Integrating healthcare services for people experiencing homelessness in Australia: key issues and research principles

Clifford, Brendan; Vallesi, Shannen; Macfarlane, Stephanie; Currie, Jane; Haigh, Fiona; Gill, Katherine; Wilson, Andrew; Harris, Patrick

doi:10.1136/ihj-2020-000065

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Subsequently, our intentional use of a case study methodology to elucidate how the six critical success factors for intersectoral collaboration undergirded tangible actions and outcomes. Further, our findings concur with Clifford et al [40] that effective intersectoral working between health and other sectors needs to occur at both a service and policy level.…”

Section: Discussionsupporting

confidence: 91%

Critical Success Factors for Intersectoral Collaboration: Homelessness and COVID-19 – Case Studies and Learnings from an Australian City

Macfarlane,

Haigh,

Woodland

et al. 2024

International Journal of Integrated Care

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Introduction:The COVID-19 pandemic disproportionally impacted people experiencing homelessness, including people sleeping rough, people in temporary accommodation and those living in boarding houses. This paper reports on intersectoral responses across six health and social care agencies in Inner Sydney, New South Wales, Australia. Prior to the pandemic the six agencies had established an Intersectoral Homelessness Health Strategy (IHHS), in recognition of the need for intersectoral collaboration to address the complex health needs of people experiencing homelessness. Description:The governance structure of the IHHS provided a platform for several innovative intersectoral responses to the pandemic. A realist informed framework was used to select, describe, and analyse case studies of intersectoral collaboration. Discussion:The resultant six critical success factors (trust, shared ways of working, agile collaboration, communication mechanisms, authorising environment, and sustained momentum), align with the existing literature that explores effective intersectoral collaboration in complex health or social care settings. This paper goes further by describing intersectoral collaboration 'in action', setting a strong foundation for future collaborative initiatives. Conclusion:While there is no single right approach to undertaking intersectoral collaboration, which is highly context specific, the six critical success factors identified could be applied to other health issues where dynamic collaboration and integration of healthcare is needed.

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Section: Discussionsupporting

confidence: 91%

Critical Success Factors for Intersectoral Collaboration: Homelessness and COVID-19 – Case Studies and Learnings from an Australian City

Macfarlane,

Haigh,

Woodland

et al. 2024

International Journal of Integrated Care

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“…Lastly, highly structured service delivery processes and procedures left little opportunity to informally engage with people seeking care. Clifford et al [ 44 ] identified siloed service delivery as an obstacle to people with substance use disorders and other long‐term health conditions, that resulted in continuous referrals between systems. Siloed service delivery also leaned into alcohol and other drugs being viewed as separate to the service role.…”

Section: Discussionmentioning

confidence: 99%

Putting out the welcome mat—A qualitative exploration of service delivery processes and procedures as barriers to treatment‐seeking for people who use alcohol and other drugs

Francia

Lam

Berg³

et al. 2022

Drug and Alcohol Review

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Introduction There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long‐established, less is known about how specific aspects of service delivery impact treatment‐seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery. Methods Thirty‐nine semi‐structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health‐care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment‐seeking. Results Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment‐seeking and engagement. Within broader health‐care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment‐seeking. Discussion and Conclusions Results suggest opportunities to engage and undertake needs‐based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health‐care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.

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“…This non-engagement with services often means that individuals experiencing homelessness become more seriously ill and are more likely to experience premature death than the general population [ 39 , 40 ]. Reduced utilisation of healthcare services can largely be attributed to often insurmountable barriers, which this population faces across all levels [ 41 ], including challenges related to access, experiencing stigma and discrimination [ 42 ], financial constraints, inadequate transportation [ 43 , 44 , 45 ] and low health literacy [ 46 ]. The issue of access to free or affordable health care repeatedly arises as a key barrier for individuals experiencing homelessness [ 19 , 47 ].…”

Section: Introductionmentioning

confidence: 99%

The Health Needs of Regionally Based Individuals Who Experience Homelessness: Perspectives of Service Providers

Bennett-Daly

Maxwell

Bridgman

2022

IJERPH

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The bidirectional relationship between homelessness and poor health and the barriers that individuals who experience homelessness face when trying to access healthcare are well documented. There is, however, little Australian research exploring the situation of individuals who experience homelessness in regional contexts and, moreover, from the perspective of service providers. A qualitative descriptive methodology underpinned this study, with in-depth semi-structured interviews being conducted with 11 service providers to identify barriers to care faced by people who experience homelessness and barriers that service providers themselves experience in supporting this population. The key barriers identified were client-level barriers: living day-by-day, financial, health literacy, mental health conditions, behaviour, safety and stigma; provider-level barriers: few bulk-billing doctors, fragmented services, limited resources, negative past experiences with healthcare; and system level barriers: transportation, over-stretched healthcare services. The combined impact of these barriers has significantly contributed to the desperate situation of people experiencing homelessness in Launceston. This situation is likely replicated in other regional populations in Australia. Given that individuals experiencing homelessness have higher rates of every measure in health inequality, steps need to be taken to reduce barriers, and a standardised approach to health care urgently needs to be implemented by governments at the state and national level to improve the health of regionally based individuals experiencing homelessness.

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Integrating healthcare services for people experiencing homelessness in Australia: key issues and research principles

Abstract: Integrating healthcare services for people experiencing homelessness in Australia: key issues and research principles.

Cited by 5 publications

References 15 publications

Critical Success Factors for Intersectoral Collaboration: Homelessness and COVID-19 – Case Studies and Learnings from an Australian City

Critical Success Factors for Intersectoral Collaboration: Homelessness and COVID-19 – Case Studies and Learnings from an Australian City

Putting out the welcome mat—A qualitative exploration of service delivery processes and procedures as barriers to treatment‐seeking for people who use alcohol and other drugs

The Health Needs of Regionally Based Individuals Who Experience Homelessness: Perspectives of Service Providers

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