Critical Characteristics of Housing and Housing Supports for Individuals with Concurrent Traumatic Brain Injury and Mental Health and/or Substance Use Challenges: A Qualitative Study

Abstract

Traumatic brain injury (TBI) and mental health and/or substance use challenges (MHSU) are commonly co-occurring and prevalent in individuals experiencing homelessness; however, evidence suggests that systems of care are siloed and organized around clinical diagnoses. Research is needed to understand how housing and housing supports are provided to this complex and understudied group in the context of siloed service systems. This study aimed to describe critical characteristics of housing and housing supports for individuals with concurrent TBI and MHSU from the perspectives of service users with TBI and MHSU and housing service providers. Using basic qualitative description, in-depth interviews were conducted with 16 service users and 15 service providers. Data were analyzed using thematic analysis techniques. Themes capture core processes in finding and maintaining housing and the critical housing supports that enabled them: (1) overcoming structural barriers through service coordination, education and awareness raising, and partnerships and collaborations; and (2) enabling engagement in meaningful activity and social connection through creating opportunities, training and skills development, and design of home and neighborhood environments. Implications for practice, including the urgent need for formalized TBI and MHSU education, support for service providers, and potential interventions to further enable core housing processes are discussed.

Rehabilitation among individuals with traumatic brain injury who intersect with the criminal justice system: A scoping review

“…The lack of training among service providers supporting individuals with TBI has been highlighted extensively in the literature, particularly among underserved populations ( 75 – 77 ), service users and families interacting with community services ( 80 ), in the context of TBI and mental health/substance use ( 81 ), and in some parts of the CJS ( 82 , 83 ). These studies also highlighted the importance of education in increasing TBI awareness and knowledge regarding appropriate supports and addressing negative views about TBI ( 82 , 84 ). Specific to the prison setting, educating staff on TBI and TBI-related behaviors and strategies to manage these behaviors could lead to decreased penalties and reduced negative interactions between staff and individuals with TBI in prison ( 85 ).…”

“…Finally, this scoping review highlights an opportunity to address the current fragmented care for individuals with TBI ( 80 , 84 , 86 – 88 ), including the lack of continuity in resources and support in community re-integration, ( 80 , 87 , 88 ) through Linkworker or NeuroResource Facilitator roles. These individuals provided direct support to the client while in custody and indirectly supported them by engaging health professionals, prison staff that interact with the client ( 52 – 56 ).…”

“…As such, opportunities to integrate linkage programs or services within the broader CJS context should be explored, particularly those that address the noted barriers regarding the cost and resources required to implement linkage programs ( 52 , 54 ). Finally, partnerships or collaborations among individuals and resources both within secured settings and in the community to support continuity of care should be considered and may address the commonly reported challenge of system navigation or care coordination among individuals with TBI receiving community services ( 80 , 84 , 92 , 93 ).…”

Rehabilitation among individuals experiencing homelessness and traumatic brain injury: A scoping review

“…The view that TBI is a complex condition, and the need for, and importance of, formal TBI education and training has been identified in research outside of those included in this review. For example, a qualitative study sought the perspectives of housing services providers in Canada and identified attitudes around TBI that affected service delivery (72). Specifically, providers referred to TBI as an unknown and reported lacking TBI knowledge and expertise or needing to go "above and beyond" their role to support individuals with TBI in finding and maintaining housing (72).…”

“…Multidisciplinary teams may also facilitate opportunities for education on TBI. Alongside the call for formal education and training, housing service providers have also reported benefitting from partnerships and collaborations with healthcare professionals who had knowledge and expertise in working with individuals with TBI (72). This is particularly important given the intersecting challenges faced by individuals experiencing homelessness and TBI reported in articles included in this scoping review, including but not limited to criminal justice involvement (45,49,56,58,60,61) domestic violence (47), and comorbid mental health and substance use (MHSU) challenges (45,(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61).…”