COVID-19 and pandemic planning in the context of rural and remote homelessness.

Addressing the vulnerability and unique needs of homeless populations during pandemics has been a major component of the Canadian federal response to the COVID-19 crisis. Rural and remote communities, however, have received little to no funding to aid in their care of homeless people during the pandemic. Similarly, there has been little to no research on rural communities' pandemic preparedness in the context of homelessness. There are large numbers of homeless individuals in rural and remote Canada, including Indigenous peoples who are over-represented in homeless populations. Rural communities, including rural and remote Indigenous communities, are often isolated and more limited than urban areas in their capacity to respond to pandemics. They are particularly vulnerable due to fewer healthcare and social service resources-the lack of which has been particularly evident during the COVID-19 pandemic. In this commentary, we suggest that policy-makers need to take seriously the situation of rural homelessness in Canada, its implications for individual and community health, and consequences in the context of pandemics. Policy- and decision-makers can address these concerns through increased homelessness funding and support for rural and remote communities, policy change to recognize the unique challenges associated with rural pandemic planning and homelessness, and more research that can be translated into policy, programs, and supports for rural homelessness and pandemic planning response.

RéSUMé: La prise en compte de la vulnérabilité et des besoins spécifiques des populations itinérantes lors des pandémies a été un élément majeur de la réponse fédérale canadienne à la crise de la COVID-19. Toutefois, pendant la pandémie, les communautés rurales et éloignées n'ont reçu que peu ou pas de financement pour les soutenir dans leur offre de soins et de services aux personnes en situation d'itinérance. De même, il n'y a que très peu de recherche dans le contexte de l'itinérance sur la préparation des communautés rurales en cas de pandémie. Or, il existe un nombre important de personnes en situation d'itinérance dans les mileux ruraux et éloignés, parmi lesquelles on observe une surreprésentation de personnes d'ascendance autochtone. Les communautés rurales, incluant les communautés autochtones rurales et éloignées, sont souvent isolées et plus limitées que les milieux urbains dans leur capacité à répondre aux pandémies. Elles sont particulièrement vulnérables en raison du manque de ressources en matière de soins de santé et de services sociaux; ceci est particulièrement évident dans le contexte actuel de pandémie de la COVID-19. Dans ce commentaire, nous appelons les décideurs politiques à prendre au sérieux la situation de l'itinérance en milieu rural au Canada, ses implications sur la santé individuelle et communautaire, et ses conséquences dans le contexte des pandémies. Les responsables politiques et les décideurs peuvent répondre à ces préoccupations en augmentant le financement pour contrer l'itinérance et mieux soutenir les milieux ruraux et éloignés en modifiant les politiques afin de reconnaître les défis uniques associés à l'itinérance et la planification en cas de pandémies pour ces milieux. Davantage de recherches sont aussi requises afin d'appliquer les connaissances aux politiques, programmes et programmes de soutien pour l'itinérance et la préparation aux pandémies en milieu rural et éloigné.

Employment services for persons with serious mental illness in northeastern Ontario: the case for partnerships.

OBJECTIVE: To better understand why employment success is low, a case study was conducted to examine the influence of place on access to employment for persons with serious mental illness (SMI) residing in two northeastern Ontario communities (Rebeiro, in progress). METHODS: Community-based participatory research methods were used to engage persons who experience SMI, decision-makers and providers in the research. Forty-six interviews were conducted, complemented by primary and secondary quantitative data sources. RESULTS: While most consumers consider employment to be a key element of their recovery, employment rates for persons with SMI remain limited in northeastern Ontario, Canada. The findings of this case study reveal the importance of collaborative partnerships to fostering better employment outcomes in northeastern Ontario. CONCLUSION: The challenges of collaboration due to rural and northern tensions, as well as various jurisdictional and funding tensions existing at the level of community support the case for partnerships in the provision of employment services in northern and rural places.

The role of public health inspectors in maintaining housing in northern and rural communities: recommendations to support public health practice.

OBJECTIVE: Although there is much evidence about the effects of particular housing conditions on health, less is known about the practices of public health inspectors (PHIs) in relation to minimizing or eliminating potential housing health risks. The purpose of this qualitative study was to illuminate the practices of PHIs in relation to types of biological and physical housing risks. METHOD: This study used photo vignettes to focus on PHIs' perceptions, options, and resultant interventions with regards to typical housing risks encountered by PHIs in northeastern Ontario. The vignettes represented two general categories of potential housing risks: biological exposures, and physical characteristics of housing. During a semi-structured interview, 34 PHI participants viewed the vignettes, assessed the housing hazard depicted in each, and described the most appropriate intervention. Traditional content analysis methods were used. RESULTS: The assessment of the physical housing hazards was fairly consistent among the PHIs. There seemed to be more variation in their assessment of risk associated with biological factors. Variation in responses was often explained by their different interpretations of the scope of the provincial legislation as well as local public health unit policies and practices. CONCLUSION: This study demonstrated that PHIs' assessment and responses to potential physical housing hazards were influenced by an interplay between variables related to residents, local service partners, organizational culture, and policy. The recommendations for action also range from specific public health unit protocol to broader research and policy advocacy initiatives. Collectively, the recommendations focus on strategies for optimizing the role of PHIs in reducing housing health risks in mid-size urban or rural areas.

Women with postpartum depression: "my husband" stories.

BACKGROUND: The research on Postpartum Depression (PPD) to date suggests that there is a knowledge gap regarding women's perception of their partners' role as carer and care activities they perform. Therefore, the purpose of this study was to describe women's understanding of their partners' or husbands' involvement in the midst of PPD. METHODS: This study used interview data from a larger study of northern and rural Ontario women's stories of help-seeking for PPD. The interpretive description approach was used to illustrate the complexity of women's spousal connections in PPD. Data from a purposive community sample of 27 women who self-identified as having been diagnosed with PPD was used. From the verbatim transcribed interviews a number of data excerpts were identified and labeled as "my husband" stories. Narrative analysis was employed to examine these stories. RESULTS: During this time of vulnerability, the husbands' physical, emotional and cognitive availability positively contributed to the women's functioning and self-appraisals as wife and mother. Their representations of their husbands' 'doing for' and/or 'being with' promoted their well-being and ultimately protected the family. CONCLUSION: Given that husbands are perceived to be central in mitigating women's suffering with PPD, the consistent implementation of a triad orientation, that includes woman, child and partner rather than a more traditional and convenient dyadic orientation, is warranted in comprehensive postpartum care. Finally, this study contributes a theoretical understanding of responsive as well as reactive connections between women and family members during the postpartum period.