Community-based Service Providers Research Articles

Understanding how community-dwelling persons with early dementia perceive health and community services: Informing the dementia strategy of Newfoundland and Labrador, Canada.

With an increased aging population, the number of individuals with dementia is expected to rise. The onset of dementia marks the start of negotiating access to a wide range of health and social services to find practical and emotional supports to deal with the management of changes and subsequent challenges that individual with dementia face. The toll of dementia goes beyond the health care system, affecting families and caregivers' quality of life. This places more pressure on family caregivers and health care institutions to provide services for affected individuals. It is important to understand the service needs of this population to enable them to live at home longer, contribute to society and maintain a positive quality of life. To increase understanding of how persons living at home with early dementia and their caregivers/significant others currently perceive and interact with health and community-based services and service providers. A qualitative descriptive approach was used to explore the experiences of individuals with early dementia and care providers with health and community-based services using semi-structured interviews and content analysis. Participants included 16 individuals 50years and older with mild/early dementia living at home, 22 informal caregivers of individuals with mild/early dementia, and 5 key community informants (community health nurses and social workers). Four thematic categories of barriers and two thematic categories of facilitators for access to and uptake of supportive services were identified. Five strategies to inform the development of an action plan to enhance access to, and uptake of, supportive services were determined. Early recognition of dementia through education and publicity enhanced public awareness, attention, and social inclusion with dementia-friendly neighborhoods and facilities need to be considered to achieve effective dementia-related services. Inclusion and recognition of the wishes of persons with dementia is key.

Linking Community-based Substance Use Disorder Treatment to Health Administrative Data: understanding vulnerable populations.

IntroductionMost substance use disorder (SUD) treatment occurs in community settings. Community-based SUD treatment information is rarely captured or utilized. The objective of this study was to examine the efficiency of a data linkage of community-based SUD treatment to health administrative data holdings in Ontario, Canada, and to describe sociodemographic and clinical characteristics of individuals accessing SUD services. MethodsData from community-based SUD service providers (>180) from April 2015 to March 2022 were linked to administrative data holdings at ICES. Linkage rates were evaluated. Sociodemographic (age, sex, neighbourhood-level income) and clinical (substance use, physician visits, Emergency Department (ED) visits and hospitalizations) characteristics were evaluated. ResultsThe linkage rate of DATIS ICES data holdings was >92% for all years (2015-2022). Of the 234,501 individuals admitted to a DATIS program, 36.1% were female, 46.2% were 25-44 years old, and 51.6% resided in the two lowest neighbourhood income quintiles. Alcohol (33.4%) was the most common substance identified. For outpatient care occurring within 1 year prior to admission, around 56.0% and 23.3% had Mental Health and Addictions (MHA) related primary care and psychiatrist visits, respectively. For acute health services, 29.8% and 14.2% had a MHA- related ED visit or hospitalization, respectively. DiscussionSUD treatment data from community settings can be successfully linked to other health administrative data. Individuals with SUD have a high rate of acute health care use, and a relatively low access to psychiatrists. SUD treatment data linkage should be used to understand how to optimize access to care for vulnerable individuals.

The Administration of Youth Justice Through the Lens of Community-Based Service Providers: Risk Factors and Programming Challenges

Since the Youth Criminal Justice Act of 2003 in Canada, the juvenile justice system has prioritized diverting youth away from in-custody sentences (incarceration in jail, prison, or other facilities) and towards a community-based system of justice. Despite this shift, there is limited research directly examining the experience of community-based service providers that were responsible for this shift in adjudicating youth. To understand the experience of working with youth involved in the system, we conducted semi-structured interviews with youth justice workers from one of the largest community-based organizations in a western Canadian province that offer alternatives to custody for at-risk youth. Findings provide a complex depiction of youth risk factors and illustrate the successes and challenges of administering youth justice in a community context.

Experts' Views on Children's Access to Community-Based Therapeutic and Education Services After Genomic Sequencing Results.

To evaluate how community-based experts respond to families seeking therapeutic and educational support services after pediatric genomic sequencing for rare conditions. We interviewed 15 experts in the provision of community-based services for children with intellectual differences, developmental differences, or both, as part of a large study examining the utility of exome sequencing. Interviewees highlighted the complexity of the overall referral and assessment system for therapeutic or educational needs, that genetic diagnoses are secondary to behavioral observations in respect to eligibility for the provision of services, and that social capital drives service acquisition. Although emphasizing that genetic results do not currently provide sufficient information for determining service eligibility, interviewees also highlighted their hopes that genetics would be increasingly relevant in the future. Genomic results do not usually provide information that directly impacts service provision. However, a positive genomic test result can strengthen evidence for behavioral diagnoses and the future trajectory of a child's condition and support needs. Interviewees' comments suggest a need to combine emerging genetic knowledge with existing forms of therapeutic and educational needs assessment, and for additional supports for families struggling to navigate social and therapeutic services.

