Emergency department interventions for homelessness: a systematic review

Abstract

Background The social determinants of health are economic and social conditions that contribute to health. Access to housing is a major social determinant of health and homeless patients often rely on emergency departments (EDs) for their healthcare. These patients are frequently discharged back to the street which further perpetuates the cycle of homelessness and negatively affects their health. Previous work has described the financial and systems implications of ED-housed interventions for homeless patients; this review summarizes ED-based interventions that seek to improve the social determinants of health of homeless patients. Methods We conducted a search of multiple databases and gray literature for studies investigating interventions for homelessness that were initiated in the ED. Studies had to use a control group or use a pre/post-intervention design and measure outcomes that demonstrate an effect on health or the social determinants of health. Results Thirteen studies were identified that met the inclusion criteria. Two studies were housing first interventions and were effective in providing housing and improving health. Seven studies used variations of case management and were able to address many of the social needs of people who are homeless. Conclusion This review demonstrated that ED interventions can be effective in improving the social determinants of health of homeless individuals and can be the place to initiate housing interventions. ED providers must advocate for the resources necessary to properly address the social needs of this marginalized population. Equipped with the proper resources, EDs can be one place where the cycle of homelessness is broken. Keywords Social determinants of health • Homelessness • Public health • Emergency department RésuméContexte Les déterminants sociaux de la santé font référence aux conditions sociales et économiques qui ont une incidence sur l'état de santé. Ainsi, l'accès au logement représente un important et les patients sans abri comptent souvent sur les

Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia

“… 13 This cohort are more likely to wait longer to receive care in ED 15 and leave before being seen by a health professional and then re-present at a later time. 16 EDs can provide a window of opportunity for intervention as well as delivering healthcare, and hold the potential to break the cycle of homelessness for thousands of people. 17 Increasing access to mainstream primary and preventative care could result in significant health improvements for people experiencing homelessness and significant cost savings to the health system.…”

CAEP position statement on improving emergency care for persons experiencing homelessness: executive summary

“…A selection of additional interventions can be found in Table 2 and the supplementary materials and a recent literature review in CJEM includes examples of ED initiated programs [ 29 ].…”

Treating homelessness as an emergency: learning from the COVID-19 response

“…As outlined in the review by Formosa and colleagues, direct referral to Housing First and case management programs from the ED is preferred and these were effective in connecting patients to housing [2]. Where these services do not yet exist, developing partnerships with community and government agencies to explore options may be beneficial.…”

“…A major barrier to health system response is not being able to measure the problem. As Formosa and colleagues point out, homelessness was "not included as a key demographic variable in many ED studies [2]." Homelessness, along with other key determinants of health such as prescription drug coverage, personal identification, and income security, are not routinely tracked.…”

“…While emergency physicians are experts at treating patients who have been assaulted or found hypothermic in a snowbank, we work in a system that permits these very same patients to be discharged back to homelessness. The research by Formosa and colleagues provides a much-needed systematic review of ED-initiated interventions to improve housing, health status, or access to care for people experiencing homelessness [2].…”