Medicine on the Move

Every other week, a team of local health care providers suits up to bring an on-the-go clinic to rural areas with significant unhoused populations, providing a steady stream of medical services to those in need.

In the last year, Mosaic Community Health, a local health organization, has built up its Street Medicine program into a service that offers health care to those who have limited access to medical assistance. The goal of the program is to serve people in their own environments, meeting them where they are, whether that’s in their cars or in the forests of Deschutes County.

To date, Mosaic’s new program has held 72 medicine clinics with more than 300 visits.
The nonprofit began testing out the program in Nov. 2023 and found a great need for bringing health care directly to those who may not have easy access to medical services.

With an increasing population of houseless residents across the region, Mosaic has launched and grown this idea into a fully operational program, attempting to decrease barriers to health by providing care for a wider range of unsheltered residents. About a year into its program, Mosaic is looking back at how the program has impacted the region and is exploring ways to continue expanding and improving services.

A human right
Mosaic Community Health aims to provide healthcare to Oregonians, regardless of life circumstances. The organization started in 2002 and has 16 health centers across Central Oregon. With a mission of providing quality care to all, the nonprofit has explored a variety of programs that help bring care to a growing unhoused population. In 2025, Central Oregon saw a 17% total increase in homelessness, according to a regional Point-in-Time count, measuring the number of people experiencing homelessness on a single night in January.

Since 2012, Mosaic has provided this type of care through its mobile clinic, a 42-foot RV that parked at congregate locations like shelters or food kitchens. While the mobile clinic changed the way houseless residents could receive health care, it did come with some limitations.
As unsheltered individuals continue to move out to more rural areas in the forests surrounding Bend and Redmond, the nonprofit began exploring the idea of “street medicine,” a different approach that allowed it to reach a wider range of people.

“The expansion of our continuum of medical outreach to unsheltered individuals underscores our fundamental belief that everyone deserves to be offered access to healthcare, which can be a pathway to support and stability,” said Elaine Knobbs-Seasholtz, chief strategy officer with Mosaic Community Health.

Last August, the Street Medicine Institute, a national organization promoting Street Medicine services, awarded Mosaic a Seed Grant for the development of its Street Medicine program. The grant, in the amount of $10,000, aimed to provide a year of intensive consultative support from street medicine experts — providing training and guidance to help Mosaic establish and grow its program.

In June, Mosaic received more funding that allowed it to continue expanding its program. The Multi-Agency Coordination group, which helps allocate funding for houseless services on a regional scale, awarded the nonprofit a $300,000 grant to support the program.

With these funds, Mosaic was able to purchase two new vehicles for all terrains, including a Sprinter Van, which they are currently building out as an “exam room.” According to Knobbs-Seasholtz, the van should be running within four to six months. Until then, the nonprofit will continue to use alternate vehicles and their tent canopy to provide these services.

Today, the Street Medicine team regularly goes out to two general areas – two large, rural encampments outside of Bend and Redmond – to maintain a consistent presence and connection with people living in the camps. On a typical outreach day, Mosaic will send a team of three health care workers to the areas to set up a clinic.

The services range from regular physical exams and rapid STD testing to advanced wound management, illness evaluations and the administration of over-the-counter medications and antibiotics.

“Street medicine provides the opportunity to treat many unengaged patients who do not feel comfortable receiving care in traditional clinic settings due to historical trauma associated with the medical establishment and ever-changing local policies,” Knobbs-Seasholtz told the Source.
“Ultimately, we aim to improve patient access to care among the most vulnerable in our community.”

Support for accessible health care
Street medicine is an important piece of Mosaic’s mission and aligns with the Street Medicine Institute’s goal of expanding this type of work across the country. SMI works by partnering with local organizations, like Mosaic, to help support the creation of street medicine in communities across the country.

“We’re kind of creating a new field of medicine, but also seeking to bring care to people that haven’t been getting it,” said Dr. Jim Withers, founder of SMI. “It’s a new classroom for learners to engage excluded populations in a transformational way.”
Out of 23 cities that competed for SMI’s grant, Bend was one of two communities selected. Withers worked with Mosaic to provide consultative services to build out its street medicine program.

According to Withers, Bend was selected because of its “compelling need” for street medicine, and due to its more rural population of unsheltered residents.

The work, Withers said, assists those who are “marginalized,” “underserved” or not well connected to the mainline services available in a community.