Utility of a virtual small group cognitive behaviour program for autistic children during the pandemic: evidence from a community-based implementation study

BackgroundAutistic children often experience socioemotional difficulties relating to emotion regulation and mental health problems. Supports for autistic children involve the use of adapted interventions that target emotion regulation and social skills, alongside mental health symptoms. The Secret Agent Society Small Group (SAS: SG), an adapted cognitive behavioural program, has demonstrated efficacy through lab-delivered randomized control trials. However, research is still needed on its effectiveness when delivered by publicly funded, community-based autism providers under real-world ecologically valid conditions, especially within the context of a pandemic. The COVID-19 pandemic has disrupted access to community-based supports and services for autistic children, and programs have adapted their services to online platforms. However, questions remain about the feasibility and clinical utility of evidence-based interventions and services delivered virtually in community-based settings.MethodsThe 9-week SAS: SG program was delivered virtually by seven community-based autism service providers during 2020–2021. The program included the use of computer-based games, role-playing tasks, and home missions. Caregivers completed surveys at three timepoints: pre-, post-intervention, and after a 3-month follow-up session. Surveys assessed caregivers’ perception of the program’s acceptability and level of satisfaction, as well as their child’s social and emotional regulation skills and related mental health challenges.ResultsA total of 77 caregivers (94% gender identity females; Mean = 42.1 years, SD = 6.5 years) and their children (79% gender identity males; Mean = 9.9 years, SD = 1.3 years) completed the SAS: SG program. Caregivers agreed that the program was acceptable (95%) and were highly satisfied (90%). Caregivers reported significant reduction in their child’s emotion reactivity from pre- to post-intervention (-1.78 (95% CI, -3.20 to -0.29), p = 0.01, d = 0.36), that continued to decrease after the 3-month booster session (-1.75 (95% CI, -3.34 to -0.16), p = 0.02, d = 0.33). Similarly, improvements in anxiety symptoms were observed (3.05 (95% CI, 0.72 to 5.36), p = 0.006, d = 0.39).ConclusionsAs online delivery of interventions for autistic children remains popular past the pandemic, our findings shed light on future considerations for community-based services, including therapists and agency leaders, on how best to tailor and optimally deliver virtually based programming.Trial registrationThis study has been registered with ISRCTN Registry (ISRCTN98068608) on 15/09/2023. The study was retroactively registered.

Temporalities of emergency: the experiences of Indigenous women with traumatic brain injury from violence waiting for healthcare and service support in Australia

ABSTRACT Globally, traumatic brain injury (TBI) has been recognised as a serious health issue not only because of the immediate impacts at the time the injury occurs but even more so due to the longstanding impacts. Even though TBI is a globally recognised condition, the research is disproportionately focused on its incidence in, and immediate and long-term effects on men. A growing body of research suggests that generally, women who experience family violence are at high risk of TBI and suffer its impacts in ways that reflect gendered differences in the patterns and frequency of violence. In Australia, the social and physical costs of TBI are multiplied for Indigenous women, whose experience of disability and access to healthcare lies at the intersection of gender and race in the historical context of settler colonialism. The present study addresses the need for research into the sociodemographic inequalities that affect access to culturally appropriate hospital care, timely response systems, and flexible, safe and engaged social services. This paper draws on data from interviews and focus groups with Indigenous women, hospital staff and community-based service providers and suggests potential pathways for further research in settler-colonial settings elsewhere in the world.

A graduate student-staffed, low-cost mental health program: a community-based model to increase access to services

ABSTRACT Student-run and student-staffed behavioral health clinics increase service capacity and access to low-cost services and are usually created by medical schools and behavioral health graduate programs. There is little information about student-staffed programs developing independently of academic institutions. As the demand for mental health services continues to grow, it is essential that successful models of community-based service provision are shared so other agencies can replicate models and increase service capacity. This article outlines the elements of a student-staffed behavioral health program model run by a nonprofit. Details on staffing, student selection, supervision, evaluation methods, supplemental training, and funding are included.

