Primary Care Training and Enhancement -- Residency Training in Street Medicine - The state of California has the largest homeless population in the country with over 180,000 people experiencing homelessness (PEH) in January 2023. According to the January 2024 Point-in-Time count, more than 6,600 homeless individuals were in Sacramento County alone, of which nearly 4,000 were unsheltered. The size of healthcare workforce serving this population pales in comparison. Current residency training programs at UC Davis (UCD) include limited exposure to mobile medicine; however, it insufficiently addresses the unique training needs for street medicine, and the demand for services in the greater Sacramento area. In a recent survey of UCD Family Medicine residents, 75% reported feeling less comfortable caring for PEH than for housed patients yet expressed broad interest in improving their competency in care for PEH. To address this shortfall, the Family Medicine Department at the UC Davis School of Medicine proposes a new primary care residency training program in Street Medicine to be known as Structured Training for Residents in Effective and Evidence-Based Treatment on the Street (STREETS). STREETS will expand resident training by developing a new longitudinal didactic curriculum, increasing street medicine training within addiction and behavioral health clinical rotations, and creating new clinical rotations focused on care for PEH. STREETS will incorporate inpatient and outpatient considerations, outreach skills and exposure to legal and social service navigation services critical to the survival and wellbeing of PEH. The team has expertise in street medicine, addiction medicine, psychiatry, and in structural competency curriculum development which prepares them to build a transformative curriculum. Existing partnerships with three local federally qualified health centers (FQHCs) with mobile or street medicine arms will allow expansion of clinical rotations with increased mobile medicine services to PEH. A street medicine consult service at UCD, currently in development, will work closely with community health workers to develop discharge plans for street-based follow-up. Residents rotating on this consult service will gain skills in health systems navigation and adapting disease management to the individual context of the patient living outside. STREETS will develop an additional elective for residents seeking training in rural street medicine in Ukiah, CA to complement the urban training opportunities in Sacramento. The proposed suite of training programs will enhance residents’ skills in tailoring clinical decision-making to a street context and providing interdisciplinary team-based care. STREETS’ objectives align directly with the Primary Care Training and Enhancement – Residency Training in Street Medicine program and will be operationalized through the following: 1. A new didactic curriculum, including (a) a case-based seminar series for clinical and social considerations in the interdisciplinary care of PEH (b) hands-on workshops in outreach skills, de-escalation, wound care and harm reduction in substance use, and (c) invited lectures by case managers and local legal aid organizations addressing healthcare and housing needs of PEH. 2. New and enhanced clinical rotations, including (a) emphasis on special considerations for PEH in existing core addiction medicine and behavioral health rotations, (b) two urban street medicine-focused rotations with core experiences on interdisciplinary Street Medicine teams with FQHC partners and (c) a rural rotation in Ukiah, CA. STREETS will dramatically increase resident knowledge, skills and competency in caring for PEH. In addition to curricular improvement, debriefing processes in the face of moral injury will promote sustainable practice for our trainees that will extend long past the funding period. The model will be disseminated through networks such as the Street Medicine Institute and publications such as MedEdPortal, furthering the reach of its impact.
