Promoting community institutional partnerships to improve the health of intimate partner violence survivors experiencing homelessness

Abstract

Background:

Disparities faced by individuals experiencing homelessness pose significant threats to the health and wellbeing of communities. Survivors of intimate partner violence are at heightened risk, with over 80% experiencing homelessness at some point in time. The intersection of homelessness and survivorship creates numerous barriers to care including safety concerns, stable housing, employment and childcare needs. The establishment of community institutional partnerships offers an opportunity to provide healthcare in transitional housing settings.

Aims:

The aim of this paper is to discuss the need for community institutional partnerships in addressing the health needs of intimate partner violence survivors and provide a working example of an existing partnership.

Methods:

A critical literature review of the literature was conducted. Multiple databases were searched to identify articles relating to health services, community institutional partnerships, intimate partner violence and sheltered housing. Articles were reviewed using The Johns Hopkins Nursing Evidence-Based Practice Quality Guide.

Findings:

Three types of partnerships that can be leveraged to address the needs of individuals experiencing homelessness were identified: academic-community, hospital-community, and large-scale partnerships. Only one article was identified that focused on the health needs of survivors experiencing homelessness, pointing to the need for implementation of more community institutional partnerships to address the unique needs of homeless intimate partner violence survivors. We highlighted a current successful community institutional partnership that addresses the health needs of survivors living in an emergency shelter.

Implications:

Addressing the complex needs of this population is imperative to dismantle health inequities and structural barriers to healthcare. Holistic, nurse-led approaches to care are essential to address the health of intimate partner violence survivors experiencing homelessness. The example of a successful community institutional partnership provides a framework for delivering a wide range of healthcare services. Future nursing research is needed to evaluate programmes and provide foundational support for increased funding.

1 |. INTRODUCTION

In the United States in 2020, nearly 580,000 people experienced homelessness on a single night with 61% staying in a shelter or transitional housing (Henry et al., 2021). One in five (18%) adults currently experiencing homelessness have a chronic pattern of homelessness, which is defined as being continuously homeless for one or more years (Henry, Mahathey, & Takashima, 2020).

Intimate partner violence is one of the leading causes of homelessness (Baker et al., 2010). Furthermore, homelessness increases the risk of revictimization among IPV survivors and contributes to negative health and social outcomes (Schanzer et al., 2007). Multiple studies show that 80% of homeless women and children have prior experiences of intimate partner violence (IPV) (Aratani, 2009) and in a recent count by U.S. Department of Housing and Urban Development HUD, 28% of the total population experiencing homelessness were also survivors of IPV (Henry et al., 2021).

The health disparities prevalent in the homeless population are well documented. Homelessness is associated with shorter life expectancy, higher morbidity and greater usage of hospital services (Kushel et al., 2002). Those who experience homelessness are also less likely to use preventative health services, which result in late diagnoses of disease, poor control of management conditions such as hypertension and diabetes, and hospitalizations (Moore et al., 2007; Rieke et al., 2015). Injuries caused by IPV, coupled with stress, fear and post-traumatic stress disorder (PTSD) are highly likely to lead to long-lasting health problems, such as chronic pain and diseases of the central nervous system (Campbell, 2002). Chronic stress and repeated injuries also lead to severe gastrointestinal distress and cardiovascular compromise (Olsen et al., 2013). The intersection of homelessness and IPV is detrimental to acute and chronic health trajectories. Individuals and families face an increased risk of physical and sexual violence, sexual and respiratory infections, blood disorders, dermatological problems and psychological distress (Speirs et al., 2013). These health problems, coupled with high-risk coping behaviours associated with IPV (i.e., smoking, drinking and the use of illicit drugs) significantly decreases the general health of this population compared with individuals without experiences of violence (Campbell, 2002). As a result, providing preventative, primary and specialty health services is critical to address the complex health needs of this vulnerable population. Availability of health services is essential to prevent disease, reduce risk factors and manage complications (CDC, 2021). However, access to these services is a major concern (Davies & Wood, 2018). Homeless populations face numerous barriers to care, including lack of stable housing, health insurance, transportation, childcare coverage and consistent mail and telephone information.

