How Do the Emergency Youth Shelter and Canadian Health System Engage? A Qualitative Case Study Exploring Healthcare Coordination for Youth Experiencing Homelessness In Toronto, Canada

Abstract

Youth experiencing homelessness (YEH) face poor healthcare coordination when accessing public systems. Many public systems that YEH interact with, such as the emergency youth shelter (EYS) and health systems in Toronto, Canada, have evolved to operate in silos, with little transparency and communication between sectoral organizations and actors. As a result, youths' health concerns are often left unresolved with little to no coordination or continuity of care. Currently, there is no evidence on what healthcare coordination processes look like between the EYS and health systems in Toronto. To address this significant gap in knowledge, I used a systems-thinking and organizational change lens to explore engagement in healthcare coordination between these two pivotal systems, and how they can be targeted for change. Qualitative methods were used to: 1) define the boundaries of each system in their healthcare coordination roles; 2) understand healthcare coordination processes for YEH within and between the EYS and health systems, and the fundamental system parts that influence these processes; 3) assess interactions between these systems parts through a casual loop diagram; and 4) identify system parts that can be targeted to meaningfully strengthen healthcare coordination for YEH. Results from this research indicate that while each system operates in silos in their healthcare coordination roles, there are significant efforts to overlap between systems through collaboration in advocacy, and the development of relevant programs and policies. Despite this, a significant healthcare coordination gap was found between systems, typically when YEH suffer from crises, and often enter a recurring loop of transition and discharge between EYSs and hospitals. Using grounded theory methodology and thematic analysis, we identified several system parts that can be targeted to strengthen healthcare coordination within and between systems. Some of these include increasing EYS funding, building human resource capacity, strengthening inter- and intra-sectoral communication channels though policy change, establishing strategic partnerships and formal referral pathways, and integrating social medicine in approaches to care. As parts of each system behave interdependently in producing the healthcare coordination outcomes frequently experienced by youth, it is critical that interventions to strengthen coordination are approached holistically using a systems-thinking lens.