COVID-19 and homelessness podcast

Transcript

COVID-19 and homelessness

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Daniel Ridge (DR): Today we are joined by three experts in the field of homelessness scholarship to discuss the impact of COVID-19 on people experiencing homelessness. The conversation draws on the recently published Special Issue of Housing, Care and Support: planning and responding to the challenges of COVID-19 among people experiencing homelessness. Our first expert in the field of homelessness research is Dr. Abe Oudshoorn, Associate Professor at the Arthur Labatt Family School of Nursing, Western University, Canada. Our second guest is Dr. Rebecca Schiff, Dean of the Faculty of Human and Health Sciences at the University of Northern Columbia, Canada. Finally, we are joined by Dr. Martin Whiteford, who is the guest editor of the Special Issue underpinning and informing this edition of the Emerald podcast.

I'd like to introduce our first guest, Dr. Abe Oudshoorn.  I'm a researcher and I'm Associate Professor in the School of Nursing at Western University in London, Ontario, Canada, and I'm the managing editor of the International Journal on homelessness. Our second guest is Dr. Rebecca Schiff. I am Dean of the Faculty of Human and Health Sciences and Professor in the School of Health Sciences at University of Northern British Columbia, in Prince George British Columbia. Our third guest is Dr. Martin Whiteford. Hi, I'm Martin Whiteford, I'm the Publishing Development Manager for Healthier Lives at Emerald Publishing. Prior to taking up this post, I was the editor of Housing, Care and Support and spent over 16 years’ conducting research on and with homeless people.

Great well, I want to jump right into the subject and ask just the general question how people experiencing homelessness are particularly vulnerable to COVID-19. Rebecca, would you like talk about why people experiencing homelessness are particularly vulnerable to not just COVID-19, but infectious disease in a general.

Rebecca Schiff (RS): And there are a variety of reasons for that. One of those is just the circumstances of homelessness, where individuals if they're living in shelters, these sort of congregate settings where physical distancing, social distancing is very difficult, where there are a lot of shared facilities. And so, it just makes it a lot easier to transmit infectious diseases like COVID 19. And so that made people experiencing homelessness particularly vulnerable. But another aspect of this is also the fact that individuals who are experiencing homelessness often have comorbid conditions. So, they have other health conditions, which also will make them more susceptible to worse outcomes if they have an infectious disease like COVID-19. So, if they have COVID, they might have more severe COVID symptoms or be more likely to die from the virus.

DR: Now both Rebecca and Abe focused on studies in Canada for the research and I was wondering if you could explain a little bit about what have been some of the national and local policy responses to this issue of homelessness in the pandemic.

Abe Oudshoorn (AO): I think the agencies who are supporting individuals did a really phenomenal job of kind of waving a flag really early to say, hey, look, this is going to impact the folks we support quite differently and we are in a very urgent situation already in terms of being over occupied and in congregate environments, for example, or, as Rebecca just mentioned, working with a lot of individuals with already very acute health needs. And so, the organization's themselves, I think moved, I would say more quickly, even then the government responses to say, you know, we need to change our environments. We need things like personal protective equipment in these spaces, we need to be screening people for fever. Governments themselves, I would say also responded relatively quickly. And some of that was just freeing up funds. I would say one of the highest impact actions that we've seen, and this isn't just a Canada phenomenon, this was other countries as well, was to rapidly shift other spaces that had because of the pandemic become underutilized, such as hotels, motels, but even places like convention centers into environments to either decrease the shelter, occupancy, or to be spaces where people could convalesce if they did become ill, or needed to isolate and so was also a poignant kind of beyond the pandemic moment, though, to show that if you just provide people a place to stay, and you fund them to stay there that the vast majority of people will, you know, successfully comfortably occupy those spaces. And so, the hotel motels also for some individuals were relatively long stays through the duration of the most intense parts of the pandemic. So, creating new spaces for people to be that provided at least temporary housing, I think was a really important action. But the other thing, I think that was fairly poignant here was shifting the way we think about harm reduction. And so, in many of the organizations currently providing services, there's still some resistance to the idea of supporting people through their drug use to reduce the harm of that use. And many of the agencies across Canada, stretch themselves or were more open to involvement of public health approaches to substance use, less punitive. And the idea of, you know, let's not discharge people, let's not force them into street homelessness, where it can be avoided, or let's go out to those who are sleeping absolutely rough. And let's provide them with kind of life saving supports and measures. And so, I would say another kind of big impact piece was really shifting some of those perspectives and some of that resistance to harm reduction.

