SPOT: An Innovative Approach to Reduce Deaths, Provide Treatment and Build Relationships

Boston Health Care for the Homeless Program (BHCHP) has been providing care to over 12,000 homeless individuals since 1985. As one of the oldest programs in the city that serves the homeless, it is always building creative and accessible ways to serve vulnerable populations.

In April 2016, BHCHP established SPOT, which stands for Supportive Place for Observation and Treatment. According to Dr. Jessie Gaeta, the chief medical officer at BHCHP, the program had observed an increased number of deaths related to opioid overdoses. The SPOT room was established with the purpose of managing overdoses better and reducing harm to individuals. The room would also allow staff members to treat individuals most affected and to connect them to treatment programs. Gaeta added that SPOT is a place where BHCHP caregivers can not only intervene and prevent deaths but also mentor and build relationships, which is key to addressing the current addiction crisis.

Gaeta is part of the response team that manages overdoses in the room. She stated that BHCHP’s program is different from other programs because they monitor the health of individuals as soon as they’ve used a particular drug. Usually within 15 to 30 minutes of walking into the room, the drugs take effect. The team’s goal is to make sure the individuals don’t die.

According to Courtney Kenney, BHCHP’s harm reduction specialist, SPOT has helped many individuals by providing a safe space, even when they aren’t using drugs. Kenney added that although many people come to SPOT after they’ve used, some people come in when they need to talk to someone and are seeking a safe space. Kenney said, “I have been pleasantly surprised by the community people have built here. SPOT is like a family to them and they are so grateful that it’s here.”

Kenney further elaborated, “For our patients, SPOT is more complex. They have found different uses for the room to meet their own needs.” Kate Orlin, a registered nurse at BHCHP, stated that the team aims to meet the goals of their patients. For example, she stated that if a patient’s goal is to enroll in a treatment program, Kenney will identify the right program. If a patient’s goal is to take a shower, SPOT will provide towels and will organize for him or her to shower in the clinic. If the patient’s goal is to see a physician, SPOT will identify a physician who can assist.

According to BHCHP, as of January 3, 2017, SPOT has seen 397 unique individuals in 2,551 encounters. Additionally, approximately 10 percent of individuals who used SPOT were connected to addiction treatment programs. The SPOT room has also been an alternative to using emergency care. Boston Health Care for the Homeless Program estimates that approximately one third of its encounters would have resulted in the use of the emergency department if SPOT had been unavailable. According to Gaeta, the room has been very well utilized and is usually at full capacity.

The SPOT room is fully equipped with medical equipment. Gaeta stated that it allows the program to monitor blood pressure and oxygen levels. Additionally, team members have the ability to administer IV fluids and medications. At any given time, there’s a full team of physicians, nurses, nurse practitioners, harm reduction specialists and counselors available. The room is located at Jean Yawkey Place and is open Monday to Friday from 8:30 a.m. to 9 p.m. It’s free to the public and can accommodate up to ten people at a time. Individuals are not required to provide a name or identification card. Also, if patients choose to remain anonymous, the staff members honor the request.

Gaeta enthusiastically stated that the local community has been very supportive of this initiative. The program has built many relationships already. As a team, Gaeta, Kenney and Orlin have learned a lot about overdose syndrome. “It has been a great learning opportunity,” said Gaeta. She added that they have learned about patterns of substance use and addiction. They’ve learned more about the causes of addition. All these lessons are important in order to provide effective treatment and long-term care. Kenney said, “However skeptical the people are when they first come in, once they realize what we’re doing at SPOT, they trust and respect us.” She added, “They trust us because we’ve been able to enroll several people into treatments programs, which is great.”









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