Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions

Abstract

Promoting timely and continuous care for people experiencing homelessness has been a challenge in many jurisdictions, plagued by access barriers and service fragmentation. As part of a larger programme evaluation, this study used qualitative methods to examine the role of a brief interdisciplinary intervention in supporting continuity of care for this population in a large Canadian urban centre. The intervention provides time-limited case management, primary and psychiatric care, and peer accompaniment to homeless adults with unmet health needs discharged from hospital. Data were collected from 52 study participants between July 2013 and December 2014. Three focus groups were conducted with service providers and people with lived experience of homelessness, and 29 individual, semi-structured interviews were conducted with service users and other key informants. Transcripts were analysed using thematic analysis. Analysis was informed by existing frameworks for continuity of care, while remaining open to additional or unexpected findings. Findings suggest that brief interdisciplinary interventions can promote continuity of care by offering low-barrier access, timely and responsive service provision, including timely connection to long-term services and supports, appropriate individualised services and effective co-ordination of services. Although brief interdisciplinary interventions were perceived to promote access, timeliness and co-ordination of care for this population with complex health and social needs, gaps in the local service delivery context can present persisting barriers to care comprehensiveness and continuity. K E Y W O R D Sbrief interventions, continuity of care, homelessness, qualitative research, service co-ordination

Health supports needed for homeless persons transitioning from hospitals

“…The literature suggested that after‐care can be scarce for certain patients, particularly those who have intensive, complex and ongoing needs, such as medically ill patients who use substances who are hard to accommodate in the community or who are not registered with a general practitioner (Healthwatch England, ; Lamanna et al; Raven et al, ). Addressing the lack of medical care, social support and unstable housing experienced by homeless patients is often not possible during relatively brief hospital admissions (Raven et al, ).…”

“…Indeed, in order for staff to assist with coordination and navigation of services, sufficient supports and resources need to be available. The literature describes various challenges reported by both patients and staff as a result of a lack of comprehensive services and supports after discharge (Hauff & Secor-Turner, 2014;Healthwatch England, 2015), including lack of access to specialty health services such as those needed for traumatic brain injury and mental health (Lamanna et al, 2017), lack of affordable or appropriate accommodation or step-down care (Hauff & Secor-Turner, 2014;Queen's Nursing Institute, 2015) and lack of rehabilitation beds (Homeless Link & St Mungo's, 2012).…”

‘Genuine doctor care’: Perspectives on general practice and community‐based care of Australian men experiencing homelessness

“…Care provision is often challenging, and some clients consume considerable hospital resources (Cornes et al, ). Recent reviews suggest that a number of community‐based healthcare interventions may be effective: services which ‘reach out’ to clients and ‘reach in’ to hospital‐based services; subacute medical respite and recovery centres; peer support and other service user involvement; and personalised case workers who coordinate care, and empower and advocate for clients (Davies & Wood, ; Henderson, Madden, & Kelsall, ; Lamanna et al, ; Luchenski et al, ; Scullion, Somerville, Brown, & Morris, ).…”

“…Coordination of care is a key challenge in providing healthcare to people with complex health and social needs (Cornes, Manthorpe, Joly, & O'Halloran, S., ). Fragmentation and duplication of the various services and agencies involved in the care of homeless people are common problems (Canham et al, ; Darbyshire, Muir‐Cochrane, Fereday, Jureidini, & Drummond, ; Jego et al, ; Lamanna et al, ): clients, providers and even case managers have reported finding it difficult to navigate through the various services involved in providing care for a single client (Cornes et al, ; Scullion et al, ).…”

Evidence for an integrated healthcare and psychosocial multidisciplinary model to address rough sleeping

“…Notwithstanding that a lack of affordable housing mitigates the effectiveness of health services (Canham et al, ) and renders homeless people dependent upon charities and social services (Parsell, ), research demonstrates how healthcare can adapt to meet the needs of homeless populations. Continuity of care is achieved for homeless people discharging from hospital when staff reduce barriers to healthcare access, provide integrated services and enact proactive engagement practices (Canham et al, ; Cornes et al, ; Lamanna et al, ). Integrating a General Practitioner and nurse within a hospital increases care received by homeless people and the functioning of the hospital and the secondary care system (Hewett, Halligan, & Boyce, ).…”