Competing perspectives on rural homelessness: Findings from a qualitative study in Ontario, Canada

Rural homelessness in Canada has only recently been acknowledged, and several gaps remain in our understanding of the phenomenon and how it is influenced by the rural context. This qualitative exploratory study aimed to help understand the experience of housing insecurity, factors that lead to rural homelessness, and potential solutions to the housing crisis in a rural Ontario community. Interviews were conducted with 27 participants: 16 individuals who were housing insecure and 11 key informants who had knowledge of the local homelessness situation. Data collection took place between August 2020 and May 2021 and inductive analysis was concurrent. Findings revealed competing perspectives on the magnitude of the crisis, its root causes, and potential solutions to rural homelessness. The invisible nature of rural homelessness and values of individualism that assign responsibility for homelessness to poor choices rather than structural factors may account for these different perspectives. Stigma also played an important role in how homelessness was understood, particularly for individuals who were homeless and perceived to be using substances. The lack of privacy, limited services, and low housing stock in the rural environment contributed to challenges with overcoming homelessness. Strategies to help improve supports for individuals facing homelessness include anti-stigma education, capacity building, and inclusion of people with lived experience of homelessness in decision and policymaking. Prevention should also be incorporated into the response to rural homelessness through intersectoral collaboration and upstream policies that target the structural drivers of homelessness.

Preventing Indigenous youth homelessness in Canada: A qualitative study on structural challenges and upstream prevention in education

Drawing on a partnership with a group of Indigenous youth experiencing homelessness in Vancouver, Canada, this study identifies four structural challenges that have impacted them and four actionable upstream strategies to further prevent youth housing precarity. As a secondary analysis of a community-engaged study with youth experiencing homelessness, we conducted a thematic analysis with qualitative data, which included qualitative interviews with five young people and researcher observations. The results reflect the racial, colonial, and economic concerns that impact Indigenous youth experiencing homelessness. The four actionable upstream solutions highlight human rights-based approaches to homelessness, ranging from advancing and strengthening public services, transitional justice processes, and cultural and socioeconomic safety. This study provides strategies to promote Indigenous youth wellbeing and decrease risk of housing precarity, while centering and drawing from youth knowledge production. Strengths and limitations of the study are also discussed.

The Effect of Emergency Financial Assistance on Healthcare Use

Does providing financial assistance to people who have just experienced an income shock affect their healthcare use? To address this question, we examine healthcare outcomes in a setting where people at risk of homelessness due to an income shock were offered or denied referral to financial assistance quasi-randomly. Among callers who have been screened as eligible for assistance at Chicago's Homelessness Prevention Call Center (HPCC), some are denied assistance because the availability of funding varies. Conditional on some observable characteristics, funding availability is as-good-as-randomly assigned to callers. We link callers to healthcare utilization records and observe their inpatient hospital stays and emergency department visits. We find that referral to financial assistance has little effect on overall healthcare use-we can reject increases in total utilization greater than 7% of the base rate and decreases of more than 4%. This null effect can be explained, in part, by the fact that the income shock does not significantly change overall healthcare use among those not receiving assistance, suggesting that these individuals can insure health and healthcare demand against these shocks in other ways.

Making the Case for Proactive Strategies to Alleviate Homelessness: A Systems Approach

Homelessness is a complex public health issue that affects some of the most vulnerable populations in the United States. This study takes a holistic approach to better understand and analyze the multiple factors and their interconnections that contribute to the complexity of this problem. A systems analysis was conducted by utilizing the system dynamics method, which allows analyzing and comparing trends and behavior of system outcomes for different "what if" scenarios, interventions, and policy implications. Three leverage points were identified in this study to increase the effectiveness and efficiency of the current strategies to address homelessness: (1) increasing the number of affordable permanent housing units, (2) increasing the utilization of transitional housing units or shelters by the individuals experiencing homelessness, and (3) providing preventative services to at-risk populations before the onset of homelessness. Our results demonstrate that the most effective strategy is an amalgam of the solutions identified by these three leverage points. In addition, a policy analysis was conducted to study and estimate the effectiveness of various potential scenarios. This research provides data-driven and model-based insights into how decision-makers can utilize a systems approach to analyze new policy implications and create effective solutions to homelessness.

Evolving an evidence-based model for homelessness prevention

While some progress has been made in addressing chronic homelessness through supportive models, a comprehensive solution for housing loss must include prevention. The purpose of this article is twofold: to conduct a review of the literature on the domains of the Framework for Homelessness Prevention; and to use literature on the concept of quaternary prevention, preventing the harms of service provision, to theorise an additional domain. The Framework for Homelessness Prevention draws upon theory from public health exploring primary, secondary and tertiary prevention, and also integrates primordial prevention. This leads to a typology of homelessness prevention that incorporates the following five domains: (a) Structural prevention; (b) Systems prevention; (c) Early intervention; (d) Eviction prevention; and (e) Housing stability. By systematically reviewing the literature we build out the evidence-base supporting these domains. The team used research databases, internet searches and retrospective reference list reviews to identify high-quality journal articles on prevention, which were then sorted by level of prevention. Through this process, we evolved our thinking on the Framework in considering that quaternary prevention was not initially included. Therefore, we explored the literature related to quaternary prevention in the context of homelessness and offer a sixth domain for the Framework: Empowerment. Ultimately, a comprehensive Framework for Homelessness Prevention will support communities and governments to more effectively prevent homelessness through upstream approaches.

Solving Homelessness from a Complex Systems Perspective: Insights for Prevention Responses

Homelessness represents an enduring public health threat facing communities across the developed world. Children, families, and marginalized adults face life course implications of housing insecurity, while communities struggle to address the extensive array of needs within heterogeneous homeless populations. Trends in homelessness remain stubbornly high despite policy initiatives to end homelessness. A complex systems perspective provides insights into the dynamics underlying coordinated responses to homelessness. A constant demand for housing assistance strains service delivery, while prevention efforts remain inconsistently implemented in most countries. Feedback processes challenge efficient service delivery. A system dynamics model tests assumptions of policy interventions for ending homelessness. Simulations suggest that prevention provides a leverage point within the system; small efficiencies in keeping people housed yield disproportionately large reductions in homelessness. A need exists for policies that ensure reliable delivery of coordinated prevention efforts. A complex systems approach identifies capacities and constraints for sustainably solving homelessness.