For 20 years, the University of �鶹��ý at ����ԴDz� ’s (JABSOM) has been on the frontlines of �鶹��ý’s houselessness crisis, delivering free care while training the next generation of physicians.

Founded in 2005 by Jill Omori, JABSOM‘s director of the Office of Medical Education, H.O.M.E. began as a single tent clinic.

Health isn’t just about medicine. It’s about wellbeing,
—Jill Omori

“When I was a student, I wanted experiences like this, and there was nothing,” Omori said. “When we started, we were in a tent with shower curtains for walls.”

Today, the program operates multiple mobile clinics and one brick-and-mortar site in Iwilei, serving hundreds each year. Students provide wound care, checkups and specialty services, while also connecting patients to food, housing and income support.

“The mission of H.O.M.E. is to provide the basic human right of healthcare,” said third-year JABSOM student Philip Lee. “We as medical students learn to take a patient history, perform exams and build rapport. We’re not just treating the disease, we’re treating them as a person.”

The clinics have helped ease pressure on �鶹��ý’s healthcare system. Omori noticed that on the days they had clinics in certain areas, there were fewer EMS calls at that time.

Beyond medical care, H.O.M.E. runs annual drives for school supplies, holiday meals and gifts for mothers. “Health isn’t just about medicine. It’s about wellbeing,” Omori said.

As the project celebrates its 20th year, Omori hopes one day such services won’t be needed.

“For a long time we were the only ones providing truly free care,” she said. “Our program fills a very big need in our community.”

Lee added, “At the end of the day, we all pursue medicine because we love people. H.O.M.E. reminds you of that every day.”

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University of �鶹��ý at ����ԴDz� student Yasmeen LaTore has been named by (IHS) to lead the ʻImi Ola Piha Homeless Triage Center as program manager, helping Oʻahu homeless patients to ‘seek one’s fullest life’ when doors open in early April, while completing her (DNP) at the (NAWSON). Focal to her capstone DNP project, is developing a training program module for onboarding new health services staff at IHS.

Since 2018, LaTore’s caring nature has prompted her to integrate her nursing education into various roles at IHS, supporting patients to manage their mental illness and substance abuse, providing COVID-19 care and serving as community liaison nursing for recently housed individuals. As lead for the new triage center, the first of its kind in the state, LaTore will be managing community-based medication-assisted detox for substance withdrawal. She will help initiate psychiatric treatment that are considered best practice with unsheltered chronically homeless when their situational circumstances are considered.

LaTore started at NAWSON as a student in the (GEPN), a post-baccalaureate program that provides a seamless pathway for non-nursing degree students to earn either their master of science in nursing (MSN) or DNP.

“IHS truly has a heart for these incredibly vulnerable persons, and we’ve put careful consideration into building a team of professionals to provide quality medical and behavioral health care to help these patients begin their journey of healing,” said Latore. “I feel so fortunate to be a part of this wonderful team and to help these patients ‘seek one’s fullest life’—ʻImi Ola Piha.”

Training standard for building cultural sensitivity

In developing her training module, LaTore worked closely with fellow NAWSON alumnae, IHS Executive Director Connie Mitchell (BSN, MSN), a , and IHS Chief Administrative Officer Leina Ijacic (BSN).

Yasmeen’s training module has become a standard for enhancing cultural sensitivity when working with people experiencing homelessness
—Connie Mitchell

“Yasmeen’s training module has become a standard for enhancing cultural sensitivity when working with people experiencing homelessness,” said Mitchell. “We are so much more effective at engaging people in managing their own health, when we are attuned to their feelings and priorities while living unsheltered or experiencing housing instability.”

LaTore agreed that individuals experiencing homelessness have unique challenges accessing and implementing treatment. She said, “As a new nurse providing care for this vulnerable population, I realized that healthcare staff often don’t learn about or make adaptations to practice that can improve the outcomes of care afforded to homeless patients. My DNP project aims to fill that gap in knowledge and provide additional training to providers. Bias, judgment and discrimination are commonly cited reasons for homeless persons neglecting care.”

In addition to new staff, including nurses, physicians, counselors and case managers, the training will also be used for students who come to IHS for their internship experiences.

LaTore is hopeful through this new training standard that homeless patients will feel seen and cared for, and that providers make modifications to account for the practical challenges due to the experience of homelessness.

