The Contributor talked with Dr. Jennifer Joy Hess, assistant professor of emergency medicine at Vanderbilt University, and Sophie Druffner, Ph.D. student for Community Research and Action at Vanderbilt, as part of a series called A Few Questions With. In this series, we interview local politicians, department heads and city leaders about their work.
Hess has been exploring the possibility to collaborate with Contributor vendors to form a Consumer Advisory Board as Vanderbilt University develops its Homeless Health Services, a collaborative approach to bring health care to people experiencing homelessness and transitioning out of homelessness where they live.
Dr. Hess, tell us a little bit about the vision and goals of the Vanderbilt Homeless Health Services. How did it come about and when will it launch?
Dr. Hess: Previously at Vanderbilt, there had been a street psychiatry service. Dr. Sheryl Fleisch was trained in street psychiatry and came to Vanderbilt and established that program, which did fantastic and lasted from 2016 to 2019 until Dr. Fleisch departed. Unfortunately, there was not enough momentum at Vanderbilt to keep the program going. I came to Vanderbilt in 2020 and am working in the emergency department. People experiencing homelessness are folks that we sometimes have a hard time treating. Often we see these patients coming back in because they were unable to receive follow up care while living on the streets.
So, there was a group of four of us — two emergency physicians, a Med-Peds physician, and a surgeon — who connected with Open Table Nashville and People Loving Nashville, and they started telling us of some of their needs and their resources. We started putting our heads together, and it’s taken a while to gain some momentum.
But as we started talking about what our mission and vision would be to bring health, not just medicine, to those living on the streets, help educate and develop empathy among the providers, and to really create a system so that when the patients touch Vanderbilt we can create the loop of care to meet not only people’s immediate medical needs but follow up and provide high quality care.
In this whole process, when we share the vision, it feels like people at Vanderbilt get very excited to come on board. There is a med student group and undergrads that want to collaborate. We hope to not only improve the health care system within Vanderbilt to serve people experiencing homelessness but also instill empathy in health care providers. We hope this will carry over so that wherever health providers are, they understand the barriers to someone experiencing homelessness getting care and understand how to connect people with community services that could lead to obtaining housing.
When you talk about systems, what do you focus on specifically?
Dr. Hess: The system we’ll have most control over will be within the VUMC (Vanderbilt University Medical Center). But it’s pretty clear that we cannot work in isolation. We have reached out to Neighborhood Health to collaborate. We realize we need to be able to seamlessly connect the care that’s been given to people experiencing homelessness whether that’s in the hospital or the specialty care at Vanderbilt or at Neighborhood Health in primary care clinics. It is also important to connect with Park Center to help us out with other resources such as housing navigation, or to connect with Open Table Nashville, and others to provide comprehensive services.
So, there is an internal system we have to build at Vanderbilt, and we also need to learn how to work with partners outside of Vanderbilt to truly develop a comprehensive health approach which includes linking to housing and other services.
Sophie: In developing this program, we’re thinking about the entire health care system. As part of that we are looking to create a Consumer Advisory Board and take an equitable approach. We are exploring how we can collaborate with different providers and also help people with lived experience provide insight to improve the system.
Dr. Hess: Some of the people who are most excited about this are educators. There is an opportunity to go beyond teaching somebody the facts to show them the human aspects of medicine. We hope to create a bi-directional learning environment that could happen at the Consumer Advisory Board (CAB). Medical students could help teach CAB members how to do a resume and offer tips for a job interview. And CAB members in turn could teach students what it actually means to live on the streets, and then we have this learning that could happen back and forth that you can’t get just in the clinic.
What is the budget, and do you have all the funding already?
Dr. Hess: We are currently working on building the budget. We’ve been working with our finance team to think through the patient stories and combine that with data. We want to build our team and provide services while creating a service model that may save the hospital some resources by reducing health costs that occur with high-needs populations. Our budget will include costs to put a team together to provide medications and supplies, to connect to other partners, and to meet social needs.
Minimum staffing you’re looking at to get launched?
Dr. Hess: Some of our staffing model will change depending on our ability to connect with Park Center. Through that potential partnership, we probably can leverage cost through some of their SOAR (SSI/SSDI Outreach, Access, and Recovery) and housing navigation programs.
But we still need a case manager, a social worker, and then we would like to have some community health workers, who would be people trained in basic health knowledge and have some experience with homeless services. We’d love to get a program manager who can help with the logistics between different departments and keep track of the financial aspects of the program. Physicians and nurses will also be a part of the program and come from different specialty backgrounds
Eventually we hope to grow the program based on efficiency we can show.
We met and spoke at The Contributor, specifically about how you seek input from people with lived experience. Why do you think it’s important to always include the voices of the people we’re trying to serve?
Sophie: What we want to go for here is for the people with lived experience in homelessness to be able to tell us where people are, what wounds are prevalent when living outdoors, and how community organizations work together from their perspective. We find it very helpful to get their impressions of how systems in Nashville work or don’t work for providing health and homeless services.
When it comes to navigating the system of homeless health care, we need their user experience. So, we really want to leverage their expert advice through the Consumer Advisory Board.
Dr. Hess: In any systems work, the more input and feedback you can have from different angles, the better you can design the model you are trying to build. Without the appropriate input you can end up with a model that delivers unintended consequences. Especially in equity work, you have to intentionally bring the voices of the vulnerable and people you want to serve to the table from the very beginning.
What are the next steps for you to make Homeless Health Services happen?
Dr. Hess: We started mapping out the timeline and are getting very close to pitching the budget. Our aim is to become a sustainable service line within the Vanderbilt University Medical Center.
We also continue to meet with vendors from The Contributor in our efforts to launch the Consumer Advisory Board and learning from the people with lived experience as we design and finalize the program.
Sophie: We’re also working with potential partners such as Park Center, Open Table Nashville, People Loving Nashville, the Vanderbilt School of Nursing, and Vanderbilt’s Peabody College. We want to create a cross-sector collaboration and are seeking input from all these groups and more. As we get off the ground and grow, we’ll create more formalized partnerships.
Dr. Hess: When street psychiatry was done previously, , Vanderbilt had an amazing team. Unfortunately, when Dr. Fleisch and key members of her team were not able to stay, the program was not sustainable. We want to learn from this and build a system that is integrated and sustainable long-term. Unfortunately, systems building is a slow process.
Sophie: We’re learning a lot from our partners and from people with lived experience. Dr. Beth Shinn (a national homelessness expert teaching at Peabody College) has been extremely helpful for us to better understand the local landscape.
Anything else?
Dr. Hess: We aren’t doing this for the fame. We are passionate because we witness inequities. Our goal is to treat people with dignity and respect. We are all human and just one decision away from being in a similar scenario. Ultimately, we would love to work ourselves out of a job because we solve the systemic problems such as addiction and access to affordable housing.
We believe housing is healthcare.