Shannon Ducharme is a Health Worker with the city of San Francisco Street Medicine Team. Shannon’s main focus for the last 8yrs has been working with PWUD and PEH. Her passion for end of life care grew out of unfortunate results by broken systems serving our most vulnerable populations.

People experiencing homelessness (PEH) and who are using drugs often present in end stages of disease process and die at higher rates than other populations. These people have different palliative care needs than sheltered populations, including family configurations, shelter at end of life, managing pain, comorbid mental illness and/or trauma, mistrust of medical systems, and managing active substance use. We noticed that members of the street medicine team (Peers, social and health workers) were working with patients individually-trying to fill system gaps on their own without support or clear palliative framework, causing profound distress and loneliness.

We developed a framework to address the phases that we observe in our work. Phases include (1) Engagement/outreach (2) Clinical care coordination (3) Street Medicine “special sauce” (active listening and intuition to both verbal and non-verbal cues, potent and consistent communication with other team members, radical acceptance/meeting people where they are, and tending to patients’ trusted relationships), (4) Inquiry (what is important), and (5) Grief support/closure (debrief and support for both care team and family members)

We hold monthly palliative care meetings where we work together to identify and cultivate the skills needed for successful palliative care with PEH. These meetings have become a rich, safe space for our team to develop and practice skills (listening, mindfulness, boundaries, and teamwork) and to highlight the intersectionality of other complex issues facing our patients like chaotic substance use, harm reduction, trauma, and racial disparities in health care alongside discussion of cases and referrals.

In this session, we will discuss our framework and team meeting process and take the audience through a case study journey. In deconstructing a case together, with activities during the case inflection points, the participants will emotionally engage with the somatic and self-reflective process of providing care for PEH at end of life.