Homelessness is a major social problem around the world including Canada. Studies of homeless populations in Canada have found higher mortality rates in men and women; higher rates of hepatitis B and C, HIV infection, prevalence of pregnancy, mental

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• Providing Health Care Services to Homeless
  Populations Lessons from the Field
• E. Ngwakongnwi1, MSc. MPH, B. Leung1 ND, MSc, D.
  Johnson2 MN, D. Cawthorpe3 Ph.D3, H. Quan1 MD
  Ph.D.
• Dept of Community Health Sciences, University of
  Calgary, Canada 2) Alberta Health Services,
  Healthy Diverse Populations, Calgary, Canada 3)
  Alberta Health Services, Psychiatry, Calgary,
  Canada
• Address all correspondence to engwakon_at_ucalgary.c
  a

INTRODUCTION Homelessness is a major social
problem around the world including Canada.
Studies of homeless populations in Canada have
found higher mortality rates in men and women
higher rates of hepatitis B and C, HIV infection,
prevalence of pregnancy, mental health problems,
and nutritional problems due to poor diet. A 2008
count of homeless people in Calgary found that
4,060 individuals were absolutely homeless,
representing an 18.2 rise from 2006. The
purpose of this study was to assess perspectives
of service providers on issues encountered in
delivering services to homeless people, by
identifying strategies that work and those that
do not.
RESULTS
Table 2. Summary of service provider
perspectives on challenges and actions for
improving health services to homeless.
CONCLUSION
Table 1. Characteristics of study participants

• Improving health services to homeless people
  requires a multi-faceted and well coordinated
  approach. There seems to be a common
  acknowledgement of gaps in health services for
  homeless persons especially related to early
  discharge from hospital with no-follow-up.
• Rethinking the 2006 conference on homelessness
  and health Following that conference, a series
  of actions have begun at the level of Calgary
• January 2007 the Calgary Committee to End
  Homelessness was established.
• They have developed a 10 year plan to end
  homelessness in the city.
• The plan designed for Calgary was delivered in
  mid-2008
• What next?

Challenges/Issues Suggested Actions
Housing/shelters Address cost of housing, institute rent control. Employers should provide housing for people relocating. Need to reduce time spent in shelters. Have a exit plan at entry.
Access (primary care) Physicians should connect to shelters. Need to adopt new care delivery models e.g. street nursing
Education Educate healthcare providers and the community about homelessness. Create awareness and address stereotyping homelessness e.g. conferences.
Health Insurance/benefits Develop a database that is accessible to service agencies. Need to have some medication onsite.
Mental Health/Addictions Address addictions as a health issue rather than a legal issue. Need to revisit the conduct of war on drugs as it often impedes action on addictions. Need more staff and increase compensation.
Continuum of care Coordinate discharge and follow up from hospital to shelter e.g. Calgary Health Region needs to fund positions of Nurse Practitioners (NP) to coordinate care and discharge planning in hospitals.
Funding More government involvement, not rely on charities for funding. Need to address the flawed granting process.
Poverty Improve cash flow by eliminating restrictions to social assistance. Need to raise social assistance payments. Need to increase minimum wage. Need for programs to train people on specific trades and skills for the industry
Collaboration /Coordination Map service agencies serving the homeless. Have a central phone system where homeless persons can have information on services and programs available. Need to improve on existing programs rather than creating new ones.
Policy/Legislature Address punitive bylaws, fines that cause obstacles to tackling homelessness. Suggest policy memos to politicians to expose the problem. Examine impact of health and social policies on the lives of the homeless.
Research Have one definition of homelessness. Evaluate effectiveness of current programs and service delivery models in tackling homelessness. Shift research from health issues of the homeless to interventions.
Variable total
Gender Females (n 79) Males (n 8) Contact with homeless Direct (n 54) Indirect (n 27) None ( n 6) Position held Health care provider (n 36) Services provider (n 12) Social worker (n 12) Administrator (n 7) Others (n20) No. years worked with homeless Mean Standard Deviation Median Range 90.8 9.2 62.1 31.0 6.9 41.1 13.8 13.8 8.0 23.0 6.75 7.39 3.5 0 - 30

• OBJECTIVES
• To identify the issues, challenges, or barriers
  that hinder service delivery to homeless people
  in Calgary metropolitan area.
• To suggest action steps to tackling homelessness
  and improving health status of homeless
  populations.

METHODS Design We used a convenient sample of
participants at a Diversity and Wellbeing
Conference Taking Action on Homelessness and
Health held in Calgary, Canada on November 17,
2006. Data collection A mixed methods approach
was used to collect data. Firstly, a
questionnaire assessed participant gender,
role, level of contact, length of time serving
homeless people and perspectives on challenges,
issues, and suggestions to improve services to
homeless people. This information was
supplemented by facilitated group discussions.
Analysis We used Qualitative Content Analysis
(QCA) - This involved systematically picking out
key words and phrases from the written content of
the responses and grouping them into common
themes or concepts. Emerging themes and concepts
were discussed with other members of the project
team to assess the information further before
arriving at the over-arching themes.
Acknowledgments/Funding Funding for this
project was provided by United Way of Calgary and
Area, through Healthy Diverse Populations,
Alberta Health Services