Ending homelessness isn’t as simple as providing a roof over a head. Persons leaving homelessness need to thrive — they need to nurture their mental well-being, integrate into their communities, engage in meaningful activity and exit poverty. While securing housing is a very important step towards thriving, supports and services are often unable to meet the additional needs of this population.
A new study conducted by Western’s School of Occupational Therapy and the Arthur Labatt Family School of Nursing — in collaboration with service providers and organizational leaders (SPOLs), policy makers and persons with lived experience of homelessness — looks at what is needed to enable people to leave homelessness and thrive.
Led by occupational therapy professor Carrie Anne Marshall and published in Health & Social Care in the Community, the study specifically addresses the perspective of SPOLs from two sites, Kingston and London, Ont., as there is not much academic literature focused on input from SPOLs.
SPOLs were interviewed regarding the strengths and challenges associated with existing supports in their respective communities and their perspectives on what individuals need to thrive following homelessness.
“Participants felt they knew what was needed,” said Marshall, “but they were caught in a system that prevented them from helping.“.
Support services are stretched thin, and SPOLs can only work with individuals for a short amount of time, even when they believe support is needed for much longer.
Substance abuse is often a coping strategy for persons experiencing or leaving homelessness, for dealing with trauma and living in less than dignified conditions. Substance misuse can create financial strain and intensify disruptive behaviours that lead to tenancy loss. Access to programs and supports that manage or prevent the harms of substance use are often limited in availability but are vital to supporting persons leaving homelessness.
“Mitigation of loneliness is often a last priority and falls off the radar as most of the supports available do not address it or address it well,” said Marshall. “It shows a need for novel interventions to fill the gaps around community integration.“.
Participants in the study said that persons leaving homelessness often struggle to pay for basic needs and that the housing available to them is inadequate. Living in conditions of ongoing need prevented individuals from thriving as they were forced to focus on survival.
A number of recommendations including mental health supports and trauma– and violence– informed care (TVIC) training for SPOLs are indicated by the findings of the study.
The stakeholders also made recommendations to address structural barriers which prevent persons leaving homelessness from thriving.
“People who are homeless are often living in poverty and they really need a higher income,” said Marshall. “Also, we need more deeply affordable housing. Not affordable housing generally, but housing that’s affordable to individuals who are living on the lowest incomes in our society. “
On the streets, people experiencing homelessness often develop connections with others in similar situations, but once they receive housing, they often lose that sense of community. Developing new connections within their community is difficult without support.
Peer support services were identified as vital for promoting community integration and more positive outcomes. Persons leaving homelessness may better connect with peer support workers, identifying with them more easily than with other care professionals. Marshall and team emphasized the need to properly prepare, train, respect, fairly compensate and respect as legitimate and skilled care providers, those who perform this peer support role.
According to Marshall, the team has focused on co-designing an intervention they can implement that promotes community integration via a peer-to-community model. Informed by the findings of stakeholder consultation including both this study and a soon-to-be-published study on the perspectives of persons with lived experience of homelessness, the intervention includes a curriculum for peer support workers that they will receive in advance of providing service.
“The team sees this project very much as a homelessness prevention strategy, where we mean preventing on-going, chronic or recurring homelessness,” Marshall said.
“What really strikes me in talking with people with lived experience of homelessness has been how little they actually ask for. They just want a place to feel safe, that’s clean, that doesn’t have bed bugs and where they are warm enough and have some control over their level of comfort in their unit.” ~Carrie Anne Marshall
Occupational therapy professor Debbie Rudman and nursing professor Abe Oudshoorn collaborated on the design of this study and strategies for the analysis and interpretation of data.