Collection, Storage, and Use of Client Data: Considerations and Recommendations for Human Trafficking Service Providers

ABSTRACT We are a team of university-based researchers who have decades of experience collaborating with multiple community-based human trafficking (HT), domestic violence, and sexual violence programs on research projects. In this paper, we provide recommendations for HT agencies on routine data collection, storage, and use based on our insights from working closely with multiple community-based HT service provider agencies. In this opinion piece, we consider important questions that HT programs face related to data. We present our recommendations as they pertain to three main challenges: (1) Which data to collect, and how; (2) How to store data; and (3) How to analyze data. We include a list of nine routine data elements that HT service providers may prioritize for data collection, a table with eight actionable recommendations, and a short glossary of program monitoring and evaluation terms. The article makes a pragmatic contribution to best practices in HT provider operations and therefore has implications for administrators of HT programs, data personnel at HT programs, and policies related to data, information, technology, and safety for HT program service provision.

Development of a Community Informed Approach for Implementing Support Network Trainings for Children with Autism Spectrum Disorder in Western Kenya

Background:Autism spectrum disorder (ASD) impacts a large global community, with a prevalence of nearly 1 in 100 children. However, little is known about the educational experience of children with ASD and other neurodevelopmental disorders (NDD) in low- and middle-income countries (LMICs). Guidance from local communities is essential when developing a cultural inquiry into this educational landscape. Our project objective was to evaluate community perspectives on ASD and areas of development for future support network trainings.
 Methods:This qualitative study was performed within the Academic Model Providing Access to Healthcare (AMPATH) program in Eldoret, Kenya. Using group discussions, this approach engaged stakeholders from three areas: medical personnel, educators, and caregivers/families. Kenyan professionals in child psychiatry, occupational therapy, and special education guided discussion and led the recruitment of key informants for interviews. Within this qualitative analysis, brief thematic analysis of dialogue elucidated key themes.
 Results:Four focus groups were held, with 87 total participants (group size = 12-29). Four main themes were identified in the data: beliefs about causes, treatment options, barriers to education, and a need for community advocacy. Advocacy was a major focus of discussions, due to a sentiment of fragmentation and poor acceptance from the community. Stigmatization carried over into localbeliefs about causes of ASD, which included poor nutrition, witchcraft, and genetics. Finding resources to access education and therapy was a challenge, especially for families in rural settings. These viewpoints informed study protocol adaptation by expanding recruitment to include community-based service providers and staff from additional schools, and integrating themes into interview questions.
 Conclusion:This project prioritized dialogue with stakeholders to gain insights to inform the development of a cultural inquiry into the special education landscape in western Kenya. Themes elucidated from this project provided critical feedback to inform future study protocol and an expanded recruitment plan.

Service providers' perspectives on the challenges of informal caregiving and the need for caregiver-orientated mental health services in rural South Africa: A descriptive study.

Informal caregivers of persons with mental disorders encounter various challenges in their role of caregiving. As such, they require support to enable them to cope with the demands of their caregiving. There is comprehensive evidence on the experiences of burden among informal caregivers in mental health; however, there is a limited number of studies that report on the mental health services aimed specifically at supporting informal caregivers in their role. To address this gap, this study aimed to explore the perspectives of the service providers regarding the challenges encountered by informal caregivers and the mental health services available to support these caregivers. Semi-structured interviews were conducted with mental health coordinators at provincial, district, and sub-district level and mental health professionals from a district hospital. Focus group discussions were conducted with primary healthcare supervisors and community health workers in Bushbuckridge municipality, South Africa at participants' workplaces and sub-district offices. Semi-structured interviews and focus group guides with semi-structured questions were used to direct data collection in August 2022-January 2023. All interviews were audio recorded and transcribed verbatim. Reflexive thematic inductive analysis was conducted using NVivo 12 software. Three themes were identified, namely perceived caregiving consequences and related factors, current state of mental health services, and factors affecting delivery of informal caregiver mental health services. The service providers acknowledged the negative consequences faced by informal caregivers. This includes the experience of caregiver burden which was attributed to the uncooperative and violent behaviours exhibited by the mental health care users. The current state of formal and informal community mental health services was described and considered inadequate to meet informal caregivers' needs. Various personal, health system, and contextual factors influencing the provision of caregiver-orientated services were identified. The findings revealed the need for intersectoral collaborations between hospital-based and community-based mental health service providers, and community stakeholders to ensure provision of user-friendly and accessible mental health services for informal caregivers.

