Health & Homelessness

Context

Homelessness in London has surged due to escalating health and housing needs and has led to calls for urgent action. In response, Londoners rallied together in 2022, advocating for change and prompting the establishment of London’s Health & Homelessness Summits. These summits, held from November 2022 to January 2023, brought together over 200 leaders from diverse sectors to address critical challenges. The result of these summits was the Whole of Community System Response to Health and Homelessness. This collaborative effort is made up of several Implementation tables focusing on a continuum of housing interventions to support getting people into homes (Figure). The work is also guided by Reference Tables formed to bring specific voices and expertise (Business, Developers, and Indigenous partners). Additionally, the System Foundations Table (SFT), formerly an Implementation Table, has recently transitioned to a Backbone Table, playing a crucial role in supporting the Health and Homelessness Research & Evaluation and Policy Development functions. 

Figure from the City of London

Shared Purpose and Values 

It’s imperative to underscore that CRHESI’s role in supporting evaluation and research of the WCSRHH is based on shared values, and in particular our commitment to serving the community’s needs – the work is designed to make a tangible difference in London. 

Also consistent with CRHESI’s work and expertise are the explicit use of trauma- and violence informed care (TVIC) and equity-promoting lens. This approach acknowledges the intersecting impacts of systemic and interpersonal violence, and of structural inequities, on a person’s life. It emphasizes both historical and ongoing violence and their traumatic effects, shifting the focus to encompass a person’s experiences of past and present violence, including marginalizing social circumstances. 

To ensure safe and inclusive participation for all involved, specific strategies have been outlined. Firstly, leveraging existing relationships for recruitment is essential, with fair compensation for time offered while ensuring individuals feel empowered to decline to participate if they choose not to. Addressing concerns about privacy and confidentiality during recruitment is crucial, with data protection integrated into all practices. Participants are encouraged to share their stories, with support available during data collection, interpretation, and public disclosure to prevent surprises. Additionally, all research staff are trained in TVIC, cultural safety, harm reduction and inclusive communication to build trust and comfort among participants. 

Our Approach  

CRHESI supports the System Foundations Table (SFT), which determines priority questions for each research/evaluation team and establishes timelines for deliverables. Teams comprise expert researchers from London’s colleges and Western University along with community partners with various kinds of expertise. CRHESI staff will coordinate research/evaluation team meetings to ensure clarity regarding roles, responsibilities, and timelines. Additionally, we will develop project plans, resources and tools, and provide regular progress reports. We are dedicated to fostering effective communication and reporting mechanisms to ensure transparency and inclusivity throughout the process.  

We employ the “Now, Next, Later” framework to outline immediate priorities, upcoming goals, and longer-term initiatives. This approach allows for a comprehensive understanding of our objectives and timelines. Furthermore, this research and evaluation is driven by health equity principles, and projects will employ mixed methods designs, combining quantitative and qualitative approaches to gain a comprehensive understanding of health and homelessness, and the impact of new supportive health and housing interventions, in the City of London. 

Partnered Research 

A key component of this research is partnership with the community including people with lived experience, the direct service workforce, and their organizations. Below are just two ways that the voice of the community experts will be crucial in this work.  

• Formulating Research & Evaluation Questions: The active involvement of those receiving and providing care is essential to ensure that questions are relevant and reflect real-world experiences and concerns.  
• Interpreting & Sharing Findings: Insights from those closest to the issues is crucial in collaborative interpretation of findings to develop key messages and ensure safe and effective knowledge mobilization strategies. 

Research & Evaluation Teams 

Team 1 is responsible for co-designing and undertaking research and evaluation to attempt to answer the Research/Evaluation Questions related the Outcomes and Experiences of: 

• People experiencing homelessness who face the highest needs and barriers 
• People precariously housed and at risk of homelessness 
• Residents of London’s various communities, and the general public

Team 2 is responsible for co-designing and undertaking research and evaluation related the Experiences and Well-being of the Workforce.  

Team 3 is responsible for co-designing and undertaking research and evaluation related to systems, structures, processes, and costs-of-care. 

Team 4 is responsible for co-designing and undertaking a process and contextual review of the WCSRHH. 

How we will work together 

In our concerted efforts to address the health and homelessness challenges facing our community, CRHESI, along with the SFT, have formulated a Basis of Unity document outlining our shared goals, values, and the operational approaches underpinning the work. 

Our approach emphasizes inclusivity, welcoming all who wish to contribute to any research & evaluation team(s), as aligned with their interests. To ensure effective leadership, team members will nominate co-chairs, ideally comprising one with an academic research background and another with community expertise. CRHESI will provide facilitation support, fostering connections with the Whole of Community Systems Response, and providing necessary tools and resources. 

Knowledge Mobilization 

In our communication and engagement, we prioritize inclusivity, respect, and collaboration as foundational values. We advocate for clear, concise language that avoids stigmatization and instead focuses on illuminating systemic shortcomings. Utilizing data interwoven with narrative, including visual and auditory elements such as photos, art, poetry, and song, we strive to convey our messages in diverse and accessible ways, ensuring the safety and comfort of all participants. Proactively addressing public concerns and expectations, we will craft communication plans to prepare both the public and policymakers for the breadth of our findings. Our approach is one of continuous refinement, as we adapt and evolve our strategies to best serve the needs of the London community, with an unwavering commitment to equity and destigmatization.