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up a rotating clinic each of a medical emergency. Our
day of the week at fixed patients are suffering and dying
community-based sites, such ten, twenty, even thirty years earlier
as a local church. Another than those living inside. Our current
team, the Mobile Medical and health care system is fragmented,
Mental Health Care Team, or provider and facility-centric, and
M3 Team, provides ill-equipped to robustly address the
patient-centered care for social determinants of health. This is
people experiencing the opposite of the system we need
homelessness with tri-morbid for this population. Street medicine
chronic medical conditions, and other patient-centered,
serious mental illness, and a integrated care models provide a crit-
substance use disorder. ical starting point to do better.
6,7
This team is “facility It starts with compassion, treating
agnostic,” meeting people people with dignity, building trust…
where they are in the and meeting people where they are.
community and providing
In Austin, the HCH program, comprehensive, integrated, wrap-
along with its street medicine team, around care for their medical, About the Authors:
is part of CommUnityCare, Austin’s behavioral health, and social needs. Tim Mercer is an Associate Professor in
largest federally qualified health A literal “one-stop-shop.” What the Departments of Population Health and
center. Most days of the week, a all of these care models have in Internal Medicine at The University of
team consisting of an MD or NP, common is that they put the patient Texas at Austin Dell Medical School and
medical assistant, and case manager at the center, meet them where they a General Internist with
hit the streets with their backpacks are, and prioritize addressing CommUnityCare’s Health Care for the
and mobile hotspots, seeing their health care and their social Homeless Program. Matt Hunt is a family
patients under the bridge or in their needs together. nurse practitioner, certified addictions nurse
campsites. On any given day, care While homelessness is complex practitioner, Affiliate Faculty of The
could involve draining an abscess and can seem overwhelming, University of Texas at Austin Dell
or providing overdose prevention and unfortunately has become Medical School, and the Team Lead for
education and supplies; managing increasingly politicized, from a health CommUnityCare’s Street Medicine Team.
complex chronic conditions such as care perspective, it is nothing short
diabetes or congestive heart failure;
facilitating access to emergency 1 Roncarati, J., et al. Mortality Among
services, whether for acute medical Unsheltered Homeless Adults in Boston, Mas-
or psychiatric conditions; or sachusetts, 2000 – 2009. JAMA Intern Med
2018; 178(9):1242-1248.
simply just sitting and talking, 2 Cawley, C., et al. Mortality Among People
building trust, and providing for Experiencing Homelessness in San Francisco
immediate felt needs such as hygiene During the COVID-19 Pandemic. JAMA
Network Open 2022; 5(3):e221870.
supplies or some dog food or a cold 3 O’Connell, J., et al. The Boston Health Care
bottle of water and bite to eat. for the Homeless Program: A Public Health
Increasingly, with the rise of Framework. American Journal of Public
Health 2010; 100(8):1400-1408.
climate-related health conditions, 4 https://www.streetmedicine.org/our-story
we treat frostbite in January and 5 Zlotnick, C., et al. Health Care for the Home-
February and manage heat illness in less: What We Have Learned in the Past 30
Years and What’s Next. American Journal of
the dreadfully long Austin summer, Public Health 2013; 102(S2):S199-S205.
ranging from heat stroke to literal 6 https://www.kut.org/health/2022-12-02/
burns people can get from lying homelessness-sick-mobile-medical-and-
mental-health-care-team-m3-dell-medical-school
on the asphalt or concrete. Other 7 https://www.statesman.com/story/news/
analogous care models are an equally healthcare/2022/12/29/austin-m3-team-
important part of the care continuum, collaboration-health-care-homeless-
community-clinics/69738687007/
including our mobile team that sets
TCMS 2023 September • October 13
