Emily Thomas MS, MD
Developing a Wellness Clinic Model at County-wide Vaccine Events for People Experiencing Homelessness
Other Program (if not listed above)
People experiencing homelessness (PEH) are less likely to interact with health systems for non-emergent needs, leading many people to only seek care when health conditions are urgent. The Department of Health Services’ Housing for Health (HFH) addresses health disparities amongst PEH through health and housing services. During the COVID-19 pandemic, HFH has overseen COVID-19 testing, quarantine and isolation shelters, and COVID-19 vaccine campaign to PEH throughout Los Angeles County. The unique opportunity to engage with a large number of unhoused individuals at vaccination events can be used to promote health services for overall wellness. Each patient at an event undergoes a 15-30 min post-vaccination observation period, where teams are able to engage clients and connect them to health services.
To develop, implement, and evaluate an expansion program of medical, social, and harm reduction services for PEH being vaccinated or residing near DHS vaccination sites.
Using anecdotal need reporting and a formal needs assessment, a working group was formed to guide the process of Vaccine PLUS (Vax+) program design. Following the initial design period, a pilot stage was initiated where two Vax+ staff members initiated services at various sites. Modifications to workflow and service model were made iteratively, resulting in further modifications to the overall Vax+ design. Once workflows were finalized, Vax+ staff members were provided with comprehensive training on all services provided at events. A Vax+ staff member was then assigned for each vaccine event and given a specific role in promoting wellness, harm reduction, and social services. Reports from each event were submitted daily for quality assurance and process improvement purposes.
Over the course of 4 weeks, there have been 107 successful Vaccine PLUS events out of the 153 total vaccine events tracked. At these events, we have conducted 441 blood pressure screenings and 203 blood glucose screenings. 439 units of Narcan have been distributed throughout the county to clients and staff members along with education on overdose prevention. We have assisted 63 clients with COVID stimulus support and attempted to connect 77 clients with local primary care services.
The Vaccine PLUS program has been implemented widely across a majority of HFH vaccine events over the past 1.5 months, with consistent tracking of services beginning on 6/14/21, but complete implementation of Vax+ has not yet been achieved across all SPA’s or amongst sheltered/unsheltered vaccine teams. Vax+ has offered a unique opportunity to capitalize on the mandatory monitoring period and provided clients with services beyond vaccination. While COVID stimulus assistance was highly sought after when conducting the initial needs assessment, it proved to be a challenging service to provide at all events given the limited advice that clinical and programmatic staff could provide. Many clients have been connected to local clinics due to abnormal blood pressure and blood glucose findings, but certain SPAs have a higher incidence of clients receiving referrals to primary care services, potentially indicating a specific lack of consistent care in SPAs 1, 6, and 7. Differences in supply and demand exist between sheltered and unsheltered populations with the former readily accepting wellness services and the latter readily accepting harm reduction supplies.