Primary Care Training and Enhancement -- Residency Training in Street Medicine - Purpose Homelessness in the U.S. has reached a record high, with over 770,000 people unhoused - an 18% increase from 2023. Connecticut mirrors this crisis, with over 3,400 people experiencing homelessness (PEH) in 2024. PEH face staggering health disparities, including high rates of chronic illness, substance use disorders, and mental health conditions. Street Medicine (SM), which delivers healthcare directly to PEH, improves outcomes but remains underrepresented in medical training. The Yale Primary Care Internal Medicine Residency Program (YPC) proposes expanding and formalizing its SM curriculum to equip residents with essential skills for caring for PEH. YPC is uniquely positioned for this work due to its strong foundation in social determinants of health (SDoH) and advocacy training, along with clinical training at Cornell Scott Hill Health Center (CSHHC), a federally qualified health center that operates an HRSA-funded street-based team. YPC residents currently rotate with this team through a well-established elective, serving 10 residents annually. This grant will expand resident participation, strengthen partnerships, and enhance training. Funding Preference & Priority YPC qualifies for a funding preference due to its high rate of graduates working in Medically Underserved Communities. It also requests the rural training funding priority, as its residents provide care in designated rural areas. Needs to Be Addressed Formal SM training is scarce, leaving physicians ill-prepared to care for PEH. Traditional healthcare settings often fail to engage unhoused individuals due to transportation barriers, mistrust, and complex co-morbidities. Without specialized training, physicians struggle to address acute needs and structural drivers of poor health. Population to Be Served The YPC SM training program will serve PEH in Greater New Haven, including those living unsheltered, in shelters, or in transitional housing. Proposed Activities and Services The initiative expands the current two-week SM elective into a longitudinal, multi-site training program spanning over two months across three years, including: - Six weeks of structured SM rotations (two-week rotations per year across PGY1-3) with the CSHHC SM team and Connecticut Mental Health Center's (CMHC) Street Psychiatry team. - Longitudinal primary care clinic sessions (24 sessions over 12 months) with the VA's Homeless Patient Aligned Care Team (H-PACT), training residents in housing-first models and interdisciplinary veteran care. - CSHHC SM experiences focused on chronic disease management, trauma-informed care, harm reduction, and healthcare barriers. - CMHC's Street Psychiatry training, ensuring competency in prevention, diagnosis, and treatment of behavioral health conditions in nontraditional settings. - Opioid use disorder training, including Medication for Opioid Use Disorder (MOUD) - Interprofessional street rounds with primary care providers, behavioral health clinicians, social workers, nurses, and medical assistants - Education on social and legal needs of PEH through the Solomon Center's Medical-Legal Partnerships (MLPs). Expected Outcomes 1. Enhanced physician training in SM 2. Improved competency in PEH care 3. Greater behavioral health integration 4. Robust data collection & evaluation This project will expand healthcare access for PEH by leveraging faculty expertise, existing SM infrastructure, and strong institutional partnerships.
