Hub and spoke approach helps battle opioid addiction in New Hampshire

Los Angeles County’s Homeless Outreach & Mobile Engagement (HOME) program uses street psychiatry to get psychiatric medication to people experiencing homelessness in an effort to get them a step closer to housing. The HOME team has 223 full-time staff members and served 1,919 people last year, 22% of whom ended the year housed.

The emergency room at Swedish Hospital in Edmonds, Washington is working to implement more focused care for those suffering from opioid addiction, an offering not typically present at most hospitals. Using a hands-on approach that integrates "substance use disorder treatment and interventions and assessment," through the use of doctors, counselors, and social workers, this program increases the likelihood of follow through with recovery.

Public libraries can serve as vital community resources. In Winston-Salem, North Carolina, the Forsyth County Public Library operates as a multi-use facility thanks to investments from a voter-approved bond and state grants. In addition to meeting rooms and computer labs, the library provides peer-support specialists trained in assisting homeless patrons with mental health counseling and job services. Health clinics and other community partners also participate in initiatives housed at the library.

Prevention Point Philadelphia provides needle-exchange, HIV and Hepatitis C testing, counseling groups, mailboxes, and Naloxone (an opioid overdose reversal drug) training to 18,000 people. The center also connects addicts to addiction services and other social programs if they want to seek recovery.

For those addicted to opioids, getting treatment can take a long time because not all emergency rooms offer buprenorphine and counseling interventions. Yale-New Haven Hospital has shown that if patients receive buprenorphine at their initial emergency room evaluation, then the immediate action improves the person’s chances in receiving addiction treatment.

In the U.S. most supportive housing programs have a 75 percent turnover rate, meaning people end up in the streets again. Direct Access to Housing in California manages a turnover rate of only 15 percent by providing a home, counseling, and financial management.

Health officials and Cleveland homeless shelters are working together to prevent a coronavirus outbreak among those who are experiencing homelessness. Mass testing, separate areas for the already tested and those yet to be, and a focus on more equitably disseminating information have been key to helping the caseload stay low, although the shelters are facing limitations such as a slow turnaround time for test results.

To help those struggling with opioid addictions, an apprentice program in Kentucky uses art and music taught by local artisans to provide participants with a path forward. After learning various skills as part of the program, a local instrument company also considers the new apprentices for hire as part of a “recovery-friendly” employment movement.

To combat homelessness, an interdisciplinary group known as the “homeless multidisciplinary street team” is focusing efforts on housing those that call 911 more often than others. Taking lessons from a similar model that failed in Los Angeles, the program so far is showing promising results, both in housing this most vulnerable population as well as in reducing costs for the city.

Homelessness is a serious issue in any state, but outlined in this article are 3 unique approaches in 3 different states that have proven successful. Albuquerque, New Mexico, Orlando, Florida, and Detroit, Michigan have all figured out effective plans to get people off the streets. Solutions range from actually giving homeless people permanent housing to designing a 90 day action plan with them to get them back on their feet to offering a quick and easy way to make some money for food or a night at a hotel.