Using Diffusion of Innovation Theory to Address Health of the Homeless in Hawaii
Abstract
:1. Introduction
1.1. Literature Review
Homeless Population on O’ahu
2. Methodology
2.1. Diffusion Innovation Theory and Institutional Theory
2.2. Institutional Theory and Isomorphism
3. Discussion and Results
3.1. Crisis Assistance Helping out On The Streets (CAHOOTS): Eugene, Oregon
3.2. Support Team Assisted Response (STAR): Denver, Colorado
3.3. Emergency Outreach and Triage Division (EOTD): Los Angeles County, California
3.4. Crisis Outreach Response and Engagement Program (CORE): Honolulu, Hawaii
4. Policy Diffused
4.1. Implications, Recommendations, and Strategies
4.1.1. Implications
4.1.2. Recommendations and Strategies
4.1.3. STAR Strategies
- Understand the population served, as it will ensure the program is culturally relevant and responsive.
- Culturally competent training should be specific to the population(s) served (i.e., NHPI, veterans, elderly, chronically homeless, and unaccompanied minors); recognize personal biases, prejudices, and stereotypes toward these populations/people; and teach the communication skills needed to address homeless people’s concerns and negotiate effectively and collaboratively to optimize health care outcomes.
- Conduct a cost–benefit analysis to provide a clearer picture of the return on investment for government (federal, state, and local), health and human service providers, and the community.
- Since CORE has not reached its first-year milestone, only funding data are available to the public. It will be important to see how the USD 3–5 million will be allocated to CORE, and especially the outcomes based on the spending (ROI). Specifically, was CORE able to meet the medical, social, and mental health needs of the homeless they served?
- The initial funding for CORE was granted from the COVID-19 American Rescue Plan Act. Using the cost–benefit analysis model to seek a more permanent stream from the state legislature to ensure the program’s growth and longevity is needed. Conversely, and to follow a policy diffusion approach, funding through the Honolulu Police Department could be sought, or perhaps a combination of public and private partnerships.
4.1.4. CAHOOTS Strategies
- 3.
- Ensure robust human services and health care networks to address the needs of the homeless community.
- A task force may be needed to explore human services and health care networks available to help the homeless populations and to provide opportunities for collaboration and the incorporation of programs and services as part of CORE’s services. There may be opportunities to develop alternate strategies through collaborative efforts.
- According to the National Library of Medicine, there are four elements a program can utilize to ensure a robust network (Institute of Medicine): (a) frequent and consistent interaction by agencies involved; (b) a coordinated effort to link clients with needed services by providers; (c) a proactive approach in outreach efforts; (d) a review of internal and external resources to include funding, use of volunteers if appropriate, and the ability of homeless individuals to access the established network.
- 4.
- Establish trust from the population served.
- Mistrust of health care service providers, including emergency medical services personnel, may prevent people from accessing care, which increases health disparities and affects health complications and outcomes. Trust can be built through the education and training of CORE staff and hiring CORE staff that reflect the homeless population—someone who looks like me and/or has been through what I have been through or am going through.
- 5.
- Build a community culture of care and compassion, supporting a helpful and healthy response to struggling community members.
- Build a robust website that includes links to resources to meet the needs of the homeless people (i.e., housing, transportation, health care, social service resources, and government benefits).
- Have available written materials (i.e., brochures) for those people who may not have access to the website. Have community health workers, homeless organizations, and others distribute these informational brochures as they are conducting business.
4.1.5. EOTD Strategies
- 6.
- Develop specialized community-based programs in other areas of O’ahu (and the neighbor islands) that target the homeless population and specialized full-service partnership programs such as Hawaii Homeless Healthcare Hui (H4).
- With such a diverse homeless population, programs that target specific groups may not work in other communities or with other groups of homeless individuals. Also, with Hawaii being made up of several islands, programs may not have funding or resources to offer their services outside of the main island of O’ahu. Developing programs that provide safe and functional environments for homeless individuals also alleviates financial and medical strains on emergency rooms and health systems and brings mental health professionals and social workers to the people, instead of requiring the people to navigate the health care system to receive services.
- 7.
- Increase the portfolio of housing resources.
- Prioritizing housing opportunities, having those difficult discussions about housing in Hawaii, and moving people from the streets into safe housing should be a priority.
- Homeless shelters, transitional housing, affordable housing, public and subsidized housing, affordable rentals and supportive housing, and housing assistance are opportunities to provide housing for homeless people. Finances and financial support are factors that make finding affordable housing for homeless people difficult.
- Taking a holistic approach, the focus should be on affordable housing and include focused health and human service programs to qualifying residents, which would increase the rates of permanent housing placements.
- 8.
- Participate in collaborative efforts to end homelessness.
- An Aloha Friday Conversation: Seizing affordable housing opportunities in Hawaii, on Hawaii Public Radio (2022) brought together representatives from the Hawai’i Budget and Policy Center, Hawaiian Community Assets, Hawaii Appleseed, the Governor’s Office on Homelessness, the Honolulu’s Tenants Union Organizing Committee, Partners in Care, the Institute for Human Services, Faith Action for Community Equity, Hawaiian Community Assets, and Permanently Affordable Living to discuss this topic of homelessness.
