Coming in from the Cold: Canada’s National Housing Strategy, Homelessness, and the Right to Housing in a Transnational Perspective

Canada’s National Housing Strategy (NHS) commits the government to eliminating chronic homelessness and promises that realizing the right to housing is a key objective. In this article, we explore how the Canadian government could realize the right to housing in the context of eliminating chronic homelessness. We argue that it is helpful to look at how other jurisdictions have successfully reduced homelessness. In this article we examine Finland and Scotland’s approaches because they offer certain similarities in how homelessness is addressed, yet they also differ, most crucially in how they understand the right to housing. We argue that both of these jurisdictions offer important lessons for Canada to draw on as it seeks to reduce long-term homelessness.

Homelessness and Macro Interventions

The emergence of social work and macro practice is often associated with the eradication of poverty and prevention of homelessness through the efforts of 19th century settlement houses. Structural violence and social determinants of homelessness are often grounded in unequal social, political, and economic conditions. Health and mental health were affected by the lack of stable housing, causing and increasing the complexity of health and human service needs and services. Furthermore, due to inequities, some populations are inadvertently more likely to face chronic homelessness, which can be mitigated through the role community-engagement and macro practice interventions.

Images of Homelessness: The Home of the Needy Aged

Homelessness in 1880s New Zealand, as reported in the press, appears to be more intimate and less melodramatic than overseas examples. House fires, such as that of William Beals' eight-roomed house in Epsom, the destruction by fire of Mr Keogh's seven-roomed dwelling on the north-west side of Mount Pukekaroro, and the 1884 fire which broke out "on the grounds of St. Mary's Orphanage, Ponsonby" are examples. Chronic homelessness, when it appears, occurs via the reporting of institutional and architectural support structures. The paper will examine a specific example of an architecture for the homeless: the Home for the Needy Aged in Newtown, Wellington.

Managed alcohol: one community’s innovative response to risk management during COVID-19

Background Harm reduction programs often lack community-based support and can be controversial, despite data demonstrating effectiveness. This article describes one small Alaskan community’s development of a harm reduction managed alcohol program (MAP) in the context of a city-run quarantine site for individuals experiencing homelessness. The MAP was developed to support quarantining by COVID-19-exposed or COVID-positive individuals who also experienced chronic homelessness, a severe alcohol use disorder, and heightened health risks related to potentially unsupported alcohol withdrawal. Method Five interviews with key informants involved in planning or implementation of the MAP were conducted using rapid qualitative analysis and narrative analysis techniques. Outcome This study documents the planning and implementation of an innovative application of a managed alcohol harm reduction intervention in the context of the COVID-19 pandemic. In this instance, a MAP was used specifically to limit hospital admissions for alcohol withdrawal during a surge of cases in the community, as well as to mitigate spread of the virus. Key informants report no residents enrolled in the MAP program as a part of quarantine required hospitalization for withdrawal or for COVID symptoms, and no shelter resident left the quarantine site while still contagious with COVID-19. Additionally, the level of community support for the program was much higher than originally expected by organizers. Conclusions This program highlighted an example of how a community recognized the complexity and potential risk to individuals experiencing structural vulnerability related to homelessness and a severe AUD, and the community at large, and was able to create an alternative path to minimize those risks using a harm reduction strategy.

Pandemic preparedness and response in service hub cities: lessons from Northwestern Ontario

Purpose Responding to the needs of homeless and marginally housed persons has been a major component of the Canadian federal and provincial responses to the COVID-19 pandemic. However, smaller, less-resourced cities and rural regions have been left competing for limited resources (Schiff et al., 2020). The purpose of this paper is to use a case study to examine and highlight information about the capacities and needs of service hub cities during pandemics. Design/methodology/approach The authors draw on the experience of Thunder Bay – a small city in Northern Ontario, Canada which experienced a serious outbreak of COVID-19 amongst homeless persons and shelter staff in the community. The authors catalogued the series of events leading to this outbreak through information tracked by two of the authors who hold key funding and planning positions within the Thunder Bay homeless sector. Findings Several lessons may be useful for other cities nationally and internationally of similar size, geography and socio-economic position. The authors suggest a need for increased supports to the homeless sector in small service–hub cities (and particularly those with large Indigenous populations) to aid in the creation of pandemic plans and more broadly to ending chronic homelessness in those regions. Originality/value Small hub cities such as Thunder Bay serve vast rural areas and may have high rates of homelessness. This case study points to some important factors for consideration related to pandemic planning in these contexts.

