Homelessness Sector Research Articles

Centring lived experience of homelessness in law and policy reform

This reflective work considers homelessness and provides a model of participation for improving homelessness responses through StreetCare, a NSW-based advisory committee of people with diverse lived experiences of homelessness. StreetCare provides unique, essential and pertinent advice to relevant stakeholders in the housing and homelessness sector at the local, state and national level. Through the example of StreetCare, this piece explains how the participation of those with lived experience in reform contributes to better outcomes, to the empowerment of lived experience advocates, and to more equitable laws.

The Needs of Women Using Homelessness Services: The Results of Collaborative Research in London

This paper explores the results of a study conducted in collaboration with the homelessness sector in central London and an academic team. Data were collected on 134 women who used homelessness services in an area of central London during a nine-day window. In addition, fully anonymised service history records, covering an average period of 85 months, were reviewed with the consent of another 59 women with lived experience of homelessness. Nine women also agreed to in-depth interviews. Five key stakeholders in policy and practice were also interviewed. The research supports the findings of earlier research into the gender dynamics of homelessness. The results highlight the presence of a high-cost, high-risk population of women who are characterised by sustained and recurrent experience of homelessness, housing exclusion, and deprivation and who make repeated and sustained use of homelessness and other services without escaping homelessness. Strong associations between domestic abuse and women’s homelessness are evident in the results of the research, again echoing the results of earlier work. The possibilities of developing new strategic responses to women’s homelessness, including specialised forms of Housing First, are considered.

Peer and lay health work for people experiencing homelessness: A scoping review.

Homelessness poses complex health obstacles for individuals and communities. Peer and lay health worker programs aim to increase access to health care and improve health outcomes for PEH by building trust and empowering community-based workers. The scope and breadth of peer and lay health worker programs among PEH has not been synthesized. The primary objective of this scoping review is to understand the context (setting, community, condition or disease) encompassing peer and lay health worker programs within the homelessness sector. The secondary objective is to examine the factors that either facilitate or hinder the effectiveness of peer and lay health worker programs when applied to people experiencing homelessness (PEH). We searched CINHAL, Cochrane, Web of Science Core Collection, PsycINFO, Google Scholar and MEDLINE. We conducted independent and duplicate screening of titles and abstracts, and extracted information from eligible studies including study and intervention characteristics, peer personnel characteristics, outcome measures, and the inhibitors and enablers of effective programs. We discuss how peer and lay health work programs have successfully been implemented in various contexts including substance use, chronic disease management, harm reduction, and mental health among people experiencing homelessness. These programs reported four themes of enablers (shared experiences, trust and rapport, strong knowledge base, and flexibility of role) and five themes of barriers and inhibitors (lack of support and clear scope of role, poor attendance, precarious work and high turnover, safety, and mental well-being and relational boundaries). Organizations seeking to implement these interventions should anticipate and plan around the enablers and barriers to promote program success. Further investigation is needed to understand how peer and lay health work programs are implemented, the mechanisms and processes that drive effective peer and lay health work among PEH, and to establish best practices for these programs.

Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study.