A DISCUSSION ON THE STATE OF AFFAIRS ON DIRECT ACTION TO SUPPORT OLDER ADULTS DURING DISASTERS

Abstract As the frequency and severity of disasters increases, supporting older adults before, during, and after disasters is paramount. Steps toward adequate disaster preparedness include ensuring older adults possess awareness of increased disaster and hazard events and understand their role in preparedness. This symposium will address the current state of affairs in the United States (US) on direct actions to support older adults before, during, and following major disasters. Additionally it will provide context on how continuing effects of climate change impact these efforts. Dr. Lisa Brown will share perspectives and describe efforts of the US National Advisory Committee on Seniors and Disasters. Dr. Sue Anne Bell will discuss the role of implementation science in improving the emergency preparedness in nursing homes. Dr. Lindsay Peterson will describe existing state policies around home and community-based service providers. Dr. Tamar Wyte-Lake will share directions the Department of Veterans Affairs is moving in to best support vulnerable populations, focusing on older Veterans. Dr. Karl Pillemer will address the role of older adults as active agents in climate change prevention and mediation. Dr. David Dosa will act as discussant. These presenters will provide important insights into ongoing efforts while highlighting areas in need of improvement and aligned action, with the hopes that this will generate important discussions well into the future. This is a Disasters and Older Adults Interest Group Sponsored Symposium.

IDENTIFYING THE RELATIONSHIP BETWEEN ALZHEIMER’S DISEASE PREVALENCE AND CURRENT SERVICE USE IN OHIO’S 88 COUNTIES

Abstract Recently released data reveals that over 235,000 people over the age of 65 have Alzheimer’s disease and related dementia (ADRD) in Ohio. Using 2020 data from the National Center for Health Statistics, county-level specific ADRD prevalence estimates for Ohio’s 88 counties were also prepared (Range: 9.4-13.4 per 1000 individuals 65+). Researchers, practitioners, and policy-makers can use these estimates to better understand the reach and impact of ADRD in local communities. Nationally and in Ohio, care and support for older adults and specifically older adults with ADRD typically falls to family caregivers, home- and community-based service (HCBS) providers, and residential care providers such as nursing homes. This study pairs the county-level ADRD prevalence data with county-level data on available services (e.g., Memory Care Units, nursing home beds) and service users (e.g., HCBS users). The 10 counties in Ohio with the highest prevalence rates are home to nearly 60% of the 65+ population statewide. Additionally, these counties had a significantly higher proportion of older Black/Hispanic individuals than the other counties (10.8 versus 2.9). When looking at capacity, the top 10 counties contained just 12% of all nursing home beds, but 54% of nursing homes memory care units for the entire state. When considering service use, these 10 counties served a smaller percentage of the state’s HCBS users (13%). For Ohio and other states, it is important to explore available services and current service usage when faced with the increasing estimates of people living with ADRD.

Working With Immigrants Who Are Child Welfare Involved: Promoting Innovative Collaborations and Systems Involvement During a Public Health Crisis

The COVID-19 pandemic has had notable impacts on public child welfare systems and their ability to serve families. For immigrant families who enter the child welfare system, pandemic-related challenges were exacerbated on top of existing immigration-related stressors and barriers. This study used in-depth qualitative interviewing with child welfare agency staff and community-based service provider partners working with immigrants to explore their experiences in providing services to families navigating this unprecedented context. Results highlight the adaptations implemented to engage immigrant clients and facilitate interagency collaboration in light of barriers imposed by the pandemic. Practice implications center the need for child abuse and neglection prevention efforts to start in community and demand collaboration between government-based child welfare agencies and a range of grassroots, trusted community providers.

Perspectives on implementing Individual Placement and Support (IPS) within primary health care settings for adults living in British Columbia, Canada

BackgroundIndividual placement and support (IPS) is an evidence-based practice (EBP) designed to help people with severe mental illness re-enter the labour market. Implementing an IPS program within a new context (e.g., primary health care setting) to support populations that are complex and multi-barriered presents a set of unique challenges and considerations. This paper provides community-based perspectives that identify implementation strengths and challenges and highlights potential strategies aimed at addressing emergent barriers.MethodsA case study was conducted across three community health centres in British Columbia (BC), Canada, where a novel IPS program was embedded within primary care services. Data collection consisted of open-ended surveys and focus groups with service providers directly involved in program implementation and their associated clinical and managerial support teams (n = 15). Using the updated Consolidated Framework for Implementation Research (CFIR) as a guide, we performed deductive thematic analysis to identify key areas impacting IPS implementation.ResultsIntegration with existing health care systems and primary health care teams and support from leadership across all levels were identified as both key facilitators and barriers to implementation. Facilitators and barriers were identified across all domains, with those within innovation and process most easily addressed. Four cross-cutting themes emerged for promoting more integrated and sustainable program implementation: investing in pre-implementation activities, supporting a dynamic and flexible program, building from community experiences, and developing a system for shared knowledge.ConclusionsImplementing an IPS program embedded within primary health care settings is complex and requires extensive planning and consultation with community-based service providers and decision-makers to achieve full integration. Future practice and policy decisions aimed at supporting employment and well-being should be made in collaboration with communities.

