A Community-Based Approach to Assessing the Success of London, Ontario’s Whole of Community System Response to Health and Homelessness

Introduction: Homelessness, and it’s associated challenges, have reached crisis levels across Canada and in many places around the world. The lack of safe, supportive, and affordable housing has led to unprecedented numbers of people experiencing homelessness and housing precarity. Coupled with under-resourced social support services and an over-stretched healthcare system, this has led to avoidable death and suffering. In London, Ontario, Canada local protests by providers and caring citizens in July 2022 resulted in development of a Whole of Community System Response to Health and Homelessness that is garnering national and international interest. As part of this response, partners have come together to establish a coordinated research/evaluation strategy. Objective: To describe the methods used to establish a coordinated community-based approach to evaluation of our Health and Homelessness plan and share early findings Methods: As part of the Whole of Community System Response to Health and Homelessness, a System Foundations table was formed with mandates to inform 1) evaluation/research 2) foundational processes and 3) policy development. Table membership was created via open call to all 70+ partner organizations. Evaluation framework development began with defining core values (including a trauma- and violence-informed, anti-oppressive and equity-promoting approach) and adopting commonly-used evaluation strategies. An open call to local researchers, analysts, decision support, and evaluation experts was used to form 9 ‘evaluation teams’ and 1 ‘evaluation oversight’ team. A University-Community Research Centre (the Centre for Research on Health Equity and Social Inclusion) was nominated to provide arms’ length coordination and facilitation of these activities. Results: The emerging oversight team will serve as a neutral facilitator to support review of meeting documents, attend other working group meetings, and engage community to identify key questions. The Quintuple Aim of Health System Improvement and Donabedian’s Triad were endorsed as the evaluation framework core along with a commitment to mixed-methods approaches and 'Now, Next, Later' framework to inform timing of evaluation and research deliverables. Nine evaluation teams are, therefore, exploring 1) outcomes and experiences within London’s highest-need homeless; 2) outcomes and experiences within London’s otherwise homeless and precariously housed population; 3) outcomes and experiences within London’s general population; 4) experiences of the workforce; 5) health equity; 6) cost of care; 7) processes; 8) structures; 9) overall project review. Facilitated by the Oversight team, evaluation/research relevant questions will be prioritized and brought to the appropriate Evaluate Teams who will coordinate appropriate processes for answering them now and over time to track collective impact. Research and evaluation teams will leverage existing resources wherever possible and be purposefully built represent different disciplines, traditions and backgrounds to ensure a wholistic research and evaluation approach (including indigenous research, evaluation, and pedagogy). Care will be taken to reflect the complexity of the system and ensure fairness and equity in all research activities. Conclusion: London’s Whole of Community System Response to Health and Homelessness is, we understand, a unique strategy requiring equally unique evaluation and research. This presentation aims to describe how this evaluation approach is being designed and implemented, and share early findings as available.

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