Peer Reviewed Articles on Homeless and Health Care

• Loading metrics

Open up Access

Peer-reviewed

Enquiry Commodity

Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: A Delphi consensus study

• Claire East. Kendall,
• Christine Mathew,
• Sarah Crispo,
• Vivian Welch,
• Anne Andermann,
• Sebastian Mott,
• Christine Lalonde,
• Gary Bloch,
• Alain Mayhew,
• Tim Aubry,
• Peter Tugwell,
• Vicky Stergiopoulos,
• Kevin Pottie

Establishing need and population priorities to amend the health of homeless and vulnerably housed women, youth, and men: A Delphi consensus report

• Esther S. Shoemaker,
• Claire E. Kendall,
• Christine Mathew,
• Sarah Crispo,
• Vivian Welch,
• Anne Andermann,
• Sebastian Mott,
• Christine Lalonde,
• Gary Bloch,
• Alain Mayhew

x

• Published: April 16, 2020
• https://doi.org/10.1371/journal.pone.0231758

Figures

Abstract

Groundwork

Homelessness is ane of the virtually disabling and precarious living weather condition. The objective of this Delphi consensus study was to identify priority needs and at-risk population subgroups among homeless and vulnerably housed people to guide the evolution of a more responsive and person-centred clinical do guideline.

Methods

We used a literature review and expert working group to produce an initial listing of needs and at-risk subgroups of homeless and vulnerably housed populations. Nosotros then followed a modified Delphi consensus method, asking expert wellness professionals, using electronic surveys, and persons with lived experience of homelessness, using oral surveys, to prioritize needs and at-take chances sub-populations across Canada. Criteria for ranking included potential for touch, extent of inequities and burden of illness. We fix ratings of ≥ 60% to make up one's mind consensus over three rounds of surveys.

Findings

Eighty four health professionals and 76 persons with lived experience of homelessness participated from beyond Canada, achieving an overall 73% response rate. The participants identified priority needs including mental health and addiction intendance, facilitating access to permanent housing, facilitating access to income back up and instance management/care coordination. Participants also ranked specific homeless sub-populations in need of additional research including: Indigenous Peoples (First Nations, Métis, and Inuit); youth, women and families; people with caused brain injury, intellectual or physical disabilities; and refugees and other migrants.

Interpretation

The inclusion of the perspectives of both skilful health professionals and people with lived experience of homelessness provided validity in identifying real-world needs to guide systematic reviews in four key areas co-ordinate to priority needs, as well as launch a number of working groups to explore how to adapt interventions for specific at-risk populations, to create evidence-based guidelines.

Citation: Shoemaker ES, Kendall CE, Mathew C, Crispo South, Welch V, Andermann A, et al. (2020) Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: A Delphi consensus report. PLoS 1 15(4): e0231758. https://doi.org/10.1371/journal.pone.0231758

Editor: Stefano Federici, Università degli Studi di Perugia, Italy

Received: July fifteen, 2019; Accustomed: April 1, 2020; Published: April 16, 2020

Copyright: © 2020 Shoemaker et al. This is an open up access article distributed under the terms of the Artistic Commons Attribution License, which permits unrestricted use, distribution, and reproduction in whatsoever medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Data files.

Funding: This manuscript was funded by Inner City Wellness Associated (ICHA), Toronto, Canada. The funders had no office in written report blueprint, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests be.

Introduction

Homelessness is recognized as i of the almost disabling and precarious conditions in high income countries [1]. Homelessness may be defined as a land in which an private or family is without stable, permanent, or appropriate housing, and lacks the firsthand prospect, means and ability of acquiring a domicile [2]. This definition assumes homelessness results from both a lack of affordable housing and an interplay between financial, cognitive, behavioral and concrete challenges, or structural factors such as racism and discrimination. In Canada, for example, men who are chronically homeless face an estimated life expectancy of 43 years of age and women confront a life expectancy of 53 years of age, compared to the average life expectancy of eighty years for men and 84 years for women in Canada. These premature and preventable deaths occur in marginalized populations and are associated with a large proportion of physical, mental health and substance use morbidity [iii].