A Study on Community needs, perceptions and demand regarding the use of the health services during COVID-19 pandemic in district Kathua, J and K.

The impact of the COVID-19 pandemic on essential health services is a source of great concern. Health gains made during the last 2-3 decades have been halted due to shifting of resources to fight the COVID-19 pandemic. This study was conducted to identify community needs, demands, and perceptions regarding the effectiveness of using health services during the pandemic. This was a qualitative study which was conducted through focus group discussions. The participants comprised of three groups: community leaders, healthcare providers, and field workers. Discussion among the participants was conducted using the standardized World Health Organization community assessment tool. In our study, it was reported that most of the essential health services were disrupted due to COVID-19 pandemic. The barriers to accessing essential health services have been exacerbated and the provision of community-based services is effected due to this. In regard to COVID-19 vaccination also, there remain individuals who are reluctant to be vaccinated. Our study shows that the community faced barriers in accessing and using health services during the pandemic. To ensure the public's access to health services and strengthen healthcare preparedness strategies like health budget allocation, manpower, infrastructure, trainings, integration with primary healthcare, etc., need to be carried out during and after the pandemic. Thus, participation and inter-sectoral coordination across levels are required to overcome these barriers.

Impairment Types and Combinations Among Adolescents and Young Adults with Disabilities: Colorado 2014–2018

ObjectiveUnderstanding the types of functional challenges faced by adolescents and young adults with disabilities (AYA-WD) can help payers, clinicians, community-based service providers, and policymakers recognize and meet needs. This paper describes state-level prevalence rates for 1) AYA-WD overall and for 2) impairment types singly and in combinations; and 3) examines how rates may differ between those insured by Medicaid versus commercial insurance. MethodsThis descriptive study uses Colorado’s All Payer Claims Dataset 2014–2018 to identify insured 10- to 26-year-olds (Medicaid only: 333,931; commercially only: 392,444). It then applies the previously validated Children with Disabilities Algorithm (CWDA) and its companion, the Diagnosis-to-Impairment-Type Algorithm (DITA), to compare state-level prevalence rates by insurance source for disability overall and for each of five impairment types singly and in combination. ResultsDisability prevalence was greater among the Medicaid-insured AYA-WD by +7.6% points (pp)—Medicaid: 11.9% (47,654/333,931), commercial: 4.3% (16,907/392,444). Most AYA-WD had a single impairment, but the prevalence of AYA-WD with two or more impairments was greater among the Medicaid-insured than the commercially insured (+9.9 pp; Medicaid: 33.5% [15,963/47,654], commercial: 23.7% [3992/16, 907]), as was the prevalence of impairment types that were physical (+6.7 pp; Medicaid: 54.7% [26,054/47,654], commercial: 48.0% [8121/16,907]); developmental (+4.1 pp; Medicaid: 35.4% [16,874/47,654], commercial: 31.3% [5290/16,907]); psychiatric (+6.7 pp; Medicaid 21.3% [10,175/47,654], commercial: 14.6% [2470/16,907]), and intellectual (+9.3 pp; Medicaid: 26.2% [12,501/47,654], commercial: 16.9% [2858/16,907]). ConclusionsCWDA and DITA can be used to understand the rates at which impairment types and combinations occur in a population with childhood-onset disabilities.

Exploring Patients’ and Caregivers’ Perception of Healthcare Provision to Cancer Patients During the COVID-19 Pandemic: A Qualitative Study

Background: Patients with cancer are among the groups that are vulnerable to the COVID-19 crisis. Identifying the factors affecting the process of healthcare provision can improve the health services provided to cancer patients. Therefore, this study aimed to explain stakeholders’ perception of the healthcare services provided to cancer patients during the COVID-19 pandemic. Methods: The present qualitative study was conducted using the conventional content analysis method in Iran in 2021. Participants included cancer patients, their families, and healthcare providers, who were selected via purposive sampling. Data were collected through 19 individual interviews and two focus groups and then analyzed using the method proposed by Graneheim and Lundman. Results: Qualitative data analysis revealed seven main categories, including the disruption of care continuity, reduced quality of health services, poor provision of community-based services, lack of comprehensive care, lack of public education, predicting changes in cancer incidence and mortality trends, and ethical challenges. Conclusion: The COVID-19 pandemic has exposed cancer patients to many challenges, including limited access to health services. Therefore, there is a need to facilitate these patients’ access to safe healthcare services.

