The provision of medical care at SRO hotels
Since evening outreach in SRO hotels began in 1996, it has continued and expanded from one to four evenings per week. Led by CitiWide staff, the outreach team goes door-to-door offering harm reduction education, syringe exchange, personal care supplies, and referrals to medical and support services. As members of the outreach team, medical providers engage residents around medical care, perform triage and evaluation, and encourage residents to seek more comprehensive care through enrollment in the Health Services Program.
In 2001, we secured additional funding to establish the SRO hotel room-based program in which comprehensive HIV care is delivered in SRO hotel rooms. Montefiore's medical providers perform history and physical exams, and provide prescriptions, vaccinations, and limited blood tests. CitiWide's supportive providers visit SRO hotels to engage individuals around health care, and address barriers to accessing care. Visits in SRO hotel rooms are either scheduled ahead of time, or are same-day appointments. Key elements of delivering medical care in SRO hotels have been consistency and accessible services. When the same medical provider arrives on the same day of the week, at the same hour to deliver services, SRO hotel residents anticipate the provider's presence. This consistency facilitates a trusting relationship, which is crucial when providing medical care for marginalized populations.
The provision of medical care at Montefiore's Community Health Center
Montefiore's CHC is the medical home of the Health Services Program, yet several barriers to receiving care at the CHC have been identified. Examples of barriers included lack of transportation, inability to access the CHC via telephones, long waits for appointments, long lines and waiting times, and insensitive CHC staff. We developed strategies to reduce barriers, which included providing transportation, next-day appointments, CHC registration prior to visits, designated appointment slots for Health Services Program participants, and incentives (food coupons) for keeping appointments. In addition, all appointments at the CHC were with medical providers familiar to Health Services Program participants. These providers also conducted outreach in SRO hotels, provided care in SRO hotels, and provided care at CitiWide's drop-in center. Additionally, Health Services Program providers (medical and supportive providers) frequently joined the CHC's staff meetings to address problems as they arose.
The provision of medical care at CitiWide's drop-in center
With the growth of Citi-Wide from 1998 to the present, participants requested health care services at CitiWide's drop-in center. To address this request, in 2002, we piloted medical care provision at CitiWide's drop-in center, and subsequently established this component of the Health Services Program after securing additional funding in 2003. The provision of medical care within CitiWide's drop-in center is modeled on the empirically demonstrated success of services for marginalized populations integrated into a single location.14-16
Important elements of this component of the Health Services Program include (a) same-day appointments to provide immediate access to medical care; (b) care delivered by familiar providers (those who conduct evening outreach, provide care at SRO hotels, and provide care at Montefiore's CHC) to build trusting patient-provider relationships; (c) transportation to appointments for those who lack transportation; and (d) supportive services providing assistance navigating health care systems and facilitating retention in medical care.