A One Health Clinic for People Experiencing Homelessness and Their Animals: Treating the Human-Animal Unit

THE INNOVATION

Many people experiencing homelessness own animals that provide emotional support and other health benefits. We created the One Health Clinic (OHC) to provide primary health care and veterinary care concurrently to this population. This integrated model leverages the power of the human-animal bond to increase primary care access for individuals experiencing homelessness, many of whom prioritize care for their animals over care for themselves.

WHO & WHERE

Our partnership includes human health practitioners from Neighborcare Health (NCH), a community health center; health sciences students from a service group at the University of Washington; and veterinary students and faculty preceptors from the Washington State University College of Veterinary Medicine. This multidisciplinary team cares for youths experiencing homelessness and their companion animals in a clinical space at New Horizons, an enhanced youth shelter in Seattle, Washington.

HOW

We launched the Seattle One Health Clinic in October 2018 in response to a community needs assessment which found that animal ownership by individuals experiencing homelessness posed a barrier to accessing health care services. NCH was running a weekly clinic for homeless youths at New Horizons, and we added veterinary care to the existing clinic. We developed protocols for patient flow and infection control to facilitate safe provision of health care to humans and animals in adjoining spaces. A student volunteer accompanies a patient and their animal through their clinic visits and completes a navigation form (Supplemental Appendix), which captures data about linked human-animal clinical issues, such as perceived mental health benefits of animals and evaluation for documentation of an emotional support animal for housing access. The form is scanned into the medical chart and captures information about zoonotic disease risks (fleas, fungal rashes, etc) and shared environmental exposures such as sleeping in congregate settings, cold, domestic violence, and noise.

The OHC is currently offered as a 4-hour session twice monthly. Outreach to homeless service providers, encampments, and through social networks raises awareness about scheduled clinics. After registering, patients and their animals are seen first by the veterinary or medical team depending on availability, with an understanding that the visit will include both components. Any concerns about human health arising from the veterinary encounter are communicated to the medical provider, and vice versa. The patient leaves with a care plan for both human and animal patients.

From 2018-2021, 236 animals were seen with 152 rabies vaccines administered (Supplemental Table 1). In 2019, the veterinarians saw 59 animal patients and the clinicians saw 45 human patients, 21 of whom returned for more than 1 visit. People often brought more than 1 animal for care at the OHC, and occasionally, the human patient would leave before being evaluated by a health practitioner. In 2019, 20% of all human patients seen were new to Neighborcare, and 22 of 46 patients were seen for multiple visits, which illustrates how the OHC successfully created a clinical environment where patients felt comfortable establishing and returning for care.

LEARNING

Patients have stated the OHC has given them peace of mind knowing they can seek timely and quality care for their animals. The OHC also provides opportunities for interdisciplinary learning between medical students, veterinary students, and other health professionals. This learning occurs during clinic visits and through an interprofessional case conference at the end of each clinic where overlapping aspects of human and animal cases are discussed. Our team is analyzing data to further quantify the impact of the clinic for future publication.

The OHC created a free toolkit of protocols and best practices for starting a One Health Clinic for other groups in the United States and Canada interested in providing similar services.