Life Skill Development and its Impact on Perceived Stress, Employment and Education Pursuits: A Study of Young Adults with a History of Homelessness and Trauma

An occupational therapy educational training group for young adults in permanent supported housing was developed, implemented and evaluated with pre-post outcome measures including Goal Attainment Scaling (GAS) and the Perceived Stress Scale-10 (PSS-10). The study explored stress levels and employment-related goals of individuals who have aged out of the foster care system and may also have had a history of chronic homelessness and trauma. Results demonstrated a trend towards significance in perceived stress 9Z=1.689, p=0.91) with 7 of 8 participants surpassing the expected outcome according to GAS. Limitations included a small convenience sample (n=8), inconsistent attendance and use of self-report measures.

Technically Accessible, Practically Ineligible: The Effects of Medicaid Expansion Implementation on Chronic Homelessness

Context: Advocates for the homeless viewed Medicaid expansion as an opportunity to enhance health care access for this vulnerable population. We study the implementation of Medicaid expansion to assess the extent to which broadening insurance eligibility affected the functioning of municipal homelessness programs targeting chronic homelessness. The article also considers how Medicaid expansion interacted with existing governance structures and contributed to conflicts pertaining to homelessness. Methods: We employ a comparative case study of San Francisco, California, and Shreveport, Louisiana, which were selected as example cases based on a sampling approach using a Most Similar Systems framework from a national sample of cities across the U.S. We conduct elite interviews with a range of local-level stakeholders and combine this data with a review of primary-source documentation. Findings: Medicaid expansion did not enhance the functioning of homelessness programs and policies because of Medicaid access challenges and governance conflicts. Administrative burden and funding limitations contributed to limited provider networks, inadequate service coverage, and lack of linkages between Medicaid enrollment and homelessness programming. Governance conflicts reinforced these functional challenges, with homelessness under the administration of local municipalities and non-government organizations while states administer Medicaid. Conclusions: Improving access to health care services for persons experiencing homelessness cannot occur without intentional coordination between sectors and levels of government and necessitates the development of targeted policies and programs to overcome these challenges.

Pilot Testing a Tracking Tool for High Need, High Cost Patients Enrolled in Complex Care Management in Safety-Net Settings

Background: Complex Care Management (CCM) programs record patients’ progress toward health and healthcare utilization goals using a tracking tool in order to ascertain whether the patient is ready to transition to routine primary care. High-need, high-cost (HNHC) patients enrolled in CCM programs make progress, but existing tracking tools do not register the kinds of progress they make, suggesting that current tools may not be suitable in safety-net settings.Methods: We developed the Contextual Health Assessment of Social Stability (CHAOSS), which incorporates a patient’s social circumstances to capture patient experiences that affect their program participation. We used cognitive interviewing methods to test CHAOSS. We sought to understand if the CHAOSS tool could be used to track the kinds of progress CCM patients and providers find clinically relevant, would patients understand the questions and could the questions show meaningful distinctions in patient circumstances.Results: To set up the need for CHAOSS, we document the demographic and clinical characteristics of HNHC patients enrolled in CCM programs in safety-net settings. HNHC patients had extremely poor and volatile health, were economically vulnerable, and experienced challenges such as chronic homelessness. We found that CCM patients understood the CHAOSS questionnaire and generated an array of responses.Conclusion: CHAOSS appears to be a suitable tool for capturing HNHC patient experiences enrolled in CCM programs in safety-net settings.