This study employed a qualitatively driven mixed-methods design, grounded in structural vulnerability theory and One Health principles, to examine how a community-based veterinary outreach model serves unhoused individuals and their companion animals. The approach prioritized qualitative inquiry through thematic analysis, supported by descriptive quantitative data to contextualize program reach and participant demographics.

The overarching design reflected a critical relational paradigm, emphasizing power dynamics, care ethics, and equity in health access (7, 8). This allowed for both a systems-level evaluation of the outreach model and an exploration of how care is experienced and understood by stakeholders in real-world conditions of structural precarity.

The focal program, operated through a collaboration between the Street Dog Coalition (SDC) and the Mobile Access Partnership (MAP), provides integrated veterinary and human services in Topeka, Kansas. Kansas State University College of Veterinary Medicine contributes veterinary students, faculty, and infrastructure through its community outreach rotation. These clinics are hosted weekly via pop-up mobile events, typically co-located with human service providers such as housing navigators, harm reduction teams, and caseworkers.

The SDC-MAP model includes:

Beneficiaries typically learn of the services via word-of-mouth, shelter case managers, or through MAP’s rotating event schedule. Intake is conducted on-site, consisting of brief documentation, consent, and verbal history gathering. All services are offered free of charge, intentionally removing financial barriers and reducing the structural stigma that may accompany the inability to pay for veterinary or human care. As of 2024, the program has served approximately 450 unique beneficiary households since its inception in 2020.

The research team included professionals from veterinary medicine, public health, and social work who were actively involved in program delivery and evaluation. This dual positionality necessitated ongoing reflexivity, supported through analytic memoing and journaling, to surface assumptions and mitigate power differentials in research relationships. The team was guided by an ethic of relational accountability (9), treating participants as knowledge-holders and collaborators (see Table 1).

A purposeful sampling strategy (8) was used to ensure diversity across key program roles. We conducted 12 semi-structured interviews with participants from four stakeholder groups.

Table 2 description of study participants by stakeholder group. This table outlines the distribution of the 12 individuals who participated in semi-structured interviews, selected through purposeful sampling to ensure diverse perspectives. Participants represented four key stakeholder groups involved with the Street Dog Coalition model, including unhoused beneficiaries, volunteer providers, program leadership, and external collaborators (e.g., social service providers). Recruitment occurred through in-person engagement at SDC-MAP events, supplemented with follow-up communications. This stratified approach enabled a multi-perspective analysis of how services were experienced, enacted, and navigated across the ecosystem.

Volunteers, including veterinary students, practitioners, and lay personnel, are central to the outreach model. Their roles span from clinical duties (vaccination, exams, medical charting) to supportive services (intake, supply distribution, conversational engagement). Training in trauma-informed care, boundary setting, and ethical relationship-building is provided through orientation sessions, pre-event briefings, and mentorship by experienced staff. Frequency of volunteering varies—some individuals participate monthly, while others are embedded weekly across the outreach calendar.

Interviews were conducted between 2023 and 2024, lasting 30–60 min, and were recorded with participant consent. Interview guides explored:

Interviews followed a semi-structured, responsive format (10), allowing flexibility while maintaining core prompts across stakeholder groups.

Quantitative data were extracted from SDC’s internal tracking database and included:

These metrics were used to contextualize qualitative findings—not as standalone analytic outputs, but to illustrate the breadth and structure of the service model.

Interview transcripts were analyzed using reflexive thematic analysis (11), combining inductive coding with theoretical sensitization to structural vulnerability (4) and One Health (5). An initial codebook was collaboratively developed, then iteratively refined through team discussions. Themes and subthemes were constructed to preserve the narrative richness of stakeholder voices while identifying shared patterns across interviews.

A visual summary of emergent themes is presented in Figure 1, accompanied by subthemes that illustrate the complexity of relational, structural, and affective dimensions of the outreach model.

To enhance trustworthiness and credibility, we employed:

Participants consistently described companion animals as stabilizing figures that provided emotional regulation, daily structure, and social identity. This bond often served as the entry point into human and veterinary services.

Subthemes:

Trust was foundational for sustained engagement, particularly for individuals navigating past trauma and systemic exclusion. Participants valued consistent volunteers, nonjudgmental care, and relational continuity.

