Harm Reduction Principles in a Street Medicine Program: A Qualitative Study

Jessica Frankeberger
Kelly Gagnon
Jim Withers
Mary Hawk
Peer-Reviewed Article
October 2022
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Interviews with street medicine program staff reveal common approaches to developing relationships with homeless patients that could be applied universally in clinical settings.


Street medicine is a growing medical field that provides street outreach to unsheltered individuals, offers medical and social services, and links them with traditional health care providers. Harm reduction is a set of practical strategies (e.g., syringe services programs) for alleviating the negative consequences of substance use, but also a relational approach rooted in humanism and non-judgement. This study explores if the principles of relational harm reduction are applicable to forming relationships with patients in the context of street medicine, where patients may or may not have substance use issues.


The study authors interviewed 11 staff members of a street medicine team in Allegheny County, Pennsylvania and found that relational harm reduction principles (e.g., individualism, humanism, nonjudgemental care) are applicable to their work. For example, many staff members practiced an individualist approach, prioritizing patients’ emotional and social needs before fulfilling broader medical goals. They also characterized their patients through a humanist perspective, focusing on their needs, gifts, and experiences rather than their social status. Staff members also avoided stigmatizing patients based on drug use, sex work, and other socially unacceptable behaviors by viewing patients within the broader context of their livelihoods.


The overlap found between relational harm reduction principles and the work of this street medicine team with homeless individuals suggests that the harm reduction principles have applicability in street medicine and potentially with more traditional providers. Accommodating the unique needs of vulnerable patients into care plans allows providers in any health care context to build long-term engagement and strengthen the health outcomes of these patients.

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