Evaluation of the implementation of a medical respite program for persons with lived experience of homelessness

Abstract

ABSTRACT Medical respite programs (MRPs) constitute a potential strategy to improve the continuum of care for persons who have lived experiences of homeless (PWLEH). A MRP was developed in Alberta, Canada, through a partnership between the provincial health authority (Alberta Health Services) and the province’s largest homeless shelter (Calgary Drop-In Centre). We conducted a qualitative study of 25 stakeholders who held an operational, administrative and/or healthcare provider role in the MRP’s design and implementation to evaluate the barriers and facilitators to its implementation using Proctor’s implementation framework. While stakeholders had a common motivation of addressing health inequity, the program’s acceptability and fidelity were hampered by a lack of clear common objectives and expectations. Program adoption was difficult due to differences in organizational policies and priorities. Program staff and leadership were dedicated to the patient population, enhancing feasibility, but the limited training and experience of frontline providers specifically in addictions and mental health resulted in important needs not being met (affecting intervention appropriateness). The lack of integration with community resources, despite being intended as a program to transition patients from hospital to community, affected program penetration. Our findings are relevant for other jurisdictions and organizations aiming to develop and implement similar interventions.