Austin brings community health into the community

Last summer, after city officials called on the Austin Police Department and other public safety departments to address issues attributed to homelessness, a coalition of public safety and social services groups began working to increase support for this vulnerable population.

One of the programs taking the lead on this effort is the Homeless Outreach Street Team (HOST), which formed in early 2016 to address homelessness in the downtown and West Campus areas of Austin. Since its inception, the program has been finding its bearings as it works both to get people off the streets and into housing as well as to identify and treat people in need of medical, psychiatric or legal care.

According to Andy Hofmeister, the assistant chief for Austin-Travis County EMS, the program is part of a larger initiative called the EMS Community Health Paramedic Program, which is composed of a small group of police, mental health specialists and medical personnel who have been taking to the streets to engage directly with Austin’s homeless. The program has seven full-time employees in total, with two additional spots open for new hires.

The entire array of community health services includes HOST, street field medicine, an opioid response team, a pop-up resource center, a medical liaison to incarcerated populations, remote medical monitoring and a partnership with the Dell Seton Medical Center residency program.

Given such a list of demands, the team can stretch itself only so far. Hofmeister noted, “There is a point of diminishing returns.” With cases limited to a 30-day term, he explained that “one of our paramedics can handle a caseload of about 15 individuals (at any given time)” – which, in the context of Austin’s growing population, is not a whole lot.

In an effort to expand capacity to deliver service to those within the community who do not otherwise access care through traditional medical channels, Hofmeister said, “We work very, very closely with other agencies so we can hopefully leverage that expertise.” Among their partners are the Austin Police Department, Integral Care, Community Care, hospital networks and the Downtown Austin Community Court.

“We want to develop new ways of delivering service to those who may not need an emergency room at that particular time,” explained Hofmeister. Some of the more recent innovations include at-home medical monitoring of recurrent cases; provision of harm-reduction kits that contain Narcan and fentanyl-testing strips; and pop-up clinics that address critical needs by providing identification, insurance, medical care or warrant resolution in an attempt to move an individual closer to housing and better health. “That’s been a popular intervention that we’ve developed,” said Hofmeister.

Even with such strides forward, there is “one big missing piece to this (and that) is support from the individual that can sit in our communications center,” said Hofmeister. Currently, the small team rotates members to field calls.

Hofmeister said he hopes soon to have a full-time staffer who can answer internal and 311 inquiries. At this point, though, these services are considered to be pilot projects; as such, their ability to expand into the community is limited. While the team awaits its next member and waits to see if its funding is expanded, Hofmeister laments that the team simply cannot serve everybody who is in need. In the meantime, it is trying to optimize the process. “We’re trying to do it (everything) based off data,” he said.

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