More than Just a Roof: Solutions to Better Support Families from Homelessness to Healing

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 I believe in that this research may contribute the literature but it should be improved. The most important problem is that the interviews are not subjected to sufficient analysis and are not justified with the literature. It looks like a crude report. Recommendations based on  the literature rather than existing studies so they are are also disconnected from the study. Authors should take into consideration my suggestions in the file I attached.

Comments for author File: Comments.pdf

Author Response

Comment 1: I believe in that this research may contribute the literature but it should be improved. The most important problem is that the interviews are not subjected to sufficient analysis and are not justified with the literature. It looks like a crude report. Recommendations based on the literature rather than existing studies so they are also disconnected from the study. Authors should take into consideration my suggestions in the file I attached.

Response 1: We thank the reviewer for their time and constructive feedback. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

 

Comment 2: Explain differences from each other [referencing the sentence “results from the interviews were narratively triangulated to develop a more holistic understanding of the issues and facilitators of homelessness for families”].

Response 2: We thank the reviewer for highlighting this lack of clarity. We have revised the manuscript to expand on the differences between interview and focus group content (see p. 4, lines 171-174). Additionally, we have revised 3. Results to discuss differences between the service recipient interviews and service provider focus groups; this choice was made to ensure that all information from the content of the interviews and focus groups can be found within the results section, but that this necessary context will be read upfront, before reading the rest of the analysis (see p. 6-7, lines 278-282).

 

Comment 3: Explain more stakeholders' roles [referencing the sentence “Involving multiple stakeholders in research aimed at producing policy reform is a valuable strategy for capturing the more complex interactions which exist in service provision and has been successfully used in a wide range of policy research (27-30).”].

Response 3: We thank the reviewer for highlighting this lack of transparency. More information on the community organization (Trellis) that staff worked with can be found in 2.1. Study Design; however, to improve transparency, we expanded on stakeholder roles, per Response 2 (see p. 4, lines 171-176).

 

Comment 4: Explain more about focus groups. Why did you use it what are pros and cons?

Response 4: We thank the reviewer for their comment. We chose to address this comment in  2.1. Study Design rather than 2.4.1. Data Saturation, as this is where the choice to use focus groups for staff was first stated. We have revised our manuscript to briefly describe our decision to use focus groups for staff participants (see p. 4, lines 159-165).

 

Comment 5: Give backgrounds of participants. Age, coded names etc.

Response 5: We thank the reviewer for their recommendation. Given our small sample size and that both the staff and parent participants are members of similar communities (e.g., all accessing or providing services through Trellis, all living in urban Calgary, Alberta, etc.) and therefore are likely to know each other, we believe that it is in the best interest of our participants not to disclose any potentially identifiable information in this manuscript. Moreover, homelessness, and many of the associated life experiences (e.g., addiction, crime, sexual violence, etc.), are highly stigmatized and thus we believe that such extra precautions to ensure anonymity are particularly important.

 

Comment 6: Where are the analysis based on quotations? It seems as interview report. Deep analysis are required.

Response 6: We thank the reviewer for their comment. To further clarify our analysis process, we have included more detail on how the interview and focus group guides were developed as well as a step-by-step breakdown of the analysis stages and author involvement (see Table 1, p. 6, lines 258-260).

We have structured the 3. Results in accordance with the standard reporting guidelines of thematic inductive analysis, wherein the analysis precedes the quotations, which then serves to reinforce or exemplify the previous content; however, Brun and Clark (2024) note that results should be presented in a way which tells an interpretative story about the data, so we have significantly revised the results section of our manuscript to uphold this and address the reviewers’ concern about the depth of our analysis. Additionally, our community partner was involved at all stages of analysis, which we believe strengthens the depth of our analysis by incorporating the perspective of those with lived experience and those who will be directly impacted by the recommendations proposed later in the manuscript. To clarify this, the ongoing involvement of our community partner was made more explicit in our manuscript (see p. 6 lines, 267-269).

 

Comment 7: How do you provide these themes? They are not clear. No justification for the main themes with analysis and literature review.