There is a high prevalence of health problems among single people who are homeless. Specialist primary health care services for this population have been developed in several locations across England; however, there have been very few evaluations of these services. This study evaluated the work of different models of primary health care provision in England to determine their effectiveness in engaging people who are homeless in health care and in providing continuity of care for long-term conditions. It concerned single people (not families or couples with dependent children) staying in hostels, other temporary accommodation or on the streets. The influence on outcomes of contextual factors and mechanisms (service delivery factors), including integration with other services, were examined. Data from medical records were collated on participants' use of health care and social care services over 12 months, and costs were calculated. The evaluation involved four existing Health Service Models: (1) health centres primarily for people who are homeless (Dedicated Centres), (2) Mobile Teams providing health care in hostels and day centres, (3) Specialist GPs providing some services exclusively for patients who are homeless and (4) Usual Care GPs providing no special services for people who are homeless (as a comparison). Two Case Study Sites were recruited for each of the specialist models, and four for the Usual Care GP model. People who had been homeless during the previous 12 months were recruited as 'case study participants'; they were interviewed at baseline and at 4 and 8 months, and information was collected about their circumstances and their health and service use in the preceding 4 months. Overall, 363 participants were recruited; medical records were obtained for 349 participants. Interviews were conducted with 65 Case Study Site staff and sessional workers, and 81 service providers and stakeholders. The primary outcome was the extent of health screening for body mass index, mental health, alcohol use, tuberculosis, smoking and hepatitis A among participants, and evidence of an intervention if a problem was identified. There were no overall differences in screening between the models apart from Mobile Teams, which scored considerably lower. Dedicated Centres and Specialist GPs were more successful in providing continuity of care for participants with depression and alcohol and drug problems. Service use and costs were significantly higher for Dedicated Centre participants and lower for Usual Care GP participants. Participants and staff welcomed flexible and tailored approaches to care, and related services being available in the same building. Across all models, dental needs were unaddressed and staff reported poor availability of mental health services. There were difficulties recruiting mainstream general practices for the Usual Care GP model. Medical records could not be accessed for 14 participants of this model. Participant characteristics, contextual factors and mechanisms were influential in determining outcomes. Overall, outcomes for Dedicated Centres and for one of the Specialist GP sites were relatively favourable. They had dedicated staff for patients who were homeless, 'drop-in' services, on-site mental health and substance misuse services, and worked closely with hospitals and homelessness sector services. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (HSDR 13/156/03) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 16. See the NIHR Journals Library website for further project information.

Investigative panel into building and retaining and effective homelessness sector workforce

Investigative panel into building and retaining and effective homelessness sector workforce

An exploration of the implementation of peer work across multiple fields in Ireland

Purpose Peer support work is increasingly becoming part of the delivery of health and social care services. However, in an Irish context, there is a paucity of research in this area. This study aims to investigate the experiences of peers and other key stakeholders across four sectors in Ireland. Design/methodology/approach Qualitative interviews (N = 35) were conducted with key respondents in mental health, substance use, migrant health and homelessness sectors. Data were analysed using thematic analysis and reported using an ecological framework. Findings Peer work is a slowly emerging area of practice, although mental health is further ahead in this journey. Findings suggest that peers are important additions to service delivery but also have various support and development needs. Organisations can encourage and support peers into employment through enacting human resource policy and practices, effective supervision, management and maintaining a positive working culture. Helping other professionals to understand the peer role and how it can function within the wider team is highlighted. National policy and governance structures can also support the emergence of the peer role, which exists in a highly complex arena. Research limitations/implications Peers can play a meaningful role in supporting service users in four sectors of health and social care in Ireland. Structures and processes to help embed these roles into systems are encouraged across micro, meso and macro levels. Implications and limitations are discussed for moving forward with peer work. Originality/value To the best of the authors’ knowledge, this is the first study to include these four areas of practice simultaneously.

Reflective Practice in Homelessness Research and Practice: Implications for Researchers and Practitioners in the Covid-19 Pandemic Era

This discussion paper focuses on “reflective practice” as conceptualized by Donald Schön with its particular application in homelessness research and practice. Reflective practices are slowly gaining ground among scholars and practitioners engaged in the homelessness sector since the onset of the pandemic where increasing reliance on tele-mediated communication has transformed the ways in which research and practice take place. This paper starts by revisiting the concept of reflection as propounded by John Dewey and later recalibrated by Donald Schön, followed by a discussion of how two specific reflective practices, namely reflection-in-action and reflection-on-action, can be leveraged in homelessness research and practice. The paper concludes by discussing some implications of such practices for researchers and practitioners involved in the homelessness sector in the pandemic era. These implications focus on issues such as housing affordability and affordable housing, case management and support services, and barriers caused by the pandemic to homelessness research.

