Access to Primary Health Care Services for Youth Experiencing Homelessness: “You shouldn’t need a health card to be healthy.”

Authors

  • Claire Pitcher University of British Columbia
  • Dr. Elizabeth Saewyc
  • Dr. Annette Browne
  • Dr. Paddy Rodney

DOI:

https://doi.org/10.25071/2291-5796.34

Keywords:

homeless, youth, access, primary care, nursing, critical social justice

Abstract

On any given night, thousands of Canadian youth face homelessness in either absolute (living on the street) or relative (couch surfing, staying in emergency shelters) terms.  This study explores influences primary health care access among youth experiencing homelessness in a large Canadian urban centre.  Using a qualitative research design and convenience sampling, 8 youth participated in in-depth individual interviews and 4 clinicians with expertise in working with youth in primary care settings participated in a facilitated solutions-focused dialogue based on findings from the youth interviews.  Data collection occurred from January to November 2016.  Main findings included: (1) Youth experiencing homelessness feel powerless when interacting with health care providers, (2) Health care systems exist as rule-based bureaucracies and (3) Homeless youth are in survival mode when it comes to their health.  The authors offer recommendations to promote more equitable access to primary health care services for homeless youth.

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Author Biographies

Claire Pitcher, University of British Columbia

Claire Pitcher is a Registered Nurse (Certified Practice: Contraceptive and STI Management) with a Master of Science in Nursing from UBC, a Bachelor of Science in Nursing from UBC and a Bachelor of Science in Nutrition and Food Science from the University of Alberta. Claire began her nursing career as a Child and Youth Public Health Nurse in 2011 and she has continued to work in public health, sexual health, vaccine research, youth concurrent disorders, child and youth mental health, teaching and other related areas since then. Her Masters thesis was titled, “Homeless and Street-Involved Youth Access to Primary Health Care Services: What Helps and What Gets in the Way?” This 3-stage Interpretive Description study included interviews with 8 youth, a solutions-focused dialogue with expert clinicians and a focused analysis of an existing data set. Her primary professional interests include adolescent health with a focus on at-risk/marginalized youth and exploring how a public health approach can promote health among adolescents. Currently, Claire works with Vancouver Coastal Health Richmond Mental Health and Substance Use Services as the Child and Youth Integration and Access Lead. In this role, Claire is responsible for both supporting frontline staff as they navigate service access for individual clients as well as developing and implementing initiatives to facilitate access to services for children, youth and their families and integration across programs and agencies.

Dr. Elizabeth Saewyc

Dr. Saewyc leads the Stigma and Resilience Among Vulnerable Youth Centre (SARAVYC) whose research focuses on how stigma and trauma influence the health of marginalized young people, and what protective factors and interventions can foster resilience. Populations include lesbian, gay, bisexual, transgender, queer and Two Spirit (LGBTQ2S) teens; runaway and homeless youth; sexually abused and sexually-exploited adolescents; and Indigenous young people in Canada and other countries. 

Dr. Annette Browne

Dr. Browne’s research focuses on strategies for fostering health equity, with a particular focus on implications for Indigenous populations. Recent studies have addressed: the impact of organizational interventions to improve health equity in primary care; health promoting interventions with Indigenous women experiencing violence; and, improving healthcare for Indigenous and non-Indigenous people in emergency departments. Working in partnership with health and policy leaders, and clinicians at the point of care, her research aims at improving healthcare delivery and policies. 

Dr. Paddy Rodney

Dr. Rodney’s research focuses on the moral climate of health care delivery and end-of-life decision-making, particularly regarding older adults.  She has worked with practice based research colleagues to attempt to address the difficulties that nurses and other health care professionals experience with cost constraints and related policy challenges in health care delivery. Dr. Rodney teaches leadership, ethics, policy and relational practice in the undergraduate and masters nursing programs, and in the doctoral nursing program, she teaches the genealogy of nursing knowledge. 

