Primary Care Training and Enhancement -- Residency Training in Street Medicine - Valley Health Team, Inc., a Federally Qualified Health Center that has been serving the community since 1973, sponsors the 36-month VHT Family Medicine Residency Program (VHTFMRP). VHTFMRP is dedicated entirely to primary care with the aim of alleviating the shortage of primary care providers in the area by recruiting, training, and retaining diverse trainees who mirror the overall patient population, and ensuring they possess the skills essential for everyday full-scope primary care practice in areas of high need in underserved regions, exacerbated by high rates of homelessness, substance use disorders (SUD), and mental health conditions. VHTFRMP benefits from robust institutional support and resources. This longstanding partnership ensures a strong foundation for the program, allowing residents to gain invaluable experience in diverse healthcare settings while contributing to the mission of expanding access to quality care. Under this enhancement project, VHTFMRP proposes to implement a comprehensive Street Medicine curriculum aimed at training residents to provide care in non-traditional settings, including homeless encampments, shelters, and mobile clinics. Objectives: 1. Develop and implement a experiential and didactic Street Medicine curriculum, enhancing residents' competencies in treating chronic conditions, behavioral health disorders, and SUD among people experiencing homelessness. 2. Establish required clinical rotations in Street Medicine, including experiential learning opportunities in urban and rural settings, to expose residents to the realities of unsheltered populations thereby increasing residents’ knowledge and skills to meet the unique needs of people experiencing homelessness. 3. Increase residents’ knowledge and skills to work in patient-centered multidisciplinary teams by integrating interprofessional training, including behavioral health, addiction medicine, and medical-legal partnerships, to equip residents with skills to navigate the complex health and social needs of their patients. Step 1: Strengthen VHTFMRP’s existing Social Determinants of Health (SDoH) curriculum by integrating Street Medicine didactics, including trauma-informed care, harm reduction strategies, and de-escalation techniques. Faculty will undergo specialized training in Street Medicine to support this initiative. Step 2: Expand clinical training through mobile medical units, outreach programs, and partnerships with local shelters and harm reduction organizations. Residents will complete required rotations in both urban (Fresno) and rural (Dinuba, Firebaugh, San Joaquin) communities, providing direct care to homeless individuals. Step 3: Enhance interprofessional collaboration by embedding behavioral health specialists, social workers, and legal aid professionals into the residency framework. Residents will learn to address systemic barriers affecting patient care, including housing instability, substance use, and mental health crises. VHTFMRP is committed to training culturally competent physicians who will continue to serve vulnerable populations in the San Joaquin Valley. By integrating Street Medicine into residency training, this project will improve access to care for unhoused individuals while preparing future physicians to address complex health disparities in underserved communities. Medical residency specialty: Family Medicine. VHT meets funding preference Qualification 1: High MUC Placement Rate based on placing greater than fifty percent of graduates from our two most recent classes in practice settings that have the principal focus of serving medically underserved communities (MUC). VHT also meets the funding priority qualification based on its training of residents in Dinuba, San Joaquin and Firebaugh, all areas designated as Rural by the Rural Health Grants Analyzer.
