Unique MedRest program serves ill and injured homeless youth

By Jolayne Houtz         

When you’re homeless and sick, the small comforts that can help speed recovery – a quiet, safe place to sleep, a little chicken soup -- are usually out of reach.

The homeless and ill may try to recuperate by riding a bus all night to keep warm. Others remain outside and struggle to keep their medications dry and their symptoms under control.

Now, a first-in-the-nation outreach effort led by the UW School of Nursing has offered an alternative to homeless young people in Seattle – and provided a gateway to other services to lead them out of homelessness to a more stable life.

The pilot program, which ended in June, is called MedRest, a medical respite program for young homeless adults aged 18 to 23 who are ill or injured, but not so seriously that they require hospitalization.

The program was the outgrowth of a community/campus partnership led by principal investigator Josephine Ensign, an associate professor in the school’s Department of Psychosocial and Community Health. The work was funded by a one-year, $75,000 pilot grant from Group Health Foundation’s Children and Teen Grants program.

Fourteen patients were accepted into the program, with ailments ranging from bronchitis to a fractured leg, referred by health care providers at two city clinics serving homeless youth.

It’s a “window of opportunity,” Ensign said, a vulnerable moment when people who might otherwise resist a helping hand are open to assistance.

Here’s how it works: A patient is transported by taxi to a transitional program in the University District run by YouthCare, a community agency serving homeless youth. An overnight health care team stays with the patient through the night, including a School of Nursing clinical faculty member and a student from nursing, medicine or another health sciences program through the Student Providers Aspiring to Rural and Underserved Experience, or SPARX, program.

They provide support and meals and monitor symptoms, then coordinate the patient's transfer to an adult medical respite program at Harborview Medical Center in the morning, where follow-up care and services can be coordinated.

One of Ensign's success stories last year was a young man she saw at a clinic who was struggling with drugs, alcohol and panic attacks. But he rejected her suggestion to try the MedRest program.

Three weeks later, after a drug and alcohol binge and a major bike wreck, he was back, barely able to walk. He agreed to try MedRest that night, went to the adult respite program the next day and ended up getting both follow-up surgery and help staying off drugs and alcohol. Today, he has a steady job and lives in his own apartment.

“Building trust underlies this. The message is, ‘When you’re ready, we’re here for you,’” said Ensign, who has worked with homeless youth for nearly 30 years as a researcher and nurse practitioner.

MedRest also aims to build health literacy among homeless young people. UW health-sciences students offer advice on health insurance, self-care and other topics through local drop-in centers, shelters and clinics, serving about 250 young people last year. In addition, the MedRest staff efforts have helped improve the rate of homeless young people applying for and obtaining their own health insurance through the 45th Street Homeless Youth Clinic.

The need for MedRest is clear, Ensign said: There are an estimated 500 to 1,000 street and shelter-based youth between the ages of 12 and 24 in Seattle/King County. In addition, MedRest provides valuable experience for student health care workers learning about the complex intersection of health and social justice issues.

Through another aspect of the program, the MedRest staff provided cultural sensitivity training about homeless youth subculture to 300 Seattle-area community health providers, such as emergency department medical social workers, physician and nurses.

Ensign and other MedRest advocates are seeking additional funding from private foundations and others to keep the overnight medical services program going. They also are working toward expanded access to MedRest by taking patient referrals from hospitals and social workers and opening the program to homeless youth under age 18. In the meantime, the MedRest Steering Committee members are continuing the community health care provider trainings.

MedRest community partners include: Public Health-Seattle & King County/Health Care for the Homeless Network; YouthCare; Country Doctor Free Teen Clinic; 45th Street Homeless Youth Clinic; Child and Adolescent Programs, King County Mental Health -- Chemical Abuse and Dependency Services Division; Interfaith Task Force on Homelessness; youth/young adult representatives; and the UW schools of nursing, social work and medicine.