Nowhere to go: a qualitative study examining the health of people who experience emergency shelter service restrictions in Hamilton, Ontario, Canada
Notice bibliographique
Résumé
Introduction: Emergency shelters offer temporary accommodation to people deprived of housing. Service restriction is the practice of limiting or denying access to emergency shelters in response to behaviours deemed harmful to staff, community members or other clients. This community-based qualitative study describes the characteristics, healthcare utilisation and morbidity of people experiencing service restrictions. Methods: We recruited 20 people who had experienced service restrictions in Hamilton, Ontario, Canada. Semistructured interviews were conducted and analysed using reflexive thematic analysis. To contextualise participants' experiences, we reviewed their medical records from 1 January 2018 to 31 December 2021 and calculated simple descriptive statistics. We employed community-based research principles, including a research team with lived experiences of being service restricted, implementing service restrictions or providing front-line care to people who are service restricted. Results: Participants averaged 17.4 primary care visits, 11 emergency department visits and 4 hospital admissions over 4 years. Common visit reasons included infections, traumatic injuries and substance use-related concerns. Service restriction exacerbated participants' health by increasing exposure to violence, infectious disease and psychological distress. Participants were dehumanised by being labelled, stigmatised and treated without compassion in healthcare and shelter settings. Institutional rules-particularly abstinence-based policies-created barriers to shelter access, while shifting to encampments worsened participants' physical and mental health. Despite these challenges, participants highlighted the strength of peer networks and community-led care. These findings illustrate how exclusionary policies and practices in shelters and healthcare settings shape the health and well-being of people who are service restricted. Conclusions: Service restriction worsened participants' health by pushing people into unsheltered homelessness, separating them from their belongings, networks and access to their usual health and social services, and increasing their likelihood of criminalisation. Abstinence-based shelter policies were important contextual factors that increased the use and harm of service restrictions. Participants practised care for themselves and others to navigate these barriers. Health and social services should champion an inclusion health approach by building on the wisdom of people with lived experience to reduce the use and impact of service restrictions.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».