An astonishing 1.25 million people experienced sheltered homelessness in the United States in 2020 (USICH, 2024). A record high number of people were homeless for the first time between 2019-2023 (Soucy et al., 2024). In addition, a record number of individuals – 256,610 in 2023 – experienced unsheltered homelessness. Homelessness affects individuals of all ages, genders, and ethnicities, although it disproportionately affects more who are non-Hispanic black, Hispanic or Latino, or Native American (USICH, 2024). Contrary to common assumptions, most people who experience homelessness do not have a substance use issue or severe mental health problem. There are a number of factors that can contribute to homelessness, including systemic failures such as high costs of housing and underfunded programs for affordable housing, wages that don’t keep up with rising costs of living, rising health care costs and inequitable or inadequate access, and mass incarceration (USICH, 2024). Other common precipitants of homelessness include domestic violence, job loss, severe health problems, and dissolution of relationships (Williams-Arya et al., 2021). Homelessness is both an individual issue and a public health issue; with the right policies and approaches, it is also a preventable problem.
Homeless shelters can provide those experiencing homelessness with a place to live and a sense of community. However, individuals living in homeless shelters may also experience problems related to this type of housing, such as feeling unsafe or distrustful of others, emotional distress, lack of health care, and job instability. Community-based participatory research (CBPR), in which participants can take an active role in the issues that affect them and their communities, can help address some of these challenges (Brydon-Miller, 1997). This approach involves a commitment to working with members of communities that have often been exploited, underrepresented, or oppressed, to promote positive social change. The CBPR approach “aims to be participatory, cooperative, empowering, and justice-oriented” (Kiser & Hulton, 2018, p. 2) to promote social change and positive outcomes for specific populations, such as the vulnerable population of homeless persons.
A team of individuals who experienced homelessness, along with academic researchers and community developers, undertook such a project to create a plan to improve the outcomes of a new housing community in Minneapolis (Olson et al., 2024). They worked together to identify concerns expressed by homeless individuals who lived in shelters, such as feeling distrustful of other residents, concerns over predators gaining access to the community, and not knowing how to handle commonly anticipated problems and situations. They then worked together to develop concepts to improve the operation of the community, based on these identified issues. In Cincinnati, a CBPR project focused on family homelessness shelters to identify the needs of families living in these shelters (Williams-Arya at al., 2021). Together, they identified common issues and needs that were then shared with shelter and community leaders to improve policies and practices. These needs included improvements in the logistics of daily life, better support for families with young children, job stability and timely communication of opportunities, skill development, and emotional support. The CBPR approach to improving shelter operations and utility to individuals and families can have a positive impact on the sense of community, support, and well-being for people experiencing homelessness.
As housing is a social determinant of health, homelessness can have a significant negative impact on individuals’ physical and mental well-being (USICH, 2024). On average, individuals who experience homelessness have life expectancies that are almost 30 years shorter than the average American. The severely shortened lifespan may be due to dangerous living conditions or illnesses, many of which are easily treatable with appropriate healthcare. These health disparities can result from lack of access to health care and related resources, crowded shelter conditions, lack of transportation, low health literacy, lack of insurance, and low-paying jobs (Kiser & Hulton, 2018). Much less is known about specific health needs in homeless populations, and different communities may have different needs. A CBPR approach to understanding and addressing the health needs of individuals experiencing homelessness is appropriate for these underserved and understudied populations.
The Healthcare for Homeless Suitcase Clinic (HHSC) project has taken a CBPR approach, forming a coalition of public health nurses, nursing faculty, local community hospital leadership, local community shelter managers, and individuals experiencing homelessness in a mid-Atlantic state (Kiser & Hulton, 2018). This coalition of community members worked together in cycles of data collection, interpretation, and reflection to make process improvements and develop innovative programs to address the health care needs of homeless individuals. From this CBPR approach, mobile health care clinics, which they called Suitcase Clinics, were developed to better meet the needs of the homeless. Needs they have been able to address include onsite urgent care, chronic disease management (e.g., hypertension, diabetes, and asthma), and preventative care at shelters. In addition, they have developed specialized Suitcase Clinics for mental health care, podiatric care, and dental care. They attribute the success of their program to the creation of strong community partnerships, recognition of community heterogeneity and willingness to adapt support services accordingly, as well as coordinated efforts to help every program participant get health care and housing. The CBPR approach has also been successful in helping homeless populations in small cities in British Columbia in Canada get more equitable health care access through the development of outreach programs to address podiatric needs (D’Souza & Mirza, 2022).
These examples highlight the power and potential positive impact of taking a CBPR approach to addressing important individual and societal challenges, particularly in vulnerable populations. With the goal of making a positive social change, CBPR makes use of key community stakeholders and academics to better the lives of those who may be most in need of advocacy.
References:
Brydon-Miller, M. (1997). Participatory action research: Psychology and social change. Journal of Social Issues, 53(4): 657-666.
D’Souza, M. S. & Mirza, N. A. (2022). Towards equitable health care access: Community participatory research exploring unmet health care needs of homeless individuals. Canadian Journal of Nursing Research, 54(4): 451-463.
Kiser, T. & Hulton, L. (2018). Addressing health care needs in the homeless population: A new approach using participatory action research. SAGE Open, July-September 2018: 1-7.
Olson, C., Grande, S. W., Toran, W., & Walsh, W. (2024). Program evaluation and improvement by a homeless community using a human centered design approach. Journal of Participatory Research Methods, 5(1): 1-21.
Soucy, D., Janes, M., & Hall, A. (2024). State of homelessness: 2024 edition. National Alliance to End Homlessness. https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness/
United States Interagency Council on Homelessness (USICH). (2024). Data & Trends. Usich.gov. https://www.usich.gov/guidance-reports-data/data-trends
Williams-Arya, P., Vaughn, L. M., Nidey, N., Sawyer, M., Porter, K., & Froelich, T. E. (2021). Striving for structure and stability in Cincinnati’s family homeless shelters. Family and Community Health, 44(4): 282-291.