Outreach workers disperse into surrounding streets, alleys and public spaces where homeless individuals and/or PWUD have been known to frequent, using available data to ensure targeted outreach.
•Characteristics—Staff will prioritize individuals who:
– Exhibit signs of addiction and/or homelessness (e.g. open drug use or purchasing, “nodding,” panhandling, etc.)
–Those already known to the outreach workers to be living with SUD
•Geographical scope—The team should agree upon a radius around the mobile unit’s parking location, the size of which may vary depending on the characteristics of the neighborhood and the size of the team. In general, the team should try to balance these goals:
–Cover as broad an area as possible to increase the number of engagements with PWUD.
–Remain within a reasonable distance of the mobile unit where potential patients may be willing and able to walk to the unit to receive clinical services
Teams may consider dropping off outreach teams at various locations en route to the final parking space, who then meet back at the van, to maximize efficiency and geographic reach
•Staff teams—Outreach teams may split up into teams no smaller than two people to ensure safety. If time permits, it is recommended that the clinician also accompany the outreach team to help build relationships and trust. Teams that are larger than two people can be intimidating when approaching individuals outside.
•Recruiting peers to help with engagement—Outreach teams may recruit PWUD to help the team connect with more PWUD, for instance, by having a person introduce the team to members of their network, or by asking a person to let people in their network know about the services offered. A formalized peer-to-peer program with stipends may be an effective outreach and education strategy.
Outreach workers will engage PWUD in harm reduction services and strategies, specifically syringe exchange, safer injection techniques and fentanyl testing.
Engaging PWUD around harm reduction supplies and services is a great way to build a relationship and gain trust. Additionally, outreach workers should:
Engaging PWUD around harm reduction supplies and services is a great way to build a relationship and gain trust. Additionally, outreach workers should:
•Offer the opportunity to see the clinician—People should be made aware of the clinical services offered in the nearby mobile unit, including testing for various infections, immunizations, skin abscess care, addiction treatment, etc., even if only a small proportion express interest in enrolling as a patient.
•Assess current engagement in medical care—Outreach workers should continually assess participants’ medical needs and their current engagement in medical care and try to facilitate access to care provided on the mobile unit whenever possible.
•Accompany individuals interested in clinical care back to the mobile unit—Individuals often agree to meet with the clinician based on the trusting relationship fostered by the outreach worker. Especially in early clinical visits, individuals may need more support as they build a relationship with the clinician
Technology can be very helpful for the outreach team and clinicians to both interact with clients (both current and potential) as well as coordinate efforts with other staff. As such, it is recommended that the program have at least one dedicated mobile phone to the mobile program.
Technology can be very helpful for the outreach team and clinicians to both interact with clients (both current and potential) as well as coordinate efforts with other staff. As such, it is recommended that the program have at least one dedicated mobile phone to the mobile program.
•Phone calls—It is helpful to have a mobile phone dedicated solely to the mobile health program. The number can be circulated on outreach/engagement materials for people to call if they have questions about services. The outreach team should carry the phone during outreach when they aren’t on the mobile unit so that people can reach them if they arrive at the van and no staff members are currently present (a sign on the door can alert people that the team is in the neighborhood with a number to call and a time the team will return to the vehicle). One designated staff member should carry the phone during mobile unit hours. Keep in mind HIPAA-related issues when speaking with patients
•Off Hours—The voicemail on the phone should indicate:
–Clinic hours and locations
–An alternate phone number (if available) to connect with staff during business hours when the mobile unit is not in operation
–To comply with HIPAA, a reminder that protected patient information should not be left in a voicemail
–A reminder that if the caller is experiencing an emergency, call 9-1-1
–If the caller needs to speak to a clinician, they should call the answering service for the clinical practice to reach an on-call clinician.
•Texting—The mobile program should also consider utilizing text messages to accommodate many people (both current and potential) who would view phone calls as a barrier to communicating. It should be made known to patients that texting is not considered secure by HIPAA and therefore no protected patient information should be shared via text. One designated staff member should carry the phone during clinical hours.
•Other Strategies—Social media and apps may also pose opportunities for promotion of program services and education and warrant further exploration.
Outreach workers will engage PWUD in harm reduction services and strategies, specifically syringe exchange, safer injection techniques and fentanyl testing.
•Number of contacts—Each outreach worker should track the number of contacts they make with people during their outreach. Contacts may range from a brief description/offering of program services (e.g. syringe exchange, MOUD on-demand, access to primary care needs on the mobile unit, naloxone, etc.) to a lengthy engagement that results in the accessing of van services. Time likely will not permit outreach workers to collect additional data (e.g. name, sex, race/ethnicity, age, etc.) and it should be understood this statistic includes non-unique contacts.
•Syringe distribution—Each outreach worker should track the number of syringes distributed during each outreach session. As with the number of contacts, time likely will not permit outreach workers to collect additional demographic data.
•Naloxone distribution—Each outreach worker should track the number of naloxone kits distributed during each outreach session. Beyond the number of kits distributed, the evaluation team should consider what other metrics would be most critical to their evaluation while being minimally burdensome on the outreach team. Depending on the funding source for naloxone, there already may be reporting requirements to funders that include additional variables (e.g. whether the kit is a refill, how the previous kits were used, etc.), though these information reports may not be readily accessible for evaluation as the funder has ownership of the data. Other models of naloxone access, such as through facilitated pharmacy access, will not have associated formal data collection instruments.
•Syringe collection—The number of syringes collected from the streets and from people with SUD should be quantified. Due to logistical and safety concerns, it is unlikely that each collected syringe can be counted
