Julian Jones used to live in Aurora’s Del Mar Park, where he could see UCHealth University of Colorado Hospital a short distance away.
To blunt pain from chronic heart problems and to sleep through cold spells, he relied on alcohol.
“I was drinking and drinking and drinking. The only way to numb yourself is to drink a lot,” said Jones, 41.
Repeated trauma in childhood – alcohol addiction as an adult
Like many people living on the streets, Jones has suffered repeated trauma during his life. Research has linked what are known as “adverse childhood events” or ACEs with poor health decades into the future, exactly the kind of challenges Jones is experiencing now.
While Jones’ mom and step-dad were socializing and drinking with friends in the next room, Jones and his friends snuck alcohol and played games they called “Chug” and “Pass Out.” He was only 11 at the time.
“I grew up with substance abuse. My cousin, my mom, my uncle, my grandpa, my step-grandfather, they all died from alcohol,” Jones said.
In high school, he joined gangs and moved from school to school. He ran away from home for the first time at age 15. He has a great voice, loves singing and rapping and was a good athlete, who grew to 6 foot 4 inches tall. But he dislocated his knee as a teen and says he never saw a doctor.
The chaos of his early years led to more chaos as an adult. Until January, Jones had been homeless off and on for about 13 years. When his mother was alive, he was able to stay with her, but after she passed away, he began sleeping on friends’ couches or in parks.
Frequent ER visits
As his health worsened, Jones started showing up frequently in the ER at University of Colorado Hospital: 18 times between 2014 and 2015.
“It would be cold. My heart would be going crazy,” Jones said.
While Jones found a temporary break from the park at the hospital, he found little continuity of care since he rarely had the same doctors. The ER also is the most expensive place to receive care.
After multiple ER visits, a determined social worker named Autumn Kuehl stepped in. She worked with the UCHealth A.F. Williams Family Medicine Clinic in Denver’s Stapleton neighborhood and currently supervises a team of social workers at various locations throughout UCHealth locations in the Denver area. Kuehl wanted to offer Jones options.
For about a month she called and left him messages.
“Hi. This is Autumn. How about you come to our clinic?” she’d say.
Jones didn’t return her calls.
That didn’t stop Kuehl, who has spent years working with homeless people. She understands their challenges and has a passion for helping people like Jones who struggle with housing and other barriers.
“Our mission is to improve the lives of our patients, not to judge them or make assumptions. They are all human. If he was your brother or your father, how would you want him to be treated?” Kuehl said. “We focus on one thing at a time and on celebrating wins, no matter how small.”
Finally, about three years ago, Jones called her back.
“I got tired of no one caring,” he said.
In Kuehl, he found a kind expert with unlimited reservoirs of patience, who was dedicated to listening to him and empowering him to get his life and health on track.
First, Kuehl and Jones began with the simpler challenges, introducing Jones to a team of primary care doctors at A.F. Williams and getting transportation to his appointments. His team connected him with a cardiologist named Dr. Levy, who Jones came to trust and who could assess his heart problems. They confirmed a diagnosis he had received a decade earlier: atrial fibrillation, an irregular and rapid heart rate that can increase risk of stroke, heart failure and heart attacks.
Jones is coping with depression and has been self-medicating for years with alcohol. Alcohol, in turn, exacerbates his atrial fibrillation, so Jones is trying to cut down.
‘Cool to have primary care’
Growing up, Jones’ family rarely went to doctors, so he’s not accustomed to having a regular doctor, much less a team of providers. After Kuehl introduced him to A.F. Williams, he realized it was nice to have a clinic where everyone knew him and his medical history. In the medical world, outstanding primary care is known as a “patient-centered medical home.” The A.F. Williams’ team has worked hard to earn this designation.
One of Jones’ primary care providers is Dr. Emily Spencer, a family physician.
“In a patient-centered medical home, we care for the patient as a whole person,” she said.
Patients find a one-stop-shop where a team of experts focuses on their needs.
“We have extended hours, same day appointments to increase patient access and we can help with issues like transportation,” Spencer said. “A lot of people might take it for granted that they can get to doctors’ appointments.”
But, for Jones, money for the bus and his medical issues can be a big obstacle.
At A.F. Williams, Kuehl works hand-in-hand with the medical experts. While the providers tackle Jones’ medical issues, Kuehl works with him on his psychosocial issues that can have profound effects on his health: like homelessness, coping with addiction and depression.
Now that Jones knows and trusts his primary care team, he’s come around to reaching out for help at his clinic.
“It’s cool to have primary care,” he said. “I’m trying to get healthy.”
One of the biggest steps in that journey was getting housing.
Thanks to Kuehl, Jones applied for a housing lottery three years ago. Since he had been homeless for so long and was considered highly vulnerable, he won a spot and was able to move into an apartment at the newly constructed Saint Francis Apartments.
“You can stay out on the streets and feel like crap or you can try to do something about it,” Jones said.
Adjusting to life off the streets
Progress is gradual and a roof over Jones’ head doesn’t solve all of his problems. After being homeless for so long, Jones was used to hanging out every day with a community of fellow homeless people. He said many family members view him as “not worth saving.” So his friends essentially are his family.
His apartment is close to downtown Denver, far from Del Mar Park. While it’s a great place and he enjoys keeping it clean and stocked with nice furniture, it’s far from his friends in Aurora and transportation is a perpetual problem. So, he often feels isolated, which can worsen his depression.
“I’m stubborn. I don’t tell anybody when it gets bad,” Jones said.
Except one person.
“I will call Autumn.”
“I hold you accountable,” Kuehl responded. “You have this responsibility to follow through on your health care because you know I’m going to ask you about it”
Regardless of how much Jones slides back on his progress, Kuehl highlights his successes.
“You have been more engaged with your health care and your life,” she said, smiling at Jones. “Your progress over the past three years has been pretty amazing to see.”
He basks in the compliments.
“I’ve always been popular,” he says with perfect comic timing and a big grin.
In all seriousness, he trusts Kuehl. He introduces her as “my social worker, Autumn.” And he has thanked her for sticking with him.
She, in turn, highlights his resiliency.
“He just keeps going. Even after being homeless for so long, and even with all his health issues and family dynamics, he has goals,” she said.
Jones rarely goes to the ER now, generally takes his medications and calls his primary care team when he needs to come in.
“Our clinic has really embraced learning about the deeper causes of homelessness and how to handle his care,” Kuehl said.
Spencer, Jones’ doctor, salutes Kuehl for her work.
Kuehl has educated all of her peers about how to sensitively tend to Jones and other patients who may be in similar circumstances.
“It’s about meeting patients where they are at and going from there,” Kuehl said.
The doctors provide another layer of support.
“We try to be a stable presence for Julian and create an environment where he doesn’t feel judged and can always reach out and we’ll always be there for him,” Spencer said.
Jones has some complicated and challenging goals. He wants to rebuild his relationship with his two teen children. He would like to get his driver’s license and ultimately get a job. With his health condition, it has been challenging to work. He wants to be a better role model for his kids and has a powerful motivation to stop drinking.
“I’m going to beat this,” he said. “I really want to break the cycle in my family of people dying from alcohol.”