Response 7: We appreciate the reviewer’s feedback. In alignment with all three reviewers’ recommendations, 3. Results has undergone major revisions to improve the justification for the main themes as well as their relationship to the subsequent policy recommendations. As part of this, we have changed headings to better reflect section content, added/removed/rearranged staff and parent quotes to further integrate stakeholder perspectives, and added direct quotes and analysis that specifically relate to the policy recommendations.

 

Comment 8: I could not find clear arguments coming from the present study. It seems just based on existing literature. Please relate them by referring the interviews.

Response 8: We thank the reviewer for their comment. In addition to best-practice literature, the policy recommendations are based on ideas that came forward from participants when we asked them specifically for their ideas for needed improvement; we asked parents the following questions:

Tell me what you would need to thrive as a parent? as a family unit?

1. What barriers do you currently face?
2. Imagine you had exactly what you needed – what would that look like?

Looking ahead to your future, what are your hopes and dreams:

1. For yourself?
2. For your family?

We also asked service providers the following questions:

Tell me what you would need to support families experiencing homelessness?

1. What barriers do you currently face?
2. Imagine you had exactly what you needed – what would that look like?

 

In the interest of transparency, the interview guides for both parent interviews and staff focus groups have been added to the supplementary materials of this manuscript.

In addition to the policy recommendations being based on the best practice literature and data collected in the present study, we also collaborated with our Trellis community partners to develop these recommendations. This was not made sufficiently explicit, so we have revised our manuscript accordingly (see Table 1., p. 6, lines 258-260; see p. 6, lines 267-269; see p. 13, lines 622-624; see p. 14, lines 661-664; see p. 18, lines 833-834). Moreover, to improve clarity on the relationship between the present study themes, current core issues with service provision, and subsequent recommendations, we have created a visual flow chart (see Figure 1., p.14-15 , lines 671-672).

 

Comment 9: It seems repetition of policy recommendations and existing literature. So no clear arguments based on present study.

Response 9: We thank the reviewer for their comment and echo the sentiment that our recommendations are similar to existing ones. Our choice to use language in the present manuscript that reflects what has previously been said was purposefully done to improve literature continuity and increase the likelihood of uptake by policy makers. Results from the present study indicate that an inability to effectively enact the previous recommendations to current systems level limitations are being felt by both service providers and service recipients, so we have revised 5. Conclusions  to clarify this (see p. 18, lines 855-857). Per Response  7 and Response 8, within 3. Results we have also reframed some of the quotes and subsequent analysis to better reflect the ideas and solutions that participants provided us in the interviews; in addition to the other revisions, we have made in the 2. Methods and 4. Discussion, we hope these additional analyses contribute to clearer line of sight to the policy recommendations.

Reviewer 2 Report

Comments and Suggestions for Authors

Although it is not a very original work, it is a well-constructed work. I belive he will contribute to the field. 

Author Response

Comment 1: Although it is not a very original work, it is a well-constructed work. I believe the will contribute to the field.

Response 1: We thank the reviewer for their time and appreciate their commentary on the methodological approach used in this study. We would also like to highlight that integrating the perspectives of service users and service providers is an important methodological approach to exploring families’ pathways into and out of homelessness. This approach to data collection is a valuable contribution to the literature as involving multiple stakeholders in research aimed at producing policy reform is beneficial (Gyasi at al., 2017; Knoppen et al., 2019; Velez et al., 2020). We have made this argument more explicit in 1.4. Present Study  (see p. 3, lines 138-139), 2.1. Study Design (see p. 4, lines 159-162; see p. 4, lines 171-176), 3. Results (see p. 6-7, lines 278-282), 4.1. Recommendations for Policy and Service Delivery (see p. 14, lines 659-664). Additionally, the present study was developed and conducted in full partnership with our community partner, and we have further clarified their unique role in the data analysis process (see Table 1., p. 6, lines 258-260; see p. 6, lines 267-269; see p. 13, lines 622-624; see p. 14, lines 661-664; see p. 18, lines 833-834).