“While most health systems have expectations that people will come to them, there will always be people, for a wide range of reasons, that cannot or will not be able to do that,” he told the Source.
Street medicine visits allow health care providers to assess urgent and unmet health care needs. In a more rural area like Central Oregon, Withers added, there are also fewer centralized resources that people can easily access due to transportation or other barriers.

Withers sees an incredible demand for street medicine in communities across the country.
“Street medicine is a gap that needs to be filled. It’s kind of like envisioning the country without a fire department anywhere. So, we’re sort of devising how to make that happen,” he said.

Other local programs connected to houseless services also find this approach invaluable when it comes to increasing access to services.

Colleen Thomas with Deschutes County’s Homeless Outreach Services Team, which offers street outreach and case management support, sees Mosaic as a vital partner in the region’s houseless services.

The Street Medicine program, Thomas said, has been monumental in bringing medical care to people who are fairly isolated. Those living unsheltered on the outskirts of town are often distrusting of systems, don’t have access to transportation or may have mobility issues.
The mobile nature of this program, she said, is meeting a huge need in the community that hasn’t otherwise been fulfilled.

As encampments across the region continue to grow, Thomas pointed out the importance of attentive and continuous care.

“It’s so vital for us to ensure the continuity of care for folks. Having the flexibility of Mosaic, to be able to be a little bit more nimble and meeting folks where they are — we’ve seen it as a huge positive connection for our clients so that they can continue to address their medical needs as they’re displaced throughout the region,” Thomas told the Source.

Since the start of the street medicine program, Thomas said folks in areas like Juniper Ridge, a highly populated encampment north of Bend, are accessing care more consistently, addressing needs like access to Hep-C treatment, abscesses or long-term chronic pain.

Patients of the Street Medicine program have seen positive results, too. Knobbs-Seasholtz shared some anecdotes Mosaic has heard directly from those accessing these services.

“If it wasn’t for all these people here and what they do to help people…you know, I probably wouldn’t be here right now,” patient Leslie reported to Mosaic.

Others reported a newfound trust in the health care system.

“They don’t judge you whatsoever when you walk in here with your problems. It doesn’t matter what you look like, where you come from. They just care about making sure you are OK,” Renu, a Street Medicine patient, told Mosaic.

Continuum of care
While the street medicine team regularly goes out to areas like Juniper Ridge and encampments outside of Redmond, it also relies on other community service partners to facilitate connections with patients and ensure that everyone is getting the care they need.

Deschutes County’s Homeless Outreach Services Team works closely with Mosaic, often getting people connected to Street Medicine through its rapport and connections with those living unsheltered. In its process of identifying barriers for people, HOST also assists in making sure people have health insurance, assisting them with the Oregon Health Plan to help cover medical visits.

Many of the services for local houseless communities, Thomas with HOST said, are collaborative and include a variety of “warm hand-offs,” getting them connected with a variety of services like food, gas, mental health support or medical care.

In addition to working with the Deschutes County HOST team, Mosaic also works with the City of Bend, particularly in the Temporary Safe Stay Area, a managed encampment in the Juniper Ridge area.

According to Brooke O’Keefe, the City of Bend shelter coordinator, Mosaic fills an important gap in services that can help transition people out of homelessness and into long-term housing or shelter.
“Healthcare challenges can often be a barrier for people experiencing homelessness as they’re making their way out of homelessness. Having an agency that fills that gap is such a benefit.”

Continued growth
While just a year in, Mosaic aims to continue improving its street medicine program to serve more people across the region.

According to Knobbs-Seasholtz, the team is considering adding a behavioral health consultant in locations with high rates of untreated mental health disorders. They are also in the planning stages of developing a Street Psychiatry program with Deschutes County Behavioral Health.

“We see a great need to expand our team and sites for this program as the numbers of unhoused individuals and unmet healthcare needs continue to grow in Central Oregon,” said Knobbs-Seasholtz. “Our intent is to expand the street medicine program to meet regional needs; to do this we need funding support from the community.”

While the work continues to expand, Knobbs-Seasholtz noted that there are unique, inherent needs and complexities around providing this level of care for unsheltered individuals.

With ever-changing local and state policies, resulting in the displacement and movement among unhoused people and camps, as well as staffing constraints, challenges do arise when it comes to developing trust and sustaining regular engagement with the unhoused population.

“This is new territory for most healthcare providers, and we are learning as we go how to best develop an effective, system-based approach to help our street medicine team assist patients in a sustainable way,” said Knobbs-Seasholtz.