DR: Something that struck me in Martin's introduction, is that he wrote this form of pandemic response, this amounted to an important shift away from homelessness being conceived solely as an individual failing to that of a wider public health problem. So, along those lines, perhaps, Martin, you could say something about that this shift.

Martin Whiteford (MW): What happened in the UK, we saw similar measures to those adopted in North America. So, there was very much in a sense of bringing people off the street, somewhere in the region of 5000 people right off the street into hotel accommodation. But I suppose the most progressive elements of the government's response, which was timely and effective, was that homelessness was reconceptualized from being a housing issue to a public health issue. And so with that, there were sort of two main responses, it was getting people off the streets into single bedroom accommodation with access to their own bathroom. And also running in parallel to that there was an emphasis on testing, and making sure people were well, and within that, again, the provision of PPE. So, from the British example, we've seen homelessness recalibrated, I think as a public health issue, more so than singularly a housing issue.

DR: What I noticed about all these articles is there was an infusion of money that came into the system. And I'm wondering what is happening now that if those levels of funding are not sustained for the long run, from sort of a critical lens, in that while there was a lot of movement by government, and by agencies who work with people experiencing homelessness, providing shelter, other resources, but also a lot of movement in Canada, by the federal government, and by the provincial and territorial governments as well, to provide funding and support, those were time limited?

And so there has been a lot of question or concern about what happens to people who have had housed who have had all these additional supports during the pandemic, when that funding ends, what happens to that and you know, the question around novel programs that have been created. So, we've seen some great harm reduction programs that have been created, as he was discussing, but a lot of those programs were dependent on this COVID-19 specific funding and aren't sure how they'll continue to operate once that funding is gone. So that's certainly a concern here in Canada.

DR: Well, I actually wanted to ask you, Rebecca, specifically about the case study that you did you tell us about your overall project and what you did for your research and some of the findings.

RS: We completed this in Thunder Bay, Ontario, Canada, which is considered to be Northern, at least in the province of Ontario. So, it's a northern location. It's a remote location. It's a city of about 100,000 individuals, and it's located in close proximity to many remote and isolated Indigenous communities as well. And so, something that we've known in Thunder Bay for quite a long time is that there are high rates of homelessness. So, if we look at homelessness per capita, there is quite a high percentage of the overall population of Thunder Bay that's experiencing homelessness, but also there's a very high percentage of people experiencing homelessness, who identify as indigenous as well. One of the things that I was interested in and this was because at the time I was a professor at Lakehead University, which is located in in Thunder Bay, and working very closely and still work very closely with the community of homelessness service providers in the city, in that we were interested in understanding what the response had been to COVID-19 within the homeless sector, and among homeless and service providers, what sort of funding and supports they had received, and what we could learn from that. So, what had worked well in Thunder Bay? What might be valuable lessons for other communities? And what we could learn from to improve upon the next time? And one of the things that certainly came out of that was the level of response. And perhaps this is a benefit of being a smaller city and that service providers were able to come together very quickly and come together very quickly with the government to develop rapid responses to COVID-19. But there are certainly other challenges that were experienced in Thunder Bay as well. There were several outbreaks within the shelters that really challenged service providers that challenge workers and challenge the sector in general. So that was just sort of taking a spotlight on one city to understand what the response was and what we could learn from that response for either future waves of the COVID pandemic or future pandemics.

DR: Well, what was your overall take away from their response? Was it thorough? Was it strong enough, because it's regional, you're not in a city that would have received a lot more funding. So, I'm curious of your overall opinion of how it was handled.

