Mobile Unit Team (MUT)

State: CA Type: Model Practice Year: 2009

There are 35,000 homeless in Orange County. From November to April, two cold weather armories are opened housing overnight up to 200 clients at each site. We wanted to provide primary care triage and wrap around services to this population, who are unable to access the system of care. Our goals are threefold: Goal 1: Provide primary care triage and wrap around services to the homeless. Goal 2: Use the Mobile Unit Team as an educational and training opportunity for healthcare providers. Goal 3: No families in the armories. We have been able to provide primary care triage and wraparound services to 2,100 individuals who are homeless in Orange County. In addition, we helped establish Illumination Foundation, a 501c3, that provides shelter and wrap around services to families in two motel settings. Currently there are 50 families receiving services at the motel sites.
There are several public health concerns surrounding the homeless population: caring for the homeless is a core public health function; lack of a medical home; inability to access a very complicated system; no coordination of care; the potential for spread of diseases such as tuberculosis; no prevention services; limited housing, occupational, and educational opportunities. We made more than 100 presentations to key stakeholders to help with the formulation of this public health initiative. We developed the following: Two dedicated CHAT-H nurses in the Health Care Agency, two mobile units providing health care triage, Illumination Foundation (a 501c3 organization). There was an obvious need to help with case management for the homeless population. Prior to this program, public health nursing did not focus on solely on the special needs of this population. In addition, there were a multitude of services provided by the community with limited or no coordination. The public health practices are the same but redirected to a special population—the homeless.
Agency Community RolesThe LHD provided leadership with funding. We were able to establish a public health nurse devoted to the homeless population and rally our private and public partners to provide help with current resources. The public partners included Orange County Behavioral Health Services, Social Security Administration, Housing and Community Services, Office of Aging and Homeless Prevention, Orange County Department of Education, Medical Services Initiative (MSI), CalOptima, and the Health Care Agency. Private partners are Kaiser Permanente, Children’s Hospital, Hospital Association of Southern California, Boys and Girls Club of Garden Grove, Orange County Rescue Mission, Catholic Worker, Salvation Army, University of Southern California, and St. Joseph’s Hospital System. They are all part of the planning process. Monthly meetings are held with all the Mobile Unit Stakeholders to help with planning and implementation. The LHD provides leadership to bring the stakeholders together and foster relationships. This role has been handled by the public health officer and public health nurse. Costs and ExpendituresThe mobile unit team was implemented in November 2007. We recruited Kaiser Permente family practice physicians and residents, Cal-Optima and MSI staff, mental and behavioral health providers, and public health nurses. This public-private partnership was supported completly by in-kind contribution of resources. Our private partners helped fund the Mobile Unit RV with two examination rooms, and pharmacy with dispensing license at the cost of $30,000 for one year of operation. ImplementationWe brought community partners and county agency directors to see first hand the armory and the condition of the homeless. More than 150 individuals experienced this environment. In addition, we gave multiple presentations across the county. Once we were able to make the homeless population visible, our partners wanted to make a difference. The in-kind contributions helped in developing this program. We also established within the Health Care Agency, a dedicated public health nurse to help with care coordination. The position title was CHAT-H (Comprehensive Healthcare Assessment Team for the Homeless). Kaiser Permanente in Orange County developed a fellowship in the Family Practice Residency Program. This position is dedicated to serving the indigent population in Orange County. The mobile unit team consisted of the fellow, Kaiser volunteer residency physicians and University of Irvine Medical School students. During a given night, 30–35 individuals were seen. In addition, behavioral health, CalOptima, and MSI for the indigent had tables at the MUT, providing additional services and coordination. A 501c3 was formed in 2008 called Illumination Foundation (IF) that helps in provider coordination, funding opportunities, and the further development of the public-private partnerships. IF was instrumental in placing families into initial temporary housing and providing the necessary services leading to permanent housing and continued success. No families are in the armory.
A grassroots program in public health can be a reality with the right leadership and support.
A 501c3 called Illumination Foundation was created. Contributions have exceeded $300,000 from our private partners. The Orange County Health Care Agency has committed to public health nurses. The sustanability will be through Illumination Foundation funding and having the CHAT-H nurses as part of the core budget for the the Health Care Agency.