In preparing for our Delphi consensus method, we gained a new appreciation for the increasing diversity of homeless populations, including gender, age, ethnicity and types of indigenous populations. Equally such, we included a list of subpopulations we should address in the development of our clinical guidelines [iv]. In 2014, for example, an estimated 235,000 people experienced homelessness in Canada, 27.iii% of whom were women and 18.7% were youth, with a growing number of seniors [4,5]. Over-represented homeless populations included Ethnic Peoples (Get-go Nations, Métis, and Inuit), people with disabilities, veterans, newly arrived refugees and other migrants, and gender diverse people [4]; while over one fifth of people with psychological or learning disabilities experience subconscious homelessness [half dozen]. As a issue, we decided to include persons with lived experience of homelessness in our working group and every bit participants in the Delphi method [7].

Primary healthcare practitioners may benefit from structured training, support, and clinical guidelines to address the multimorbidity, advocacy and social needs of this population [8,nine]. Engaging stakeholders, including people with lived experience, to prioritize needs and populations that volition then be scientifically assessed using systematic reviews, may improve real-world trustworthiness and ultimately uptake of the final guidelines [x]. This arroyo has been implemented by the National Institute for Health and Care Excellence in the United Kingdom, which engages Denizen Panels to include the voices of lay members into clinical care guidelines [11]. Our approach is informed past the methods outlined by the MuSE (Multi-Stakeholder Eastngagement Consortium) [12]. and the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) group to develop health guidelines [13]. The objective of our Delphi consensus report was therefore to engage practiced health professionals and people with lived feel in a priority setting consensus process for needs and populations and to ultimately guide the development of show-based clinical guidelines.

Methods

Study design

We used a modified Delphi arroyo using 3 phases, which are outlined beneath [8,xiv]. This method has been successfully used for priority setting for other marginalized populations [15–17].

Five members of the inquiry team, which included two health professionals, family physicians and two persons with lived feel of homelessness, all with expertise in homeless wellness care, and a scientist with expertise in evaluating modify, met in person in July 2017. The grouping reviewed literature and reports outlining the prevalence of disease and bear upon of homelessness as described in the introduction, as well as current approaches to delivering care for at take chances populations. We airplane pilot tested the survey with four adept health professionals and iv lived experience participants. The working grouping modified questions to ensure multi-stakeholder clarity and acceptability. They developed an initial list of needs and at hazard homeless wellness populations for experts to consider in recommending priorities for homeless health guidelines (encounter Delphi Round 1 in S1 Appendix).

Ethics blessing

We obtained ethics review and approving from the Bruyère Enquiry Ideals Board (Ottawa, Ontario) (M16-17-012).

Survey participants

We invited good health professionals and persons with lived experience of homelessness from beyond Canada to participate in our Delphi. We used purposeful snowball sampling approaches amidst our homeless wellness networks. We purposefully selected participants to ensure the inclusion of a variety of local perspectives, including indigenous perspectives.

Canadian wellness professionals from family unit medicine, internal medicine, psychiatry and nursing were purposely identified using the post-obit inclusion criteria: a) homeless health expertise and/or b) provincial or territorial variety province and/or c) research in the area of homeless wellness. Every health professional was ultimately selected for their knowledge in homelessness. In add-on, we decided to include people with lived experience of homelessness. Due east-mail invitations were sent to each expert to make up one's mind interest and to explain the fourth dimension commitment involved in participating in the Delphi process.

Certain people were selected directly from our network, but the majority of participants were selected from 10 sites beyond Canada, shelters, food banks, and other community organizations. In these scenarios, ane of our community outreach workers collaborated with local staff to select, invite and verbally deliver the survey to participants.

Survey assistants and analysis

The Delphi Consensus process included 3 surveys rounds. We administered 3 rounds of surveys using Survey Monkey from May 15, 2017 to Nov 15, 2017. Each survey was live for three–4 weeks and two reminders were sent. For people with lived experience, a research staff person interviewed the accepting participant and sent paper survey results by fax. The definition of the consensus was determined before the analysis of the circular by the Delphi working group and in consultation with an epidemiologist. Investigators were blinded to the results during the data assay. Follow-up was done through electronic mail and phone telephone call or using local contacts with community partners. If a participant did not reply afterward 3 follow-upwards attempts over several weeks, they were removed from the next round.

