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HCH CLINICIANS' NETWORK
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| Carol Jenkins, RN Member, HCH Clinicians' Network by Rachel Hutson, MSN, RN December 2000 | |
 Award winners at the annual membership meeting [left to right] 2000 Local Heroes Patricia Berens, PA; Matias J. Vega, MD; Carol Jenkins, RN; Wallace Cooper, PA; and winner of the Award for Outstanding Service, Nathan Nickerson, MSN, ANP, RN. |
Carol Jenkins is a nurse at the Colorado Coalition for the Homeless Stout Street Clinic. She chose to work with homeless people in order to share much of what has been given to her: love, acceptance and security. She believes that people who have a great deal in life have a responsibility to give back to society, and Jenkins enjoys contributing by working at the Stout Street Clinic in Denver. Over the nine years that she has worked with Stout Street Clinic, Jenkins says that she has seen clients present with progressively more complicated social and medical problems. She often sees patients who are discharged too early from hospital to the street in pajamas and slippers, without needed medications. Jenkins finds that limited resources for homeless people are further strained by the increasing numbers of people who are paroled from jail to homeless shelters. The challenges of working with homeless people are not the people themselves. Instead, Jenkins is frustrated by negotiating the obstacles that homeless people face. She frequently sees clients, for example, who have been denied services that could have prevented serious medical complications or hospitalizations. |
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Jenkins appreciates the clients whom she serves as well as the "wonderful staff at Stout Street Clinic." She likes being creative in program development and problem-solving issues that arise on a daily basis. Humor helps her survive job-related stress, and she says "I work with some really funny people!" She credits her supportive husband and family for helping her remember to take care of herself, so that in turn she can care for others. An insight that Jenkins has gained from co-workers and her years of experience is that "Calamity breeds calamity, and calm breeds calm." She recommends that clinicians in health care for the homeless inject calm into calamity to turn it around. "Lower your voice, and slow your speech and movements when working with an angry or excited client," she advises. "Honor and respect a client's words. Listen. It breeds cooperation." Lastly, Jenkins recommends, "Apologize, apologize, apologize. When clients have to wait a long time, or a chart is lost, or I don't hit a vein on the first blood draw attempt, our clients' capacity for forgiveness is amazing. Just like the rest of us, clients need to have their time, schedule, and self respected and honored. A heart-felt apology helps all of us get through the slights and insults of our busy and often hectic environment." Back to Top |
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Peggy Harter, MC, LPC, LADAC Member, HCH Clinicians' Network by Lisa Cunningham Roberts, MA, NCC November 2000 | |
| Peggy Harter is the mental health team leader at Albuquerque Health Care for the Homeless, Inc., Albuquerque, New Mexico. Team members include clerical staff, a client advocate, two mental health case managers, one dual diagnosis case manager, and a social worker. Harter worked in an inpatient, dual diagnosis treatment program before coming to the HCH project three years ago. Albuquerque HCH offers comprehensive medical, dental and mental health services, a motel voucher program for recuperative care, and transitional housing. The program features extensive street outreach and substance abuse case management based on the principles of harm reduction and community/social models of recovery. Harter says she really enjoys her job, which she finds "challenging, fun and never boring!" She feels good about working with people who often "fall through the cracks" and have limited access to medical care and other resources. Lately, she and her colleagues have noticed that their clients are older, sicker and generally more disabled than those seen in the past, often requiring supported housing in group homes, nursing homes or state mental hospitals. The number of inpatient mental health beds in New Mexico, however, is so limited that many people end up in jails instead. According to Harter, clients with mental health problems have a much harder time getting approved for SSI/SSA-Medicaid/Medicare, for general assistance and food stamps. Resources to pay for medications are scarce. As resources diminish and client needs become more and more complex, Harter acknowledges that there is greater potential for staff burnout and discouragement. She strives to provide the support her team needs to maintain a positive attitude, which includes making time to talk about successes and well as struggles. Harter encounters many challenges in her role as client advocate, particularly in dealing with limited resources and pervasive discrimination that people with mental illness and/or chemical dependency face daily. She reports numerous incidents in which clients received minimal treatment at a health care facility because they were perceived to be high or drunk, while major medical problems such as schizophrenia, alcohol dementia or head trauma were not addressed. Striving to know her clients as individuals, Harter tries to understand how they cope with psychiatric symptoms, and works to build therapeutic relationships based on trust and respect. She is impressed by their survival skills, perseverance and willingness to share their life stories. The imperative to be "genuine and real" in her clinical encounters is one of the major benefits of her work, she says. One reason for Harter's positive attitude is reflected in the advice she offers others engaged in similar work: "Take really good care of yourself personally and professionally, set clear boundaries that provide the structure you and your clients need, be a strong advocate, and above all, be yourself." Back to Top | |