Consistency of participation over time among persons aging with physical disability as measured by a tool designed for use among community-based organizations

BackgroundCommunity participation measures for persons aging with disability were developed and evaluated to support community-based organizations (CBOs) with efficient assessment of change in participation and need for supports/services to facilitate participation. ObjectiveTo evaluate a set of nine activity domain measures to broadly assess community participation and change in participation over time. MethodsA community-based sample (N = 323) of persons ages 45–65 responded to a survey with repeated measures three times annually (T1, T2, T3) between 2019 and 2022. Nine activity domain measures were developed based on extant research and evaluated with assistance from community-based support service providers. Statistical analyses employed T-tests and chi-square tests to assess change in participation over time, perceptions of participation satisfaction, and assistance needed to facilitate participation. Participants were asked if they thought changes were attributable to aging, the COVID-19 pandemic, or other factors. ResultsFindings showed varying levels of participation across the nine activity domains, with the lowest participation rate for employment and the highest participation rates for personal leisure and managing medications across T1, T2, and T3. Change in participation over the three-year period was limited; most change was reported as activity reduction. In general, respondents indicated that reduction was due to their aging or the COVID-19 pandemic. Personal assistance, transportation, environmental modifications, and improved health were identified as factors needed to help increase participation levels. ConclusionThe activity domain measures demonstrated efficiency in identifying participation rates and change. CBOs may deem them useful for assessing support and service needs to facilitate participation.

Lessons Learned From a Community–University Partnership to Increase HIV Testing Services for Emerging Adults at a Minority-Serving Institution

The success and advancement of HIV prevention efforts with emerging adults from minority communities requires continued and diligent collaboration between researchers, community members, and community-based organizations. This paper provides an overview of a 3-year collaboration between a Minority Serving Institution of Higher Education, and a grassroots, minority servicing HIV prevention agency. In South Florida, a geographic area with high incidence of HIV, we relied on community-based participatory research (CBPR) to guide the implementation of culturally, linguistically, and developmentally appropriate HIV prevention programming for 18 to 24-year-old Latinx university students. The project partnership was organized around: (a) integrating community knowledge through formative research to understand needs and determine relevant risk factors, (b) building a highly collaborative relationship between a large academic institution and community-based service provider, and (c) designing and implementing ongoing, strategic environmental prevention activities through community-involved research. We describe the collaborative partnership and multiple prevention strategies that were implemented. The success of the community–university partnership was highly dependent on the depth and breadth of collaboration, mutual support, and respect among collaborators. To advance sexual health promotion programs designed for Latinx emerging adults, we describe lessons learned for future CBPR implementation that focus on involving members of priority populations in research teams, aligning project voices, navigating internal governmental systems, creating mutual and direct benefits of partnership, and utilizing networks to enhance sustainability.

Causes and decision paths of employee turnover in the homeless service sector

ABSTRACT Community-based service providers working with people experiencing homelessness encounter many occupational challenges and high turnover rates are a challenge in the sector. This qualitative study examined the perceived causes and decision paths of turnover among service providers working with people experiencing homelessness in Canada. In-depth interviews were completed with 40 service providers working in homeless service, supportive housing, and harm reduction programs. Thematic analysis and a deductive-based matrix analysis were used to identify causes and decision paths of turnover, respectively. Primary causes of employee turnover included: (1) career advancement and growth; (2) incongruence between providers’ needs, values, and work position; (3) mental health deteriorations; (4) organizational stability and support issues; and (5) staff dismissal. Further, two contextual factors – low sectoral wages and a transitory work culture – shaped service providers’ occupational experiences and had indirect effects on turnover. Push and pull decisions were the primary paths to voluntary turnover among participants. Overall, the findings highlight that employee turnover often occurs voluntarily when service providers experience unmet occupational or work-interacting personal needs, or want to pursue new career-related opportunities. Practice and policy recommendations, including use of realistic job previews and establishment of workforce development strategies, are made to prevent turnover.