The Impact of the COVID-19 Pandemic and Associated Societal Restrictions on People Experiencing Homelessness (PEH): A Qualitative Interview Study with PEH and Service Providers in the UK

People experiencing homelessness (PEH) faced unique challenges during the COVID-19 pandemic, including changes to accommodation availability, societal restrictions impacting access to essentials like food, and services moving to online and remote access. This in-depth qualitative research aims to add to the existing, but limited research exploring how the pandemic affected PEH. 33 semi-structured qualitative interviews (22 with PEH during the pandemic and 11 with homelessness sector service providers) were undertaken in the United Kingdom between April 2021 and January 2022. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. To ensure consistency of coding, 10% of interviews were coded by two researchers. The PEH sample was 50% female, aged 24-59 years, 59% white British, and included people who had lived in hostels/hotels, with friends/family, and on the streets during the COVID-19 pandemic. Providers came from varied services, including support charities, housing, and addiction services. Five key themes were identified: (i) the understanding of and adherence to public health guidance and restrictions; (ii) the experience of people accommodated by the 'Everyone In' initiative; (iii) the impact of social distancing guidelines on PEH experiences in public spaces; (iv) the importance of social support and connections to others; and (v) how homelessness services adapted their provision. Policy makers and public health communicators must learn from PEH to maximize the effectiveness of future public health strategies. Housing providers and support services should recognize the implications of imposing a lack of choice on people who need accommodation during a public health emergency. The loss of usual support for PEH triggered a loss of ability to rely on usual 'survival strategies', which negatively influenced their health. This research highlights successes and difficulties in supporting PEH during the COVID-19 pandemic and informs planning for similar public health events.

PIE in PICU and NICU: Developing Psychologically Informed Environments

This paper sets out how the Psychologically Informed Environments (PIE) model, which originated in the homelessness sector, can be applied to the complex medical environments of Neonatal and Paediatric Intensive Care (P/NICU). Whilst there are key differences between NICUs and PICUs, there exist so many commonalities, most notably the similarity of parent and staff experiences and the coexisting medical, psychological and developmental needs of babies and children. PIE provides a whole systems approach to improving psychological wellbeing in all those in the environment: babies, children, parents, families and staff. The paper explores how PIE methodology could be applied to P/NICUs; offering examples grounded in practice; and describing how PIE can meet the fundamental needs of babies and children, parents and staff and has the potential to prevent the challenging environment having a negative impact on those who are exposed to it.

The impact of the COVID-19 pandemic on people experiencing homelessness: a qualitative interview study in the UK

BackgroundPeople experiencing homelessness faced unique challenges during the COVID-19 pandemic, including changes to accommodation availability, societal restrictions impacting access to essentials like food, and services moving to remote access. There is a paucity of in-depth qualitative research exploring how the pandemic affected this population, which this research aims to address. Methods33 semi-structured qualitative interviews (22 with people who experienced homelessness during the pandemic and 11 with homelessness sector service providers) were done in the UK between April 26, 2021, and Jan, 25, 2022. Ethical approval was granted by the University College London research ethics committee (Project ID: 14895/005) and all participants provided informed consent. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis utilising NVivo software. Four interviews were coded by two researchers for consistency of codes. FindingsIn our sample of people experiencing homelessness, 11 (50%) were female, 13 (59%) White British, all were aged between 24 and 59 years, and all had lived in hostels or hotels, with friends or family, or on the streets during the pandemic. Providers interviewed worked for varied services, including support charities, housing, and addiction services. Four key themes were identified: understanding of and adherence to COVID guidelines; changes to accommodation and experiences of “Everyone In” (a government initiative in which people sleeping on the street or in accommodation where it was difficult to self-isolate were provided emergency accommodation); living through a pandemic while navigating homelessness; and, adaptations to service provision for people experiencing homelessness. InterpretationPolicy makers and public health communicators must learn from people experiencing homelessness to maximise effectiveness of future public health strategies. Housing providers and support services should recognise the implications of imposing a scarcity of choice on people who need accommodation during a public health emergency. The loss of usual support was destabilising for people experiencing homelessness, triggering a need to adopt survival tactics which negatively influence their health. Although this research was limited by the possibility that views expressed might differ from those unwilling or unable to participate, it does highlight successes and difficulties in supporting people experiencing homelessness during the COVID-19 pandemic and informs planning for similar public health events. FundingNuffield Foundation, Wellcome Trust.