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Nathan Nickerson, MSN, ANP, RN Winner, 2000 Outstanding Service Award by Edward Bonin, MN, FNP-C, RN October 2000 |
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 Nathan M. Nickerson, MSN, ANP, RN |
How did you come to work in health care for the homeless? During the '70s, Nate Nickerson was a college student volunteering at the Pine Street Inn, a large men's shelter in Boston, where he met Barbara McInnis, RN, a woman who greatly influenced the direction of his career. He was so moved by his experience at the Pine Street Inn, that he became a fulltime employee after graduation. Nickerson became Clinic Coordinator for the volunteer nurse's clinic and an activist involved in organizing Boston's Coalition for the Homeless. The Massachusetts Department of Mental Health hired Nickerson to open a 60-bed shelter for the homeless and mentally ill. The shelter became a focal point for Nickerson's |
| political action as it struggled against the threat of closure. During this time, Nickerson lived in an intentional community, that is, a community offering hospitiality to homeless people and taking them in. After living several years in rural Maine, Nickerson returned to school and study nursing. Following graduation, he worked two years as a critical care staff nurse. Nickerson attended a nurse practitioner program and focused on providing care to the underserved. His clinical rotations included both the Boston and Cambridge Health Care for the Homeless Programs. Upon Nickerson's return to Portland, Maine, he worked with the city's Public Health Division providing health care to a growing homeless population. Nickerson was the lone health care provider going where his clients were- soup kitchens and shelters. In 1991, the Homeless Health Program was funded in Portland. From its humble beginnings, Nickerson has nurtured the program. Many new services have been added over the years and Nickerson's role has changed considerably. Currently, he manages the program, and unfortunately for his clients, has little time for direct care. What do you like about your job, and what keeps you motivated? "Health care access is a matter of social justice. I get great satisfaction being part of something that meets a genuine need that would go unmet if we weren't making it happen. I am amazed at people's life stories, their courage, struggles, sense of humor, and potential. I feel privileged to work side-by-side with great people. This work is always challenging, interesting and vital." What are your "passions" when it comes to health care for the homeless? "My particular passion is addressing the complex needs of homeless people who have severe, persistent mental illness, particularly those who do not self-identify as such. I believe services can be "packaged" and delivered in an acceptable and accessible manner. Health care for the homeless is exciting because we are learning how to deliver care to this difficult population, and we have much to teach the mainstream in this regard." Are there any lessons learned that you would like to share? "Ideally, we need a good model of delivery along with the right people providing care. If I could have only one of those, however, I would choose having the right people. The right people will make it work. You can have a great model, but without the right people, nothing will get done." What can health care for the homeless professionals do to improve services to the people we serve? "As advocates, we need to 'get to the table' where decisions and policies are made affecting our clients' lives. We must speak relentlessly, forcefully and truthfully about the conditions of homelessness that people struggle with. This activity should happen on all levels, but I tend to focus on the state and city levels since it seems to be where we have the greatest impact." Back to Top | |
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Abby Lehrman, BS Member, HCH Clinicians' Network byAdele O'Sullivan, MD September 2000 |
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 Abby Lehrman, BS San Francisco, California |
This is Abby Lehrman, an Outreach Worker with Street Outreach Services in San Francisco. We are proud to profile Abby, an energetic woman who has made a difference in the lives of homeless people in San Francisco since 1984. The story of how she started and why she continues to make an impact revolves around her ability to accept people - as they are, who they are - and love them. Her genuine disregard for the invisible line between herself and the marginalized citizens she serves as an outreach worker is uncommon even in the relatively accepting world of homeless advocacy.