References

Anderson, J. M., Rodney, P., Reimer- Kirkham, S., Browne, A. J., Khan, K. B., & Lynam, M. J. (2009). Inequities in health and healthcare viewed through the ethical lens of critical social justice: Contextual knowledge for the global priorities ahead. Advances in Nursing Science, 32(4), 282-94. https://doi.org/10.1097/ANS.0b013e3181bd6955

Barker, B., Kerr, T., Nguyen, P., Wood, E., & DeBeck, K. (2015). Barriers to health and social services for street- involved youth in a Canadian setting. Journal of Public Health Policy, 36(3), 350-63. https://doi.org/10.1057/jphp.2015.8

Browne, A., & Reimer-Kirkham, S. (2014). Problematizing social justice discourses in nursing. In P. Kagan, M. Smith & P. Chinn (Eds.), Philosophies and practices of emancipatory nursing: Social justice as praxis (pp. 21-38). New York, NY: Routledge. https://doi.org/10.4324/9780203069097-2

Browne, A. & Tarlier, D. (2008). Examining the potential of nurse practitioners from a critical social justice perspective. Nursing Inquiry, 15(2), 83-93. https://doi.org/10.1111/j.1440-1800.2008.00411.x

Browne, A., Varcoe, C., Ford-Gilboe, M., Nadine Mathen, C., Smye, V., Jackson, B.E., Blanchet Garneau, A. (2018). Disruption as opportunity: Impacts of an organizations health equity intervention in primary care clinics. International Journal for Equity in Health (17), 154, p. 1-16. https://doi.org/10.1186/s12939-018-0820-2

Busen, N. H., & Engebretson, J. C. (2008). Facilitating risk reduction among homeless and street- involved youth. Journal of the American Academy of Nurse Practitioners, 20(11), p. 567-75. https://doi.org/10.1111/j.1745-7599.2008.00358.x

Canada (2012). About primary health care. Retrieved from the Government of Canada website: https://www.canada.ca/en/health-canaAnderson, J. M., Rodney, P., Reimer- Kirkham, S., Browne, A. J., Khan, K. B., & Lynam, M. J. (2009). Inequities in health and healthcare viewed through the ethical lens of critical social justice: Contextual knowledge for the global priorities ahead. Advances in Nursing Science, 32(4), 282-94. https://doi.org/10.1097/ANS.0b013e3181bd6955 DOI: https://doi.org/10.1097/ANS.0b013e3181bd6955

Barker, B., Kerr, T., Nguyen, P., Wood, E., & DeBeck, K. (2015). Barriers to health and social services for street- involved youth in a Canadian setting. Journal of Public Health Policy, 36(3), 350-63. https://doi.org/10.1057/jphp.2015.8 DOI: https://doi.org/10.1057/jphp.2015.8

Browne, A., & Reimer-Kirkham, S. (2014). Problematizing social justice discourses in nursing. In P. Kagan, M. Smith & P. Chinn (Eds.), Philosophies and practices of emancipatory nursing: Social justice as praxis (pp. 21-38). New York, NY: Routledge. https://doi.org/10.4324/9780203069097-2 DOI: https://doi.org/10.4324/9780203069097-2

Browne, A. & Tarlier, D. (2008). Examining the potential of nurse practitioners from a critical social justice perspective. Nursing Inquiry, 15(2), 83-93. https://doi.org/10.1111/j.1440-1800.2008.00411.x DOI: https://doi.org/10.1111/j.1440-1800.2008.00411.x

Browne, A., Varcoe, C., Ford-Gilboe, M., Nadine Mathen, C., Smye, V., Jackson, B.E., Blanchet Garneau, A. (2018). Disruption as opportunity: Impacts of an organizations health equity intervention in primary care clinics. International Journal for Equity in Health (17), 154, p. 1-16. https://doi.org/10.1186/s12939-018-0820-2 DOI: https://doi.org/10.1186/s12939-018-0820-2

Busen, N. H., & Engebretson, J. C. (2008). Facilitating risk reduction among homeless and street- involved youth. Journal of the American Academy of Nurse Practitioners, 20(11), p. 567-75. https://doi.org/10.1111/j.1745-7599.2008.00358.x DOI: https://doi.org/10.1111/j.1745-7599.2008.00358.x

Canada (2012). About primary health care. Retrieved from the Government of Canada website: https://www.canada.ca/en/health-canada/services/primary-health-care/about-primary-health-care.html

