Integrating Healthcare and Housing Supports in Shelters: Exploring Root Causes and Symptoms
This post is the fourth in a series highlighting House of Friendship’s work on ShelterCare. Over 70% who seek emergency shelter in Waterloo region are navigating addiction, mental, and/or physical health challenges. Through the ShelterCare Solutions Lab, we will work together on designing solutions to better meet these needs through responsive and relationship-based healthcare and housing supports in emergency shelter. The previous post on Prototyping and Lessons Learned can be found here.
A problem tree is causal analysis aimed to look at root problems, and how they can affect people we work with. In this case, the causal analysis looked at the homeless population that is unwell. Of course we cannot generalize to say that all individuals who are precariously housed are unwell, but the goal was to identify different root causes for this particular population and then understand what related symptoms are created for homeless folks we work with.
Although this model has been created to symbolize a tree, and that issues grow from roots through to the branches, these “root causes” that have contributed to an unwell homeless population are not linear in nature. For example, as a team we have identified root causes such as difficulty accessing mental health supports. There is no one symptom that an unwell homeless population faces when they try and navigate the mental health system, in fact it is related to many other factors such as; undiagnosed mental health issues, or lack of medication adherence, or even the fact that staff may feel unequipped to deal with complex mental health issues. The idea here is that all these pieces are interrelated and connected. One piece leads to another that leads to another, but not in such an orderly fashion as the tree presents.
Examples of some Root Causes identified for an unwell, homeless population:
Childhood, and repeated trauma
Neoliberalism
Toxic drug supply
Lack of affordable housing
Defunding of housing services
Income inequality
Poverty
Examples of some Symptoms; a product of “root causes”
Substance use being a barrier to appropriate treatment
Inefficient use of system resources
Stigma; from landlords and community
Multiple rehousing attempts before permanent housing is retained
Confusion/duplication over case coordination and support
Pathologizing individuals who experience homelessness
From designing the problem tree, we noticed that there were subgroups of symptoms that lead to a bigger problem. The addition of many symptoms and root causes often added together would equal a bigger, larger issue. Long stays in emergency shelter, for example, were a product of many smaller symptoms interconnected to create the larger, systemic issue of individuals spending an excess amount of time in shelter. But how do we fix one problem before the other? Can these problems be fixed at the same time? These are questions the team has been reflecting upon, in order to find some plausible solutions to some of these issues.
As a person-centred community, who takes pride in being strengths-based and an advocate for change, it is important to note the language we use when discussing the homeless population. Many of us have heard the terms over and over again about individuals “not being ready” for housing or are in the spirit of “this isn’t possible”. These kinds of statements in and of itself are barriers to helping rehouse these individuals. To no fault of our own, we, as a system feel exhausted about the failed attempts to help our community members access housing, and when they are “unwell”, it makes it that much harder
One of the biggest aspects to the unwell homeless population is determining the biggest priority. Of course there are so many things in the shelter system that need to be improved upon, but where should our focus lie? One obvious factor for us, as shelter workers, is the fact that the opioid crisis is at the forefront of our minds right now. To put it simply, we are just trying to keep people alive! The amount of loss the shelter system has seen in recent years is alarming, and it feels as if there is no end in sight.
As we recognize none of these problems and symptoms have easily identifiable solutions, we know the work must go on. We do not want to design an average system, and miss people who are higher acuity, or individuals who have higher health needs. Rather, we want to create a design that is strengths-based and reduces stigma faced by the homeless population. By creating this problem tree, it helps us to understand the problems this population deals with everyday, and small steps that can be taken to help them find a safe space to call home. We have to start somewhere as small changes tend to lead to bigger ones.
As a current shelter employee, I am really excited about the positive changes that are coming! We have a great group of workers who are involved in the ShelterCare Solutions Lab, who have so much experience and knowledge to share. There is so much passion to advocate for and implement change, and I am looking forward to what comes next.
Get Involved
Do you have suggestions for our problem tree?
Can you see something that is missing or needs to be updated?
Check out the ShelterCare website for more information and how to connect with Sarah Brown and the Solutions Lab team.
As a Solutions Lab Provider, Overlap Associates partners with organizations to work through complex housing issues and scale potential solutions. A Solutions Lab is a collaborate initiative to solve complex housing problems using innovative methods and tools. For the organizations participating, a Lab is an opportunity to develop innovative solutions to a complex housing problem, as well as build capabilities for design, collaboration and problem-solving. Learn more about our Housing Solutions Labs here.