I. Overview
The Telegraph and Shattuck Avenue corridors in Berkeley are meccas for homeless and street-identified youth from around the country. Homeless and runaway youth congregate in 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.
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 hepatitis 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. Decreasing the incidence of these conditions would not only help the street youth, but benefit the health of the entire 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 trusting relationships with providers, an adult- rather than youth-oriented culture, and inconvenience in terms of time and location.
In July 1997, the Berkeley Chaplaincy to the Homeless began a drop-in center for homeless youth that now serves 20-50 youth per day. Their services include food, recreation, counseling, advocacy, and health care. This program has been extremely successful at establishing trust with the youth and providing needed services. In 1998, the Chaplaincy approached the Suitcase Clinic, a UC Berkeley-sponsored, student- and volunteer-run organization 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 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 have been secured for the youth clinic project and partners have made commitments to participate in this effort. However, without the donation of physical space for the drop-in, the project will not reach fruition.
II. 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 and Housing Project, and medical clinics such as the Berkeley Free Clinic. Through their outreach efforts, the students gained a better understanding of available services and service gaps. The students concluded that many of the homeless did not utilize existing social and medical services because of cultural and institutional barriers that prevented access to care.
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, and the “Suitcase Clinic” was born. 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 a variety of services. Working with the Berkeley Emergency Food and Housing 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 UC Berkeley students played an essential role in the development of the Clinic and are now integral in 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 funds, conduct evaluations, and oversee most of clinic operations.
The Suitcase Clinic opened during the fall semester of 1990. Its 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 , and 2) To provide a community service arena where all providers would cooperate in fulfilling the service requirements of the population. Another goal of the Clinic has been to provide a learning experience and opportunity for professional, graduate, and undergraduate students.
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.
III. Mission of Suitcase Clinic
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.
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 desires, rather than from providers’ beliefs about participants’ needs. 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 educational experience of volunteers should not supersede the service provision to participants.
➢ That Clinic projects and provided services should be culturally appropriate and accessible.
➢ That the Clinic should maintain an informal environment that fosters teamwork and community building.
IV. Community Assessment
Stories from Youth
∗ Names and identifying characteristics have been changed to protect the identities of these individuals.
Alicia∗, better known as Trax by her peers, is an eighteen year-old female who has been living on the streets for three years now. At age fifteen she left her home in Tucson, Arizona, choosing life on the streets as a welcome alternative to the physical and sexual abuse she was suffering at the hands of her stepfather. During the past three years Alicia has moved from one city to another with a core group of close friends whom she refers to as her “family.” The group never stays in one location for more than a few months at a time and frequently spends nights in alleyways, in parks, or under bridges.
From the time she left her home in 1997 until February of this year, Alicia had not utilized any type of health care services because, in her words, “people just treat me like I’m not human—like I’m a diseased dog or something.” Alicia’s perception of how others view her was only reinforced upon seeking medical treatment in Berkeley for an injury sustained to her upper back after a fall. “During the whole fifteen minutes I was with the doctor, he didn’t even look at me,” Alicia noted. “I mean he looked at my body and stuff but he didn’t look me in the face once. He didn’t even talk to me. He just talked to my health worker like I wasn’t even in the room.”
When asked how this encounter would affect her use of health care services in the future, Alicia angrily remarked, “Man, screw doctors. Screw nurses. I got my ‘family’ to take care of me. Man, I can do a better job taking care of myself.”
Warren (a.k.a. Swill) shared a story similar to Alicia’s. Warren is nineteen years old and has been on and off the streets since the age of fifteen. Having no stable source of income, Warren frequently “dumpster dives” for food and stays outside or in abandoned buildings when he does not have enough money to pay for meals or single room occupancy hotels.
