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Pathways to Health connects vulnerable people to health access

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The St. Catherine’s Pathways to Health program connects Greene County residents with needed resources. Contributed photo

Creativity is thinking up new things; innovation is doing the new thing. With the overall aim of improving the health and well-being of the most vulnerable in the community, St. Catherine’s Pathways to Health program is implementing new methods to facilitate street outreach for those who are homeless or at-risk, and who typically do not seek access to primary health services.

St. Catherine’s Pathways to Health program was created as a client-engagement centered program.

To be successful, street outreach needs to be much more than giving out blankets on a cold day, or water bottles on a warm one. To meet the true needs of the community, street outreach must be dynamic and mobile, able to meet people where they are, and it must build their trust.

Fear of being judged, fear of losing control over their lives or those of their children, are common reasons why many in need do not seek access to health care or supplemental resources.

“It can take weeks or even months of non-judgmental, client-engagement methods for someone to fully confide their needs,” said Dave Healy, Pathways to Health supervisor.

Programs at St. Catherine’s, however, are designed to empower individuals and families to be the architects of improving their lives by using the Social Determinates of Health to make risk- recommendations. Social Determinates of Health (SDoH) as defined by the CDC are the conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes.

Although the Pathways to Health team always has a stock of essential items such as blankets and water in tow, outreach to individuals in need without using Social Determinates of Health is not sustainable.

Temporary fixes, by even the most well-meaning providers, do not go far enough to address the complex social issues that leads someone to homelessness, food insecurity, abject poverty or severe health neglect typically seen among vulnerable populations. By using the Social Determinates of Health and a mobile Care-A-Van unit to meet people where they are, the Pathways team is able to evaluate and make on-the-spot assessments that can lead to both immediate and long-term solutions.

“Whoever you help today will have the same set of needs tomorrow unless you can make an on-the-spot determination and simultaneously offer a pathway to better outcomes,” said Louisa Marra, associate executive director of Homeless Services.

Now in its third year of operation and with the financial backing of a Mother Cabrini Health Foundation grant, Pathways has identified over 1,200 individuals annually through outreach touchpoints to help connect with vital health services, including mental health, behavioral services and substance abuse treatment, access to telemedicine, find permanent food supplies and stable housing, among others.

With the Care-A-Van, the program is currently serving Greene, Albany, Columbia and Rensselaer counties, and may be able to expand services to Schenectady County.

For year four, Pathways will add ride-along clinicians to make on-the-spot clinical assessments and in some cases diagnoses, which many partnering programs require in order to provide the next level or a continuum of care. Being able to make a clinical assessment or diagnoses could mean the difference between waiting only days or even just hours before someone becomes eligible, rather than be on a waitlist for weeks or months when immediate access to housing, food or health care is needed.

“When you’re sleeping on a park bench in sub-zero weather, one night is an eternity,” said Sarah Ryan, program manager for Pathways to Health.

The Pathways to Health program has also been able to utilize strategic community partnerships such as Healthy Alliance’s Micro-Spend program, allowing flexible spending for the immediate needs of community members.

The Micro-Spend is a niche program that offers alternatives for clients who were previously ineligible or turned away due to a their very specific and unique needs. Program such as this are not the norm, and St. Catherine’s Pathways to Health program was one of only a few Update organizations that helped pilot the program in 2021.

Perhaps the most important piece in modern street outreach is the human aspect. Whether consciously or subconsciously, everyone understands what it means to be treated with dignity and respect. It is and will remain in this spirit that St. Catherine’s Center for Children continues helping the most vulnerable among us gain the sense of belonging needed to thrive, a place in the community, a purpose, safety, stability and security; and the knowledge that these things are not conditional by virtue of circumstance, rather unconditional by virtue of our humanity.

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