Populations Served: Family Health Centers of San Diego’s (FHCSD) Mobile Harm Reduction Team (M-HRT) Program will engage, screen and enroll 350 individuals, youth, and families who are experiencing homelessness and substance use disorder (SUD) or co-occurring mental health conditions (COD) through field-based outreach and engagement in M-HRT services. Operating in conjunction with the operational hours and various site locations of FHCSD’s safe syringe program and surrounding neighborhoods, we anticipate that our population of focus (POF) will disproportionately be experiencing SUD and serious mental illness (SMI) and face significant economic, social and physical barriers to maintaining stable housing, achieving optimal SMI and SUD treatment, and accessing other supportive services. Each year, 20 high-risk M-HRT participants will also receive financial support for 3 months of Recovery Residency.
Strategies and Interventions: M-HRT will establish a comprehensive and highly coordinated program that, with strong case management and participant support, will provide: 1) program services including case management, substance abuse and mental health treatment and recovery services, homeless services navigation, peer support within SUD services, and health and benefit enrollment assistance; 2) internal supported referrals to wrap-around FHCSD services for primary and dental healthcare, Medication Assisted Treatment, psychiatry, and other services provided by FHCSD; and 3) external referrals to community resources for needs such as employment assistance, legal aid, residential treatment, as well as other supportive services as indicated. M-HRT will employ evidence-based practices in all aspects of the program, including Harm Reduction (HR), Intensive Case Management (ICM), Trauma Informed Care (TIC), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), and Relapse Prevention (RP). Enhanced access to a hard-to-reach POF through field-based outreach in collaboration with FHCSD’s syringe services program will enhance the service experience of M-HRT participants across the continuum of care by systematically assessing client needs and service gaps, developing strategic partnerships to address those needs, and conducting careful and ongoing review of service collaborations to secure those needs.
Goals and Objectives: The overarching goal of M-HRT is to reduce service barriers and increase access to high-intensity service interventions by expanding field-based services, increasing our capacity to reach the POF with robust services that impact their health and quality of life. This will reduce inequities, trauma, and stigmatization for participants as it improves their care. Offering field-based services also increases the visibility of available services to, and health education for, the POF. It will also increase access to age-appropriate services for San Diego’s rapidly growing population of older adults within M-HRT’s POF. Objectives include enrolling 350 participants over the course of the 5-year project period (45 participants will be enrolled in Year 1, and 75 in each of Years 2-5); and fundamentally addressing participant psychosocial, mental health, and medical needs through a range of services, the development of individualized care plans, internal and external referrals, and linkages to care.