abstract: 'Background People who use drugs and are structurally vulnerable (e.g.,

  experiencing unstable and/or lack of housing) frequently access acute

  care. However, acute care systems and providers may not be able to

  effectively address social needs during hospitalization. Our objectives

  were to: 1) explore social service providers'' perspectives on addressing

  social needs for this patient population; and 2) identify what possible

  strategies social service providers suggest for improving patient care.

  Methods We completed 18 semi-structured interviews with social service

  providers (e.g., social workers, transition coordinators, peer support

  workers) at a large, urban acute care hospital in Western Canada between

  August 8, 2018 and January 24, 2019. Interviews explored staff

  experiences providing social services to structurally vulnerable

  patients who use drugs, as well as continuity between hospital and

  community social services. We conducted latent content analysis and

  organized our findings in relation to the socioecological model. Results

  Tensions emerged on how participants viewed patient-level barriers to

  addressing social needs. Some providers blamed poor outcomes on

  perceived patient deficits, while others emphasized structural factors

  that impede patients'' ability to secure social services. Within the

  hospital, some participants felt that acute care was not an appropriate

  location to address social needs, but most felt that hospitalization

  affords a unique opportunity to build relationships with structurally

  vulnerable patients. Participants described how a lack of housing and

  financial supports for people who use drugs in the community limited

  successful social service provision in acute care. They identified

  potential policy solutions, such as establishing housing supports that

  concurrently address medical, income, and substance use needs.

  Conclusions Broad policy changes are required to improve care for

  structurally vulnerable patients who use drugs, including: 1) ending

  acute care''s ambivalence towards social services; 2) addressing

  multi-level gaps in housing and financial support; 3) implementing

  hospital-based Housing First teams; and, 4) offering sub-acute care with

  integrated substance use management.'
affiliation: 'Hyshka, E (Corresponding Author), Univ Alberta, Sch Publ Hlth, Edmonton,
  AB, Canada.

  Hyshka, E (Corresponding Author), Royal Alexandra Hosp, Inner City Hlth \& Wellness
  Program, Edmonton, AB, Canada.

  Gehring, Nicole D.; Speed, Kelsey A.; Hyshka, Elaine, Univ Alberta, Sch Publ Hlth,
  Edmonton, AB, Canada.

  Gehring, Nicole D.; Speed, Kelsey A.; Dong, Kathryn; Salvalaggio, Ginetta; Hyshka,
  Elaine, Royal Alexandra Hosp, Inner City Hlth \& Wellness Program, Edmonton, AB,
  Canada.

  Dong, Kathryn; Salvalaggio, Ginetta, Univ Alberta, Fac Med \& Dent, Edmonton, AB,
  Canada.

  Pauly, Bernie, Univ Victoria, Sch Nursing, Victoria, BC, Canada.'
article-number: '1138'
author: Gehring, Nicole D. and Speed, Kelsey A. and Dong, Kathryn and Pauly, Bernie
  and Salvalaggio, Ginetta and Hyshka, Elaine
author-email: ehyshka@ualberta.ca
author_list:
- family: Gehring
  given: Nicole D.
- family: Speed
  given: Kelsey A.
- family: Dong
  given: Kathryn
- family: Pauly
  given: Bernie
- family: Salvalaggio
  given: Ginetta
- family: Hyshka
  given: Elaine
da: '2023-09-28'
doi: 10.1186/s12913-022-08498-x
eissn: 1472-6963
files: []
journal: BMC HEALTH SERVICES RESEARCH
keywords: 'Social needs; Social work; Social services; Structural vulnerability;

  Illegal drugs; Houseless; Acute care; Qualitative research'
keywords-plus: 'HEALTH-CARE PROVIDERS; SUBSTANCE USE; EMERGENCY-DEPARTMENT; HOMELESS

  ADULTS; MENTAL-ILLNESS; SAFETY; STIGMA; WORK; INTERVENTIONS;

  DETERMINANTS'
language: English
month: SEP 8
number: '1'
number-of-cited-references: '64'
orcid-numbers: 'Dong, Kathryn/0000-0002-0843-4618

  Speed, Kelsey/0000-0002-5728-5209'
papis_id: 3c98705d2e417de0bd6b110226deb1b9
ref: Gehring2022socialservice
researcherid-numbers: 'Dong, Kathryn/JBS-4781-2023

  Hyshka, Elaine/AGG-3812-2022

  '
times-cited: '0'
title: 'Social service providers'' perspectives on caring for structurally vulnerable
  hospital patients who use drugs: a qualitative study'
type: Article
unique-id: WOS:000852400500001
usage-count-last-180-days: '2'
usage-count-since-2013: '5'
volume: '22'
web-of-science-categories: Health Care Sciences \& Services
year: '2022'