Meet the BHCHP Street Team
Street Medicine has been a critical innovation of BHCHP since a disproportionate number of deaths occurred among the several hundred unsheltered individuals during the winter of 1985-86. This newsletter offers a glimpse into the evolution and accomplishments of BHCHP’s Street Team that continues the mission of providing continuity of the highest quality medical, psychiatric, and substance use disorder care to Boston’s “rough sleepers,” those who assiduously avoid shelters and sleep in doorways, under bridges, down back alleys, on park benches, and along the banks of the Charles and Muddy Rivers.
In the summer of 1985, in the midst of the devastating epidemics of AIDS and TB, BHCHP initiated direct clinical care in most of Boston’s adult shelters and soup kitchens, family shelters and motels, and opened the nation’s first medical respite care unit of 25 beds nested within the Lemuel Shattuck Shelter. Continuity and coordination of care were fostered by daily anchor clinics at Boston City Hospital (now Boston Medical Center) and Massachusetts General Hospital. But the deaths on the streets during that first harsh winter called for an expansion of the care delivery model. With funds from the Massachusetts DPH, Pine Street Inn began an Overnight Van that has combed the city each night for these past 37 years from 9PM until 5AM bringing food, blankets, clothing, and a dedicated staff to engage these individuals who assiduously avoid shelters and struggle to survive while exposed to the extremes of heat and cold and the vicissitudes of life on the streets. Recognizing a need for medical care, Dr. Jim O’Connell was invited by the PSI Van staff to join two nights each week. He was later joined on the van by Dr. John Romano, the medical director of BHCHP’s respite unit. These nightly rounds were expanded several years later to include daytime street rounds with the welcomed addition of BHCHP nurse practitioner, Denise Petrella. The Street Team has continued to grow ever since, becoming a national and international model of street medicine.
The Street Team adheres to the core principle, articulated by Dr. Phil Brickner of St. Vincent’s Hospital in Greenwich Village and the Robert Wood Johnson Foundation’s Health Care for the Homeless Program, that care must be brought directly to those struggling to survive in shelters and on the streets rather than expecting them to come to traditional clinic sites in health centers and hospitals. Trust, earned through a consistent and compassionate presence, and is bedrock for engagement in health care. Continuity of care optimizes quality and becomes a core of the relationships fostered by the Street Team. To achieve this goal, the Street Team strives to follow each patient from the streets to clinic to hospital to McInnis House to housing. While first aid and episodic care occurs frequently during sessions on the van and rounds on the streets, the team has gained vast experience caring for rough sleepers with acute and chronic diseases, such as heart failure, chronic lung disease, hepatitis C, AIDS, skin infections and infestations. For more than 20 years, BHCHP’s street clinic at MGH has fully integrated the care on the streets within the mainstream of the hospital, including accessibility to essential specialty clinics and inpatient care.
Including Dr. Jim O’Connell, the founder of BHCHP’s Street Team and Julie Bogdanski its Administrative Assistant, the team is comprised of two internists, a family physician, two psychiatrists, a physician assistant, two nurses, a care manager, and a recovery coach, is overseen by Medical Director Dr. Dave Munson and Team Manager Rebecca Tachick, RN.
We spoke to the Street Team about their inspiring work.
Mike Jellison is the Team’s Recovery Coach supported by Mass General Hospital and has been doing this for 7 years. The importance of Mike’s role of peer support in the care of people experiencing homelessness cannot be understated as Mike is able to engage with our patients as a person with lived experience. He describes our patients on the street as having experienced serious hardships and traumas, but they “also have beautiful, wonderful and heartwarming stories of who they are. Our patients didn’t just wake up one morning and think ‘I want to be a person experiencing homelessness’ they’ve had lives, dreams, and goals.” Mike is grateful to be able to share the journeys of his patients, “I can’t think of another job out there that would have enriched my life as much as this role has for me.”
Katie Koh, MD has been a psychiatrist on the Street team for 4 years. Seeing patients in various settings, “allows for incredibly rich and intimate conversations about people’s life experiences, symptoms, fears, hopes… I help a patient develop insight to what they may be experiencing and how a psychiatric disorder can affect their thoughts and behaviors or how medications or therapeutic strategies can help alleviate their suffering.”
She says that her patients have been through unimaginable life experiences and adversity, and “yet find a way within themselves to keep moving forward to a better life, and often let me into their inner worlds. Their resilience is truly breathtaking and moves and motivates me every day.”
Becky Lee, MD joined the Street Team as a physician in 2020. She describes most of her patients as having experienced serious trauma in their lives, needing medical or psychiatric care, but who “fly under the radar.”
