Headline
Analysis of street medicine programs reveals differences in behavioral health services across programs, highlighting key facilitators and challenges to better integration of these services within street medicine.
Context
Street medicine programs are increasingly used to bridge gaps in care for people experiencing unsheltered homelessness, offering patient-centered care that is often delivered wherever an individual may be living. These programs typically provide primary care, case management, behavioral health care, and referrals to address additional health and social needs. There is significant variation among street medicine programs in terms of their integration of more specialized forms of behavioral health care, including psychiatric and substance use disorder (SUD) care. This study documents this variation among street medicine programs in California.
Findings
The authors analyzed survey data collected from 25 organizations providing street medicine across California, along with supplemental interviews with program staff, to assess which behavioral health services were offered within these programs. Most organizations reported directly offering some forms of mental health and substance use disorder (SUD) diagnosis and treatment, with many also incorporating medications for addiction treatment (MAT). The importance of interdisciplinary care teams, including social workers, case managers, and community health workers, were identified as facilitators of effective care for patients with mental health needs or SUD.
Programs reported difficulty in referring patients to mental health and SUD treatment programs, citing challenges such as limited capacity of external providers and patient-related obstacles in keeping appointments as key barriers. Partnerships and programmatic integration with psychiatric and SUD providers were identified as important strategies to address these challenges.
Takeaways
These findings offer perspective on the range of approaches to integrating behavioral health services within street medicine, highlighting the flexible nature of these programs to adapt to community needs and available resources. The findings also highlight significant opportunity to improve behavioral health care for people experiencing unsheltered homelessness, through greater use of interdisciplinary care teams and partnerships with community based behavioral health providers.