Primary Care Training and Enhancement -- Residency Training in Street Medicine - Chronic homelessness has increased by 64% in Ohio from 2020 to 2023. Longer episodes of homelessness increase conditions such as serious mental illness, substance use disorder, and physical disabilities. According to the Substance Abuse and Mental Health and Services Administration (SAMHSA), 21% of individuals experiencing homelessness reported having a serious mental illness, and 16% reported having a substance use disorder. The MetroHealth System (MHS) has long partnered with homeless service providers to help coordinate care along the housing continuum: unhoused, shelter-based, and permanent supportive housing. The Homeless Outreach Program brings primary care services onsite to community organizations to assist with addressing the ongoing basic and clinical needs of the unhoused. We are applying for a funding preference with the overarching goal of this project is to increase the primary care workforce to meet the needs of the unhoused in Ohio by training residents to provide care in nontraditional settings. We will expand our current program by training more residents and increasing the hours and scope of dedicated street medicine training. This proposal focuses on training residents to address the unique challenges of street medicine through four specific goals. First, enhance care for the unhoused by equipping residents with culturally sensitive and economically appropriate approaches to reduce health disparities with applied learning in Quality Improvement (QI) methods and processes. Second, improve the residents’ knowledge and skills in medication-assisted treatment (MAT) and mental health care. Third, strengthen community partnerships by collaborating with existing organizations, such as Northeast Ohio Coalition for Homelessness (NEOCH), and building new relationships to improve individual/community health. Finally, promote interprofessional collaboration by enabling residents to apply their training in teams to deliver patient-centered care. Methods: To address residents' training needs, we will expand our existing family medicine community and behavioral health curriculum to include hands-on learning in nontraditional care settings precepted by experienced attendings. Within the initial three months of year 1, we will collaborate with other MHS primary care residency programs and community partners to identify training priorities and opportunities to augment our current training. The augmented program will include didactic and experiential training on the management of chronic health problems experienced by unhoused individuals, SUD, MAT, mental health disorders, health disparities, social drivers of health, legal issues specific to homeless individuals, methods of continuous improvement, and other topics identified by system leaders and learners. Once these priorities and opportunities are identified, we will use participatory codesign methods to augment and enhance the existing program to meet the needs of our training programs and patient population. By month 4 in year 1, the curriculum will be implemented with rapid PDSA cycles to address learners' and preceptors' needs and resolve barriers. Residents will complete training and a QI project in street medicine designed to improve the care of unhoused individuals. They will gain proficiency in using mobile clinics and portable equipment, participate in a community health event, and present outcomes at a Learning Collaborative. Evaluation: Program evaluation will include tracking program completers and annually reporting the proportion of individuals within each social need category who were connected to resources and successfully completed social care referrals to partner agencies. Training and content delivery will be evaluated using pre/post learner assessments developed by content leaders, which may include knowledge, attitude/motivation assessments, and simulations. Results will be disseminated regionally and nationally through conferences.
