Primary Care Training and Enhancement -- Residency Training in Street Medicine - Need: Rates of homelessness in Portland have tripled since the pandemic. This surge includes significant increases in chronic and unsheltered homelessness, with veterans and survivors of domestic violence disproportionately affected. In 2024, the City helped 2,000 people find shelter, with an average of 600 people staying in Portland’s three shelters nightly. However, this growth has far exceeded the City’s response capacity. During this time, Maine saw a 187% increase in unsheltered individuals, from 95 to 273, living in tent cities across the area’s wooded areas, underpasses, and parks. The Preble Street Learning Collaborative (PSLC) patients typically face several challenges: 1) systemic barriers to outpatient care due to conditions that prevent them from seeking treatment; 2) “lost to follow-up” at critical transitions from emergency departments, detox centers, hospitals, or carceral settings; 3) excessive reliance on emergency departments and law enforcement/EMS for crisis intervention; 4) invisibility in formal systems of care, due to homelessness, substance use, or mental health conditions, and 5) difficulty accessing benefits or housing without assertive support. Approach: To achieve the goal of the PCTE-RTSM, we will implement the following strategies during the grant period: Targeted Curriculum for Primary Care Services to Homeless Populations: Family Medicine residents have 6 weeks of experiential learning at PSLC for individuals experiencing homelessness (IEH). This grant will allow us to develop curricula for specialized training, providing Street Medicine Trajectory (SMT) sessions and didactics through residents' scholarly activities. Training on Behavioral Health and Substance Use Disorders: Residents will be trained on prevention, diagnosis, treatment, and referral for behavioral health issues, focusing on substance use disorders and Medication for Opioid Use Disorder. They will see patients with substance use and mental health issues, collaborate with addiction specialists, and spend time at the local methadone clinic. Interprofessional Team Training for Chronic Conditions in Homeless Populations: Residents will work with Medical Outreach Case Managers at PSLC, who play a vital role in clinical care. They are trained in trauma-informed care, de-escalation, and cultural awareness. The team includes a PA, Psychiatric NP, and RN, and residents from other GME programs like emergency medicine, psychiatry, and addiction medicine will also engage at PSLC. Partnerships for Clinical Rotations to Serve Homeless Populations: PSLC’s strong community partnerships will expand through this grant, including organizations like Milestone, Greater Portland Health, and Pine Tree Legal. These relationships will establish clinical rotations focused on homeless healthcare, with at least two one-month rotations available. Education on Social Determinants of Health (SDoH): Residents will be educated on the causes, epidemiology, and treatment of health conditions faced by homeless populations, emphasizing stigma reduction. They will learn trauma-informed care, patient-first language, and harm reduction techniques, incorporating MaineHealth’s GME curriculum that models patient-centered, non-judgmental care. Training on Cultural and Linguistic Competency: Residents will undergo didactic training on topics like homelessness, immigrant health, Opioid Use Disorder, and more. They will also take part in advocacy training, DEI (Diversity, Equity, and Inclusion) sessions, and learn about language frameworks and addressing microaggressions. Legal Systems Training for Residents: Residents will complete a rotation with Pine Tree Legal Assistance, a nonprofit providing civil legal aid to low-income individuals. This training will help them understand the legal issues that affect healthcare, including housing, employment, and family law. Funding Priority: We are requesting a Funding Priority for Qualification 1: High MUC Placement.
