Federal Grant Supports OU Training Program Advancing Care for People Experiencing Homelessness

The University of Oklahoma has embarked on a transformative initiative to address the complex healthcare needs of unhoused populations through the establishment of the Street Medicine and Advocacy Pathway at its College of Medicine. This innovative program, backed by a substantial five-year, $1 million federal grant from the Health Resources and Services Administration (HRSA), is designed to equip medical residents with the skills, knowledge, and empathy required to deliver comprehensive, patient-centered care to individuals grappling with homelessness, chronic illness, and co-occurring behavioral health conditions.

Homelessness presents a multifaceted challenge that intertwines chronic physical illnesses, mental health disorders, and substance use, creating significant obstacles to effective healthcare delivery. Recognizing these intricate dynamics, the University of Oklahoma’s initiative targets internal medicine and family medicine residents who opt into the pathway, immersing them in both clinical and community settings to foster a holistic understanding of patients’ experiences. The program emphasizes not only disease management but also the social determinants of health, including housing instability, food insecurity, and access to social services, which are critical factors shaping health outcomes among this vulnerable demographic.

Central to the training is the immersive eight-week rotation, which balances time between the federally qualified Healing Hands Health Care Services clinic in Oklahoma City and various community organizations such as food banks, homeless shelters, and social service agencies. This dual exposure provides residents with invaluable firsthand experience, enabling them to appreciate the real-world barriers their patients face beyond the medical realm. Such practical engagement facilitates the development of advocacy skills, empowering physicians to navigate complex systems and forge meaningful partnerships that enhance continuity of care outside traditional clinical settings.

The pathway is among only 24 primary care residency programs nationwide to receive HRSA funding, underscoring its significance and pioneering role in medical education. Dr. Brian Lich, an associate professor of internal medicine and lead on the grant, articulates the critical need for this initiative, highlighting the disproportionate health disparities faced by unhoused populations and the imperative for healthcare providers to adopt more integrated, compassionate care models that transcend conventional clinical boundaries.

A notable aspect of the program is its focus on cultivating physician advocates who can address social challenges with practical solutions. Dr. Mary Gowin, associate professor and co-leader of the grant, emphasizes that physicians must move beyond passive resource referral to actively engage in connecting patients to community services, thereby enhancing treatment adherence and health outcomes. This advocacy approach is rooted in the recognition that medical diagnoses must be contextualized within patients’ lived environments, especially when those environments are profoundly unstable.

The epidemiological context lent urgency to this initiative. According to the 2024 Point-in-Time Survey for the Oklahoma City metropolitan area, nearly 1,838 individuals are experiencing homelessness, with significant portions living with severe mental illness, substance use disorders, or chronic medical conditions such as HIV/AIDS. Vulnerable subpopulations—including veterans, minors, unaccompanied youth, and those with disabling conditions—face compounded risks, necessitating targeted interventions that address both health and social needs.

Physicians involved in the Street Medicine and Advocacy Pathway are trained to confront the paradox of treating acute medical conditions in the absence of stable social support. Dr. Lich provides a clinical illustration: patients with diabetic foot ulcers requiring extended intravenous antibiotic therapy may face insurmountable barriers without access to housing or transportation. This stark reality challenges the traditional paradigms of care delivery and calls for integrated strategies that encompass medical and social frameworks.

Prior to this grant, residents already engaged with community clinics and underwent advocacy rotations, but the new funding formalizes and significantly expands this training, providing structured time and resources dedicated to understanding and addressing homelessness as a public health crisis. Additionally, the creation of the Oklahoma Street Medicine Network facilitates collaboration among healthcare providers, social service agencies, and community stakeholders, fostering a shared vision for systemic improvements and coordinated responses.

The program aligns with broader trends in medical education promoting experiential learning and social accountability, preparing future physicians to address health inequities through an interdisciplinary lens. By bridging clinical medicine with community advocacy, the initiative exemplifies an emerging standard of care that acknowledges the inseparability of social determinants and health outcomes.

Ultimately, the University of Oklahoma’s Street Medicine and Advocacy Pathway represents a timely and impactful response to one of society’s most entrenched health disparities. Through this program, medical residents gain the expertise and perspective necessary to enact meaningful change, positioning them as catalysts for advancing health equity and improving the lives of those living on the margins.