Sharing the burden of treatment navigation: social work and the experiences of unhoused women in accessing health services in Santa Cruz

Abstract

This paper explores the challenges faced by unhoused women in accessing general and reproductive health care services in Santa Cruz, CA. Semi-structured interviews with women experiencing houselessness were conducted in Santa Cruz, CA with a focus on their narrative experiences as patients. The overwhelming majority of participants expressed appreciation for clinics that provided support through longer hours, alternative therapies, and appointment reminders. Overall, the interviews indicated that women who had access to a social worker were much more likely to report improved access to satisfactory treatment. These findings suggest that there is not a tangible lack of healthcare services for unhoused women in the local community, but rather a burden of treatment navigation caused by a dearth of information on how to access care. The interviews suggest that this burden can be reduced with social work interventions and service centers that offer health navigation support. By adapting theories of the "burden of treatment," we argue that additional attention must be paid to overcoming the "burden of treatment navigation." For related reasons, we suggest that increasing the availability of social workers would concretely improve health outcomes for unhoused women.

A scoping review examining patient experience and what matters to people experiencing homelessness when seeking healthcare

“…A common issue raised was the struggle PEH experienced navigating healthcare systems 30,33,34,47,51,56,57 . Instances varied from di culty understanding health systems 47,51,56 to the inherent complexity of referral systems 57 and paperwork 56 . A lack of healthcare insurance also exacerbated di culties with service navigation in a USbased paper 47 .…”

“…Instances varied from di culty understanding health systems 47,51,56 to the inherent complexity of referral systems 57 and paperwork 56 . A lack of healthcare insurance also exacerbated di culties with service navigation in a USbased paper 47 . Case workers or navigators who could help facilitate the navigation of services were seen as critical enablers 30,33,34,36,47 .…”

“…Furthermore, some PEH held concerns of prejudicial information in medical records in uencing the provision of medical care 35,36,54 . Negative experiences created power dynamics 33 , strained relationships 50 , adversely impacted care 33 , were associated with a loss of self-con dence 52 , and contributed to a reluctance to engage healthcare services in the future 29,31,33,47,[50][51][52] . In contrast, positive experiences encouraged health-seeking behaviour and service engagement 34,51 , upheld dignity 29 and decreased feelings of shame among PEH 30 .…”

“…Person-centred care incorporates the diverse experiences of individuals and their speci c needs and priorities. Repeatedly, participants valued services that recognised the complexities relating to homelessness and which tailored services to meet their needs 33,34,47,53 . PEH greatly appreciated the social capital gained from health services, in particular positive social interaction, shared norms and decreased feelings of isolation 30,49,53 .…”

Care for Transactions

“…All these topics could also be engaged with a view to illustrating how geographers are contributing simultaneously to important debates beyond the discipline. And there are obviously many other areas for engagement like this: ranging from materialist accounts of the mutations of actually existing neoliberalism (Peck & Theodore, 2019; Sparke & Williams, 2022; Sparke & Levy, 2022) to similarly ‘conjunctural’ contributions to interdisciplinary scholarship on topics as wide‐ranging as anti‐Blackness (Roy et al, 2020); bio‐economies (Birch, 2019); care‐navigation (Saharan et al, 2021); drones (Cheikhali, 2022; Lockhart et al, 2021); geopolitics (Paasche & Sidaway, 2021); global cities (Leitner & Sheppard, 2020); health education (Mitchell‐Sparke et al, 2022); rentier capitalism (Christophers, 2022); vaccine apartheid (Sparke & Levy, 2022) and the Virocene (Fernando, 2020). We could go on listing other diverse opportunities for engagement here at length.…”