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A Study of the Deaths of Persons who are Homeless in Ottawa: A Social and Health Investigation Manal Guirguis-Younger Tim Aubry Vivien Runnels.

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Presentation on theme: "A Study of the Deaths of Persons who are Homeless in Ottawa: A Social and Health Investigation Manal Guirguis-Younger Tim Aubry Vivien Runnels."— Presentation transcript:

1 A Study of the Deaths of Persons who are Homeless in Ottawa: A Social and Health Investigation Manal Guirguis-Younger Tim Aubry Vivien Runnels

2 Study Partners Saint Paul University University of Ottawa (Centre for Research on Community Services and the Institute of Population Health.) Funded by the City of Ottawa through the Supporting Communities Partnership Initiative, Government of Canada

3 Study Partners Community Groups and Organizations City of Ottawa Homelessness Initiative Teams Alliance to End Homelessness

4 Research Team Saint Paul University – Manal Guirguis Younger – Vivien Runnels Royal Ottawa Hospital – Susan Farrell University of Ottawa Centre for Research on Community Services – Tim Aubry University of Ottawa – Jeff Turnbull – Tiina Podymow – Peter Tugwell

5 Community Advisory Committee Judy Taylor Pam Oickle Bruce Ransome Donna Pettey Denise Vallely Donna Lougheed Susan Brandt Manal Guirguis Younger (Principal Investigator) Vivien Runnels (Research Coordinator )

6 Why look at Deaths? A large number of studies show that individuals who are homeless have a mortality rate that is 2 to 10 times higher than the general population Homelessness is a way of being rather than a single demographic Strong impact on all aspects of persons life

7 Why look at Deaths? Must examine untimely deaths of persons who are homeless in the context of homelessness What can we learn about the lives and deaths of individuals who are homeless? And what preventive strategies can we recommend?

8 Background Literature Review Study of best practices & current research: San Francisco/Hwang et al. – Multiple approaches to studying deaths Coroner’s studies Special Populations (e.g., First Nations) Common Features (e.g., age, SES) Deaths occurring at the same time (e.g., heat wave)

9 Purposes of the Study This investigation aims to: Develop a sustainable methodology to study deaths occurring among persons who are homeless in Ottawa Provide an initial study to assess the methodology -- using an empirically-based approach to methodology development

10 Purposes of the Study ( continued) Provide information regarding long and short term health and social factors contributing to the deaths of persons who are homeless in Ottawa. Provide recommendations regarding preventive strategies that would potentially reduce the mortality rate within the homeless population

11 Methodology: Carrying out a Social Autopsy on Persons who are Homeless No clear precedent for methodology Complications No systematic way to identify homelessness at the time of death Consent – permission to collect information about persons who are deceased – Next of kin consent

12 Methodological Model setting the stage Identifying Community Organizations (> 40 organizations that are involved in service provision with homeless persons) Providing project information and asking for collaboration: letters, phone calls Meeting with the leaders of target organizations

13 Methodological Model setting the stage Presentation to community groups Attending memorial services Attending events addressing housing issues in Ottawa

14 Methodology Issues of Disclosure Confidentiality – Deceased person (identity and personal information) – Family members (flow of information)

15 Methodology Issues of Disclosure – Service providers/organizations: Ontario Freedom of Information and Protection of Privacy Act (Ch F. 31, part II, s. 21. e, R.S.O, 1990).

16 Methodology Tools Sources of Information Three groups of individuals, each requiring a different semi-structured interview – Service provider interviews – Friends and acquaintances – Families – Open ended interview

17 Methodology Service Providers Interview protocol with service providers includes the following areas: – Personal profile of the deceased – Housing/Shelter information – Daily challenges/Daily activities – Income – Social participation – Mental and physical health – Substance use – Events prior to death – Relationship with family*

18 Methodology Family Members Interview protocol with family members includes the following information: – Developmental history covering areas such as physical and mental health, education, social participation, contact with the law, absence from home, etc. – Other information surrounding the deceased person’s recent situation and circumstances of death

19 Methodology Friends Interview protocol with friends/acquaintances includes the following information: – Social relationships and networks – Support – Significant others – Spirituality (e.g., connection with spiritual leaders etc.) – Desires, wishes, and aspirations.

20 Methodology Duration and number of cases Time sample: 6 months (July 2003 – January 2003) Total number of cases: 25 cases

21 Analyses Descriptive data: demographics, and cause of death if known Qualitative analysis of social and health themes/patterns leading to the possibility of untimely death.

22 Findings Findings are based on group data Information was organized in terms of major themes that emerged from the intensive interviews and from observations

23 Who were the people? Immediate causes of Death Health picture is quite complex, with multiple diagnoses of serious disease


25 Immediate Causes of Death Negligible proportion of the deaths were directly related to violence None of the deaths were caused by exposure

26 Long-Term Contributors to Homelessness and Death Life Course Development and Life Style -Presence of emotional/physical/sexual abuse were frequently cited as triggers that may have led to homelessness -Unaddressed learning disabilities, and visible or invisible disabilities were identified as negatively impacting on schooling, employment, and relationships

27 Long-Term Contributors to Homelessness and Death - Unexamined sudden changes in behaviour, e.g., withdrawal, delinquency - Difficult life events, death of a parent, alienation from family - High-risk life style-practices that increase risk of communicable disease - High-risk life-style practices contribute to inability to maintain housing

28 Long-Term Contributors to Homelessness and Death Experiences with Housing and Shelter - Difficulty coping with housing requirements -Safety issues; especially for women -Incarceration/detention

29 Long-Term Contributors to Homelessness and Death Experiences with Health Care Homelessness undermines the effectiveness of health care Issues of trust Mental illness as a barrier, difficult to offer or implement treatment

30 Long-Term Contributors to Homelessness and Death Substance abuse: unavailability of suitable programs, readiness, deeper emotional issues Poor social support: isolation/little support from others

31 Preventive Strategies to Untimely Death Service Provision - Basic needs: significant challenges -Shelter systems -Targeting special populations

32 Preventive Strategies to Untimely Death Service providers as agents - Support - Link for re-engagement, implementation of services

33 Limitations of the Study Initial information regarding deaths: must rely on the community and service providers to forward the information, with possible misses Definitions of homelessness

34 A Study of the Deaths of Persons who are Homeless in Ottawa: A Social and Health Investigation Homelessness has been described as “a very fluid social problem.” (Fitzgerald, Mack, Dail, 2001). From a research perspective the study of homelessness and death requires a fluid methodology.

35 Future Directions Implementation of the social autopsy methodology to follow the impact of homelessness on death Feasible implementation of Sustainable Methodology based on limited but random number of cases Multiple Sites Methodology as a program evaluation tool

36 Future Directions: Themes for Research The Quality of Dying: Palliative Care for those who are homeless – A home to die: A unique form of Palliative care – An essential service: meeting the challenge.

37 Future Directions: Follow-up Studies The Quality of Dying Challenges and Best Practices Providing a safe and trusting environment to die Recreating a home: The special needs of persons who are homeless Addressing the complex medical care of this special population

38 Future Directions: Quality of Dying There is a need of a model of best practices Local example: Home Hospice at the Mission Multi-site applications in other communities

39 Future Direction Research looking at the role of outreach workers – Role/training – Bridge access to services – Help support persons who are homeless to reconnect with the community – Facilitate transitional housing, employment, social situations

40 Ending Remarks Many Questions Remain Commendable efforts are in place but we must continue to tackle the challenge We need to move beyond the local findings and begin to look more to the mobilization of knowledge across Canada

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