Santa Clara Valley Medical Center

Puentes Clinic - Valley Homeless Healthcare Program

The Valley Homeless Healthcare Program (VHHP) was established as the “safety net for the safety net,” providing comprehensive services—including medical, dental, substance abuse, mental health, and support services — to homeless individuals who cannot or will not seek care in traditional healthcare settings. As a Health Resources and Services Administration (HRSA) 330 grant‐funded program, VHHP provided services to over 4,000 homeless persons in Santa Clara County in 2006.

The centerpiece of the VHHP “safety net” is the Puentes Clinic, created specifically to address the inter-related health and psychosocial problems experienced by injection-drug users (IDUs)—most of whom are homeless. During the past four years, Puentes has evolved into a comprehensive model that effectively promotes and integrates walk-in primary care, mental health and substance abuse services, and HCV treatment tailored to the lifestyles and competing daily priorities of the IDUs being served.

In a departure from traditional clinic models, Puentes Clinic’s services are based on a set of operating principles defined by the specific medical needs of the IDU population. These principles are illustrated in the unique features of the program and include:

• Use of walk-in or episodic care to build trust, create access, and deliver primary care. An open schedule helps create a “medical home” to address urgent medical concerns and offers opportunities to engage patients for more comprehensive care;  An interdisciplinary team that delivers integrated primary care, addiction, and mental health services consisting of internists, case managers, a psychiatrist, and a partnership with a psychology training program providing cognitive behavioral therapy and group counseling; 
• Outreach through partnerships with needle exchange programs and the county methadone clinics;
• Developing expertise in the treatment of the prevalent illnesses in the population, including Hepatitis C and soft tissue infections.