Josephine Ensign, DrPH

1
MedRest Medical Respite for Homeless Young People

• Josephine Ensign, DrPH
• University of Washington
• Seattle, WA
• Bjensign_at_u.washington.edu

2

• Funding provided by Group Health Foundation
  Children and Teens Grant

3
Partnership between

• University of Washington Schools of Nursing,
  Medicine and Social Work
• Seattle-King County Public Health/Health Care for
  the Homeless Network
• YouthCare
• Seattle-King County Medical Respite Program
• 45th Street Homeless Youth Clinic
• Country Doctor Homeless Youth Clinic

4
45th Street Homeless Youth Clinic
5
MedRest provides

• Overnight supervision of ill/injured homeless
  young people ages 18-24y
• Connect next day with Seattle-King County Medical
  Respite Program
• Life skills/self care training and connection
  with health insurance for homeless young people
  ages 12-24
• Cultural competency training to Seattle area
  emergency department/social service personnel

6
MedRest staff

• 20 UW health science (SPARX) student volunteers
• 8 Clinical Faculty
• MedRest Program Manager
• MedRest PI
• MedRest Steering Committee

7
MedRest Timeline

• April-June 2008
• Hired Program Manager
• Finalized referral and overnight protocols
• Trained overnight staff
• Set up MedRest site
• Finalized legal contracts
• June 2008-May 2009
• MedRest operational

8
MedRest numbersJune 2008-May 2009

• Provided overnight medical respite to 14 young
  people for 16 bed-nights (1 went to longer-term
  respite/inpatient CD treatment)
• Life-skills/self-care training to 250 homeless
  youth
• Cultural competency and minors healthcare rights
  training to 300 Seattle-area health care and
  social service providers

9
Referral Diagnoses

• Sinusitis/Bronchitis
• Post-appendectomy
• Upper respiratory infection/asthma
• ACL Tear (knee injury)
• Strep pharyngitis/viral syndrome
• Scabies
• Diabetes/off meds
• Skin infections

10
Resources provided to young person

• Medical benefits information
• Transportation
• Links to Transitional Housing
• Self-Care information
• Links to employment opportunities
• Links to MH and CD counseling
• Links to teen feed/food
• Assistance with follow-up medical appointments

11
Potential barriers from providers perspective

• Too many steps to initiate referral
  (transportation/too far/too sick).
• Lack of awareness
• Only 4x/week Needs to be 7 days/week
• Separation from friends
• Too many requirements for Respite

12
Barriers froma young persons perspective

• Lack of awareness about program
• Separation from friends/pets
• Clinics are only places processing MedRest
  referral
• Isolation/unfamiliar environment and staff
• Hospital/shelter environments are uncomfortable
  and chaotic
• Too much of a hassle just to rest

13
Suggestions on ways to improve the current model
of MedRest

• Referrals directly from drop-in centers/shelters
• Have program be connected with familiar
  agency/location
• Availability 7 nights a week
• Connect model with YouthCare on-call staff
• More days for MedRest stay
• Consider hotel Vouchers

14
What would make it easier for young people to
access MedRest?

• Increase places referring to MedRest/Respite
  (drop-in centers, more clinics)
• Widen age limit
• More transportation to clinics from drop-in
  centers
• More service providers announcing/spreading the
  word about MedRest at drop-in center meetings and
  events.

15
Most important elements of MedRest stay to young
people

• Dont have to worry about watching your back
• Cool Staff
• Medications
• Comfortable atmosphere
• Have your own space
• Clean clothes to sleep in
• Resources established for post-MedRest stay
  (food, clothing, shelter)

16
WHAT WORKED WELL

• Partnership building Outreach to
  youth/agencies/case managers/potential funders
• Volunteers
• Flow during overnights
• Collaboration with respite
• Post-respite stay follow-up
• Maintaining steady schedule for coverage
• Cultural Competency trainings
• Youth like skills/self-care trainings

17
Teach us more how to take care of ourselves. We
didnt get that growing up. (22 y.o. male)
18
CHALLENGES

• University Clinical Faculty hiring process
• Volunteer availability/busy students
• Need for peer outreach worker
• One-year pilot/unrealistic
• Difficult to convince young people of need for
  health insurance when are free clinics

19
VISIONS FOR THE FUTURE

• Referral system directly from shelter and
  outreach sites
• Include MH issues as part of eligibility to
  MedRest
• Create MedRest site within one of the existing
  agencies, such as YouthCare
• Build on success of life-skills and cultural
  competency trainings
• Education/incentives for youth connecting to
  health benefits