Canadian Nurses Association. (2017). Code of Ethics. Retrieved from: https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-interactive

Dawson, A., & Jackson, D. (2013). The primary health care service experiences and needs of homeless youth: A narrative synthesis of current evidence. Contemporary Nurse: A Journal for the Australian Nursing Profession, 44(1), 62-75. https://doi.org/10.5172/conu.2013.44.1.62

Elliott, A. S., Canadian Paediatric Society, & Adolescent Health Committee. (2013). Meeting the health care needs of street- involved youth. Paediatric & Child Health, 18(6), 317-21. https://doi.org/10.1093/pch/18.6.317

Ensign, J., & Panke, A. (2002). Barriers and bridges to care: Voices of homeless female adolescent youth in Seattle, Washington, USA. Issues and Innovations in Nursing Practice, 37(2), p. 166-72. https://doi.org/10.1046/j.1365-2648.2002.02067.x

Ensign, J., & Santelli, J. (1997). Shelter- based homeless youth: health and access to care. Archives of Pediatrics & Adolescent Medicine, 151(8), 817-23. https://doi.org/10.1001/archpedi.1997.02170450067011

Foundry. (n.d.). Foundry - Who We Are. Retrieved from https://foundrybc.ca/who-we-are/

Gaetz, S., Dej, E., Richter, T., & Redman, M. (2016). The State of Homelessness in Canada 2016. Toronto: Canadian Observatory on Homelessness Press.

Haldenby, A. M., Berman, H., & Forchuk, C. (2007). Homelessness and Health in Adolescents. Qualitative Health Research, 17(9), 1232-44. https://doi.org/10.1177/1049732307307550

Hardill, K. (2019). That look that makes you not really want to be there: How neoliberalism and the War on Drugs compromise nursing care of people who use substances. The Canadian Journal of Nursing Discourse, 1(1). https://doi.org/10.25071/2291-5796.15

Klodawsky, F., Aubry, T., & Farrell, S. (2006). Care and the lives of homeless youth in neoliberal times in Canada. Gender, Place & Culture: A journal of feminist geography, 13(4), p. 419-36. https://doi.org/10.1080/09663690600808577

Noel, C., Srivastava, R., Lo, R., Berger, A., Tehrani, N., & Lichter, M. (2016). Unmet eyecare needs among a homeless youth population. Canadian Journal of Ophthalmology, 51(3), 180-4. https://doi.org/10.1016/j.jcjo.2016.03.010

Nicholas, D. B., Newton, A. S., Calhoun, A., Dong, K., deJong- Berg, M. A., Hamilton, F., Kilmer, C., McLaughlin, A. M., Shankar, J. (2015). The experiences and perceptions of street-involved youth regarding emergency department services. Qualitative Health Research, 26(6), 851-62. https://doi.org/10.1177/1049732315577605

Pitcher, C. (2016). Homeless and street-involved youth access to primary health care services: What helps and what gets in the way? (Master thesis, University of British Columbia). Retrieved from https://open.library.ubc.ca/cIRcle/collections/ubctheses/24/items/1.0340641

Price, C., Chanchan, D., Wheeler, C., Seip, N., & Rush, J. (Eds.). (2019). At the Intersections: A collaborative report on LGBTQ youth homelessness. (2nd Edition). Location needed: True Colors United and the National LGBTQ Task Force.

Purkey, E., & MacKenzie, M. (2019). Experience of healthcare among the homeless and vulnerably housed, a qualitative study: Opportunities for equity-oriented health care. International Journal of Equity in Health, 18(1), 101-107. https://doi.org/10.1186/s12939-019-1004-4

Reid, S., Berman, H. & Forchuck, C. (2005). Living on the streets in Canada: A feminist narrative study of girls and young women. Issues in Comprehensive Pediatric Nursing, 28(4), 237-56. https://doi.org/10.1080/01460860500396906

Reimer-Kirkham, S., & Browne, A. J. (2006). Toward a critical theoretical interpretation of social justice discourses in nursing. Advances in Nursing Science, 29(4), 324-39. https://doi.org/10.1097/00012272-200610000-00006

