Addressing Homelessness Holistically
With Heartland Alliance Health, Bruce Doblin has made research a condition for change
While much of the country contracted during the earliest stages of the COVID-19 pandemic, Chicago’s Heartland Alliance Health pushed to expand.
“One of the earliest lessons we learned was the need to reduce more barriers to healthcare,” says Bruce Doblin, MD, medical director at Heartland Alliance Health and a clinical instructor of Medicine in the Division of General Internal Medicine and Geriatrics. “Many of our patients were afraid to seek care in our health centers and so we greatly expanded our shelter-based and community sites for care from 12 to 72 locations in the first six months of the pandemic.”
“We know that many serious chronic illnesses and preventive screenings were put on hold over the past two years,” says Doblin, an internist a history of community-based practice. “We are eager to address this backlog as we reach out to our participants and all of the communities we serve, to bring people back into the care system.”
Heartland Alliance Health is a federally qualified healthcare center primarily focused on serving individuals in the Chicago area who are experiencing homelessness, a mission that stretches back more than 40 years.
As the pandemic took hold of the nation, the overlapping homelessness endemic in Chicago exacerbated health risks for an already vulnerable population.
“The challenges that a homeless person faces each day are numerous and too often these individuals cycle in and out of emergency rooms and hospitals and there is little coordination with the community-based clinic where they receive the bulk of their healthcare,” says Doblin.
In 2020, Doblin; Matthew O'Brien, MD, associate professor of General Internal Medicine and Geriatrics; and Aaron Quarles, MD, assistant professor of Emergency Medicine, were awarded a Northwestern Primary Care Practice-Based Research Program (NP3) Seed Grant to explore “Data Systems to Track Homeless Healthcare Services and Outcomes in Chicago.”
The grant provided an opportunity for Heartland Alliance Health and Northwestern to partner on a project specifically seeking data on the services used by Heartland Alliance Health patients across the city.
Soon after the project began, Abel Kho, MD, director of the Institute for Public Health and Medicine Center for Health Information Partnerships and the Institute for Augmented Intelligence in Medicine, brought his expertise with expansive data analysis and the CAPriCORN system to the research team, a critical move in making the work a success, says Doblin.
“Northwestern has built a large and dedicated group of academic physicians and researchers eager to work with community-based organizations, which has so impressed me,” says Doblin. “Once we create a screening tool that can identify those individuals experiencing homelessness, we’ll begin to better understand their needs for healthcare services and how we can work together to provide them.”
What does Heartland Alliance Health do?
We provide holistic care that partners primary care and behavioral health and a series of other supporter services including assistance with benefits and entitlements, legal help, dietary counseling, showers, laundry, and much more.
What has been your favorite part in this collaboration with Northwestern?
Our work with Northwestern University has been so productive. We’ve been impressed with all the resources at the University used to conduct research and gather data what would be normally out of reach for a community-based primary care organization likes Heartland Alliance Health. I am a graduate of Northwestern, having completed medical school and my internal medicine residency there, and I can tell that times have dramatically changed in terms of the desire to work with others organizations in the city. Northwestern, through its Institute for Public Health and Medicine, under the leadership of Dr. Ronald Ackermann, has been a fantastic resource for making progress in serving the needs of the community through research, education, and training.
Why is this project so important?
It was our desire to work with Emergency Rooms around the city to make sure we were identifying all those getting care that were experiencing homelessness and to create and test a new series of screening questions for the ER staff. We found that many at Northwestern were already working hard to organize services for our patients and others experiencing homelessness. With their interest in working with and supporting community-based organizations, we knew we found the right partner. Without identifying those experiencing homelessness, those with no housing or those with unstable housing who are staying with friends or family or doubled up once they entered emergency rooms and hospital units, we would only capture a small part of the information we needed. By missing opportunities to identify all homeless individuals in Chicago, we would have been prevented from creating a system to offer holistic medical and supportive services. This would then lead to many missed opportunities to make referrals to organizations like ours for ongoing primary care or other community services. It our hope that in the future, we’ll be working more closely with many ER and hospital system to create better collaborations of care. The Northwestern team has been open and eager to make this a citywide project and we have built a team that represents many important organizations around town.
How has Heartland Alliance Health continued to provide services throughout the pandemic?
After we shifted to add more care in community settings, we also worked to make telehealth an option for those who could utilize it. And, we took on a new focus to take responsibility to make sure there was a system of coordinated services around the city to acknowledge the need to integrated services that allows all the various health care institutions to join as partners in providing care. Working together, we can better create a holistic system of services that meets the needs of those experiencing homelessness. Trying to better understand what kinds of services individuals experiencing homelessness utilize will allow us to better work together and integrate our efforts. Coordinating emergency room care, inpatient hospital care, and the outpatient services we provide in our three health centers on the south, north, and west sides of the city is our goal.
What do you hope for the future of the Northwestern project?
Our work has been so successful that we have submitted a grant to a large local foundation to further our work for another year or two. I can’t be more pleased to be home again working with the dedicated and brilliant staff at Northwestern.
Northwestern’s NP3 program is designed to support research partnership development and collaboration between community-based primary care practices and academic researchers. These one-year awards are supported by the Northwestern University Clinical and Translational Sciences (NUCATS) Institute, the Center for Community Health (CCH), and the Division of General Internal Medicine and Geriatrics. CCH has a presence in the NUCATS Institute, as well as Northwestern’s Institute for Public Health and Medicine, and provides community and stakeholder engagement infrastructure across the research spectrum.
Written by Roger Anderson