Street Medicine Program Brings Care to People Most in Need

The Street Medicine Program offered through Tower Health provides community wellness services to homeless individuals and those at risk of being homeless throughout Berks County.

The care philosophy of the emerging field of Street Medicine is to take primary and urgent care literally to the streets – to patients most in need and unable to obtain services through mainstream health systems. Successful programs are in place in over 85 communities across the country and around the world. By reaching out to patients, many challenges to accessing healthcare are reduced, including housing instability, limited finances, health-related legal issues, transportation and food insecurity. Street Medicine breaks down those barriers and provides regular healthcare – and all care, including medications, laboratory tests, diagnostic studies, and follow-up, are free of charge.

As Associate Vice President, Community Wellness, for Reading Hospital, Desha Dickson was a champion for street medicine along with a doctor who had previously practiced in an area where there was a successful street medicine program. After working through initial logistics, Street Medicine has been in place for five years. It focuses on five main goals:

  1. Increase access to primary care
  2. Reduce emergency room visits
  3. Increase prescription drug adherence
  4. Increase overall health awareness
  5. Increase access to specialty care

A core team of three people – plus many, many dedicated volunteer physicians, residents, medical students, nurses and registrars – make Street Medicine happen. Jodylynn Mill is the Clinical Director; CRNP; Darla Harris is the Case Manager, RN; and Yomari Salvador-Rivera is the Program Coordinator.

The medical teams are a consistent presence and do a combination of street outreach and holding clinics that are open to everyone. A 6-month schedule with clinic dates is promoted to all patients, and on average locations are rotated bi-monthly with both daytime and evening hours. Partner sites include New Journey Community Outreach, City Light Ministry, Hope Rescue Mission and the YMCA. Desha Dickson explains that “the Street Medicine SUVs are wrapped—marked by design—so people see us coming. Our role is advocate, friend, partner in their health, in an approachable way. We’re driving by and walking in areas where the homeless may be, going to where people already are and where they might be coming for a meal.”

Case Manager and Registered Nurse, Darla Harris shares that “what was initially surprising to me is how many of our patients have insurance—90% of our patients have Medicaid. But it’s the fear of being looked down on and frowned on that is a deterrent to them accessing the care they need. It is crucial for us to meet them in their environment for them to accept care.” In addition to her role providing healthcare services, Darla assists patients with medical system challenges. She schedules appointments, gets insurance authorization, helps with rides, and then follows-up with the patients after appointments.

Street Medicine opened their first telehealth kiosk at Hope Rescue Mission in November 2021. Desha Dickson is “really excited about the opening of our first virtual clinic. We can do both appointments and walk ins, and it provides an extra layer of access we didn’t have before.” At the scheduled time for an appointment, Nurse Practitioner Jody Mill calls the kiosk to talk with the patient. She walks them through some diagnostic steps and starts to build a relationship with them about their health. The onsite Hope Rescue Mission Case Manager helps each patient get ready and assists during the call if needed. The Case Manager then cleans the kiosk station between appointments. Additional kiosk locations are being planned for 2022.

One ongoing challenge is that with a transient population, up to 40% of the patients may only be seen once. Word of mouth about their experiences and the quality of the healthcare services should encourage patients to make their first visit and return. Program Coordinator Yomari Salvador-Rivera sees that the “patients are comfortable with us and feel safe so they are honest about their bodies. That helps us help them to access the care they need.”

The concept of a ‘classroom of the streets’ provides a unique service-learning opportunity for nursing and medical students and other clinicians. Working in the community helps to create a better understanding of marginalized populations and support a new model of patient-centered, relationship-focused, and culturally-sensitive care. Street Medicine has become a powerful global movement for health care equality and social change—where more compassionate communities value every person and they are treated with dignity. And this is what drives all of the amazing volunteers and the Street Medicine core team. Yomari says “I love working with other people who feel the same way; there are so many people helping out in Reading and doing it under the radar, they do it because they want to help others.” Darla adds that “it’s about the gratitude for the simplest things; one man asked for a flashlight and when we got one for him, he was so very grateful. It’s amazing.” And Jody sums it up: “it’s really the feeling at the end of the day, that you’ve done something to make a difference; you’ve helped make a change, even if it’s only one person.”

Street Medicine was the first recipient of the United Way of Berks County’s new Impact Grants. The Impact Grants were made possible by the generous donation from philanthropist Mackenzie Scott in 2020.