6 Guiding Principles
In using the Bridging the Transition Framework, we encourage the use of 6 Guiding Principles that are supported by practice and research evidence and known to be effective for homelessness prevention. These include:
Social justice is an interdisciplinary concept acknowledging the ways in which resources are distributed in society, with an interest in advancing the common well-being of all by seeking to distribute resources in a more equitable manner [1]. Social justice is fundamentally connected with human rights in that it aims to elevate the well-being of materially and socially oppressed groups in society [1]. Homelessness is the direct result of poverty [2], and is an issue for which a social justice lens is particularly useful. Many persons who experience homelessness live in situations of extreme deprivation in countries that have ample resources for all. As health and social care proivders, we have a role in seeking to realize social justice for individuals who experience homelessness through our individual encounters, and through the use of community and population level approaches.
Learn more about Social Justice by reading Chapter 9 in the Bridging the Transition Book: Guiding Principles of the Bridging the Transition Framework: Social Justice. For the perspectives of service providers, researchers and persons with lived experiences of homelessness on the importance of social justice as a perspective in homelessness prevention, watch the video below.
Housing First (HF) is a person-centred philosophy of practice which emphasizes that individuals are housing ready from the moment that they are born, and do not need to prove their ability to be “housing ready” prior to being offered permanent housing [3]. HF emerged out of criticisms of the “treatment first” or “staircase model” approach, which emphasized the treatment of mental health and substance use challenges before an individual could be regarded as “housing ready.” These “treatment first” approaches emphasized the use of shelters and transitional housing, and are often seen as inhumane because they prolong homelessness for individuals who already live with multiple health and social challenges. Practitioners, researchers policymakers and advocates using this framework should emphasize the primacy of permanent housing in their support of persons experiencing homelessness over encouraging “housing readiness."
Learn more about Housing First by reading Chapter 10 in the Bridging the Transition Book: Guiding Principles of the Bridging the Transition Framework: Housing First. For the perspectives of service providers, researchers and persons with lived experiences of homelessness on the importance of Housing First as an approach in homelessness prevention, watch the video below.
Rates of mental illness, trauma, and substance use disorders are known to be high in the homeless population [4]. The recovery model posits that a person living with mental illness and/or substance use disorder can create a life of personal meaning in the face of challenges imposed by a diagnosis [5, 6]. Many individuals living with mental illness, trauma, and substance use difficulties experience symptoms episodically or chronically, meaning that they live with these challenges to a greater or lesser degree in the long term. Adopting a recovery-oriented approach to practice is particularly important given that individuals may become homeless in part due to functional challenges associated with mental illness, and these challenges are likely to persist across the trajectory of homeless to housed.
Learn more about the recovery model by reading Chapter 11 in the Bridging the Transition Book: Guiding Principles of the Bridging the Transition Framework: Recovery. For the perspectives of service providers, researchers and persons with lived experiences of homelessness on the importance of the recovery model in homelessness prevention, watch the video below.
Harm reduction is a philosophy which emphasizes the safety of individuals engaged in activities that have the potential to impose harm such as substance use and sex work [7,8]. Harm reduction approaches encourage the use of a range of practices including the provision of clean and safe tools for administering substances, or by providing condoms and sexual health education. One common misconception is that harm reduction and abstinence approaches are mutually exclusive [9]. Practitioners, researchers, policymakers and advocates should be aware that using a harm reduction philosophy does not preclude supporting individuals with goals related to abstinence or supporting a reduction in behaviours that have the potential to impose harm should a person wish to focus on such goals. Individuals using this framework should employ a harm reduction approach by providing supports aimed at promoting the health and well-being of persons who experience homelessness by encouraging the use of safe strategies. Offering support with abstinence or reducing engagement in a behaviour that palace their health at risk when a service user expresses an interest in such goals is both supportive and person-centred. Such an approach requires the presence of a strong therapeutic alliance, which needs to be developed over time. Abstinence should not be emphasized as a goal if a person does not express an interest in making such a change in their lives, and never as a precondition for accessing services.
Learn more about harm reduction by reading Chapter 12 in the Bridging the Transition Book: Guiding Principles of the Bridging the Transition Framework: Harm Reduction. For the perspectives of service providers, researchers and persons with lived experiences of homelessness on the importance of harm reduction as a perspective in homelessness prevention, watch the video below.
