Managing Multiple Disadvantages: The Regulation of Complex Needs in Emergency Shelters for the Homeless

Met and unmet needs of homeless individuals at different stages of housing reintegration: A mixed-method investigation

“…Safety was the only category in which individuals reported more unmet than met needs due to the prevalence of aggression, particularly for emergency shelter users and temporary housing occupants, as well as the administrative problems and unemployment reported by all participants. These factors, already mentioned in previous studies [ 15 , 21 , 60 , 61 ], have represented key barriers to effective social integration among homeless individuals, including those living in permanent housing. Aggression has been reported as an important risk factor, suggesting that homeless individuals are particularly victimized by stigma and discrimination from the general population.…”

Integrated responses for people with cognitive disability and complex support needs: Factors and principles

“…Barriers to the successful implementation of practice models at the service level included administrative and bureaucratic impediments such as an organisational culture unreceptive to relational approaches to complex populations (Keesler, 2014;Rhodes et al, 2013), rigid screening and assessment requirements and intake procedures that can result in the denial of services for those deemed too 'complex ' (Dyer and Biddle, 2016;Quirouette, 2016) and long waiting lists (Campbell et al, 2017;Kirst et al, 2015;Johnson et al, 2015). Also noted was an overemphasis on risk (Dyer and Briddle, 2016; Kelly, 2017), sometimes coupled with poor guidance regarding what constituted 'risk' (Keller, 2016).…”

“…Identified systemic barriers included the marginalisation of specific groups who are disproportionately exposed to risk factors for poor mental health, substance abuse, suicide and injury, such as people with disability and complex support needs (Quinlan and Smele, 2017), Aboriginal people with disability (McIntrye and Townsend, 2017;Stephens et al, 2014;Quirouette 2016) and people from culturally and linguistically diverse backgrounds (Bogenschutz, 2014). This marginalisation was often compounded by social issues including poverty and discrimination (Caxaj, 2016;Gardiner et al, 2017;Henning, 2016;Johnson et al, 2015), which services frequently did not adequately consider (Davidson et al, 2014;Quirouette, 2016). Additionally, people with complex support needs living in rural and remote communities were identified as experiencing specific barriers to service access due to poor availability of geographically proximate specialist services (Barbabella et al, 2017;Bellon et al, 2015;Caxaj, 2016;Hoeft et al, 2018).…”

“…Despite an increasing focus on integrated care, interrelated and compounding complexities often result in individuals having to navigate uncoordinated or siloed systems with little to no support (Bogenschutz, 2014;Hardwick, 2013;Kelly, 2017;Sestoft et al, 2014;Whiteford et al, 2014). Transitions between, for example, primary care and specialist services were identified as points of high service dropout (Padwa et al, 2016); or those remaining in services become 'stuck' in services that are ill-equipped and inappropriate for long-term support, such as emergency shelters or the criminal justice system (Dyer and Biddle, 2016;Quirouette, 2016). It has been found that these person-level difficulties are exacerbated by a lack of accessible or culturally relevant information (Bogenschutz, 2014;McIntyre et al, 2017;Olsen and Carter, 2016), a reluctance on behalf of the individual to engage with mainstream services (Day et al, 2016;de Vet et al, 2017;Dyer and Biddle, 2016) and negative experiences due to staff attitudes (Davies et al, 2016;Venville et al, 2016;Quirouette, 2016).…”

“…Transitions between, for example, primary care and specialist services were identified as points of high service dropout (Padwa et al, 2016); or those remaining in services become 'stuck' in services that are ill-equipped and inappropriate for long-term support, such as emergency shelters or the criminal justice system (Dyer and Biddle, 2016;Quirouette, 2016). It has been found that these person-level difficulties are exacerbated by a lack of accessible or culturally relevant information (Bogenschutz, 2014;McIntyre et al, 2017;Olsen and Carter, 2016), a reluctance on behalf of the individual to engage with mainstream services (Day et al, 2016;de Vet et al, 2017;Dyer and Biddle, 2016) and negative experiences due to staff attitudes (Davies et al, 2016;Venville et al, 2016;Quirouette, 2016). Additionally, the evidence base consistently referenced reports of the person with complex support needs and/or their support networks experiencing marginalisation in decision-making processes relating to their needs (Keller, 2016;Kelly, 2017;Nicholas et al, 2017;van Rensburg and Fourie, 2016;Venville et al, 2015).…”