Community Health Forum
December 4, 1999
St. Vincent de Paul Village

Summary: Margaret McCahill, MD - UCSD
Medical Director, St.Vincent de Paul Village

The Partnership between Multi-Disciplinary Medical Education
and Service to the Homeless Community in a Free Clinic

The licensed community clinic at St. Vincent had 6,000 patients in 1992 in 1999 the number of visits significantly increased to 26,000 patients. The clinic maintains a total average of 3,570 visits a month.

The homeless population is divided into two segments the situationally homeless and the long term homeless. Approximately of these two segments 1/3 are children and families and another 5% are youth. Senior citizens are a growing population in the homeless community.

Common problems when working with homeless populations are difficulties in tracking these individuals. A variety of issues such as mental illness, substance abuse or a combination of the two adds to the complexity. A concern for the medical practitioner is how to meet the needs of the homeless. Some programs have proved successful when mental health services are offered in a traditional primary care setting.

The approach at St. Vincent de Paul Village is a combination of education and service to access and treat homeless persons. A multi-disciplinary approach including case management, an assessment center, and a counseling center have proven useful in providing services. In the area of health service there are faculty and trainees in gastroenterology, dentistry, OB/GYN, family medicine, adult and pediatric medicine, as well as other disciplines.


Maria Leech, MA - UCSD Division Chief, Reproductive Medicine/Community Services
Reproductive Medicine in the Community

The Division of Community Services functions as a broker of services. Current projects in the Division of Community Service:

Services

CAL-LEARN provides case management to pregnant or parenting 18 year olds. The goal is to assist these individuals in learning ways to access health care for themselves and their family.

OPTION FOR RECOVERY is a collaborative effort to provide outreach to others and children who have a problem with substance abuse. Since the program inception in 1989, 475 infants have been born drug free.

BRIGHT FAMILIES functions as a collaborative with 11 different agencies in San Diego. The goal of the program is to prevent unintended pregnancies and also to involve fathers in the care of their children.

HOMELESS OUTREACH serves homeless pregnant women and teens.

Research

Cal-Learn Tutoring Program provides tutoring on a one-to-one basis for teenagers. The goal is to increase the number of students graduating from high school and improve self-sufficiency. The project is currently in the pilot phase.

Other areas include intern training and clinical guidance for graduate and undergraduate students in public health, social work, rehabilitation, and communication.
Sheila Pickwell, Ph.D., CFNP - UCSD
Director, Graduate Nursing Education

UCSD Family Nurse Practitioners' Community-Based Programs

The participants in the Nurse Practitioner (NP) Program work with refugees and border populations. Examples of some programs are the Breast Cancer Early Detection Program (BCEDP), work with refugees, and a mobile clinic.

BCEDP

The BCEDP program is an on-site mammography program, which goes to the garment factories along the border. Exams take place in the summer when more time can be dedicated to screening and travel to the garment factories. The largest factory is American Fashion with hundreds of women working 40 hours a week for an income of $800 a month. Their low incomes and the high deductible on their insurance make them eligible for the state program. Hundreds of exams are performed each year and some early cancers have been detected-last year 3, this year 2. Each year more women come for exams as they hear about our project and our success in detecting early cancer. Katy Parker owns the mammogram machine and takes the pictures, Sheila Pickwell does the clinical exams, and Linda Olsen-UCSD radiologist reads the films. Funding for the program is obtained from contracts with us, and an ongoing task of bringing in a little money to keep the program running. BCEDP is a state program funded by the tobacco tax money.

Refugees

For approximately 15 years Catholic Charities of San Diego County has, been responsible for the resettlement of newly arriving refugees to San Diego. It is estimated that 2,500 refugees a year from all over the world come to San Diego. For six or so years Catholic Charities has contracted with the NP program to provide health screening two days a week and also monitor the tuberculosis (TB) program-giving out Isoniazid (INH) to the infected. All active TB cases go to the health department for follow-up. A part-time nurse practitioner does most of the screening. Currently we are seeing Kosovar refugees and still many African and Vietnamese families. Russians continue to come in many of which have chronic disease such as hypertension, Diabetes, heart diseases, and liver disease.

Illegal women and children who are being held by Immigration and Naturalization Service (INS) are screened for a variety of reasons. The facility is able to house about 30 patients at a time. Our major population through the ten years has been Central American teens coming here to escape conscription in rebel armies, Mexican citizens coming to work here, the Chinese who are being caught in packing crates in Long Beach, and we are getting many Russians who can't get in as refugees. Every Tuesday a staff member examines the new comers. Most of these are healthy people as a rule since they are coming here illegally to work. Most claim Amnesty and will spend years in court trying to stay-they are bonded out of the facility and live and work in the community until a determination of their status is determined.

Mobile Clinic

The mobile clinic is a joint effort between Logan Heights Community Clinic and UCSD Adolescent Medicine. Larry Friedman from Adolescent Medicine is the Principal Investigator on the project. Both Larry and Bret Pickering alternate Tuesday and Thursday evenings with a resident. Adolescent Medicine staffs the clinic Tuesday and Thursday evenings from 6:00p.m. -10:00 p.m. The NP program was selected to staff the clinic on Wednesdays in Ocean Beach. The majority of the population is made of homeless and other at risk teens. We work with a team of outreach workers who go out into the streets to locate clients. Emphasis is placed on testing for HIV and there is a counselor from the UCSD Mother, Child, and Adolescent HIV programs who participates. Many of the patients have cases of various sexually transmitted diseases (STD), infected tattoos, other skin problems and ear, nose, throat and lung problems. The clinic offers the ability to treat these individuals who may others not actively seek treatment.