Delivering Health Services to People Experiencing Homelessness: Is Outreach the Answer? A Scoping Review With Implications for Practice
Karla Jaques, Catherine Guan, Natasha McEwan, Maria Beer, Andrew Reid, Vilas Kovai, Raquiba Jahan Khan, Natalie Tat, Patrick HarrisObjectives
The impact of homelessness on health is profound and compounding; however, people experiencing homelessness (PEH) often face significant barriers when accessing mainstream healthcare services. Homelessness is a significant determinant of health, contributing to high morbidity and mortality among PEH. Despite increased health needs, PEH often face structural, systemic barriers that lead to underutilisation of mainstream healthcare. Outreach health services, delivered in flexible, nonclinical and welcoming settings, are one approach that is commonly utilised to improve access inequities. However, the characteristics and delivery approaches associated with effective outreach remain unclear.
Methods
This scoping review explored the approaches, models of care and outcomes associated with outreach health services for PEH and identified key principles underpinning service delivery. Following PRISMA‐ScR guidelines, searches were conducted across CINHAL, PubMed and Scopus (2019–2024).
Results
Of 5998 potentially relevant articles, 123 met the inclusion criteria after screening. Outreach interventions were delivered across diverse settings including multiple locations (53), shelters (20), mobile/street medicine (14) and colocation with existing health or social services (13).
Conclusions
Effective outreach models often blended settings and appointment types to enhance engagement and combat systemic exclusion. Outreach services for PEH are most effective when they are flexible, context‐specific and responsive to local needs. Reducing the persistent health inequities experienced by PEH requires coordinated action across patient, service and system levels. Aligning outreach services with broader, locally grounded health, housing and social support initiatives can help address the systemic exclusion experienced by this population.