Rew, L. (1996). Health risks of homeless adolescents: Implications for holistic nursing. Journal of Holistic Nursing, 14(4), 348-59. https://doi.org/10.1177/089801019601400407

Smith, A., Forsyth, K., Poon, C., Peled, M., Saewyc, E., & McCreary Centre Society (2019). Balance and connection in BC: The health and well-being of our youth. Vancouver, BC: McCreary Centre Society

Smith, A., Stewart, D., Poon, C., Peled, M., Saewyc, E.M., & McCreary Centre Society. (2015). Our communities, our youth: The health of homeless and street-involved youth in BC. Vancouver, BC: McCreary Centre Society.

Statistics Canada. 2019. Aboriginal Peoples Highlight Tables, 2016 Census. Retrieved from: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/abo-aut/Table.cfm?Lang=Eng&S=99&O=A&RPP=25

Statistics Canada. 2017. Focus on Geography Series, 2016 Census. Statistics Canada Catalogue no. 98-404-X2016001. Ottawa, Ontario. Data products, 2016 Census.

Thorne, S. (2008). Interpretive description. Walnut Creek, CA: Left Coast Press.

United Nations. (1989). Convention on the Rights of the Child. Retrieved from https://www.ohchr.org/en/professionalinterest/pages/crc.aspx

World Health Organization. (2014). Recognizing Adolescence. Retrieved from http://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.htmlda/services/primary-health-care/about-primary-health-care.html

Canadian Nurses Association. (2017). Code of Ethics. Retrieved from: https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-interactive

Dawson, A., & Jackson, D. (2013). The primary health care service experiences and needs of homeless youth: A narrative synthesis of current evidence. Contemporary Nurse: A Journal for the Australian Nursing Profession, 44(1), 62-75. https://doi.org/10.5172/conu.2013.44.1.62 DOI: https://doi.org/10.5172/conu.2013.44.1.62

Elliott, A. S., Canadian Paediatric Society, & Adolescent Health Committee. (2013). Meeting the health care needs of street- involved youth. Paediatric & Child Health, 18(6), 317-21. https://doi.org/10.1093/pch/18.6.317 DOI: https://doi.org/10.1093/pch/18.6.317

Ensign, J., & Panke, A. (2002). Barriers and bridges to care: Voices of homeless female adolescent youth in Seattle, Washington, USA. Issues and Innovations in Nursing Practice, 37(2), p. 166-72. https://doi.org/10.1046/j.1365-2648.2002.02067.x DOI: https://doi.org/10.1046/j.1365-2648.2002.02067.x

Ensign, J., & Santelli, J. (1997). Shelter- based homeless youth: health and access to care. Archives of Pediatrics & Adolescent Medicine, 151(8), 817-23. https://doi.org/10.1001/archpedi.1997.02170450067011 DOI: https://doi.org/10.1001/archpedi.1997.02170450067011

Foundry. (n.d.). Foundry - Who We Are. Retrieved from https://foundrybc.ca/who-we-are/

Gaetz, S., Dej, E., Richter, T., & Redman, M. (2016). The State of Homelessness in Canada 2016. Toronto: Canadian Observatory on Homelessness Press.

Haldenby, A. M., Berman, H., & Forchuk, C. (2007). Homelessness and Health in Adolescents. Qualitative Health Research, 17(9), 1232-44. https://doi.org/10.1177/1049732307307550 DOI: https://doi.org/10.1177/1049732307307550

Hardill, K. (2019). That look that makes you not really want to be there: How neoliberalism and the War on Drugs compromise nursing care of people who use substances. The Canadian Journal of Nursing Discourse, 1(1). https://doi.org/10.25071/2291-5796.15 DOI: https://doi.org/10.25071/2291-5796.15

Klodawsky, F., Aubry, T., & Farrell, S. (2006). Care and the lives of homeless youth in neoliberal times in Canada. Gender, Place & Culture: A journal of feminist geography, 13(4), p. 419-36. https://doi.org/10.1080/09663690600808577 DOI: https://doi.org/10.1080/09663690600808577