RS: I think that the community did the best that they could with the resources that were provided to them. Again, I'm not sure that the funding is always proportional to the rate of homelessness and in various cities, but there are so many factors that come into play. So, in very large cities, such as Toronto, the rate of homelessness, so per capita, homelessness might be much lower than it is in Thunder Bay, but it's a much larger, more complex environment, and so on and so forth. So, I think the biggest takeaway was around collaboration, and the value of sort of breaking down walls, breaking down silos between public health. So public health, the police and emergency services, the municipal government, federal government, provincial government, and the network of nonprofit organizations that provide services all really broke down a lot of barriers and communication and started to work together in new ways that were very useful and will hopefully continue beyond the pandemic and prove more useful for addressing an ending homelessness in general. And as Martin was referring to earlier, around, you know, identifying homelessness as a public health concern, a public health issue, and it has turned into a broader discussion in the city, which is hopefully more useful in terms of ending homelessness in general.

DR: Well, Abe, as you took a different approach to your research, used a rapid review methodology for your project, can you tell us about your methodology and why you chose that way of working in this particular case?

AO: So, for me it was important to get the word out to communities across our own country, but also globally, about all the different approaches that were available, so that we could have this knowledge out while the pandemic was still unfolding. Because one of the things that I noticed right off the bat in just following the news was that everyone was taking a different approach. There were many similarities. But there were also differences and even just concerned that that not all communities would be thoughtful about what all the available options were. And so that was the hope was to, as quickly as possible, gather as broad a perspective of what are all the different approaches that that communities can take to this crisis to make sure people experiencing homelessness are as safe as possible? And to just publish that, that list of options and opportunities so that hopefully communities can look at that and say: Hey, look, is there anything here we're not doing that we could be doing? What are other communities actually doing? And what are they accomplishing? And so that was the goal of using a very kind of broad sweep of services. And not necessarily saying, hey, look, we need to evaluate all of these, you know, across the length of time and see what the outcomes are related, because that can happen. But in the midst of the crisis, really the focus was let's get this out there. Let's tell people what the all the options are so that they can be making sure they're not missing anything and down the line. We can get into the details of what the best interventions are for now, let's just look at what all the possible interventions are.

DR: Well, you used Twitter. Can you tell us about that? Of course.

AO: One of the challenges is finding out who is doing what. And obviously, you can't just email all of the housing and homelessness divisions across the country and expect a response. Well, they were all, you know, extremely overstretched. And so, we were dependent on public, generally public reporting, or comment about different actions that municipalities were taking. And so, we used basically news reports was one way and there's a database of news articles. And then we use Twitter, because that's a place where lots of people are reporting real time about what their communities are doing about homelessness. So, I think, you know, I was really happy in terms of the breadth of different interventions we were able to uncover through those two methods and how quickly we were able to get that information and then subsequently get it out.

DR: Well, Rebecca, earlier, you had mentioned service providers. So, I would actually like to put this question to everybody. And I'm curious about how COVID-19 is affected the homelessness service providers through this experience.

RS: Another study that I was involved with throughout COVID-19, was funded by the Canadian Institutes for Health Research was around the experiences of frontline workers in the homeless sector. And that study was led by Dr. Jeanette Waegemakers at the University of Calgary and included cities across the country. So we interviewed, or sorry, we conducted surveys with frontline workers in many cities, large cities, small cities, from Western Canada to Eastern Canada, and found through that study that there are really high rates of traumatic stress that were experienced by workers in the sector, and also that there were rates of traumatic stress rates of what could be qualified as PTSD among workers in the sector, and not necessarily PTSD from their experiences within the sector. It might be from other experiences, but just that we know that there are high rates of PTSD in this sector. Another thing that we knew from this study was that previously, the principal investigator on the study had conducted a survey and this was pre-COVID. They had conducted the same survey with frontline workers in in Calgary and Edmonton. So, two large cities in in Western Canada. And so, I was able to compare the data from pre-COVID With during COVID. And there was certainly an elevated rate of traumatic stress that was experienced during COVID. So basically, workers were more stressed out, and the pandemic was very stressful to them. We also conducted interviews with managers in homelessness serving organizations, or service providing organizations and uncovered some strategies that were used, but also some of the concerns that they had around the risks that were associated with working on the frontline during the pandemic in these organizations… in shelters and other service providing organizations.

