People experiencing homelessness have lower health outcomes and higher rates of hospital readmission than the general population. This results in a significant cost to the health care system. Despite this, there is no coordinated service model in Canada to address the cycle from hospital to homelessness.
This Research and Planning Fund project plans to streamline housing and income supports to break that cycle. Research has shown that it is possible to identify at-risk patients in hospital and connect them with needed services. This project will measure the effectiveness and the cost of that service model. It will also document how the model can be implemented in other locations across Canada.
3 Key Goals
Evaluate the effectiveness of the H2I service model across acute and tertiary psychiatric facilities and acute medical facilities in London.
Build cross-sectoral relationships by actively including research partners, community partners and housing sectors throughout the study.
Create a set of best practices and an implementation guide that can be used to better address homelessness across Canada.
Project scope and expected outcomes
Addressing the revolving-door cycle from hospital to homelessness
Patients discharged from medical or psychiatric wards to homelessness in Canada face difficult recoveries. This leads to more frequent hospital readmissions. Previous research has demonstrated the benefits of providing housing and income supports while patients are in the hospital. For instance, it reduces the rates of patients discharged into homelessness.
Community follow-up can also help improve health and housing outcomes for individuals whose support needs cannot be met in hospital.
While these results of this service model are promising, a more extensive evaluation is needed. For example, acute and tertiary care sites are different, with their own distinct challenges. Rigorous study is needed in both settings. The unique needs of certain patient groups also need further evaluation. The H2I project will undertake that evaluation in order to look at the model’s impact on the system as a whole.
Answering questions about health and homelessness
With funding from the National Housing Strategy Research and Planning Fund, the H2I project will consider 5 research questions:
- What are the effects of offering income and housing supports to individuals at-risk of homelessness in different healthcare facilities?
- How does transitional support post-discharge affect outcomes in the various groups?
- What are the costs and other implementation issues related to the intervention strategy within hospital, and within each subpopulation?
- What are the costs and other implementation issues related to transitional support for each subpopulation?
- What are service-user and staff perceptions of the intervention within different healthcare facilities for each subpopulation? What are perceptions in the community?
Providing housing and income supports and measuring results
The H2I project will use a mixed-method longitudinal design.
This will allow individuals with lived experience, participants and service providers in the healthcare and housing sectors to give their feedback. It will also enable the project to collect administrative data to look at the impact on the system as a whole.
Participants will be invited to take part in the study.
Eligibility is admission to a psychiatric or medical unit while being homeless or at risk of experiencing homelessness upon discharge. All participants will be offered housing and income supports while in hospital and transitional support after they are discharged. Research participants will be interviewed when they leave hospital and six months later.
The project will collect a both quantitative and qualitative data:
- Quantitative data will include demographic data, quality-of-life measures, housing history, housing preferences, and health, social and justice service use data.
- Qualitative data will include the program experiences of participants, staff members and community agencies/service providers.
A standardized evaluation framework will be used to do economic, ethical, policy and systematic effectiveness analyses.
Better housing and health outcomes through cross-sectoral collaboration
Knowledge and dissemination is central to the project’s participatory action research approach. It will focus on building relationships by actively including research and community partners and housing sectors during the study. Both the research team and the stakeholders will share the research approach and findings across Canada and abroad. This includes through the project website, conferences, publications and an end-of-project event.
The primary intended audience for the project findings are its cross-sectoral partners.
Other potential audiences include healthcare and social service agencies in other cities and regions. In fact, several municipalities have expressed interest in the program. The findings will also offer service providers more effective techniques to support individuals with mental health and addictions issues and to prevent homelessness.
In the long term, it is hoped that the research will build cross-sectoral networks and inform policy. It also could help reduce homelessness across Canada.
The cross-sectoral collaboration initiated through the healthcare system can also be extended to other vulnerable/at-risk populations. For instance, the researchers are currently collaborating on a similar study with the agency Youth Opportunities Unlimited. This will address discharge from hospital to homelessness for the youth population.
Program: NHS Research and Planning Fund
Location: London, ON
Activity Stream: Program of Research
Research Team: London Health Sciences Centre; Parkwood Institute,St. Joseph’s Healthcare London
- The Canadian Mental Health Association Elgin-Middlesex
- City of London
- Salvation Army Centre of Hope