Street Medicine Resource Guide

Street Medicine Resource Guide

Introduction

Street Medicine is a mobile healthcare approach delivering comprehensive medical, behavioral, and social services directly to people experiencing unsheltered homelessness.

The intent of Street Medicine is to bring services to individuals experiencing unsheltered homelessness in the “streets” using a multidisciplinary team to reduce barriers to care and to provide direct access to patients. Street Medicine teams often consist of licensed medical professionals (doctors, advanced practice nurses, physician assistants, registered nurses), social workers, case managers, community health workers, and peer support specialists. These teams, on occasion, travel to encampment areas or have a fixed schedule and location for the delivery of primary and acute care, wound care, chronic disease management, substance use disorder treatment, certain medication management, and social support services like food and housing assistance.

Street Medicine is not considered to be adequate primary care by itself, rather it is best viewed as an intermediate form of “home care”. Because of the inherently complicated conditions of delivering services in a street environment, Street Medicine lends itself to offering high-level clinical interventions and should not serve as permanent intensive primary clinical care. When services are provided by a street team, efforts should always be made at every encounter to refer patients to primary care services and any necessary follow-up services.

The purpose of this document is to establish guidelines, clinical best-practices, information on services, trauma-informed care, and community resources for Street Medicine services in the state of Utah.

Regulations

House Bill 339, Street Medicine Amendments (2026) defines Street Medicine as, “health care that is provided by a licensed health care provider, who conducts patient visits outside of a health care facility, clinic, or shelter to an individual experiencing unsheltered homelessness”. This bill further defines unsheltered homelessness as, “an individual not having a long-term or permanent structure which to live” and “may include sleeping in a vehicle, abandoned building, farm, wilderness, street, park, or encampment” (Utah Code § 26B-4-328).

While House Bill 339 (2026) expands the reach of healthcare delivery by formally defining and validating "street medicine" within the state of Utah, it does not create a separate class of licensure or provider type, nor does it waive, relax, or alter any professional regulations established under Utah Code Title 58 (Occupations and Professions). Delivering healthcare outside a traditional brick-and-mortar facility to individuals experiencing unsheltered homelessness is a shift in place of service, not a shift in scope of practice. Every practitioner operating on a Street Medicine team remains strictly bound by the distinct licensing acts, supervisory agreements, and delegation rules governing their respective professions. Engaging in clinical tasks, assessments, or the dispensing of medications outside one's legally defined scope of practice remains a violation of state law, regardless of the field setting.

Clinical Guidelines

Providing high-quality Street Medicine services requires highly specialized and organized clinical guidelines and programming. Meaning, the Street Medicine team must function in a manner that provides evidence-based and trauma-informed care under many circumstances and in many different environments. Teams must make considerations for all environmental elements in which they provide treatment to individuals experiencing homelessness including the individual’s ability to access medications or follow-up care, their ability to care for self, and their right to receive or refuse care.

  • Treatment Site: While many Street Medicine teams may travel to or visit encampments to offer services, it is recommended by the Street Medicine Institute that providers maintain a consistent and predictable schedule for the individuals they are serving. When approaching an encampment, the team should announce themselves loudly and respectfully, as well as their purpose prior to rendering any services. Providers should never enter a person’s shelter or encampment without permission. Teams are advised to maintain a consistent location and time each week to build rapport and establish trust, while maintaining consistency with individuals wishing to receive services. This may include pre-outreach efforts to notify members of the community of the team schedule as well as notifying the individuals receiving services.
  • Safety and Security Considerations: When providing services in unsheltered environments, all teams must prioritize the safety and security of both the practitioners and the individuals experiencing homelessness. To mitigate the risks of delivering care in non-traditional settings, Street Medicine operations must adhere to a "two-person minimum" rule; under no circumstances should a provider engage in street outreach or clinical care alone. Working in pairs or larger multidisciplinary teams ensures continuous situational awareness, where one team member can focus entirely on the surroundings while the other provides clinical care. Programs must establish explicit, formalized protocols for verbal de-escalation, immediate field evacuation, and medical or behavioral emergencies.
  • Referrals: When referring individuals to specialized or follow-up medical care, Street Medicine providers must proactively identify and make efforts to decrease systemic barriers unhoused individuals face. Providers should collaboratively navigate these challenges with the individual by providing clear education on transportation options, precise clinic locations, and pre-appointment expectations (e.g., fasting, laboratory requirements, or registration processes). Furthermore, referrals must be approached through a strict trauma-informed lens; many unhoused individuals have experienced systemic neglect or medical trauma within traditional healthcare institutions, requiring deliberate trust-building and advocacy to ensure successful continuity of care.

