Client–provider relationships in a community health clinic for people who are experiencing homelessness

Abstract

Recognizing the importance of health-promoting relationships in engaging people who are experiencing homelessness in care, most research on health clinics for homeless persons has involved some recognition of client-provider relationships. However, what has been lacking is the inclusion of a critical analysis of the policy context in which relationships are enacted. In this paper, we question how client-provider relationships are enacted within the culture of community care with people who are experiencing homelessness and how clinic-level and broader social and health policies shape relationships in this context. We explore these questions within a critical theoretical perspective utilizing a critical ethnographic methodology. Data were collected using multiple methods of document review, participant observation, in-depth interviews and focus groups. The participants include both clients at a community health clinic, and all clinic service providers. We explore how clients and providers characterized each other as 'good' or 'bad'. For providers, this served as a means by which they policed behaviours and enforced social norms. The means by which both providers' and clients' negotiated relationships are explored, but this is couched within both local and system-level policies. This study highlights the importance of healthcare providers and clients being involved in broader policy and systemic change.

Developing best practice in psychologically informed environments

“…Previous studies have identified a similar sense of conditionality to care (e.g. Oudshoorn et al, 2013), whilst Thompson et al, (2004) framed this differently, as the necessity for 'willingness' from service users. This would support a view that the required compliance, proposed by those in the current study, could also be viewed by services as a need for 'engagement', locating the problem within the service user.…”

On the Frontlines: Perspectives of Providers Working With Homeless Women

“…Several investigators have documented perceptions among homeless adults and identified key issues related to lack of compassion and empathy from service providers (Nickasch & Marnocha, 2009; Salem & Ma-Pham, 2015). The literature also reveals a need for health-promoting homeless–provider relationships (Oudshoorn, Ward-Griffin, Forchuk, Berman, & Poland, 2013).…”

“…Without doubt, negative provider attitudes toward homeless clients can act as barriers to quality health care and affect those experiencing homelessness. Homeless clients have listed respect, actively seeking ways to lessen the power differential, a nonjudgmental approach, and solidarity as the key components of the patient–provider relationship (Oudshoorn, Ward-Griffin, Forchuk, et al, 2013). Another study of provider perceptions revealed that HW described experiences with service providers as neutral, dehumanizing (e.g., unmet expectations, judged, minimized, alienated, powerless), or humanizing (e.g., cared for, trusted, shared past/identity, empowered; Biederman & Nichols, 2014).…”

Building connection against the odds: project workers relationships with people experiencing homelessness

“…Existing evidence suggests that many PEH have negative experiences of care, both within housing services (Stevenson, 2014) and healthcare settings (Oudshoorn et al , 2013). The conditionality of housing and support left PEH feeling disillusioned and hesitant to seek help (Jost et al , 2014), preventing PEH from trusting and engaging with services and workers (Zerger et al , 2014).…”