Round i

In Delphi circular 1 (Encounter S2 Appendix and S3 Appendix), we collected participants' characteristics such as practitioner specialty, historic period range and gender. We provided participants with a list of seven potential priority needs as well as a list of 7 at-risk populations. The objective for all participants was to rank the highest priority needs considering value added (opportunity for a unique and relevant contribution), level of inequity (reduction of unfair and preventable wellness inequities) and burden of condition (number of people that may suffer from a disease or condition) [18]. They besides ranked the most at take chances populations from a list of vii previously identified populations. Microsoft Excel 2010 was used to run descriptive statistical analyses, including hateful and standard difference. Participants were too asked to list additional priority needs and at gamble populations that were missing from the review generated lists. These were afterward added to the list for round two (see Delphi Round 1 Survey, S1 Appendix).

Round two

Round two of the Delphi consisted of two sections. Section one included the priority needs that ranked in the elevation 60% of participant ranking, including experts and people with lived experience. We would later study the experts and lived experience results separately but for our Delphi process we included both groups together. A mean rank (and standard departure) was calculated for each need [19]. In section two, participants were asked to select their four highest priorities from a list of ix needs including those from the first circular and an additional two based on participants' comments from round one. They were asked to consider the following criteria: added value, equity, and burden of affliction.

Round three

Round three of the Delphi survey included priority needs and at risk populations identified in the previous round. No free-text selection was provided and no qualitative data was gathered during this round. People with lived experience had the option to answer step one and two surveys consecutively, and significant effort was fabricated to follow upwardly with them to include them in the tertiary and final round of the survey.

The third and final circular built consensus on the need and population ranking. We finalized rankings at a squad meeting of experts working in the field of evidence-based homeless wellness. Electronic survey participants had the choice to complete the survey using Survey Monkey or to request paper copies to facilitate completion. Nosotros analyzed the information using Microsoft Excel 2010.

Results

We reached a 73% response rate amid health professionals (114 invited and 84 completed the start round of the survey). It was difficult to estimate the response rate of people with lived experience of homelessness given the majority were approached past community volunteers from the organization partners. Reasons why participants chose non to participate in all steps included exit of absence or sabbatical leave, clinical workload, or reasons not described. Please refer to Fig 1 for the number of participants in each round of the Delphi consensus process.

Tabular array 1 outlines the demographic characteristics of all Delphi survey participants. In full, six Canadian provinces and ten urban centres were represented. The bulk of participants came from Ontario (61.xc% health professionals; 53.95% people with lived feel). Participants in both groups were well balanced in terms of gender and although all age groups were included in the survey, very few participants were younger than 25 years sometime whereas people with lived experience were on average slightly older than the health professional group. Approximately 80% of participants in both groups listed English language every bit their first linguistic communication. The sex, historic period, and first language distribution among people with lived experience and health professionals remained very similar across the three rounds. Amidst people with lived experience, 39 people experienced homelessness or being vulnerably housed for less than two years (51.32%) and eight participants reported xi+ years as their length of experiencing homelessness or beingness vulnerably housed (ten.53%). Compared to the first round, people with lived experience who answered the third circular of the Delphi were less likely to experience long term homelessness. Six people with lived feel also identified every bit health professionals.

Amidst health professionals, well-nigh worked every bit main care providers, specialist physicians and registered nurses (n = 51, lx.71%), and others were researchers, public health experts, social workers, or community wellness advocates. Health professionals with different lengths of experience working with homeless populations participated in the Delphi survey; 24 (28.57%) of participants indicated 11+ years of feel in the field and 15 (17.86%) reported less than 2 years of feel.

Table 2 lists the prioritized and ranked needs from the Delphi consensus process by people with lived experience of homelessness and health professionals. Both groups prioritized, in the gild of importance: facilitating access to housing, mental health and addiction care, care coordination/case management, and facilitating access to adequate income. There were few important differences in ranking between the two groups of participants. Ane difference was that wellness professionals ranked chronic disease management as the 5th priority while people with lived experience ranked nutrition and dietary support as their fifth priority. In terms of populations, both groups prioritized women, families, and children, Indigenous Peoples (First Nations, Métis, and Inuit), persons with acquired brain injury, intellectual, or physical disabilities, youth, and refugees and other migrants (run across Table 3).

Table 4 outlines the relevance and importance of the needs and populations that were selected and that will be used to develop systematic reviews and so trustworthy clinical guidelines for practitioners to ameliorate the health of people experiencing homelessness or who are vulnerably housed

Word

Using a Delphi consensus method, guided by 3 criteria: value added, inequity, and burden of illness, we were able to place and rank priority needs for people who are homeless or vulnerably housed in Canada. Early working grouping lists were more disease specific simply health professionals and persons with lived experience of homelessness rankings rapidly shifted to more upstream social determinant of health needs such as income support and a shared consensus emerged between health professionals and people with lived feel.