It is widely recognized that individuals who experience homelessness have endured physical, sexual, and emotional trauma both before and during homelessness [4,10,11]. Homelessness itself has been described as a form of trauma in that the denial of the right to housing can be experienced as deep exclusion and abandonment by one’s community. Knowledge that trauma is more prevalent among persons who experience homelessness means that it is necessary to use approaches that acknowledge the presence of this trauma in the delivery of services. When using this framework, practitioners, researchers, policymakers and advocates are encouraged to use a universal precautions approach to trauma. This means that when individual encounter a person with experiences of homelessness, they should assume that the person has experienced trauma and use evidence-based trauma informed approaches in the delivery of services. One such approach is “Trauma and Violence-Informed Care” (TVIC). TVIC builds on “Trauma Informed Care” (TIC) by acknowledging that individuals may experience trauma both from traumatic experiences (i.e. physical and emotional trauma), and also from the structural environments in which they are situated (i.e. being denied the right to resources for survival, poverty) both historically and in the present [12]. TVIC emphasizes minimizing harm associated with trauma, rather than treating the trauma itself [13]. Approaches that minimize the activation of past and present traumatic experiences including person-centred and strengths-based approaches should be employed by individuals who are using this framework.
Learn more about TVIC by reading Chapter 13 in the Bridging the Transition Book: Guiding Principles of the Bridging the Transition Framework: Trauma and Violence-Informed Care. For the perspectives of service providers, researchers and persons with lived experiences of homelessness on the importance of TVIC as a perspective in homelessness prevention, watch the video below.
Intersectionality is an acknowledgement of the ways in which race, gender, ability, sexual orientation andclass intersect to influence social possibilities and health [14]. The fact that persons of colour, men, individuals identifying as LGBTQ2+ , indigenous persons, and individuals living with disabilities are disproportionately represented in statistics on homelessness suggest that these social locations should be accounted for in support services. Often, these social locations layer over one another to create deep degrees of discrimination and health inequities. For example, a racialized woman living with poverty and with mental illness experiences discrimination related to her gender, race, disability, and class.
Learn more about TVIC by reading Chapter 14 in the Bridging the Transition Book: Guiding Principles of the Bridging the Transition Framework: Intersectionality. To understand more about the perspectives of service providers, researchers and persons with lived experiences of homelessness on the importance of intersectionality as a perspective in homelessness prevention, watch the video below.
References
-
Stronks, K., et al. Social justice and human rights as a framework for addressing social determinants of health Final report of the Task group on Equity, Equality and Human Rights. 2016. Retrieved online at: http:// www.euro.who.int/ data/assets/ pdf_file/0006/334356/HR-task-report.pdf ?ua=1
-
Gaetz, S., et al., The State of Homelessness in Canada 2016. 2016, Canadian Observatory on Homelessness Press: Toronto. Retrieved online from: https://homelesshub.ca/sites/default/files/ SOHC16_final_20Oct2016.pdf
-
Tsemberis, S., Housing first: The pathways model to end homelessness for people with mental illness and addiction manual. 2010: Hazelden.
-
Gutwinski, S., Schreiter, S., Deutscher, K., & Fazel, S. (2021). The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLoS medicine, 18(8), e1003750. https:// doi.org/10.1371/journal.pmed.1003750
-
Mental Health Commission of Canada, What is Recovery? 2020 [cited 2020 January 26, 2020]; Available from: https://www. mental healthcommission.ca/English/what-we-do/
-
SAMSHA., Recovery and Recovery Support. 2019 [cited 2020 January 26, 2020]; Available from: https://www.samhsa.gov/find-help/recovery.
-
Harm Reduction International. What is harm reduction? 2020; Available from: https://www.hri.global/what-is- harm-reduction.
-
Rekart, M.L., Sex-work harm reduction. The Lancet, 2005. 366(9503): p. 2123-2134. doi: 10.1016/ S0140-6736(05)67732-X.
-
Henwood, B.F., D.K. Padgett, and E. Tiderington, Provider views of harm reduction versus abstinence policies within homeless services for dually diagnosed adults. J Behav Health Serv Res, 2014. 41(1): p. 80-9. doi: 10.1007/s11414-013-9318-2
-
Miller, J. P., O’Reilly, G. M., Mackelprang, J. L., & Mitra, B. (2020). Trauma in adults experiencing homelessness. Injury, 51(4), 897-905. https:// doi. org/10.1016/j.injury.2020.02.086
56. -
Deck, S. M., & Platt, P. A. (2015). Homelessness is traumatic: Abuse, victimization, and trauma histories of homeless men. Journal of Aggression, Maltreatment & Trauma, 24(9), 1022-1043. https:// doi.org/10.1080/10926771.2015.1074134
-
Wathen, C. N., Schmitt, B., & MacGregor, J. C. (2023). Measuring trauma-(and violence-) informed care: a scoping review. Trauma, Violence, & Abuse, 24(1), 261-277. DOI: 10.1177/15248380211029399
-
Government of Canada (2018). Trauma and violence-informed approaches to policy and practice. Retrieved online at: https:// www.canada.ca/en/ public-health/services/ publications/health-risks- safety/trauma-violence-informed-approaches- policy-practice
-
Oexle, N. and P.W. Corrigan, Understanding Mental Illness Stigma Toward Persons With Multiple Stigmatized Conditions: Implications of Intersectionality Theory. Psychiatr Serv, 2018. 69(5): p. 587-589. doi: 10.1176/appi.ps.201700312