Subthemes:

Participants described systemic barriers that shaped their access to both veterinary and human care. These included housing discrimination against pet owners, inflexible clinic policies, and lack of mid-tier veterinary options. Descriptive program data mirrored these challenges: Of the 451 pets served, 217 beneficiaries were lost to follow-up, and 43 declined services due to the mandatory spay/neuter policy. These figures reflect the fragility of sustained engagement when external systems fail to accommodate beneficiaries’ lived realities. Staff underscored the disconnect between their relational efforts and the broader policy landscape, stressing that relational care must be matched by structural reform.

Subthemes:

The notion of beneficiary “graduation” to traditional veterinary care was emotionally complex. While the notion of graduation symbolized forward movement, it was often constrained by structural conditions beyond beneficiaries’ control. Among the 79 graduates, at least four returned due to financial or logistical difficulties—a pattern some providers referred to as “recidivism.” These experiences prompted critical reflection on the suitability of graduation as a programmatic goal:

“We need a middle step—something between outreach and full-on private care. A hand-off does not work if the other hand’s not there to catch them.” (SDC.009).

This tension illustrates that graduation, while well-intentioned, may prematurely withdraw services in contexts where beneficiaries remain structurally vulnerable. It challenges programs to rethink what “continuity of care” means when safety nets are limited, and when “success” depends not only on the readiness of the beneficiary but also on the responsiveness of downstream systems.

Subthemes:

Volunteers reported experiences of fulfillment, moral distress, and relational labor that extended beyond technical veterinary tasks. They grappled with emotional boundaries and the ethical tensions of scarcity.

Subthemes:

Participants—both beneficiaries and providers—framed outreach encounters as mutual acts of care and transformation. The clinic space became a site of belonging, healing, and shared humanity.

Subthemes:

The findings of this study strongly affirm the centrality of the human-animal bond (HAB) in shaping care-seeking behaviors, relational trust, and healing processes among unhoused individuals. Echoing established literature from One Health and human-animal interaction fields, participants consistently described companion animals as emotional anchors, sources of stability, and primary motivators for engaging with supportive services (1, 2). However, this bond extended beyond emotional comfort; it actively functioned as a relational conduit between beneficiaries and providers. In this context, pets became “co-beneficiaries,” shaping how outreach teams delivered care in ways that felt respectful, nonjudgmental, and dignified.

A prominent example is the intentional use of treats by volunteers—not merely as a clinical behavior management tool, but as a mechanism of relational alignment. This practice modeled what Hall (12) describes as relational attunement, a posture of care that centers presence, dignity, and mutual recognition. Hall’s concept, rooted in relational spirituality, is particularly salient in outreach models like the Mobile Access Partnership (MAP), which is organized in part by faith-based institutions, as well as Street Dog Coalition (SDC), where many volunteers and care providers share religious affiliations. In these contexts, relational attunement serves as a psychologically and theologically grounded framework for understanding how trust, reciprocity, and compassion facilitate healing.

For secular audiences, this approach is analogous to the well-established psychological theory of attachment (13), in which trust-building and security are fostered through consistent, compassionate, and responsive relationships. The HAB operates as both catalyst and medium for this process. Several participants described instances in which they initially sought help only for their pet but, through the process of engagement, found themselves accessing hygiene services, medical care, housing support, or mental health referrals.

Importantly, this study illustrates that the HAB is not simply a static or sentimental connection—it is an active force within the broader care ecosystem. The HAB helps establish psychological safety, lower social barriers, and invite layered engagement across domains of care. These findings align with cross-sectoral outreach literature that highlights animal welfare as an effective entry point for holistic service provision (4). However, this success is not automatic. The HAB must be intentionally activated through trauma-informed practice, culturally responsive care, and sustained, relationship-centered engagement.

Trust emerged as the foundational condition for any form of engagement. Beneficiaries, many of whom described histories of institutional harm, viewed MAP-SDC events as rare spaces where trust could be rebuilt over time. This trust was not derived from organizational branding or eligibility screening processes, but from repeated human interactions—conversations, shared meals, and respectful treatment of their pets. In this sense, trust was relationally earned rather than institutionally bestowed.

This finding aligns with broader critiques of access-to-care models that emphasize intake processes, referrals, or checklists without accounting for the social–emotional labor required to bring structurally vulnerable populations into care (5). It also reinforces the need to understand care as an emergent process, not a transactional exchange. As one provider noted, “we are not just treating a pet; we are welcoming someone back into a system that’s failed them.”

