ROANOKE – In the cold, predawn hours of a dark morning in late January, teams of volunteers spread out across the city of Roanoke.
Their goal was to speak to as many people as possible, gathering information for the Winter 2023 Point in Time Survey. Among them were students from Radford University Carilion’s (RUC) Department of Physician Assistant (PA) Studies.
The survey is administered once or twice per year, across the country, including all jurisdictions of Virginia. In Roanoke, it is conducted by the Blue Ridge Interagency Council on Homelessness, using almost exclusively volunteers to count and collect information on people experiencing homelessness in the city. Each person surveyed is classified as sheltered (residing in emergency shelters), unsheltered (residing outdoors) or under-sheltered (living in a structure but without basic amenities like electricity, running water, etc.). The questions they are asked include information not only about their living conditions but also their healthcare options, their personal histories and whether they can access basic necessities.
“We need to know their situations before they go to shelters and missions for breakfast, and that’s why we go so early in the morning,” said PA student Madison Ann Pelfrey, who participated in the survey and noted that the teams began working around 4:15 a.m. “It gives us a more accurate snapshot of their living conditions.”
According to the Council on Homelessness, the data collected offers a snapshot of homelessness on a single day, which the organization then uses to qualify for federal assistance funds from the U.S. Department of Housing and Urban Development (HUD). In addition, the council says the data “provides valuable information for area service providers, policymakers and the general public on the individual and family challenges and barriers associated with homelessness.”
PA program professor Judy Smith, Ph.D., routinely joins the teams for the surveys and says that the program has been providing this volunteer opportunity to students for about a decade. Back then, fellow RUC faculty member and the chair of the Blue Ridge Interagency Council on Homelessness, Paula Prince, Ph.D., asked Smith if the PA students would be willing to participate. A new element had recently been added to the survey assessing medical vulnerability. Prince thought it would be a perfect opportunity for students learning healthcare, and Smith agreed.
“I think the student participation in the survey is important because this is a population that the students most likely haven’t interacted with before,” Smith said. “They may have worked in emergency rooms and have seen homeless patients, but to go out and see how these folks are living is such a humbling experience and really makes an impact on them.”
Smith says the experience is a meaningful way to help PA students develop empathy and compassion for their patients – vital elements of a healthcare professional’s growth.
“You know, it’s hard for the students to have empathy for people if they don’t understand their context,” Smith says. “The homeless population has to work hard at living. Their basic necessities aren’t guaranteed, which adds a level of stress to their lives that we may not fully understand. When the students get to see that, it creates empathy and understanding that they may not have otherwise.”
PA student Jack Yoder agrees, saying, “You have to lead with empathy and compassion. You can’t practice medicine without it.”
Pelfrey says that employing empathy, compassion and kindness is “everything when it comes to working with patients,” adding those traits are what many healthcare workers are drawn to in their professions of choice.
“It’s so much easier to show compassion and care for people we understand,” Pelfrey says. “While I may not have firsthand experience being homeless, I can understand the circumstances that lead someone to where they are and treat them compassionately rather than with pity.”
Joe Howard, another PA student who helped with the survey, said his participation helped refine his skills in interacting with patients.
“If you approach someone with the intent to help them, it can lead to not-so-ideal interactions sometimes,” Howard says, “but everyone we encountered during this exercise was positive. If you treat your patients with respect, you’ll receive that same respect for the most part.”
That respect was evident in many of the interactions the students had with those they surveyed, as well as with members of their teams there to help them reach the homeless populations.
“Each team was paired with a police officer, and ours was Officer Wood, who was amazing,” says Frank Fleming, another PA student who helped with the survey. “It was amazing for me to see how he knew the people we surveyed and how much respect he showed them.”
Fleming recalls how one of his classmates was having a hard time with one of the unsheltered people they surveyed. He says Wood came over and spoke softly with the person, explaining what was going on and why they were there. Fleming says the humanity shown to the man made a tremendous difference.
“Empathy and compassion don’t always come naturally, honestly,” Fleming says. “We have to practice those things, and that’s why I think our program has us participating in activities like this. It helps us develop the skills we need to create trusting relationships with our patients.”
Fleming, Howard, Pelfrey and Yoder are all first-year PA students. In their second year, they will all begin clinical rotations, working with patients in various healthcare facilities, clinics and offices across the region. All agree that activities like the Point in Time Survey help them prepare for the next step in their educational journeys.
“As we do our rotations, we work with preceptors who are working healthcare professionals,” Fleming says. “So there is a very good chance that we will encounter the people we met during the survey again as patients before we graduate. Having an existing relationship will be invaluable as we treat them.”
Pelfrey says that a recent classroom session on “implicit bias,” or making assumptions about a patient and their circumstances, came to life as she worked with the survey respondents.
“It’s just something that you do – that everyone does – but we have to go into a room as a provider with no preconceived expectations, and this really put that idea into practice for us,” Pelfrey says.
“A lot of people think the homeless choose to be in the situation they are in – and some do – but that’s not always the case,” says Smith. “A lot of them have chronic illnesses or other life situations that led them where they are. Providing our students with the chance to see the various stories of these people’s lives can be the start of shattering myths that pervade society about the homeless.”
Mark Lambert
Radford University