Community–institutional partnerships (CIPs) are collaborations between community members, grassroots and/or community-based organizations, academic institutions, state and local public health agencies, health care institutions and/or funding agencies (Seifer, 2006). CIPs are critical to meeting the health needs of homeless populations because partnerships between multiple organizations allow for comprehensive and integrated approach to care provision by combining resources to achieve mutual goals (Dulmus & Cristalli, 2012). According to the U.S. Department of Housing and Urban Development, 61% of homeless individuals stay in sheltered locations, which include emergency shelters and transitional housing programmes (Henry, De Sousa, et al., 2020). However, little is known about the capacity for shelters and transitional housing programmes to provide adequate health services within their means. Due to the large number of people who reside in shelters, transitional housing settings serve as optimal locations to provide health services and resources needed for successful transitions back into the community. Transitional housing programmes could provide valuable health services and resources that address the health needs of the homeless population.

Nurses are uniquely positioned to provide health care in community settings due to their ability to collaborate across various public health sectors. Hard to reach populations, such as survivors of IPV experiencing homeless, benefit from holistic health services provided by nurses (Weber, 2019). Through adaption of care plans and goals to meet individual needs and addressing community health concerns, as well as trauma-informed care provision, nurses provide safe, equitable healthcare environments when working with clients to ensure successful and healthy transitions into permanent housing programmes. The purpose of this paper is to discuss the need for community institutional partnerships to address the health needs of IPV survivors and provide a working example of an existing partnership.

2 |. IN- SHELTER HEALTH CLINIC: WORKING EXAMPLE

One example of a longstanding Community-Academic Partnership is found in a partnership between a nursing school at an academic institution and a community-based shelter for individuals and their children who have recently escaped IPV. The partnership was developed in 1997 by the school of nursing faculty and students in collaboration with the advisory board at the shelter. The emergency/transitional housing shelter is located within a large metropolitan city and has served IPV survivors for over five decades. Since initiation, the shelter has served over 100,000 individuals, providing clients with a place to stay, job opportunities, resources and education. Families enter the shelter with a history of physical and emotional abuse that led to a personal crisis and abrupt departure from their home and resources, including health care. Currently, the shelter has the capacity to house 70 individuals and offers a range of services that include daycare for children, weekly case management meetings and a health suite that offers treatment for episodic health concerns, medical referral and assistance with obtaining insurance. The average time clients spend at the shelter before obtaining stable housing varies from a month to 2 years. During a client’s stay, clients are actively connected to employment opportunities, housing, healthcare and education. The shelter is a haven for individuals who have suffered traumatic abuse and equips survivors of violence to regain their identity and build healthy lives for themselves and their children.

The health suite, supported by a local school of nursing, is located within the emergency/transitional shelter. Registered nurses collaborate with shelter staff to offer health services and address needs for the residents on a weekly basis. This partnership started as a service-learning opportunity for doctoral students to address the unmet needs of the community. Funding for the health suite was provided by both private foundations and local institutions. Community health nurses are employed by the school of nursing and work in partnership with shelter case managers, mental health practitioners and legal representatives. In addition to addressing episodic health care concerns, nurses offer health promotion and education activities, assist families with obtaining health insurance, as well as connect them to primary care providers and community resources. Reoccurring support groups are provided to help shelter residents understand the connection between trauma and health. Nurses also partner with the local health department, school of medicine and school of dentistry to provide primary care services such as mental health services, physical exams, immunizations and dental care. Service-learning opportunities are available for both medical residents and nursing students through the health suite service activities. Collaboration between the shelter, the school of nursing and other institutions allows the health suite to address the complex needs of IPV survivors in transitional housing (refer to Figure 1).

Figure 1: Organizational Chart of Community Institutional Partnership Led by a Emergency/Transition Shelter and a School of Nursing to Address the Health Needs of IPV Survivors.

While the clinic is staffed by registered nurses, student nurses enrolled in a master’s entry level, pre-licensure nursing programme have the opportunity to rotate through the community-based shelter in two capacities. The first is through a community outreach programme in which students spend 12 months at the community site assisting staff with outreach and health education needs. The second opportunity is through a public health clinical placement. The students, who are under the supervision of the staff nurse, work with clients and families to address specific health needs and goals over a 4-month period. During this time, the students conduct projects for the shelter, which include updating health resources, providing mental health first aid training to staff, and creating and implementing nutritional education classes for residents.