Services

Street Medicine teams act as a mobile care clinic and social services unit offering acute and chronic disease management (treatment and management of hypertension, diabetes, frostbite and wound care treatment). While Street Medicine teams offer a range of care and interventions, the primary focus of any Street Medicine team should include referring the individuals to a brick-and-mortar facility or hospital for follow-up services. This referral is essential to the treatment of individuals experiencing homelessness as it builds upon the continuity of care models that are vital for the individual to continue accessing resources within their community.

Common behavioral health services include diagnostic services, case management, peer support, crisis management, brief therapeutic interventions or counseling services, distribution of psychiatric medications when medically necessary and appropriate, and substance use disorder treatment including Medication Assisted Treatment (MAT) services.

Medicaid Covered Services and Eligibility Verification

When enrolled Utah Medicaid providers administer Street Medicine services to a verified Medicaid member, they may bill for the covered services. When billing for services, all providers must adhere to all rules and regulations for Medicaid providers, including the verification of eligibility.

To verify eligibility, providers may use the Patient Eligibility Verification Lookup Tool on the Utah Medicaid website. Eligibility may also be verified via the Provider Reimbursement Information System for Medicaid (PRISM) portal. Providers must adhere to all rules and regulations set forth in the Section 1: General Information provider manual and must also adhere to all policies for members enrolled with Managed Care Entities.

Information on covered Medicaid services may be found in applicable service manuals and through using the Utah Medicaid Coverage and Reimbursement Lookup Tool. When providing services in the street environment, providers must include the appropriate Place of Service code on the submitted claim.

Administration and Management of Long-Acting Injectables

HB 339 permits providers to dispense and administer Long-Acting Injectable (LAI) medications on the street. These medications may be used in the treatment of psychosis, or the treatment of substance use disorders. Providers prescribing and administering these medications must adhere to Title 58-88-202 Dispensing Practice.

Street Medicine teams must utilize the following scope-of-practice matrix to design their staffing models, establish clear clinical hierarchies, and ensure that field care is within their respective scope of practice.

Professional Role

Allowed Field Practices (Under Title 58)

Field Restrictions / Requiring Supervision

HB 339 Specific Authority

MD / DO

Full independent diagnosis, prescribing, wound care, and psychiatric evaluation.

None (within standard specialty competency).

Full authority to dispense/administer LAIs on-site.

Physician Assistant

Full dispensing authority at a licensed dispensing practice within their specialty scope.

Allowed to dispense, transport, and administer LAIs to street medicine patients.

Full authority to dispense/administer LAIs on-site.

Advanced Practice Registered Nurse

Independent practice (or per collaborative agreement if applicable); diagnosis, prescribing.

Bound by standard Utah prescriptive limitations for controlled substances.

Full authority to dispense/administer LAIs on-site.

Registered Nurse (RN)

Field triage, wound care management, patient education, executing ordered care plans.

Cannot independently diagnose or prescribe; requires a provider's order for Rx administration.

Can administer LAIs under a valid order from an MD/DO/APRN/PA.

LCSW / CMHC

Crisis de-escalation, psychiatric diagnostic assessments, therapy, coordinate HMIS intakes.

Cannot prescribe or perform physical medical interventions.

Care coordination for behavioral health LAI follow-ups.

 

Trauma Informed Care

The United States Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as the following: “Individual trauma results from an event, series of events, or set circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effect on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being”.

“SAMHSA further describes six key principles of a trauma-informed approach when delivering services within the homeless system:

