Q&A with HHHRC Director Heather Lusk on Harm Reduction in Hawai’i – State of Reform


Heather Lusk is the Executive Director of Hawai’i Health and Harm Reduction Center (HHHRC). HHHRC has remained open throughout the pandemic, serving communities at the intersection of homelessness, chronic diseases such as HIV, behavioral health and substance use.

In this question-and-answer session, Lusk explains how the HHHRC was able to pivot its services to adapt to the pandemic, advocate for reimbursement for “street medicine” and fight against burnout of health workers. .

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Nicole Pasia: How has the HHHRC reoriented its resources to prepare for and respond to the pandemic? How has functioning as a community organization helped you in your response efforts?

Heather Lusk: “In many ways we as an agency working in a public health crisis were able to pivot, very quickly into COVID, due to our experience working with HIV, and then also given that we are already in public health and we are used to things like universal precautions and disease transmission and prevention. It seemed natural [fit] for us. Harm reduction is a public health approach that recognizes that there are complex reasons why – whether it’s trauma or behavioral health – people do what they do. We also use a hierarchy of needs. We need to meet people’s basic needs before we can deal with issues like substance use, mental health, if they don’t get food, [if] they have no shelter.

… In addition to providing services, we saw ourselves as a very important part of education, especially of people who might be outside of traditional communication channels, around COVID. Around this time, we started increasing our food, our collaboration with the food bank, and we distributed nearly half a million pounds of food during COVID …

We ran our COVID case management and isolation site in Waikiki, where we saw nearly 900 people who had COVID or were at risk of COVID where they needed to quarantine and our specialty is homelessness and behavioral health. So a lot of what we were trying to do was not just keep them safe, but also try to help them get out and, for lack of a better term, get out in better shape than they ever got. entered. ”

NP: Can you tell us more about the field services you have provided to the community?

HL: “We have a mobile medical unit, and we’re going to take it out onto the streets. We’ve really discovered through the pandemic that… it just makes sense to keep our services where people are. Then [it’s] build relationships [with them] and finally, once they have formed a relationship, they must be ready to come to Kakaako in our clinic. I’m sure you’ve heard this from other health care providers, but the hardest part is getting them to come in and make the appointment. We are now taking our behavioral health with our iPads to the field thanks to our mobile medical unit. The outreach workers, addiction counselors, the people who focus on homelessness and our medical assistants are there and they can then return the telehealth to our providers here at the office to get everything including the person in the field. may need.

One thing I love about the work you all do is that you are aware of the reform. So a political problem is that street medicine is not reimbursable in the United States, let alone in Hawaii. It’s not considered a site, right? We are not at the clinic site and we are not at someone’s home. So I can’t pay for all the mobile street medicine I do until this changes.

NP: As an organization that works with homeless people, how the recent moratorium on evictions have expirations affected your work and the communities you serve?

HL: “We are very concerned about the moratorium on evictions which was overturned by the Supreme Court. I’m actually the president of the Homeless Coalition here, and we’re actively trying to both keep our people who are already housed, housed… Because the last thing we need besides the homeless crisis is we have is even more people going homeless because of the moratorium on evictions.

You may be aware that there is a new Medicaid or med-QUEST program called CIS, or Community Living Services. The state of Hawaii has obtained an 1115 waiver from CMS to essentially begin reimbursing housing-related issues through Medicaid plans in Hawaii. So it’s happening. It should be deployed by the end of the year or early next year. And it’s going to allow providers like me and other healthcare providers to start charging for things like housing assistance and transportation and screening people, to make sure they’re still housed.

So we are really trying not only to prepare but also to help provide technical assistance and support to other agencies that serve the homeless community that may not have relationship with the plans. , to be accredited with the health plans, because that’s going to be major support for some of the gaps… I think collaboration is more important than ever in COVID, and we continue to try to build bridges.

NP: What other health problems do you think are not being adequately treated?

HL: “The one [issue] I think that’s actually the most important thing, which I think we don’t talk about enough, is the indirect trauma that our healthcare staff go through, as well as the compassion fatigue and burnout that resulting. I see it in my own staff because we ran an isolation and quarantine site. I see it in providers I know who work in hospitals. I do not feel that as a sector we are concerned with the welfare of health care workers.

One thing I’m particularly proud of is having started a wellness program here. I pay my staff two hours a week just for wellness time, where they’re on the clock, but I pay them to do a yoga class. We do meditation classes, we do a Zumba class, we do mindfulness teachings, and we do grief support. We help people talk to their therapist during this time. I’ve seen a few other agencies doing this and I’ve spoken to a few of the hospitals that seem to be trying too, but I just want to remind everyone that our healthcare workforce isn’t just depleted. . They have carried the burden of the compassion, the hard work and the trauma they endure. [It’s] really impact their well-being.

How do we as a sector, especially those of us like me, is in administration… How do we create opportunities, both in our own systems but also on a corporate scale? community, so that it is more normal to talk about the well-being of health workers? [Normalize talking] on compassion fatigue and talk about the importance of giving our healthcare workers opportunities to build their resilience and create protective factors to compensate for all the incredible amount of suffering they themselves have seen, lived and experienced over the past year and a half. For me, this is such an important part, and healthcare workers are suffering and they need support. “

This interview has been edited for clarity and length.


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