Abby came from New York, where she graduated from NYU with a degree in education. When she came to California |
| there were no jobs for teachers, so she went to work for the Welfare Department. This was her initial contact with the indigent, but frustrating for Abby because she handled paper instead of working directly with people who had so many needs. Her desire for direct service led her to St. Martin de Porres House of Hospitality, a soup kitchen and hospitality center in the Potrero Hill district of San Francisco. In 1984, Abby started volunteering there, distributing free meals. That began a friendship - a solidarity in fighting homelessness, hunger, substance abuse, disease, and a host of other hardships faced by the people on the fringes of San Francisco's booming economy. Along the way she has overcome her own challenges as well, including recovery from drug and alcohol addiction. In 1994, Street Outreach Services, a mobile medical outreach program administered by San Francisco Community Clinic Consortium, came to St. Martin's to start a clinic. Abby describes watching these clinicians work and being impressed by the desire of homeless people to take care of their health. She saw a chance to be part of a program that tries to help overcome barriers and make health care possible for these marvelously unique people she had come to know as her friends. So when a position became available later that year, Abby joined Street Outreach Services. Most days, Abby and a staff of medical providers, outreach workers and volunteers take a well-equipped van out into the streets to the places where homeless people live and congregate. She walks through areas within a few blocks of the van to let people know that the mobile clinic is there and what services are available. She encourages them to use these services, and offers to accompany them. Abby listens, makes referrals, sets up appointments and offers whatever hygiene supplies, condoms, clothing or other items are needed. Many acute health problems are treated on site, but when clinical services are needed elsewhere, Abby frequently accompanies clients to their appointments. "The client is always the one who has to jump through the hoops," she laments. Whether she's driving a carload of people to the Department of Motor Vehicles to get State ID's or helping someone navigate the complicated San Francisco General Hospital pharmacy system to obtain necessary prescriptions, it is her goal to "keep the client out of the bureaucracy." She feels she can help her clients cope with system frustrations just by being there, and guide them around barriers of isolation, lack of information and limited transportation." "Abby is a life jacket, historian and shrink for a lot of people out here. What Abby gives people is her undivided attention, which is more important than food and water - because when you're homeless, you're invisible." Helping people battle the entanglements of poverty and addiction is not easy. Abby describes the constant challenge to remain non-judgmental in her attitude toward each person and to offer care to all, even perpetrators of domestic violence. Each day she must cope with a system that is not necessarily designed to work for the individuals she serves. When asked how she energizes and cares for herself in this role, she refers to the healthy boundaries which embrace her work and the rest of her life. She is faithful to her meditation practice each morning and to her own program of recovery, including meetings. She is energized by her home and her social life. "And then," she says, "I try to remember that I don't control the outcome. I do my part, I do my best. But then I have to let go of what happens." What Abby Lehrman tries hardest to show people is that homelessness is a complex problem without a "one size fits all" solution, and that the individuals experiencing homelessness elude stereotypes. Abby says she falls in love with the uniqueness of each person. They have jobs and families and pets and lives. Homeless people are not a "they" sitting on the other side of some arbitrary fence from "us"; they are just people, who sometimes need a little help. "And love, of course," Abby says. "It's all about love." Back to Top | |
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Edward (Eddie) Bonin, MN, FNP-C, RN New Network Steering Committee Member by Linda S. Ruble, PA-C, ARNP August 2000 |
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 Eddie Bonin, CPNP, RN HCH Adolescent Clinic, New Orleans, Louisiana |
Who would ever think that what Edward (Eddie) Bonin refers to as "being pink slipped" could be a good thing? Turns out, it was good for him, good for the Health Care for the Homeless Adolescent Health Services in New Orleans, good for the street kids in the French Quarter, and good for the HCH Clinicians' Network Steering Committee. Bonin's somewhat circuitous route to Health Care for the Homeless began in 1986 when he graduated from nursing school. His first job was in a neonatal intensive care nursery in New Orleans. Encouraged by his friends, after seven years of practice he entered the Louisiana State University Graduate School of Nursing, and in 1996 he earned his masters degree. He certified as a family nurse practitioner that summer and began working-along with two other new graduate nurse practitioners-with a private practice group. |
