Do hotel isolation centres help protect people in shelter system?
COVID: Front-line Thinkers is a regular series highlighting COVID-19 research in Canada.
The goal: Improving the health and well-being of people experiencing marginalization during the pandemic by evaluating programs that support these populations, and figuring out how to make these services more effective. The team: A group of 35 scientists, as well as community partners and people with lived experience of marginalization; the principal investigators are based at MAP Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto. The timeline: The project, which received funding from the University of Toronto COVID-19 Action Initiative, U of T’s faculty of medicine and the St. Michael’s Hospital Foundation, launched in May. It has a budget of $450,000 and is slated to run for a year. The first phase, which will evaluate six programs that support marginalized populations, is underway now.
When the pandemic hit, and COVID-19 infiltrated Toronto’s shelter system, the city set up isolation centres in hotels, where those experiencing homelessness can safety self-isolate and recover.
But how well are these isolation sites working? Are there any unintended harms? And what can be done to improve them?
These are among the questions that a team of scientists and community partners is probing as part of a collaborative and urgent effort to improve the lives of those on the margins, who have been hit hardest by the pandemic.
“What we’ve learned during the past few months is that the current context within the pandemic often makes people who are already marginalized even more marginalized,” said Dr. Michelle Firestone, a scientist at MAP Centre for Urban Health Solutions, which is leading the project.
“It exacerbates a lot of the preexisting or systemic issues a lot of communities face.”
Dr. Ahmed Bayoumi, a scientist at MAP and Firestone’s coprincipal investigator of the project, said it grew out of the need to “think broadly about how the pandemic response, in particular, was having an effect on the lives of people in the communities we work with.”
“We recognize that COVID is going to be with us for a while — certainly for the rest of this year and into next year,” he said. “We’re looking at programs that have been initiated … to try and learn from that, in terms of how can we move forward to both improve current responses but also inform future responses.”
Which programs are you evaluating? Researchers are looking at several supports that have emerged during the pandemic for people experiencing homelessness. These include the COVID recovery hotels, a substance use harm-reduction program within those hotels, as well as a mobile outreach initiative serving the encampments that have sprung up in parks across the city.
At the same time, the team is evaluating the impact of the disappearance of programs due to the pandemic, such as a trailer located in the parking lot of the Toronto South Detention Centre, which provided reintegration supports to inmates after their release. The trailer closed because physical distancing wasn’t possible.
Also on the list are services that provide counselling and transitional housing supports to women and children experiencing violence, and an initiative that was developed to guide the response to COVID-19 for people with developmental disabilities.
Additional programs will be selected for a second phase of the project, which is slated to start in the fall or early winter.
How will you measure the effectiveness of these programs? Work is underway to develop a framework for evaluation, and to put together mini-teams to head the research into the six programs, Firestone said.
“We’re going to be asking, and kind of leaning on our academic and community partners, to help us with each of these evaluations,” she said. “We hope they will be sort of co-led by community and researchers, as well as people with lived experience and peer researchers as well.” Recommendations for improvement will be based on surveys and interviews with those who use these programs and deliver these services.
When will you share your recommendations? The team plans to make public its recommendations for each program as soon as the evaluation is complete.
“We don’t want this to be an academic exercise where we come up with recommendations long after they’ve been useful,” Bayoumi said. “So we are trying to work very fast, and to work closely with the communities in order to to make sure that the recommendations are potentially actionable.”
What’s the biggest obstacle you face? “I think the biggest obstacle going forward is actually going to be how we think about moving those recommendations into practice or into policy,” Bayoumi said. “We want to make recommendations that are actionable, but sometimes the ability to act on those is so constrained by political and financial forces.”
“We want to make recommendations that are actionable, but sometimes the ability to act on those is so constrained by political and financial forces.”
DR. AHMED BAYOUMI MAP CENTRE FOR URBAN HEALTH SOLUTIONS