Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Lehigh Valley Hospital, Inc. (LVH)

Name of Innovative Program: 
Street Medicine: Integrated Behavioral Health Care for the Lehigh Valley's Homeless
Sponsoring Organization
Lehigh Valley Hospital, Inc. (LVH)
Name of Innovative Program Lead: 
Brett Feldman, PA
E-mail Address of Innovative Program Lead: 
Brett_J.Feldman@LVHN.org
Physical Address of Innovative Program: 
1628 W. Chew Street, Allentown, Pennsylvania 18102
Project Description: 

The Lehigh Valley Hospital Street Medicine (LVHSM), launched in October 2013 under the direction of Brett Feldman, a physician assistant, provides free integrated physical and behavioral health care for people who are homeless. This population is largely excluded from the traditional health care system due to lack of health care insurance,  transportation and  trust in the health care system. LVHSM is supported by a team of over 80 advanced practice clinicians, nurses,  physicians, behavioral health professionals and many others who volunteer their services on the street and shelters.  With a backpack full of supplies, Mr. Feldman makes street rounds and visits tent cities, in addition to regularly scheduled free clinics at soup kitchens and homeless shelters across the region. By building trust while providing care, the LVHSM team demonstrates the  positive outcomes on the physical and behavioral health of Lehigh Valley's homeless population. 

How does the innovative program work to improve behavioral health access?: 

LVH Street Medicine visits all inpatient psychiatric patients identified as homeless during their hospital stays--80 to 100 per year--to start building a relationship.  Upon discharge, the team remains in contact with these individuals on the streets, in shelters or soup kitchens, providing free medications and behavioral health consultations until the person can access a psychiatrist. This can take up to 4 months. In addition, 120 homeless patients with physical and behavioral health needs are served monthly--including veterans and those recently released from prison who may not be comfortable in a clinic. To address the need for psych support outside traditional care settings, LVHSM successfully piloted a telemedicine consult for a chronically homeless individual who would not leave his encampment. With a secure, Skype-like link on an iPad, a  a tele-psych assessment was conducted, qualifying the individual to enter into a transitional living center.  

How does the innovative program work to improve behavioral health quality? : 

It is estimated that nationally 25% of the homeless have a major mental illness, and this is consistent with the homeless population in the Lehigh Valley. LVH Street Medicine connects with mentally ill homeless people in multiple ways: upon admission to the psychiatric inpatient unit, on the street, or in shelters and soup kitchens.  The team works to build trust until the individual feels safe and willing to accept assistance, and this takes time. Patience is key, but Mr. Feldman's reputation as "the doc" among the homeless population is facilitating this process. The Street Medicine team visits encampments and distributes food, socks, blankets and other supplies while building these relationships. Once accepted, the team provides integrated physical and behavioral health care, bridging the gap between inpatient and outpatient psychiatric care, delivering  care to people on their own terms, wherever they are most comfortable, and without judgment. 

How does the innovative program work to address behavioral health costs? : 

Homelessness both causes and results from serious health care issues. People experiencing homelessness are more likely to access the most costly health care services. Preventable readmissions due to unmet behavioral health (BH) needs is considered waste. From 8/14 to 8/15, BH 30-day readmission rates at LVH for homeless, uninsured consumers served by LVHSM was 14% vs. 15% for those covered by Magellen. More impressive, in the most recent quarter (ended 12/31/15), LVHSM's BH readmission rate was reduced to an astounding 6%.  In addition, the Street Medicine team has experienced great success enrolling uninsured homeless people in Medicaid.  From 1/1/15-9/1/15, the number of insured increased from 24% to 56%, and in the last quarter (ended 12/31/15), 73% were insured.  The team also works tirelessly to find secure housing solutions to end homelessness and connect individuals to appropriate social services. 

Creativity and Innovation: 

The case for integration of physical and behavioral health services is evidence-based and supported by major foundations and government agencies, including Medicaid.  LVH Street Medicine believes that people who are homeless deserve this same level of care coordination wherever they may live--on the streets, in tent cities, or shelters. The team thinks outside the box to develop strategies to connect even the most reluctant homeless consumer to appropriate care.  Once such case was the delivery of a tele-psych assessment delivered in the field via iPad. This proved so successful that the hospital hopes to expand  this innovative program to meet the needs of the chronically homeless who are reluctant to come to the hospital or clinic.  

Leadership: 

LVH Street Medicine team members presented  at International Street Medicine Symposiums in Dublin, Ireland, in 2015,  San Jose, CA, in 2015, and the 2016 National Healthcare for the Homeless Conference. Mr. Feldman serves on the International Street Medicine Institute Board of Directors and many local boards. The program has funding to host a regional homelessness conference at Lehigh Valley Hospital in the coming year to share its innovative model of integrated physical and behavioral health care for the homeless and to learn best practices from other programs. The program is embraced by all levels of LVH senior management, including the president & CEO who rounds with them on the street regularly, as well as the chair of the Department of Community Health and other network leaders. Partnerships with other community agencies include the Allentown and Bethlehem Health Bureaus, 7 area homeless shelters, 2 area soup kitchens, and numerous community coalitions.

Sustainability: 

Lehigh Valley Hospital has incorporated the Street Medicine program into its Department of Community Health, providing necessary administrative support for its continued growth and success.  The program has also received support from the Dorothy Rider Pool Health Care Trust and the Pennsylvania Department of Health.  The most valuable resource has been the outpouring of volunteer services from across the hospital and community, with a cadre of over 80 physicians and advanced practice clinicians, including psychiatry and behavioral health, internal medicine, family practice, emergency medicine, neurosurgery, palliative care,  geriatrics, pain management and nephrology, resident physicians, nurses, case managers, and diabetes specialists, as well as 80 additional volunteers from other fields.  LVHSM recognizes the incredible potential of these passionate volunteers to extend the impact of Street Medicine. 

Replicability: 

LVH Street Medicine's model of integrating physical and behavioral health for the homeless has great potential for national replicability.  First and foremost, the project requires support from organizational leadership and modest start-up funds. Our program demonstrated that once members of the LVH community become aware of the issue of homelessness in our own backyard, and the potential impact it can have, volunteers from virtually all sectors of our organization have been eager to lend a hand from the provision of clinical services to donations of food, clothing and supplies. The city of Allentown, PA, with its population of about 118,000 has demographics and challenges that are similar to most urban areas across the country. A key component to successful replicability is the result of coordinated efforts to enroll homeless consumers into a health care plan, resulting in significant savings to the health care system and improving care for the consumer.

Results/Outcomes: 

LVH Street Medicine initiated homelessness screenings at three of the network's emergency departments and to date has screened 2,665 unique patients; of them 7.1% qualified as homeless. Between 8-10 homeless consumers per month are being admitted to the hospital's psychiatric unit, and the Street Medice team has succeeded in providing follow-up integrated physical and behavioral health services for them until they can be seen regularly by a behavioral health professional on an out-patient basis. An additional 120 unique patients PER MONTH are treated by the team in shelter and soup kitchen clinics. Between 2/1/15-12/31/15, the number of insured increased from 24% to 73% and the 30-day readmission rate decreased from 50% to 13%, resulting in low costs of care for all area hospitals and providing better services for the consumer. The results: Better Health, Better Care, Better Cost.

Supporting Files: 
#22225