At Homeless Clinic, Alabama Pharmacy Students Gain Experience and Serve Local Need

A student-run wellness clinic in Mobile, Alabama, is helping serve the needs of the local homeless population while providing interprofessional experiences for pharmacy students and other volunteers.

The University of South Alabama Student-Run Free Clinic was established by students and faculty at Auburn University Harrison School of Pharmacy and the University of South Alabama.

“There’s an entire board of students that basically run the clinic, . . . and then we, as faculty, just kind of advise,” said Nicole Slater, assistant clinical professor of pharmacy practice at Auburn University and one of the faculty preceptors for the clinic.

Board members include students in pharmacy, medicine, occupational therapy, physical therapy, recreational therapy, audiology, and physician assistant programs at the 2 universities.

The clinic opened in 2014, occupying space in a local homeless shelter. Last summer, the clinic was moved to a larger space operated by the Salvation Army of Coastal Alabama, also in Mobile, with patient hours on Friday afternoons.

Slater said that since last fall, the volunteers have been operating a second interprofessional wellness clinic on Wednesday afternoons at the Salvation Army’s Family Haven shelter in Mobile.

Family Haven, according to the Salvation Army’s website, provides emergency housing for up to 3 months and can accommodate 15 families at a time.

Alabama has a total homeless population of 3,793, according to the most recent estimate from the U.S. Interagency Council on Homelessness. The estimate is based on community point-in-time counts conducted in January 2017 and equates to a state homeless rate of 78 per 100,000 population.

Slater estimated that about 12–15 patients normally visit the main Salvation Army clinic each Friday, and about 35 pharmacy students volunteer at the 2 clinics each semester. Clinic staffing during the summer depends on the availability of students representing all of the health professions needed at the clinic.

“There’s not nearly as many students in the summertime, typically. But we do still try to run clinics, if possible. But we leave that up to the students,” Slater said.

She said the setting resembles an interprofessionally staffed primary care practice with a limited menu of services.

“We’re a wellness clinic, so we can’t prescribe anything for them,” she said.

The organization’s bylaws state that the clinics offer preventive care and health education and provide referrals for patients who need direct mental health or medical care. Slater said patients with urgent medical needs are referred to the local Health Care for the Homeless Program, which provides medical services to homeless patients.

During a recent week, about 4 or 5 of the 20 clinic patients at the main site were referred to the medical facility, Slater said.

“If it’s just something like they have a cold, we can recommend fluids and stuff like that,” Slater said. “Sometimes they just need somebody to talk to and listen to them, and so we can provide that.”

Other common needs that the students can address include counseling about smoking cessation, blood pressure control, diabetic foot care, and managing diet and sodium intake.

Slater noted that clinic visitors have limited food choices.

“They’re homeless, so they eat what they can get,” she explained. But she said the volunteers suggest ways to make the best of available dietary options.

Slater said each clinic day begins with a team huddle and a review of patient and staff safety and clinical concerns the volunteers may expect to encounter. But because patients aren’t seen by appointment, no one knows exactly what situations will arise during the day.

“Whoever shows up, we see. We don’t turn anybody away,” Slater said.

Slater said clinic visitors sign in at the front desk and are seen in 1 of the clinic’s 2 patient rooms, with students working in pairs so that no one is ever alone with a patient.

“They assess and triage the patients for what they need” she said, whether that’s a full workup on a new patient or follow-up from a previous visit.

After assessing the patient, the students present the case to the onsite preceptor before delivering a care plan to the patient.

Slater said she became involved in the program in 2014, when several pharmacy students wanted to work at the clinic but needed a faculty adviser. She said that in addition to supporting the university’s emphasis on interprofessional training, the clinic provides students an opportunity to help patients who may require out-of-the-box solutions to their problems.

Sometimes those solutions can be difficult to find.

For example, Slater said, some clinic attendees have diabetes and require insulin but lack access to a place to properly store the medication.

As a result, she said, “sometimes they don’t take their medicine. Some will . . . just keep it in their backpack and keep using it.”

At the end of each clinic shift, the team meets for a second huddle to discuss interesting cases and situations that called for creative solutions. Slater said first-timers at the clinic have been enthusiastic and eager to return for additional sessions.

“They love it,” she said. “All of the students that I worked with have been so excited.”

But one group of her students won’t be coming back—the graduating members of the class of 2018 who were involved in setting up the clinic project.

“I’m very partial to this class, because I started my career at the same time they started here,” Slater said. “We’re certainly losing some good students. But we also have a good handful [remaining] that are very active and involved and are very passionate about the clinic.”

[This news story appears in the May 15, 2018, issue of AJHP.]