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Emergency department interventions for homelessness: a systematic review

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Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Background

The social determinants of health are economic and social conditions that contribute to health. Access to housing is a major social determinant of health and homeless patients often rely on emergency departments (EDs) for their healthcare. These patients are frequently discharged back to the street which further perpetuates the cycle of homelessness and negatively affects their health. Previous work has described the financial and systems implications of ED-housed interventions for homeless patients; this review summarizes ED-based interventions that seek to improve the social determinants of health of homeless patients.

Methods

We conducted a search of multiple databases and gray literature for studies investigating interventions for homelessness that were initiated in the ED. Studies had to use a control group or use a pre/post-intervention design and measure outcomes that demonstrate an effect on health or the social determinants of health.

Results

Thirteen studies were identified that met the inclusion criteria. Two studies were housing first interventions and were effective in providing housing and improving health. Seven studies used variations of case management and were able to address many of the social needs of people who are homeless.

Conclusion

This review demonstrated that ED interventions can be effective in improving the social determinants of health of homeless individuals and can be the place to initiate housing interventions. ED providers must advocate for the resources necessary to properly address the social needs of this marginalized population. Equipped with the proper resources, EDs can be one place where the cycle of homelessness is broken.

Résumé

Contexte

Les déterminants sociaux de la santé font référence aux conditions sociales et économiques qui ont une incidence sur l’état de santé. Ainsi, l’accès au logement représente un important et les patients sans abri comptent souvent sur les services des urgences (SU) pour obtenir des soins de santé. Qui plus est, après avoir obtenu leur congé de l’hôpital, ces patients retournent la plupart du temps à la rue, ce qui a pour effet d’entretenir le cercle vicieux de l’itinérance et d’avoir une influence défavorable sur leur santé. La portée financière des interventions amorcées au SU pour les patients sans abri et leurs retombées sur les systèmes de soins de santé ont déjà fait l’objet d’études. La revue systématique avait donc pour but de présenter un résumé des interventions visant à améliorer les des patients sans abri, mises en œuvre au SU.

Méthode

La revue consistait en une recherche d’études dans de nombreuses bases de données et dans la documentation parallèle portant sur des interventions amorcées au SU pour les sans-abris. Les études sélectionnées devaient s’appuyer sur un groupe témoin ou sur une démarche de type avant-après ainsi que sur des mesures de résultats démontrant une influence des interventions sur l’état de santé ou sur les.

Résultats

Treize études satisfaisaient aux critères de sélection. Deux d’entre elles portaient sur des interventions accordant la priorité au logement et ces dernières se sont révélées efficaces dans l’accès au logement et dans l’amélioration de l’état de santé. Dans sept autres études, on avait appliqué diverses variantes de la prise en charge de cas, qui se sont montrées efficaces dans la satisfaction de nombreux besoins sociaux des sans-abris.

Interprétation

Les résultats de cette revue systématique ont démontré que les interventions amorcées au SU peuvent améliorer efficacement les des sans-abris et que les SU peuvent certes être le lieu de mise en œuvre d’interventions accordant la priorité au logement. Aussi les fournisseurs de soins au SU doivent-ils réclamer les ressources nécessaires pour répondre adéquatement aux besoins sociaux de cette population marginalisée. Ainsi dotés des ressources appropriées, les SU peuvent devenir l’un des points de rupture du cercle vicieux de l’itinérance.

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Funding

This research received no specific grant from any funding agency, commercial or not-for-profit.

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Authors and Affiliations

  1. School of Medicine, New York Medical College, Valhalla, NY, USA

    Evan A. Formosa

  2. University of Toronto, Toronto, ON, Canada

    Vanessa Kishimoto

  3. University Health Network, Library and Information Services, Toronto, ON, Canada

    Ani Orchanian-Cheff

  4. Department of Medicine, University of Toronto, 1901 Elizabeth Street, R Fraser Elliot Building, 3-805, Toronto, ON, M5G 2C4, Canada

    Kaitlin Hayman

  5. University Health Network, Toronto, ON, Canada

    Kaitlin Hayman

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  1. Evan A. Formosa
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Correspondence to Kaitlin Hayman.

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Formosa, E.A., Kishimoto, V., Orchanian-Cheff, A. et al. Emergency department interventions for homelessness: a systematic review. Can J Emerg Med 23, 111–122 (2021). https://doi.org/10.1007/s43678-020-00008-4

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