Street roots., June 24, 2011, Image 1

PA T R IC K J. L Y N C H , M E D IC A L ILLU STR A TO R
Screening, tracking and treating traumatic
brain injury on the .street is possible
BY STACY BROWNHILL
STAFF W R ITER
I
magine twoscenarios.
In the first, á once clever and outgoing young
man experiences a traumatic brain injury (TBI),
losés his job, isolates his family and friends and winds
up on the streets. When he tries to get help, his
erratic behavior frustrâtes his social workers. He
forgets his follow-up appointments. When he goes to a
health clinic, the question of prior head injury is
never raised, overshadowed by a litany of other issues \
and lack of time. Even if he thinks to tell the doctor
himself, the TBI record is not shared with other
clinics. As his own behavior becomes increasingly
unfamiliar, the man starts self-medicating with
alcohol, decreasing his chances for disability benefits
and amplifying his already antisocial behavior. His
chances of rebuilding his life are slim.
In the second scenario, the employer, social
workers and doctor recognize symptoms of the man’s
TBI. The m a n takes a basic screening assessment that
supports the diagnosis, and when he is asked, he
recalls the brain injury incident. The TBI is
systematically highlighted in a shared database so that
all safety-net agencies are aware of his history. His
TBI qualifies him for prioritized housing at a shelter,
giving him rest, structure and a network of advocates.
He is given a day planner so he can remember his
appointments. Social workers are able to get him
disability benefits. He builds a new life.
Unfortunately, if you’ve been following our series
on traumatic brain injuries and homelessness —“All in
their heads” (Street Roots, May 27) and “What we
don’t know will hurt us” (Street Roots, June
The good, the bad and the ugly:
trackfcg health ear® for the homeless
,
This is the third report in our ongoing coverage of
traumatic brain injuries among people experiencing
homelessness. Go to www.streetroots.wordpress.com
to read the first two installments in this series.
10)—you’ll recall the first scenario is much closer to
the truth. Studies show TBI is common on the
streets, even a cause of homelessness, but screening,
tracking, treatment and recovery «are rare.
However, there are tangible ways to move Portland
towards scenario two, and improve how we share
homeless health care information in general.
■
B
The good
“When I went to a brain injury conference, I
realized, it’s not all mental illness, it’s brain injury,”
says Dr. Jan Caughlan, Director of Mental Health and
Social Work at Baltimore’s Health Care for the
Homeless. “We should call ourselves Health Care for
the Brain Injured,” she jokes.
Caughlan, who started out as a case manager in
1991, says she’s learned that, as a rule, TBI is not
recognized and patients do not self-identify. “To
diagnose TBI, you have to pay attention. You have to
get a good history. You may be working on your gut,
but the behavior of a brain-injured client is really
different from a mentally ill client,” She says, “and it’s
common.”
Caughlan describes her TBI cases as “very
individual,”'but often marked by erratic, frustrated
Every night when the dock strikes 12 in San Francisco, records
from over a dozen incompatible safety-net databases - including
data from shelters, ambulances, mental health services, hospitals
and sobering centers - are dumped into one central digital
warehouse called the Coordinated Case Management System
(CCMS). Once there, the data is collated and duplicates are
deleted for an end result of around 270,000 individual profiles of
vulnerable people, most of who are homeless.
The noble success of CCMS is that it provides a benefit to
overburdened agencies without requiring them to change their
systems or do any extra work. The next time a homeless person
walks into any safety-net agency in San Francisco, a social worker
or physician can simply click a link to CCMS and see a client’s
complete health and social service history.
And it's inexpensive. Three committed employees of the San
Francisco Department of Public Health created CCMS, without
extra funding, using the software Oracle.
Boston is another innovative hub for health care for the
homeless systems. From 1993-1995, Boston merged records of 75
different clinics and soup kitchens into one database using
Cehtricity software. “It has helped us begin to understand
homeless people's patterns of behaviors,” says O’Connell with
See HEAD CASES, page 7
See GOOD, BAD UGLY, page 7
It starts with screening
Janet Byrd
Getting the policy
ball m oving forward
begins with how we
craft the message
»
Page 4
W - - i
S T A F F W R IT E R
omplaining about health care and health insurance is a
national pastime, but when you're homeless and mobile,
without insurance or a regular doctor, health care is truly an
uphill battle. Tracking and sharing the health history of a
homeless person across multiple systems is fundamental in
providing bettor care, reducing costs, and creating a more efficient
and successful system of safety nets. But it’s rare.
I Inside
■
■
I
B Y S T A C Y B R O W N H IL L
Interstate and
Diamonds are the
beyond
poor's best friend
History resonates as
the city prepares to
expand urban renewal
in the Interstate
Corridor
Environm entalist
Saleem A li talks
balancing need with
greed
Page 3
Page 8