Abstract
Introduction
The Parent-Child Assistance Program (PCAP) in Saint John, NB, Canada is a three-year evidence-based program that provides system navigation and support to birthing people who use substances during pregnancy. One or the key domains that PCAP focuses on is safe, secure housing. Birthing people accessing integrated treatment programs consistently report challenges with housing security. Yet, there is limited research specifically examining BPWUS experiences or housing Insecurity and homelessness. This study alms to explore barriers and promising practices to accessing stable housing for BPWUS in New Brunswick by drawing on PCAP housing stability data and conducting qualitative interviews with community partners using an ecological systems approach to identify individual, program and systemic policy interventions.
Methods
New Brunswick Social Pediatrics (NBSP) created a Housing Stability Index to assess PCAP clients at intake using responses from the PCAP Addiction Severity Index Survey (ASI). Housing stability was categorized as stable, precarious and unstable housing status for ease of analysis and application to current community. The frequency and percent of each housing category in the index were analyzed using SPSS to examine housing status at the beginning of the program. Semi-structured interviews were also conducted with community partners with experience working with BPWUS and housing. Recruitment consisted of promoting the study through e-mail outreach to PCAP community partners and social media promotion on NBSP platforms. The qualitative data was thematically analyzed using an iterative coding process.
ResultsAnalysis of housing variables for 65 PCAP clients (n=65) from the ASI survey showed that almost 100% reported unstable or precarious housing at intake. A total of 12 community partners participated in interviews. All participants were from Zone 2 of the Horizon Health Network. The socioecological model was used to guide thematic coding of barriers and promising practices at an individual community and societal/policy level. Main themes from thematic analysis include: intersecting identities; stigma; hostile housing landscape; community collaboration; harm reduction; advocacy.
Conclusions
I. Housing stability is a key area of need for BPWUS.
Il. Housing stability necessitates an intersectional, harm reduction approach.
III. Stigma is especially negative towards BPWUS
IV. The lack of provincial government investment in tailored, residential programs for BPWUS demonstrates a failure to uphold the Government of Canada's National Housing Strategy Act (2014) which states "housing rights are human rights."
Pediatricians must consider the difficulties in securing adequate housing when making recommendations for children and when collaborating with child protection services. Opportunities for Pediatricians to advocate for families can include different levels or Intervention from letters of support, working with community agencies aimed at improving housing, to participating in harm reduction policy change.