- Other possible collaborators are as follows: City and County of Honolulu, Hawaii Public Housing Authority, Hawaii State Government, financial/banking industry, health care systems, the Institute for Human Services, housing development companies, real estate developers and companies, public and private organizations, representatives from homeless communities, and the community at large.
- CAHOOTS credits much of its success to a collaborative effort. Realizing a mobile unit alone is not sufficient to support the myriad of needs of the homeless population; therefore, other social services should work in conjunction with the CORE unit to provide support for housing and mental and physical health needs.
5. Limitations of Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CORE | Crisis Outreach Response and Engagement program |
CAHOOTS | Crisis Assistance Helping Out on The Streets |
STAR | Support Team Assisted Response |
EOTD | Emergency Outreach and Triage Division |
PIT | Point in time |
References
- Rogers, E.M. Diffusion of Innovations, 4th ed.; Free Press: New York, NY, USA, 1995. [Google Scholar]
- Partners in Care O’ahu’s Continuum of Care 2020. O’ahu Point-in-Time-Count. Comprehensive Report. Updated 11 June 2020. Available online: https://www.honolulu.gov/rep/site/ohou/PIC2020PITCountReportFinal.pdf (accessed on 28 December 2021).
- Withy, K.M.; Amoa, F.; Andaya, J.M.; Inada, M.; Berry, S.P. Health care needs of the homeless on O’ahu. Hawaii Med. J. 2008, 67, 213–217. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693419/ (accessed on 28 December 2021). [PubMed]
- Office of Disease Prevention and Health Promotion (ODPHP). Social Determinants of Health. Healthy People 2030. Updated 19 August 2020. Available online: https://health.gov/healthypeople/objectives-and-data/social-determinants-health (accessed on 10 January 2022).
- Green, J. Homeless in Hawaii: Facts and Resources. Updated 28 October 2019. Available online: https://ltgov.hawaii.gov/homeless-in-hawaii-facts-and-resources/ (accessed on 5 February 2022).
- Yee, C. Blangiardi Delivers 2022 State of the City Address. Updated 15 March 2022. Available online: https://www.khon2.com/local-news/blangiardi-to-deliver-2022-state-of-the-city-address/ (accessed on 16 March 2022).
- Patton, M.Q. Qualitative Research & Evaluation Methods, 3rd ed.; Sage Publications, Inc.: Thousand Oaks, CA, USA, 2002. [Google Scholar]
- Shipan, C.R.; Volden, C. The mechanisms of policy diffusion. Am. J. Political Sci. 2008, 52, 840–857. Available online: http://www.jstor.org/stable/25193853 (accessed on 10 December 2021). [CrossRef]
- Shipan, C.R.; Volden, C. Policy diffusion: Seven lessons for scholars and practitioners. Public Adm. Rev. 2012, 2, 788–796. [Google Scholar] [CrossRef]
- Rogers, E.M. Diffusion of preventive innovations. Addict. Behav. 2002, 27, 989–993. Available online: https://www.sciencedirect.com/science/article/abs/pii/S0306460302003003 (accessed on 10 December 2021). [CrossRef] [PubMed]
- Berry, F.; Berry, W. Innovation and diffusion models in policy research. In Theories of the Policy Process; Weible, C., Sabatier, P., Eds.; West View Press: New York, NY, USA, 2018; pp. 253–297. [Google Scholar]
- Haider, M.; Kreps, G.L. Forty years of diffusion of innovations: Utility and value in public health. J. Health Commun. 2004, 9, 3–11. [Google Scholar] [CrossRef]
- Baybeck, B.; Berry, W.; Siegel, D. A strategic theory of policy diffusion in a network. In Proceedings of the Ninth Annual State Politics and Policy Conference, Chapel Hill, NC, USA, 22–23 May 2009. [Google Scholar] [CrossRef]
- DiMaggio, P.J.; Powell, W.W. The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields. Am. Sociol. Rev. 1983, 48, 147–160. [Google Scholar] [CrossRef]
- Department of Mental Health. Emergency Outreach and Triage Division (EOTD)—Field Response Operations. Available online: https://dmh.lacounty.gov/our-services/countywide-services/eotd/ (accessed on 3 December 2021).
- Eugene Police Department. CAHOOTS. Updated 17 December 2019. Available online: https://www.eugene-or.gov/4508/CAHOOTS (accessed on 10 December 2021).
- White Bird Clinic. Crisis Assistance: Helping Out on the Streets. Media Guide 2020. 2020. Available online: https://whitebirdclinic.org/cahoots/ (accessed on 10 December 2021).
- Legislative Analysis and Public Policy Association. Crisis Assistance Helping Out on the Streets (CAHOOTS). Updated 27 August 2020. Available online: https://legislativeanalysis.org/crisis-assistance-helping-out-on-the-streets-cahoots/ (accessed on 10 December 2021).
