The UNC Department of Family Medicine has been awarded a Primary Care Training Enhancement grant for Residency Training in Street Medicine (PCTE-RTSM) from the U.S. Health Services and Resources Administration (HRSA). This initiative aims to increase the number of primary care physicians equipped to care for individuals experiencing homelessness in non-traditional clinical settings.
The program will launch an innovative curriculum that includes Critical Time Intervention (CTI) training—a time-limited, evidence-based model designed to support vulnerable individuals during periods of transition, such as moving from homelessness to stable housing. CTI emphasizes building trust, connecting clients to community resources, and gradually transferring care responsibilities to long-term support systems. The model has been shown to improve housing stability and reduce recurrent homelessness, particularly among individuals with serious mental illness and those exiting institutional settings [1].
Residents will engage in experiential learning with community homeless service agencies, local governments, and safety net providers in Orange, Lee, and Wake Counties – regions facing growing housing insecurity. Wake County reports an affordable housing deficit of over 65,000 units, with more than 900 individuals experiencing homelessness on any given night and a projected shortage of over 110,000 homes by 2029 [2]. In Orange County, cost-burdened households remain a significant concern, and recent weather events such as Tropical Storm Chantal have led to emergency housing responses for displaced families [3]. Lee County faces similar challenges, including limited affordable rental options and rising eviction rates, which contribute to regional housing instability [4].
The project is led by Timothy Daaleman, DO, MPH, Professor of Family Medicine and part of the Orange County Partnership to End Homelessness leadership team, the region’s Continuum of Care. He is joined by collaborators Marni Holder, MSN, RN, and Tim Smith, MPA, who bring substantial experience in community and patient engagement focused on improving access to care. Together, they will guide the development and implementation of the curriculum and foster partnerships with local organizations.
“This grant comes at a critical time,” said Dr. Daaleman. “North Carolina is continuing to see an increase in the number of persons experiencing homelessness. Primary care physicians will need a foundational understanding of the social factors and community-level supports that impact health and health care. Training to function effectively in interdisciplinary teams is essential to respond to the needs of this vulnerable population.”
This grant marks the fourth HRSA PCTE award received by UNC Family Medicine, with previous grants focused on behavioral health integration and improving language and disability access.
The new curriculum will be integrated into the UNC Family Medicine Residency Program, which is consistently ranked among the top programs in the nation. The residency offers full-scope training in inpatient and outpatient care, family-centered perinatal care, behavioral health, geriatrics, sports medicine, and community-based practice. Residents train in diverse settings – from UNC Hospitals to rural clinics and community health centers – and are supported by over 70 faculty members committed to mentorship and innovation [5].
Citations:
- Center for the Advancement of CTI. “Critical Time Intervention Overview.” https://www.criticaltime.org/cti-model/
- Wake County Government. “Housing Affordability and Homelessness.” https://www.wakegov.com/news/housing-affordability-and-homelessness
- Orange County Government. “Tropical Storm Chantal Housing Displacement Report.” https://www.orangecountync.gov/DocumentCenter/View/25645/Tropical-Storm-Chantal-Housing-Displacement-Repor
- Lee County Government. “Housing Needs Assessment.” https://www.leecountync.gov/Departments/Housing/Housing-Needs-Assessment
- UNC School of Medicine. “Family Medicine Residency Program.” https://www.med.unc.edu/fammed/education/residency/