I. The Dermatology Clinic for Homeless Men and Women at the Downtown Emergency Service Center (DESC)
Through participation in the dermatology clinic, medical and physician assistant students learn and practice a set of clinical and interviewing skills, as well as becoming familiar with the special health challenges of homelessness, including limited access to health care, mental health services, and basic amenities such as water and toilet facilities. Student coordinators and student care providers attend quarterly seminars taught by Frederica Overstreet, MD, MPH and and other physicians on topics relating directly to special problems of Seattle's homeless population. All student leaders also attend an orientation at the Downtown Emergency Service Center, led by DESC staff, and a training on clinic administration. Since 1994, the Dermatology Clinic has provided dermatology care for more than 2,400 persons on two Wednesday evenings each month at the Downtown Emergency Service Center (DESC), a shelter for more than 200 adult men and women. Dermatological problems are common in the homeless community, but often go untreated in the presence of more serious medical and social concerns. Approximately ten student coordinators share leadership responsibility, scheduling students and attending physicians, ensuring that supplies are stocked and supervising each clinic session. Care is delivered by two medical student teams, each consisting of a pre-clinical medical student (first or second year [first year MEDEX]) and a clinical (third or fourth year) medical or second year MEDEX student. The teams are precepted by a volunteer attending physician. Students and physicians are oriented to, and instructed to use our ARTE (Articulating and Reflecting Tacit Expertise) teaching program to enhance the learning experience. This program helps students appreciate and learn the complex, tacit skills and knowledge essential in family medicine and many other specialties. Effective diagnosis and treatment requires sophisticated cognitive skills, particularly in the care of underserved and vulnerable patients with multiple comorbidities in communities of special need. ARTE helps future health care providers master skills essential for meeting the challenges of building patient investment, setting priorities, engaging patients in behavior change. Expert practitioners like our preceptors use tacit knowledge and skills that are not often apparent to learners. ARTE aims to help faculty and medical students identify and reflect on the interpretation of classroom learning into community practice.
II. Health Mentoring at Seattle World School
The Seattle World School serves recently arrived high school-aged immigrant and refugee youth who are very new to the Seattle area, by offering health mentoring on a variety of relevant health topics. Immigrant youth have been shown to be at a higher risk of unhealthy behaviors for a variety of reasons, even more so than youth of this age in the general population. This project aims to provide youth with the tools and support to make positive physical and mental health decisions. CHAP students and staff work closely with the Seattle Public Schools Office of Health Education to develop and present a variety of health topics such as smoking prevention, positive body image, and media literacy, in a classroom setting of supportive small group mentoring. This project welcomes health sciences students in medicine, nursing, pharmacy, public health, social work, and physician assistant training. Mentors and students remain in the same groups throughout the year and are able to build meaningful relationships with the kids. From April 1997 to May 2010, CHAP students worked with Hamilton International Middle School in Seattle to offer this program to sixth – eighth graders. Our partnership with the SWS rose out of a decreasing need for this project at Hamilton, and a very high need at the SWS.
III. Foot Care Clinics
Medical and Nursing students who participate in CHAP Foot Care Clinic develop a toolkit of clinical and health promotion skills for working with the homeless community, for whom quality foot care can be a potential life-saver. Prior to each clinic, students attend a two-hour seminar by Frederica Overstreet, MD, MPH, and Josephine Ensign, DrPH, which teaches students principles of diabetic pathophysiology and foot care management, in addition to health education techniques and strategies for encouraging positive health behaviors by diabetic and non-diabetic patients. During clinics for individuals affected by homelessness, students work one-on-one with clients to provide foot examinations and foot care while gaining skills in relevant health education and promotion. Current sites for this project include Mary's Place Drop-in Center for Homeless Women, Downtown Emergency Service Center in collaboration with CHAP Dermatology Clinic, ROOTS (Rising out of the Shadows), a shelter for young adults in the University District, and Hammond House, a shelter for women in Downtown, Seattle.