1. SHOP Guides: Medical Students Addressing Barriers to Care Through Patient Advocacy for Those That Are Homeless Tracey Smith DNP 1, Isaac Tan MS4 1, Janice Frueh PharmD 2, Rod Lane MBA 3, Phillip Knouse MS4 1, Katherine Plachta MS4 1, Samuel Hughes MD 4 (1- SIU School of Medicine, Springfield, IL; 2- SIUE School of Pharmacy, Edwardsville, IL; 3- Helping Hands, Springfield, IL; 4- Family Medicine Residency Ehrling Bergquist Clinic HO1)

2. Disclosures Tracey Smith: Memorial Medical Center and St. John’s Hospital for Enos Park Access Program; Illinois Emergency Management Agency for Radon Awareness

3. Objectives 1.Discuss ways that medical students can build partnerships to improve client's health literacy with existing agencies focused on the provision of services to those that are homeless 2.Discuss how medical students can identify gaps in community resources by connecting with clients and agencies by conducting an in depth assessment of needs to gain population health management skills 3. Discuss three support mechanisms that medical schools need to have in place to support students as they transition from provision of care in a clinic to care in a community

4. Historical Background

6. SHOP (Student Healthcare Outreach Program) Consists of: – a free clinic – a vulnerable community group –a care facilitator program (our version of a hot spotters program) The objectives of the SHOP program are individualized per student and close interaction with faculty advisors guide the student through their unique learning plan.

7. Patient Check InPatient History Preventative Screenings Physical Exam Medical Student/ Physician Conference Outreach Services Check Out Medication Station Free Clinic

8. SHOP Outcomes Free Clinic # Clients: ↓ from 60 to 25 per event Health insurance coverage: ↑ of 10% to > 90% Identification of Primary Care Provider: ↑ of 10% to 60% Most common medical problems: hypertension, dental problems, depression # Student volunteers: Increasing each academic year High rate of returning volunteers after initial experience Interdisciplinary approach

9. Vulnerable Populations Group 10 representatives from local agencies who address the care of vulnerable populations in the Springfield area Three meetings held between June 2014 and beginning of 2015 Themes identified to focus on: housing, access/ navigation of medical care, patient “dumping”, mental health needs, dental health, separation between agencies and healthcare entities, and nutrition needs/food insecurities

10. SHOP Outcomes Vulnerable Populations Group Housing: a roundtable of local community leaders has been created investigating this more Access/navigation of medical care: Care Facilitator Program established, Enos Park Access Program Patient “dumping”: Hospital to Shelter Committee- Respite Program: training for agency staff in safety- discharge planning discussion facilitated Mental health needs: a new mental health primary care model to be opened Jan 13 th Separation: Increased inclusion in conversations

11. Care Facilitator Program Primary Agency

12. Care Facilitator Program Recruiting Students Medical students are introduced to the program at a presentation given early in their second year Interested students attend a more detailed informational session about care facilitation Incoming student volunteers meet with a faculty advisor and are teamed with more experienced students Each team is responsible for one client

13. Care Facilitator Program Recruiting Clients Clients are recruited from the SIU SOM free clinic or are referred from Helping Hands Clients are prioritized based on their degree of need as assessed by risk stratification at the first encounter Each team meets with their client to discuss goals and define an action plan Teams communicate with their clients at least weekly to assess progress

14. Care Facilitator Program Curriculum Development & Coordination All volunteers meet monthly to share their progress and setbacks with each team The monthly meeting is an opportunity for students to learn from each others’ experiences Currently using Camden Coalition webinars to teach and learn about topics relevant to care coordination Example topics covered include: the history of hotspotting, appropriate patient selection, recognizing signs of childhood trauma, harm reduction

15. SHOP Outcomes Care Facilitation Program 18 medical students currently volunteering Students from other disciplines (nursing, business, pharm D, etc.…) joining soon 7 clients currently active 11 clients in total since the program’s inception Graduated clients are contacted every few months to follow up and continue to do well

16. Small Group Discussion (10 minutes) Break into small groups of 5-10 people Review case presentation provided Each small group should answer the following three questions for the patient scenario on the next slide: 1.List potential community resources/agencies students could partner with in your area to improve the patient's health literacy and/or improve patient’s health. 2.Complete an abbreviated “ecomap” to potentially identify community resource gaps to initiate a discussion about population health management skills with students. 3.Identify three support mechanisms that medical schools need to have in place to support students as they transition from provision of care in a clinic to care in a community

17. Patient Outcomes?

18. Questions? tsmith@siumed.edu jfrueh@siumed.eud

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