EnsignDr. Josephine Ensign is a family nurse practitioner who has spent the last 15 years working with homeless youth, particularly adolescent females. She volunteers at the 45th Street Clinic for homeless teens in Seattle’s University District as well as a new medical respite shelter, MedRest, which is the first facility of its kind in the country. Nurse practitioner students assist Ensign with basic street-based care for homeless youth from a medically equipped van that makes weekly stops in areas popular with homeless youth.
Why is the 45th Street Clinic unique?
Because it has youth input in its design and approach. For instance, young people who were coming in for help wanted naturopathic treatments for their illness so now we offer both this approach and traditional medicine. It also provides counselors and referrals for HIV, substance abuse, pregnancy and any other problems kids may have. So it’s a one-stop clinic.
Who pays for these services?
The clinic receives some federal monies as well as community matching funds. But there is no charge for services, and most of the clinic staff is volunteer. Any graduate nurses interested in helping with our program are always welcome. The Clinic especially needs nurse practitioners.
Who comes to the Clinic?
Adolescents who are living on the streets, or with friends, or with extended family members, or sometimes in shelters. Most of them live on the streets or are "couch surfers".
What impact does the Clinic have on homeless youth?
The Clinic is more than "youth-friendly". It provides youth-centric care, bringing health care to the young person instead of the other way around. We are pretty low-key and work on building a relationship with these young people, meeting them where they are. These adolescents have not had healthy relationships with adults, so you must spend time building trust. It’s a cumulative process.
What is your role there?
I work as a family nurse practitioner and also in a research capacity with homeless adolescent women who experience barriers to health care. Adolescent females are the most hidden of all people on the streets and the most difficult to reach. My research provides feedback to the clinic. I’m also involved, along with one of my nurse practitioner students, in doing an evaluation of the MedRest program.
What is the MedRest program?
MedRest is a 4-bed medical respite shelter that opened in September of ’99 and is jointly operated by the School of Nursing and the School of Social Work here at the UW as well as by YouthCare, the 45th Street Clinic and the Seattle King County Department of Health. MedRest is not-for-profit and staffed by a nurse with nurse practitioner and physician back up. It is the first program of its kind in the country for homeless adolescents.
How successful has the MedRest program been?
Since it opened in September, we have helped nine patients. Two of these are now in stable housing and two more are in substance-abuse treatment programs. MedRest is for very sick youths that need someone to care for them, usually short-term, although there’s no time limit. Some patients just have a bad flu and need someone to look after them.
Do you think MedCare is a model for the future?
Yes, I do. I also work as a clinician at a family clinic that sees a lot of recent immigrant populations. Studies have shown that the culture clash that immigrants often experience can lead to homelessness. So, with all the demographic changes happening in Seattle, this could lead to more homelessness for youth. But lots of people are thinking long-term in Seattle to help prevent homelessness, such as putting programs in place to help youth before they become homeless. I would hope that the 45th Street Clinic and MedRest could be models for other U.S. cities faced with increasing populations of homeless youth.
CREDIT: Dr. Josephine Ensign examines a young woman at the 45th Street Clinic.