When Tina Kaur worked as a nurse in shelters providing health care to the young people residing there, many of whom were immigrants to Canada, she often wondered what happened to them when they transitioned out of the shelter system.
“Typically, as a nurse, you stay connected with your patient until they are improved, but for me, my scope of practice was limited by where my patients lived,” says Kaur. “I saw this huge gap in care provision for these youth, because once they transitioned into housing their access to health care became more limited.”
Kaur’s experience led her to the PhD program at Bloomberg Nursing, where she is now in her final year. In 2024, she received a Social Sciences and Humanities Research Council (SSHRC) grant to understand how homeless youth access health care when their living situation changes.
The funding provided significant support for Kaur who faced the challenge of building relationships with a hard-to-reach population and engaging them in speaking with her for the study. Focusing on Toronto, which has one of the largest youth shelters in the province, Kaur conducted a qualitative study with youth between the ages of 16-26 who had moved into housing within the last three years. This provided her with a diverse set of perspectives, with some youth having settled into housing while others had made the transition more recently.
Findings show fragmented care
Her findings showed considerable fragmentation in the youth’s ability to access the health care services they needed. Only 44 per cent of youth in this study were connected to primary care compared to close to 75 per cent of youth in the general population.
Additionally, compared to the average population, more of the youth in the study had a higher need for access to health care because of mental health concerns or substance use issues. Some of them Kaur says, were connected to specialists but not primary care, so once they left the shelter it became their responsibility to navigate the health care system, including seeing their specialists.
“We would label this as invisible work; normally a parent, or a primary care provider would be coordinating care for them, but these youth were expected to do this themselves,” says Kaur.
This leads to a greater reliance on acute care access through the emergency department. And for many of the youth who were trying to maintain their housing or going to school to end the cycle of poverty they found themselves in, focusing on health care was just not a priority.
Research aims to reimagine transitional care planning
For Kaur it became clear that access to housing alone did not bridge any gaps in care utilization. Her research points to an important opportunity to reimagine transitional care planning for homeless youth and the need to develop interventions that follow them as they transition into the community.
“One of my biggest hopes with this research is to raise awareness of unmet health care needs for these youth, because they do want health care access, and they need it to feel their best,” says Kaur. “We should be helping to remove barriers for them so they can access these services.”