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Hot Topics in Nursing: Taking it to the Streets

CU Street Medicine team serves a growing homeless population on the streets

Written by Deborah Sherman on March 20, 2023

On a cold January day, five volunteers bundled in heavy coats and boots stomped around the snow in a remote area of Aurora looking for people experiencing homelessness who may need medical care. The volunteers are part of a team called CU Street Medicine that makes old-fashioned house calls for “rough sleepers” wherever they are; in parks, under bridges, along trails, and on sidewalks.


Scott Harpin, PhD, MPH, RN, Associate Professor at the CU College of Nursing and co-chair of the CU Street Medicine program

“The motto of the CU Street Medicine team is to bring care to the people,” said Scott Harpin, PhD, MPH, RN, Associate Professor at the University of Colorado College of Nursing and the co-chair of the CU Street Medicine program.

“We have to be unique and innovative in how we get models of care to people in our community because that one-size-fits-all model does not work for everyone. That’s what makes me proud of the street medicine program – that we try to bring health and wellness to the people.”

CU Street Medicine team was founded in early 2021 by a CU student group that connects healthcare students to external volunteer opportunities like YHC Clinic for street medicine. CU Medical student Rebecca Henkind and CU Nursing student (now alumni) Kiera Connelly met and became friends while working at the Colorado Coalition for the Homeless before attending CU. The women, both EMTs, wanted other healthcare students to experience working with an often ignored and disrespected population and, hopefully, transform perceptions.

“People experiencing homelessness have the most barriers to accessing healthcare. Even when they do access it, they experience a lot of negativity and trauma trying to navigate the system while being unhoused,” says Kiera Connelly, RN. “They are still human. But when healthcare professionals get burned out, the first thing to go is their compassion. It's tough to see. I think this program will help us provide better care because it teaches students not to make assumptions and to see the whole person.”


Kiera Connelly, RN (BSN '21)

On that January day, the team met Guy Niederwerfer at the Aurora Day Resource Center. The 52-year-old Colorado native was experiencing his second bout of homelessness after losing his job at Amazon. He says getting medical care without transportation and other resources is challenging.

“When it comes to being homeless, it’s hard to find any kind of help. You’ve got to go through so many steps just to get food stamps and a bus pass. You feel frustrated and feel useless,” he said.

His statement echoes a common theme of other basic needs and what is called ‘social determinants of health’ impacting lives in all walks of life.

The street medicine team is an interprofessional organization comprised of students and faculty on the CU Anschutz Medical Campus and community partners including Connelly, Henkind, Dr. Harpin, and program co-chair Dr. Katy Boyd-Trull. They partner with community collaborators. On this day, it was Sarah Nachtman, the community well-being manager for the City of Commerce City, and her city council and police department. The group received support, guidance, and funding from the Street Medicine Institute and has been noted as an exemplar of community clinical care by the CU Anschutz chancellor.



Guy Niederwerfer - experiencing homelessness

Twice a week, members of the team spend their own time finding and talking to homeless clients about their medical issues. They sit with people, listen to stories, then provide resources and treatment.

“We see a lot of common ailments like high blood pressure, high blood sugar, and a lot of wounds. I perform wound care, frostbite care, and try to address other medical issues,” said Connelly.

“We have a licensed medical provider on call, Dr. Boyd-Trull, whom we consult with. She can call in prescriptions. I can go pick them up and deliver them to the patients and teach them how to properly take the medication.”

The program is what Harpin calls a ‘win-win-win.’ Individuals receive care wherever they sleep, the university is able to offer a unique, impactful curriculum, and students often find a new passion for healthcare and learn about social justice in a way that can’t be taught in classrooms.

“This is one of the most powerful clinical experiences the students can have. They learn how to talk to and get to know folks and how to address their actual needs. The truth is, there is not a single definition for why people end up living on the streets. When the students do this volunteer work, they often fall in love with healthcare again. So, they don’t just find compassion for the people they’re working with, they also get back to the roots of why they applied to be in healthcare, to begin with,” said Dr. Harpin.