DR: Would you like to add anything?

AO: The other challenge, and we had mentioned the influx of resources into the system, which was fantastic in that it provided stable accommodation for a lot of individuals. However, you know, you can't just staff up at the tap of a finger. And that's part of the challenge that I saw in our sector locally is that,

you know, you've got a sector that is trying to bring on new folks into providing care and has, you know, more funding to support people, but you know who are they going to hire into this work. And so, on top of everything Rebecca just mentioned, you also have a lot of requirements for training. So, you've got really experienced people who are both being asked to do their work in a different way in in a less safe way. And a lot of times, who now also have to train up all these new people who are joining the organizations. So that's difficult as well. You don't have this this flexible, readily available workforce to come in at, you know, an emergency time.

MW: As Abe said earlier, I think it was also an opportunity to innovate forms of practice and change policy. Most notably, perhaps in terms of harm reduction has already been mentioned. So, in the UK, we saw a real change in the way that opioid maintenance treatment was delivered. We also saw changes in the way that organizations managed the issue of alcohol use, particularly the move towards managed alcohol programs. So not, you know, not discounting what's been said about the stress and the trauma involved in providing care and support during a pandemic. It was also an opportunity to innovate for many services and many frontline practitioners

DR: I mean, it sounds like there were these initial changes that happened in the sector. But I'm wondering, you know, are these things continuing as the treatment or the work that providers are doing with people who are experiencing homelessness is that been forever changed because of COVID-19?

MW: Well, I can only speak for the UK context, and then some of that some of that practice and policy has been translated into how people receive care and support now, but a lot of that was bound up with the initial injection of funding into the system. And as Abe and Rebecca said, from the Canadian experience, that funding has fallen away. And with it, the ability to effect positive change is being challenged.

AO: I think another if I just added quickly, perhaps transformation, but I mean, we'll have to see over the next several years is around the way that this and I called the homeless sector, this sort of sector of mostly nonprofit organizations in Canada, and a few government agencies who work together on, you know, towards ending homelessness. So, this homeless sector understands, to a large extent the value of harm reduction approaches, and, and so on, but the opportunity in the pandemic to expand that collaboration and bring others and particularly public health, but other organizations who have traditionally sort of been outside of this homeless sector haven't been directly involved, to bring them in and to increase that understanding. So, what I might look for in the next few years is whether and how those collaborations continue if there's continued work from these organizations that hadn't traditionally been involved with homelessness service planning previously.

RS: Well, where are we now with COVID-19 and homelessness, because we've gotten through the worst of the pandemic it seems. And there's a vaccine out there is there an active and concerted effort to get people experiencing homelessness vaccinated. There was an in Canada…people experiencing homelessness were prioritized for first doses of the vaccine and subsequent doses as well. I know certainly in Thunder Bay and across the province of Ontario, I can't necessarily speak for the rest of the country. I think there have been outbreaks, though. So, in the shelter system, so there's still risk, there's still concern, there's also a lot of vaccine hesitancy among people experiencing homelessness. So that's also remained a challenge as well. I think in terms of helping people to stay well and reducing outbreaks in the shelter system. In public health, people experiencing homelessness have always been a prioritized population. And so this, you know, predates the pandemic. It's our annual influenza vaccination campaigns, it's whenever there's reports about new communicable diseases or bad drugs or those sorts of things. They're always prioritized well, and there's always additional public health resources that go to populations who may be more marginalized. But I think what is happening now is simply a function of the general public health response, which I would say is a bit more negligent at this point in time…where we've kind of given up a lot of our efforts is going to always affect a certain population more. And so, as our government goes on holiday over the summer and stops advertising boosters, then we know with the outbreaks are going to impact things like you newcomer families in congregate living environments. It's going to impact people in shelter. It's going to impact older adults who have long-term care. So, you know, I don't know that there's functions specific to this population. But as we kind of, you know, lose focus on protecting people that we know that the most vulnerable are going to be highest impacted.

