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Background The purpose of this study is to highlight the experiences of women who are often hidden in what we know and understand about homelessness, and to make policy and practice recommendations for women-centred services including adaptations to current housing interventions. Methods Three hundred survey interviews were conducted with people experiencing homelessness in Calgary, Alberta, Canada. The survey instrument measured socio-demographics, adverse childhood experiences, mental and physical health, and perceived accessibility to resources. Eighty-one women participants were identified as a subsample to be examined in greater depth. Descriptive statistics and logistic regressions were calculated to provide insight into women respondents’ characteristics and experiences of homelessness and how they differed from men’s experiences. Results Women’s experiences of homelessness are different from their male counterparts. Women have greater mental health concerns, higher rates of diagnosed mental health issues, suicidal thoughts and attempts, and adverse childhood trauma. The results should not be considered in isolation, as the literature suggests, because they are highly interconnected. Conclusion In order to ensure that women who are less visible in their experiences of homelessness are able to access appropriate services, it is important that service provision is both gender specific and trauma-informed. Current Housing First interventions should be adapted to ensure women’s safety is protected and their unique needs are addressed.

Fifteen to thirty percent of Canadians have access to palliative care, with even fewer access opportunities for people with experiences of homelessness. Existing research identifies barriers to access but rarely shows how health and social institutions actively organize exclusion. Part of a larger study, this paper examines how health and social systems shape the need for community-based palliative and end-of-life care, using 3 stories from clients of the Community Allied Mobile Palliative Partnership (CAMPP). Using institutional ethnography, data were collected between Fall 2019 and Summer 2020. Sources included approximately 100 h of observation of the CAMPP team’s work, 3 in-depth client interviews, and supplementary provider interviews. Data were analyzed to trace institutional processes that shape everyday experiences of illness and care. Findings reveal systemic demands like renewing insurance for medical equipment, restrictive housing rules, and standardized hospital protocols that overwhelm capacities of many people with experiences of homelessness. Rowan’s story illustrates how bureaucratic requirements jeopardized his oxygen supply. Harriet’s story shows the harm of being separated from her caregiver in housing and hospital contexts compounding distress and reluctance to receive care. Chapa’s story demonstrates how fear and stigma delayed critical cardiology care. Overall, the clients valued CAMPP’s persistent, relational, non-judgmental, and flexible approach. The team’s independence from the mainstream health system mandates enabled responsive care but relies on precarious funding, constraining sustainability. Community-based palliative teams like CAMPP fill critical gaps in mainstream services by tailoring care to complex social realities. Their model shows the value of equity-informed, relational approaches, yet structural exclusion and precarious funding threaten long-term viability. Policy integration must sustain such programs without eroding the autonomy that enables them to deliver meaningful palliative and end-of-life care for people with experiences of homelessness.

‘Equity-focused care’ has gained attention in recent years. With widespread use, concepts take on different meanings creating confusion for service providers. This study examines what people experiencing homelessness with life-limiting illnesses value in equity-focused care, and how service providers—who identify their work as equity-focused—describe their roles within a care system that relies on, yet often undervalues, this kind of work. We conducted 11 interviews with service providers and seven with people experiencing homelessness with a life-limiting illness and who received care from a community-based palliative care team in Western Canada. Interviews were transcribed and analyzed via thematic analysis. We constructed three themes: Adapting to Individual Needs; Service Provider Orientation to Practice; and Being Present with People. Themes aligned with two spheres of influence from the Education Training Research’s Health Equity Framework: Relationships and Networks and Systems of Power. Findings highlighted that service providers deliver equity-focused care by developing strong relational care networks challenging existing power structures –making this model incongruent with existing individually-focused biomedical care models. Findings transform the theoretical concept, ‘equity-focused care’, into tangible knowledge that highlights areas for policy change to support equity-focused care.

Background Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. Results Results revealed a significant association between housing instability and hospital use with unstably housed individuals twice as likely torequire hospital care. Conclusions Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such as safe supply and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.

