Firestone Michelle, Khoee Kimia, Kolla Gillian, O'Campo Patricia, Nisenbaum Rosane, Holness D Linn, Schlosser Lisa, Beder Michaela, Steer Lorie, Pariseau Terry, Bayoumi Ahmed M
MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
Can J Public Health. 2025 Apr 25. doi: 10.17269/s41997-025-01031-7.
The City of Toronto opened COVID-19 Isolation and Recovery Sites (CIRS) in 2020 in response to the need for supported isolation spaces for people experiencing homelessness. As a team of academic researchers and community partners, we assessed how lessons from the CIRS can inform post-pandemic policies for people experiencing homelessness. We focused on identifying models and systems of care for understanding existing services and integration, identifying innovations, and imagining how care can be transformed to be more caring and just.
We conducted 43 key informant interviews with clinicians, peer and harm reduction workers, executive leaders, operational leaders, and people who worked for funding or decision-making organizations. Data were coded and analyzed using deductive content analysis.
The CIRS presented a new service model that moved away from being overly medicalized towards having a community orientation, which involved greater integration of services for people experiencing homelessness, transparent decision-making, and open communication. Key to this approach were clinical case management, harm reduction services, strong support of peer workers, and adequate and consistent funding. Future models will need to address power imbalances and hierarchies through formal agreements and processes as well as establishing collaborative cultures.
The CIRS offer an important opportunity to rethink services offered within shelter settings. Such change will require a strong vision, sufficient funding, political will, and accountability among all stakeholders. The COVID-19 pandemic offers decision makers an opportunity to consider system-level transformation by looking at largely successful elements of the crisis responses.
多伦多市于2020年开设了新冠疫情隔离与康复场所（CIRS），以满足无家可归者对支持性隔离空间的需求。作为一个由学术研究人员和社区合作伙伴组成的团队，我们评估了CIRS的经验教训如何为无家可归者的疫情后政策提供参考。我们专注于确定护理模式和系统，以了解现有服务与整合情况、识别创新之处，并设想如何将护理转变为更具关怀性和公正性。
我们对临床医生、同伴及减少伤害工作者、行政领导、运营领导以及为资助或决策组织工作的人员进行了43次关键信息访谈。使用演绎性内容分析法对数据进行编码和分析。
CIRS呈现了一种新的服务模式，从过度医疗化转向以社区为导向，这涉及为无家可归者提供更综合的服务、透明的决策制定以及开放的沟通。这种方法的关键在于临床病例管理、减少伤害服务、同伴工作者的有力支持以及充足且持续的资金。未来的模式需要通过正式协议和流程以及建立协作文化来解决权力不平衡和等级制度问题。
CIRS提供了一个重新思考庇护场所内所提供服务的重要契机。这种变革将需要坚定的愿景、充足的资金、政治意愿以及所有利益相关者的问责制。新冠疫情为决策者提供了一个机会，通过审视危机应对中大体上成功的要素来考虑系统层面的变革。