Well, so you know, this is a crisis that's gone on for a couple of years now. And I'm wondering what lessons policymakers and service providers can take away from the experience that they had over the last couple of years. I want to go back to a study that I was part of in 2011-2010 during NH1. So when we had the NH1 one pandemic in Canada, and we wanted to examine homelessness in the context of the NH1 pandemic, and we had interviewed service providers and government agencies and public health and found that people experiencing homelessness were not really identified as a vulnerable population and, and despite the fact that there are a lot of vulnerabilities and that information, it sort of made its way up and we saw during the COVID 19 pandemic that the federal government had become aware that this was something that needed to be paid attention to and at a provincial level as well. But there were still a lot of agencies, as we saw during NH1, and one, you know, shelters and other service providers that didn't have pandemic plans in place for their agency. So, they didn't have a plan. What do we do during a pandemic? How do we create isolation facilities? How do we ensure social distancing? How do we, you know, access PPE and training for, you know, workers and all that sort of thing. So, I think that one of the things that will be positive or useful coming out of this pandemic is that agencies all have those in place. Now, they, they've been through a really a really tough time they've developed this is what we do. This is our protocols and our policies, so that if they are faced with these types of situations in the future, they will know what they're what they're doing. So that might be something that's come through COVID that will be a useful tool or resource for agencies going forward that they didn't have previously.

DR: Hey, would you like to add to that?

AO: For me, I think there's a story to tell here to perhaps change some perspectives to serve as a reminder to people who already know this, and maybe to motivate some folks with power and resources, which is, there's a sense sometimes that homelessness is this inevitability, or that you know, there will always be as much homelessness as there are limited resources to support people experiencing homelessness. And what we saw was, was a very different story. So, we halted for the most part, evictions. And we provided at least temporary housing options for hundreds, if not 1000s of people. And in doing that our shelters reduce their capacity. So, there isn't this kind of infinite number of people in need. There's a finite amount. And when you control the inflow, and when you add more outflow, you actually reduce homelessness. And I think that's a really important story because it says that this is a solvable problem. And this is a systems solvable problem. And we got a little picture of that. But of course, in our lack of thought on this, we absolutely then the rug was pulled on resources. I wasn't sure we would. I was hopeful we wouldn't. But in most jurisdictions, at least in Canada, that funding simply did come to an end. And so, our shelters filled back up. So, I hope that we remember from this moment that that some more resources into permanent housing and to prevent homelessness actually work.

DR: Well, do you feel both of you, or, all three of you, actually, that your role as researchers is almost an activist role?

RS: Yes, I consider myself a researcher activist. And I work very closely with community constantly, sort of in participatory action research methodologies, and other methodologies. And certainly, where I can use my position as a researcher to advocate for and to help further the spread of, you know, voices of people experiencing homelessness, of agencies that are working with those individuals as well. So yeah, so I certainly see part of my role as being an advocate and activist around homelessness as well.

AO: I think all researchers are storytellers, right. And so sometimes that story is: Hey, this protein does something useful, or this author wrote something that we should pay attention to. But for many researchers like ourselves that story is there's a policy here that matters, there's a policy that we need, or there's a policy we need to get rid of. And then that way, I do think that many researchers are advocates at least around policy. And like Rebecca, I do work closely with community providers who are trying to create change and I do think that makes me an activist in a way and I think that's congruent with what researchers are to do is we're to tell our stories to policy that matters.

DR: That's great. Well, thank you so much for joining me. I really enjoyed having you. Thank you. Thanks, Daniel.

Thank you for listening to today's episode. You can find a transcript of our conversation and more information about our guests on our website. I'd like to thank Dr. Martin Whiteford for his help with today's episode, as well as Alex Jungius of This is Distorted.