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. 2025 May 17;25(1):715.
doi: 10.1186/s12913-025-12835-1.

Brain injury, mental health and substance use in homeless populations: community-generated recommendations for healthcare service delivery and research

Cole J Kennedy  1   2   3 , Jasleen Grewal  4 , Grace Warren  1 , Julia Schmidt  4   5 , Janelle Breese Biagioni  6 , Mauricio A Garcia-Barrera  7   8
Affiliations

Brain injury, mental health and substance use in homeless populations: community-generated recommendations for healthcare service delivery and research

Cole J Kennedy et al. BMC Health Serv Res. .

Abstract

Background: The prevalence of acquired brain injury (ABI) and mental health/substance use (MHSU) disorders is high amongst people experiencing homelessness, yet guidance for addressing these complex comorbidities is lacking. Therefore, the objective of this study was to engage community-based stakeholders in a health priority-setting process to generate, identify and prioritize recommendations for clinical practice and research to improve healthcare services for individuals with concurrent ABI-MHSU who are experiencing homelessness.

Methods: Data were collected during a one-day workshop as part of the BC Consensus on Brain Injury. Participants were 163 stakeholders in the ABI-MHSU and homeless communities (Mage = 46.40, SD = ± 13.80, 72% female), including service providers, people with lived experience, healthcare professionals and other community-based stakeholders. Stakeholders participated in concurrent focus groups based on the nominal group technique. Initial recommendations were generated then collated, themed and rank-ordered by priority and a consensus voting method was used to identify the top five priorities for research and clinical practice.

Results: Stakeholders discussions and subsequent prioritization evaluations identified the following recommendations for clinical practice: (1) Provide accessible and affordable supportive housing; (2) enhance resources (financial, human) for healthcare service providers; (3) design needs-based services that promote quality of life; (4a) improve communication and collaboration between service providers; (4b) adopt a long-term and integrated approach; and (5) reduce stigma and discrimination through public health education. Recommendations for research, also ordered by priority, included: (1) Evaluate and optimize existing interventions for immediate implementation; (2) develop specialized interventions and diagnostic techniques; (3) collect meaningful data to better understand impacts and intersections; (4) increase mechanisms for knowledge transfer; and (5) explore methods for risk identification and prevention.

Conclusions: This is the first study to identify and prioritize recommendations for research and clinical practice related to healthcare services for people experiencing homelessness with concurrent ABI-MHSU conditions. The stakeholder-generated recommendations from this study provide a valuable resource for researchers, clinicians and policymakers to enhance care for this underserved population.

Keywords: Acquired brain injury; Addiction; Community-engaged research; Health service research; Mental health; Neuropsychiatry; Nominal group technique; Substance use.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval was obtained by the Research Ethics Boards of the University of British Columbia (#H22-03403) and University of Victoria (#22–0614) and all methods were performed in accordance with the relevant guidelines and regulations approved by the Research Ethics Boards. All participants provided informed consent to participate. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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