Background Current literature has established that adverse childhood experiences (ACEs) are associated with the onset of a variety of physical, mental, and behavioural illnesses. However, there are few studies that have thoroughly examined this association in low-income or marginalized groups. Methods To address this knowledge gap, this study used self-reported data on childhood experiences and adult health outcomes in a sample of 91 Indigenous persons experiencing homelessness. While the primary focus of the study was to assess the relationship between ACEs and health status, we also assessed reports on use and perceptions of health care services to test for potential illness-mitigating factors. Results Results indicated that reported number of ACEs was significantly associated with reported levels of mental illness ( p < .001, d = 1.12). Significant associations were not observed for physical illness or patterns of substance use. We also found that the number of reported ACEs was significantly correlated with the number of formal health care services that an individual used ( r = 0.32). Conclusions Our results reveal that the relationship between ACEs and adult illness is not as deterministic as the current literature suggests. Access to formal health care services may allow individuals to mitigate their adverse health, thereby eliminating some of the effects of ACEs. Conversely, current tools used to measure ACEs may not translate to an Indigenous population, which speaks to a need to revise ACE related surveys to include additional adversity categories.

Homelessness for families in Alberta, Canada, is a growing concern despite an abundance of research and continued support for Housing First programs, and the consequences can be severe. This study used a descriptive qualitative design to examine the experiences of families currently living in or that have a history of homelessness with the goal of developing recommendations to improve system coordination. Participants included parents who had at least one dependent child while homeless (n = 15) and staff who were currently working at a homeless support service (n = 18). Interviews were analyzed using a thematic inductive approach and integrated using functional narrative analysis. Four themes emerged: (1) Housing as a Foundation for Success in Other Domains; (2) Challenges with System Navigation: A Door Within a Door Within a Door; (3) Services’ Contributions to Trauma; and (4) Exposure to Social Bias and Stigma Within Services. We posit several recommendations for policy and service delivery which focus on finding “homes” and building community connections, enhancing Housing First program models, expanding on existing trauma-informed approaches, and prioritizing system-level change.

Background Distinct from western Managed Alcohol Programs (MAPs), Indigenous-led alcohol harm reduction programs can be defined by both ‘culture as healing’ and decolonized harm reduction philosophies. We sought to explore experiences of Indigenous ‘family members’ (participants) in an Indigenous-led alcohol harm reduction program and culturally supportive housing to identify appropriate supports according to family member perspectives, and to inform delivery of the program. Methods Situated within an Indigenous-western research partnership, we completed semi-structured interviews with seven family members of an Indigenous-led alcohol harm reduction and culturally supportive housing program. Community-guided protocols informed relational knowledge gathering practices including semi-structured in-depth interviews, qualitative thematic analysis, collaborative interpretation of findings, and development of knowledge products. Results Family members highlighted the importance of tailored Indigenous-led alcohol harm reduction in shifting their relationships to alcohol from survival to having choice and control of their drinking ( It’s a choice I’m making right now ). The provision of varied and incremental culture-based opportunities ( Multiple pathways for connecting to culture ) facilitated engagement with culture as healing. Policies that honour respect and autonomy were identified as supportive to healing and harm reduction, countering family members’ experiences in western spaces ( Give me the reigns of taking care of myself with a home ). Conclusions An Indigenous-led alcohol harm reduction program within a model of culture as healing facilitated shifts in relationships to alcohol, providing a space where family members could explore long term goals of healing and connection to culture. Family members’ experiences and recommendations offer key considerations for the design of Indigenous-led harm reduction and culture as healing models. Recommendations emphasize the provision of tailored alcohol harm reduction plans in parallel to multiple and accessible opportunities for connection to culture as healing in order to meet diverse participant goals and relationships to alcohol and culture.