Despite the strong relational foundations described by participants, several systemic barriers complicated the promise of continuity. One prominent tension was the mandatory spay/neuter policy required for continued access to veterinary care. While intended to advance animal welfare, this rule created a moral and logistical conflict for some beneficiaries, leading to disengagement. As previously noted, 43 beneficiaries declined services due to this policy, underscoring how well-intentioned rules may inadvertently replicate exclusion. This echoes literature in harm reduction and trauma-informed care, which warns against rigid policy enforcement that does not align with beneficiaries’ lived realities (6).

Program staff were acutely aware of this tension, often expressing frustration at being caught between relational commitments and policy mandates. Their narratives suggest a need for flexible, beneficiary-centered frameworks that honor both animal health goals and human complexity. Rather than viewing disengagement as beneficiary non-compliance, it should be interpreted as a signal that relational care must be matched by structural reform.

Perhaps the most contested construct in this study was that of “graduation.” Originally conceived as an indicator of programmatic success, graduation denotes the moment when a beneficiary is referred out of outreach services and into traditional veterinary care. Yet both providers and beneficiaries challenged this framing. Several described it as abrupt, ill-fitting, or poorly timed given the complex realities of financial instability, housing precarity, and transportation barriers.

Among the 79 graduates, at least four returned due to financial or logistical difficulties—what some staff described as “recidivism.” Others expressed concern that the concept itself may be misaligned with a program grounded in structural vulnerability theory. As one participant stated, “we need a middle step—something between outreach and full-on private care. A hand-off does not work if the other hand’s not there to catch them.”

This suggests that graduation should be reimagined as a relational transition, not a service termination. A trauma-informed model might include follow-up check-ins, warm referrals with transportation support, and the opportunity for re-engagement without stigma. Such a model reflects best practices in housing and harm reduction sectors, where continuity and flexibility are central to sustained outcomes (7).

Volunteers played a pivotal role in mediating care relationships, modeling trauma-informed practices, and serving as boundary crossers between beneficiaries and systems. Their consistency, demeanor, and use of low-barrier language were frequently cited by beneficiaries as reasons they returned. Importantly, many volunteers took initiative to address gaps in care, such as printing pet health summaries for use at shelters or social service appointments.

Yet this relational labor is not without risk. Several providers expressed a need for more training around emotional boundaries, trauma exposure, and self-regulation. As one volunteer shared, “you want to do everything for them, but that’s not sustainable.” This echoes concerns in community health worker and peer navigator literature, where burnout and overextension are common due to poorly defined roles or lack of institutional support (8).

To ensure sustainability, programs like SDC should invest in robust training, clear scopes of practice, and support mechanisms for volunteers. This is particularly crucial given the increasing role volunteers play in navigating both veterinary and human service systems.

Taken together, the findings invite a critical reexamination of how success is defined in community-based veterinary care. Traditional metrics such as graduation rates, number of procedures performed, or follow-up rates tell only part of the story. Equally important are metrics that reflect relational depth, trust-building, emotional safety, and responsiveness to structural vulnerability.

As such, future research should explore alternative indicators of programmatic impact, including longitudinal engagement, perceived trustworthiness of providers, and beneficiary-defined quality of care. Additionally, greater attention should be given to structural barriers—such as the scarcity of pet-inclusive housing and the lack of mid-tier veterinary services—which limit exit pathways for beneficiaries. Understanding these structural gaps will require cross-sectoral collaboration and research that bridges veterinary science, public health, and policy analysis.

Ultimately, the MAP-SDC partnership offers a promising model of relationally grounded, One Health-aligned outreach that centers both ends of the leash. But its success will depend on the degree to which relational insights are matched by institutional reforms and community-informed definitions of care success.

Several limitations merit mention. The study’s sample size was modest, and while purposively diverse, may not capture the full range of experiences. Interviews were limited to one geographic site, potentially limiting transferability. Nevertheless, the triangulation of perspectives across stakeholder groups and the integration of theory enhance the analytic rigor.

Future research might explore mid-range care models for beneficiaries transitioning out of outreach, examine pet-inclusive housing initiatives, or assess volunteer training protocols in multisectoral settings. Further attention to how structural reforms—not just relational adjustments—can create continuity across veterinary and human service systems is warranted.