Healthcare outcomes for unsheltered persons experiencing homelessness using a street medicine model of care: a pilot program evaluation

Abstract

AbstractUnsheltered homelessness is associated with a myriad of barriers including unmet medical, mental health, physical, and social needs. This study evaluated a Street Medicine approach to examine and reduce the complex barriers to care by providing coordinated mobile services. Participants were urban adults with mental health, substance use, or co-occurring issues who were experiencing unsheltered homelessness. Services provided were integrated, person-centered, and trauma-informed based on participants’ needs. The range of offered services included psychiatric and medical care, case management, housing support, mental health, and substance abuse treatment, as well as a variety of supportive services. Structured baseline interviews (N = 295) and 6-month follow-ups (N = 118) were conducted, and a range of outcomes were examined including quality of life, behavioral and physical health indicators, substance use, and recovery domains. Using a bivariate analysis approach, promising results were seen at follow-up including improved quality of life, reduced PTSD symptom severity, reduced substance use, and reduced risk behavior. Several significant interactions were also discovered including the impact of housing status on quality of life and recovery. Race and gender differences were examined and improvement across outcomes differed by race/ethnicity. The results suggest that mobile services targeting unsheltered persons are viable options towards improved health, health equity, and quality of life. Further research should continue to evaluate interventions and ways to reduce stigma, discrimination, and barriers to treatment for unsheltered persons experiencing homelessness.

Keywords

• Unsheltered homeless
• street medicine
• program evaluation
• mental health
• integrated care
• bivariate analysis