Santa Clara Valley Health and Hospital System

Valley Homeless HealthcareProgram (VHHP)

Cheryl J. Ho, MDCheryl J. Ho, MDCharles Preston, PhDCharles Preston, PhDSanta Clara Valley Health and Hospital SystemSanta Clara Valley Health and Hospital SystemMarch 6, 2008March 6, 2008

VHHP Mission StatementVHHP Mission Statement

““Valley Homeless Valley Homeless Healthcare Program Healthcare Program seeks to establish a seeks to establish a safety-net for the safety-safety-net for the safety-net.”net.”

VHHP Mission StatementVHHP Mission Statement

“ This program seeks to address the needs of vulnerable populations who require an integrated model of care incorporating medical, mental health, and substance abuse services.”

Mental Health

Drug and Alcohol

Valley Medical

Barriers to Health CareBarriers to Health Carefor Homeless Individualsfor Homeless Individuals

Patient

Health Care Provider

Health Care System

Health Status of Homeless Individuals: Health Status of Homeless Individuals: “Multiplicity of Needs”“Multiplicity of Needs”

Higher prevalence ofHigher prevalence of::– HIV, TB, Hepatitis CHIV, TB, Hepatitis C– Hypertension (2x)Hypertension (2x)– Poor dental health (31x)Poor dental health (31x)– TobaccoTobacco– Alcohol problems(6-7x)Alcohol problems(6-7x)– Severe, chronic mental illnessSevere, chronic mental illness

Expanded Scope of Practice Expanded Scope of Practice Methods and PrinciplesMethods and Principles

Co-LocationCo-Location: with Addiction Medicine: with Addiction Medicine

““Mini-Fellowship” ModelMini-Fellowship” Model: HCV Clinic: HCV Clinic

Integration of Care, or the “One Stop Integration of Care, or the “One Stop Shop”Shop”: Psychiatry, Psychology and Social : Psychiatry, Psychology and Social Work ServicesWork Services

Co-LocationCo-Location

Co-Location: Co-Location: Addiction Medicine and Primary CareAddiction Medicine and Primary Care

““Mini-Fellowship” ModelMini-Fellowship” Model

HCV Prevalence HCV Prevalence in Population Subgroups: USin Population Subgroups: US

Civilians(NHANES, n= 21,241)

EMT(Philadelphia, n= 2136)

VA Outpatient(SF area, n= 1032)

Homeless(Palo Alto VA, n= 829)

Male Inmates(CA state prison, n= 6536)

Female Inmates(CA state prison, n= 577)

55%

39%

40%

18%

3%

2%

0% 20% 40% 60%

Hepatitis C Treatment and Hepatitis C Treatment and the “Mini-Fellowship” Modelthe “Mini-Fellowship” Model

Difficulty with Gastroenterology accessDifficulty with Gastroenterology access

““Mini-Fellowship” for 9 monthsMini-Fellowship” for 9 months– ½ day per week½ day per week– Own “panel” of patients within GIOwn “panel” of patients within GI– Developing a relationship based on trustDeveloping a relationship based on trust

Site VisitsSite Visits

Quarterly Conference and Review with Quarterly Conference and Review with GastroenterologyGastroenterology

Hepatitis C Treatment and Hepatitis C Treatment and the “Mini-Fellowship” Modelthe “Mini-Fellowship” Model

Integration of CareIntegration of Care“The One Stop Shop”“The One Stop Shop”

Barriers to Care:Barriers to Care:The Health Care SystemThe Health Care System

704-0900 488-9919

334-1000

Barriers to Care:Barriers to Care:The Health Care SystemThe Health Care System

704-0900 488-9919

334-1000

Mental Health Drug and Alcohol

Valley Medical

Integrated Care:Integrated Care:A New ModelA New Model

Mental Health

Drug and Alcohol

Valley Medical

Integration of Care: A New ModelIntegration of Care: A New Model

Side by Side PracticeSide by Side Practice– Psychiatry and PsychologyPsychiatry and Psychology– Sees patient at the same timeSees patient at the same time

““Warm Handoff”Warm Handoff”– In person, in real-timeIn person, in real-time

Practice InnovationsPractice Innovations– PsychologyPsychology– Chat RoomChat Room

Mental Health In Primary Care Mental Health In Primary Care

Quicker and better access for patients Quicker and better access for patients

More comprehensive care for patientsMore comprehensive care for patients

Reduced demand on primary care time Reduced demand on primary care time 

Instant access to consultative relationships with Instant access to consultative relationships with reduced demand on specialists for treatmentreduced demand on specialists for treatment

Increased physician satisfaction Increased physician satisfaction

Training of residence- patient self-managementTraining of residence- patient self-management

Expanding services to pre-existing primary care Expanding services to pre-existing primary care clinicsclinics

Medical HomeMedical Home