Noel, C., Srivastava, R., Lo, R., Berger, A., Tehrani, N., & Lichter, M. (2016). Unmet eyecare needs among a homeless youth population. Canadian Journal of Ophthalmology, 51(3), 180-4. https://doi.org/10.1016/j.jcjo.2016.03.010 DOI: https://doi.org/10.1016/j.jcjo.2016.03.010

Nicholas, D. B., Newton, A. S., Calhoun, A., Dong, K., deJong- Berg, M. A., Hamilton, F., Kilmer, C., McLaughlin, A. M., Shankar, J. (2015). The experiences and perceptions of street-involved youth regarding emergency department services. Qualitative Health Research, 26(6), 851-62. https://doi.org/10.1177/1049732315577605 DOI: https://doi.org/10.1177/1049732315577605

Pitcher, C. (2016). Homeless and street-involved youth access to primary health care services: What helps and what gets in the way? (Master thesis, University of British Columbia). Retrieved from https://open.library.ubc.ca/cIRcle/collections/ubctheses/24/items/1.0340641

Price, C., Chanchan, D., Wheeler, C., Seip, N., & Rush, J. (Eds.). (2019). At the Intersections: A collaborative report on LGBTQ youth homelessness. (2nd Edition). Location needed: True Colors United and the National LGBTQ Task Force.

Purkey, E., & MacKenzie, M. (2019). Experience of healthcare among the homeless and vulnerably housed, a qualitative study: Opportunities for equity-oriented health care. International Journal of Equity in Health, 18(1), 101-107. https://doi.org/10.1186/s12939-019-1004-4 DOI: https://doi.org/10.1186/s12939-019-1004-4

Reid, S., Berman, H. & Forchuck, C. (2005). Living on the streets in Canada: A feminist narrative study of girls and young women. Issues in Comprehensive Pediatric Nursing, 28(4), 237-56. https://doi.org/10.1080/01460860500396906 DOI: https://doi.org/10.1080/01460860500396906

Reimer-Kirkham, S., & Browne, A. J. (2006). Toward a critical theoretical interpretation of social justice discourses in nursing. Advances in Nursing Science, 29(4), 324-39. https://doi.org/10.1097/00012272-200610000-00006 DOI: https://doi.org/10.1097/00012272-200610000-00006

Rew, L. (1996). Health risks of homeless adolescents: Implications for holistic nursing. Journal of Holistic Nursing, 14(4), 348-59. https://doi.org/10.1177/089801019601400407 DOI: https://doi.org/10.1177/089801019601400407

Smith, A., Forsyth, K., Poon, C., Peled, M., Saewyc, E., & McCreary Centre Society (2019). Balance and connection in BC: The health and well-being of our youth. Vancouver, BC: McCreary Centre Society

Smith, A., Stewart, D., Poon, C., Peled, M., Saewyc, E.M., & McCreary Centre Society. (2015). Our communities, our youth: The health of homeless and street-involved youth in BC. Vancouver, BC: McCreary Centre Society.

Statistics Canada. 2019. Aboriginal Peoples Highlight Tables, 2016 Census. Retrieved from: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/abo-aut/Table.cfm?Lang=Eng&S=99&O=A&RPP=25

Statistics Canada. 2017. Focus on Geography Series, 2016 Census. Statistics Canada Catalogue no. 98-404-X2016001. Ottawa, Ontario. Data products, 2016 Census.

Thorne, S. (2008). Interpretive description. Walnut Creek, CA: Left Coast Press.

United Nations. (1989). Convention on the Rights of the Child. Retrieved from https://www.ohchr.org/en/professionalinterest/pages/crc.aspx

World Health Organization. (2014). Recognizing Adolescence. Retrieved from http://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.html

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Published

2019-12-17

How to Cite

Pitcher, C., Saewyc, E., Browne, A., & Rodney, P. (2019). Access to Primary Health Care Services for Youth Experiencing Homelessness: “You shouldn’t need a health card to be healthy.”. Witness: The Canadian Journal of Critical Nursing Discourse, 1(2), 73–92. https://doi.org/10.25071/2291-5796.34
Received 2019-08-15
Accepted 2019-12-03
Published 2019-12-17