Primary care training and enhancement -- residency training in street medicine - homelessness is a social and economic public health crisis in new mexico (NM) and across the nation

In NM, homelessness has increased significantly in recent years. According to the 2024 point-in-time count report, the number of individuals experiencing unsheltered homelessness rose by 62% from 2023. Of those individuals, 48% of adults reported a serious mental illness, 42% reported a substance use disorder, and 38% listed access to services as a barrier to housing. In NM, limited access to services presents a greater challenge to receiving care than inadequate health insurance. In a survey of people experiencing homelessness across NM, 73% of people had health insurance. However, 58% of those individuals did not have access to healthcare services and 69% did not have a primary care provider. A severe physician shortage, high poverty levels, rurality and lack of transportation, substance use disorders, and mental health challenges further impede care. Studies show that adverse social determinants of health, such as those listed above, contribute to poorer health outcomes, including among individuals experiencing homelessness. Despite this, traditional medical education has focused largely on medical health factors and providing training in a clinical setting. To fill this GAP, the proposed project will increase the number of family medicine (FM) and internal medicine (IM) residents in NM trained in providing patient-centered, empathetic, and interprofessional care to people experiencing homelessness. For this we will establish a cross-residency street medicine training program at two residency sites. Building on current programs at each site, the project will be rooted in leveraging teamwork and enhancing understanding of community-specific social determinants of health. Using street medicine as a model for care greatly reduces disparities in access to healthcare by meeting individuals outside of a traditional clinical setting with increasing bridging to support services. The cross-residency street medicine training project will be established through a partnership between the FM and IM residency programs at the university of new mexico (UNM) in albuquerque, NM and the shiprock-university of new mexico (SUNM) FM residency program of the shiprock service unit of the indian health service (IHS) northern navajo medical center (NNMC) program on the navajo nation (diné bikéyah) in shiprock, NM. The proposed project will provide residents with curricula-based and hands-on training focused on 1) patient-centered, sensitive and quality care; 2) developing treatment plans that address patient needs regarding support for mental health and substance use disorders; 3) assisting patients with navigating systems related to their care including medical, behavioral health, legal, and social support; and 4) leveraging interprofessional teams to fill gaps in traditional primary care with a focus on social determinants of health that impact care and wellbeing. The outcome of this project will be to produce more physicians with competencies to work in complex, real world settings involving unhoused populations. The long-term impact of this street medicine project will be to improve the quality of care for NM communities with a focus on individuals experiencing homelessness. The proposed project qualifies for funding preference #1 based on a high rate of graduate placement in practice settings that focus on serving residents of medically underserved communities (MUCS). The UNM IM residency program had an 82% MUC placement rate in academic years 2022 to 2024. The proposed project qualifies for the funding priority for rural areas, including for tribes or tribal organizations. Our rotation site at NNMC, where half of our residents will be trained, is an IHS facility located on navajo nation land. NNMC serves native american patients, and the address for NNMC qualifies as rural using the rural health grants eligibility analyzer.