Gehring, N.

Barriers and facilitators to delivering social services to patients experiencing unstable housing, homelessness, and substance use disorders in acute care
Gehring, N.D., Pugh, A., Salvalaggio, G., Hyshka, E.

Substance use disorder and homelessness are significant public health problems. People experiencing unstable housing, homelessness, and/or substance use disorders have higher rates of acute care utilization compared to the general population. While addressing medical needs, acute care visits are typically not designed to address underlying contributors to illness, including the social determinants of health. The objective of this study was to identify the barriers and facilitators to providing social supports in acute care for this population, as well as interventions that could potentially address their social needs.

Using a focused ethnographic design, eighteen semi-structured interviews were conducted with frontline social service providers at Edmonton's Royal Alexandra Hospital. Interviews explored staff experiences providing social services to patients experiencing unstable housing, homelessness, and substance use disorder, as well as staff views on bridging patients between hospital and community supports. Latent content analysis was performed. Findings may be limited to social work providers' personal experiences.

Participants described several ways to assess patients' housing status including evaluating intake assessments, verifying residential addresses, and building trust/rapport to facilitate self-disclosure. Several participants cited barriers to facilitating housing and income support for patients, such as heavy caseloads, lack of appropriate and affordable housing options, and restrictive income and housing eligibility criteria. Participants further described the need for strong transitional and permanent housing and income supports to address these gaps.

These findings suggest a number of policy, program, and practice changes that could potentially improve care for acute care patients experiencing unstable housing, homelessness, and substance use disorders including: 1) implementing a consistent approach to identifying homeless and/or unstably housed patients; 2) addressing multi-level system gaps in human resources, housing options, and financial supports; and 3) implementing hospital-based Housing First teams and harm reduction sub-acute care facilities.