Abstract
Background: Skid Row in Los Angeles is known for its concentration of services for unhoused people, yet our pilot study revealed significant prevalence of unmanaged acute/chronic injuries and challenges in accessing health services. The mechanisms of why health services are inaccessible in Skid Row, despite the large volume available, remains unexplored.
Goal: The proposed community-engaged implementation science study will identify and address barriers to health service delivery for people who access health services in the Skid Row area of Los Angeles (i.e. service recipients). We will develop recommendations and guidelines for a “zero-barrier clinic model,” The model will triangulate data from patient experiences and community stakeholder insights.
Aim 1: Secondary analysis of exploratory data from a needs assessment survey (n=101) to identify service recipients’ needs and access barriers.
Aim 2: Explore experiences of intersectional and vulnerable populations (unstably housed women, gender and sexual minority persons (GSMP), sex workers, and disabled people) using rapid qualitative analysis methods (n=30) to understand socio-structural factors limiting access to health services.
Aim 3: Gather community stakeholder insights (n=10) and triangulate findings with a Community and Scientific Advisory Board (CSAB) to develop service delivery recommendations.
Research questions:
(1) what are the social and structural barriers to accessing health care in Skid Row?
(2) What clinical design elements would facilitate direct access to health care for individuals who utilizing services on Skid Row?
Data interpretation: Multi-level interpretation process: 1) CSAB triangulation using the WHO framework for primary care, 2) member checking, and 3) researcher triangulation to strengthen reliability and validity of our findings.
Implementation: This study will produce evidence-based guidelines for addressing access barriers to health services on Skid Row.
Next steps: This pilot data will support extramural funding efforts that contribute to building a responsive clinic model that delivers zero barrier harm reduction-based healthcare.