Q&A: Dr. Scott Miscovich on the new Kaneohe Joint Outreach Center
The new Kaneohe Joint Outreach Center opened this week to serve individuals experiencing homelessness on the Windward side of Oahu. The medical clinic, which is operated by Hawaii Homeless Healthcare Hui (H4), will provide walk-in medical services, social services, referrals for mental health and drug abuse treatments, as well as food supplies and hygiene items.
The new outreach center is a three-year pilot program made possible by a public-private partnership with legislative leaders, the State Department of Human Services, and private sector partners through the Hawaii Executive Conference (HEC) Health and Wellness Committee, among others.
We recently caught up with Dr. Scott Miscovich, one of the founders of H4, to discuss the Kaneohe Joint Outreach Center and H4’s overarching goals. Miscovich co-founded H4 with now-Lt. Gov. Josh Green.
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Emily Boerger: Can you tell me about the importance of this new facility? Especially its location in Kaneohe.
Dr. Scott Miscovich: “We haven’t been able to address homelessness on the Windward side of Oahu comprehensively. So, to have a facility now open for that area is going to allow full outreach for the Windward population. The Windward homeless population is very different because the people choose the Windward side to be homeless to avoid detection, to have some privacy. So the Windward homeless population is significantly under-counted and it needs very specific attention by outreach workers, medical providers, and benefit coordinators. So, this is really important to address what we believe to be upwards of 1,000 homeless on the Windward side.”
EB: This question probably applies to H4’s Chinatown location as well, but what makes this kind of facility unique in the services that it offers?
SM: “This is taking the approach that Lt. Gov Green and I have supported with the founding of our non-profit. We feel that someone needs to address the most difficult and challenging homeless sub-groups in the state of Hawaii. These are the individuals that have both mental illness and/or addiction — they have dual-diagnosis. These are the individuals who are the most challenging. They’ve often been the most long-term homeless on the streets. They are the ones that often are suffering the most. They often have a shorter life-span and are dying in the streets, which is just unacceptable in this day and age.
So, this is not the group that is supported by the traditional Housing First model. This is the group that needs really advanced, very well-trained medical professionals and other support social professionals to really start making a difference. And our feeling is that these homeless can only be solved one patient at a time because they are all so individual.
So, we’re going to have addiction-psychiatry, we’ll have psychology, we’ll have regular psychiatry. We will also have highly trained medical professionals because many of these individuals have additional comorbid diagnoses including cardiac illnesses possibly from long-term methamphetamine use, to numerous wound infections. Often they can have diabetes. So, we are really going to have a complex team of medical providers to be able to address all of these issues.”
EB: So it sounds like this is more about getting the necessary physical and mental health treatments, rather than primarily about housing. What do you hope the center accomplishes or what are the overarching goals?
SM: “The overarching goals are to address the sub-set of homeless individuals that are suffering from mental illness, addiction, and complex medical illnesses that are not able to transition directly into housing first. This group needs to have their complex medical issues addressed before they can successfully be able to be managed in a Housing First situation.
And the thing that you have to understand is this group also is the highest-cost group. So this is also the group that is rotating in and out of the emergency room, rotating in and out of hospitalization, and there are literally costing our Medicaid/Med-QUEST budget in excess – for the data we have on groups of these patients – up to $200-250,000 a year for this group. Others cost usually over $80-$100,000 per year. This is a tremendous burden to society.”
EB: So, the hope is that getting them the treatment they need earlier will reduce some of those costs?
SM: “Exactly. And then those savings can perhaps be used for other programs that we’re going to be able to use to help the overall population. Perhaps the excess savings will go into the Housing First program and could go into Rapid Re-Housing.”
EB: Are there plans for other locations operated by H4? What are the next steps?
SM: “The Lt. Governor and I and our team at H4 would like to have this expand across the state. I just spoke to City Councilman Ron Menor at the [Kaneohe center] opening and he wants to open discussions to have one center in his region. And we’ve been working with City Councilwoman Carol Fukunaga to improve the care and perhaps put a center in Kakaako.
Actually, right now I’m driving to my… on Wednesday morning I always spend three hours with the Lt. Governor and we do planning. We really now are putting a big move to have a 2-exam room mobile clinic which will allow us to be able to be in remote areas. We want to have “H4 mobile” that will be able to be doing four or five hours, three days a week across different areas. And this is to address these very remote locations, or the locations that are moving. Often what happens is some of the homeless will migrate, they’ll move. Just last night on the news there’s a large group that’s on the slopes of Diamond Head. So we want to start focusing and targeting these individuals as much as possible. And moving into bricks and mortar areas may not always be the answer.
We also want to be looking at the neighbor islands too and will definitely try to help them in the same way.”
This interview has been edited for clarity and length.