Systems and policy factors affecting service delivery for homeless adults with intellectual and developmental...

Intellectual and developmental disability (IDD) is characterized by impairment of cognitive function that results in daily living limitations. Adults with IDD face barriers to meeting basic needs and must navigate multiple public systems to access services. The housing affordability crisis has contributed to a disproportionate overrepresentation of adults with IDD who experience homelessness. Little evidence has articulated the unique systems- and policy-level issues facing homeless adults with IDD.

The purpose of this study was to 1) map the systems with which adults with IDD who experience homelessness must interface in order to access needed services and 2) describe the systems- and policy-level issues impacting service delivery and care coordination of this population.

This qualitative study interviewed professionals providing disability, homeless, and/or social care services to adults experiencing homelessness between March and June 2021. Data were analyzed using qualitative content analysis.

Participants (n = 18) mostly identified as female (n = 11), the mean age was 44 (13.9), and included clinicians (n = 5), case managers (n = 7), allied professionals (n = 5), and outreach specialists (n = 1). Participants identified five unique systems with which individuals at the intersection of IDD and homelessness frequently interact to access care and services. The theme structurally fragmented care for complex needs captures participants' perceptions of systems-level issues, and the theme policy-driven gaps in care encompasses perceptions of policy-level issues.

Homeless adults with IDD exist in a nearly perpetual process of cycling through public systems, and health equity cannot be attained without attention to the structural ableism that is embedded throughout. Findings highlight the importance of moving away from a crisis-driven model of care to a cohesive care ecosystem, and future research is needed to develop and test models of care that eliminate system churn so that all individuals are supported.