Emergency department care experiences among members of equity-deserving groups: quantitative results from a cross-sectional mixed methods study

BACKGROUND

Emergency departments (EDs) serve an integral role in healthcare, particularly for vulnerable populations. However, marginalized groups often report negative ED experiences, including stigmatizing attitudes and behaviours. We engaged with historically marginalized patients to better understand their ED care experiences.

METHOD

Participants were invited to complete an anonymous mixed-methods survey about a previous ED experience. We analysed quantitative data including controls and equity-deserving groups (EDGs) - those who self-identified as: (a) Indigenous; (b) having a disability; (c) experiencing mental health issues; (d) a person who uses substances; (e) a sexual and gender minority; (f) a visible minority; (g) experiencing violence; and/or (h) facing homelessness - to identify differences in their perspectives. Differences between EDGs and controls were calculated with chi squared tests, geometric means with confidence ellipses, and the Kruskal-Wallis H test.

RESULTS

We collected a total of 2114 surveys from 1973 unique participants, 949 controls and 994 who identified as equity-deserving. Members of EDGs were more likely to attribute negative feelings to their ED experience (p < 0.001), to indicate that their identity impacted the care received (p < 0.001), and that they felt disrespected and/or judged while in the ED (p < 0.001). Members of EDGs were also more likely to indicate that they had little control over healthcare decisions (p < 0.001) and that it was more important to be treated with kindness/respect than to receive the best possible care (p < 0.001).

CONCLUSION

Members of EDGs were more likely to report negative ED care experiences. Equity-deserving individuals felt judged and disrespected by ED staff and felt disempowered to make decisions about their care. Next steps will include contextualizing findings using participants' qualitative data and identifying how to improve ED care experiences among EDGs to make it more inclusive and better able to meet their healthcare needs.

Understanding the associations between owner and pet demographics on pet body condition among those experiencing homelessness and housing vulnerability in Canada

Approximately 35 000 people experience homelessness in some form each night in Canada, with similar rates (approximately 1/200 individuals) among developed countries. Ten to twenty percent of those individuals are pet owners. Animal companionship provides a variety of mental and physical benefits to people who are living homeless or vulnerably housed, but many in the non-vulnerable sector, including veterinary professionals and animal welfare advocates, express concern for the health and welfare of these animals. We describe the demographics of a population of animals owned by individuals experiencing homelessness and housing vulnerability, and investigate animal and owner factors influencing body condition score and over-conditioning using data collected from Community Veterinary Outreach (CVO). Community Veterinary Outreach is a registered charity focused on improving the health and welfare of people and their pets who are experiencing homelessness and housing vulnerability. The organization provides free services to clients in ten Canadian communities. Data associated with 636 owners and 946 animals were collected during clinics held between April 2018 and March 2020, representing a total of 1124 visits. The population of dogs and cats seen by CVO was demographically similar to populations seen in general companion animal veterinary practice and were in similar health. For both species, the mean body condition score was 5.4/9, where an ideal score is five for cats and four to five for dogs, and 38 % of animals were considered over-conditioned (overweight/obese). Risk factor analysis demonstrated significant associations between being over-conditioned and pet age and the reason for the veterinary visit for cats, and pet age, the number of abnormal findings on physical exam, and a previous CVO visit for dogs. Pet age, sex-neuter status, disease of the oral cavity, and a previous CVO visit were significantly associated with body condition score in cats. Body condition score in dogs was associated with owner age, and with interactions between pet age and breed size group, and between sex-neuter status and owner-reported housing security. These findings suggest that animals owned by those experiencing homeless and housing vulnerability are generally in good health and similar factors influence body condition score and over-conditioning as animals seen in general companion animal veterinary practice. Further efforts to provide support to pet owners within these communities by veterinarians will help support the good health of this population.

The impact of interventions for youth experiencing homelessness on housing, mental health, substance use, and family cohesion: a systematic review

BACKGROUND

Youth often experience unique pathways into homelessness, such as family conflict, child abuse and neglect. Most research has focused on adult homeless populations, yet youth have specific needs that require adapted interventions. This review aims to synthesize evidence on interventions for youth and assess their impacts on health, social, and equity outcomes.

METHODS

We systematically searched Medline, Embase, PsycINFO, and other databases from inception until February 9, 2018 for systematic reviews and randomized controlled trials on youth interventions conducted in high income countries. We screened title and abstract and full text for inclusion, and data extraction were completed in duplicate, following the PRISMA-E (equity) review approach.

RESULTS

Our search identified 11,936 records. Four systematic reviews and 18 articles on randomized controlled trials met the inclusion criteria. Many studies reported on interventions including individual and family therapies, skill-building, case management, and structural interventions. Cognitive behavioural therapy led to improvements in depression and substance use, and studies of three family-based therapies reported decreases in substance use. Housing first, a structural intervention, led to improvements in housing stability. Many interventions showed inconsistent results compared to services as usual or other interventions, but often led to improvements over time in both the intervention and comparison group. The equity analysis showed that equity variables were inconsistently measured, but there was data to suggest differential outcomes based upon gender and ethnicity.

CONCLUSIONS

This review identified a variety of interventions for youth experiencing homelessness. Promising interventions include cognitive behavioural therapy for addressing depression, family-based therapy for substance use outcomes, and housing programs for housing stability. Youth pathways are often unique and thus prevention and treatment may benefit from a tailored and flexible approach.

Individual, Housing, and Neighborhood Predictors of Psychological Integration Among Vulnerably Housed and Homeless Individuals

The current longitudinal study evaluated the individual, housing, and neighborhood characteristics predictive of feeling psychologically integrated within one's neighborhood among a population of homeless and vulnerably housed individuals. Participants were recruited at homeless shelters, meal programs, and rooming houses in Ottawa, Canada and participated in three in-person interviews, each approximately 1 year apart. Prospective and cross-sectional predictors of psychological integration at Follow-up 1 and Follow-up 2 were examined. There were 397 participants at baseline, 341 at Follow-up 1 and 320 at Follow-up 2. A hierarchical multiple regression uncovered several significant predictors of psychological integration. The most salient and common predictors were being older, having greater social support, living in high quality housing, and residing in a neighborhood with a positive impact. Implications for service provision and policy advancements are discussed.