Previous research has shown that housing insecurity contributes to animal relinquishment and that tenants with dogs face disadvantages in the rental market. Still, little is known about how dog owners navigate rental markets, nor how landlords and property managers perceive dogs and other pets. This case study reports on in-depth interviews with younger tenants with dogs and on open-ended survey responses from landlords and property managers. In their housing searches, tenants with dogs reported feeling powerless in negotiations and feeling discriminated against. They described settling for substandard properties, often located in less desirable neighborhoods. Also, some said they felt obliged to stay put in these rentals, given how difficult it had been to find a place that would accommodate their dogs. Meanwhile, landlords and property managers indicated that listings advertised as “pet-friendly” tend to receive more applicants than listings in which pets are prohibited. Suggestions for improvement included meeting pets prior to signing the lease; getting everything in writing; steering clear from furnished units; charging utilities to tenants; and speeding up the pet approval process when dealing with condominium boards. These suggestions offer implications for future research, partnerships, and policy options to improve the prospects of pets and their people in rental housing.

The COVID-19 pandemic and the policy measures adopted in response have disproportionately impacted persons with disabilities. Given the increased risk of COVID-19 and the resulting health impact for this vulnerable population, governments must engage stakeholders such as community organizations to co-design pandemic response plans. Collaboration with key stakeholders could assist in transforming services in crucial areas, such as health, where emergency policies are organized around the needs of persons with disabilities. Unfortunately, there is inadequate data collection and insufficient emergency preparedness planning and responses for persons with disabilities. This knowledge gap means consideration of health and social policy implications specific to the needs and experiences of persons with disabilities is lacking. This research study aimed to evaluate strategies through which decision-makers could engage stakeholders, such as community organizations, to co-design disability-inclusive policy responses during the COVID-19 outbreak in Alberta. Through interviews, the study focused on understanding the level of engagement, barriers to community organizations’ engagement and participatory policy aspects best suited for co-design. Key findings from the research highlighted the participants’ viewpoints on barriers, facilitators, preferences and other critical approaches through which decision-makers engage with community organizations. Results highlighted that top-down and tokenistic consultation approaches limit community organizations’ engagement in designing pandemic planning and response. Inaccessible ways of consultation and navigation barriers exacerbate obstacles to stakeholder engagement. Stakeholder engagement in data surveillance efforts was unclear, and the impact assessment process needs strengthening. The study results also showed that having COVID-19 disability advisory groups at the federal and provincial levels are a robust mechanism to connect communities with the government. However, the process of influencing government decision-making and policy actions needs to be openly communicated to civil society. Solutions are achievable. Political commitment, long-term investments and an accessible engagement environment would significantly improve stakeholder engagement. Governments must transition from traditional consultative methods to sustainable engagement practices while sharing how public policies reflect communities’ input. Financial investments must create an accessible consultation environment for designing participatory pandemic policies that reflect the priorities of persons with disabilities. Some key recommendations emerging from our analysis include: * Invest financially to create an accessible consultation environment for co- designing policies. * Consult stakeholders to develop new regulations or adjust existing ones to create inclusive pandemic response plans. * Inform how pandemic response plans include and address community inputs and concerns in a transparent manner. * Professionally contract stakeholders to co-design and communicate pandemic information. * Engage with multiple stakeholders to evaluate the impact of pandemic response plans.

Background Homeless and unstably housed individuals face barriers in accessing healthcare despite experiencing greater health needs than the general population. Case management programs are effectively used to provide care for this population. However, little is known about the experiences of providers, their needs, and the ways they can be supported in their roles. Connect 2 Care (C2C) is a mobile outreach team that provides transitional case management for vulnerable individuals in a major Canadian city. Using an ethnographic approach, we aimed to describe the experiences of C2C team members and explore their perceptions and challenges. Methods We conducted participant observations and semi-structured interviews with C2C team members. Data analysis consisted of inductive thematic analysis to identify themes that were iteratively discussed. Results From 36 h of field observations with eight team members and 15 semi-structured interviews with 12 team members, we identified five overarching themes: 1) Hiring the right people & onboarding: becoming part of C2C; 2) Working as a team member: from experience to expertise; 3) Proud but unsupported: adding value but undervalued; 4) Team-initiated coping: satisfaction in the face of emotional strain, and; 5) Likes and dislikes: committed to challenges. Conclusions A cohesive team of providers with suitable personal and professional characteristics is essential to care for this complex population. Emotional support and inclusion of frontline workers in operational decisions are important considerations for optimal care and program sustainability.