A new study by researchers at the University of Washington provides support for an integrated model of health care that could be especially effective in improving access to care for individuals experiencing homelessness and their pets.
One Health Clinic opened in 2018 in Seattle as part of UW’s Center for One Health Research. The center, which was created in collaboration with Washington State University, explores the connections between the health of humans and animals within their shared environments.
The One Health Clinic aims to remove barriers to medical and veterinary care for youth and young adults experiencing homelessness and their pets by providing that care and other services under one roof. The study found that from 2019 to 2022, 80% of all clients who visited the clinic for their pets’ veterinary care also received care for themselves, and nearly half of the clients established care for themselves for the first time in at least two years.
Natalie Rejto is the lead author of the study, a patient navigator at One Health Clinic and a postdoctoral fellow at the Center for One Health Research. Vickie Ramirez is a co-author of the study and program manager at COHR.
They join us to share their findings and thoughts on expanding the clinic’s model to improve health outcomes for both people and their pets.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Miller: This is Think Out Loud on OPB. I’m Dave Miller. Young people experiencing homelessness in Seattle were more likely to seek medical care for themselves if they went to a clinic that offered care for their pets. That’s one of the big findings from a new study out of the University of Washington. Researchers there looked at four years of data from a clinic that opened in 2018. They found that 80% of clients who visited the clinic for their pets’ healthcare also received care for themselves, and about half of those young people had not seen a nurse or a doctor for at least two years. Natalie Rejto is the lead author of the study. She is a patient navigator at the One Health Clinic and a postdoctoral fellow at the Center for One Health Research. Vickie Ramirez is a co-author of the study and the program manager at that center. They both join me now. It’s great to have both of you on the show.
Natalie Rejto: Thanks for having us.
Vickie Ramirez: Thanks for having us.
Miller: Vickie, where did the idea for this dual clinic come from?
Ramirez: Yeah, it’s a good question. So in 2016, 2017, we were newly based here out of the University of Washington ‒ actually that was about 2015 ‒ but walking around the neighborhoods and in the university district near the University of Washington, we would see folks who appeared to be experiencing homelessness with their animals, and their animals were in amazing, healthy shape. We had known that there are veterinary clinics providing free vet care in Seattle, and if you go to those clinics, there will be people waiting in line for six, or seven, or eight hours even for care for their animals. So we thought that perhaps by adding veterinary care to a human health care clinic that maybe people would come to get care for their animals and stick around for their own health as well.
Miller: So from the very beginning, the idea was that veterinary care is a kind of magnet?
Ramirez: Absolutely, absolutely.
Miller: Can you give us a sense for the centrality of these animal companions in the lives of these young homeless people?
Ramirez: Yeah, maybe I’ll start, Natalie, and you can join in. Before we started the clinic, we did interviews with lots and lots of folks experiencing homelessness with animals, just really asking about what that animal means to them and why they have one when they’re kind of going through difficult times. And the stories were varied, as all people’s stories are, but they had general themes. It was unconditional love from an individual, someone who was nonjudgmental, someone to care for, to get up in the morning to take care of, someone who they have a responsibility for so that they would choose maybe not to use some kind of drug or use excessive alcohol because they knew they would have to walk their animal in the morning. And so many times people talk this about how that animal kept them from following through with suicidal thoughts. And it’s just that relationship, that they have someone with while they’re going through these hard times.
Miller: Natalie, what stood out to you in those first interviews?
Rejto: One thing on that note that stands out to me a lot that Vickie touched on the motivation not to follow through with suicidal ideation. To really illustrate that one client shared, “Honestly, she keeps me alive,” talking about their pet. “I promised her that I’d be here.”
Miller: So what’s an example of how this dual system might work? Natalie, you’re a patient navigator. If somebody shows up to the clinic on one of the days when the veterinary clinic side is operating, can you walk us through how it might go?
