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Understanding Homelessness

Health Complexity

Overview Before we begin...Overview of Physical Health Conditions Common in Homeless Populations Physical Illness as a Socially Determined Condition Spectrum of Physical Health Problems Emergency Care and System Fragmentation Complexity Rather Than Isolated Illness Chronic and Infectious Diseases in Homeless Populations Infectious Diseases Interaction Between Chronic and Infectious Disease Mental Health and Substance Use: Clinical and Systemic Complexity Mental Health Disorders Substance Use and Health Consequences Trimorbidity and Clinical Complexity: When three crises overlap Multimorbidity and Complexity of Care Needs Social Complexity and Care Burden Barriers to Healthcare Access: Stigma, Administrative, Financial and Logistical Obstacles Consequences of Access Barriers Innovative Healthcare Delivery Models: Street Medicine, Mobile Clinics, Outreach Teams and Telehealth Evaluating Applicability in European Contexts Ethical Dilemmas in Providing Healthcare to Marginalised and Excluded Groups Integrative Synthesis Core Insight for Integrated Health and Social Care When Multimorbidity Meets System Fragmentation Applied assessment Closing reflection

Social Integration

Overview Before we begin...Housing as a Determinant of Health Housing First and Housing-Led Approaches in Europe The Eight European Housing First Principles Evidence Base and Health Outcomes European Implementation Contexts Housing First in Central and Eastern Europe (CEE)Housing-Led Approaches: Conceptual and Structural Differences Structural Preconditions and System Integration Economic Stability and Broader Pathways to Social Integration Employment Support and Vocational Reintegration Broader Forms of Social Integration Interdependence of Housing, Income and Participation Structural Barriers Across European Contexts Legal Protection, Eviction Prevention and Sustaining Tenancy Rights-Based Approaches Preventing Evictions: Early Intervention Matters Sustaining Tenancy: Beyond Preventing Eviction Psychological Dimensions of Tenancy Sustainment Structural Variation Across Europe Community Integration, NGOs and Peer Empowerment Community as Health Infrastructure Role of NGOs in Integration Pathways Municipalities and Local Governance Peer Involvement: Lived Experience as Structural Knowledge Benefits of Peer and Community Involvement Community Integration in Central and Eastern Europe Integrative Synthesis Integrative Synthesis Integrative Synthesis Integrative Synthesis Integrative Synthesis Integrative Synthesis Core Insight for Integrated Health and Social Care Applied Practice When Integration Depends on Coordination Applied assessment Closing reflection

Architecture

Clinical Practice

Overview Before we begin...Operationalising Integrated Care in Complex Mental and Physical Health Situations Trauma, Chronic Stress and Neurobiological Dysregulation 2. Chronic Stress as a Biological Condition 3. Neurobiological Dysregulation 4. Complex Trauma and Emotional Regulation 5. Trauma and Substance Use 6. Trauma and Physical Health Interaction 7. Clinical Implication: Reframing Behaviour 8. Intersectional Vulnerability Key Clinical Insight Multimorbidity and Dual Diagnosis 2. Dual Diagnosis and Psychiatric Comorbidity 3. The Interaction Between Mental Illness and Physical Health 4. Medication Adherence and Executive Function 5. Emergency Department Cycling 6. Matching Support Intensity: ICM vs ACT 7. Parenting and Multimorbidity 8. Minority Stress and Access to Care 9. Clinical Interpretation Shift Key Clinical Insight Evidence-Based Tools as Instruments of Integrated Care 2. Harm Reduction 3. Motivational Interviewing (MI)4. De-escalation and Conflict Management 5. Integrating Physical Health into These Tools 6. Tool-to-Principle Mapping Key Clinical Insight Integrated Case Lab Integrated Case Lab: Clinical Scenarios Cross-Case Reflection Sparring Section – Integration Under Constraint Ethical Tensions in Complex Mental and Physical Health Care Ethical Reflection Questions Closing reflection

Implementation

Overview Before we begin...Policy, System Readiness and Professional Action Introduction Why System Readiness Matters From Fragmentation to Coordination Variation Across Contexts The Role of Professionals The Aim of This Module European and National Frameworks for Integrated Care National Variation in Implementation The Economic Case for Integrated Care Legislative and Regulatory Dimensions Policy as Enabler — or Constraint Key Insight Institutional and Structural Barriers to Implementation 2. Financial Silos and Misaligned Incentives 3. Legislative and Regulatory Constraints 4. Organisational Culture and Professional Identity 5. Workforce Capacity and Burnout 6. Data, Monitoring and Evaluation Gaps 7. The Economic and Political Dimension Key Insight Advocacy and Leadership in Practice 2. Professional Leadership Without Formal Authority 3. Evidence as a Tool for Change 4. Linking Practice to Policy 5. Realistic Scope of Influence 6. The Ethical Dimension of Leadership Key Insight The SCIROCCO Maturity Model The SCIROCCO Dimensions Reflective Application Key Insight Your Role in Implementation Cross-Profile Insight Capstone Exercise Returning to Alex, Jana, and Peter Final Reflection Integrated Health and Social Care

M5 · Clinical Practice

Slide 34

CONTENT

Ethical Reflection Questions

1. Which ethical tension feels most destabilising in your practice?

2. Where do you feel pressure between policy and compassion?

3. Does your system support proportional decision-making?

4. How does your team share responsibility for difficult decisions?

CLINICAL CONSOLIDATION INSIGHT

In complex care:

Ethical dilemmas are not signs of failure. They are indicators of layered vulnerability. Integrated care does not eliminate ethical tension — it structures how we respond to it.

When:

Decisions are collaborative

Boundaries are transparent

Autonomy is respected

Support intensity is adjusted

Housing is stabilised

Physical and mental health are integrated

Ethical practice becomes coherent.

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