The acme four priority needs selected were: facilitating access to housing; providing mental health and habit care; delivering intendance coordination and case management; and facilitating access to adequate income. Access to housing, considered a basic human right [50], is a critical first step in implementing health and social care interventions for people experiencing homelessness and the prioritization of this demand reflects the published enquiry [51]. Prioritizing access to early housing have improved outcomes amongst people with serious mental affliction [52,53], substance use disorders, veterans [26–28], and people experiencing homelessness in rural regions [54]. The provision of mental wellness and habit intendance, selected by both groups of Delphi participants, reverberate the high prevalence of mental health conditions, and alcohol and substance apply among people experiencing homelessness or who are vulnerably housed. Increasing our awareness of mental wellness difficulties and addictions among people experiencing homelessness or who are vulnerably housed is key to sustaining housing and community integration [55], and tin can prompt and inform research priorities.

Case management provides intentional person-centered support, assessment and planning in order to facilitate the delivery and uptake of health and social care services in a timely mode [56]. Constructive instance management can bridge care settings (i.e. inpatient or long-term care), care providers (i.e. informal caregivers, health specialists), and other resource (i.e. education, community services) to tailor an individualized care pathway, and has been shown to help individuals accomplish housing stability [23]. The majority of people experiencing homelessness or who are vulnerably housed experience income insecurity [57]. Having identified admission to income support as a priority by both Delphi groups participants supports bear witness suggesting income as a critical determinant of wellness and well-being [58] and potential roles of care providers in mitigating consequences of income insecurity [37,59]. Delphi participants further identified specific populations that could do good from targeted research to focus the guidelines specifically to their needs in improver to that of the population of people experiencing homelessness. Participants prioritized: Ethnic Peoples (First Nation, Métis, and Inuit); youth; women, families, and children; and people with acquired brain injury, intellectual, or physical disabilities.

Indigenous Peoples in Canada include First Nations, Métis and Inuit populations. In urban settings, this population is over represented in Canada's homeless population. Although the prevalence varies by region, approximately 20–50% of those vulnerably housed or homeless are Indigenous [sixty]. Indigenous people experience multiple chance factors for condign homeless or vulnerably housed, such as low instruction level, insecure employment and poor health [41], which are further exacerbated by structural and systematic barriers [42]. This finding sparked the development of an Indigenous researcher led approach for Indigenous people who are homeless or vulnerably housed [61].

Youth who are homeless or vulnerably housed are often difficult to place and back up due to their social situation and challenges relating to youth protection [62]. Precariously housed youth experience high rates of substance employ [44,63], exposure to domestic violence [45], and oftentimes resort to sex work to meet their basic needs once removed from the family unit setting [46]. Women, families, and children are often underrepresented among official homeless counts [64] every bit they are more than likely to be experiencing hidden homelessness compared to unmarried men [6]. Women have dissimilar paths into various forms of homelessness, suffer different sequelae than men [48], and experience significant negative health consequences [65]. Disability is a significant feature among those who experience different forms of homelessness, especially in terms of having acquired brain injuries [66], developmental disabilities, neurocognitive damage, and musculo-skeletal injuries [67]. Disability, often accompanied by decrease or loss of income, social supports, and safe and secure housing [49] can become a forerunner to homelessness.

Strengths and limitations

The main forcefulness of our study stems from the inclusion of people with lived experience of homelessness from across Canada. Our team collaborated with a various range of community organizations and sought need prioritization. Our study has a number of limitations. Repeatedly reaching persons with lived experience, nearly with no stock-still address or contact numbers, was a meaning challenge and meant accepting lower response rates over fourth dimension. We did not include a substantive qualitative stage to the study and are unable to describe in detail the rationale for how participants prioritized the needs and populations. Finally, we are unable to carry subgroup analysis of the needs ranking (east.g. for Ethnic Peoples) as the sample size of individual groups is too small.

Conclusion

Our Delphi consensus method, with people with lived experience of homelessness and expert health professionals, uncovered priority needs for homeless populations. These needs sparked a series of systematic reviews and ii distinct homeless health guidelines. Including people with lived feel provided a unique real world perspective on needs and marginalization. While medical weather condition appeared on the initial list of needs, the voices of both health professionals and people with lived experience shifted the consensus to social determinants of health reflecting existing structural barriers. Providing mental wellness and habit care was identified every bit the most important upshot amidst both groups of respondents.