Rejto: Yeah, great question. So, typically there are folks lined up ready as they know when the clinic occurs, since it occurs on a regular basis. Vickie, for example, if she is the manager, will keep track of folks that are there, and then I as navigator will connect with a client as well as their animal, and hear about what brought them in that day, what sort of health concerns they might have for themselves, for their animal. And also, a really important part of that is establishing trust and empowerment at that first interaction. For example, as we see, Vickie talked about animals being really well taken care of. Acknowledge that as an entry point of, “Wow, your cat looks really well cared for. I see they have a good bond with you. You’re doing a great job.”
Miller: In that moment, I’m curious if you can even notice sometimes that the animal is in better shape than the human?
Rejto: As Vickie mentioned, I think a lot of times we see these animals are so well cared for, freshly brushed, well groomed, just beautiful animals.
Ramirez: And I’ll jump in. A lot of folks will talk about that their animal will eat first. Like if they don’t have enough that day, they will source food and provisions for their animal before themselves.
Miller: And is it the case that often people will come in specifically and at least at first only to get care for their animals, even if they may not be in great shape themselves? Vickie, do you see that?
Ramirez: One hundred percent. Folks come for the veterinary care. And our veterinary care is provided by Washington State University’s College of Veterinary Medicine faculty. Dr. Katie Kuehl is the lead vet and then her fourth-year veterinary students provide the care. And they have also been taught about trauma-informed care, which is not a common theme in veterinary training, but they have been taught how to connect with people, how to approach people with curiosity instead of judgment. And that positive veterinary experience really creates a positive health care experience that the medical team can build on.
Miller: I’m curious, Vickie, about that transition. If somebody goes in and says, “I’m worried about my dog’s teeth,” or “I need help with fleas or something for my dog,” how does the turn happen where someone says, “Okay, but what about you”?
Ramirez: On intake, when we’re doing the paperwork at the very front end, we start with talking about their animals and because that’s what they’re here for, and then we ask about what if they have any health concerns for themselves. And Natalie can talk more about what people are saying, but the majority of the time they say “No, no, I don’t have anything. I don’t. I don’t need anything.” But we let them know that this is a One Health clinic, and so part of the process is that they should have to just at least say hello to the nurse practitioner. There’s no clinical visit required at all, but they do have to just check in with the nurse practitioner. And the neighbor care health practitioner ‒ the human health care provider ‒ is so good at talking about all the services available that the majority of the time folks will actually get a pregnancy test, get a physical, or something.
Miller: Natalie, what have you come to understand as the reasons that this population ‒ young people experiencing homelessness ‒ may not already be seeking healthcare for themselves. I mean, the big finding is that, when you add in the enticement or sort of the on-ramp of care for their pets, you can increase the likelihood that they’ll seek care for themselves, but what are the reasons they may not be seeking it in the first place?
Rejto: That’s a great question. And other clinics have opened within shelter environments and are not seeing those rates of follow-up. And what I think this shows is that having the convenience of access is not enough to really embody that trauma-informed care to have that actual collaboration and ability to build trust. Working with that human-animal bond over time I think is why we might be seeing those follow-ups, because we even found if perhaps the first appointment maybe they just say hi, but don’t accept human healthcare, that by and large most human clients eventually received some kind of healthcare. And so I think that might speak to the trust that’s being built.
Ramirez: If I could jump in, too.
Miller: Yeah. Please do.
Ramirez: I would love to. There is a lot of trauma in medical care for folks experiencing homelessness, and that’s primarily from biases towards their housing status, towards their economic status, towards their race, gender, sexual orientation. There have been so many opportunities for negative healthcare experiences in their past, even these youth and young adults. It’s like Natalie said, that relationship building, where we are approaching it from a non-judgmental, trauma-informed way, really creates a foundation where they can start to trust the human healthcare providers again.
