Do homelessness services need to be culturally relevant?

Canadian Observatory on Homelessness/Homeless Hub: York University
September 23, 2016
Categories: Ask the Hub

The following question came from Natalie D. via our latest website survey: “What is the effectiveness of non-Indigenous organizations in meaningfully supporting Indigenous people? Is there a need for the homelessness sector to support the development and delivery of programs that are culturally relevant?”

In Canada, the social services sector is known for being dominated by people who are white and middle class. (In one U.S. study, researchers found that while most social service agencies served 2/3 people who were visible minorities, the majority of staff were white and of European descent.) And according to Statistics Canada, the social service sector is 77% female. Given the country’s vast diversity, especially in major cities, many employees and service users are from non-Western cultures. So the need for employees and on a wider scale, entire organizations, to be aware of cultural differences, is absolutely necessary.

Groups that tend to be marginalized—non-English speakers, racialized communities, newcomers, and those experiencing homelessness—tend to have poorer health outcomes than others. This is also the case for Indigenous peoples in Canada, who are over-represented in the homeless population, and are more likely to live in poverty than people who aren’t Indigenous. All of these factors lead to a great need for services that are accessible and culturally relevant.

Organizations that primarily employ people who haven’t been marginalized can still serve others, but generally: the more diverse the organization, the better. In healthcare research, there’s evidence showing that: “Current prevalent models of health and social service provision, which largely reflect white, middle class values, do not effectively meet the needs of ethnically and racially diverse groups.” Indeed, Indigenous groups and organizations have been saying this for some time. This, combined with the importance of self-determination and holistic care for Indigenous people, has inspired the creation of many independent, Indigenous-led social service organizations.

When white-dominated organizations make efforts to meet cultural needs, service use tends to increase. One 1986 California study found that “…a culturally compatible approach to services was effective in increasing utilization. Several program components were identified as the best indicators of increased utilization: language and ethnic/racial match of therapists and clients, and location of services in the ethnic community.” A more recent study in three British Columbia communities concluded that more culturally appropriate services are needed for Indigenous peoples.

It makes sense that when service users can understand and access services that use would increase—but it often requires making large organizational changes and focusing on “cultural competency” or “cultural safety.”

The rise of cultural awareness and competency

In the 1980s, many academics began writing about the need for “cultural competency” in social service organizations. Betancourt, Green and Carrillo (2002) define cultural competence (in health care) as: “…the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.” They defined the main barriers to culturally relevant care as:

  • Lack of diversity in health care’s leadership and workforce.
  • Systems of care poorly designed to meet the needs of diverse patient populations.
  • Poor communication between providers and patients of different racial, ethnic, or cultural backgrounds.

To address these barriers, they recommend meaningful community involvement, assessments and evaluations; and adopting practices like tracking language preferences and making them available (whether through staff or interpretation services). While their work took place in the U.S., such definitions can be expanded to Canadian social services, where organizations face similar issues.

In 2016, Wong and Omori wrote that: “The purpose of cultural competency is to make healthcare services accessible, acceptable, and effective for all people, regardless of their cultural background.” Their study addressed homelessness as its own unique culture, and advocated for healthcare workers to be aware of broad trends (like higher instances of cardiovascular disease), but also to learn from each individual about what’s important to them and what matters in terms of their care.

Concept map of issues discussed in the Our Health Counts study: poverty, housing, impacts of colonization, government responsibility
Media Folder: 
Making services culturally safe

More recently, many academics and reports are using the term “cultural safety.” According to the Nursing Council of New Zealand (2005):

Cultural safety is defined as effective practice determined by the individual and family. “Unsafe cultural practice comprises any action which diminishes, demeans or disempowers the cultural identity and well-being of an individual (From: Understanding Cultural Safety: Traditional and Client Perspectives).

Most literature on cultural safety focuses on its importance with Indigenous peoples, who face unique challenges due to ongoing colonization. In a 2016 study, Oelke, Thurston and Turner proposed a framework to address structural violence against Indigenous peoples. They found that best practices included:

...ensuring cultural safety, fostering partnerships among agencies, implementing Aboriginal governance, ensuring adequate and sustainable funding, equitable employment of Aboriginal staff, incorporating cultural reconnection, and undertaking research and evaluation to guide policy and practices related to homelessness among Aboriginal peoples.

