Street Medicine

Leadership

• Medical Director: Dr. Barry Zevin
• Nurse Manager: Joel Parker
• Program Manager: Jesse Escobar

Engagement Style 

1. Neighborhood Outreach: When people think of Street Medicine they often envision a team walking around a neighborhood engaging with whomever they encounter. This would fall under neighborhood outreach and it can be a great way to get a feel for a neighborhood, who’s living there, and what resources are most needed. SF HOT has an outreach team focused on each of the following districts of San Francisco: the Mission, Upper Bayview, Lower Bayview, Central Tenderloin, Southern Tenderloin (SOMA), Richmond/Taraval, and Parks and Rec (Golden Gate Park, Upper Haight). Our goal is to have nursing support for each of these neighborhoods at least one day per week. We also partner with HRTC and CHEP on neighborhood outreach.

2. Referrals & Focused Outreach: We accept referrals internally from other DPH programs and externally from CBOs and other SF county programs. Many of these come through our Medic on Duty line, but they can also come from email or through our electronic medical system. We request information about the goal of outreach and how to locate the person, and then do our best to find and engage them. Referrals might include concerns related to LTFU, infectious disease treatment, patients who are disconnected from care and need outreach, patients needing focused treatment like wound care, or assessing people who are decompensating. Over time, Street Medicine staff acquire patients they are providing ongoing care for. These are focused outreach visits.

3. Offsite Clinics: It can be easier for some patients to meet with us if they can find us in a set location that is convenient for them. Because of this, we have partnered with other organizations to provide medical care in places where people are already going for other services. The most common service we partner with is harm reduction services – or syringe access services. St. James Infirmary and San Francisco Aids Foundation are both organizations who have weekly sites across the city providing harm reduction supplies such as clean needles, condoms, naloxone, and other engagement tools like food and socks. At the indoor locations we can set-up a little clinic, outdoors we bring supplies we might need. We also partner with Harm Reduction Therapy Center, Homeless Youth Alliance, SF Hope Center, Martin de Pores, Glide, Urban Alchemy, Code Tenderloin, Healthright 360, and the SOS Van to provide offsite clinics.

4. Health fairs: Health fairs are pop-up clinics that happen periodically at different locations to provide basic health care and other services.

Special Projects 

• Post Overdose Response Team (POET): Prior to the Covid pandemic, San Francisco was already experiencing an overdose epidemic, which was fueled by the increasing availability of fentanyl. In 2018 there were 259 overdose related deaths in SF, in 2020 there were 711. The Street Overdose Response Team (SORT) was started to address this epidemic. Overtime, the work of responding to an immediate overdose was differentiated from the work of following-up with a patient to provide support in an effort to prevent future overdose. The latter is now called Post Overdose Response Team (POET) and they work alongside and within Street Medicine. 

• Ending the Epidemics (ETE): In California there is a movement to address HIV, STIs, viral hepatitis, and overdose as part of a greater syndemic, with shared root causes and solutions, called End the Epidemics. Street Medicine has worked closely with End Hep C SF, Community Health Equity & Promotion Branch (CHEP), and City Clinic to support efforts to address HCV, HIV, syphilis and other STIs. We provide focused outreach in order to follow-up on positive lab results, run offsite testing and treatment clinics, and coordinate low threshold HCV treatment via referral.

• All Love: All Love was created to respond to an increase in syphilis rates, particularly an increase in congenital syphilis. It also encompasses work that came before to address the special needs of women experiencing homelessness. All Love attempts to look at homelessness through the lens of gender and works to improve our work with people who: identify as women, gender nonconforming, or transitional aged youth (TAY), are pregnant or postpartum, or engage in sex-work or sex-exchange. All Love understands that these groups may prefer to access services with their partners, and so partners are also welcome.

• Palliative Care Team: The Palliative Care Team was created in response to a need for low barrier palliative care and hospice care management. The team accepts referrals and may provide anything from end of life options counseling to full care management depending on the patient’s wants and needs. 

• Enhanced Care Management (ECM): The ECM Team was developed from California Advancing and​ Innovating Medi-Cal (CalAIM) funding. “Our vision is to meet people where they are in life, address social drivers of health, and break down the walls of health care. CalAIM will offer Medi-Cal enrollees coordinated and equitable access to services that address their physical, behavioral, developmental, dental, and long-term care needs throughout their lives, from birth to a dignified end of life.*” ​The Street Medicine ECM Team will focus on supporting unhoused people who need extra support linking to services.