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Wednesday, Jul 23, 2008

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GROUPS THAT CHANGE COMMUNITIES

Downtown Clinic and
Service Center

Downtown Clinic for the Homeless
Dr. Lawrence Madlock
411 Seventh Ave. S.
Nashville, Tenn. 37219
(615) 862-7900

Downtown Service Center
Dick Achuff, administrator
526 Eighth Ave. S.
Nashville, Tenn. 37219
(615) 862-7935

These efficient, caring institutions in Nashville, originally independent organizations funded by large private grants, were picked up and continued by local government when their Robert Wood Johnson grants ran out in 1989, because city officials decided that their services were too important to lose.

Briefly told, the Downtown Clinic is a full-service primary-care center and emergency medical treatment facility, with a strong mental-illness component, operated as a totally free, no-questions-asked service to Nashville's homeless people. Madlock, an enthusiastic, hands-on physician runs a small but busy shop, with the help of a part-time psychiatric resident, two registered nurses, three mental-health social workers and three therapists, who stay very busy seeing an average of 30 medical cases and 25 mental-health cases a day.

The clinic is bright and clean, with glossy white and peach walls and pale-gray tile floors buffed so shiny that they look like glass -- a custom that Madlock says he insists on as a sign of respect to his patients. But he's not satisfied, and he won't be satisfied until the Health Department comes up with medical fixtures and equipment to replace the pre-war antiques that now equip the place, and until someone finds funds to extend the clinic's weekday hours into evenings and weekends.

Among model programs within the clinic, two stand out:

The Mobile Outreach Team, a tight-knit group of three workers, a mental-health social worker, a nurse and a paramedic cross-trained in mental health, operate a roving van that patrols the city's downtown neighborhoods like an old-time police car on a beat. The crew, who are widely known on Nashville's streets, stop periodically, chat with people, and offer every health service from Band-Aids to a friendly ear and serious counseling time. By building street-level trust over the long term, they have become an extremely effective mechanism to get street people in for testing (from TB to HIV) and education.

Three non-traditional funding methods -- the Health Department's formulary, drug-company samples, and a grant from Comic Relief, tied in with a deal negotiated with a local pharmacy -- provide free prescription medications to the clinic's patients.

Around the corner and down the block, the Downtown Service Center is a full-service day center for the community's homeless people. Along with the basics, a large, safe and moderately comfortable lounge area with couches, games and television, and an enclosed waiting area out back in the fresh air, it offers clean restrooms; private showers; secure lockers; washing machines and driers. A safe, separate area with lots of toys is reserved for mothers with children, and no one complains if a kiddo sneaks out a toy or two when she leaves.

But those immediate needs are only the start.

A computerized intake system not only builds a base of data about Nashville's street people but facilitates intake, information and referral; and most of the basic services, from food-stamp intake to SSI application, are made available at the center in a one-stop-shopping system. Drug, alcohol and mental-health counseling are available there, and chief social worker Liz Sullivan has set up a near-unique system aimed at speeding SSI eligibility determination and payments by bringing a Social Security worker AND psychologist to the center on a regular schedule to interview, evaluate and process applications all at once. The expedited procedure has cut some clients' waiting time for benefits from the usual 90 days to only 14 to 21 days. What's more, 80 percent of her clients are approved, contrasted with 30 percent of all SSI applications.

Then, once the recipient is getting his SSI, Social Security or other benefits, he is urged to participate in social worker Zel Morris' "Representative Payee Program." Once Morris has received the client's permission, she opens an account for him at a cooperative branch bank, then works with the client to develop budgeting skills and a savings plan. She dispenses money for rent, bills and an allowance according to a pre-arranged plan while working with the individual toward the time when he will be able to handle those matters on his own.

Finally, a full-time "job developer" trolls the Nashville business community, trying to make connections between area employers and employable, drug-and-alcohol-free clients. Soon, McKnight hopes to develop a computerized "job bank," a one-person program using a computer database as a city-wide clearinghouse to track all employable homeless people and all appropriate job openings, making instantaneous matches when the right person and the right job meet.

The center, open days only, operates seven days a week, 365 days a year. "They don't get holidays," notes McKnight. "Why should we?"

The Nashville Metropolitan Health Department (Ken McKnight, director, division of services for the homeless, 615-340-5655) supports these organizations, and the related Mobile Outreach Team and contract substance-abuse services, at a budget level of more than $1.1 million a year ... and they work.

All the feature stories on @GRASS-ROOTS.ORG's pages are reported and written by Robin Garr, a prize-winning journalist who has visited more than 500 innovative grassroots programs in all 50 states since 1990.
Browse his book, Reinvesting In America, at Amazon.com.
Send him E-mail.
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