MSM STREET CARE SERVICE OUTLINE
General Health Screening
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Medical Evaluation & Screening
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History & Physical Exams
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Portable Diagnostics
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Ultrasound, EKG, Glucose Test Kits, Lipid Panel, etc.
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Social History
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Risk stratification for care coordination
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Medical and essential services
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Chronic Disease Management
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Hypertension, Diabetes, etc.
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Medication Management
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Over the counter and prescription medication.
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Wound Care
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Braces, slings, compression socks, hygiene kits, etc.
Education & Counseling
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Motivational interviewing
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Facilitated by an addiction specialist and/or counselor
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Provide information about medical conditions & healthcare system
Building Trust
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Kits and Items
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Empathetic listening; Volunteerism
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Foot Washing, Delivering meals, etc
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Counseling services
Care Coordination
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Brokerage Model
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Longitudinal Follow Up and Patient Advocacy
Area of Operations
Our Workflow
Custom EMR built REDCap
Every week before street rounds, we review all patient agreements, medical notes, and case management updates. Each individual service plan is synthesized into a priority patient list for that week’s street rounds. Then, our street team leaders guide a multidisciplinary team (physicians, researchers, mental health professional, and case workers) out to meet our patients under bridges and in encampments to follow up with each person. In other words, we go to the people.