Formative experiences at NAWSON

LaTore will earn her DNP in August and participate in the spring commencement ceremony. She is thankful for the experiences NAWSON has afforded her.

“As a GEPN student, I had no previous nursing experience, I can vividly recall being nervous to take a patient’s blood pressure,” said LaTore. “The education I received at NAWSON and its supportive faculty members has equipped me with the nursing care and clinical decision making skills that have allowed me to operate at the highest level of the nursing scope of practice.”

Ijacic, who constantly seeks to resource innovations in her role at IHS for the last three years, said “My UH nursing education provided the foundation for the decisions I make daily. My senior capstone project covered clinical quality improvement and patient safety. It taught me about the administration of running a healthcare facility. The hands-on clinical training exposed me to the major healthcare systems in �鶹��ý, the importance of culturally competent care and how programs work best when we tailor them for our �鶹��ý community.”

Mitchell, who has led IHS for nearly 17 years, also credits her UH ����ԴDz� nursing experience for shaping the way she approaches life.

“It [nursing education at NAWSON] has served me well throughout my professional life, no matter where I found myself. I often remember the challenge imparted to me by one of my instructors about not only caring for individual patient needs, but to offer leadership when opportunities arise to shape the health of our community,” she said. “I’m reminded of that challenge everyday at IHS, whether we’re provide access to basic needs like food, hot showers, and a safe place to sleep; or when we fight for access to mental health treatment at the Legislature for those who can’t do so themselves, or when we’re advocating for changes in practice standards with health plans or government policy makers.”

—By Arlene Abiang

Homeless activists on Oʻahu are taking charge of the growing issue in the islands and tackling problems on their own terms. The University of �鶹��ý’s seeks to amplify some of those voices and spotlight initiatives from Waiʻanae to Waimānalo.

The livestream conversation, Finding Home, Building Community, will be held on Friday, September 17 at 3 p.m. The forum will explore how a new generation of grassroots leaders are paving a path for finding homes and building community. The livestream event is open to the public. (.)

“If we build the right relationships, houseless people can be part of the solution, instead of people seeing us only as a problem,” said Twinkle Borges, an activist with Puʻuhonua O Waiʻanae, a village that has come together on state land on the shoreline near the Waiʻanae Boat Harbor.

Borges will be featured on the forum, alongside Jessy Freddy Francis (We Are Oceania); Tina Grandinetti, UH alumna who works at the state Legislature; Ronette Kawakami, associate dean at the ; James Koshiba (Hui Aloha); Blanche Macmillan (Hui Mahiaʻi Aina); and Lindsay Pacheco (Ka Poʻe O Kakaʻako).

Maya Soetoro-Ng, UH faculty with the , will serve as moderator.

“Houselessness is a complex problem and requires many solutions,” explained Soetoro-Ng. “This is a chance for us to examine some of the solutions that are really working, in which unsheltered families are coming together and building their own communities from the ground up.”

The Better Tomorrow Speaker Series is a joint venture of the �鶹��ý Community Foundation, Kamehameha Schools and UH ����ԴDz�.

Lead sponsors for this forum include the Matsunaga Institute for Peace and the William S. Richardson School of Law. Co-sponsors include Ceeds of Peace and the College of Social Sciences.

For more information, visit the UH ����ԴDz� Better Tomorrow Speaker Series website or email btss@hawaii.edu.

Formerly houseless Native Hawaiian and Micronesian families and their successful journey to obtain stable housing is the focus of a new pilot study by social work researchers at the University of �鶹��ý at ����ԴDz�. The study, published in the April 27 issue of , used a strengths-based perspective to understand their improved living situations and showed similar themes of strength within their stories.

Assistant Professor Francie J. Julien-Chinn and PhD candidate Mei Linn N. Park of the Thompson School of Social Work & Public Health conducted narrative interviews and analyzed the collected stories of four families, thematically utilizing a family resiliency framework. Through in-depth, qualitative interviews, researchers provided space for families to tell their stories about their challenges, strengths and protective factors related to being houseless.

Protective and resilience factors

The results were consistent with the hypothesized theoretical framework, which identified protective and resilience factors, such as social support, initiative, insight, spirituality, creativity, commitment and hope. In addition to these themes, the study revealed a preference for the term “houseless” over “homeless,” a predominant connection to the ʻāina (land) and the impact of trauma.

