London expands approach to prevent discharge from hospital to homelessness


LONDON, ON - During a virtual event for Londoners hosted by Lawson Health Research Institute and the City of London, a multi-sectoral research team announced two projects representing a collaborative approach to preventing homelessness from within hospital walls. 

Built on the unique and successful No Fixed Address (NFA) strategy, these projects are being tested as a potential best practice for preventing hospital discharge to homelessness. NFA seeks to stop the cycle between hospital admissions and homelessness by providing timely and accessible supports to patients who would otherwise be discharged into homelessness.  It brings housing and financial supports into the health-care system, starting as soon as upon admission, to assist in finding appropriate housing and supports or avoiding a potential eviction. 

“Canada lacks a validated and coordinated service model to address the issue of hospital stay to no fixed address, which can often be the beginning of an individual’s experience with homelessness,” explains Dr. Cheryl Forchuk, Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery, and Assistant Scientific Director at Lawson. “There are multiple factors that cause people to be discharged into homelessness - systemic, organizational and personal. We need a collaborative and coordinated approach that honours housing as a basic human right.” 

Several departments at London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London collaborate with staff from the City of London, Canadian Mental Health Association (CMHA) Elgin-Middlesex, Youth Opportunities Unlimited (YOU), Salvation Army’s Housing Stability Bank and Ontario Works in the City of London to provide direct, on-site (or virtual) support for patients at risk of homelessness.

“Implementing a coordinated approach to addressing homelessness allows our staff to actively work alongside our partners in health care to prevent and divert individuals and families from an experience of homelessness by assessing their needs and connecting them to the housing supports.,” says John D’Oria, Coordinated Access Manager, City of London. “Whether it’s financial, social service or mental health support, this partnership and approach allows for a holistic approach to client care at the right time.”

Patients discharged from hospital to homelessness in Canada face many challenges that make recovery more difficult. They often experience higher readmission rates and emergency department visits. This is particularly concerning for youth, who have been found to be the fastest growing segment of the homeless population.

NFA was initially tested with strong success for mental health patients across the city and the second version of the project was extended to medical units at LHSC’s University and Victoria Hospitals.

PROJECT 1: Collaboration to Address Homelessness - Health, Housing and Income (H2I) 

This research study will evaluate the City of London’s Coordinated Access Outreach program at hospital sites. A Coordinated Access Outreach worker will support individuals at risk of homelessness to maintain or obtain housing. Ontario Works will assist with the provision of income and employment supports and the Salvation Army Housing Stability Bank may be accessed for needed financial resources to secure or maintain housing.  

Over two years, 106 participants will be interviewed in hospital and again six months post-discharge. Focus groups with participants, health care providers and community partners will provide further insight into the effectiveness of NFA. This project is funded by the Canada Mortgage and Housing Corporation (CMHC)’s National Housing Strategy. 

PROJECT 2: Preventing discharge to No Fixed Address – Youth (NFA-Y) 

This research study will customize, implement and evaluate the NFA strategy for vulnerable youth ages 16-24. The unique health and housing needs of youth at-risk will be explored by streamlining housing and financial support into a coordinated system of care, with additional support provided by Youth Opportunities Unlimited and Children’s Aid Society London and Middlesex. 

Over 3-4 years, data to be collected from 93 youth at three time points. Focus groups with youth participants, health care providers, and community agency partners will help enhance the NFA strategy to meet the unique needs of youth. This project is funded by the National Centres of Excellence (NCE) Making the Shift (MtS) Youth Social Innovation Lab. 




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