Enhancing Health Inclusion Services for Homeless People: Towards Trauma-Informed e-Case Management System in Acute Care

Introduction: Severe health issues, such as increased death rates, traumatic injuries, and a variety of acute and chronic diseases, are closely linked to homelessness. Homeless people seeking medical treatment face obstacles due to systemic problems in healthcare and social systems, including stigma, language hurdles, and a lack of understanding about accessible and affordable healthcare. The number of homeless people in Ireland has increased by 77.8% in the last year (1), resulting in a serious healthcare issue. St. James's Hospital, Dublin, has been leading the way in addressing this issue since 2016 by offering inclusive health services that promote trauma-informed care and integrated care in Ireland. It is suggested to work with homeless individuals and key stakeholders to implement an electronic case management system to promote care continuity and coordination across time and space. This digital platform facilitates smooth coordination, monitoring, and exchange of data regarding the treatment of homeless people across multiple stakeholders, ensuring integrated care. The PhD study intends to investigate user needs for this system in acute care to enhance inclusive health services. Method: The overall study design will be concurrent mixed methods research. The study is organised into four phases, beginning with a review of the literature on user needs, trauma-informed care, and homelessness. This stage is enhanced by observations by patient rounding made at St. James's Hospital and knowledge gained from already-existing platforms like Socrates (2) and the Combined Homelessness and Information Network (3). In the second phase, an anonymous global online survey will be conducted to investigate best practices for trauma-informed acute healthcare. It aims to comprehend how these principles can be incorporated into electronic case management. Semi-structured interviews with users and key stakeholders are conducted in the third phase to determine the user needs. The final phase engages Focus Groups with users and key stakeholders to validate findings, refine recommendations, and shape the electronic case management system for outlines and implementation roadmap. A dialogue has been initiated with the Patient and Public Partnership (PPP) peers in Ireland to facilitate their collaboration in the research. Expected Contribution: This current study holds the potential to improve care coordination for the homeless with the goal of reducing care fragmentation and advancing integrated care. An understanding of the user needs of this system in an acute care setting in Ireland is anticipated to result in a considerable improvement of the overall experience of homeless individuals. The study's findings will support St. James's Hospital's efforts to provide accessible healthcare services to address this healthcare issue. It is also anticipated that completing the PhD thesis will facilitate the application of research findings in acute healthcare settings both nationally and globally. References 1.Focus Ireland. Latest Figures [Internet]. Donate - Focus Ireland. 2023. Available from: https://www.focusireland.ie/knowledge-hub/latest-figures/ 2.CHAIN [Internet]. Homeless Link. Available from: https://homeless.org.uk/what-we-do/streetlink-and-chain/chain/ 3.SNPC Medical Record Network [Internet]. SafetyNet. [cited 2023 Nov 21]. Available from: https://www.primarycaresafetynet.ie/copy-of-mobile-health-screening-uni