Selected International Models of High-Integration Practice

With Transferability Analysis

The following examples illustrate different pathways to high-level integration of health and social care for people experiencing homelessness. Each model highlights one particularly strong integration component. Rather than presenting them as idealised systems, they are examined through a transferability lens relevant to European Integrated Health and Social Care (IHSC) contexts.

United States

Canada

United Kingdom

Ireland

Boston Health Care for the Homeless Program (BHCHP)

Website:https://www.bhchp.org

Focus: Medical Respite as Structured Continuity of Care

BHCHP, founded in 1985, is one of the most established integrated healthcare systems for people experiencing homelessness. Its most internationally influential innovation is medical respite care.

High-Integration Component

Medical respite programs provide:

Short-term residential post-acute medical care

Nursing supervision

Medication management

Case management

Housing pathway activation

Structured discharge planning

This creates a formalised continuum:

Hospital

Medical Respite

Community Primary Care

Housing

This directly addresses the high-risk discharge-to-street cycle.

Why It Represents High Integration

Clinical and social teams coordinate daily

Housing planning begins during medical stabilisation

Data monitoring tracks readmissions and outcomes

Multidisciplinary teams operate under shared accountability

Transferability to European Context

Medical respite is highly transferable, but requires:

Structured hospital–community agreements

Dedicated funding streams

Regulatory flexibility for transitional care

Municipal or regional coordination

In European systems with universal healthcare, financing barriers may be lower than in the U.S., but administrative fragmentation can still limit implementation.

Medical respite is particularly adaptable in urban regions with:

High hospital utilisation among PEH

Strong municipal health authority

Established Housing First pathways

Toronto Inner City Health Associates (ICHA)

Website:https://www.icha-toronto.ca

Focus: Assertive Community Treatment (ACT) in Shelter and Community Settings

Toronto's model integrates psychiatric care directly into homeless-serving environments.

High-Integration Component

Embedded ACT teams operating in:

Shelters

Supportive housing

Community settings

ACT teams include:

Psychiatrist

Nurse

Social worker

Addiction specialist

Case manager

They provide:

Direct psychiatric treatment

Medication management

Crisis response

Housing coordination

Ongoing engagement

Unlike standard case management, ACT delivers services directly rather than referring externally.

Why It Represents High Integration

Mental health and social care operate as one coordinated team

Services are delivered where individuals live

High-intensity support prevents hospitalisation and housing loss

Harm reduction and trauma-informed practice are embedded

Transferability to European Context

ACT models are already present in some European contexts but often under-scaled.

Key adaptation considerations:

Workforce availability (psychiatrists, community nurses)

Sustainable funding for small caseload teams

Legal frameworks for community psychiatry

Integration with Housing First programs

ACT is particularly transferable in systems facing:

High rates of severe mental illness among PEH

Frequent psychiatric hospital admissions

Poor outpatient follow-up

Pathway – Hospital Inclusion Health Teams

Website:https://www.pathway.org.uk

Focus: Integrated Hospital Discharge for Homeless Patients

The Pathway model was developed within the NHS to prevent unsafe discharge of patients experiencing homelessness.

High-Integration Component

Multidisciplinary Inclusion Health Teams embedded in hospitals.

Teams typically include:

GP or hospital physician

Specialist nurse

Housing worker

Social worker

Peer advocate

Core functions:

Early identification of homeless patients

Coordinated discharge planning

Housing referral activation

Benefits coordination

Community service linkage

Why It Represents High Integration

Health and housing coordination begins during hospital admission

Formal discharge protocols reduce discharge-to-street

Hospital systems are structurally connected to community providers

Transferability to European Context

This model is highly transferable within publicly funded hospital systems.

Prerequisites include:

National or regional health system governance

Mandated discharge planning standards

Collaboration agreements with housing services

Data sharing mechanisms

Countries with strong hospital infrastructure but weak discharge coordination could particularly benefit.

Dublin Inclusion Health Service (DIHS)

Website:https://www.hse.ie (search: Dublin Inclusion Health Service)

Focus: Hospital–Community Integrated Homeless Health Services

The Dublin Inclusion Health Service operates within Ireland's national health system (HSE).

High-Integration Component

Multidisciplinary Inclusion Health Teams embedded in hospitals.

Specialised Inclusion Health Teams linking:

Hospital-based services

Primary care

Addiction services

Mental health

Homeless shelters

Social care providers

The model integrates:

GP-led homeless health clinics

In-hospital inclusion teams

Addiction support

Case coordination

Shelter collaboration

Why It Represents High Integration

Clinical integration across hospital and community

Direct coordination with national health structures

Discharge planning integrated with shelter systems

Ongoing follow-up beyond hospital setting

Transferability to European Context

The Irish model demonstrates that strong health–social integration is possible within a European public healthcare framework.

Transferable elements include:

Dedicated inclusion health teams

Hospital–primary care linkage

Shelter collaboration protocols

Integrated addiction and mental health services

Adaptation requires:

Political commitment

Dedicated workforce roles

Formalised inter-agency agreements

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