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Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: A Delphi consensus study

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Listed:
  • Esther S Shoemaker
  • Claire E Kendall
  • Christine Mathew
  • Sarah Crispo
  • Vivian Welch
  • Anne Andermann
  • Sebastian Mott
  • Christine Lalonde
  • Gary Bloch
  • Alain Mayhew
  • Tim Aubry
  • Peter Tugwell
  • Vicky Stergiopoulos
  • Kevin Pottie

Abstract

Background: Homelessness is one of the most disabling and precarious living conditions. The objective of this Delphi consensus study was to identify priority needs and at-risk population subgroups among homeless and vulnerably housed people to guide the development of a more responsive and person-centred clinical practice guideline. Methods: We used a literature review and expert working group to produce an initial list of needs and at-risk subgroups of homeless and vulnerably housed populations. We then followed a modified Delphi consensus method, asking expert health professionals, using electronic surveys, and persons with lived experience of homelessness, using oral surveys, to prioritize needs and at-risk sub-populations across Canada. Criteria for ranking included potential for impact, extent of inequities and burden of illness. We set ratings of ≥ 60% to determine consensus over three rounds of surveys. Findings: Eighty four health professionals and 76 persons with lived experience of homelessness participated from across Canada, achieving an overall 73% response rate. The participants identified priority needs including mental health and addiction care, facilitating access to permanent housing, facilitating access to income support and case management/care coordination. Participants also ranked specific homeless sub-populations in need of additional research including: Indigenous Peoples (First Nations, Métis, and Inuit); youth, women and families; people with acquired brain injury, intellectual or physical disabilities; and refugees and other migrants. Interpretation: The inclusion of the perspectives of both expert health professionals and people with lived experience of homelessness provided validity in identifying real-world needs to guide systematic reviews in four key areas according to priority needs, as well as launch a number of working groups to explore how to adapt interventions for specific at-risk populations, to create evidence-based guidelines.

Suggested Citation

  • Esther S Shoemaker & Claire E Kendall & Christine Mathew & Sarah Crispo & Vivian Welch & Anne Andermann & Sebastian Mott & Christine Lalonde & Gary Bloch & Alain Mayhew & Tim Aubry & Peter Tugwell & V, 2020. "Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: A Delphi consensus study," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-14, April.
    • Handle: RePEc:plo:pone00:0231758
    DOI: 10.1371/journal.pone.0231758
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    References listed on IDEAS

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    1. Daphne Habibis, 2013. "Australian Housing Policy, Misrecognition and Indigenous Population Mobility," Housing Studies, Taylor & Francis Journals, vol. 28(5), pages 764-781, July.
    2. Tsemberis, S. & Gulcur, L. & Nakae, M., 2004. "Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals with a Dual Diagnosis," American Journal of Public Health, American Public Health Association, vol. 94(4), pages 651-656.
    3. Jalene Tayler Anderson & Damian Collins, 2014. "Prevalence and Causes of Urban Homelessness Among Indigenous Peoples: A Three-Country Scoping Review," Housing Studies, Taylor & Francis Journals, vol. 29(7), pages 959-976, October.
    4. Collins, S.E. & Malone, D.K. & Clifasefi, S.L., 2013. "Housing retention in single-site Housing First for chronically homeless individuals with severe alcohol problems," American Journal of Public Health, American Public Health Association, vol. 103(S2), pages 269-274.
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