Social Determinants of Health

The initiatives in this domain support high-need patients and assist providers in providing care by addressing SDoH factors. The efforts include advancing health equity by working with sectors on the factors that influence health, including employment, housing, public safety and food access.

Street Medicine Program

We are partnering with Regional Health Reach and MC Collaborative to provide medical and dental care to unsheltered homeless individuals in the city of Rochester. Regional Health Reach is a federally qualified health center providing quality comprehensive medical and dental care to homeless individuals in the city of Rochester and the greater Rochester area. Services are provided at area homeless shelters, a mobile medical van, and a clinic located at the St. Mary’s Campus. MC Collaborative is a care agency that focuses on assisting individuals facing significant mental health, physical health, and addiction issues.

Regional Health Reach is collaborating with MC Collaborative to pilot a Street Medicine Program which brings services out of the clinic and provides care directly on the street, in encampments, parks, and under bridges. Regional Health Reach and MC Collaborative will deploy a mobile outreach team made up of a provider, medical assistant, and outreach worker to identify and engage with homeless individuals living on the streets or in high-risk areas.

As part of this collaboration, we are providing technical support to ensure the program meets its goals. This support includes consultation on data and analytics, and a program evaluation report.

The mobile outreach team will use telehealth to link individuals to care and the mobile medical van will also be available to provide medical and dental care. MC Collaborative will provide ongoing case management and coordinate health home care management services.

Our Community Partners