Date of Award

Spring 5-10-2022

Degree Type

Dissertation

Degree Name

Doctor of Social Work (DSW)

First Advisor

Dennis P. Culhane, PhD

Second Advisor

Ingrid M. Duva, RN, PhD

Third Advisor

Kris Clarke, MSS, PhD

Abstract

Objective: Housing and Urban Development (HUD) Continuums of Care (COCs) are responsible for providing entry to integrated healthcare for unhoused people toward housing stability. A client’s safety is a crucial variable to receive services. A comprehensive safety strategy understands the importance of relationship quality for clients and their multidisciplinary healthcare teams (MHT) to prevent safety incidents. Greater depth of knowledge on participant experiences informs the development of a process model for implementing the Community Resiliency Model (CRM) for crisis prevention response to decrease health disparities among unhoused Indigenous peoples in Albuquerque.

Methods: This qualitative key informant study applied an ecological lens on Relational-Cultural Theory (RCT) and 24 participant interview content analysis. Participants include unhoused people who self-identified with Native American, about accessing and receiving homeless services and members of their MHT across COC agencies.

Findings: Participants shared a congruent understanding of the interpersonal, multidisciplinary, and organizational resilience factors for crisis stabilization and prevention. Integrated healthcare providers identified cohesion when an MHT has the organizational supports needed to consistently provided compassionate care and relevant recovery options. Interpersonal resilience emerged as the sense of belonging experienced in a compassionate and accepting relationship. Relational courage is a key facilitator of interpersonal resilience when an integrated healthcare provider can clarify with a client what is the most important and brings purpose or meaning. Participants emphasized multilevel factors for the cultivation of hope in recovery at the heart of crisis prevention.

Discussion: The findings provide a rationale for a paradigm shift to resilience for housing stability. CRM wellness skills can enhance growth-fostering connection and cultural relevance for safety planning. Significantly, cohesion enhances the capacity of an MHT to support a client’s success in recovery. Cohesion correlates with integrated healthcare providers in their OK Zones. Ethical distress escalated crises and contributed to barriers preventing safety incidents. The implications for integrated healthcare and housing policy are to increase multilevel support for organizations to provide workforce training, implementation support, and solutions to sustain MHT cohesion and maintain intra-organizational systems. Cohesion is a key variable to enhance the capacity for a comprehensive safety strategy to be successful.

Included in

Social Work Commons

Share

COinS