Objective: To determine how accessible health care services are for people who are experiencing homelessness and to understand from their perspectives what impact clinician bias has on the treatment they receive. Methods: Narrative interviews were conducted with 53 homeless/vulnerably housed individuals in Ontario, Canada. Visit history records were subsequently reviewed at 2 local hospitals, for 52 of the interview participants. Results: Of the 53 participants only 28% had a primary care provider in town, an additional 40% had a provider in another town, and 32% had no access to a primary care provider at all. A subset of the individuals were frequent emergency department users, with 15% accounting for 75% of the identified hospital visits, primarily seeking treatment for mental illness, pain, and addictions. When seeking primary care for these 3 issues participants felt medication was overprescribed. Conversely, in emergency care settings participants felt prejudged by clinicians as being drug-seekers. Participants believed they received poor quality care or were denied care for mental illness, chronic pain, and addictions when clinicians were aware of their housing status. Conclusion: Mental illness, chronic pain, and addictions issues were believed by participants to be poorly treated due to clinician bias at the primary, emergency, and acute care levels. Increased access to primary care in the community could better serve this marginalized population and decrease emergency department visits but must be implemented in a way that respects the rights and dignity of this patient population.

Addressing the vulnerability and unique needs of homeless populations during pandemics has been a major component of the Canadian federal response to the COVID-19 crisis. Rural and remote communities, however, have received little to no funding to aid in their care of homeless people during the pandemic. Similarly, there has been little to no research on rural communities’ pandemic preparedness in the context of homelessness. There are large numbers of homeless individuals in rural and remote Canada, including Indigenous peoples who are over-represented in homeless populations. Rural communities, including rural and remote Indigenous communities, are often isolated and more limited than urban areas in their capacity to respond to pandemics. They are particularly vulnerable due to fewer healthcare and social service resources—the lack of which has been particularly evident during the COVID-19 pandemic. In this commentary, we suggest that policy-makers need to take seriously the situation of rural homelessness in Canada, its implications for individual and community health, and consequences in the context of pandemics. Policy- and decision-makers can address these concerns through increased homelessness funding and support for rural and remote communities, policy change to recognize the unique challenges associated with rural pandemic planning and homelessness, and more research that can be translated into policy, programs, and supports for rural homelessness and pandemic planning response.

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Information-communication technologies, like computers and cellphones, are popular among young people. This article details a youth-centered participatory action study in which 12 homeless youth designed and developed a mobile application for other homeless youth. We frame our analysis through a theory of critical youth empowerment and discuss the steps taken to develop the application, as informed by the method of spiral technology action research. Developing the application allowed these young people to express their opinions and frustrations, while also providing an opportunity for them to make the lives of their peers better through improved access to supports and services.The use of information-communication technologies (ICTs) can be an important source of empowerment, especially for young people. Being able to access ICTs, such as youth-centered health web sites, has given young people a means of monitoring and altering their own health-related behaviors and attitudes. Researchers have sought to further capitalize on the benefits of ICTs by involving young people in their creation and implementation. Youth-centered participatory action research has been particularly important

Anti-social behaviour statutes are proliferating in western societies, yet little statistical analysis has been conducted on their enforcement patterns and trends, particularly in Canada. A study of the Ontario Safe Streets Act enforcement in Toronto shows a 2,000 percent increase in tickets from 2000 to 2010, with most being issued downtown to homeless individuals. Further research shows that this increase is not the result of increasing crime rates, increases in aggressive solicitation practices, widespread complaints from businesses or the public, or police responses to gangs, nor is it for revenue generation. We argue such anti-social behaviour statutes are a misguided public policy response to the visibility of homelessness.

Purpose People experiencing homelessness are high-users of hospital care in Canada. To better understand the scope of the issue, and how these patients are discharged from hospital, a national survey of key stakeholders was conducted in 2017. The paper aims to discuss this issue. Design/methodology/approach The Canadian Observatory on Homelessness distributed an online survey to their network of members through e-mail and social media. A sample of 660 stakeholders completed the mixed-methods survey, including those in health care, non-profit, government, law enforcement and academia. Findings Results indicate that hospitals and homelessness sector agencies often struggle to coordinate care. The result is that these patients are usually discharged to the streets or shelters and not into housing or housing with supports. The health care and homelessness sectors in Canada are currently structured in a way that hinders collaborative transfers of patient care. The three primary and inter-related gaps raised by survey participants were: communication, privacy and systems pressures. Research limitations/implications The findings are limited to those who voluntarily completed the survey and may indicate self-selection bias. Results are limited to professional stakeholders and do not reflect patient views. Practical implications Identifying systems gaps from the perspective of those who work within health care and homelessness sectors is important for supporting system reforms. Originality/value This survey was the first to collect nationwide stakeholder data on homelessness and hospital discharge in Canada. The findings help inform policy recommendations for more effective systems alignment within Canada and internationally.

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Substance use is common among homeless and precariously housed youth, yet few longitudinal studies track their usage over time. This paper analyzes data from a study of 187 youth and reports on their substance usage in the preceding month, year, and over their lifetime. The results are compared within the sample by sex and against a sample of similarly located housed youth. Findings suggest that female homeless and precariously housed youth report lower substance use, but that with interventions substance use decreases for both sexes. Compared to housed youth, those who are homeless and precariously housed begin substance use at a significantly younger age.