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"As much as I enjoyed working with the clients, things did not work out there. The doctors didn't really understand the nurse practitioner's role," recalls Bonin. After a year-and-a-half he began looking for another job. In October 1997, a classified ad for a nurse practitioner caught his attention. To his delight, Bonin learned that the position was in a clinic just one block from his French Quarter home. Even better, it was working with homeless youth." "During undergraduate school, I had worked in an adolescent psychiatric hospital, so I knew that many of these kids had been on the street or ended up there. I thought this job would work out for me." Before he was able to set up the job interview, his current employer made an economic decision: All three nurse practitioners received termination notices. That pink slip spurred him on, leading to his interview with the HCH Adolescent Clinic.The rest, as Bonin says, is history." What do you like about your job? "I never regret getting that first and only pink slip of my life. Living in the French Quarter in New Orleans for the past 15 years, I have seen many street youth 'hanging out' in Jackson Square and around the many bars in the Quarter on a daily basis. For many years, I never gave them much thought. Now, because of my work, they are very visible - not only to me, but to many of my friends. I became an advocate for them in ways that I never thought of. For example, I get checks for socks and clinic supplies from friends who respect what I do. I guess they listen when I lament about the lack of funding." "It gives me a great lift when I'm walking in the Quarter and suddenly hear a chorus of 'Hey, Doc!' ring out. All the kids call me 'Doc' although I explain to them that I am not a physician. It's really satisfying knowing that I help keep these kids healthy. I have also assisted in finding housing and jobs for some of them." Bonin received the following note from a couple who were his clients from November 1999 to May 2000: "You all will never know how much you have really done for us, and for the rest of the lost kids in New Orleans. It is so nice to know people who really care about their patients. We have looked to you for health care, but more importantly, for guidance [sic]. All of the thanks in the world to all of you for treating us with much love and respect - two qualities which are truly very rare in the free clinic world. We really need more of you. Thank you!"According to Bonin, "It is because of kids like these that I continue to work with teens." As a new member of the HCH Clinicians' Network Steering Committee, Bonin says he is learning more about the Network and his role as a Steering Committee member. "I would like to see the Network grow in numbers. Recruiting members is necessary to sustain the work done by my predecessors [on the Steering Committee]. I would also like to increase public awareness of the Network and its activity, but I don't know how to accomplish this-yet!" Do you have any advice to share with your HCH colleagues? "Get as much done in one visit as you can, because you many never see this client again. I view my clients as a whole person, not just as a medical condition. It's amazing what we can do for our clients when we put our minds to it. One referral in the right direction can mean a new life for that person." Eddie Bonin, MN, FNP-C, RN, works at the HCH Adolescent Clinic, 1432 North Rampart Street, New Orleans, LA 70112. For more information, contact Bonin at 504 948-6701 or nobones523@aol.com; FAX is 504 948-6838. Back to Top | |
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Susan Marie Kline, MN, ARNP New Network Steering Committee Member by Amalia R. Torres, CDA July 2000 |
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 Susan Kline, MN, ARNP Seattle, Washington |
Susan Kline, MN, ARNP, is a pediatric nurse practitioner who provides clinical services to homeless children and families as an employee of Group Health Community Foundation in Seattle, Washington. She is also engaged in program development and monitoring of Family Programs for Public Health - Seattle & King County, Health Care for the Homeless Network. In addition, she is a clinical faculty member in the Department of Parent and Child Nursing at the University of Washington. Kline just completed her term as president of the Washington Chapter of the National Association of Pediatric Nurse Associates and Practitioners. In her role as president, she developed a continuing education training program that promotes skill and knowledge in working with homeless families. In 1999, Kline received the HCH Clinicians' Network Award for Outstanding Service at the annual Network Membership Meeting in Washington, DC. There she delivered a poignant message. She reminded us that by focusing on the children, we become poised to break the cycle of homelessness. |
"Children are our links to the future, and in them resides a great power. By focusing on the children, we may be able to mitigate the effects of instability and all that is negatively associated with homelessness. By focusing on the children, we can utilize a powerful motivator for change."Kline is guided by these principles in her work. She envisions the gradual development of a partnership between parents and providers over time that opens the door to healing for homeless children. How did you come to work at HCH? "In 1990-1991, I was working in Leon, Nicaragua, as a nurse educator and primary care provider at the Instituto Politecnio de la Salud, UNAN - a small clinic in the countryside - where I also served as a consultant for UNICEF. Upon returning to the United States, I knew I could not go back to working in a typical medical practice. An instructor in the nursing school at the University of Washington in Seattle, who knew of my bilingual skills and my desire to work with