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Street medicine pilot launches in Garden Grove

April 5, 2023

Health care providers are taking to the streets of Garden Grove armed with a “doctor’s office on wheels” to bring medical assistance to homeless people where they are at – including primary care, but also behavioral health services and case management.

The street medicine program is being organized by the county’s provider of publicly funded health coverage, CalOptima Health, in partnership with the city of Garden Grove and Healthcare in Action, a medical group that provides health care and other services to unhoused individuals. Through a $4 million, two-year contract, Healthcare in Action will deliver care to up to 200 CalOptima members using a medical van to reach those living in parks, under freeways and elsewhere on the streets.

CalOptima Health CEO Michael Hunn talks with nurse Nicole Coye inside the mobile doctor’s office during its introduction in Garden Grove, CA on Tuesday, April 4, 2023. The mobile medical unit is a partnership between CalOptima Health, the City of Garden Grove and Healthcare in Action. (Photo by Paul Bersebach, Orange County Register/SCNG)

Visitors look at the mobile doctor’s office during its introduction in Garden Grove, CA on Tuesday, April 4, 2023. The mobile medical unit is a partnership between CalOptima Health, the City of Garden Grove and Healthcare in Action. (Photo by Paul Bersebach, Orange County Register/SCNG)

CalOptima Health CEO Michael Hunn, left, talks with Healthcare in Action CEO Michael Hochman, M.D. during the introduction of the mobile doctor’s office in Garden Grove, CA on Tuesday, April 4, 2023. The mobile medical unit is a partnership between CalOptima Health, the City of Garden Grove and Healthcare in Action. (Photo by Paul Bersebach, Orange County Register/SCNG)

Visitors look inside the mobile doctor’s office during its introduction in Garden Grove, CA on Tuesday, April 4, 2023. The mobile medical unit is a partnership between CalOptima Health, the City of Garden Grove and Healthcare in Action. (Photo by Paul Bersebach, Orange County Register/SCNG)

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“This program focused on bringing supportive health care and social services for our homeless community is a model of dedicated teamwork, outside-the-box thinking and passion for serving those in need,” Garden Grove Mayor Steve Jones said during a press conference on Tuesday.

Along with being mobile, the program uses a “people-centric” approach, said Benjamin Kaska, Healthcare in Action’s director of clinical operations.

“There’s a barrier to care,” Kaska said for people who are dealing with homelessness. “When you go to a doctor’s office, you’re expected to arrive on time, have all your paperwork organized, I.D., your payment. In this environment, you remove those barriers. We come out and provide the care directly to them, wherever they’re located.”

A large percentage of folks experiencing homelessness are in “survival mode,” prioritizing where their next meal will come from, where they will sleep and taking care of their belongings, said Kelly Bruno-Nelson, CalOptima’s executive director of Medi-Cal/CalAIM.

“Clearly, health care needs come secondary to that,” Bruno-Nelson said. “It’s not that folks on the street don’t care about their health, it’s that they can’t prioritize it because they have to prioritize basic needs that those of us who are housed don’t have to prioritize.”

Deploying with be a medical team with a physician assistant and registered nurse, who will provide primary care and clinical management, and a “peer navigator” team with a social worker and an individual with lived experience, who will be offering supportive services and community resources.

The peer navigator team will approach people on the street to make connections and see what help they need; once someone engages with the program, Healthcare in Action will function as their primary care physician and visit on a regular basis, Bruno-Nelson said.

“We feel very strongly about, when it comes to street medicine, unlike the traditional health care system, it’s rapport first, and then care second,” she said. “If you can’t build rapport with those that you’re serving, you won’t be able to provide the care. So, you have to have folks on your team who know what it feels like to be unhoused. Lived experience is very important.”

Challenges the teams will face include locating their patients and providing medications, because most pharmacies require a form of identification, according to Kaska.

“Some of the barriers that we’ve tried to avoid still exist within other areas, and we try our very best to navigate those waters and provide the care despite the barrier,” he said. “Some of our teammates, for instance, will go and will pick up the medication for the patient and deliver it back to them, which is time intensive, but it matters.”

Kaska said locating unhoused patients is easier with the help of those who know the community best, including local law enforcement. Also, patients can be given a cellphone or a GPS tracker if they’re willing.

After six months of running the street medicine program in Garden Grove, the goal is to expand to other cities throughout the county, according to Bruno-Nelson.

CalOptima CEO Michael Hunn said the county organized health system’s entry into providing street medicine is one of the many programs in the relatively new state initiative, California Advancing and Innovating Medi-Cal, or CalAIM. The state Department of Health Care Services launched the multiyear health program to strengthen Medi-Cal by integrating in other social services.

“We’re taking (CalAIM) seriously,” Hunn said. “The impetus for this, and us expanding into it, is to be that health plan that takes the health and – as this van says – puts it in action.”

In his years working in health care, Michael Hochman, CEO of Healthcare in Action, said he has never seen so many community entities joining together to address homelessness.

“This is the first time in 20 years that I have seen around the table city leaders, county leaders, law enforcement, EMS, fire, health plans, community organizations; it’s really an incredible testament to Hunn and his team at CalOptima and the city of Garden Grove to pull this together,” Hochman said. “I applaud them not just for being ambitious with the goal of making a dent in homelessness in Garden Grove, but in the holistic approach.”

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Street medicine pilot launches in Garden Grove

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