Primary care training and enhancement -- residency training in street medicine - homelessness is a growing crisis in rural appalachia, exacerbated by economic decline, geographic isolation, and…

The Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professionals awarded West Virginia University $498,605 under the Primary Care Training and Enhancement program (CFDA 93.884) on July 1, 2026, to establish residency training in street medicine for people experiencing homelessness in rural Appalachia.

The project, titled "Inspire to Empower," expands street medicine education by establishing a required four-week rotation for PGY2 and PGY3 residents and a dedicated community and street medicine track offering longitudinal education in chronic disease management, harm reduction, behavioral health, and advocacy. The award funds integration of social workers, legal professionals, peer recovery specialists, and other healthcare professionals into resident training. West Virginia University will develop a centralized referral and call system to improve care coordination and access to medical, behavioral health, and social services, and will create sustainable partnerships with shelters, outreach teams, and harm reduction programs to increase training in non-traditional care settings.

The project addresses a documented crisis: West Virginia has experienced a 24 percent increase in homelessness since 2021, with the 2023 point-in-time count identifying more than 1,400 individuals, though estimates suggest the true number exceeds 3,600 annually. The state leads the nation in opioid overdose deaths at 80.9 per 100,000 people. Individuals experiencing homelessness in rural areas face heightened risks of chronic disease, mental illness, substance use disorders, and infectious diseases, compounded by transportation barriers, distrust of healthcare institutions, and lack of shelters and support services.

The award period runs through June 30, 2031, with place of performance in West Virginia.

Primary care training and enhancement -- residency training in street medicine - homelessness is a growing crisis in rural appalachia, exacerbated by economic decline, geographic isolation, and limited healthcare access. West virginia (WV) has seen a 24% increase in homelessness since 2021, with more than 1,400 individuals identified in the 2023 point-in-time count-though estimates suggest the true number exceeds 3,600 annually. Individuals experiencing homelessness in rural areas face higher risks of chronic disease, mental illness, substance use disorders (SUDS), and infectious diseases, compounded by barriers such as transportation challenges, distrust of healthcare institutions, and lack of shelters and support services. WV also leads the nation in opioid overdose deaths (80.9 per 100,000 people), underscoring the urgent need for integrated behavioral and medical healthcare solutions. Despite these needs, formalized training in street medicine remains scarce, particularly in rural settings. Inspire to empower will train primary care residents to provide high-quality, trauma-informed care for people experiencing homelessness by expanding street medicine education, clinical rotations, and interdisciplinary collaboration. This project will: · expand rural street medicine training by establishing a required 4-week rotation for PGY2 and PGY3 residents and a dedicated community & street medicine track offering longitudinal education in chronic disease management, harm reduction, behavioral health, and advocacy. · enhance interdisciplinary collaboration, integrating social workers, legal professionals, peer recovery specialists, and other healthcare professionals into training. · develop a centralized referral and call system to improve care coordination and access to medical, behavioral health, and social services. · create sustainable partnerships with shelters, outreach teams, and harm reduction programs to increase training in non-traditional care settings (e.g., encampments, mobile clinics). · track resident outcomes, including post-graduate employment in underserved areas and engagement in street medicine initiatives. Through these initiatives, inspire to empower will increase the number of physicians trained in street medicine, enhance residents' clinical competency in treating vulnerable populations, and expand healthcare access for individuals experiencing homelessness in rural appalachia. The project will be rigorously evaluated through resident surveys, faculty feedback, community partnership assessments, and patient care tracking, ensuring measurable improvements in training outcomes and healthcare delivery. This program will establish a sustainable, structured rural street medicine training program, preparing future physicians to provide high-quality care outside traditional clinical settings, improve health outcomes for vulnerable populations, and foster long-term community collaborations to address the needs of people experiencing homelessness in appalachia.