Supporting vulnerable populations through research

Dr. Katrina Milaney, PhD’11, knows the longer you’re homeless, the worse your health becomes.

Improving the health of chronically homeless Calgarians is the driving force behind her research.

While social agencies are making progress providing housing for more than 8,000 homeless people in Calgary during the past decade, about one-quarter of the city’s emergency shelter users are chronically homeless, meaning they have been without a stable home for six months or more. Forty percent of those have been homeless for 10 years or more.

“When people in shelters access health care they’re often in a crisis or emergency state. They don’t have consistent access to adequate or appropriate health care, and effective ways to bridge those gaps need to be found,” says Milaney, an assistant professor in the Department of Community Health Sciences and member of the O’Brien Institute for Public Health at the Cumming School of Medicine.

Milaney partnered with the Calgary Drop-in and Rehabilitation Centre (the DI) as the lead author of a study investigating the health care needs of Calgary’s chronic homeless population and recommending practical solutions to bridge service gaps.

She studied the experiences of 300 people who slept in Calgary emergency shelters, or on the streets, for six months or more, and found they are five times more likely to suffer childhood trauma than people in the general population. Their struggles with health issues, and a lack of psychiatric or social supports, made it much harder for them to find stable housing.

The study also found that chronically homeless people face many barriers to accessing appropriate mental and physical health services, and frequently require emergency medical assistance. 

“The DI is the largest emergency shelter in North America, with more than 1,000 people staying there every night. Staff on the front lines are trying to support people with complex health problems, but an ambulance often needs to be called,” says Milaney, who worked in leadership positions with homeless-serving agencies for several years before becoming a professor in 2014.

To give homeless people better access to the health services they need most, the study recommended that mobile paramedic healthcare teams bring emergency and primary care services to homeless shelters. After the report and its recommendations were released, Alberta Health Services provided $750,000 to the Calgary Recovery Services Task Force, a group representing 26 homeless-serving agencies, government and other stakeholders, to improve health services for Calgary’s homeless.

“A mobile health team that can travel to shelters is now being developed and step-down beds (intermediate or less-intensive care than might be received at a hospital) are being added to help people staying in shelters after being discharged from hospital,” says Milaney. 

Several other recommendations are moving closer to implementation, such as increasing treatment beds and expanding mental health support in Calgary shelters.
Milaney is still working with vulnerable populations, undertaking two follow-up studies that will examine health service gaps for immigrant and refugee women experiencing homelessness, and for Indigenous women and children experiencing homelessness. 

Families are the fastest growing group of homeless people in Calgary and nationally. 

“It’s very satisfying to pick up on questions that emerged from my original study and look more deeply into how supports and services must be gender-appropriate for families in each of these two important, but very different groups,” she says.