Suitcase Clinic:
A Proposal for the Establishment of a Youth Clinic (Name for Drop-In?)
Written by:
Table of Contents
I. Overview
II. History of Suitcase Clinic
III. Mission of Suitcase Clinic
IV. Community Assessment
A. Stories from Youth
B. Research Data
V. Youth Clinic Mission and Values
VI. Youth Clinic Program Description
A. Outline of Planned Projects and Services
B. Description of Night at the Drop-In
C. Security and Property Protection Measures
VII. Church and Community Benefits
VIII. Collaborating Organizations
IX. Letters of Support
Overview
The Telegraph and Shattuck Avenue corridors in Berkeley represent meccas for homeless and street-identified youth from around the country. Homeless and runaway youth flock to Berkeley because of its long history as an open and welcoming place. Yet, until a few years ago, almost no homeless services were available in Berkeley to serve the special needs of hard to reach street-identified youth. The City of Berkeley estimates that youth between the ages of 13 and 23 account for 100-200 of the homeless people in Berkeley on any given day. A Berkeley Department of Mental Health study on homeless youth found that over 80% of the youth had mental health issues and histories of abuse by parents or guardians. All of the youth surveyed in the study used drugs or alcohol on a daily basis, and half of the youth acknowledged experimenting with IV drugs.
Youth that live on the street are extremely vulnerable to suicide, HIV/AIDS, sexually transmitted infections, traumatic injuries, and infectious diseases such as tuberculosis, hepatitis B and C. Existing health care and social service providers in Berkeley report that teenage pregnancy, asthma, infestations, and wound care are other important health issues among Berkeley’s street youth. The health problems of street youth also become public health risks for other members of the Berkeley community.
Berkeley has several nonprofit organizations that provide health care services to homeless and uninsured individuals. Each of these organizations has found that youth are reluctant to access their services for a variety of reasons including the presence of adults, a lack of trust in the providers, an adult rather than youth-oriented culture, and inconvenience in terms of time and location.
In 1998, the Berkeley Chaplaincy to the Homeless approached the Suitcase Clinic, with a request to assist in the establishment of a homeless youth-focused health services clinic and drop-in center similar to the existing Suitcase Clinic sites. The Suitcase Clinic, a UC Berkeley-sponsored, student- and volunteer-run organization, operates two multi-service centers for homeless and low-income individuals in Berkeley every week. The Chaplaincy has taken the lead in establishing programs for homeless youth in the Telegraph and Haste area of Berkeley. In July 1997, the Chaplaincy began a drop-in center for homeless youth that now serves 20-50 youth per day. Their services include food, recreation, counseling and advocacy, health care, and others.
This program has been extremely successful at establishing trust with the youth and providing needed services. Since the Chaplaincy’s original request for support, the Suitcase Clinic and several other organizations have been working to recruit a multidisciplinary team of volunteers and paid staff to provide health and social services, advocacy, and counseling together under one roof for a weekly evening drop-in center for homeless and street-identified youth. Over $10,000 in funds has been secured and partners in the project have made commitments to participate in this effort. Now, the support of local religious organizations is needed to provide space for the operation of this drop-in center on a weekly basis.
The remainder of this proposal chronicles stories of homeless and street-identified youth and reviews statistical data on this population. The history of the Suitcase Clinic is reviewed including its mission and values. A description of the proposed once a week drop-in is included as is a review of its potential benefits to youth, the community, and collaborating sponsors. Several letters of support from collaborating organizations are included. Participants in the Suitcase Clinic look forward to gaining your support for this effort. Without the generous donation of physical space for the drop-in, the project would not be able to occur. Please do not hesitate to contact us if you have further questions, concerns, or suggestions after reading this proposal.
History of Suitcase Clinic
In the summer of 1989, a group of first year UCB/UCSF Joint Medical Program students discussed the idea of developing a program to help the people living on the streets of Berkeley. This group developed their ideas further in their Fall 1989 Health Policy course. They envisioned a program that would provide needed, specialized, and appropriate services to those who typically receive inadequate health care. As a first step in the development of their idea, the students conducted a community needs assessment.
