What is a Community Health Worker?
By Jim Ryan, Project Access Program Coordinator It’s 7:25am on a Wednesday morning and Sarah Bates is standing in the alley between 2nd and 3rd Avenues off of Howard Street with a dozen or so folks who have migrated from beneath Spokane’s downtown underpasses and various panhandling corners to be there. Sarah, who stands out from the crowd with her orange IKEA briefcase and unpretentious but decidedly first-hand attire, smiles and connects with several faces that she knows. “Did you get that foot looked at?” she asks one gentleman. “Do you need another bus pass?” she offers a middle-aged woman. Then it’s 7:30 and the door to Shalom Ministries opens. Inside, a hot breakfast is served every weekday to “downtown Spokane’s most vulnerable and at-risk community members.” Sarah, Operations Manager for Project Access Spokane, is not here to eat, though occasionally she’ll grab a cup of coffee and join one of her clients for a meal. Rather, she is here to outreach in her capacity as Community Health Worker for the city’s H3 (Homelessness, Housing & Health Care) Grant. Administered by the Spokane County Medical Society Foundation, the H3 grant seeks to identify and assist Spokane’s most medically vulnerable homeless citizens through intensive coordination with community providers of medical and behavioral health care, substance abuse treatment, housing, dental care and other social services with a goal of long-term stabilization, easy and continuous access to appropriate health services, and broad-based improvement in the patient’s health outlook. As you might expect, this population can be difficult for which to coordinate services —not necessarily because of any negligence on their part, but because of the logistical complications that come with living on the streets. Daily, street-level outreach is vital in maintaining the connection that is required to successfully transition these individuals out of the vicious circles in which they have found themselves caught, usually for many years. Specifically, the H3 grant specifies a number of conditions that are statistically predictive of extreme medical vulnerability among the homeless, including: cirrhosis of the liver, end-stage renal disease, HIV +/AIDS, a history of frostbite, being aged 60 or older or a combination of substance abuse, mental illness and Emergency Department usage. The statistics show that when coupled with other serious medical problems, those are especially fatal conditions for anyone living on the street. I recently accompanied Sarah on a chilly Wednesday morning to the Days Inn downtown, where she was temporarily housing two clients during the transition from the street to more permanent housing. One client, whom we’ll call Marvin, is a 64-year old Vietnam veteran who, in addition to being over 60, has a history of frostbite and suffers from neuropathy and PTSD. Marvin currently needs to have several toes amputated but cannot undergo such a procedure until he is housed. Obtaining housing has been difficult for him, not only for the obvious financial
reasons, but also because his homeless status has resulted in several misdemeanor trespassing charges, mostly around the Plaza bus terminal. Sarah has been working with Marvin to find a housing provider that will take the totality of his circumstances under consideration and give him the chance he needs to transition to stability. The H3 grant will then pay his security deposit and two month’s rent to get him on his feet, at which point he’ll be expected to pay his own way with SSI income. After spending just a short time with Marvin, it becomes abundantly clear that he could never make this transition on his own. He is well-read, articulate, and profoundly likable, but he is debilitated by social anxiety, paranoia and speech patterns that tend to be rather erratic and mumbling. These might not be barriers to stability in and of themselves, but in concert with one another, they have marginalized Marvin. With coordinated intervention, however, he has been responsive and responsible. He has kept his appointments, lived up to his promises and proven time and again that he is willing and able to hold up his end of the bargain. The other client we met that Wednesday morning was Ethan, a 56-year old chronic inebriate with a history of frequent emergency room visits. He has a couple of 20-30 year-old felony convictions, one of which included a charge of “assault with the intent to commit sexual offense,” a misdemeanor. In some states, this charge rather unreasonably requires Ethan to register as a sex offender. In Washington, it does not, but Ethan’s travels over the years have earned him two “failure to register” citations which, bizarrely, are a problem for the state and show up on his record. As a result, housing is difficult to come by. The best he could do recently was a ratty, bed bug-infested slum for which he was paying $500/month while being eaten alive at night. Sarah is working with Ethan to demonstrate that he long ago cleaned up his act and deserves the opportunity to live somewhere clean and safe. Those are just a couple of examples of the outreach Sarah is doing through the Spokane County Medical Society Foundation’s various initiatives. Depending on the day, you might find her at Shalom, House of Charity, Truth Ministries, Volunteers of America or any number of other charitable organizations around town. You might find her at Value Village or Goodwill, purchasing warm clothing, blankets or other necessities which she will take directly to the corner, underpass or shelter where a client may or may not be expecting her visit. You might find her working with a Spokane deputy prosecutor to mitigate an outstanding warrant for a client; reducing his sentence from jail time down to community service. The biggest surprise, she tells me, is how many of those individuals defy expectations when they are engaged in this way. Marvin, in particular, was regarded by many in the community as “unapproachable,” “cranky,” and “mean.” He had long ago been written off as a lost cause. Today, he is preparing to move into his own small apartment. His problems are not solved, to be sure, but he is one big step closer to stability. This is a winter that will not find Marvin literally freezing to death beneath the rumble of traffic on I-90.
December SCMS The Message 10