3 |. METHOD

A critical review of literature was conducted to ascertain existing community–institutional partnerships that seek to increase access to services for survivors of IPV living in transitional housing settings. With the assistance of a lead informationist, PubMed (Public/Publisher MEDLINE), CINAHL (The Cumulative Index of Nursing and Allied Health Literature database), EMBASE (Excerta Medica database) and Google Scholar were searched to identify articles relating to healthcare services, partnerships and transitional housing. Intimate partner violence, domestic violence and violence were initially used in the search but resulted in only six articles. Therefore, search terms were broadened to include all articles that focused on individuals experiencing homelessness. The following medical subject headings (MeSH) terms were used: Public-Private Sector Partnerships, Community–Institutional Relation, community–academic, academic community, community university, university community, Housing, Emergency Shelter, Homeless Persons, housing, shelter and transitional housing. Articles published until November 2021 were eligible for inclusion. Additional inclusion criteria included population sample being people experiencing homelessness or living in transitional housing, health services being delivered by a partnership (i.e., academic community partnership, public/private institution partnership) and provided direct healthcare services in a housing setting. Exclusion criteria included shelters and programmes only serving children and services being provided outside the Unied States. All references were uploaded to Covidence, a web-based platform that assists with the article screening process. Title and abstract screening, followed by full-text review, were conducted independently by two doctoral students. Findings from included studies were also extracted by two doctoral students and quality assessment was completed following the Johns Hopkins Nursing Evidence-Based Practice Quality Guide.

The search yielded a total of 1475 articles from three databases. After exclusion of duplicates (594), 878 articles were eligible for title and abstract screening. A resulting 84 articles were assessed for eligibility through full text review. Articles were excluded for the following reasons: health services not provided (26), no partnership (15), not homeless population (15), No in shelter services provided (5), paid services only (3), not located in the United States (2) and paediatric population (1). A final total of 17 articles were included in the review. Figure 2 highlights the search outcomes in further detail.

Figure 2: PRISMA Flow Diagram (Page et al., 2021).

4 |. RESULTS

The search yielded 17 articles that examined partnerships addressing the health of individuals experiencing homelessness, seen in Table 1. The three main types of partnerships were academic community partnerships (n = 12), hospital community partnerships (n = 3) and large-scale partnerships (n = 2). Only one article highlighted health services for survivors of IPV. Out of the 17 studies, 14 described sustained partnerships that continue to this day and 3 studies discussed pilot studies or partnerships between organizations and facilities that only occurred at one time (Lashley, 2008; Owusu et al., 2012; Schick et al., 2020). Healthcare services provided were vast and ranged from preventative care services, mental health services and acute and chronic medical care, to oral health and foot care, HIV and TB management and screening, and health education (Table 1).

Table 1:

