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Community-based service providers working with people experiencing homelessness encounter many occupational challenges and high turnover rates are a challenge in the sector. This qualitative study examined the perceived causes and decision paths of turnover among service providers working with people experiencing homelessness in Canada. In-depth interviews were completed with 40 service providers working in homeless service, supportive housing, and harm reduction programs. Thematic analysis and a deductive-based matrix analysis were used to identify causes and decision paths of turnover, respectively. Primary causes of employee turnover included: (1) career advancement and growth; (2) incongruence between providers' needs, values, and work position; (3) mental health deteriorations; (4) organizational stability and support issues; and (5) staff dismissal. Further, two contextual factors – low sectoral wages and a transitory work culture – shaped service providers' occupational experiences and had indirect effects on turnover. Push and pull decisions were the primary paths to voluntary turnover among participants. Overall, the findings highlight that employee turnover often occurs voluntarily when service providers experience unmet occupational or work-interacting personal needs, or want to pursue new career-related opportunities. Practice and policy recommendations, including use of realistic job previews and establishment of workforce development strategies, are made to prevent turnover. [ABSTRACT FROM AUTHOR]

Homeless services systems are now employing Moving On Initiatives (MOIs) to assist formerly homeless residents of permanent supportive housing programs with the transition from these highly supportive programs to affordable housing without the embedded supports. There remains a dearth of evidence on the effectiveness of these initiatives in regard to post-move housing retention and other participant outcomes, and no review of MOI evaluation outcomes has been conducted to date. To address this gap, a scoping review was used to map and summarize the existing literature on MOI participant outcomes and discuss outstanding gaps in this body of literature. Overall, the early evidence on this emerging approach is promising as this review finds high rates of post-move housing retention and other positive participant outcomes in the few sources located that describe MOI outcomes. However, large-scale studies of MOIs with longer follow-up periods are needed to assess the long-term effectiveness and outcomes of these initiatives. [ABSTRACT FROM AUTHOR]

Permanent supportive housing (PSH) programs are now using Moving On initiatives (MOIs) to increase the homeless service system capacity. These initiatives support tenants with the transition from PSH to mainstream affordable housing by providing them with mainstream housing assistance and various transitional services. Research on this approach has primarily consisted of evaluations of individual programs. Less is known about MOI implementation features across programs. This study utilizes a document review and descriptive survey of 27 MOIs to describe MOI implementation variation and identify common strategies for helping people to move on from PSH. Findings suggest that a wide degree of variation exists in these approaches between and within MOI programs. Two primary types of move on strategies were identified: "Moving Up and Out" and "Transitioning in Place." Implications for the homeless service system are discussed. [ABSTRACT FROM AUTHOR]

This study describes expert perspectives on service user transitions within and from homeless service programs. Semi-structured qualitative interviews were conducted with subject matter experts (SMEs) who had practice or research experience regarding transitional supports in homeless services. Interviews were analyzed using rapid assessment procedures that allowed for the categorization and characterization of targeted interview domains. Findings indicate that assessment is a critical, but underspecified, aspect of transitional programs in homeless services. SMEs viewed assessments for transition readiness as goal-setting opportunities and said that frequency of assessment is best individualized to the person. Transitional supports, including housing navigation and peer support, were viewed as important elements of successful programs. SMEs further noted that opportunities for eventual transition from the program should be communicated to service users early on and that having an organizational culture that embraces service user transitions was critical, highlighting the importance of shifting culture around transitions in homeless services. [ABSTRACT FROM AUTHOR]

Globally, homelessness has grown over the past decade due to a diverse range of social and economic factors, including lack of affordable housing and retrenchment of social programs. People experiencing homelessness (PEH) experience markedly higher disease burdens than housed populations, as well as reduced access to healthcare. Street Medicine is a promising form of healthcare delivery that seeks to address the healthcare needs of this population despite known structural barriers to access. However, there is limited empirical literature describing Street Medicine practice and program elements. To address this gap, scoping review methods were used to review two major academic databases, web-based literature, and sources provided by content experts. Studies had to specifically reference "Street Medicine" as healthcare delivery and at least one of the review's primary focuses: definitions, philosophies, or program elements. We conducted qualitative analysis to identify relevant themes. Of 1,016 unique sources identified, 349 met inclusion criteria. Six practice categories were identified: direct care, wraparound health services, harm reduction services, psychosocial case management, provision of life necessities, and education/research/advocacy. Despite a shared definition, there are a wide variety of Street Medicine program elements in use. This review sets parameters around which future research on effectiveness of these elements could be based. [ABSTRACT FROM AUTHOR]

This scoping review examines how housing "readiness" is assessed among permanent supportive housing residents before transitioning to mainstream housing through a Moving on initiative (MOI). This paper connects the concept of housing-readiness to concepts of readiness in mental health and substance use treatment, as well as to notions that any concept of readiness implies a category of non-readiness. It then employs scoping review methods to map the existing literature on MOI readiness assessments and markers of readiness, in order to discuss outstanding gaps in this field and inform future MOI practices. Sources were screened according to specified inclusion criteria, resulting in a total of 19 sources. Inclusion required indication of a readiness assessment approach or tool, or some marker of readiness. Common markers described in these sources include financial stability, health and behavioral health, housing stability, support needs, independent living skills, and housing choice. Overall, this review finds common themes across sources that can guide future research on the effectiveness of readiness assessment tools and markers of readiness. Findings can inform future MOIs, participant preparation and engagement in PSH, and the design of readiness assessment tools in the wider field of homelessness services. [ABSTRACT FROM AUTHOR]

Service providers working with people experiencing homelessness can be directly and indirectly exposed to trauma and other chronic stressors in their work. The types of individuals that are most at-risk of problematic outcomes from traumatic event exposure are unknown. This study examined exposure to and effects of workplace traumas and stressors among service providers working with people experiencing homelessness in Canada. A cross-sectional survey was completed by 701 direct service providers working in the homeless service, supportive housing, and harm reduction sectors. Descriptive statistics, hierarchical multiple regression, and double moderation models were used in the analysis. Employment in homeless service settings, service provision to single adults, and more time in direct contact with service users were each positively associated with the frequency of exposure to critical events and chronic stressors. Younger age, lived experience of behavioural health problems, more frequent exposure to chronic stressors, and less social support from coworkers were significantly correlated with post-traumatic stress and general psychological distress. Emotional support from supervision moderated the relationship between direct exposure to workplace critical events and post-traumatic stress. More trauma-informed psychosocial supports tailored to the needs of direct service providers working with people experiencing homelessness are needed. [ABSTRACT FROM AUTHOR]