Supporting data

References

1. 1. Fazel Due south, Khosla V, Doll H, Geddes J. The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis. PLoS Med. 2008;five(12):e225–e225. pmid:19053169
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
2. 2. Gaetz S, Barr C, Friesen A, Harris B, Hill C, Kovacs-Burns Chiliad, et al. Canadian Definition of Homelessness. Toronto: Canadian Observatory on Homelessness Press; 2012.
3. 3. Hwang SW, Kirst MJ, Chiu S, Tolomiczenko Yard, Osculation A, Cowan 50, et al. Multidimensional Social Support and the Wellness of Homeless Individuals. J Urban Heal. 2009;86(5):791–803.
   • View Article
   • Google Scholar
4. 4. Gaetz South, Dej E, Richter T, Redman M. The Land of Homelessness in Canada 2016. Toronto, ON: Canadian Observatory on Homelessness Press; 2016.
5. 5. Stergiopoulos Five, Herrmann Northward. Former and Homeless: A Review and Survey of Older Adults Who Use Shelters in an Urban Setting. Can J Psychiatry. 2003;48(6):374–lxxx. pmid:12894611
   • View Article
   • PubMed/NCBI
   • Google Scholar
6. half dozen. Rodrigue Due south. Hidden homelessness in Canada. Statistics Canada = Statistique Canada; 2016.
7. 7. Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing modify. Implement Sci. 2013;8(1):117.
   • View Article
   • Google Scholar
8. 8. Hwang SW, Burns T. Health interventions for people who are homeless. Lancet (London, England). 2014 October;384(9953):1541–seven.
   • View Commodity
   • Google Scholar
9. 9. White, Newman (2015) Access to primary care services amidst the homeless- a synthesis of the literature using the equity of access to medical care framework.
10. 10. Frank L, Basch East, Selby J V. The PCORI Perspective on Patient-Centered Outcomes Enquiry. JAMA. 2014;312(15):1513–4. pmid:25167382
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
11. eleven. National Institute for Health and Care Excellence. Find guidance | NICE [Internet]. 2020 [cited 2020 February 12]. Available from: https://www.nice.org.uk/guidance
12. 12. Petkovic J, Riddle A, Akl EA, Khabsa J, Lytvyn L, Atwere P, et al. Protocol for the development of guidance for stakeholder date in health and healthcare guideline evolution and implementation. Syst Rev. 2020;ix(1):21. pmid:32007104
    • View Article
    • PubMed/NCBI
    • Google Scholar
13. xiii. Moher D, Schulz KF, Simera I, Altman DG. Guidance for developers of health research reporting guidelines. Vol. seven, PLoS Medicine. 2010. p. e1000217. pmid:20169112
    • View Article
    • PubMed/NCBI
    • Google Scholar
14. 14. Keeney S, Hasson F, McKenna H. The Delphi Technique in Nursing and Health Inquiry. Oxford, U.k.: Wiley-Blackwell; 2010.
15. 15. Farrell B, Tsang C, Raman-Wilms 50, Irving H, Conklin J, Pottie G. What Are Priorities for Deprescribing for Elderly Patients? Capturing the Vox of Practitioners: A Modified Delphi Process. PLoS One. 2015;ten(four):e0122246. pmid:25849568
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
16. 16. Swinkels H, Pottie K, Tugweel P, Rashid M, Narasiah L. Development of guidelines for recently arrived immigrants and refugees to Canada: Delphi consensus on selecting preventable and treatable conditions. CMAJ. 2011;
    • View Commodity
    • Google Scholar
17. 17. Pottie 1000, Batista R, Mayhew Chiliad, Mota L, Grant K. Improving delivery of primary care for vulnerable migrants: Delphi consensus to prioritize innovative practice strategies. Can Fam physician. 2014;60(i):e32–twoscore. pmid:24452576
    • View Article
    • PubMed/NCBI
    • Google Scholar
18. eighteen. Briss PA, Zaza S, Pappaioanou M, Fielding J, Wright-De Agüero Fifty, Truman BI, et al. Developing an testify-based Guide to Community Preventive Services—methods. The Job Forcefulness on Community Preventive Services. Am J Prev Med. 2000;eighteen(i Suppl):35–43. pmid:10806978
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