In September 1999, Warren contracted food poisoning after eating out of a garbage can on Telegraph Avenue. Suffering from severe abdominal pain, nausea, and diarrhea, he sought medical care at a local low-cost health clinic the following day. Warren feels that because of his lifestyle and ragged appearance he was treated poorly by an extremely unsympathetic clinic staff. He believes that because of his age, he was dealt with in a condescending manner, or in his own words, “dissed.”
Three months later Warren came down with a bad case of the flu. His symptoms did not subside after a week, but he decided not to visit a medical clinic because of his previous unpleasant experience. After almost another full week of suffering, Warren was still extremely ill and his health was apparently getting worse. Fearing for his safety, some of his friends brought him to the Highland Hospital emergency room in Oakland. Warren had a temperature of 105° F, a severe bronchial infection, and incurred a hospital bill of several hundred dollars.
Had Warren been able to access care in a culturally appropriate environment, his worsened condition, trip to the emergency room, and expensive hospital bill could most likely have been avoided.
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 run away or been thrown out of their permanent homes. Some of the youth have run away or “aged out” of institutional care such as foster homes, juvenile detention, or inpatient psychiatric facilities. According to studies on homeless youth, family conflict is consistently reported as the 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, and alcohol and drug use. Neglect and physical or sexual abuse in the home are common experiences among street-identified youth. 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. Additionally, about one-third of homeless youth have had trouble meeting their educational goals.
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 for non-homeless youth. Some youth resort to prostitution and drug dealing to survive. HIV infection rates 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. At the Chaplaincy youth drop-in center, staff estimate that on average seven individuals could benefit from medical care per day.
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. In consultation with homeless and street-identified youth, community organizations, and government staff, the Suitcase Clinic has developed plans for a youth-focused evening drop-in center that meets the needs of this underserved population.
V. Youth Clinic Mission and Values
Mission
The mission of the Youth Clinic is to…
- Provide culturally appropriate and youth accessible services to homeless and street-identified youth that increase their opportunities for positive social and physical well-being
- Advocate with homeless and street-identified youth for services, resources, tolerance, and affordable housing
- Involve youth from the client base in the management of the clinic and the determination of the type, nature, and style of service provision and resource distribution
Values
Participants in the Youth Clinic drop-in center believe in…
- Respect for dignity and autonomy in the provision of services
- The use of an empowerment and development model with a strength-based perspective
- A commitment to non-judgmental service provision
- Avoiding permanent exclusions from participation in drop-in programs and services
- Maintaining an environment accessible to youth culture, including their animal companions
- A formal commitment to “starting where people are” and high tolerance
- The importance of ongoing staff training, policy review and development
- The inclusion of youth in management structures
- The necessity of political advocacy and the need to foster the development of self-advocacy skills among youth
- Using youth culture-appropriate communication styles and presentations
VI. Youth Clinic Program Description
Note: A working budget has been developed and is available upon request.
A. 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)
➢ Acupuncture and herbal medicine
- For alcohol and drug detoxification, stress reduction, relaxation, and overall health and well-being
➢ Optometry
➢ Chiropractic
➢ Basic counseling and social services
- Trained UCB undergraduate and graduate caseworkers
- Counseling and sensitivity skills, suicidality and crisis screening, addressing violence and intoxication, and deescalating conflict
- Professional support staff
- Crisis management and training with protocols
- Team follow-through with appointments, phone calls, and advocacy
➢ Educational services
- Classes- potential topics include health education, pet care, and others requested by youth
- Tutoring for GED, etc.
- Job search training and assistance
➢ Legal services
- Including emancipation issues, misdemeanor crimes, and government benefits
➢ Animal care
- Veterinary care
- Pet food, leashes, licenses
Medical Services
Diagnosis and Treatment of:
Cough
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, Influenza, Hepatitis B Virus
- 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.
