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UBC Theses and Dissertations

Homeless and street-involved youth access to primary health care services : what helps and what gets in the way? Pitcher, Claire


Introduction: On any given night, thousands of Canadian youth face homelessness in either absolute (living on the street) or relative (couch surfing) terms. Youth experiencing homelessness report disproportionately high rates of illness and unique influences on their access to health care as compared to their stably housed peers. Method: I conducted a mixed methods study to examine influences on homeless youth access to health care. First, I interviewed eight homeless youth about their experiences accessing health care. Next, I conducted a focused analysis of the 2014 Homeless and Street-Involved Youth Survey which was conducted in 13 communities across British Columbia with 671 youth. Finally, I facilitated a solutions-focused dialogue with a panel of 4 health care and allied service providers who work with homeless youth. Data analysis was informed by procedures consistent with interpretive description as the methodological orientation. Results: I identified three themes from the interviews: youth experiencing homelessness feel powerless when interacting with health care providers; health care systems exist as ‘rule-based’ bureaucracies; and homeless youth are in ‘survival mode’ when it comes to their health. At the same time, findings from the focused survey analysis suggest that the effect of individual factors (e.g., age) on access to health care is confounded by more systemic factors, such as discrimination and access to stable shelter, which are themselves associated with foregone care. The expert panel supported these findings and further suggested that hurtful interactions may damage not only a youth’s relationship with the health care system but also their overall trust in others. The panel also suggested that before health care providers can ‘do health stuff’ with a youth they need to have had several opportunities to cross paths and connect in more informal ways first. Discussion and Implications: A multi-pronged intersectoral approach founded on communication, collaboration and coordination of care is needed to facilitate access to health care for homeless youth. Additionally, specialized training is needed for people who work with these youth. More work is also needed across health care and social service sectors to empower youth in relation to their health and seeking health care.

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