Please find the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

Reviewer 3 Report

Comments and Suggestions for Authors

I enjoyed reading this manuscript and very much appreciate the opportunity to review it. The study will be a valuable contribution to the literature, particularly if the authors can further frame the introduction, clarify methods, integrate results, and tighten the discussion. Here is my specific feedback on each section: 

1. Introduction: The introduction is well-written, but could use additional framing to set the stage for the study. Can the authors build on the paragraph starting on line 45 to directly convey what more we need to know and how the study will help.

2. Background: The sub-headings in this section are vague and do not reflect the content in the paragraphs that follow. The Background section mostly contains information about homeless sector service experiences and the impacts of those experiences on consumers. Can the authors come up with better sub-headings? More citations are required for sentences starting on lines 52, 69, 70, and 91. Can the authors tie in the paragraph starting on line 69 better, so that the reader can easily sort out the roles of colonization and racial harm on service experiences? Also, this paragraph references child welfare experiences, not housing experiences. Can the authors find evidence to build in from the housing literature? The Background section would also benefit from reference to theory or conceptual framework. Perhaps the authors could consider the literatures on service silos, collaboration, and integration. Finally, prior to the Methods section, it might be useful to include a "Current Study" section of some sort to revisit the purpose of the study. 

3. Methods: We need substantially more information here. In the Participants sub-section, can the authors provide more information about the staff participants. Who were they? What are their staff roles? The authors could separate the Data Collection and Analysis subsections. In the Data Collection sub-section, can the authors include more information about how the demographic data were collected? Were all study participants asked the same questions? What there some sort of a survey? Were there different interview guides for the parents and staff? What questions were asked? What tools were used to record and transcribe interviews? The authors should build out a separate Analysis subsection and include more details. What program was used to analyze the data? Who coded the data? Can the authors provide more detail on the steps taken to conduct the analysis?

4. Results: There is a lot of great detail included in this section. It would be helpful for the authors to present it in a way that is more easily digestible. The sub-headings are vague and not always consistent with the content that follows, and the content in each section does not always seem to hang together. Sub-heading 3.1, for example, could be something like "Housing as a foundation for success in other life areas" or something like that. Can quotes be set off from the text? Is it possible to include Staff IDs with quotes in the way that Parent IDs are included? This will allow the reader to see the extent to which different staff perspectives are represented in the results. The two paragraphs starting on line 210 do not seem to fit with the rest of its sub-section; the content seems connected to another theme. Only 2 parents are represented in 3.1. Can more perspectives be included? Where does the phrase "pressure cooker" come from? What does it mean? Sub-section 3.2 is brief and only includes one parent quote. Again, the sub-section header is vague and confusing. The sub-section 3.3 header does not seem to reflect the content included there. No staff perspectives are represented in sub-section 3.3. What does P.8 on line 268 refer to, and why is the quote italicized, but others are not? The two paragraphs starting on line 292 do not seem to hang with the rest of the content in sub-section 3.4. No staff perspectives are included in 3.4. What is does "smudge" mean? Would it make sense to include a separate results section with participant recommendations, as these recommendations are referenced in the Discussion?

5. Discussion: The Discussion feels like a big jump from the Results section. It is not clear to me that the Discussion and recommendations there flow directly from the Results. More references to existing literature and connections to the Results section are needed. In line 316, the authors indicate that the study "uniquely integrates" family and staff perspectives, but it is not clear to me that the study does this. Some Results sub-sections lack perspectives from both parties, for example. Further, the Methods section does not provide any detail on how the perspectives were integrated. The authors could also further specify how the results build on existing knowledge. In sub-section 4.1, the extent to which recommendations stem from participant views is unclear. This becomes a particular challenge when the recommendations seem inconsistent with or major leaps from the results as conveyed. For example, on line 402, the authors recommend "Focus on Finding 'Homes' and Building Community Connections" and convey that housing alone is not sufficient, but the results seem to suggest that a house/apartment is the foundation for success in other life areas (see 3.1). Maybe the authors could expand on the results in the paragraph starting on line 218 to set the stage for the recommendation on line 402. There are currently no related quotes included, for example. The recommendation on line 427 is not connected to the content that follows. The content is more about landlord incentives and landlord liaisons. Do the authors have any ideas on how to fund the ideas suggested in the Discussion? Finally, the paragraph starting on line 474 starts by sharing that a key strength of the study is that it integrated service recipients' and staff perspectives, but it is not clear from the manuscript if or how the authors integrated perspectives, as described above.