“Recollecting and reflecting on being formerly houseless can be retraumatizing; however, acknowledging the impacts of historical trauma such as the loss of ʻāina and honoring cultural strengths such as the deep connection and relationship with the ʻāina seemed to empower participants’ sense of resiliency within their stories,” said Park, a doctoral student in UH ����ԴDz�’s .

“It is hard, for some, to think that houseless individuals or families can be seen as resilient. However, these brave and vulnerable stories deserve to be heard. Houselessness is a structural concern that needs immediate attention. There is much more to learn from this population to better understand and support the houseless crisis,” added Julien-Chinn.

This research is an example of UH ����ԴDz�’s goal of (PDF), one of four goals identified in the (PDF), updated in December 2020.

Last May, the University of �鶹��ý began a partnership with the �鶹��ý Department of Health (DOH) to train Community Health Workers (CHWs) as part of the DOH-UH Contact Tracing Training Program and the in an effort to enhance health outreach in high-risk communities affected by COVID-19. A year later in May, nearly 150 students statewide will have earned their certification training through the UH online program, and have been or will be ready to play a vital role in the state’s response to the ongoing pandemic.

CHWs draw on our own resiliency building experiences to help other individuals navigate and heal
—Lia Thorne

As CHWs, these trainees have the skills to help connect disadvantaged populations with health care providers and community resources to improve the quality of their health and lives. These populations include the Native Hawaiian/Pacific Islander communities, as well as uninsured and homeless individuals. CHWs are trusted advocates for their patients who oftentimes do not know where to turn to for help.

“�鶹��ý is blessed with a rich and diverse population and afflicted with stark health inequities,” said CJ Johnson, DOH COVID-19 Outreach and Public Health Education community liaison. “As the Department of Health and its community partners rise to the formidable challenge of a vaccination campaign without any precedent in its scale and urgency, the importance of community health workers has never been clearer. The professional and lived experience they bring to the table ensures that our plans include community voices and address community needs.”

Helping to end homelessness

Martha Boyd is a CHW with the Queen’s Care Coalition (QCC). Boyd has been with the coalition since it began operating in 2018 and was able to complete the UH program while she was employed. “What I learned at UH was priceless! I could take what I learned in school and immediately apply it to my patients I was seeing in the community,” she said.

At Queen’s, Boyd works with patients who are usually homeless, uninsured or underinsured. She assists up to 12 patients at a time for about 90 days, depending on the cases. “They come to the Emergency Department for colds, food or clothing because they do not know about resources in the community that can help them,” she explained. “I offer shelter options, food bank options, clothing, connection to insurance services, connections to a primary care doctor, and often accompany them to doctors appointments.”

“When I do this, the patient is not viewed as a ‘homeless, non-compliant patient,’ but as a ‘human being’ that needs care,” she said. “This changes the way doctors and staff respond to the patient.”

Boyd said their work at QCC is important “to really help end homelessness in �鶹��ý, by trying to get our patients in housing, shelters and help with their problems, whether it is mental health, no money or no family connections.”

According to Boyd, some patients are not aware of COVID-19 or are resistant to getting vaccinated. To address their questions and concerns, she provides them with information from the CDC or consults with her medical director to make sure they have the facts and answers to help them make an informed decision.

“I don’t try to change their minds. The patient is still capable of making their own medical decisions,” she said. “My care for the patient is driven by what the patient desires and wants, not me ‘making’ them do what I want.”

Due to COVID-19, Boyd and her colleagues have adapted in the way they deal with their patients. While face-to-face interactions have been minimized, creative solutions have helped them build and sustain the relationships with their patients, including buying them cell phones so they can keep their telephonic appointments with doctors. According to QCC, the average cost savings per patient served through the QCC program is about 40%.

Addressing vaccine mistrust

Another UH program graduate, Lia Thorne, serves as a CHW with HMSA and focuses on Quest HMSA members. Thorne provides members with services ranging from weekly touch-base phone calls to assisting them in navigating public programs, such as applying for federal , formerly known as Food Stamps, and/or Temporary Assistance for Needy Families benefits. Her caseload can be as high as 25 patients at a time.