“They have their security, we have our community”: Mutual support among people experiencing homelessness in encampments in Toronto during the COVID-19 pandemic

Unaffordable housing is a growing crisis in Canada, exacerbated by the COVID-19 pandemic, yet perspectives of people living outdoors in encampments have primarily gone unheard. We conducted qualitative interviews with encampment residents to explore how mutual support occurred within the social context of encampments. We found that mutually supportive interactions helped residents meet basic survival needs, as well as health and social needs, and reduced common health and safety risks related to homelessness. The homelessness sector should acknowledge that encampment residents form their own positive communities, and ensure policies and services do not isolate people from these beneficial social connections.

“We actually came to a point where we had no staff”: Perspectives of Senior Leadership in Canadian Homelessness Service Providers During COVID-19

Canadian homeless service providers (HSPs) serve individuals with complex needs. COVID-19 has introduced additional challenges to service provision leading to increased pressure on the organizations and the staff they employ. Little is known about how Canadian HSPs were affected by the global pandemic. The current research sought to address this knowledge gap by using qualitative research methodology to assess leaders’ perception of staff well-being and identify specific organizational challenges associated with the COVID-19 pandemic. 42 semi-structured interviews were conducted with senior leadership in Canadian HSPs, including Program Directors, Executive Directors, CEOs, key department managers and program coordinators. Although unanticipated, themes relating to positive outcomes and growth were also identified. Qualitative analysis revealed four overarching themes within the data: Organizational Challenges, Individual Challenges, Organizational Opportunities and Individual Opportunities. Implications of this study include informing pandemic preparedness in the homelessness sector and reducing occupational risks for staff.

Coordinated Access and Coordinated Entry System Processes in the Housing and Homelessness Sector: A Critical Commentary on Current Practices

Coordinated access and coordinated entry systems have become central features in community responses to homelessness in Canada and the United States. Coordinated systems assess individuals and families experiencing homelessness on their needs, prioritize them based upon these needs, and then match them to appropriate housing. Despite the widespread implementation of coordinated systems, there have been few evaluations of the effectiveness of these systems. The current article fills this knowledge gap by providing an overview of the evidence and a critical commentary on the four pillars of coordinated systems—(a) access, (b) assessment, (c) prioritization, and (d) matching and referral—and presenting a critique of current practices. Using the policy streams framework, the critique demonstrates that the components of coordinated systems lack a strong evidence base and that there is little evidence that coordinated systems improve individual-level outcomes such as length of stay in housing. Further, current coordinated system practices, particularly assessments, may be contributing to inequitable access to housing. Limitations of the critique and considerations for implementation are discussed.

Homelessness within the COVID-19 Pandemic in Two Nova Scotian Communities

Expanding the emergent literature on homelessness and the COVID-19 pandemic, this qualitative study presents a portrait of the homelessness sector in two Nova Scotian, Canadian communities: Halifax Regional Municipality and Cape Breton Regional Municipality. This research provides an understanding of the health and wellness of populations experiencing homelessness during the first waves of the COVID-19 pandemic, the processes involved in supporting populations experiencing homelessness during the pandemic, and determining what has worked, what has not, and required changes. The data will inform relevant emergency crises and disaster relief responses for those experiencing homelessness and those who are marginalized, vulnerable, and living on the fringes of society. What follows are the core themes, and lessons learned, along with recommendations that capture the narratives from a group of individuals experiencing homelessness throughout the pandemic and those tasked with developing, supporting, innovating, and funding the disaster responses in two Nova Scotian communities.