- Denver the Mile High City. Support Team Assisted Response Program (STAR). Available online: https://www.denvergov.org/Government/Agencies-Departments-Offices/Agencies-Departments-Offices-Directory/Public-Health-Environment/Community-Behavioral-Health/Behavioral-Health-Strategies/Support-Team-Assisted-Response-STAR-Program (accessed on 10 December 2021).
- Star Program Evaluation. Available online: https://wp-denverite.s3.amazonaws.com/wp-content/uploads/sites/4/2021/02/STAR_Pilot_6_Month_Evaluation_FINAL-REPORT.pdf (accessed on 10 December 2021).
- Homelessness Policy Research Institute (HPRI). Homeless Outreach: The Los Angeles County Context. Available online: https://socialinnovation.usc.edu/wp-content/uploads/2020/09/Homeless-Outreach-Literature-Review-Draft-V7.pdf (accessed on 12 December 2021).
- The People Concern. About. Available online: https://www.thepeopleconcern.org/about/ (accessed on 12 December 2021).
- The People Concern. Outreach Teams. Available online: https://www.thepeopleconcern.org/outreach-teams/ (accessed on 12 December 2021).
- Ordonio, C. A New Program to Help Homeless People on Oahu Is off to a Slow Start. Honolulu Civil Beat. Updated 16 December 2021. Available online: https://www.civilbeat.org/2021/12/a-new-program-to-help-homeless-people-on-oahu-is-off-to-a-slow-start/ (accessed on 10 December 2021).
- Mizuo, A. City Launches New Program to Address Nonviolent Emergency Calls Involving the Homeless. Updated 16 October 2021. Available online: https://www.staradvertiser.com/2021/10/16/hawaii-news/honolulus-new-homeless-crisis-outreach-response-and-engagement-program-begins/ (accessed on 10 December 2021).
- Schaefers, A. Honolulu’s CORE Program Begins Outreach in Waikiki, Where Unsheltered Homelessness Is on the Rise. Updated 16 June 2022. Available online: https://www.staradvertiser.com/2022/06/19/hawaii-news/the-citys-core-program-begins-thrice-weekly-outreach-in-waikiki-where-unsheltered-homelessness-is-on-the-rise/ (accessed on 20 June 2022).
Author(s) | Year of Publication | Key Points |
---|---|---|
Baybeck, B., Berry, W., and Siegel, D. [13] | 2009 |
|
Berry F and Berry W. [11] | 2009 |
|
DiMaggio, P. J. and Powell, W. W. [14] | 1983 |
|
Haider, M. and Kreps, G. L. [12] | 2004 |
|
Rogers, E. M. [1] | 1995 |
|
Rogers, E. M. [10] | 2002 |
|
Shipan, C. R. and Volden, C. [8] | 2008 |
|
Shipan, C. R. and Volden, C. [9] | 2012 |
|
Author(s) | Year of Publication | Main Contents |
---|---|---|
CAHOOTS—Crisis Assistance Helping Out on the Streets—Eugene, OR, USA | ||
Eugene Police Department [16] | 2019 |
|
White Bird Clinic [17] | 2020 |
|
Legislative Analysis and Public Policy Association [18] | 2020 |
|
STAR—Support Team Assisted Response—Denver, CO, USA | ||
Denver: The Mile High City, The Denver Local [19] | 2023 |
|
STAR Program Evaluation [20] | 2021 |
|
EOTD—Emergency Outreach and Triage Division—Los Angeles County, CA, USA | ||
Homeless Policy Research Institute (HPRI) [21] | 2020 |
|
The People Concern [22] | 2022 |
|
The People Concern [23] | 2023 |
|
CORE—Crisis Outreach Response and Engagement program—Honolulu, HI, USA | ||
Ordonio C [24] | 2021 |
|
Mizuno A [25] | 2021 |
|
Schaefers A [26] | 2022 |
|
Program: | Strategies: |
---|---|
STAR |
|
| |
CAHOOTS |
|
| |
| |
EOTD |
|
| |
|
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Spencer, L.; Tanner, A.; Lu, K. Using Diffusion of Innovation Theory to Address Health of the Homeless in Hawaii. Healthcare 2023, 11, 2828. https://doi.org/10.3390/healthcare11212828
Spencer L, Tanner A, Lu K. Using Diffusion of Innovation Theory to Address Health of the Homeless in Hawaii. Healthcare. 2023; 11(21):2828. https://doi.org/10.3390/healthcare11212828
Chicago/Turabian StyleSpencer, Lisa, Anita Tanner, and Kristina Lu. 2023. "Using Diffusion of Innovation Theory to Address Health of the Homeless in Hawaii" Healthcare 11, no. 21: 2828. https://doi.org/10.3390/healthcare11212828
APA StyleSpencer, L., Tanner, A., & Lu, K. (2023). Using Diffusion of Innovation Theory to Address Health of the Homeless in Hawaii. Healthcare, 11(21), 2828. https://doi.org/10.3390/healthcare11212828