Thorne has extensive experience working at various health care systems across the island. She notes that while the role of CHWs has been brought to the forefront even more during COVID-19, they have been involved in patient care for as long as medical and health existed.

“We do not possess all knowledge, but we do possess the bonds that tie us to our communities,” she said. “We are a key component in the continuity of patient care because we have close relationships with those cultures and communities that we personally identify with, live in and serve.”

With regard to COVID-19 vaccinations, Thorne said she hears a lot of mistrust issues from members, including how vaccines are made, difficulty with understanding the different vaccination tiers, and concerns about how policy decisions were made. “Many people feel disgruntled about having to wait for a vaccination. Relaying accurate information is vital to bringing about understanding and trust,” she said.

Thorne provides members with visual aids that can be found on trusted sites such as CDC and DOH, especially in other languages. This sometimes leads her to sharing and educating members about using the internet, and accessing apps on their smartphones. She knows it’s important work, and part of her role as a CHW.

“The reality is this–[due to COVID-19] every human being on this planet now has a shared traumatic experience. CHWs draw on our own resiliency building experiences to help other individuals navigate and heal,” Thorne said.

More on CHW certificate program

The CHW program is a certificate program that can be completed in one or two semesters. The statewide program is accessible at . Additional programs are offered at and . Courses include: CHW fundamentals, counseling and interviewing, health promotion and disease prevention, case management, an in-person practicum component and COVID-19 health clinical training.

Interested students may visit the respective UH community college websites to .

—By Arlene Abiang

Support from the University of �鶹��ý at ����ԴDz� (UROP) has allowed students and faculty to pursue their academic goals in research subjects as diverse as understanding homeless behaviors to the reemergence of a kind of folk music in Japan. UROP is an example of UH ����ԴDz�’s goal of (PDF), one of four goals identified in the (PDF), updated in December 2020. The following three projects have been supported by UROP in the past year.

Understanding homelessness in �鶹��ý

Bryce Dolph, a senior major, observed an individual experiencing homelessness outside of his residence, who exhibited symptoms of schizophrenia, and often had dirty bandages and visible ulcers. Dolph thought about how this person was in no condition to be living on the street and wondered how many others are in similar situations. With the guidance of Associate Professor John (Jack) Barile, Dolph’s project aims to understand the disparities individuals who experience homelessness encounter, how individuals become homeless and learn about their accessibility to resources.

“There is stigma surrounding people experiencing homelessness who engage in compulsory behavior in public, and it is common to think, ‘oh, they’re just crazy,’ without considering the circumstances they endured prior to and while experiencing homelessness,” Dolph said. “The data from this project will go on to provide advocacy about how environmental factors alongside access to needed resources may influence the quality of life for this population.”

Dolph received a research stipend from allowing him to take a break from his second job and focus on his project. Dolph aspires to be a psychiatrist specializing in helping those who are in disadvantaged situations.

Shimauta folk music

Iroha Mochida, a senior major, spent her childhood in Tokunoshima, one of eight Amami Islands in Japan. There, she studied Shimauta, traditional folk music that has been transmitted orally for centuries. While it experienced a serious decline during the middle to the late 20th century, the music has been revitalized by modern singers. Mochida’s project explores the role of online media in contemporary Shimauta culture through interviews, surveys and interpreting different online media sources. Under the guidance of Anna Stirr, an associate professor and project mentor, Mochida also received support from .

“UROP has provided a huge support for me to pursue my academic interest,” Mochida said. “I am really grateful that I am conducting my own research project on Shimauta, which I had been hoping to do since my freshman year. They offer financial support as a research scholarship, and it helped me to purchase relevant sources such as academic books, journals and a subscription of newspapers. The UROP staff is always accessible.”

Project funding applications open

UROP is accepting project funding applications from students conducting or planning to conduct faculty-mentored research or creative work beginning in summer or fall 2021. If selected, funding may cover materials, supplies, travel, stipend and other costs. UROP provides up to $5,000 for a project conducted by one student and up to $10,000 for a group project. The deadline for applications is March 3. To apply or for more information, .

