DOI: 10.6084/m9.figshare.28919206.v1
title: Barriers, facilitators and solutions to the care of people experiencing homelessness with traumatic brain injury in Quebec, Canada: clinicians’ and concerned parties’ perspectives

description: People experiencing homelessness have disproportionately high rates of traumatic brain injury (TBI), yet services remain inaccessible or poorly adapted to their needs. Limited research has explored the barriers, facilitators and potential solutions to improve healthcare for this population. The objectives were to identify the individual- and environment-level barriers to healthcare for people experiencing homelessness who have sustained a TBI, identify the environment-level facilitators to care for this population, and identify potential solutions to improve care. A qualitative descriptive study was conducted and four focus groups were held (<i>n</i> = 20), consisting of healthcare professionals (<i>n</i> = 10), community workers (<i>n</i> = 6), and managers from both sectors (<i>n</i> = 4). Data were analyzed using Braun and Clarke’s thematic analysis approach. Participants reported: (1) healthcare structures misaligned with the realities of people experiencing homelessness; (2) reduced trust in health services by people experiencing homelessness; (3) reliance on overburdened community organizations lacking TBI expertise; and (4) transforming care requires cross-sector collaborations and rethinking current healthcare delivery to provide more flexible TBI services. Healthcare for this population is not optimal and fails to meet their needs. Implementing low-threshold service models, fostering collaboration, and providing targeted training could significantly improve TBI care for this population. Possible solutions to the current siloed approach to care for people experiencing homelessness (PEH) include the development of mobile health services that include traumatic brain injury (TBI)-specific expertise, and housing services adapted to the needs of people experiencing homelessness living with cognitive and behavioral impairments.Cross-sector collaborative training and initiatives have shown potential for other populations with complex health needs and could be adapted to bridge the gap between TBI-specific and homelessness-specific services.Healthcare policies need to include access to healthcare and rehabilitation services for underserved populations to support transition from homelessness to more humane and adequate housing situations. Possible solutions to the current siloed approach to care for people experiencing homelessness (PEH) include the development of mobile health services that include traumatic brain injury (TBI)-specific expertise, and housing services adapted to the needs of people experiencing homelessness living with cognitive and behavioral impairments. Cross-sector collaborative training and initiatives have shown potential for other populations with complex health needs and could be adapted to bridge the gap between TBI-specific and homelessness-specific services. Healthcare policies need to include access to healthcare and rehabilitation services for underserved populations to support transition from homelessness to more humane and adequate housing situations.