Summary of Articles

Authors	Type of Healthcare Service	Healthcare Provider	Barriers and Facilitators for Sustained Partnership	Type of Partnership
Arndell, 2014	Health education, street outreach, and one-on-one patient care were provided on a reoccurring basis throughout the year	Medical & Pharmacy students	Barrier: The partnership did not include evaluation of healthcare services and only included evaluation of student satisfaction during the program. Facilitator: Health services are provided through the offering of a yearly elective course with sustained funding from an academic institution.	Academic Community Partnership
Batra, 2009	Comprehensive primary care services including point of care testing, counseling, psychiatric screening, prescription refills and direct referrals were provided on a consistent basis.	1st and 2nd year medical students	Barrier: The structure and administrative duties of the clinic are maintained by volunteers. Facilitator: Medical students are gaining valuable experience and creating innovative solutions to address gaps in care to meet immediate needs of the population.	Academic Community Partnership
Christensen, 2004	Mental health, addition counseling and treatment, and case management were provided to individuals experiencing homelessness on a sustained basis.	Nursing, medical, and social work students; Medical residents	Barrier: Engaging people living in the streets and maintaining long-term contact Facilitator: The initiative has sustained funding from the city and collects both provider and community measures for continued evaluation.	Academic Community Partnership
Gerberich 2000	Health care services and education were provided to men experiencing homelessness through a service-learning project.	Community health nursing students	Barrier: No sustained programming or plan for continued implementation Facilitator: This project addressed a major gap in care for Men and established a point of contact for continued programming in the future.	Academic Community Partnership
Lashley, 2007	TB symptom and HIV risk assessments were conducted once by student nurses.	Student nurses	Barrier: Screenings were provided over a short period of time by students posing logistical challenges; residents often left the shelter after screening and could not be contacted with results of screening. Facilitator: The majority (98%) of community clients were successfully screened and referred for follow up care.	Academic Community Partnership
Lashley, 2008	Oral education, screening, and treatment were provided on a reoccurring basis.	Nursing and dental students	Barrier: The program was funded by small grants and not sustained. Facilitator: Access to timely oral healthcare was provided and both quantitative and qualitative measures were collected.	Academic Community Partnership
McCann, 2010	Preventive maintenance (immunizations, physical exams, and health-related screenings) and management of acute and chronic illness (HTN and asthma) were provided on a consistent basis.	Nurses, residents, nutritionists	Barrier: Financial and organizational issues within the community center that may impact sustainability of partnership. Facilitator: Sustainability plan has been introduced to discuss partnership maintenance and additional funding has been obtained from foundations and the university medical center.	Academic Community Partnership
Omori, 2012	Care for acute and chronic medical problems, health maintenance and preventive health services, minor procedures, vaccinations and TB testing, laboratory testing and diagnostic imaging, health education, dental assessments, and free medications for the uninsured, management of complex health problems, coordination or specialty appointments, lab visits and social work were provided on a reoccurring basis.	Physicians, residents, pharmacists, school of medicine faculty, community physicians	Barrier: Poor long-term outcomes measurements for participants Facilitator: Opportunities for medical students to practice in community settings; involvement of students in pre-medicine, medicine, and residency programs.	Academic Community Partnership
Owusu, 2012	Mental health screenings and mental health education were provided on a reoccurring basis.	Medical students, physicians	Barrier: Scheduling challenges, difficulty engaging homeless clients, client distrust of health service providers. Facilitator: Building a sense of community by establishing positive interactions and encouraging involvement of many organizations and people.	Academic Community Partnership
Ragavan, 2016	This project developed and implemented a health curriculum for IPV survivors residing at a transitional housing program (THP) in northern CA that addressed their self-identified needs and empowered them to improve their and their children's health. The curriculum was implemented on a recurring basis throughout the year.	Nursing, public health, medical, social work, & psychology students	Barrier: Conflicting schedules hinder the women from attending all the educational sessions; Due to current trauma experiences, many of the sessions caused acute trauma responses, limiting participation. Facilitator: The women felt as though the interactive activities and tools they acquired through the session benefited their daily lives and positively affect their relationships with their children	Academic Community Partnership
Schick, 2020	Diabetes self-management program targeting African American individuals living with diabetes and multi-ethnic populations with low literacy was provided as a one-time education clinic.	Community health workers, academic research partner	Barrier: The community was not involved in making decisions for the project design or implementation; The project had high attrition rates. Facilitator: Critical information was being provided to high-risk clients, and quantitative measures showed client success after completion of the educational clinic.	Academic Community Partnership
Schoon, 2012	Foot care for elderly patients along with health promotion activities were provided on a recurring basis.	Nursing students supervised by registered nurses	Barrier: Due to lack of evaluation metrics and faculty time, there was no plan for financial commitment. Facilitator: Clients who took part in the foot care clinic received many benefits as well as trusted the staff, so they recruited their peers and other clients to attend.	Academic Community Partnership
Corbin et al., 2000	General health services were provided (specific services not specified) once a month.	Registered nurse & Medical Doctor	Barrier: Community mistrust of the medical institution along with limited and consistent services provided serve as major barriers. Facilitator: Community members have begun to experience timely and efficient care by the healthcare team, building trust.	Hospital Community Partnership
Dahl, 1993	Health assessment, screening, treatment of acute and chronic illness, and social work evaluations were conducted consistently over a three-year pilot period.	Registered nurse, medical doctor, dentist, & social worker	Barrier: No indication of sustained funding for this project. Facilitator: A needs assessment was conducted prior to initiation of services that included members of the community.	Hospital Community Partnership
Mund, 2008	Medical outreach, comprehensive HIV care, acute care, gynecological care, vaccinations, Hepatitis C Virus testing, assessment, and treatment, HIV counseling and testing, and referrals to specialty care are provided on a reoccurring basis.	Registered nurses, medical doctors, community health workers	Barrier: Limited financial funding affects expansion of programming and retention of program staff. Facilitator: Consistent weekly services allow for the building of client rapport and trust.	Hospital Community Partnership
Lincoln, 2009	Mental health services, substance abuse treatment, referral and primary care on-site in the shelter are provided on a regular basis.	Registered nurses, medical doctors, community health workers	Barrier: A multi-system collaboration presented challenges in developing project policies and procedures; Large scale planning and implementation discussions were conducted over time to reached agreed upon best practices. Facilitator: The healthcare providers are embedded into the shelter and street outreach programs, advancing community trust; the project had both quantitative and qualitative measures that highlighted the success, allowing for the integration into sustained mental health care provided by the state’s department of mental health.	Large-Scale Partnership
Yaggy, 2006	Primary physical and mental health care along with medication management were provided on a reoccurring basis to elderly individuals experiencing homelessness or living in subsidized housing.	Medical doctors, social workers, pharmacists	Barrier: The program does not have adequate funding, and expansion is not available; staff for the program must follow both the program and parent agencies policies. Facilitator: The clinic utilizes medical records that connect to the large-scale hospitals in the area, allowing for sustained care.	Large-Scale Partnership

