Sept. 7, 2022, UPDATE: This story has been updated to reflect the full funding amount for the project’s current grant and to also name more community partners.
Oregon Health & Science University nursing faculty and students are taking health services to the streets to support the growing number of Southern Oregonians who are experiencing homelessness — and to improve how health care serves this community.
After a successful pilot project, the OHSU School of Nursing’s Street Nursing Team is now expanding the homeless health services it currently offers in Jackson County and plans to bring their efforts to Klamath County by the end of next year.
“The rising cost of living, the COVID-19 pandemic and the 2020 wildfires have sadly all contributed to increasing homelessness in Southern Oregon,” said the project director, Heather C. Voss, Ph.D., RN., who is also an associate professor of clinical nursing in the OHSU School of Nursing Ashland Campus.
“Not having a place to call your own home can lead to new health concerns and worsen pre-existing ones,” Voss continued. “At the same time, people who are unsheltered don’t often feel comfortable seeking help from traditional health institutions. The OHSU Street Nursing Team seeks to build trust over time by meeting people wherever they are, week after week. If someone wants help, we offer basic health services and can connect them with other providers for more advanced care.”
Learning beyond the classroom
The team’s efforts began as an offshoot of a class on population health, which explores how socioeconomic circumstances and the way institutions are organized causes some groups to collectively experience health issues differently than the population as a whole. To apply her class’s lessons to the real world, Rachel Richmond, M.S.N., RN, an assistant professor of clinical nursing in the OHSU School of Nursing Ashland Campus, in 2015 began organizing foot-soak clinics.
Foot-soak clinics offer a safe, judgment-free space where clients can engage with students or faculty while also addressing foot ailments, which are common among people experiencing homelessness. OHSU nursing faculty originally organized foot soaks weekly in Ashland, but they’ve recently increased their frequency to up to three times a week, and they now happen in both Ashland and Medford.
Early this year, the foot soak clinics transitioned into a street nursing pilot project, with small groups of OHSU nursing faculty and students visiting people experiencing homelessness near Ashland and Medford. Between January and June of this year, 179 visits occurred at encampments and other sites.
During each visit, team members offer local residents a variety of services, such as foot soaks, hygiene supplies, clean socks and overdose prevention education that includes how to give the overdose-reversing drug naloxone. Team members also coordinate client care by facilitating virtual telehealth appointments with other health care providers and accompanying patients as advocates during in-person medical appointments.
Now, OHSU faculty are expanding the Street Nursing Team’s outreach efforts. By the end of 2026, the team hopes to conduct more than 1,000 visits with Jackson and Klamath county residents who are unhoused, and have nearly 300 nursing students participate. Student team members will be enrolled in the OHSU School of Nursing’s undergraduate and graduate programs, with the latter working to become psychiatric mental health nurse practitioners in a program led by assistant professor Helena F. Turner, M.S., PMHNP.
Changing minds, changing care
To further enhance nursing education, various classes at the OHSU School of Nursing’s campuses in Ashland and Klamath Falls will teach about people without housing and related topics. Expected lessons include the traumatic experiences that are common among unhoused people; how some health care approaches can inadvertently be harmful; best practices for providing care outside of a traditional clinical setting; and, how mobile health options can better meet certain patients’ needs. By encouraging students to understand the nuanced complexities of people without housing early on, OHSU hopes its future graduates will become nurses who provide care from a more patient-centered mindset.
In the future, health issues of people who are unhoused may be incorporated into learning experiences offered at all five OHSU School of Nursing regional campuses, and for students as well as faculty.
“Students who participate in the Street Nursing Team make the street their classroom, and learn by directly interacting with people who are unhoused,” said Richmond, who is the team’s project manager. “This immersive learning experience changes students’ perspectives, and can prevent future nurses from passing stigmatizing judgement on patients who are unhoused.”
“I hope this project will help tomorrow’s health care workers see each and every patient as a whole human being who deserves respect and compassion,” Richmond added.
In addition, the Ashland and Klamath Falls campuses will offer a total of $660,000 in scholarships to as many as 26 undergraduate and 12 graduate nursing students interested in serving patients without housing. Scholarships will be offered to students who have experienced housing insecurity or otherwise come from disadvantaged backgrounds. As part of the scholarship program, recipients will have additional hands-on educational opportunities with local providers. Supporting underrepresented students is part of OHSU’s larger efforts to grow and diversify Oregon’s health care workforce.
To support the current health care workforce, the OHSU Street Nursing Team also plans to offer evidence-based training opportunities for health care workers and community service agencies that work with the unhoused population.
Local organizations that have partnered with the OHSU Street Nursing Team include: Jackson County Library Services, La Clinica, Jackson County Syringe Exchange Program, Stabbin' Wagon syringe exchange, Options for Helping Residents of Ashland and Jackson Care Connect. The team continues to build connections with other organizations and hopes to add more partnerships as the project moves forward.
OHSU staff leading Street Nursing Team efforts include Voss, Richmond, Turner, Joanne Noone, Ph.D., RN, CNE; and, Brenna Park-Egan, M.S., CPH.
The project is currently supported by a four-year, $3.9-million grant from the U.S. Department of Health & Human Services’ Health Resources & Services Administration, and previously received a $20,000 grant from Jackson Care Connect.