6. Conclusion: Is "pressure cooker" a quote from a participant, and what does it mean? The authors convey that the study's recommendations are from study participants, but it is not clear who recommended the recommendations. Maybe the authors could include a recommendations sub-section in the Results section.

Thank you for the opportunity to review this manuscript. With revisions, the piece will be a valuable contribution to the existing knowledge base. 

Author Response

Comment 1: I enjoyed reading this manuscript and very much appreciate the opportunity to review it. The study will be a valuable contribution to the literature, particularly if the authors can further frame the introduction, clarify methods, integrate results, and tighten the discussion.

Response 1: We thank the reviewer for their time and constructive feedback. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

 

Introduction

Comment 2: The introduction is well-written, but could use additional framing to set the stage for the study. Can the authors build on the paragraph starting on line 45 to directly convey what more we need to know and how the study will help.

Response 2: We thank the reviewer for their comment and have elaborated on how the present study fills an existing gap in the literature (see p. 3, lines 138-139); we chose to add this information to 1.4. Present Study, as this is the 1. Introduction section that introduces the present study by framing it with current gaps in literature and service provision.

 

Background (we have removed this heading in the revised manuscript)

Comment 3: The sub-headings in this section are vague and do not reflect the content in the paragraphs that follow. The Background section mostly contains information about homeless sector service experiences and the impacts of those experiences on consumers. Can the authors come up with better sub-headings?

Response 3: We thank the reviewer for their comments. We have restructured 1. Introduction in accordance with the reviewer’s recommendations to improve flow and clarity. We now begin the paper briefly highlighting the instances of families experiencing homelessness and the theoretical orientation of the present study, then discuss the present challenges facing families who navigate the homelessness service sector and subsequent health consequences (see p. 2, lines 67-68; see p. 3, line 110); we then narrow our discussion to highlight the continued gaps in service provision, despite previous policy recommendations, and the consequences for Canadian families (see p. 3, line 121), which contributes to the justification for the present study. The subsection headings have been revised to reflect that 1. Introduction predominantly focuses on homeless sector service experiences.

 

Comment 4: More citations are required for sentences starting on lines 52, 69, 70, and 91.

Response 4: We thank the reviewer for their attention to our references. We have added a citation for what was originally line 52 (see p. 2, line 72). Per Response 5, we have removed what was originally line 69 (see p. 2, lines 84-85) and added a citation to what was originally line 70 (see p. 2, line 93). What was originally line 91, reflected the authors’ view on the current state of the literature, so this sentence has been revised to clarify that this is our opinion (see p. 3, line 141).

 

Comment 5: Can the authors tie in the paragraph starting on line 69 better, so that the reader can easily sort out the roles of colonization and racial harm on service experiences?

Response 5: We agree that it is important to clarify the roles of colonization and racial harm on service experiences, so we have revised 1.1. Present Challenges Faced by Families When Navigating the Homelessness Service Sector to more clearly state this (see p. 2, lines 86-87) and provide a relevant Canadian example (see p. 2, lines 89-91). Additionally, this section has been revised to draw on relevant theory including minority stress theory (see p.2-3, lines 99-101) and critical race theory (see p. 3, lines 101-105).

 

Comment 6: Also, this paragraph references child welfare experiences, not housing experiences. Can the authors find evidence to build in from the housing literature?

Response 6: We thank the reviewer for their suggestion. We discuss how prejudice can impact Indigenous and racialized families’ ability to access housing (see p. 3, lines 101-103). We believe that highlighting prejudice in the child welfare system is directly related to children’s experience with housing as it contributes to the ongoing instability they face, which impacts health outcomes. Moreover, parents who are now experiencing homelessness often have experienced the child welfare system which can impact their willingness to engage in services as an adult. These concepts become a core theme in 3. Results.

