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.

Adaptations for Children and Youth Mental Health During and Post COVID-19: Can we seamlessly integrate telemental health when this is all over? (Preprint)

UNSTRUCTURED COVID-19 is having major repercussions for children and adolescents’ mental health and well-being.Children and youth who are low-income, marginally housed, and in the throes of trauma and/or abuse are particularly vulnerable, as the public safety net upon which they rely was unable to address a documented mental health crisis that existed well before the pandemic. current efforts to provide laptops and internet hotspots for distance learning during COVID-19 offers an opportunity to connect more children to their mental health providers post-pandemic.

The ‘Collective Voice that Could Change the World’: A Qualitative Interpretive Meta-Synthesis of Arts-Based Programming for Adults Experiencing Homelessness

Homelessness is a global phenomenon that contributes to and exacerbates social exclusion and marginalisation. The objective of this study is to generate a rich description of the experience of participating in arts-based programming as told by adults experiencing homelessness using a qualitative interpretive meta-synthesis. The synthesis includes eight studies, using direct quotes provided by fifty-three individuals in Canada, the USA and Australia. Synthesis of the eight studies results in three themes that describe the experience of participating in arts-based programming across geographic locations and art mediums: ‘arts as healing’, ‘arts as advocacy’ and ‘arts as self-empowerment’. While social workers, homelessness service providers, arts-based educators and researchers may be intuitively aware of the power of the arts, the synergistic findings of these eight articles indicate its influence among marginally housed populations. Implications and opportunities for future research are discussed.

Automated Mobile Phone-Based Mental Health Resource for Homeless Youth: A Pilot Study Assessing Feasibility and Acceptability (Preprint)

BACKGROUND Youth experiencing housing instability (e.g., homeless or marginally housed) have higher rates of mental health problems than their housed peers. Mobile technologies have often been touted for their potential to reduce health disparities and reach people who might not otherwise receive services. Few studies have developed and evaluated technological resources for these populations to determine how to effectively engage and reach them. OBJECTIVE The primary aims of this pilot study are to establish the feasibility and acceptability of delivering automated mental health resources via smartphone technology. METHODS Youth aged 16-25 (N=100) were recruited through homeless shelter agencies in the Chicagoland area. Eligible participants completed a baseline assessment and received an Android smartphone with a 3-month data plan. The phone was pre-loaded with several smartphone applications designed to promote mental health wellness, and an app designed to provide real-time resources for homeless individuals in Chicago. One app specifically designed for this study, Pocket Helper, sent participants a daily surveys and tips via push notification. Tips focused on coping and motivation, and surveys assessed mood. Pocket Helper also included an automated self-help system with brief cognitive-behavioral interventions (5-10 mins) and access to several interactive mobile tools including a crisis text line, a telephone hotline, and a crowd-based emotional support tool. Participants completed assessments at 3 and 6 months to assess changes in self-reported mental health symptoms, substance use, risk behaviors, psychological resources and strengths, and life satisfaction, as well as to provide feedback on and benefit from the intervention. RESULTS Participant satisfaction varied with the different apps. The majority of youth preferred daily tips (40.5% at midpoint, 41.2% at endpoint) and surveys (48.6% at midpoint, 41.2% at endpoint). At midpoint, participants least preferred the Illinois Warm Line and daily surveys (29.7% and 21.6%, respectively), though Koko was close behind (18.9%). At endpoint youth least preferred the Illinois Warm Line and Koko (35.3% and 23.5%, respectively). Overall, over 70% of respondents both time points reported benefiting from the intervention. Participants reported a preference for daily push features like the daily survey and tips, but reported lower engagement with other tools, such as those requiring them to open certain apps themselves interact with other users. CONCLUSIONS This set of automated mental health interventions seem to be an acceptable way to engage homeless youth in mental health treatment. Participants preferred fully automated features and brief interventions over features requiring interaction with others or more involved engagement. We plan to conduct focus groups with youth who participated to better understand their attitudes toward various components of the intervention. Future research should explore ways to retain homeless youth in these types of interventions, or evaluate whether briefer interventions are more feasible in this population. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT03776422

“Build a Bridge So You Can Cross It:” A Photo-Elicitation Study of Health and Wellness Among Homeless and Marginally Housed Veterans

As part of a photo-elicitation interview study, we aimed to describe homeless and marginally housed Veterans’ experiences with health and wellness, health decisions, and health-related behaviors. Twenty Veterans receiving Veterans Affairs Homeless Patient-Aligned Care Team care took photographs depicting health and wellness, then used their photographs to discuss the same topics in 30-60 minute audio-recorded, semi-structured photo-elicitation interviews. Transcripts were analyzed using template analysis. Veterans described eight dimensions related to their health and wellness; physical, social, and environmental were most commonly discussed, followed by emotional, intellectual, spiritual, occupational, and financial wellness. Photographs contained literal and metaphorical depictions that were positively-oriented, comprehensive, and reflective. Of central importance was overcoming external and internal obstacles to wellness. Photo-narratives may be helpful in educating health care providers and advocating for the needs of homeless and marginally housed Veterans. Integrated primary care services should address the multi-faceted aspects of health and wellness for Veterans.