Health, Housing and Income (H²I)

The H²I Project

A research team at Lawson Health Research Institute is evaluating a program to prevent discharge from the hospital into homelessness.

The program is being tested at two hospitals in London, Ontario: London Health Sciences Centre and St. Joseph's Healthcare London.

Funding for the research is provided by Canada Mortgage and Housing Corporation.

In order to access the other studies done by Forchuk and colleagues related to this topic please use the links below:

General Page
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Background: The Program

Sometimes people leaving hospital do not have a place to go. They may lose their home while staying in hospital, or they may have been experiencing homelessness when they were admitted.

Once a person is discharged into homelessness, it can be harder to find housing. The person may face problems like lack of resources, transportation, or ID.

Homelessness can also interfere with recovery from health or mental health problems. This creates a “revolving-door” effect where the person cycles between being in hospital and being at “no fixed address”.

To put a stop to this problem, our team developed a housing support program. The goal of this program is to make sure people leaving hospital have a safe place to go.

The program brings supports for housing and income into the hospitals. This makes them easier to access earlier on in a person’s hospital stay. Finding housing takes time and can involve many steps. Starting early can make a difference.

The program works like this:

1. Staff from community agencies are brought into the hospital to help with housing or money issues.
2. People can get help from the staff at any time during their hospital stay by referral, drop-in, or appointment.
3. People who have higher needs are set up with a caseworker who will continue to support them after they have left the hospital.

Evaluation

Our research team is running a study called “Collaboration to Address Homelessness: Health, Housing and Income” (H2I). The study is testing a program to prevent hospital discharge to homelessness. We will look at whether the program helps people find housing before or after leaving hospital. We will also look at whether the program affects health and quality of life. Feedback from participants will be used to improve the program.

Our team will compare how well the program works for two groups: people receiving treatment on medical wards, and people receiving treatment on psychiatric wards.

We are comparing these two groups because our previous research found they had different needs. People getting treatment on medical wards had shorter hospital stays. This made it hard to find housing while the person is in hospital. We also found some people being treated on psychiatric wards had difficulty keeping housing they found through the program.

The program we are evaluating has been tested several times while creating and improving it. Here are links to the Implementation Guide developed through this process:

Implementation Guide (download)

Research Plan

• Up to 106 adults are recruited from people accessing the NFA program. About half will be people getting treatment on medical wards. The other half will be people getting treatment on psychiatric wards.
• We will interview participants two times, six months apart. The interviews ask questions about housing, quality of life, health, mental health, and service use.
• Participants can an also take part in a focus group with other people who have used the program. At the focus group, the participants can discuss their experiences with the program and provide suggestions for improvement.
• We also have focus groups with healthcare providers whose clients have used the program, and staff from the community agencies running the program.

Forchuk, C., Godin, M., Hoch, J. S., Kingston-MacClure, S., Jeng, M. S., Puddy, L., Vann, R., & Jensen, E. (2013). Preventing psychiatric discharge to homelessness. Canadian Journal of Community Mental Health, 32(3), 17-28. doi:10.7870/cjcmh-2013-028

Forchuk, C., MacClure, S. K., Van Beers, M., Smith, c., Csiernik, R., Hoch, J., & Jensen, E. (2008). Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelters and ‘no fixed address’. Journal of Psychiatric and Mental Health Nursing, 15(7), 569-575. doi:10.1111/j.1365-2850.2008.01266.x

Forchuk, C., Russel, G., Kingston-MacClure, S., Turner, K., & Dill, S. (2006). From psychiatric ward to the streets and shelters. Journal of Psychiatric and Mental Health Nursing, 13, 301–308. doi:10.1111/j.1365-2850.2006.00954.x