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Homelessness & Health in Canada explores, for the first time, the social, structural, and environmental factors that shape the health of homeless persons in Canada. Covering a wide range of topics from youth homelessness to end-of-life care, the authors strive to outline policy and practice recommendations to respond to the ongoing public health crisis. This book is divided into three distinct but complimentary sections. In the first section, contributors explore how homelessness affects the health of particular homeless populations, focusing on the experiences of homeless youth, immigrants, refugees and people of Aboriginal ancestry. In the second section, contributors investigate how housing and public health policy as well as programmatic responses can address various health challenges, including severe mental illness and HIV/AIDS. In the final section, contributors highlight innovative Canadian interventions that have shown great promise in the field. Together, they form a comprehensive survey of an all too important topic and serve as a blueprint for action.

Homelessness & Health in Canada explores, for the first time, the social, structural, and environmental factors that shape the health of homeless persons in Canada. Covering a wide range of topics from youth homelessness to end-of-life care, the authors strive to outline policy and practice recommendations to respond to the ongoing public health crisis. This book is divided into three distinct but complimentary sections. In the first section, contributors explore how homelessness affects the health of particular homeless populations, focusing on the experiences of hom.

IntroductionImprovements in the availability and effectiveness of highly active antiretroviral therapy (HAART) have prolonged the lives of people living with HIV/AIDS. However, mortality rates have remained high among populations that encounter barriers to accessing and adhering to HAART, notably people who use drugs. This population consequently has a high burden of illness and complex palliative and supportive care needs, but is often unable to access these services due to anti‐drug policies and discrimination. In Vancouver, Canada, the Dr. Peter Centre (DPC), which operates a 24‐bed residential HIV/AIDS care facility, has sought to improve access to palliative and supportive care services by adopting a comprehensive harm reduction strategy, including supervised injection services. We undertook this study to explore how the integration of comprehensive harm reduction services into this setting shapes access to and engagement with care.MethodsQualitative interviews were conducted with 13 DPC residents between November 2010 and August 2011. Interviews made use of a semistructured interview guide which facilitated discussion regarding how the DPC Residence's model of care (a) shaped healthcare access, (b) influenced healthcare interactions and (c) impacted drug use practices and overall health. Interview transcripts were analysed thematically.ResultsParticipant accounts highlight how the harm reduction policy altered the structural‐environmental context of healthcare services and thus mediated access to palliative and supportive care services. Furthermore, this approach fostered an atmosphere in which drug use could be discussed without the risk of punitive action, and thus increased openness between residents and staff. Finally, participants reported that the environmental supports provided by the DPC Residence decreased drug‐related risks and improved health outcomes, including HAART adherence and survival.ConclusionsThis study highlights how adopting comprehensive harm reduction services can serve to improve access and equity in palliative and supportive care for drug‐using populations.

We examine the long-term housing trajectories of 543 program participants at the Toronto site of the At Home/Chez-Soi project, a randomized controlled trial of a Housing First (HF) intervention for adults with mental disorders. The average follow-up period for our study was 5.5 years. We find that the HF approach, which includes housing subsidies and support services, was strongly associated with rapid transitions to sustained housing (70.4 percent of HF participants vs. 27.9 percent of treatment as usual participants). Mood disorders with psychotic features and primary psychotic disorders were negatively associated with the rapid and sustained housing trajectory, and alcohol use disorders were positively associated with a rapid then declining housing trajectory. We argue that to understand the long-term impacts of housing programs, research needs to better explore comprehensive and personalized care to support individuals with severe mental disorders.

Background: People experiencing homelessness have diverse patterns of healthcare use. This study examined the distribution and determinants of healthcare encounters among adults with a history of homelessness. Methods: Administrative healthcare records were linked with survey data for a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness. Binary and count models were used to identify factors associated with hospital admissions, emergency department visits and physician visits for comparison across the 2 cohorts. Results: During the 1-year follow-up period, a higher proportion of people in the cohort with a mental illness used any inpatient (27% vs 14%), emergency (63% vs 53%), or physician services (90% vs 76%) compared to the general homeless cohort. People from racialized groups were less likely use nearly all health services, most notably physician services. Other factors, such as reporting of a regular source of care, poor perceived general health, and diagnosed chronic conditions were associated with higher use of all health services except psychiatric inpatient care Conclusion: When implementing interventions for patients with the greatest health needs, we must consider the unique factors that contribute to higher healthcare use, as well as the barriers to healthcare access.

This study identifies time-patterned trajectories of housing stability among homeless and vulnerably housed individuals who participated in a multisite four-year longitudinal study in Canada. Findings show four distinct trajectories for the homeless and vulnerably housed: high levels of sustained housing stability, improving levels over time leading to high levels of housing stability, decreasing levels of housing stability over time, and low levels of housing stability over time. The presence of resources rather than risk factors differentiated the trajectories of participants who achieved housing stability from those who had low levels of housing stability. Participants who had better housing stability were more likely to live in subsidized housing. Findings highlight the need for programs and policies directed at addressing the housing affordability problem through income support strategies and the creation of affordable housing.

Engaging peer-interviewers in qualitative inquiry is becoming more popular. Yet, there are differing opinions as to whether this practice improves the research process or is prohibitively challenging. Benefits noted in the literature are improved awareness/acceptance of disenfranchised groups, improved quality of research, and increased comfort of participants in the research process. Challenges include larger investment in time and money to hire, train, and support peer-interviewers, and the potential to disrupt peer recovery. We illustrate, through case study, how to engage peer-interviewers, meet potential challenges, and the benefits of such engagement. We draw upon our experience from a qualitative study designed to understand men's experiences of problem gambling and housing instability. We hired three peers to conduct semi-structured qualitative interviews with 30 men from a community-based organization. We contend, that with appropriate and adequate resources (time, financial investment), peer-interviewing produces a positive, capacity building experience for peer-interviewers, participants and researchers.