Homelessness—‘It will crumble men’: The views of staff and service users about facilitating the identification and support of people with an intellectual disability in homeless services

Abstract

People with an intellectual disability (ID) face significant health inequalities and barriers to accessing appropriate support, which are made worse if the person is also homeless. An important barrier is that services may not recognise that the person has ID. This qualitative study explored the views of staff members and service users about the identification and support needs of homeless people with ID and the role of an ID screening questionnaire as a way to help improve service provision. Semistructured interviews were conducted with 16 staff members and 8 service users from homeless services in the South East of Scotland between March 2017 and 2018. Thematic analysis identified four themes: 'not diagnosed or declared', which explored the barriers to support due to the person's ID not being identified by others or disclosed by the person; 'It will crumble men', which reported on the additional challenges faced by homeless people with ID; 'disabling environment' which identified the ways in which organisations can make support difficult for people with ID to access; and 'It's not against them, it's to help them' which explored the benefits and issues associated with screening for ID in homeless services. The results identified the complex support needs likely to be experienced by many homeless people with ID and suggested a number of implications for practice. First, the screening tool was seen as having a number of benefits, if used where there is a process to provide the person with further specialist assessment and support. Second, staff members identified a need for training in relation to identifying and supporting this group of people. Third, the screening tool was seen as a way to help provide information about the prevalence and needs of people with ID, in order to inform and shape policy, service development, and delivery. K E Y W O R D Shomeless, intellectual disability, learning disability screening questionnaire, qualitative

Homelessness and people with intellectual disabilities: A systematic review of the international research evidence

“…The ideal situation is to prevent people with ID from becoming homeless. For this to be realized, there needs to be nationally coordinated strategic policy approaches to homelessness and the inclusion of the specific needs of the ID population (McKenzie et al., 2019). In some studies, wider transcultural issues were identified as predetermining factors that may result in homelessness.…”

“…In order to provide pathways out of homelessness, appropriate and responsive physical and psychosocial interventions and supports need to be in place (van der Laan et al., 2018; van Straaten et al., 2017). A significant barrier that impacted upon the care and support provided to people with ID within homelessness services, and those exiting, related to the limited knowledge, skills and expertise of support staff regarding the specific needs and requirements of the population (McKenzie et al., 2019). To help mitigate against these factors, wider policies and strategies need to include a focus on the needs of people with ID to ensure that education opportunities, discrimination, social exclusion, socioeconomic disparities and equality of healthcare access provision are identified and resources and support targeted (Gowda et al., 2017; Nishio et al., 2017; van Straaten et al., 2014).…”

“…To help mitigate against these factors, wider policies and strategies need to include a focus on the needs of people with ID to ensure that education opportunities, discrimination, social exclusion, socioeconomic disparities and equality of healthcare access provision are identified and resources and support targeted (Gowda et al., 2017; Nishio et al., 2017; van Straaten et al., 2014). Consequently, education and practice development programmes need to focus on increasing the awareness that people with ID become homeless and the identification and assessment of their subsequent support needs requires a specific attention (McKenzie et al., 2019; Oakes & Davies, 2008; van Straaten et al., 2014). In terms of discharge from homelessness services and resettlement into the community, there is a need for effective interagency communication, information sharing and service collaboration thereby ensuring that care and support is coordinated and responsive in order to prevent a return to homelessness (McKenzie et al., 2019; Nishio et al, 2017; Nishio, et al, 2015; van Straaten et al., 2014).…”

“…Consequently, education and practice development programmes need to focus on increasing the awareness that people with ID become homeless and the identification and assessment of their subsequent support needs requires a specific attention (McKenzie et al., 2019; Oakes & Davies, 2008; van Straaten et al., 2014). In terms of discharge from homelessness services and resettlement into the community, there is a need for effective interagency communication, information sharing and service collaboration thereby ensuring that care and support is coordinated and responsive in order to prevent a return to homelessness (McKenzie et al., 2019; Nishio et al, 2017; Nishio, et al, 2015; van Straaten et al., 2014).…”

“…Practitioners in care agencies, such as housing, education, health and social care, need to recognize that some people with ID become homeless and that on initial presentation it may not be apparent that the person has intellectual and developmental impairments. Furthermore, some people with mild ID may be unaware of their intellectual and cognitive impairment, thereby being unable to disclose this important information to ensure effective access to relevant care and support (McKenzie et al., 2019). Therefore, simple screening is required at the time of reception into homeless services to ensure that the necessary assistance and supports are tailored to the specific needs of the individual with ID (McKenzie et al., 2019; Nishio, et al, 2015).…”