Integrating homelessness support – developing a relational understanding

TY - JOUR

T1 - Integrating homelessness support – developing a relational understanding

AU - Clark, Michael

AU - Cornes, Michelle

AU - Tinelli, Michela

AU - Coombes, Jo

AU - Burridge, Stan

AU - Wittenberg, Raphael

AU - Carlisle, Jess

AU - Harris, Jess

N1 - Publisher Copyright: © 2024, Emerald Publishing Limited.

PY - 2025/3/11

Y1 - 2025/3/11

N2 - Purpose: People experiencing homelessness often have multiple health and other support needs, requiring complex, coordinated support. Admission to hospital is potentially an opportunity to address these needs and begin integrating care, but so often it is a missed one. Our purpose in this research was to evaluate an ongoing, roll-out programme that offered government funding to 17 “test sites” across England to develop integrated care as part of post-discharge “step-down” support. In this paper, we examine senior stakeholder experiences of seeking to implement integrated care as part of specialist step-down care. Design/methodology/approach: In this paper, we focus on data collected in interviews with key stakeholders (N = 10) who managed the mobilisation of local out of hospital care models for people experiencing homelessness. Interviews were conducted and analysed from a relational perspective, that is focusing on relationships between interactants, through which, for example, identities, understanding and integrating practice emerge. Findings: A relational perspective on the data provides insights to better understand the complexity of integrating care at the point of hospital discharge for people experiencing homelessness. Research limitations/implications: Although in depth, the data were limited to certain perspectives on the issues. Other perspectives and data collection from in-depth study of case sites would be invaluable in developing the empirical evidence base for a relational understanding of integrating care. Practical implications: A relational perspective highlights the emergent and ongoing nature of integrating care in this context of support for people experiencing homelessness. The need for different system agents to work to be constantly enacting the desired support is crucial to understanding future system changes for integrating care. Originality/value: This is the first paper developing a relational analysis of integrating care. It highlights a different theoretical perspective on the issues and important insights.

AB - Purpose: People experiencing homelessness often have multiple health and other support needs, requiring complex, coordinated support. Admission to hospital is potentially an opportunity to address these needs and begin integrating care, but so often it is a missed one. Our purpose in this research was to evaluate an ongoing, roll-out programme that offered government funding to 17 “test sites” across England to develop integrated care as part of post-discharge “step-down” support. In this paper, we examine senior stakeholder experiences of seeking to implement integrated care as part of specialist step-down care. Design/methodology/approach: In this paper, we focus on data collected in interviews with key stakeholders (N = 10) who managed the mobilisation of local out of hospital care models for people experiencing homelessness. Interviews were conducted and analysed from a relational perspective, that is focusing on relationships between interactants, through which, for example, identities, understanding and integrating practice emerge. Findings: A relational perspective on the data provides insights to better understand the complexity of integrating care at the point of hospital discharge for people experiencing homelessness. Research limitations/implications: Although in depth, the data were limited to certain perspectives on the issues. Other perspectives and data collection from in-depth study of case sites would be invaluable in developing the empirical evidence base for a relational understanding of integrating care. Practical implications: A relational perspective highlights the emergent and ongoing nature of integrating care in this context of support for people experiencing homelessness. The need for different system agents to work to be constantly enacting the desired support is crucial to understanding future system changes for integrating care. Originality/value: This is the first paper developing a relational analysis of integrating care. It highlights a different theoretical perspective on the issues and important insights.

KW - Homelessness

KW - Integration

KW - Multiple exclusion

KW - Rainbow model of integrated care

KW - Relational

KW - VUCA environment

KW - Wicked policy issue

UR - http://www.scopus.com/inward/record.url?scp=105001083827&partnerID=8YFLogxK

U2 - 10.1108/JICA-05-2024-0021

DO - 10.1108/JICA-05-2024-0021

M3 - Article

AN - SCOPUS:105001083827

SN - 1476-9018

VL - 33

SP - 1

EP - 17

JO - Journal of Integrated Care

JF - Journal of Integrated Care

IS - 1

ER -