19. 19. Schmidt RC. Managing Delphi Surveys Using Nonparametric Statistical Techniques. Decis Sci. 1997;28(three):763–74.
    • View Article
    • Google Scholar
20. 20. Stergiopoulos V, Gozdzik A, O'Campo P, Holtby AR, Jeyaratnam J, Tsemberis S. Housing First: exploring participants' early support needs. BMC Health Serv Res. 2014;14(i):167.
    • View Commodity
    • Google Scholar
21. 21. Greenwood RM, Schaefer-McDaniel NJ, Winkel Grand, Tsemberis SJ. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. Am J Community Psychol. 2005;
    • View Article
    • Google Scholar
22. 22. Collins SE, Malone DK, Clifasefi SL. Housing memory in single-site housing outset for chronically homeless individuals with astringent alcohol problems. Am J Public Wellness. 2013;103(supplement 2):S269–274.
    • View Article
    • Google Scholar
23. 23. Palepu A, Gadermann A, Hubley AM, Farrell S, Gogosis E, Aubry T, et al. Substance Utilize and Access to Wellness Care and Addiction Treatment among Homeless and Vulnerably Housed Persons in Three Canadian Cities. PLoS One. 2013;viii(10):e75133. pmid:24124470
    • View Article
    • PubMed/NCBI
    • Google Scholar
24. 24. Tsemberis S, Gulcur L, Nakae M. Housing First, Consumer Pick, and Damage Reduction for Homeless Individuals With a Dual Diagnosis. Am J Public Heal J Public Heal. 2004;9494(4):651–half dozen.
    • View Commodity
    • Google Scholar
25. 25. Stefancic A, Henwood BF, Melton H, Shin SM, Lawrence-Gomez R, Tsemberis S. Implementing Housing Outset in rural areas: Pathways Vermont. Am J Public Health. 2013;
    • View Article
    • Google Scholar
26. 26. Nelson Yard, Aubry T, Lafrance A. A review of the literature on the effectiveness of housing and support, assertive customs treatment, and intensive case management interventions for persons with mental affliction who take been homeless. Am J Orthopsychiatry. 2007;77(three):350–61. pmid:17696663
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
27. 27. Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall Chiliad. Intensive instance management for astringent mental disease. Cochrane Database Syst Rev [Cyberspace]. 2017;(1). Available from: http://doi.wiley.com/ten.1002/14651858.CD007906.pub3
    • View Article
    • Google Scholar
28. 28. McFarlane WR, Stastny P, Deakins S. Family-aided assertive customs treatment: a comprehensive rehabilitation and intensive instance direction arroyo for persons with schizophrenic disorders. New Dir Ment Wellness Serv [Internet]. 1992;(53):43–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1579118 pmid:1579118
    • View Article
    • PubMed/NCBI
    • Google Scholar
29. 29. Rog DJ, Marshall T, Dougherty RH, George P, Daniels AS, Ghose SS, et al. Permanent Supportive Housing: Assessing the Show. Psychiatr Serv. 2014;65(3):287–94. pmid:24343350
    • View Article
    • PubMed/NCBI
    • Google Scholar
30. 30. Goering PN, Streiner DL, Adair C, Aubry T, Barker J, Distasio J, et al. The At Home/Chez Soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a Housing Get-go intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open. 2011;1(2):e000323–e000323. pmid:22102645
    • View Article
    • PubMed/NCBI
    • Google Scholar
31. 31. Herman DB, Mandiberg JM. Disquisitional Fourth dimension Intervention: Model Clarification and Implications for the Significance of Timing in Social Work Interventions. Res Soc Piece of work Pract [Internet]. 2010;20(v):502–8. Available from: http://journals.sagepub.com/doi/x.1177/1049731509360667
    • View Article
    • Google Scholar
32. 32. Evans J, Semogas D, Smalley JG, Lohfeld L. "This place has given me a reason to care": Agreement "managed alcohol programs" as enabling places in Canada. Health Place [Internet]. 2015;33:118–24. Available from: https://world wide web.sciencedirect.com/science/article/pii/S1353829215000313 pmid:25817940
    • View Article
    • PubMed/NCBI
    • Google Scholar
