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Pandemic hits youth experiencing homelessness hard

May 26, 2020
Guylaine Spencer

Naomi Thulien

Above: Dr. Naomi Thulien

Imagine if every time you went home, you had to buzz in and get screened for COVID-19 symptoms before you were allowed to enter the building.

That’s what young people who are trying to enter a homeless shelter during the COVID-19 crisis need to do these days, even if they’ve been staying there for weeks, says Dr. Naomi Thulien, assistant professor and researcher in the McMaster School of Nursing. “While this makes sense from a public health perspective, it can challenge a young person’s sense of belonging.”

One youth from Hamilton told Thulien that “it just reminds me that I don’t have a home and I don’t really belong anywhere. So it makes me feel more stigmatized.” He also worries that if he answers yes to any of these questions, he may not get a bed that night.

Thulien has seen first-hand how the pandemic is affecting young people and the agencies supporting them. In addition to her academic role, she is the nurse practitioner and medical director at Toronto’s Covenant House - Canada’s largest agency for youth who are experiencing or have experienced homelessness. The organization also serves youth who have been sexually trafficked. Thulien has maintained a clinical practice at Covenant House Toronto since 2011. In addition, she works with the Shelter Health Network to run a weekly clinic based at the Youth Wellness Centre in Hamilton.

Thulien has been busy responding to the challenges presented by the crisis. “My medical director role at Covenant House was only two hours a week and now it’s ten hours. There have been the logistical challenges of moving staff offsite, how we screen youth, who gets masks, and how we set up our shelter. In the early days, in March, protocols and policies were being updated provincially and locally – sometimes almost hourly – and we were just keeping on top of that.”

Covenant House usually houses almost 100 young people. “Last week, we moved around half of them – about 40 – into a hotel in Toronto. So everyone now has a single room. Tomorrow, I’m going to set up a clinic in the hotel. The rooms are paid for by the City of Toronto but Covenant House supplies the staff,” she says.

They’ve had to make changes to meals, too. “At the shelter, the youth still get meals in a common area but we move in fewer people at a time so we can maintain physical distancing, and we reinforce good hand hygiene,” Thulien says.

The psychological impact on the young people is huge. “For anyone who was in school or had a job, those things are put on hold or gone. There’s this real sense of instability now and not being able to plan for the future. A lot of us feel that way but when you don’t have a home, and you don’t have family support, that just makes it harder. Even in the shelter, in the great hall, young people are encouraged strongly to practice physical distancing. For those of us who have our own homes, we wouldn’t distance with the people we live with. So there’s less physical contact as well. During the time when they need more physical contact than ever, that can’t happen now. That’s hard.”

To date, there have been no confirmed cases of COVID-19 at Covenant House. “I’m proud of our screening process. We’ve worked closely with the City of Toronto, the Inner City Health Associates [similar to the Shelter Health Network in Hamilton], and St. Michael’s Hospital. All youth are screened at the front door for the virus, and those who screen positive for potentially having COVID-19 are sent by taxi to an assessment centre at St. Mike’s hospital. St. Mike’s will make sure they have a place to stay and food to eat until their results come back. It’s usually a recliner in the emergency department or a specific isolation centre in Toronto. We generally get results back in 24 hours. We save their bed for them until their results come back.”

For protection inside the shelter, all staff members wear surgical masks. “We also received a donation of cloth masks. Every single young person has one. We don’t make them wear them but we strongly encourage them to wear a mask.”

The importance of long term supports (beyond temporary shelters) appear even more salient during the COVID crisis, says Thulien. She is leading a research project on transitioning youth out of homelessness. Part of that project involves making a documentary film. “We received funding from the St. Mikes Hospital Foundation to do a short documentary. This project involves 24 young people from Toronto, Hamilton and St. Catharines who are receiving rent subsidies for two years, with half of them also getting mentorship. We are going to feature three young people in the film – one from each city –  and highlight what rent subsidies are able to do.”

As hard as it is for the youth staying at shelters like Covenant House or in subsidized housing, it’s even harder for those who are living on the streets, Thulien notes. “We had to close down our drop-in centre at Covenant House, so we don’t see young people as much anymore. I’m not sure how they are doing. So many services are closed. The youth have nowhere to go. They can’t go into a coffee shop to use a washroom anymore. I take the GO train to Toronto and then I take the TTC to get to work. I’m seeing folks sleeping in the subway cars, in ways I never saw before. In Union Station, people are sleeping there. The true impact of this crisis on youth who have experienced or are experiencing homelessness is still unknown.”

Thulien has just received a knowledge synthesis grant from Canadian Institutes of Health Research (CIHR), Canada's federal funding agency for health research. The application was ranked 2nd in the competition. The project is titled Pandemic-Proof: Synthesizing Real-World Knowledge of Promising Mental Health and Substance Use Practices for Young People Who Are Experiencing or Have Experienced Homelessness.

“This pandemic is negatively affecting the young people we serve,” she says. “Despite this, we are hearing from our colleagues on the front lines that some are trying really innovative things to connect with young people who have experienced or are experiencing homelessness. In fact, we believe that some of these ideas may be really forward thinking and should continue after the pandemic is over. With this grant, we plan to study this work and share this information quickly with folks on the front lines and in government in a way that is easy to understand and helps them make informed decisions.” 

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