 

Comment 7: The Background section would also benefit from reference to theory or conceptual framework. Perhaps the authors could consider the literatures on service silos, collaboration, and integration.

Response 7: We thank the reviewer for their comment. Orientating research within a particular theoretical framework can create barriers to practical uptake of findings in a pragmatic way by service providers. Therefore, we chose to conceptually follow the arguments of Cejudo 2017, whereby families in homelessness have to navigate multiple systems. As the reviewer pointed out, highlighting this conceptual approach to the research would be beneficial; thus, we have revised 1. Introduction to help contextualize the rest of the manuscript (see p. 1, line 40-45). Please also see Response 5, which outlines the theories we added to expand on the roles of colonization and racial harm in service recipients’ experiences.

 

Comment 8: Finally, prior to the Methods section, it might be useful to include a "Current Study" section of some sort to revisit the purpose of the study.

Response 8: We have added 1.4. Present Study accordance with the reviewer’s recommendation (see p. 3, line 137).

 

Methods

Comment 9: We need substantially more information here. In the Participants sub-section, can the authors provide more information about the staff participants. Who were they? What are their staff roles?

Response 9: We thank the reviewer for their comment. We have revised 2.2. Participants to provide greater detail on the recruitment process (see p. 4-5, lines 194-198; see p. 5, lines 205-209). Staff roles are captured in 2.2.1. Description of our Sample (see p. 5, lines 238-241). Given that 2.2. Participants focuses on the recruitment and screening criteria and the 2.2.1. Description of our Sample subsection focuses on sample characteristics, we have chosen to leave this information as is.

 

Comment 10: The authors could separate the Data Collection and Analysis subsections.

Response 10: We have revised our subsections to reflect this recommendation (see p. 6, line 252).

 

Comment 11: In the Data Collection sub-section, can the authors include more information about how the demographic data were collected?

Response 11: We have revised 2.2.1 Description of our Sample to include details on how the demographic data were collected in-line with a qualitative approach to data collection (see p. 5, lines 214-220).

 

Comment 12: Were all study participants asked the same questions? What there some sort of a survey? Were there different interview guides for the parents and staff? What questions were asked?

Response 12: We thank the reviewer for their queries. We have revised 2.3. Data Collection to improve the transparency of interview/focus group guides and their development (see p. 5, lines 245-249). In the interest of transparency, the interview guides for both parent interviews and staff focus groups have been added to the supplementary materials of this manuscript.

 

Comment 13: What tools were used to record and transcribe interviews? The authors should build out a separate Analysis subsection and include more details. What program was used to analyze the data? Who coded the data? Can the authors provide more detail on the steps taken to conduct the analysis?

Response 13: We thank the reviewer for their comments. We have revised 2.3. Data Collection to clarify the transcription process (see p. 5, lines 249-251). The present study was conducted in collaboration with a community partner who could not access expensive qualitative software such as InVivo, so analysis was conducted manually (see p. 5, line 254).

Qualitative analysis followed the thematic inductive analysis phases developed by Braun and Clarke (2006); this involved the researcher familiarizing themselves with the data, generating initial codes, searching for themes, reviewing themes, defining themes, and producing a report. Given the exploratory nature or our research questions, we chose thematic analysis because rather than trying to fit data into a pre-existing coding frame, thematic inductive analysis is more data driven. To improve transparency of the analysis process, we have included a table based on the phases of thematic analysis (see Table 1., p. 6, lines 258-260).

 

Results

Comment 14: There is a lot of great detail included in this section. It would be helpful for the authors to present it in a way that is more easily digestible. The sub-headings are vague and not always consistent with the content that follows, and the content in each section does not always seem to hang together. Sub-heading 3.1, for example, could be something like "Housing as a foundation for success in other life areas" or something like that.