  1. Safety: People experiencing homelessness and program staff should feel physically and psychologically safe. Physical settings and interpersonal interactions should promote a sense of safety for every child, young person, family, Veteran, person living with a disability, or individual adult experiencing homelessness.
  2. Trustworthiness and Transparency: Homelessness service systems and programs should operate and make decisions in ways that are transparent to everyone, building and maintaining trust with people experiencing homelessness, staff, and other stakeholders.
  3. Peer Support: Peers are integral to establishing and maintaining safety and hope, building trust, enhancing collaboration, and using their lived expertise to help others with housing stability and other goals, like recovery and healing.
  4. Collaboration and Mutuality: Value is placed on relationship, partnership, and leveling power differences between staff and consumers to promote shared power and decision-making across the program. There is recognition that everyone has a role to play in advancing trauma-informed approaches.
  5. Empowerment, Voice, and Choice: The homelessness service system, and organizations within it, foster a belief in people’s resilience and the ability of individuals and communities to heal from trauma. People’s strengths and experiences are recognized, honored, and built upon. Consumers are supported in shared decision-making, choice, and goal-setting to determine their own housing and service needs.
  6. Cultural, Historical, and Gender Issues: Homelessness services systems and programs actively identify and address inequities and biases caused or perpetuated by their service delivery models. They promote access to culturally and gender-responsive services, leverage the healing values of traditional cultural connections, adapt programs, policies, and procedures to the racial, ethnic, and cultural needs of consumers, and recognize and address the impacts of historical trauma.”

Street Medicine services must fundamentally be rooted in a trauma-informed approach, recognizing that those experiencing homelessness and living unsheltered are both a consequence of prior traumas and an ongoing source of daily traumas. When providing services, it is imperative for all team members to maintain transparency regarding clinical and case management services, while upholding any individual’s right to autonomy, voice, and choice for care or services.

Utah Homeless Management Information System (HMIS)

HMIS is a federally required database used across Utah to track the needs, barriers, and demographics of individuals experiencing homelessness. Local providers use this system to coordinate care, manage daily operations, and analyze population trends. All HMIS data is based on client self-reporting and is entered into the system by authorized personnel. For detailed guidelines and access, visit the Utah HMIS website.

Community Resources

  • Fourth Street Clinic (Salt Lake City)
    • Services: Comprehensive medical, dental, behavioral health, and pharmacy services tailored specifically for individuals experiencing homelessness.
    • Phone: 801-364-0058
    • Website: fourthstreetclinic.org
  • Volunteer Care Clinic (Provo)
    • Services: Free, walk-in clinic providing non-emergency medical care for low-income and uninsured residents in Utah County (operated via United Way).
    • Phone: 801-373-4760
    • Website: Volunteer Care Clinic
  • Community Health Centers
    • Services: Community Health Centers provide primary care, pharmacy, health educations, case management, and long-term healthcare.
    • Phone (Association for Utah Community Health Administration): 801-974-5522
    • Website/Locator: auch.org or the federal locator tool at findahealthcenter.hrsa.gov

Behavioral Health / Crisis Interventions

  • 988 Suicide & Crisis Lifeline / Mobile Crisis Outreach Teams (MCOT)
    • Services: The universal entry point for 24/7 psychiatric crisis counseling and services. 988 provides telephonic emotional and mental health support by trained crisis workers. MCOT can assist with urgent challenges for an individual or someone else who may be in crisis. The team can assist in providing a crisis assessment, creating a safety plan, and referring to helpful community resources.
    • Phone/Text: 988
    • Website: 988.utah.gov
  • Huntsman Mental Health Institute (HMHI)
    • Services: Psychiatric hospital unit providing acute crisis care, receiving centers, and long-term stabilization resources.
    • Main Clinic/Hospital Phone: 801-583-2500
    • HMHI Crisis Warm Line (Peer Support): 801-587-1055
    • Website: healthcare.utah.gov/hmhi
  • Utah Local Mental Health Authorities (LMHAs)
    • Services: Utah utilizes 13 distinct public LMHAs split by county regions to administer ongoing community mental health and substance use disorder treatment under the Department of Health and Human Services (DHHS) oversight.
    • Full State Directory (All 13 Regions): Available through the DHHS Office of Substance Use and Mental Health at sumh.utah.gov (Admin Phone: 801-538-3939).
    • Salt Lake County (Behavioral Health Services): 385-468-4707 | saltlakecounty.gov/behavioral-health
    • Utah County (Wasatch Behavioral Health): 801-377-1213 | wasatch.org
    • Weber/Morgan Counties (Weber Human Services): 801-625-3700 | weberhs.org
  • Utah 211 (United Way of Utah)
  • Services: The central, state-recognized clearinghouse for all health and human services. Essential for emergency shelter availability, rent/utility assistance, food pantries, and community clinics across every county in Utah.
  • Phone: Dial 211
  • Website: 211.org