Faculty mentoring grant

UROP’s faculty mentoring grant supported Assistant Professor Christopher Muir to develop to process and validate photosynthesis data. Scientists currently use a system to measure how much energy leaves gain from sunlight and R is one of the most common languages for statistical computing, especially in biology. However, there are no standardized tools to get the data into the R programming language. With the help from UH ����ԴDz� student Daniel Trupp, Muir wanted to create a software that was more reliable.

“We put the software online and spread the word via social media,” Muir said. “We got a good response, but no major bugs yet. I have been using it in my research and would like to make some more additions before eventually releasing a stable version.”

UROP is currently accepting applications for its 2021 Faculty Mentoring Grant for Summer Undergraduate Research and Creative Work. Up to $75,000 in grants will be awarded to eligible faculty who will mentor UH ����ԴDz� undergraduate students conducting research and creative work projects in summer 2021. The funds are intended to increase undergraduate student participation in summer research and creative work, including the Summer Undergraduate Research Experience, a cohort-based program from June 3 to July 30, 2021. The deadline for applications is March 1. To apply or for more information, .

—By Marc Arakaki

To help address homelessness in �鶹��ý and on University of �鶹��ý campuses, UH is participating in the annual Point in Time (PIT) Count, a national census of the number of people experiencing homelessness on a single night. This year, the date of the PIT Count is Monday, January 25, and for the first time, the university is proactively urging students at UHʻs 10 campuses to participate. that will gather the count and important data. UH is partnering with , which has been overseeing the PIT Count in �鶹��ý since 2003.

“This partnership represents an important step toward ending homelessness in our community,” said Anna Pruitt, UH ����ԴDz� research associate and affiliate faculty member in the UH ����ԴDz� . “Through this partnership, we are able to leverage university resources to meet community needs, which, in turn, can be used to improve campus life.”

The PIT Count has previously included individuals experiencing unsheltered homelessness (sleeping in cars, on beaches and sidewalks) and sheltered homelessness (sleeping in emergency shelters).

This year, Partners in Care has expanded efforts to count individuals who may have been missed in previous years, specifically college students, and those who may be at-risk for homelessness and food insecurity, for example, those who are “couch surfing.” It’s an effort to expand prevention services and tailor existing services to extant needs. Pruitt has been working with Associate Professor Jack Barile and graduate research assistants Rachel Marshall and Marissa Minami with his in the Department of Psychology on this project.

Partners in Care will report the data to the U.S. Department of Housing and Urban Development. At the local level, Partners in Care, in collaboration with UH researchers, will analyze the survey responses and draft a report for the community. This information will be used by planning committees to develop new programming or expand existing resources to new areas. In particular, findings will be returned to the UH community along with suggestions on how to reduce housing and food insecurity among students. Any responses from the survey regarding neighbor islands will be shared with for �鶹��ý Island, Maui and Kauaʻi.

“We hope this project will extend beyond a description of housing and food insecurity in our community and will be used to develop interventions and systematic approaches to addressing these issues,” said Pruitt. “In particular, I hope that these results can inform prevention approaches that keep housing insecure students from falling into homelessness. As the research tells us, the best way to solve homelessness is to prevent it.”

Resources for individuals experiencing homelessness

If you or someone you know is experiencing homelessness, food insecurity, or domestic violence, the City and County of Honolulu has a (PDF) with contact information and resources.

Aloha United Way is also available for assistance and can be reached by calling 211.

As the COVID-19 pandemic shuttered many businesses and forced many into unemployment, the University of �鶹��ý at ����ԴDz� (JABSOM) worried how it would affect its annual Giving Tree, which fulfills Christmas wish lists of homeless keiki. This year, the UH (HOME) Project and the Family Medicine Interest Group took a digital route.

“Fortunately we moved everything online this year and we were able to reach a bigger part of the community and we got more donations than we have before,” said Amandalin Rock, a third-year medical student at JABSOM.

The community responded, fulfilling the wish lists of 380 homeless—the largest endeavor in the history of the giving tree at JABSOM.

“I’m just really touched that everybody has just been so generous and even after all the kids were sponsored I was getting calls from people wanting to donate and wanting to contribute to the program,” said HOME Project Founder and Director of the Office of Medical Education Jill Omori. “And so we’ve just been really blessed this year.”

