Provider Profile Vol. 5 | Dr. Andrea Littleton

Addressing the Whole Person

Dr. Littleton with a Patient

The streets outside the Care For the Homeless (CFH) Health Center (located at the Living Room/Safe Haven Shelter) rattle with a rhythm that should be familiar to most New Yorkers. Semi-trucks blow by, footsteps patter on the sidewalk, and the nearest park teems with laughing children. Across the street, a Dominican monastery stands as tall and proud as the day it was built in 1891, adding a touch of history to the area.

Conversely, the rhythm inside the halls of the shelter and health center are anything but familiar. Located in the Bronx, the Living Room/Safe Haven a is a 24-hour, open access drop-in site, meaning anyone experiencing street homelessness is welcome to come in and spend time off the streets. CFH site partner BronxWorks offers hot meals, showers, laundry, and housing services to compliment the medical services provided by CFH.

Despite the similarities it shares with other CFH sites, the Living Room holds many qualities that sets it apart from the rest.

Long time CFH provider and BronxWorks Medical Director, Dr. Andrea Littleton, commented, “In a lot of ways, it’s a shelter of last resort. For some who experience homelessness, one of the reasons they stay homeless is because of their mental health and/or their substance abuse issues. A lot of shelters have regulations that are difficult for people experiencing these conditions to conform to. So, when they can’t adapt to the regular shelter system, they come to the Living Room.”

Dr. Andrea Littleton has been associated with Care For the Homeless for the past 16 years. She originally became affiliated through Montefiore, where she completed her family residency program in social medicine. “Eventually I became the Medical Director for the CFH team serving Bronx sites,” Dr. Littleton recalled. “I spent time at each site, trained residents, and supervised their work. That’s how I met Dr. Nickisha Berlus, who just started at CFH last year.”

“I loved the work. Still love the work.”

In 2010, CFH’s contractual arrangement with Montefiore ended, but Dr. Littleton knew she wanted to stay on at CFH in some capacity. “When they asked me what I had in mind I said: I want to be at the Living Room. I want to be at a drop-in shelter. And I want to do street outreach. So, that’s what I’ve been doing since 2010.”

Throughout the nearly 10 years since, Dr. Littleton has not only fulfilled that goal, but made efforts to expand the reach of her programs. In conjunction with BronxWorks staff, Dr. Littleton and her colleague Luis Fernandez, CASAC-2 (Certified Alcohol and Substance Abuse Counselor) reach out to individuals experiencing street homelessness, engage with them, give them necessary medications, and ensure that they aren’t having any medical problems.

“The street outreach that we do is really exciting,” Dr. Littleton explained. “BronxWorks is the street outreach team for the Bronx, so they see people who are still living actively on the street. I go out with them every other week and target people that they believe have medical needs and would benefit from seeing a doctor.”

Street outreach also looks to understand an individual’s condition beyond their medical needs. This is known as social medicine, something Dr. Littleton is a passionate champion of. “It addresses the whole person,” she commented, “and how their culture, socioeconomic background, and political environment affects their health care and their ability to access it.”

“As a person of color myself,” Dr. Littleton continued. “I’ve always understood and felt how people (based on certain parts of their history) may be treated differently in our country. They might not have the same opportunities as others and that’s always bothered me. Something like health should be a right and the fact that it isn’t in a country like ours, one of the wealthiest in the world, is especially frustrating.”

“To be able to put a little dent in that inequality and give people access to good care, is something I’ve always wanted to use my education and skills for.”

Through the street outreach team at the Living Room, Dr. Littleton and her CFH colleagues have done just that. “We found that a lot of times, our clients that had left the shelter system and ended up back on the street, did so because of substance abuse and/or mental health issues,” Dr. Littleton commented. “If we engage with them and get them on treatment, then a lot of the time they’re willing to come back in, get a room, and start back on that path towards housing again.”

“We’ve also been providing Medication-Assisted Treatment (MAT) here for a couple of years and it’s been very successful,” Dr. Littleton continued. “Luis Fernandez, CASAC-2 and I now have a panel of over 50 people who are being treated with Suboxone. We’re so lucky that there’s good treatment now for people who use heroin and opioids.”

“With suboxone, patients feel like themselves,” said Dr. Littleton. “They don’t feel high or low, and they’re free to do what they need to get back on their feet. They can get their housing and their lives back.”

Victor S., a patient of Dr. Littleton’s, testified, “I get a lot more done now and I’m finally working towards things that I wanted to get done during my 25-years of addiction. I’m closer to my family. I’m closer to my lady. The program changed a lot for me.”

Moving forward, Dr. Littleton hopes to expand the current program as well as encourage current students to pursue social medicine as part of their studies.

“I think it’s really important for people in all different stages of medicine to be exposed to populations of people that could really benefit from their services,” she continued. “It’s a lot of work to address every aspect of a person, but it’s rewarding.”

Dr. Littleton’s devotion to social medicine is indicative of what makes CFH’s health care model so innovative. Health care and homelessness are always intertwined, each having a significant affect on the outcome of the other. Adherence to this philosophy communicates to those experiencing homelessness, that providers who are actively interested in treating both their medical and homeless conditions.

Please help us ensure we can retain and recruit inspiring medical professionals like Dr. Littleton and Luis Fernandez. Your gift of any amount can help change the lives of New Yorkers experiencing homelessness, thank you.

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By Connor T. Moriarty