Primary Care Training and Enhancement -- Residency Training in Street Medicine - Funding Request: The applicant is requesting funding priority and funding preference as documented in Attachments 6 and 7. Project Overview: The UBPCTE-RTSM program will enhance primary care residency training by equipping family medicine residents with the knowledge and skills to provide high-quality, patient-centered care to individuals experiencing homelessness (PEH) in Erie and Cattaraugus Counties, NY. This initiative integrates street medicine principles into graduate medical education, addressing gaps in primary care, behavioral health, and chronic disease management for PEH in non-traditional settings, including encampments, shelters, and mobile outreach teams. Needs to be Addressed: Erie County has over 5,600 individuals experiencing homelessness annually, many with high rates of chronic disease, mental health conditions (65%), and substance use disorders (18.5%). Barriers such as transportation challenges, stigma, and lack of outreach services limit access to care. In rural Cattaraugus County, homelessness is increasing, yet there is little street-based medical care, psychiatric services, or harm reduction programming. Without a trained workforce, PEH remain underserved, leading to worsening health disparities. Proposed Services: The program will establish two required one-month Street Medicine rotations, one urban in Buffalo and one rural in Olean, providing residents hands-on experience in mobile and shelter-based healthcare. Residents will receive didactic and experiential training in chronic disease management, behavioral health, harm reduction, and trauma-informed care. The program includes interprofessional training with emergency medicine, addiction medicine, and legal services, in partnership with UB Emergency Medicine, the Erie County Department of Health, and the HOPE of Erie County program. Faculty supervision will be provided at a 1:3 preceptor-to-resident ratio to ensure high-quality learning. Target Population: This program will train residents to care for PEH in both urban and rural settings, including justice-involved individuals, older adults, those with co-occurring disorders, and those at risk of chronic disease complications. The program will serve Erie and Cattaraugus Counties, including the Buffalo Niagara Metropolitan Region and the Seneca Nation of Indians’ Cattaraugus Reservation. Expected Outcomes: The program will increase the number of primary care physicians trained to serve PEH and improve health outcomes for vulnerable populations. It will enhance interprofessional collaboration to address medical, behavioral health, and social needs while reducing emergency department overuse by improving access to preventive and chronic disease management services. By expanding Street Medicine training, this initiative will serve as a national model for integrating Street Medicine into primary care residency education.