The inclusion of youth with lived experience of homelessness in emerging networked publics: Challenges in online storytelling and allyship

There has been considerable debate over the extent to which vulnerable and diverse populations are politically involved in decision-making. Specifically in Canada’s homelessness sector, there is a macro-level push to include individuals with lived experience of homelessness in the policymaking process. This research paper will explore the ways in which youth with lived experience of homelessness and their allies are engaging in online forms of activism and storytelling, and ultimately examine this interaction under the idea that media is both a practice and an imaginary. This study situates this argument in the wide critique of Jürgen Habermas’ exclusionary public sphere. Instead, this paper examines the emerging concepts of “affective publics” and “networked publics” to understand how online marginalized voices are only empowered to the extent to which they perform in mediated spaces to gain visibility. By drawing on Pierre Bourdieu’s articulation of social capital, this study examines recent examples of Canadian organizations amplifying youth voices on Instagram to interrogate some of the implications that arise in online allyship and storytelling. Keywords: affective publics, networked publics, youth homelessness, lived experience, storytelling, allyship, activism, social capital

The effects of COVID-19 on the mental health and job stress of frontline homelessness services workers in Texas (U.S.).

As the COVID-19 pandemic persists in the U.S. and elsewhere, there is a growing need to understand the impacts of the pandemic on essential and frontline workers. Given the dearth of research on the experiences of homelessness services workers during the COVID-19 pandemic, this study aimed to understand the impact of COVID-related stressors in the workplace on the wellbeing of the homelessness services workers in the state of Texas (U.S.). Using a cross-sectional survey design, the analysis focusses on examining the relationship between COVID stressors with mental health symptoms and job stress indictors. Data were collected from a sample of 132 frontline homelessness services workers across the state during April, May and June of 2021. Primary outcomes of interest were measured with the Depression, Anxiety and Stress Scale (DASS-42) and the Professional Quality of Life Scale (ProQOL). Multiple linear regression models were specified to explore associations between the outcomes of interest and predictor variables (i.e. demographics, work experiences and COVID-19 stressors). Results showed that perceiving a decline in job satisfaction because of the COVID-19 pandemic was associated with higher stress (β=++0.18), 95% CI [.13, 6.68], higher burnout (β=0.32), 95% CI [2.54, 7.30] and lower compassion satisfaction (β=0.42), 95% CI [-8.14, -3.69]. Additionally, being worried about contracting COVID-19 at work was associated with an increase in burnout (β=0.19), 95% CI [.40, 4.79]. Also notable is that older age and Black/African American race were associated with lower stress, lower burnout and higher compassion satisfaction. Implications for supporting the homelessness sector through high-quality supervision, useful training, adequate benefits and routine check-ins are discussed.

The impact of COVID-19 on research within the homeless services sector

Purpose This paper aims to discuss the challenges of conducting research with homelessness services frontline workers during the COVID-19 pandemic. Design/methodology/approach Between 2015 and 2019, the research team surveyed frontline staff in three cities about their psychosocial stressors and needs. In 2020, the authors replicated the previous study and expanded data collection to seven cities across Canada to determine the extent to which the COVID-19 pandemic impacted the well-being of frontline staff. This report describes how the authors adapted the research methodologies to continue work throughout the pandemic, despite various restrictions. Findings The original studies had very high participation rates because of several methodological approaches that minimized barriers, especially in-person data collection. During the pandemic, distancing requirements precluded replication of these same methods. Research strategies that enabled staff participation during working hours, with designated time allotted for participation, was key for ensuring high participation rates, as access to technology, availability of free time and other factors frequently make online survey research a hardship for these staff. Restrictive interpretation and regional variations of COVID-19 guidelines by some research ethics boards were also a challenge to rapid and responsive data collection. Originality/value Few studies describe the experiences of frontline workers in the homelessness sector, and quantitative reports of their experiences are particularly scant. Consequently, little is known about specific methodologies that facilitate large-scale data collection in the homelessness services sector. The present research advances the field by providing lessons learned about best practice approaches in pre and post COVID-19 front line worker contexts. A strength of this research is the well-controlled design. The authors collected data within several of the organizations that had previously participated. This fortunate baseline provided opportunity for comparison before and during the pandemic; the authors can highlight factors that might have had influence during the pandemic.