JABSOM medical students and pre-medical student volunteers spent hours wrapping up gifts and getting them ready to be delivered to keiki across several Oʻahu shelters, including the Family Assessment Center in Kakaʻako, Onelauena and Onemalu Shelters in Kalaeloa, Kakaʻako Paiʻolu Kaiaulu Shelter in Waiʻanae, IHS Women’s and Children’s Shelter, Villages of Māʻili Shelter, and the boat harbor encampment in Waiʻanae.

This year, they also supplied gifts for some of the kids to give to their parents and made goodie bags for families containing food, hygiene products and emergency supplies (first-aid kits, flashlights, blankets, etc).

For more, go to the .

Former homeless youth who have spent an extensive period of time in foster care or experienced disruptions in their foster youth placements are at a significantly higher risk of engaging in detrimental risk-taking behaviors conducted by the University of �鶹��ý at Mānoa Myron B. Thompson School of Social Work faculty Amanda Yoshioka-Maxwell. Both homeless youth and former foster youth face increased risk, but this study in particular takes into consideration youth who have experienced both homelessness and foster care.

These findings shed light on the importance of network engagement and how the characteristics affect behavioral health outcomes.

The data was collected during a two- to four-week interval over three periods of time from 2015 to 2016 at a drop-in center in Hollywood, California. The population consisted of 184 primarily male homeless foster youth that was mainly African American, Latino, and mixed-race, who were approximately 22-years-old.

“We already know that homeless former foster youth face higher rates of risk behavior compared to their peers without foster care experience, but we need to start focusing on the impact of social network engagement and how network connectivity plays a role in risk-taking behaviors,” said Yoshioka-Maxwell.

The participants were required to complete a risk-behavior questionnaire that was modeled after the YouthNet Study, and the Foster Care Experiences Assessment, a qualitative assessment created by Yoshioka-Maxwell that gathered information on the range of experiences among former youth, both during and after placement.

The data revealed that youth experiencing homelessness for the first time before exiting foster care were more likely to engage in condomless sex, and youth with higher numbers of foster care placements were more likely to engage in methamphetamine use. The findings are useful in targeting interventions for reducing risk among the population, perhaps indicating the point of intervention where types of social networks, and their associated risk, may be mitigated.

Although prior research has started to demonstrate high rates of poor behavioral health outcomes among homeless former foster youth, the population has actually received relatively little attention in scientific literature, in comparison to homeless youth and youth with foster care experiences. Future policy research is needed to better understand the long-term implications of child welfare policy on young adult homelessness.

�鶹��ý residents have long struggled with the elevated cost of housing and high rates of homelessness. The devastating economic fallout from the COVID-19 pandemic is now pressing more households to the edge. To help explore connections between poverty and housing policy, the University of �鶹��ý at ����ԴDz� will feature Pulitzer Prize-winning sociologist Matthew Desmond, a Princeton University professor.

The livestream interview, �鶹��ý’s Coming Covid Eviction Crisis and How to Stop It on July 28 at 9 a.m. will highlight what can be done to prevent a surge of evictions.

“�鶹��ý is about to enter a time of unprecedented hardship for poor and low-income families. The state Legislature has done more than anyone could have hoped to help preserve housing stability, allocating $85 million in rental assistance. But that money has to be spent by January 1. Desmond’s talk will present an opportunity for us to learn what else can be done to help families stay in their homes next month, next year, and for years to come,” said Philip Garboden, �鶹��ý Community Reinvestment Corporation professor in affordable housing, and assistant professor in UHERO and the in the .

Garboden and UH ����ԴDz� Public Policy Center Director Colin Moore will also be featured in the livestream. “�鶹��ý‘s most vulnerable residents are facing an unprecedented housing crisis. We’re fortunate to have Desmond, one of the world’s top scholars on housing insecurity and eviction, join us to discuss how we can assure that all people in �鶹��ý have a safe and affordable place to live,” said Moore.

The livestream event is open to the public.

• Related UH News story: Super Bowl champ/activist shares quest against racism, June 18, 2020

During the COVID-19 pandemic, the has also hosted virtual forums that showcase the issues surrounding Black Lives Matter. On June 17, author, humanitarian and NFL Super Bowl champion Michael Bennett was a featured panelist in Reclaiming Humanity: Racism, Violence, Resistance, Love moderated by Associate Professor Robert Perkinson.

For more on future events register on the website.

—By Moanikeʻala Nabarro