The Our Health Counts study from Hamilton, Ontario, was conducted by Indigenous organizations and also cited cultural safety as an important factor in healthcare. The writers also recommended emphasis be placed on Indigenous-specific services, as well as support for self determination. (The concept map from that study is pictured right, illustrating the different topics connected to social and healthcare services.)

In terms of housing services, challenges go way beyond policies and structures. In her article on cultural safety, housing and health, Christensen (2016) points out that the concept of “home” is different for many Indigenous people:

While ‘home’ is conceived of and experienced in different ways between and within the ethnic and cultural bounds of the Dene, Métis and Inuit, certain elements, like the land and the family, thread them together. Keeping in mind these shared components in Indigenous senses of home reveals the broader significance and meaning of Indigenous experiences of ‘homelessness’. Attacks on the family and on Indigenous homelands through colonial processes of domination and dispossession are therefore deeply implicit in Indigenous experiences of homelessness. In interviews and focus group discussions, the concept of ‘home’ was never limited to four walls and a roof: home was also closely linked to positive, healthy relationships with family and friends, physical and mental health and wellbeing, strong cultural ties, and self-determination.

Furthermore, public housing policies also contribute to homelessness for Indigenous people. Those wishing to stay with family or friends in public housing are often forced to leave after two weeks, else the original tenant(s) may get evicted. Another policy that causes issues is that when children are apprehended by the child welfare system, parents are no longer eligible to stay in family units. In Christensen’s words: “Due to the dismal numbers of single-adult dwellings in public housing in the NWT, the apprehension of children into child welfare often leads directly to the homelessness of parents.” Other interviewees from her work include women who move from their rural communities to Yellowknife, where their children live in foster care, in hopes of remaining close and regaining custody—which also often leads to homelessness.

Christensen proposes the following changes (and more) to make housing services more culturally appropriate:

  • Flexible housing policies that let tenants self determine their needs.
  • Services that not only address physical homelessness, but also spiritual homelessness.
  • A focus on integrated approaches to rebuilding parental-child relationships.
  • Meaningful and continuing involvement of Indigenous governments, ensuring a better emphasis on Indigenous knowledge and practices being included in policies

In other words: acknowledging cultural differences and the consequences of colonization, and changing housing services accordingly, are an important step in improving housing outcomes for Indigenous peoples.

“Nothing about us without us”

Being aware of cultural and historical differences is important, but not as crucial as including service users (in this case, Indigenous peoples) in design, delivery and assessment of services. A lot of the work I do as a social worker in-training is in harm reduction, where “nothing about us without us” is a cornerstone of how we build and run various programs. This message is applicable to any group of people in need of such services, like newcomers, Indigenous people, drug users, and people experiencing homelessness in general. Homelessness itself is a culture, one that includes survival tactics and other strategies/practices that people who haven’t experienced it may not know much about—so it’s important to get input from and employ people with that experience.

The Homelessness Resource Center (HRC) makes similar recommendations in its guide on building culturally competent services for LGBTQI2-S youth. As Youth on Fire is quoted:

Hiring staff who identify as GLBT sets a positive tone for the space. When almost half our members are queer, it is really important to have staff that identifies the same way. You can put up a poster or change the rules, but the best way to signal that you’re a safe space is to have someone on staff who is GLBT. It also helps the young people trust the rest of the staff, because acceptance is now signalled as a genuine priority.

Along with hiring staff from within communities, the HRC recommends seeking staff who are open-minded and willing to learn. Not everyone will have the same lived experience, but a true commitment to learning and growth can go a long way to ensure services are accessible and safe.

Inclusion not only allows service users to find employment and be involved in how programs and services are run, it gives organizations the required lived experience and input they need to make said programs and services more effective.

More resources on cultural competence

Image: Our Health Counts

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

Emma Woolley is a 2016 graduate of York University's Bachelor of Social Work program with a background in publishing, freelance writing and digital communications. Her interest in affordable housing, homelessness, 2LGBTQ rights, and social justice led her to work with The Homeless Hub. Emma is now pursuing her Master of Social Work at The University of Toronto, where she is focusing on anti-oppressive, strengths-based, recovery-oriented, and critical approaches to mental health care.

Add Comment

Recent Tweets

Content on this site is licensed under a Creative Commons Attribution Non-Commercial No Derivatives License

The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.