Primary Care Training and Enhancement -- Residency Training in Street Medicine - Applicant: McLennan County Medical Education and Research Foundation d/b/a Waco Family Medicine Address: 1600 Providence Drive, Waco, TX 76707-2261 Project Director: Ryan Laschober, MD Project Geographic Area: McLennan, Hill, & Bell Counties, TX Funding Requested: $2,471,335 Description. McLennan County Medical Education and Research Foundation dba Waco Family Medicine will develop a Street Medicine residency program to increase the number of physicians trained in a primary care specialty who are also prepared to provide care for people experiencing homelessness, by bringing care to people outside of traditional clinical settings. The Street Medicine team will employ a hybrid care delivery model, ensuring comprehensive, person-centered healthcare for individuals experiencing homelessness. This approach combines traditional street outreach (meeting patients where they live) and with a mobile medical unit strategically deployed at key organizations serving unhoused populations. By integrating these modalities, the team can provide both immediate, on-the-ground care in the street medicine tradition and more advanced medical services via the mobile unit. This model enhances accessibility, continuity, and the depth of care available, addressing both urgent and chronic health needs while reducing barriers to traditional healthcare access. Needs to be Addressed. The 2023 Waco-McLennan County CHNA includes addressing affordable housing and homelessness as 2 of the top 5 priorities for community improvements. People experiencing homelessness are affected by high rates of mental health issues, substance use disorders, co-occurring disorders, co-morbidities, and chronic health conditions. They also struggle to access care, with unmet health needs being as much as 10 times higher in the homeless population compared to the general population, which is partly due to low health literacy and barriers to access. The transient nature of homelessness and competing survival priorities further complicate the ability to access care and receive on-going treatment for chronic conditions. The program will be a tool for addressing the needs of unhoused individuals by training providers to fill the healthcare needs of persons experiencing homelessness, while being cognizant of barriers. Proposed Services. Twelve Post-Graduate Year 1 and twelve Post-Graduate Year 3 Residents will complete a 4-week community medicine rotation including experience in street medicine service, social drivers of health training, and engagement with community-based organizations. Services will include street medicine provided by Residents and staff team via traditional on-the-ground care and mobile unit. The mobile unit will be staffed by an interdisciplinary team and provide medical, behavioral health, and addiction medicine services. Clinical curricula and trainings will be enhanced to meet the needs of the program. Residents will also complete SBIRT and smoking cessation training, participate in training on medical-legal issues, conduct a community needs assessment, and participate in tours to enhance understanding of the needs/challenges for those living in poverty. Residents will receive training in the delivery of addiction medicine services, participate in community engagement, and a team-based care workshop to further develop their skills operating within the team dynamic. Residents will complete a 4-week clinical rotation in the evaluation and treatment of behavioral health disorders including SMI and SUD and will attend monthly behavioral health grand rounds. Populations Served. The program will train providers to address the needs of persons experiencing homelessness, with a focus on both backpack medicine as well as a mobile clinic. WFM provided services to 3,566 individuals who self-reported as homeless according to the 2023 UDS submission. Funding Preference. WFM is eligible for a Funding Preference under Qualification 1: High MUC placement rate: 95.8%.
