JUANA SUMMERS, HOST:
An unconventional way of practicing medicine has been catching on lately. It's called street medicine because medical professionals care for patients on the street outside of traditional brick-and-mortar facilities. Practitioners and advocates say providing mental and physical health care for those who are unhoused is a key piece of the puzzle in mitigating homelessness. And the federal government recently made a small but significant change in order to better fund this kind of work. NPR's Katia Riddle has more.
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KATIA RIDDLE, BYLINE: Tents dot the sidewalk on a block that's a common gathering place for unhoused folks in Portland, Oregon. On this day, Lorie Dolo Scott is part of the street medicine team working here. She watches a colleague of hers a few yards away. Her colleague is leaning over a man, holding a clipboard.
LORIE DOLO SCOTT: So she's going to register him.
RIDDLE: Registering him for the state's Medicaid program. Their organization is called Central City Concern. It's a nonprofit. Dolo Scott says this team has adapted to do this kind of work in all kinds of settings recently.
DOLO SCOTT: I can just do it anywhere. I can figure it out.
RIDDLE: Is this an example of something that you couldn't - until recently, you could not do - register someone on the sidewalk like that?
DOLO SCOTT: We could register them, but we couldn't bill for it.
RIDDLE: They couldn't bill Oregon's Medicaid. That's the joint federal state health insurance program for low-income people. Because the care took place outside a medical facility, that limited what they could provide. Now that's changed.
DOLO SCOTT: Which makes the feasibility of this type of work, of getting nearer to people so much easier.
RIDDLE: Before she worked with unhoused people, Dolo Scott worked in countries with disaster and refugee crises - Haiti, Kosovo, Iraq, Sri Lanka.
DOLO SCOTT: So I guess my comparison would be that it's harder to do it here in the States than it is to do it in a war zone because of the red tape. In the war zone, you're like, oh, you need help? I'm helping you, right? Here, it's like, you need help? OK, let's talk about your registration. And for some people, that becomes its own barrier.
RIDDLE: The change to the federal Medicaid code went into effect about a year ago.
BRETT FELDMAN: You know, street medicine is fairly new.
RIDDLE: Brett Feldman is the director of the street medicine program at the University of Southern California. He led an effort to petition Medicaid for this change. Feldman says it wasn't that Medicaid resisted funding this kind of work before. They just hadn't needed to.
FELDMAN: I just don't think anybody had asked before that.
RIDDLE: The number of teams has more than doubled in California in the last few years. Street medicine is coming to more and more states across the country.
FELDMAN: And the care we provide is more than just what you would expect at an office visit, even if that office is under the bridge. So we dispense medications, draw labs. A lot of us do ultrasound and EKGs.
RIDDLE: A fundamental part of working with this population is treating behavioral health disorders. With a shortage of psychiatrists, says Feldman, people who practice primary care, like him, have learned how to deliver treatments like antipsychotics.
FELDMAN: I mean, we can give one injection. It can last a month or more. They're never lost or stolen or degraded by the elements, which have been just a game-changer on the street.
RIDDLE: Getting to that point, where a patient will trust a doctor enough to allow them to inject an antipsychotic or talk to them about treatment for substance use disorder - that takes time. Back in Portland, outreach worker Laurel Sanford approaches a group of people gathered together in the parking lot. She hands out little things - water, stickers.
LAUREL SANFORD: You want some stickers?
RIDDLE: These are initial offerings to build relationships.
SANFORD: Yeah.
RIDDLE: Is that right?
SANFORD: For sure. Yeah.
RIDDLE: One woman says she needs help. Sanford takes her over to the van, where they have medical supplies.
SANFORD: So I'm trying to get her hooked up with our navigation team 'cause she is telling us she's pregnant.
RIDDLE: This population has high levels of trauma. They often resist treatment at first.
SANFORD: I think that it's so intense now with the kinds of problems that people have - mental health problems, drug problems.
RIDDLE: For Sanford, this work became personal a few years ago.
SANFORD: My son and his friends kind of got involved really in the drug culture.
RIDDLE: She says her son is in recovery now. He's been living with her. But there were days when she knew he was out here, too.
Wow. You would go look for your son and his friends.
SANFORD: I tried not to. But, you know, every once in a while, they would just turn up in the churn of people.
RIDDLE: As a parent, that just - it's so heartbreaking.
SANFORD: Yeah, it was rough. It was really rough. But, you know, I was always happy when I saw them 'cause that meant they were still alive.
RIDDLE: Members of the street medicine team say there's no silver bullet for solving these kinds of behavioral problems. It will take a lot of strategies deployed together to make a big difference, including one small change in Medicaid policy. Katia Riddle, NPR News, Portland, Oregon.
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