Yale Street Medicine Training Track

People experiencing homelessness face a dramatically reduced life expectancy, often by decades. The causes are multifactorial and include unstable and inadequate living conditions, limited healthcare access, co-occurring mental health and substance use disorders, incarceration, and systemic barriers. Those without stable housing experience higher rates of chronic disease, infectious illnesses, and external injuries, making them one of the most medically vulnerable populations in the U.S. The number of people experiencing homelessness in Connecticut increased by 13% from 2023 to 2024. This growing crisis disproportionately affects individuals with serious mental illness, substance use disorders, and chronic disease, many of whom lack stable access to primary care. For these reasons, the Yale Primary Care (YPC) Internal Medicine Residency has created the Yale Street Medicine Training Program (YSMTP), supported by a Health Resource Services Administration (HRSA) grant. The YSMTP features a 3-year street medicine training track for select residents who will gain vital skills and hands-on experience in the care of persons experiencing homelessness (PEH) or more specifically, persons experiencing unsheltered homelessness (PEUH).

The training track features community partnered care at the core of the program which ensures development of key skills in providing trauma-informed, patient-centered care in non-traditional settings.

The primary experience is a 2-week clinical immersion during every year of residency, where residents will see patients with the Cornell Scott-Hill Health (CSHH) Street Medicine Team, which is based out of the Downtown Evening Soup Kitchen in New Haven. The multi-disciplinary team of physicians, APRNs, social workers, and case managers has been providing care at shelters, directly in the street, at outdoor encampments, at soup kitchens, and drop-in centers for over a decade on a consistent schedule. They see unsheltered patients all over the greater New Haven area delivering services such as essential primary care, addiction medicine, harm reduction, wound care, and infectious disease management. In addition, residents will also see patients at the Yale Transitions Clinic, a weekly clinic for individuals recently released from incarceration who are establishing a medical home.

After the residency intern year, track participants will join the West Haven VA Homeless Patient Aligned Care Team (HPACT)’s Mobile Medical Unit MMU during their 2-week ambulatory education blocks. HPACT goes out to serve unhoused veterans and additionally treats veterans at a standalone clinic attached to the West Haven Veterans Affairs Medical Center.

The Connecticut Mental Health Center Street Psychiatry program overlaps at least twice a week with the CSHH Street Medicine Team. During the yearly 2-week clinical immersions, track residents work with a team of psychiatrists, psychologists, social workers, and nurses who are focused on providing care to unhoused individuals who often suffer from mental illness.

Track residents will receive training via our Medical Legal Partnership with the Solomon Center for Health Law & Policy at Yale Law School. Both experiential and didactic experiences will focus on key topics that commonly affect unhoused populations, like patient rights, police misconduct, navigation of the housing system, public benefits, immigration law, and legislative advocacy.

1. Patient Care in Nontraditional Settings:
1. Recognize barriers to care, including access barriers and stigma.
2. Formulate treatment plans for acute and chronic conditions which are unique to, and exacerbated by, experiences of homelessness.
2. Medical Knowledge:
1. Describe common conditions which impact unsheltered patients and their evidence-based treatments, including but not limited to:
1. mental health conditions
2. substance use disorders
3. reproductive health
4. acute/chronic wounds
5. malnutrition
6. acute and chronic respiratory disease
7. infectious diseases (particularly dermatologic infections, HIV, hepatitides, and sexually transmitted infections)
8. physical disability
3. Interprofessional and Communication Skills:
1. Apply advanced communication skills to engage with patients in their lived environments, including the use of trauma-informed, non-stigmatizing communication and motivational interviewing.
4. Professionalism:
1. Describe the historic and modern ethical considerations in working with unsheltered patients
2. Apply a compassionate, respectful, and harm-reduction framed approach to working with patients and interdisciplinary team members.
5. Practice-based Learning and Improvement:
1. Apply evidence-based practices to unsheltered patients and practice person-centered care, including the incorporation of environmental and social factors.
2. Examine the influence of social and structural determinants of health upon their effectiveness
6. Systems-Based Practice:
1. Participate in an interdisciplinary street team and appraise resources available to patients within the health care system and between legal and social service systems.
2. Apply the skills of physician advocacy as it relates to improving the care of unsheltered persons beyond a case-by-case or individual level.

Training track residents are expected to complete scholarly research on topics related to the care of unhoused individuals during their time in residency. This can be in the form of quality improvement activities, educational research or clinical research. Mentorship will be provided and there is ample opportunity to present at local and national conferences. All training track residents will also be able to attend national conferences relating to care of the unhoused. These annual events are highly informative and a great opportunity to network with members of the Street Medicine Institute and the National Health Care for the Homeless Council. There are also regional conferences such as the Connecticut Coalition to End Homelessness’ Annual Symposium.