We spoke with members of CU Street Medicine about obstacles they face, including a rise in homelessness, substance abuse, and a lack of funding. All liability and malpractice coverage for students to volunteer comes from YHC which was founded by Dr. Katy Boyd-Trull, co-CU Street Med faculty advisor.

street med hero

CU Street Medicine team

Q&A Header

Denver’s homeless population jumped 24% in 2022 from the previous year. Is the street medicine team seeing that and able to treat everyone?

“Homelessness is much more visible these days. The shelters are very busy now and always at capacity. During cold weather days, you throw out the rules of bringing folks into places because it’s a matter of keeping people warm, off the streets, and alive. To take care of them, we need more financial support to expand our program. I believe if people see what we’re doing and how worthwhile it is for everyone involved, they’ll see it’s money well spent and want to support street medicine.” – Dr. Scott Harpin

“Anyone working with PEH has doubtless noticed an increase in the population. Most likely, the public has also noticed, as the rough sleepers are particularly visible. Street medicine teams bring vital care to PEH, but it’s important to note that we are not a replacement for a primary care clinic. We will never be able to provide as much comprehensive care as a clinic because of the environment we practice in. We currently offer our services to as many as we can, but do not currently have the capacity to reach everyone in our community; we hope to expand our reach this coming year, and donations and grants are a vital part of that plan. In addition, in many cases, identifying someone with medical conditions is not enough. We have to establish trust with that person before we can treat them. Sometimes this can take months or years; people experiencing homelessness often have histories of institutional trauma and a natural distrust of large organizations that we have to navigate before we can establish patient-provider relationships to initiate treatments.” – Rebecca Henkind, medical student

“I’ve seen a significant increase in homelessness. There are the chronic homeless who have been out here for years, and then there are people I meet who have been out here for a couple of weeks. With the housing crisis in Colorado, it’s pretty rough. We can’t keep up unless we get more housing, which is really the solution to all of this. Until we get there, I think it’s only going to get worse. I think with time, the public and government will come to understand that once you’re on the streets, everything gets so much harder to be able to get back into a house. It’s not just one factor. I think the burden it puts on all of the systems is much more expensive than just providing housing.” – Kiera Connelly, RN

How is the rise in the number of unhoused people impacting the nursing and healthcare professions?

“We are really seeing the need to treat people where they are and with what they are experiencing. We changed our medical school curriculum last year. Every medical student now is required to do a service-learning project in the community in their first year and a half of medical school. That just wasn't done before. We call that structural competency. That is changing the structures in our health sciences education to improve the awareness of our students and our faculty for things that matter and include them in our missions. Our CU Nursing program has taken this to heart as well, and we’re being far more thoughtful about the lives of people we’re seeing both in hospitals and other health settings.” – Dr. Scott Harpin.

In 2012 Colorado legalized marijuana. Has that led to an increase in homelessness?

“I think that's a common misconception that people came to Colorado because marijuana is legal. But most people I meet grew up here. Most are in their 50s and 60s and had jobs and families and became estranged from all of that. Sometimes it's related to substance use or mental health. Sometimes it's totally unrelated. If you can imagine sleeping in the snow out here each night, how hard it would be to not use substances or to not develop a mental health condition.” – Kiera Connelly, RN

“I also think this is a common misconception. Many times, homelessness itself can lead to substance usage. For example, imagine you suddenly lost housing and had to sleep outside. Would you feel safer sleeping during the day, or during the night? I’d feel safer during the day, and I know most people experiencing homelessness agree since public visibility is higher. If I then had to stay up all night to stay safe and protect my belongings do you know what would suddenly look appealing? Meth. It helps many people experiencing homelessness stay awake and alert during the most dangerous hours of the day, and that usage, brought on by necessity, can precipitate dependence.” – Rebecca Henkind, medical student

“Recreational legalization was now 10 years ago. There have been a lot of anecdotes about weed and other substances ‘leading’ to homelessness, or vice versa. It might be true that individuals on the street could have co-occurring substance use issues. But there are myriad other factors that might have an even bigger impact on the issue, like the housing crisis, volatility in the economy, jobs coming and going, etc. Coupled with Colorado being a great place to live creates the potential for people not to have a roof over their heads. But in my opinion, I choose not to spend time on the ‘why’ of the matter and instead want to focus on what I’m going to do about it. The Street Medicine work is my little part in working on that goal.” – Scott Harpin