Philadelphia is addressing its opioid crisis by deploying mobile medical units to provide Medicaid-funded "street medicine" to the unhoused population.

This initiative was made possible by a recent Pennsylvania policy change, allowing the city to bill Medicaid for outreach site medicine.

Maire St. Ledger, family nurse practitioner from Project HOME's Epstein Street Medicine program, said the opioid epidemic has significantly increased homelessness in Philadelphia, and its mobile units aim to offer both essential care and dignity to unhoused people.

"There are a number of organizations that are providing medical care to people who are unhoused," said St. Ledger. "But we're the only team that we know of providing primary care. So, there are a lot of people that will go out with vans who will do point-of-care testing for HIV, for example. There's another van that just does wound care, but we do all of that."

St. Ledger highlighted the program's significant impact on participants -- aiming to improve medical outcomes, build trust, and enhance access to health-care and support services with holistic, trauma-informed and harm-reduction care.

She noted a few years ago, MPOX spread rapidly, but collaboration with the local health department and community partners helped prevent further spread through vaccination.

St. Ledger said they rely heavily on their outreach teams to build relationships with the participants, which helps the mobile unit assist people by providing them with resources.

"They try to engage with patients or with people who were unhoused," said St. Ledger. "It might just be, in the beginning, bringing them some water, bringing them clean socks or a blanket - building those relationships, getting them referred to housing, to shelters, to detox, to rehab, whatever it might be."

Dr. Judy Chertok is a Family Medicine and Addiction Medicine Physician and Associate Professor at the University
of Pennsylvania collaborating with Prevention Point Philadelphia on the Overdose Surge Response Bus, launched in the summer of 2020.

Using city data to identify overdose hotspots, the team deploys its mobile unit to provide crucial resources to the hardest-hit communities.

"We collaboratively work to do some canvassing and provide lots of harm-reduction supplies, Narcan," said Chertok, "and then, for people that are interested, they can meet with the doctor and do same day starts of medication like Buprenorphine for addiction."

Chertok said a new survey on the Mobile Overdose Response Program examines several aspects, including the general demographics of the first 237 patients.


It also analyzes housing rates, substance-use severity, and assessed for predictors of engagement and care after using the mobile unit.

"So the unit sees people for a few weeks, and then links them to ongoing care," said Chertok. "And so we try to look to see if there are any facilitators of what help someone get from this mobile space into ongoing care and stay on medication."

Support for this reporting was provided by The Pew Charitable Trusts.




get more stories like this via email

People who are part of the Deferred Action for Childhood Arrivals program, known as DACA, will be dropped from their CoveredCA health plans at the end of August.

The move comes after the Trump administration changed a Biden-era definition of "lawfully present" to revoke health care eligibility for thousands of immigrants.

Christine Smith, policy and legislative advocate for the nonprofit Health Access California, said people only have a few weeks to get medical appointments in before their coverage ends.

"If you're enrolled in Covered California and you're a DACA recipient, the Trump administration just ended your coverage," Smith emphasized. "People should use as much of your health care as you can before the August 31st deadline."

The Centers for Medicare and Medicaid Services defended the move, saying it will save taxpayers money. CoveredCA estimated the change affects about 2,400 DACA recipients in the state who make too much to qualify for Medi-Cal and have jobs not providing health insurance. They can still buy private insurance but it is much more expensive. People who prepaid for their coverage can seek a refund.

Smith predicted it will be a blow not just to those who lose coverage but to the state's health care system as a whole.

"The lines in the ERs are going to be longer because people are not going to be able to get affordable preventive care," Smith projected. "They're just going to get sicker and then end up in the ERs. People will overall incur more medical debt. Hospitals will have more uncompensated care."

The change is nationwide. As of mid-July, about 538,000 people in the DACA program across the U.S. are ineligible to enroll in any state-based insurance marketplace and are unable to access premium subsidies or cost-sharing assistance.

Artificial intelligence is appearing more prominently in many aspects of life and research suggests older populations are curious, yet remain wary of using the technology in their everyday lives.

According to Stats Indiana, there are more than 1.5 million Hoosiers aged 65 and older, or 18% of the state's population. Experts said it is likely the demographic will use AI in some form in the next few years, either by choice or necessity.

Dr. Shaun Grannis, vice president of data and analytics for the Regenstrief Institute on Aging, said AI offers real benefits.

"It can reduce loneliness through conversation, provide reminders for medications and appointments," Grannis outlined. "It can support cognitive stimulation via games, storytelling, news updates."

The technology can also offer a low-pressure way to access information on public services, he added, which is valuable for those with mobility issues or those who feel intimidated by technology.

Grannis cautioned any tool which can be used for good can also lead to problems. He noted AI can create a false sense of companionship and mask social isolation. Overdependence is a legitimate concern, he argued, if the technology becomes a "crutch" for all forms of interaction.

"All cognitive activities or decision-making, it can actually lead to and create a negative feedback loop, lead to a decline in engagement and even basic self-management skills," Grannis explained. "This is risky."

Grannis believes one solution is designing AI systems to complement, not replace, human interaction. He stressed it can be done though building broader support ecosystems including family, friends, caregivers and community services. Grannis emphasized it would encourage real-world activity, prompting the user to go for a walk, call a grandchild or attend a local senior event.

If you have an extra five minutes, you can save a life because you can learn cardiopulmonary resuscitation at no cost from a new mobile, hands-only CPR kiosk.

The new kiosk is in the lobby of Saint John's Health Center in Santa Monica. The machine's touch screen gives a brief overview of hands-only CPR and you can practice right there, on a mannequin.

Dr. Rigved Tadwalkar, cardiologist at St. John's, said it is an easy way for people to get more comfortable giving chest compressions in an emergency.

"It's a lot like a video game but of course, a lot more important than a video game," Tadwalkar pointed out. "It gives real-time feedback about the depth and rate of compressions, proper hand placement, which are all factors that influence the effectiveness of CPR."

The American Heart Association operates the St. John's mobile kiosk and a stationary model at L-A-X with support from the hospital. Santiago Canyon College in Orange County also has a mobile hands-only C-P-R kiosk now through September, sponsored by Edwards Lifesciences.

Steven Munatones, an Orange County business owner, said he survived what's known as a "widowmaker" heart attack which led to cardiac arrest nine years ago, thanks to his 17-year-old son, who gave him immediate CPR with instructions from a 911 operator.

"You don't have to put your mouth to anybody's mouth," Munatones explained. "You just put your hand on their chest and pump. He saved me, and others can do the same, anywhere. So, it's absolutely a lifesaving, heroic act that anybody can do."

Statistics show 350,000 Americans suffer from cardiac arrest outside a hospital each year and about 90% die, in part because they do not receive CPR. About 70% of those cardiac arrests happen at home, so people often depend on family or friends to give CPR before an ambulance arrives.