Implementing a hospital-based case management intervention for people experiencing homelessness: the navigator program
Abstract Background People experiencing homelessness (PEH) have worse health than the general population, and higher rates of hospitalization. The transition period after discharge from hospital is often challenging for PEH, in part due to loss to follow-up, competing priorities, housing instability...
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| Format: | Article |
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BMC
2025-07-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-13170-1 |
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| author | Jesse I. R. Jenkinson Dinesh Moro Oluwagbenga Dada Kate Francombe Pridham Jeremy Cygler Stephen W. Hwang |
| author_facet | Jesse I. R. Jenkinson Dinesh Moro Oluwagbenga Dada Kate Francombe Pridham Jeremy Cygler Stephen W. Hwang |
| author_sort | Jesse I. R. Jenkinson |
| collection | DOAJ |
| description | Abstract Background People experiencing homelessness (PEH) have worse health than the general population, and higher rates of hospitalization. The transition period after discharge from hospital is often challenging for PEH, in part due to loss to follow-up, competing priorities, housing instability, and the absence of a primary care provider. In-patient hospital stays represent a window of opportunity to intervene and connect with patients, supporting them to stay in hospital and complete their treatment plan, identify and address their social needs, and support their transition of care into the community. This qualitative study explores supports and challenges to the implementation of the Navigator Program, a hospital-based critical time intervention that supports PEH during their hospital stay and after discharge into the community. Methods We interviewed 35 participants (homeless outreach counsellors working on the program, hospital physicians and staff in the implementation setting, community service providers, and the implementation team) and conducted 130 h of non-participant observation. Analysis used the Framework Method and the Consolidated Framework for Implementation Research to highlight the barriers and facilitators to implementation. Results A core aspect of successful implementation and program uptake was that all participants saw a need for the program. The flexible approach to model design and implementation was an essential approach to program development that adjusted to the implementation setting, while leaving room to create more systems and structures as the program progresses. Implementation also relied on clear approaches to attaining buy-in from all stakeholders, done through a mix of formal and informal approaches. Operating as a hospital-based program was essential for successful implementation, supporting team-building among care providers in both the healthcare and social service sectors, which can lead to improved patient care coordination. Conclusion The implementation of programs addressing complex social and health issues can contribute to its success or failure. In this study, we discuss the effective implementation approaches of the Navigator Program, as well as lessons learned. This study provides practical and helpful strategies for implementing similar programs in hospitals across Canada, and in countries with similar healthcare system structures. |
| format | Article |
| id | doaj-art-12630f8a2da4489ab4845d1c3705a6f5 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-12630f8a2da4489ab4845d1c3705a6f52025-08-20T03:45:48ZengBMCBMC Health Services Research1472-69632025-07-0125111410.1186/s12913-025-13170-1Implementing a hospital-based case management intervention for people experiencing homelessness: the navigator programJesse I. R. Jenkinson0Dinesh Moro1Oluwagbenga Dada2Kate Francombe Pridham3Jeremy Cygler4Stephen W. Hwang5MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health TorontoMAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health TorontoMAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health TorontoMAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health TorontoDivision of General Internal Medicine, Department of Medicine, University of TorontoMAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health TorontoAbstract Background People experiencing homelessness (PEH) have worse health than the general population, and higher rates of hospitalization. The transition period after discharge from hospital is often challenging for PEH, in part due to loss to follow-up, competing priorities, housing instability, and the absence of a primary care provider. In-patient hospital stays represent a window of opportunity to intervene and connect with patients, supporting them to stay in hospital and complete their treatment plan, identify and address their social needs, and support their transition of care into the community. This qualitative study explores supports and challenges to the implementation of the Navigator Program, a hospital-based critical time intervention that supports PEH during their hospital stay and after discharge into the community. Methods We interviewed 35 participants (homeless outreach counsellors working on the program, hospital physicians and staff in the implementation setting, community service providers, and the implementation team) and conducted 130 h of non-participant observation. Analysis used the Framework Method and the Consolidated Framework for Implementation Research to highlight the barriers and facilitators to implementation. Results A core aspect of successful implementation and program uptake was that all participants saw a need for the program. The flexible approach to model design and implementation was an essential approach to program development that adjusted to the implementation setting, while leaving room to create more systems and structures as the program progresses. Implementation also relied on clear approaches to attaining buy-in from all stakeholders, done through a mix of formal and informal approaches. Operating as a hospital-based program was essential for successful implementation, supporting team-building among care providers in both the healthcare and social service sectors, which can lead to improved patient care coordination. Conclusion The implementation of programs addressing complex social and health issues can contribute to its success or failure. In this study, we discuss the effective implementation approaches of the Navigator Program, as well as lessons learned. This study provides practical and helpful strategies for implementing similar programs in hospitals across Canada, and in countries with similar healthcare system structures.https://doi.org/10.1186/s12913-025-13170-1Ill-housed personsUnhousedCase managementHospital dischargeProcess evaluationImplementation |
| spellingShingle | Jesse I. R. Jenkinson Dinesh Moro Oluwagbenga Dada Kate Francombe Pridham Jeremy Cygler Stephen W. Hwang Implementing a hospital-based case management intervention for people experiencing homelessness: the navigator program BMC Health Services Research Ill-housed persons Unhoused Case management Hospital discharge Process evaluation Implementation |
| title | Implementing a hospital-based case management intervention for people experiencing homelessness: the navigator program |
| title_full | Implementing a hospital-based case management intervention for people experiencing homelessness: the navigator program |
| title_fullStr | Implementing a hospital-based case management intervention for people experiencing homelessness: the navigator program |
| title_full_unstemmed | Implementing a hospital-based case management intervention for people experiencing homelessness: the navigator program |
| title_short | Implementing a hospital-based case management intervention for people experiencing homelessness: the navigator program |
| title_sort | implementing a hospital based case management intervention for people experiencing homelessness the navigator program |
| topic | Ill-housed persons Unhoused Case management Hospital discharge Process evaluation Implementation |
| url | https://doi.org/10.1186/s12913-025-13170-1 |
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