Miller: I have to say that what maybe makes this more surprising, because I understand everything you’ve said. And we’ve heard versions of that in previous conversations, but it’s worth noting that the clinic in question here, it operates every day for people, and my assumption is that this is at a shelter itself full of people who are really practiced at trauma-informed care and serving the population that they’re serving. So it’s not like this is some emergency room that is not used to dealing with this population, but you’re saying even here, even in this clinic that is set up specifically for homeless youth, even they deal with that same reticence on the part of the people that they’re trying to serve.
Ramirez: Yes, but they may not be at… The services, but they may be hesitant to access that. And then through their animal they’re like, “Oh, there’s a vet there, so maybe I’ll go engage with the vet.” So just because something is there doesn’t mean it will be utilized.
Miller: And it’s not money that is not necessarily an issue here, right? The care is free for people and for their pets.
Ramirez: Correct.
Miller: Who is paying for this care?
Ramirez: That’s a good question, and that’s a question that … I help other communities try to start in their areas as well ‒ this modeled care ‒ and that’s always the question. In our situation, it’s a little bit different. Because we work… With human healthcare, we work with the federally qualified health center that is responsible for providing care for those experiencing homelessness. And then Washington State University, this is a clinical rotation for their students and so those costs are covered as part of the veterinary school experience. And then our evaluation and data analysis are funded by
small grants and foundation donations. So, it actually works out very well because no one has a lot of money to give, but if we can all pull together our little pools and use it together, we can stretch it so much farther and provide such better care.
Miller: Natalie, what have you heard or seen about what it’s like for these different realms of healthcare providers to work together for people who normally just treat animals or normally just treat humans to be collaborating.
Rejto: That’s a great question, and I think it really touches on something so unique about this clinic, that it’s not simply that folks can access human health care and animal healthcare, that they are, in fact, working collaboratively. So, you’ll see situations where it overlaps that the health outcome is better. For example, if a person is with the vet talking about that their cat is good at killing rodents in the environment, and then at the human healthcare encounter, if that human client finds out that they’re pregnant, then the veterinarian, as well as the human healthcare provider, work together on what are sort of next steps to reduce the potential of the human interaction with the fetus with the cat killing rats in the environment.
Miller: Vickie, has this work challenged any of your preconceived notions about homelessness?
Ramirez: There are lots and lots of people who will say, “Oh, you can’t take care of yourself. Why do you have an animal?” I always approached it more with curiosity, like that’s that it must be really hard, and I wonder if it’s worth it. But over these last eight, nine years of just working in this field, working with our collaborators ‒ we collaborate with folks with lived experience just so that we’re making sure we’re doing everything in the appropriate way ‒ and I have learned so much from those with lived experience, those who are currently homeless, those who are formerly homeless. It definitely puts everything into perspective and has really taught me a lot about how we all need to be supporting each other better.
Miller: Vickie, this study period covered four years from 2019 through 2022. What’s been happening at the clinic since then?
Ramirez: Oh, it’s been really gaining a lot of traction because we created a free tool kit that people can utilize to replicate this model in their community and that’s at https://www.onehealthclinic.org/toolkit if anyone wants to check it out. We helped the public health department in Tucson to start a clinic there. We helped a housing organization in New York City to start one there, and we’re working with cities all across the country and actually into Canada and into Europe to also replicate that model because what we need to show is that this works really successfully in Seattle with the youth and young adults. We have opened another clinic in Seattle just recently with adult populations just trying to see whether this works with that group as well, but we really have to look at it across the country because Oregon, Portland, Seattle, animal-loving areas with lots of resources, but maybe that’s not the same in other locations.
Miller: Vickie and Natalie, thanks very much.
Rejto: Yeah. Thanks.
Ramirez: Thank you so much, Dave.
Miller: Vickie Ramirez is the program manager at the Center for One Health Research. Natalie Rejto is a postdoctoral fellow at the Center and a patient navigator at the One Health Clinic. They recently released a paper showing that young people experiencing homelessness were more likely to seek medical care for themselves if they went to a clinic that offered care for their pets.
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