Where’s the Disconnect? Exploring Pathways to Healthcare Coordinated for Youth Experiencing Homelessness in Toronto, Canada, Using Grounded Theory Methodology

Abstract

About 900 youth experiencing homelessness (YEH) reside at an emergency youth shelter (EYS) in Toronto. Several EYSs offer access to healthcare based on youth’s needs, including access to primary care, and mental health and addictions support. However, youth also require healthcare from the broader health system, which is often challenging to navigate and access. Currently, little is known about healthcare coordination efforts between the EYS and health systems for YEH. Using grounded theory methodology, we interviewed 24 s stakeholders and concurrently analyzed and compared data to explore pathways to healthcare coordinated for youth who resided at an EYS in Toronto. We also investigated fundamental parts (i.e., norms, resources, regulations, and operations) within the EYS and health systems that influence these pathways to healthcare using thematic analysis. A significant healthcare coordination gap was found between these two systems, typically when youth experience crises, often resulting in a recurring loop of transition and discharge between EYSs and hospitals. Several system parts within each system act interdependently in hindering adequate healthcare coordination between the EYS and health systems. Incorporating training for system staff on how to effectively coordinate healthcare and work with homeless populations who have complex health needs, and rethinking information-sharing policies within circles of care are examples of how system parts can be targeted to improve healthcare coordination for YEH. Establishing multidisciplinary healthcare teams specialized to serve the complex needs of YEH may also improve healthcare coordination between systems, and access and quality of healthcare for this population.

Where are the links? Using a causal loop diagram to assess interactions in healthcare coordination for youth experiencing homelessness in Toronto, Canada

“…These factors intercept pathways to prevention response and timely healthcare, sometimes leading youth to inevitably experience health crisis such as overdosing, alcohol poisoning and suicide attempt. When experiencing crises, youth often enter a vicious cycle, which we refer to as the endless shelter–hospital loop, where youth are sent to receive emergency care at hospitals, are prematurely discharged into the EYS system and then re-enter the health system for similar health concerns/crises [ 14 ]. This critical disconnect requires strengthening healthcare coordination within and between systems, to improve the healthcare trajectories and health outcomes of YEH.…”