indigent special needs populations, referred me to my current clinical job." In January 1992, Kline was employed by Group Health Community Foundation, providing services to the Health Care for the Homeless Network in Seattle-King County. In this position she was an essential member of the interdisciplinary, interagency Central Family Services Team, which serves multiple family shelters. Her organizational skills and leadership qualities allowed her to develop peer review activities to formulate standards of practice. Susan was instrumental in developing a model for therapeutic case management and a screening tool that could be used by non-health care providers to identify and prioritize health issues of children and families. What do you like most about your job? "I enjoy working with like-minded folks who are committed to improving living standards for homeless people. The number of challenges equals the number of rewards. I also enjoy the opportunity to mentor residents from Seattle's Providence and Group Health Cooperative Medical Residency Programs during their community health rotations, as well as pediatric nurse practitioner graduate students from UW." As a new member of the HCH Clinicians' Network Steering Committee, what would you like to accomplish over the next three years? "I want to help providers and community members look at issues related to children and families. As providers who are aware of the challenges these families face, we need to ask ourselves how we can use evidence-based practice within HCH. First we need to take steps toward defining best practices for HCH in mental health, chemical dependency, nursing, and medical care." Kline is a strong advocate for children, and uses every venue available to address their multiple needs. Such an opportunity arose in Seattle when she was asked to sit in on a Community Round Table meeting developed by a local television station. There she realized that 'the entire country is dealing with a health care delivery system that has not adjusted to the needs of families and kids for support and services, regardless of their housing status.' In her role as a new HCH Steering Committee member, Kline intends to continue playing an active role as an advocate and mentor in her community. She hopes this experience will enable her to bring a national perspective to her work. Already her enthusiasm, knowledge and willingness to serve have been advantageous to the Steering Committee. She has been recruited to serve as Research Committee Chair 2000-2001. Back to Top | |
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David Buck, MD, MPH Member, HCH Clinicians' Network by Karen Holman, MD, MPH June 2000 |
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 David S Buck, MD, MPH Health Care for the Homeless - Houston (HHH) |
David Buck, MD, MPH, is the medical director of Health Care for the Homeless - Houston (HHH), a unique, new consortium of service providers in Houston, Texas. He is also an associate professor of family practice at Baylor College of Medicine and serves on the Network's Research Coordinating Committee. Dr. Buck is involved in a variety of innovative projects. He recently participated in a gathering of health care providers from around the country to discuss the determinants of trust in the client-provider relationship and how to engage homeless persons in their health care. In the coming year, HHH will establish Class D pharmacies at several clinic sites, open a respite center, and participate in the development of a research center dedicated to investigating health care issues in the homeless. |
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HHH works out of a central clinic (SEARCH) and staffs five other sites across the city. It also conducts an active street outreach program. Baylor family practice residents provide the majority of care at one site, and students from several health care disciplines provide services at a special Sunday morning clinic at another site. The students socialize with their homeless clients at Sunday breakfast. This is followed by clinical services to the clients. An hour long meeting at the end of the morning allows students and faculty to reflect on what they have seen and done. HHH is starting to use an internet based medical record as a national pilot for MedicaLogic. The Bureau of Primary Health Care is also launching its electronic medical records with MedicaLogic. Dr. Buck has been motivated to help disadvantaged populations since 1984 when he worked with Mother Teresa in Calcutta. He found the experience inspiring but overwhelming. Back in the states he worked to develop medical and dental clinics for an indigent population in Houston. His frustration with his own lack of skills led first to a MPH (master of public health) degree. His thesis centered on using the empowerment model to motivate people to change. He began medical school at Baylor College of Medicine just as he was completing his MPH and specialized in family practice. Prior to joining the faculty at Baylor, he worked at several community and rural health clinics. The most significant change in caring for the homeless that Dr. Buck has witnessed in Houston is the willingness of the major community agencies providing homeless services to work together with health care clinicians, educational institutions and public organizations, with a common goal of improving services to the homeless. This consortium has also had success in reducing stress and burnout among individuals in the member organizations through mutual support, a shared workload, and a reduction in interagency problems. Dr. Buck has witnessed the enormous benefits that result from cooperation instead of each agency pulling in its own direction. Dr. Buck is sustained in his work by the dedicated health care team he works with, by the small successes he sees in individual homeless patients, and in the success of Houston's consortium. When asked for a "pearl of wisdom" to leave with us, Dr. Buck paraphrased America Brachio: "Hire people who have passion for their work." For more information on Dr. Buck's program, contact him at dbuck@bcm.tmc.edu or visit www.homeless-healthcare.org. Back to Top | |