They met with homeless individuals on the street, community-based organizations such as the Berkeley Emergency Food Project, and medical clinics such as the Berkeley Free Clinic. Through their outreach efforts, the students tried to gain a better understanding of available services and service gaps. The students concluded that many of the homeless did not utilize social and medical services because many services were inaccessible.
Based on their assessment, the students conceived of a mobile clinic that would travel directly to clients and provide services. Medical and other supplies were carried in suitcases, hence the name “Suitcase Clinic.” A van was donated to the project, but when the van broke down the student volunteers reevaluated their plans.
The students realized that homeless individuals needed more than medical care and conceived of a clinic that would provide more than medical services. Working with the Berkeley Emergency Food Project and the First Presbyterian Church, Clinic organizers decided to hold the Clinic on Tuesday nights in conjunction with the Food Project’s evening drop-in center at the church.
Undergraduate students played an integral role in the development of the Clinic and are now primarily responsible for its continuing operation. Undergraduates helped develop a semester-long UC Berkeley course associated with the Clinic, initially sponsored by the Anthropology Department. The course is now sponsored by the Health and Medical Sciences Division in the School of Public Health. The course was designed to increase volunteer recruitment, raise student awareness, and train new undergraduate volunteers. Undergraduates coordinate the Clinic’s various departments, help raise the necessary funds for operation, conduct Clinic evaluations, and oversee other aspects of the Clinic.
The Clinic opened during the fall semester of 1990. The Clinic organizers had two primary goals for the Clinic at its outset: 1) To provide a multidisciplinary clinic where the homeless could receive a wide range of services including medical care, chiropractic services, optometry and haircuts. 2) To provide a community service arena where all providers would cooperate in fulfilling all of the service requirements of the population. A corollary goal of the Clinic has been to provide a learning experience and opportunity for students - medical, optometry, undergraduate, etc.
In 1998, the Clinic opened a second site at a local women’s shelter run by the Berkeley Emergency Food and Housing Project. This site was established to make services more accessible and appropriate for homeless women and children. The Women’s Clinic operates every Monday night and offers services similar to those on Tuesday night.
Mission of Suitcase Clinic
Mission
The mission of the Suitcase Clinic is to promote the health and overall well-being of homeless and low-income individuals through service provision, cooperative learning, and collective action among community and professional volunteers, students, and participants.
Clinic Philosophy
We, community and professional volunteers, students, and participants, that support the mission of the Suitcase Clinic, believe…
➢ In the dignity of all human beings, and hold that health care is a right of all persons, regardless of ability to pay.
➢ That health is a state of complete physical, mental, and social well being, not merely the absence of disease and infirmity. Health promotion requires more than medical care and should include programs that address behavioral, social, and environmental issues that affect people’s quality of life.
➢ That Clinic projects should stem from the participants’ expressed needs and hopes, rather than from providers’ beliefs about participants’ needs. In other words, the Clinic values the principle of “starting where people are.”
➢ That Clinic projects should strive to be proactive rather than reactive by:
- Responding to the concerns of all homeless and low-income persons and not just those that come to Clinic;
- Utilizing individuals’ strengths and resources rather than simply focusing on needs; and
- Advocating for public policies that address long-term concerns in addition to immediate needs.
➢ That empowerment involves cooperative learning which encourages personal reflection and a Clinic environment that fosters personal growth through the sharing of ideas, resources, and support.
➢ That the learning experience of volunteers should not take precedence over their role in offering services and programs for participants.
➢ That Clinic projects and services should be accessible in terms of time, place, and manner.
➢ That the Clinic should maintain an informal environment that fosters teamwork and community building.
Community Assessment
“On the street I saw a girl cold and shivering in a thin dress, with little hope of a decent meal. I became angry and said to God: ‘Why did you permit this? Why don’t You do something about it?’ For a while God said nothing. That night He replied quite suddenly: ‘I certainly did something about it. I made you.’”
Stories from Youth
Research Data
Between 100 and 200 youth are homeless on the streets of Berkeley on any given day. Roughly 30-40 youth inhabit the Telegraph and Haste area at most times of the year with increasing numbers during the summer months. A core group of about 15 youth remain in the Telegraph area for several months, whereas others stay for days to weeks. The homeless youth population in Berkeley ranges in age from roughly 13 to 25 years old and is predominantly white.