Response 14: To address this and the following comments, we have reframed the results section quite a bit, including changing the themes to: Housing as a Foundation for Success in Other Domains (see p. 7, lines 289-290); 2) Challenges with System Navigation: A Door Within a Door Within a Door (see p. 8, lines 379-380); 3) The Service Sectors’ Contribution to Trauma (see p. 10, line 441); and 4) Exposure to Social Bias and Stigma Within the Service Sector (see p. 11, line 523). We have also added additional analysis and quotes specifically from the questions we asked participants about solutions and ideas for service provision improvement. We hope this leads to a stronger connection to the discussion /recommendations.

 

Comment 15: Can quotes be set off from the text?

Response 15: We have implemented this recommendation throughout 3. Results.

 

Comment 16: Is it possible to include Staff IDs with quotes in the way that Parent IDs are included? This will allow the reader to see the extent to which different staff perspectives are represented in the results.

Response 16: We thank the reviewer for this recommendation. However, unfortunately because staff spoke in groups, when we transcribed the data from our recordings, we could not ascertain who said what. As a result, we are unable to assign codes to individual staff participants. 

 

Comment 17: The two paragraphs starting on line 210 do not seem to fit with the rest of its sub-section; the content seems connected to another theme.

Response 17: We thank the reviewer for their comment, however we do believe that this quotation fits in this section, as it illustrates how shelter rules can impede families’ ability to acquire housing. We have moved this quote earlier in the subsection to better situate its relevance to the overall theme (see p. 7, lines 307-317).

 

Comment 18: Only 2 parents are represented in 3.1. Can more perspectives be included?

Response 18: We appreciate the feedback and have identified that the participant ID for one of our quotes was missing. This error has been rectified, so now this section includes the perspectives of three parents (see p. 7, line 317). We have also revised 3.1. Housing as a Foundation for Success in Other Domains to include an additional staff quote (see p. 8, lines 368-378) which brings forth the “landlord liaison” position, which becomes a central component of the proposed policy recommendations.

 

Comment 19: Where does the phrase "pressure cooker" come from? What does it mean?

Response 19: We thank the reviewer for their comment. The phrase “pressure cooker” was used by a staff member in one of the focus groups, which is signified by the phrase being in quotation marks and italicised. However, we have expanded on the intended meaning of this phrase to improve clarity (see p. 7, lines 294-298).

 

Comment 20: Sub-section 3.2 is brief and only includes one parent quote. Again, the sub-section header is vague and confusing.

Comment 20: We have revised the 3.2. Challenges with System Navigation: A Door Within a Door Within a Door header to better reflect the section content (see p. 8, lines 379-380). To reflect the reviewer’s recommendation to include more parent quotes, we have added two parent quotes and subsequent analysis; we have expanded on the challenges parents faced when accessing support services (see p. 9, lines 397-414). We have also included staff perspectives on existing Canadian federal and provincial support services (see p. 9-10, lines 425-440).

 

Comment 21: The sub-section 3.3 header does not seem to reflect the content included there.

Response 21: We have revised the 3.3. The Service Sectors- Contribution to Trauma header to better reflect the section content (see p. 10, line 441).

 

Comment 22: No staff perspectives are represented in sub-section 3.3.

Response 22: We thank the reviewer for their feedback and have revised 3.3. The Service Sectors- Contribution to Trauma to include greater detail on perspectives of staff as it relates to training on trauma-informed approaches (see p. 11, lines 502-517).

 

Comment 23: What does P.8 on line 268 refer to, and why is the quote italicized, but others are not?

Response 23: We thank the reviewer for their attention to detail. Given that this quote is short, we have decided to keep it embedded in the text, however we have revised the formatting to be consistent with the other quotations in our manuscript (see p. 10, lines 477-478).

 

Comment 24: The two paragraphs starting on line 292 do not seem to hang with the rest of the content in sub-section 3.4.

Response 23: We thank the reviewer for highlighting this oversight and have removed this quote.

 

Comment 25: No staff perspectives are included in 3.4.

Response 25: We have added the following quote from staff regarding a landlord liaison position to help limit the influence of racial bias and stigma for families while they attempt to acquire stable housing; we hope that this revision will help draw a line of sight between the results and the recommendations (see p. 12, lines 557-568).

 

Comment 26: What is does "smudge" mean?