What does Becky have in her backpack? It’s a long list! It includes: Equipment to take vital signs, a glucose monitor, stethoscope, a portable ultrasound probe that plugs into an iphone, phlebotomy supplies to draw blood, an emergency medication kit, life-saving naloxone, post-exposure HIV prophylaxis, antibiotics, and vials of lidocaine and steroids to do procedures like abscess drainage and joint injections, a wound care kit, heavy duty nail clippers, pregnancy tests, safe smoking supplies and safe injection supplies, fentanyl test strips, condoms, socks, hats, gloves, hand warmers, granola bars, gift cards and T passes.
Becky says that what our patients need most is “whole-hearted, unconditional love and compassion.” She quotes Fr. Gregory Boyle’s definition of compassion – “Compassion is not a relationship between the healer and the wounded. It’s a covenant between equals”.
Dave Munson, MD first started on the Team in 2012 and, as its Medical Director, is responsible for its clinical operations and quality metrics, and for prioritizing continuity of care across settings for our patients. He focuses on building relationships with our patients who he says, often “feel marginalized by the health care system at large.” From his experience, Dave sees that “most people experiencing homelessness are the victims of unfortunate circumstances that could befell any of us.” If anyone asked him how they might help our patients, he would say, “try volunteering at a local shelter or soup kitchen. Spending time with people who are experiencing homelessness will help decrease the stigma many of our patients face.” Dave enjoys mentoring students and future clinicians who are interested in our work.
Richard Nickerson, a case manager for 4 years, says that his experience on the Street Team has expanded his capacity for compassion and his “ability to meet someone where they are.” His favorite part of his role is engaging with patients on their own terms. He wished folks knew his Street Team patients as he knows them, what they have endured, who they are as individuals. His hope is that people will feel more compassion and be able to engage with those experiencing homelessness, even if it’s a simple acknowledgement, like making eye contact when walking by them.
Jen Nunes, PA-C, has been on the Street Team just over two years and says our patients’ hesitancy to engage in traditional medical care is often caused by previous negative experiences, mistreatment and lack of accommodation and that our Street Team’s model is an effective way to engage with them. Jen loves learning from her patients, following their lead, listening more than talking and being part of a strong team with diverse experience and expertise.
Jen’s describes her patients as “some of the most generous and selfless people I’ve ever met, even in the face of tremendous personal challenges.” Her hope is that others will “treat those living on the street with dignity, respect, and kindness. A simple greeting or smile can go a long way in someone’s day.”
Eileen Reily, MD has been a Street Team psychiatrist for 20+ years, treating folks with serious mental illnesses such as schizophrenia, bipolar disorder, depression, and post-traumatic stress disorder. Eileen’s deep and pioneering experience has made her an expert in the field.
She humbly describes her work as “old-fashioned home visits to folks who do not have homes, “ extending visits to where the patients go intermittently, such as hospitals and our own Barbara McInnis House respite program. She sees her patients as isolated and lonely, needing “affirmation of themselves as valuable human beings.”
She humbly describes her work as “old-fashioned home visits to folks who do not have homes, “ extending visits to where the patients go intermittently, such as hospitals and our own Barbara McInnis House respite program. She sees her patients as isolated and lonely, needing “affirmation of themselves as valuable human beings.”
Eileen is honored that patients share their lives with her. When asked how others can help the Street Team patients, Eileen answers simply, “Look them in the eye, show kindness and concern, offer to buy a sandwich or coffee, simply show that you notice them and care.”
Beckie Tachick, RN is currently the Street Team Manager, and has been on the Street Team for 8 years, primarily as a case manager. Prior to that, Beckie had been a volunteer at our BHCHP foot clinic at St. Francis House and an Americorps member on our Family Team. She values the high quality continuity of care that we provide our patients, following them as they transition from the street to clinic to housing, as that consistency and compassion are core to building trust with patients. Many of our patients Beckie says, “have experienced unimaginable levels of trauma in their lives,” and trust is difficult for them. It takes time and dedication. Beckie enjoys engaging with her patients, many of whom “have a brilliant sense of humor,” despite all they have been through. She says she feels “so lucky to be able to build relationships with our patients that allow space to share tears and big belly laughs.”
Mary Ying, RN, Nurse Case Manager has been on the street team for 2 ½ years, having previously been an inpatient psychiatric nurse. She views herself as an advocate, assisting patients in navigating the complexities of the healthcare system in various settings – on street outreach, within our clinic, during hospitalizations, and post-discharge follow-up. Her street clinical care includes wound care, triaging patient’s medical complaints (e.g., headaches, cold-like symptoms, chest pain or fractured ribs), administering routine vaccines and substance use disorder treatment. She values the special relationships she forms with her patients, bearing witness to their struggles and their resiliency, growth, humor and how they care for one another on the streets.