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Betty Schulz, CPNP, RN New Network Steering Committee member by Laura Gillis, MS, RN April 2000 |
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 Betty Schulz, CPNP, RN Mercy Children's Health Outreach Project, Baltimore, Maryland |
Betty Schulz is a pediatric nurse practitioner who provides services to homeless children and their families in Baltimore City. Along with another pediatric nurse practitioner and a social worker, Betty visits shelters and soup kitchens engaging homeless families, conducting physical and psychosocial assessments, referring them for necessary medical and related services. Betty and her colleagues reconnect homeless families with their primary care providers or refer them back to Mercy Family Care if they do not have a medical provider. The Homeless Children's program in Baltimore City is called Mercy Children's Health Outreach Project. Health Care for the Homeless, Inc. (HCH) contracts with Mercy Medical Center to provide primary care services to homeless children. |
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How did you come to work at HCH? "I saw a newspaper ad for a nursing position at Health Care for the Homeless for a pediatric nurse. The position was intriguing to me because there were no services available at that time specifically for homeless children. Initiating a new service for homeless children reflected what I had enjoyed doing my whole career - working with underserved populations. Although the job sounded very stressful, I wanted to give it my best shot. That was nine years ago! "Originally I worked from the HCH clinic in downtown Baltimore focusing on outreach to family shelters. In 1992, HCH secured funding through the Homeless Children's Program from the Bureau of Primary Health Care. My position then moved to a pediatric primary care clinic affiliated with a local university medical center. I provided primary care services with a multidisciplinary team as well as limited outreach. Currently, the Homeless Children's Program is located at Mercy Family Care, a community health center operated by Mercy Medical Center. The focus of my work again is on health care outreach to family shelters." What do you like about your job? "Primarily I love working with kids. I like the challenge of providing comprehensive care to children whose care has been neglected due to the multiple family crises that many homeless families face. I also like the advocacy portion of my job. Working at the client level can be very frustrating because the system is not set up to meet the needs of homeless families. Advocating for systems change is a way to counteract that frustration. I like educating policymakers, business people, and the general public about the lives that some children in our society are forced to live. "My experience in advocating for change began when I first started at HCH and joined the Coalition for Homeless Children and Families. I found myself on their steering committee and then two and a half years ago, I became the Chair of the Coalition. The Coalition for Homeless Children and Families is a group of 70 organizations in the Baltimore area that work with and/or are concerned about homeless families. In the last two years the membership of the Coalition has grown and we are in the process of re-evaluating where we need to focus our attention. This experience has shown me what a fairly small group of people can do when they are really committed to a cause." As a new member of the HCH Clinicians' Network Steering Committee, what would you like to accomplish over these next three years? "I want to bring a focus on homeless families to the Network and I want to use the position on the Steering Committee to advocate for them nationally. The week before the nominations form from the HCH Clinicians' Network arrived in my mail, I had my annual evaluation. One of my goals was to get involved nationally in advocating for homeless children. I found it serendipitous that the request for nominations for the Steering Committee arrived right after I had made this decision. "I am also very interested in finding out more about the other HCH projects in the country. I am curious to learn what services they are providing to homeless children and their families. I want to know where the gaps are in delivering services to this fastest growing segment of the homeless population. I want to work with the Network to find methods to serve families that are homeless and close these gaps. "As a HCH Clinicians' Network member, I have found the whole HCH network of providers and advocates very supportive to me in dealing with the stresses of providing care to homeless children. Being a part of the HCH Clinicians' Network Steering Committee will enable me to be in a role of supporting other HCH clinicians through the very difficult job that they have every day. I hope to encourage all the clinicians working with homeless persons to use the Clinicians Network as source of information and strength for the important work they are doing." Back to Top | |
