Understand Existing Street Medicine Models

Starting in 2022, a team of researchers at the Keck School of Medicine of the University of Southern California’s Division of Street Medicine conducted the first review of the current state of street medicine in California. The team identified 25 programs in California that met the definition of street medicine, as defined by the Street Medicine Institute. The researchers conducted a 41-question survey and interviews with select program leaders and other health care leaders. They also conducted site visits with diverse street medicine programs around California.

Their paper, The California Street Medicine Landscape Survey and Report, includes these key findings:

• The majority of the 25 programs identified are in Los Angeles County or the San Francisco Bay Area.
• Nearly half are part of a Federally Qualified Health Center. Other sponsors are hospitals, independent nonprofit organizations, government entities, academic institutions, and health plans.
• Street medicine is a critical access point for people of color, with 25% of patients identifying as Black and 23% identifying as Latino/x.
• Prescribers (physicians, physician assistants, and nurse practitioners) form the staffing backbone of nearly all street medicine teams in California. Teams also routinely include registered nurses, community health workers, and peers.
• More than two-thirds of street medicine programs diagnose and treat mental health conditions and substance use disorders, with 60% providing medication-assisted therapy. The majority provide primary care services.
• Nearly all street medicine patients are insured, with at least 57% having Medicaid and 14% having Medicaid and Medicare.

CHCF published State of Street Medicine in California (PDF), a summary of the landscape paper.

Street Medicine Video Site Visits

While the USC Street Medicine team was conducting the landscape survey described above, they were accompanied by videographer-storyteller Mark Horvath of Invisible People, a nonprofit group that educates the public about homelessness. Horvath created video site visits of street medicine programs in Bakersfield, Los Angeles, Oakland, and Redding.

While of broad interest, these videos may be of particular interest to clinicians or organizations interested in launching or expanding their street medicine programs. Viewers will learn about different models, engagement strategies, and street-based health care interventions.

In November 2022, California’s Department of Health Care Services issued detailed guidance (PDF) on how managed care health insurance plans could work with street medicine providers to address the clinical and nonclinical needs of Californians experiencing homelessness. The guidance clarifies how plans can contract with different types of street medicine teams and allow those teams to bill for providing care outside of a facility.

A CHCF issue brief, A Game Changer for Street Medicine: Key Takeaways from New Medi-Cal Guidelines, outlines the key takeaways from the department’s guidelines and describes several areas to watch as implementation unfolds.

An article published on The CHCF Blog, “Street Medicine in California: ‘Go to the People,’” features an interview with Brett Feldman.

For more information, please contact CHCF’s Michelle Schneidermann.