Of the approximately 150,000 people experiencing homelessness in California, 70% are living unsheltered, according to the Annual Homeless Assessment Report developed by the US Department of Housing and Urban Development. Living unsheltered adds to the already-existing health burden for people experiencing homelessness.

A study in JAMA Internal Medicine found the mortality rate of unsheltered adults was almost 3 times that of adults primarily sleeping in shelters and nearly 10 times that of the overall adult population, with common causes of death including cancer and heart disease. In addition, people experiencing street-based homelessness are hospitalized and readmitted at higher rates, and experience trauma and exposures at higher rates than sheltered people experiencing homelessness.

Street medicine, or street health, is the practice of bringing health care to people experiencing unsheltered homelessness. What began in the early 1990s, with the recognition that meeting unsheltered people where they are both reduces barriers to care and builds trust, has proven to be essential in meeting the needs — including mitigating the impact of COVID-19 — of some of the highest-risk people experiencing homelessness.

At least 25 street medicine teams operate in California. Street medicine, broadly defined, includes walking teams, medical vans, and outdoor clinics, with teams frequently extending to include outreach to shelters and other interim or permanent housing settings. Using tailored outreach and engagement strategies, street medicine programs can provide direct care outdoors to people who have not sought or do not want to seek care in traditional settings, or help link people to brick-and-mortar primary care sites and housing.

To help stimulate the spread and scale of these programs, it’s necessary to understand the characteristics of these programs and the policies and funding mechanisms that would help support and sustain them. CHCF is funding researchers at the USC Keck School of Medicine to produce a street medicine landscape report and resource guide.

The report will include a broad array of programs — from those offering clinically intensive programs and delivering full-scope services on the street to teams with a more limited focus on care coordination and referrals, mobile clinics (vans/trailers), and behavioral health teams.

Among the questions the report seeks to answer are these:

• Where are the street medicine programs in California located?
• Who do they serve and what do people served by these programs value?
• What models of care have been implemented and with what type of staffing?
• How are street medicine services funded?
• What is the breakdown of social versus clinical services?
• What are the key partnerships required for successful implementation?
• How are programs thinking about sustainability? What are the policy and payment opportunities required for spread and scale?

The project will include surveys and in-depth interviews with providers and other subject matter experts, and at least five site visits across California. In addition to the report, the grantee will seek to reach policymakers, providers, and managed care plans through webinars and policy briefings, videos, and other content in early 2023.