Most of the youth have either runaway or been thrown out of their permanent homes. Some of the youth have runaway or “graduated” from institutional care such as foster homes, juvenile detention, or inpatient psychiatric facilities. According to several studies on homeless youth, family conflict is consistently reported as their primary cause of homelessness. Family conflict results from a variety of factors including difficult relations with step-parents, conflicts over sexual activity and sexual orientation, teenage pregnancy, school problems, alcohol and drug use. Neglect and physical or sexual abuse in the home are also common experiences among youth. Across studies, rates of sexual abuse histories among homeless youth range from 17-35% and physical abuse from 40-60%. Nearly one-fifth of homeless youth have at some point in their lives been removed from their home by child welfare authorities because of neglect and abuse. The early childhood history of most youth on the street is characterized by residential and familial instability.
About 1/3 of homeless youth in most studies have falling at least one year behind in school due to suspensions, expulsions, or dropping out. Many youth have emotional and mental health problems resulting from their experiences and use of alcohol and drugs. In several studies, 30-50% of homeless youth sampled had attempted suicide at least once in their lifetime.
In a study of Berkeley’s homeless youth, it was found that all of the youth interviewed used marijuana at least once per day. Alcohol and hallucinogens were also used on a regular basis by some of Berkeley’s youth. Many of the youth interviewed for the study estimate that about 1/2 of their counterparts use intravenous drugs such as heroin.
While on the streets, youth are often the victims of crime and abuse with rates of trauma and rape 2-3 times greater than non-homeless youth. Some youth resort to prostitution and drug dealing to survive. Homeless youth are more sexually active than age-matched housed youth and report condom usage rates around 50%. According to some studies, 10-20% of homeless girls are currently pregnant and 30-40% have been pregnant at least once in their lifetime. Rates of HIV infection and AIDS among homeless youth vary across studies from 0-7%. Risks of infection are high among youth because of several risk factors including unprotected sex with multiple partners and IV drug use.
Homeless youth are at greater risk for medical problems and their health often deteriorates while homeless. They sleep too little, often in unsafe, unclean, or overcrowded environments. They have little money and eat poorly. They have little opportunity for adequate personal hygiene and have difficulty finding places to go to recuperate from illness or injury. Homeless youth suffer disproportionately from traumatic injury, skin infestations, infectious diseases, nutritional disorders, and other conditions. On a daily basis at the Chaplaincy youth drop-in center, staff estimate that on average seven individuals could benefit from medical care but are reluctant to use services for a variety of reasons. These reasons include the presence of adult patients, a lack of trust in the providers, an adult rather than youth-oriented culture, and inconvenience in terms of time and location.
Most of the studies on homeless youth document the need for a comprehensive, youth-focused center that provides a complete array of services. Youth tend to avoid services utilized by adults or run by staff insensitive to their situation. These centers must first build trusting relationships with the youth and meet their basic needs. With this background information in mind coupled with ongoing consultation with homeless and street-identified youth, several community organizations, and government staff, the Suitcase Clinic has developed plans for a youth-centered evening drop-in center.
Youth Clinic Mission and Values
Mission
The Suitcase Clinic’s Youth Clinic will:
1) Provide culturally appropriate and youth accessible services to homeless and street identified youth that increases opportunities for positive social and physical outcomes.
2) Advocate with homeless and street identified youth for services, resources, tolerance, and affordable housing.
3) Include youth from the client base to manage the S.C.Y.C. and determine the type, nature, and style of service provision and resource distribution.
Values
The Suitcase Clinic Youth Clinic will recognize these values in its service delivery:
1) Respect for dignity and autonomy in the provision of services.
2) Use of an empowerment and development model with a strengths-based perspective.
3) Commitment to non-judgmental service provision.
4) No permanent exclusions from participation in drop-in programs and services.
5) Accessibility to youth culture, including animal companions.
6) Formal commitment to “starting where people are” and high tolerance.
7) Ongoing training of staff, policy review and development.
8) Inclusion of youth in management structures.
9) Commitment to advocacy and assisting youth to gain self-advocacy skills.
10) Use of youth culture appropriate communication styles and presentations.