Response 26:  Smudging is a very common cultural ceremony practiced by Indigenous peoples in Canada; it is the practice of burning various medicinal plants to cleanse the spirit and develop connectedness with their Creator. We have revised the manuscript to more clearly articulate that smudging is an example of a traditional cultural practice that Indigenous families may find helpful (see p. 12, lines 569-571).

 

Comment 27: Would it make sense to include a separate results section with participant recommendations, as these recommendations are referenced in the Discussion?

Response 27: We thank the reviewer for their comment. To address this concern, instead of creating a separate section/theme-related recommendation subsection, we have added this content throughout each theme within 3. Results; we believe that presenting the results in this way better reflects that these ideas came from our participants. We hope this leads to a stronger connection between 3. Results and the 4. Discussion and subsequent 4.1. Recommendations for Policy and Service Delivery.

 

Discussion

Comment 28: The Discussion feels like a big jump from the Results section. It is not clear to me that the Discussion and recommendations there flow directly from the Results.

Response 28: In alignment with this suggestion, we have reframed 3. Results and revised 4. Discussion to better reflect what our participants told us they needed and how the current literature supports the subsequent recommendations. We have also created a visual depiction of the flow between our themes, the core issues with service provision, and our subsequent recommendations to improve clarity, all of which were developed in collaboration with our community partner (see p. 14-15, lines 671-672).

 

Comment 29: More references to existing literature and connections to the Results section are needed.

Response 29: We thank the reviewer for their comment. The beginning of 4. Discussion is intended to be a brief summary of 3. Results wherein we identify the two primary issues with service provision as seen by service recipients and service providers to provide context for the policy recommendations, which is mostly where we tie in existing literature. However, we have added some additional citations throughout 4. Discussion, per the reviewer’s recommendation. 

 

Comment 30: In line 316, the authors indicate that the study "uniquely integrates" family and staff perspectives, but it is not clear to me that the study does this. Some Results sub-sections lack perspectives from both parties, for example. Further, the Methods section does not provide any detail on how the perspectives were integrated.

Response 30: We thank the reviewer for their feedback. To improve the integration of parent and staff perspectives in the results section, we have added staff quotes and subsequent qualitive analysis into all the themes outlined in the results section. Per Response 13, we have added greater detail on the analysis process used to integrate the parent interviews and staff focus groups (see Table 1., p. 6, lines 258-260; see p. 6, lines 267-269).

 

Comment 31: The authors could also further specify how the results build on existing knowledge.

Response 31: We thank the reviewer for their suggestion. We detail how the results of the present study may help explain why many of the recommendations previously proposed in literature have not been effectively implemented (see p. 14, lines 661-664). Moreover, the main impact of the present study lies in the proposed recommendations which uplift existing and novel policy recommendations by grounding them in the lived experiences of service recipients and service users and developing them in collaboration with our community partner to enhance their pragmatic viability and hopefully improve uptake.

 

Comment 32: In sub-section 4.1, the extent to which recommendations stem from participant views is unclear. This becomes a particular challenge when the recommendations seem inconsistent with or major leaps from the results as conveyed. For example, on line 402, the authors recommend "Focus on Finding 'Homes' and Building Community Connections" and convey that housing alone is not sufficient, but the results seem to suggest that a house/apartment is the foundation for success in other life areas (see 3.1). Maybe the authors could expand on the results in the paragraph starting on line 218 to set the stage for the recommendation on line 402. There are currently no related quotes included, for example.

Response 32: We thank the reviewer for their comment. To more clearly illustrate the connection between 3. Results and 4.1. Recommendations for Policy and Service Delivery, we have added additional analysis and quotes specifically from the questions we asked participants about solutions and ideas for service provision improvement. We have revised the discussion to clearly state that based on the four themes presented in the results, in collaboration with our community partner, we identified two core issues with the current state of service provision for families experiencing homelessness (see p. 13, lines 622-633). These two core issues were then used to guide our policy recommendations, which we explicitly state in the revised the manuscript (see p. 14, lines 658-661). Per Response 28, we have also created a visual depiction of the flow between our themes, the core issues with service provision, and our subsequent recommendations to improve clarity, all of which were developed in collaboration with our community partner (see p. 14-15, lines 671-672).

