Biederman Submits Kate B. Reynolds Charitable Trust Application

Kudos to Donna Biederman and her entire team for the submission of their Kate B. Reynolds Charitable Trust application entitled "Improving Access to Health Care for Homeless Individuals: The Durham Transitions Consult Clinic." This proposal requests funding for a three year period with a start date of June 1, 2018. 

Homelessness has increased nationwide and the number of unsheltered homeless individuals in Durham County is at an all-time high. Homeless and housing insecure persons have a higher rate of emergency department (ED) utilization, longer inpatient hospital stays and may miss primary care and follow up appointments due to the increased burden of unstable housing. Housing is an integral part of health and health care and is increasingly viewed as a health care intervention.

Duke University Health System (DUHS) and Lincoln Community Health Center (LCHC) have plans to begin screening for housing insecurity and homelessness. Each of these entities also have clinics that are currently providing primary care for homeless and housing unstable patients: Lincoln Healthcare for the Homeless Clinic (HCH) and the Duke Outpatient Clinic (DOC). However, at this time, there is not a clear pathway for referrals to these clinics once housing issues are identified. Neither clinic has a dedicated housing specialist available to work with homeless patients to identify a pathway to housing which results in missed opportunities and overburdened staff. Additionally, there is no process for triaging homeless patient to the level of service that best matches their need. Our proposed intervention, the Durham “Transitions Consult Clinic,” will improve and expand on current initiatives serving the homeless in our community with primary goals of increasing access to primary care and housing.

The Transitions Consult Clinic will capitalize on lessons learned from the Durham Homeless Care Transitions program (DHCT). Our team has more than 45 combined years of experience in working at the intersection of health and housing. In 2016, we received a Hillman Innovations in Care award and launched DHCT to assist homeless persons with ongoing medical needs transitioning from institutional settings (e.g., hospitals, behavioral health facilities, local jail) back into the community. DHCT offers patients up to nine months of case management by a Population Health Specialist and medical respite care as determined by the Nurse Practitioner who serves as the clinical director. We’ve learned that not all patients are appropriate for DHCT. Some are medically stable and self-reliant. Their primary need is housing. Others need high level psychiatric care, substance abuse treatment, or skilled nursing services. In these cases, the referring agencies are unaware of potential options and need expert consultation to ensure patients are discharged into optimal care situations. The Transitions Consult Clinic, a clinic without walls, will expand the capacity of DHCT by adding a Housing Specialist to our team. Primary referral sources to the Transitions Consult Clinic include DUHS, Project Access of Durham County, DHCT, LCHC and the Community Paramedic Program.