Youth Clinic Programs Description
Outline of Planned Projects and Services
➢ Safe, clean, respectful environment
➢ Evening Snacks
➢ Personal Hygiene Services
- Available restrooms
- Laundromat service
- Students wash and dry clothes during 3 hours of drop-in operation
- Personal hygiene supply kits: soap, shampoo, toothpaste, etc.
- Donated clothing – from campus drives
➢ Recreation
- TV and VCR
- Games
- Arts and Crafts
➢ Medical services (See below)
➢ Accupuncture
- For alcohol and drug detoxification
- For stress reduction and relaxation
- For overall health and well-being
➢ Optometry
➢ Chiropractic
➢ Basic counseling and social services
- Trained UCB undergraduate and graduate caseworkers
- Sensitivity and counseling skills, suicidality screening and protocol, protocols and training for dealing with violence and intoxication, diffusing violence, etc.
- Professional support staff
- Crisis management and training with protocols
- Team follow-through with appointments, phone calls, etc.
➢ Educational services
- Classes
- Tutoring for GED, etc.
- Job training, resume preparation
➢ Legal services
- Emancipation issues, minor crimes, benefits, and other legal issues
➢ Pet care
- Pet food, leashes, licenses
- Veterinary care
➢ Medical Services
Diagnosis and Treatment of:
Coughs
Diarrhea, vomiting, and other digestive problems
Colds
Cuts and bruises
Sore throats
Rashes, scabies, lice, and other skin problems
Flu
Infections: ear, throat, sinus, etc.
Abdominal pain
Menstrual cramps, vaginitis
Musculoskeletal injuries/pain
Headaches
Acute care, education, and referral for the following chronic problems:
Asthma
High blood pressure
Arthritis
Diabetes
Ulcer disease
Chronic back pain
Recurrent headaches
Seizure disorders
Services/Supplies Available:
Medical advice and referrals
Free influenza vaccinations in the fall
Blood sugar testing
Blood pressure screening
Urine dipsticks
Bandaids, simple wound dressing materials
Condoms
Feminine hygiene supplies
Home pregnancy testing kits
Services Specific to Youth Clinic:
• Sexually transmitted infection (STI) diagnosis and treatment
• Family planning and STI prevention counseling
• Wound care diagnosis, treatment, and education
• HIV testing and referral
• Immunizations – Varicella, HBV, Influenza
Hepatitis C testing
DO NOT provide:
Treatment of HIV infection or AIDS
Treatment of medical emergencies
Pediatric follow-up and well-baby checks
Prenatal care or specialized care for pregnant women
Regular care for chronic problems such as asthma, high blood pressure, seizures
Narcotics or other potentially addictive medications
Advanced specialty care in dermatology, podiatry, orthopedics, mental health, etc.
Description of Night at the Drop-In
Security and Property Protection Measures
Church and Community Benefits
The Youth Clinic would benefit all those who contribute to the endeavor. Aside from the satisfaction of participating in a worthwhile cause, providing health and social services to homeless and runaway youth, the church also benefits from the increased interaction with the University. For many students, the numerous churches surrounding campus are interchangeable with one another. However, for the thousands of students who have been active and will be active in the Suitcase Clinic, a few churches have special significance to us: First Presbyterian allowed us to set up the Suitcase Clinic on Tuesday nights so many years ago and continues to support us; First Congregational provides the space for a youth drop-in center; and finally Trinity Church, where so many of our clients go to have meals for a quarter. Although, many of us have never belonged to a church, we now recognize the importance of the churches in providing valuable services, especially for those who need the help but are not being assisted by the city bureaucracy. The church will benefit from the positive collaboration with students in that so many more students will be aware of the church’s participation in a worthy cause. In addition, the Youth Clinic would provide opportunities for church members to be active participants. For example, last year, student church members at First Presbyterian decided to provide foot-washing and clean socks to clients on Tuesday. This has become the most popular service at clinic. The clients greatly appreciate having clean feet and socks after being on their feet all week.
Collaborating Organizations
Chaplaincy to the Homeless
Joint Medical Program/UCB School of Public Health
City of Berkeley – Health and Human Services
LifeLong Medical Care
Berkeley Free Clinic
Alameda County Health Care for the Homeless
Berkeley Emergency Food and Housing Project
Graduate Theological Union
UC Berkeley Campus Christian Group?? (Nina from footwashing)
Letters of Suppor
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