B. Description of Night at the Drop-In
Youth Clinic Nightly Operations: Tentative Plan
Clinic coordinators arrive: 5:30 PM
Case worker staff arrive: 6:00
Team meeting: 6:00—6:30
Setup of equipment/intake: 6:30—6:45 Food/refreshment set up
Clients admitted to site. Introductions of providers: 6:45
Clients select service desired
Providers move to refreshments area to continue introductions
Service provision—Individual/Group*: 7:00—9:00
Clients depart premises: 9:00
Clinic review, debriefing, troubleshooting and problem solving: 9:00—9:30
Site is secured by coordinators. Staff and providers exit: 9:30
*Suitcase Clinic adult service provision sites have incorporated a combined support/advocacy group for homeless adults to discuss the nature of the barriers to obtaining housing. A similar service offering is contemplated for the Youth Clinic.
Program development is continuing regarding the nature of the group service to offered. Some potential elements of this service include:
Services needed for youth
Search for leadership to join clinic directors team
Support for advocacy efforts
Personal growth work
Economic empowerment—small magazine production
Outside speakers
C. Security and Property Protection Measures
All Youth Clinic case workers, clinic coordinators and selected medical service personnel will be required to attend a 4-hour response workshop in crisis management procedures and clinic policy, presented by the Clinic’s current social worker. This training will cover site and personnel safety, conflict de-escalation and emergency/crisis procedures. A module which teaches the Management of Assaultive Behavior is currently being adapted from the one in use at San Francisco General Hospital.
All clinic personnel, with the exception of specialty providers, will attend a weekly meeting to develop contingency and intervention plans for particular clients. This is the primary ingredient in successful crisis management. In the event of a crisis event, whether it be a medical problem or an interpersonal conflict, the clinic coordinator will either assume the role of ‘lead’ and appoint a ‘shadow’ to directly address the crisis situation or appoint other clinic staff to these roles.
Threats, acting-out behavior, or violence to individuals or property are not tolerated at the Suitcase Clinic; the clinic response is one that attempts to mediate between the problem experienced by the client and clinic needs and prerogatives. In the past, clients need only permission to ‘walk and talk’ with a caseworker off the premises, in a less stressful environment, in order to calm down; at times, however, they have been asked to leave and return when they are better able to control themselves. A cellular telephone will be present on site at all times that the clinic is in operation and will remain with the clinic coordinator. Staff have existing connections with the Mobile Crisis team of Berkeley Mental Health and the Berkeley Police Department mental health liaison as well.
SITE SECURITY:
At current Suitcase Clinic sites, the clinic coordinator has the ultimate responsibility for ensuring that doors are locked at the end of the evening and the space is properly arranged to the host’s specifications. Clinic staff are examining the availability of a general liability insurance policy with additional coverage options for window replacement. We would welcome additional discussions about this matter.
VII. Church and Community Benefits
“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.’”
As this quote illustrates, each of us has tools and resources that can help eliminate the needless suffering experienced by homeless and street-identified youth. The donation of a physical space to the Suitcase Clinic effort is a crucial resource in this process. Without a location for the drop-in, the tremendous amount of energy and resources already garnered by the Suitcase Clinic will remain untapped.
A church donation will improve links between the university and the religious community. Faculty from the Pacific School of Religion’s Faith and Health Initiative have expressed an interest in supporting this effort and using it as a potential model of collaboration between a faith organization and School of Public Health. Opportunities for student and church involvement in community service and advocacy will grow. The possibility for direct service will be available to congregation members, as will increased interaction between the Church itself and the student members of the clinic, who may seek to learn more about the mission of faith based service providers. Merchants on Telegraph and Shattuck Avenues will see fewer youth outside their storefronts.
Most importantly of all, positive energy will be directed at alleviating suffering and demanding changes to promote the well-being of homeless and street-identified youth, who in our society are often considered the most deprived of access to both material and spiritual goods. Your support in this effort will add to the growing list of individuals and organizations below willing to fight for change. Thank you in advance for your support.
VIII. Collaborating Organizations
The following organizations and individuals support the Suitcase Clinic’s effort to establish a youth-focused drop-in center. References and letters of support from these organizations can be made available upon request.
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, FOCUS
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