A relational ecology for crisis prevention among unhoused indigenous peoples in Albuquerque.

Abstract

The purpose of this study was to inform the development of a crisis prevention process model focusing on the qualities present in relationships among unhoused Indigenous peoples and integrated healthcare providers when crisis is prevented. The scope of the study is on multidisciplinary healthcare teams (MHT) and removing barriers for clients to access the resources they need. This key-informant study conducted 24 semistructured interviews including (14) unhoused Indigenous people and (10) members of their MHT in 2021. The study consisted of two phases beginning with identifying study and interview questions through a participatory evaluation process. During the second phase, interviews were conducted and recorded by researcher. Coding assistance by the research team supported heuristic content analysis. An integrated healthcare provider's cultural understanding of a client emerged as a fundamental tenant for a client to experience a sense of belonging on their MHT. Seventy-two significant statements were identified, two themes were acquired, structured into three categories, and synthesized into eight codes: cultural understanding, sense of belonging, focusing, strengths, listen, communication, informed, and intraorganizational systems. Ethical distress contributed to escalated crises and prevention barriers while MHT cohesion enhanced the capacity to support a client's success. Participant experiences shaped theoretical integration of the relational-cultural theory, motivational interviewing, and the Community Resiliency Model prevention process model to improve MHT safety planning. The implications for integrated healthcare and housing policy are to increase multilevel support for organizations to sustain MHT cohesion and maintain intraorganizational systems. Public Health Significance StatementThis study addresses the problem of health disparities among unhoused Indigenous peoples with focus on reducing safety incidents in community behavioral health settings. The integration of relational and somatic clinical models expands on trauma-informed care to further the paradigm shift from a deficit model to an emphasis on resilience and healing in recovery. Public health implications are identified on the interpersonal, multidisciplinary, organizational, and structural policy and practice levels.