33. 33. Kerr T, Stoltz J-A, Tyndall M, Li Grand, Zhang R, Montaner J, et al. Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. BMJ [Internet]. 2006;332(7535):220–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16439401 pmid:16439401
    • View Article
    • PubMed/NCBI
    • Google Scholar
34. 34. Hwang Southward, Tolomiczenko G, Kouyoumdjian F, Garner R. Interventions to Improve the Health of the Homeless: A Systematic Review. Am J Prev Med [Internet]. 2005;29(4):311–311. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16242595 pmid:16242595
    • View Article
    • PubMed/NCBI
    • Google Scholar
35. 35. Stergiopoulos V, Dewa C, Durbin J, Chau North, Svoboda T. Assessing the Mental Wellness Service Needs of the Homeless: A Level-of-Care Arroyo. J Health Care Poor Underserved. 2010;21(3):1031–45. pmid:20693742
    • View Article
    • PubMed/NCBI
    • Google Scholar
36. 36. Wild C, Macy-hurley R, Cowan L. Dimensions of Promising Practice For Case Managed Supports in Ending Homelessness. Calgary, AB; 2011.
37. 37. Canadian Medical Association. Physicians and Health Equity: Opportunities in Do. 2012.
38. 38. The College of Family Physicians of Canada. Best Advice Guide: Social Determinants of Health [Internet]. Ottawa, ON; 2018. Available from: http://patientsmedicalhome.ca/resources/best-advice-guides/best-advice-guide-social-determinants-health/
39. 39. Adams J, White One thousand, Moffatt S, Howel D, Mackintosh J. A systematic review of the health, social and financial impacts of welfare rights communication delivered in healthcare settings. BMC Public Wellness. 2006;vi(one):81.
    • View Article
    • Google Scholar
40. 40. Leads Wellness. Meliorate Health. I Connectedness at a Fourth dimension [Internet]. 2018 [cited 2017 Jun eight]. Bachelor from: https://healthleadsusa.org/
    • View Article
    • Google Scholar
41. 41. Anderson JT, Collins D. Prevalence and Causes of Urban Homelessness Among Indigenous Peoples: A Three-State Scoping Review. Hous Stud. 2014;29(seven):959–76.
    • View Article
    • Google Scholar
42. 42. Habibis D. Australian Housing Policy, Misrecognition and Indigenous Population Mobility. Hous Stud. 2013;28(5):764–81.
    • View Article
    • Google Scholar
43. 43. Public Health Agency of Canada. Canadian Street Youth and Substance Employ: Findings from Enhanced Surveillance of Canadian Street Youth, 1999–2003 [Cyberspace]. Ottawa, ON; 2007. Bachelor from: http://www.catie.ca/en/resource/canadian-street-youth-and-substance-utilize
44. 44. Kerr T, Marshall BD, Miller C, Shannon Chiliad, Zhang R, Montaner JS, et al. Injection drug use among street-involved youth in a Canadian setting.
    • View Article
    • Google Scholar
45. 45. Ringwalt CL, Greene JM, Robertson MJ. Familial backgrounds and risk behaviors of youth with thrownaway experiences. J Adolesc [Internet]. 1998;21(3):241–52. Bachelor from: http://www.ncbi.nlm.nih.gov/pubmed/9657892 pmid:9657892
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
46. 46. Roy É, Haley N, Lemire Due north, Boivin J-F, Leclerc P, Vincelette J. Hepatitis B virus infection amongst street youths in Montreal. Can Med Assoc J. 1999;161(6):689–93.
    • View Article
    • Google Scholar
47. 47. Rodrigue S. Hidden homelessness in Canada [Internet]. Ottawa, ON: Statistics Canada; 2016. Available from: http://www.statcan.gc.ca/pub/75-006-ten/2016001/article/14678-eng.htm
48. 48. Tessler R, Rosenheck R, Gamache Grand. Gender Differences in Cocky-Reported Reasons for Homelessness. J Soc Distress Homeless. 2001;ten(3):243–54.
    • View Commodity
    • Google Scholar
49. 49. Woolley East. How many homeless people live with disabilities? [Cyberspace]. The Homeless Hub. 2015 [cited 2017 Apr 24]. Available from: http://www.homelesshub.ca/blog/how-many-homeless-people-live-disabilities
