Primary care training and enhancement -- residency training in street medicine - populations facing a housing crisis experience more behavioral and medical concerns leading to downstream effects and…

The Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professionals awarded Christiana Care Health Services Inc. $306,808 on July 1, 2026, under the Primary Care Training and Enhancement program (CFDA 93.884) to develop and implement a street medicine residency training curriculum.

The award funds the Christiana Care Family Medicine Residency Program (CCFMRP) to create a required curriculum preparing approximately 42 residents annually to deliver full-spectrum primary care to individuals experiencing homelessness. The curriculum incorporates didactic instruction from behavioral health specialists, cultural and linguistic competency experts, medical-legal aid professionals, and local housing alliance representatives. CCFMRP will expand experiential learning through clinical rotations at the New Castle County HOPE Center, a transitional living facility operated by Christiana Care that provides temporary housing, wrap-around social services, case management, and on-site medical services to the unhoused population in Delaware, including the state's first and only medical respite program. Residents will also participate in substance use disorder clinics providing full-spectrum primary care including medication-assisted treatment for opioid use disorders. The program includes development of a food access curriculum focusing on limited-resource populations, conducted in partnership with the Food Bank of Delaware and Christiana Care's Food Farmacy Community Garden. Residents will complete a photo-voice project capturing community disparities and the importance of cultural competencies and social justice.

Performance occurs in Wilmington, Delaware. The project period runs through June 30, 2031.

Primary care training and enhancement -- residency training in street medicine - populations facing a housing crisis experience more behavioral and medical concerns leading to downstream effects and costs to the healthcare system. We must create a workforce of well-trained primary care physicians prepared to treat this population and address their complex needs. Physicians who train in underserved areas often continue treating these demographics throughout their career, making the christianacare family medicine residency program (CCFMRP), the oldest and largest such residency in delaware, perfectly situated to confront this need. Implementation of a new, required curriculum will prepare 42 residents per year to provide full spectrum street medicine care by including didactic sessions from behavioral health specialists, cultural and linguistic competency experts, medical-legal aid experts, and local housing alliances. CCFMRP will expand experiential learning, develop a food access curriculum focusing on a population with limited resources, and work with the food bank of delaware and our christianacare food farmacy community garden. Residents will complete a photo-voice project to capture aspects of the community that illustrate disparities and the importance of cultural competencies and social justice. Residents will spend time at the new castle county hope center (hope center), a transitional living facility managed by christianacare, providing temporary housing, wrap-around social services, case management, and on-site medical services to the unhoused population in delaware. The hope center is home to the first and only medical respite program in the state and serves medically vulnerable patients experiencing homelessness that are stable to be discharged from local hospitals. The residents will also participate in our substance use disorder (SUD) clinics providing full spectrum primary care including treatment of SUD with medications for opioid use disorders. CCFMRP will increase the exposure and variety of activities including access to our mobile health unit where patients receive healthcare in nontraditional easily accessible settings. Service locations for our mobile unit will be determined through collaboration with community centers and local leaders, prioritizing healthcare, and social needs for marginalized populations. CCFMRP will develop street medicine teams to reach hotspot encampments identified by communities and local organizations. The program will create a longitudinal experience with friendship house, a local non-profit organization focused on housing insecurity, that will deepen learners' understanding of the challenges facing patients experiencing homelessness. Resident experience will be tailored to their level of training for additional responsibility throughout. Residents will be paired with a medical-legal expert providing services to address health harming social needs. They will learn the innerworkings of housing alliance agencies by spending time in empowerment centers where patients are connected to financial, social, and basic need services to promote wellbeing. Residents will travel with community health educators to patients to provide connection to crucial services and care. CCFMRP will amplify existing and develop new connections to our surrounding community including in our school-based health centers, community-based youth organizations, youth correction facilities, geriatric care centers and the state-run tuberculosis clinic. This project will help US allocate appropriate resources, access patients facing housing instability and connect them to our clinics while helping residents better understand the community they serve. By utilizing non-traditional healthcare settings and multidisciplinary teams, the residency will create a pathway for residents to demonstrate proficiency in caring for an underserved population facing a housing crisis. CCFMRP will create a workforce dedicated to their community in need and prepared to continue this work throughout their careers.