Social Work Education and Homelessness: Mobilising Academia–Industry Partnerships to Create a Homelessness Subject

ABSTRACT Homelessness is a significant issue facing many Australian people, and one that social workers are likely to encounter in their professional lives. At present, though, there are no guidelines for social work programs on how to transfer homelessness knowledge into social work education programs. Social work curricula need to be informed by homelessness research, policy, and practice to reflect the contemporary Australian terrain, and to be responsive to emerging concerns. One approach, discussed in this article, is the mobilisation of an academia–industry partnership to create a dedicated homelessness subject for social work students. The subject, profiled here, offers an example of how social work can incorporate homelessness knowledge to benefit graduates, the sector, consumers, and academia. IMPLICATIONS Homelessness is a critical issue for social work practice, policy, and research, the impacts of which graduates are likely to encounter regardless of their specific fields of practice. There are no current guidelines for including homelessness in Australian social work education programs. A dedicated social work subject can furnish graduates with a strong foundation for entering the homelessness sector. Academia–industry partnerships have the potential to provide a systematic method of translating homelessness knowledge to future social workers through educational programs.

A qualitative study of the Scottish homeless service provisions through the production of reflexive mapping exercises

BackgroundThe Scottish oral health and psychosocial wellbeing programme, Smile4life, identified a scarce knowledge of the health and social services available for those going through homelessness or at risk of becoming homeless. The Public Bodies (Joint Working) (Scotland) Act 2014 aims to integrate health and social care in Scotland to meet the needs of vulnerable populations. The Reflexive Mapping Exercise aims to integrate care by providing a framework to map services that allows for analysis of the geographic distribution and types of support that has been offered. The reflexive component discusses joint strategies to integrate services, improve practices, and reduce unequal distribution that might marginalise individuals, limiting their access and engagement with services. MethodsThe reflexive mapping framework aims to maximise participation and development through co-designed participatory research, involving an advisory group composed of key stakeholders and individuals with lived experience. Policy makers and practitioners working in the homelessness sector collaborated to gather, review, and update the data collected about services through online searches, telephone calls, institutional visits, and event consultations. An analysis of the current service provision was made to identify deficits and areas to improve. FindingsThe mapping is a visual and descriptive publication that includes services from different areas of support and their referral pathways. The completed mappings and reflexive exercises have shown a scarcity of services allocated to the most deprived areas of Scotland, with the majority of services seeking to address crisis periods with little aim at prevention, early intervention, and sustainability. InterpretationThe mapping process identified the need to take a prophylactic approach and create a more equitable distribution of services. The Reflexive Mapping Exercise helps to provide a framework that promotes communication and integration of health and social care services among practitioners and vulnerable services users. A reflexive approach helps to plan the strategic delivery of homeless services in Scotland with the service user at the forefront of care. The limitations surrounding the dynamic nature of service provision changes have been identified and are planned to be addressed through the formation of an online interactive resource. FundingThis work was supported by Scottish Government (grant number 121.80.4497).

Queer homelessness: the distinct experiences of sexuality and trans-gender diverse youth

Queer young people, or young people who are sexuality diverse and/or trans and gender diverse, face a higher lifetime likelihood of homelessness than their cis-heterosexual peers. However, queer young people are often treated as a homogenous group within research, a methodological decision that obscures differences on the basis of gender identity. Drawing upon 2,159 intake records from a youth housing program in Australia, the authors compare the experiences of (i) cis-heterosexual; (ii) sexuality diverse; and (iii) trans and gender diverse young people across a number of domains related to vulnerability, including victimization and violence, health, substance use, and support systems. Eighteen percent of young people in the sample identified as queer, and five percent identified as trans or gender diverse. Queer young people were more likely to report family and intimate partner violence, poor mental health, and recent substance use than cis-hetero youth. Trans and gender non-conforming respondents were more likely than sexuality diverse peers to be experiencing current, rather than past, family violence, and less likely to report intimate partner violence and substance use. We conclude by discussing these issues within the context of past research and their implication for future research and practice within the homelessness sector.