at the top of my game every day that someone comes in to access services,” he says. “Because it only takes one bad encounter to lose that person forever, but every good encounter can lead to getting [that person] out of homelessness.”
*Not his real name. His real name has been changed to protect his identity.
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