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Why?

The Big Why

California is experiencing dual epidemics of homelessness and addiction. While solutions exist, certain populations continue to be impacted. The Safe Haven Clinic is an innovation designed to provide a low threshold first step in the continuum of services and care for people caught in cycles of homelessness and/or addiction.

What Is Street Medicine?

Street Medicine brings care to people experiencing homelessness where they are, reducing barriers to healthcare access. Primary care and case management provided by interdisciplinary Street Medicine teams is enhanced by co-located Medical Respite, Sobering, and Pharmacy services in the Safe Haven Clinic.

What Is A Sobering Center?

Sobering Centers provide an alternative to jail and emergency rooms for people experiencing recurrent public intoxication. A Sobering Center embedded in a Safe Haven Clinic supports immediate transitions to other needed care, such as medically-supervised detox in Medical Respite.

What Is The Pharmacy?

For people experiencing homelessness, medication management help can be lifesaving, and for many on a path to sobriety, medication assisted treatment (MAT) is vital. The Pharmacy offers both, plus lab services, vaccines and out-patient pharmacy to support all key Safe Haven Clinical components.

What Is Medical Respite?

Medical Respite provides an essential healing environment for people who do not need hospitalization but lack adequate housing to fully recover or receive treatment, including Palliative Care. Medical Respite integrated with Street Medicine, Sobering, and Pharmacy services provide critical care to patients with complex health needs.

Why Street Medicine?

Street Medicine teams provide care to people experiencing homelessness where they live. In Safe Haven Clinics the teams have a physical hub to provide follow up, case management, and walk-in care, plus integrated respite, sobering, and pharmacy services.

Having a brick & mortar Safe Haven Clinic from which Street Medicine providers can base their delivery systems facilitates support from, and provides additional assurances for, providers of medical malpractice insurance.

A priority of Street Medicine is building bridges for patients into primary and specialty care. Electronic medical records are necessary for continuity of care, but maintaining compliant medical records is challenging when delivering back-pack medicine at the street level. The Safe Haven Clinic utilizes electronic medical records that can be used in mobile clinics such as Street Medicine.

Community support and engagement is the lifeblood of Street Medicine. A brick & mortar Safe Haven Clinic provides the office space for volunteer coordination, training and meetings, as well as clinic services for follow-up Street Medicine visits.

Why Sobering Center?

A Sobering Center is a more humane, less expensive alternative to jail or emergency rooms for publicly intoxicated people. Safe Haven Clinic’s integrated Medical Respite offers an immediate next step for those who can benefit from medically supervised detox.

The Sobering Center is designed and operated with the sobering person’s safety as the paramount concern. While sobering, if additional medical treatment is required, the patient is transferred to an Emergency Department or is moved over to the Medical Respite component of the Safe Haven Clinic. Varying levels of care are co-located under the same roof so patients can safely sober.

People experiencing public intoxication are diverted to a safe place to sober with medical supervision instead of receiving costly treatment in an overburdened hospital emergency room or being arrested and then cycling through expensive legal repercussions over minor offenses.

An influx of federal money is allowing counties throughout the state to get more people into treatment. The money that states use to help fund Sobering Centers comes from various sources. Some is provided through SAMHSA in the form of federal grants and from reimbursement through Medicaid (MediCal), and some comes directly from the state budget.

First responders and the Safe Haven Clinic may potentially develop MOUs to establish a partnership allowing paramedics to divert publicly-intoxicated people to the Sobering Center where they can safely sober instead of taking them to jail or a hospital.

Law enforcement and first responders are a primary source of patient referrals to the Safe Haven Clinic Sobering Center. With a Safe Haven partnership MOU, law enforcement and first responders spend less time on jail or hospital admit paperwork and more time responding to needed calls for service. Sobering in the Safe Haven Clinic is more cost effective than in jail or an expensive ED bed.

Why Pharmacy?

An integrated pharmacy provides a range of on-site services for people engaged with all components of a Safe Haven Clinic, such as lab services, medication storage and management, Medication Assisted Treatment (MAT) and medication to help with alcohol withdrawal.

Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations. A Safe Haven Clinic Pharmacy, which cares for both uninsured and low-income patients, could qualify as such a healthcare organization.

By law, methadone can only be dispensed through an opioid treatment program (OTP) certified by SAMHSA. But under the COVID-19 national health emergency, OTPs such as the Medical Respite department of a Safe Haven Clinic could provide methadone under a blanket exception: up to 28 doses, or as determined by the clinical team’s ability to safely manage the medication. Innovations developed during the pandemic should be continued.

Also under the COVID-19 national health emergency, the Department of Health and Human Services (HHS) expanded its guidance allowing pharmacy staff to order and administer COVID-19 tests, COVID-19 vaccinations, and pediatric immunizations to patients three years of age and older. Previous guidance allowed pharmacy interns to administer these immunizations only under the supervision of a qualified licensed pharmacist. Innovations developed during the pandemic should be continued.

An on-site Pharmacy offers a safe place for people experiencing homelessness to safely store their medication to prevent meds from being lost or stolen. Pharmacy staff work in concert with practitioners in the Medical Respite component of a Safe Haven Clinic so that patients have access to the medicine they need while being monitored for medicine duplication and dangerous drug interactions.

Why Medical Respite?

Medical Respite offers compassionate care to people experiencing homelessness, such as end of life care, recuperation from medical procedures, and wound care. In a Safe Haven Clinic, it also offers medically-supervised detox and Medication Assisted Treatment (MAT).

A low-barrier entry Safe Haven Clinic with an embedded Medical Respite allows care and treatment 24-7. Referrals can come from the Street Medicine outreach teams, first responders, law enforcement, and partner agencies or self admissions. Unlike a SNF, the patient does not need to have Medicare Part A, a qualifying hospital stay, or a physician referral.

America’s homeless population is aging; people 50 and older now make up more than 30 percent of the nation’s homeless population. A Safe Haven Clinic offering Medical Respite is a low-barrier option for compassionate and medically-supervised palliative and end of life care.

Withdrawal associated with addiction can be painful and life threatening. In a Safe Haven Clinic, a safe environment for withdrawal is maintained. For example, the pain of withdrawing from opioids can be managed with Medication Assisted Treatment (MAT), a treatment that often serves as a bridge for patients ready to explore recovery options. By law, MAT must be administered under physician direction. In the Medical Respite, detox is medically supervised by a Safe Haven Clinic physician with 24/7 nursing.

MediCal is the primary insurer for people who are experiencing homelessness in California. State and Federal Medicaid agencies and managed care organizations are increasingly vested in medical respite for populations experiencing homelessness.

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