50. 50. Stergiopoulos V, Gozdzik A, O'Campo P, Holtby AR, Jeyaratnam J, Tsemberis S. Housing First: exploring participants' early back up needs. BMC Health Serv Res. 2014;fourteen(1):167.
    • View Article
    • Google Scholar
51. 51. Stock M. Ending Homelessness? A critical exam of Housing First in Canada and Winnipeg. Winnipeg, MB; 2016.
52. 52. Stergiopoulos V, Hwang SW, Gozdzik A, Nisenbaum R, Latimer E, Rabouin D, et al. Result of Scattered-Site Housing Using Rent Supplements and Intensive Case Direction on Housing Stability Among Homeless Adults With Mental Illness. JAMA. 2015;313(9):905–15. pmid:25734732
    • View Article
    • PubMed/NCBI
    • Google Scholar
53. 53. Aubry T, Goering P, Veldhuizen Due south, Adair CE, Bourque J, Distasio J, et al. A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness. Psychiatr Serv. 2016 Mar;67(three):275–81. pmid:26620289
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
54. 54. Stefancic A, Henwood BF, Melton H, Shin S-M, Lawrence-Gomez R, Tsemberis Southward. Implementing housing first in rural areas: pathways Vermont. Am J Public Wellness. 2013;103(Suppl 2):S206–9.
    • View Article
    • Google Scholar
55. 55. Vicky Stergiopoulos V, Carolyn Dewa C, Janet Durbin J, Nancy Chau N, Tomislav Svoboda T. Assessing the Mental Health Service Needs of the Homeless: A Level-of-Care Approach. J Wellness Care Poor Underserved. 2010;21(3):1031–45. pmid:20693742
    • View Article
    • PubMed/NCBI
    • Google Scholar
56. 56. McDonald KM, Sundaram V, Bravata DM, Lewis R, Lin N, Kraft SA, et al. Closing the Quality Gap: A Critical Assay of Quality Improvement Strategies (Vol. seven: Care Coordination). Endmost the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Intendance Coordination). Rockville, MD: Agency for Healthcare Enquiry and Quality; 2007. pmid:20734531
57. 57. Buckland 50, Roberts P, Marland R. Structural and Systemic Factors Contributing to Homelessness in Canada: An Analysis of Research Gaps And Proposed Enquiry Directions. Ottawa, ON; 2001.
58. 58. Canada PHA of. What Makes Canadians Salubrious or Unhealthy? Ottawa, ON; 2013.
59. 59. Canada TC of FP of. Best Advice Guide: Social Determinants of Health. Ottawa, ON; 2018.
60. 60. Walker R. ENGAGING THE URBAN ABORIGINAL POPULATION IN LOW-Cost HOUSING INITIATIVES: LESSONS FROM WINNIPEG. Can J Urban Res. 2003;12(1):99–118.
    • View Article
    • Google Scholar
61. 61. Thistle J, Laliberte Due north. Pekiwewin (Coming Dwelling): Clinical Practice Guidelines for Health and Social Service Providers Working with Indigenous People Experiencing Homelessness. In: erbal concurrent session presented at Canadian Alliance to End Homelessness Conference. Edmonton, Alberta; 2019.
62. 62. Gaudet S. The Boundaries of Youth. In: Emerging Adulthood: A new stage in the life grade. Ottawa, ON: Government of Canada; 2007.
63. 63. Canada PHA of. Canadian Street Youth and Substance Use: Findings from Enhanced Surveillance of Canadian Street Youth, 1999–2003. Ottawa, ON; 2007.
64. 64. Segaert A. The National Shelter Study: Emergency Shelter Use in Canada 2005–2009 [Internet]. 2012. Available from: http://homelesshub.ca/sites/default/files/Homelessness Partnering Secretariat 2013 Segaert_0.pdf
65. 65. Wenzel SL, Tucker JS, Hambarsoomian K, Elliott MN. Toward a More Comprehensive Understanding of Violence Confronting Impoverished Women. J Interpers Violence. 2006;21(6):820–39. pmid:16672743
    • View Article
    • PubMed/NCBI
    • Google Scholar
66. 66. Hwang SW, Colantonio A, Chiu Southward, Tolomiczenko M, Kiss A, Cowan L, et al. The outcome of traumatic brain injury on the health of homeless people. C = J l'Clan medicale Tin can. 2008;179(8):779–84.
    • View Article
    • Google Scholar
67. 67. Hwang SW. Homelessness and health. CMAJ. 2001;164(2):229–33. pmid:11332321
    • View Article
    • PubMed/NCBI
    • Google Scholar

brettyoult1948.blogspot.com

Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231758

Share this post