 

Comment 33: The recommendation on line 427 is not connected to the content that follows. The content is more about landlord incentives and landlord liaisons.

Response 33: We thank the reviewer for their comment. This recommendation centres on the idea that anti-racist housing first programming is necessary for these programs to be effective for racialized service users and that landlord liaisons may be an effective way to do this. Thus, we have revised the 4.1.2. Enhance Anti-racist Housing First Programing heading to better reflect section content (see p. 16, line 698).

 

Comment 34: Do the authors have any ideas on how to fund the ideas suggested in the Discussion?

Response 34: We appreciate the reviewer’s comment; unfortunately, this is outside of the expertise of the study team and out of the scope of this study. However, if the reviewer has any recommendations on funding models that may increase uptake of the policy recommendations proposed in the present study, we would be interested to hear and potentially integrate them into the manuscript.  

 

Comment 35: Finally, the paragraph starting on line 474 starts by sharing that a key strength of the study is that it integrated service recipients' and staff perspectives, but it is not clear from the manuscript if or how the authors integrated perspectives, as described above.

Response 35: This comment has been addressed in revisions throughout 1. Introduction (see p. 3, lines 138-139), 2. Methods (see p. 4, lines 171-176; see p. 4, lines 182-184; see p. 6, lines 262-269), 3. Results (see p. 6-7, lines 278-282), and 4. Discussion (see p. 14, lines 661-664). Additionally, we have revised all the themes to include both staff and parent quotes to improve narrative integration. We have also revised the manuscript to more clearly reflect the role of our community partner in the process of integrating staff and parent perspectives, give their unique stakeholder role (see Table 1., p. 6, lines 258-260; see p. 6, lines 267-269; see p. 13, lines 622-624; see p. 14, lines 661-664; see p. 18, lines 833-834).

 

Conclusion

Comment 36: Is "pressure cooker" a quote from a participant, and what does it mean? The authors convey that the study's recommendations are from study participants, but it is not clear who recommended the recommendations. Maybe the authors could include a recommendations sub-section in the Results section.

Response 36: instead of a separate section/theme related to recommendations, we added a section/quote into each theme which better reflects ideas that came from our participants. We hope this leads to a stronger connection between results and discussion/recommendations. The term pressure cooker was used by a participant to describe growing pressure in the service sector and has been clarified as a direct quote.

 

Comment 37: Thank you for the opportunity to review this manuscript. With revisions, the piece will be a valuable contribution to the existing knowledge base.

Response 37: We appreciate the reviewer’s time and careful attention to detail when reviewing our manuscript. We believe that your insights have greatly improved the quality of our manuscript.

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

I enjoyed reading the manuscript and appreciate how the authors edited the piece in response to my suggestions. Table 1 and Figure 1 are great additions. I believe the article will be a valuable contribution to the existing knowledge base. 

There are some remaining typos and grammatical errors, but I'll leave those issues up to the publisher to address. It is tricky to catch these sorts of things in a copy with track changes. 

Author Response

Thank you for the review of our paper entitled, More Than Just a Roof: Solutions to Better Support Families From Homelessness to Healing. We greatly appreciate the reviewers’ comments and the opportunity to address them, as follows:

Comment 1: I enjoyed reading the manuscript and appreciate how the authors edited the piece in response to my suggestions. Table 1 and Figure 1 are great additions. I believe the article will be a valuable contribution to the existing knowledge base. 

Response 1: We thank the reviewer for their time and constructive feedback throughout this process. We are pleased to hear that our revisions have addressed the reviewer’s previous comments and believe that their suggestions have greatly improved the quality of this manuscript.

 

Comment 2: There are some remaining typos and grammatical errors, but I'll leave those issues up to the publisher to address. It is tricky to catch these sorts of things in a copy with track changes. 

Response 2: We appreciate the reviewer’s continued attention to detail. As suggested, we will revise any remaining typos or grammatical errors after review from the publisher.