Health services were provided by a wide variety of different care providers in both the medical and psychosocial fields of practice. A few partnerships consisted of nurses and nursing students as main health care providers (n = 3), some partnerships comprised of a team of nurses and physicians (n = 2), others had mainly medical students providing care services (n = 2), as well as a combination of pharmacists and medical students (n = 2). However, many studies (n = 8) described interdisciplinary teams of health care providers that included nursing/medical students, nurses, physicians, social workers, psychiatrists, nutritionists and pharmacists.

4.1 |. Academic–community partnerships

Academic–community partnerships were the most common partnership type found in the literature, offering a range of health services for transitional shelter residents. Services included primary care and preventive health services, such as immunizations, health screenings, point of care testing, physical exams, health screening and promotion, and specialty care services including dental screening and mental health counselling (Ragavan et al., 2016; Omori et al., 2012; McCann, 2010). The array of services offered through academic–community partnerships provides service-learning opportunities for students enrolled in a variety of health programmes. Most of the service providers included in the literature were nursing students. However, service-learning opportunities are not exclusive to the field of nursing and can also include medical students, pharmacy students, dental students, social work students, and nutrition students. Academic community partnerships improve patient health care experiences and outcomes while providing service-learning opportunities for early career healthcare providers. These partnerships also build a foundation for continued outreach and research to address gaps and barriers to health service delivery experienced by both clinicians and clients.

Limitations of academic community partnerships include the inability to provide continuous care and evaluation strategies for both student and client outcomes. The most frequently cited barrier to maintaining successful partnerships was competing schedules between those involved in the partnerships (i.e., faculty and health students’ conflicting schedules with members and leaders of community organizations) (Ragavan et al., 2016; Schick et al., 2020; Owusu et al., 2012). This was especially apparent for partnerships that were formed between health students whose main commitment was to their studies, which prevented them from committing full-time to health outreach work. Additionally, healthcare providers rotate at clinical sites, which does not allow for sustained relationship-building or continuity of care.

The lack of evaluation measures to determine the efficacy of their work was another barrier to academic–community partnerships (Omori et al., 2012; Owusu et al., 2012). Evaluation of the health services focused on student satisfaction and learning rather than patient outcomes. The sustainability of academic community partnerships relies heavily on school and private institutional funding. More robust evaluation methods are needed to measure programme outcomes to support long-term sustainability of partnerships between academic and community institutions.

4.2 |. Hospital community partnerships

Hospital-community partnerships, which were less common than academic community partnerships, provide direct access to care, promote lower cost of care and focus on the overall health of populations. Hospital partners can include both private and public entities that aim to reach vulnerable populations, reduce healthcare costs and expand their reach using mobile clinics and health centres. Through collaboration with community partners, medical staff can provide primary care, health screening and promotion, immunization, social work evaluations and specialty care referrals (Clinton, 2001; Dahl et al., 1993). Nurses are the backbone of these partnerships, working in collaboration with physicians, medical residents and social workers to assist with the care of clients.

Hospital systems can carry positive and negative reputations in communities, which can play a role in the receptiveness of community members to services offered. For this reason, community trust of health services and medical personnel is critical to increase clients’ receptivity of health services (Clinton, 2001). Additionally, rigorous evaluation methods are needed to ensure patient health outcomes are being met and support long-term funding of programming.

4.3 |. Large-Scale partnerships

Large-scale partnerships include a combination of state, community and hospital entities. Together, these partnerships address health at multiple levels through direct patient care, community infrastructure and political advocacy. Large-scale partnerships provide an array of medical services including primary care, HIV care, gynaecologic care, immunizations, referrals to specialty care, health education, counselling services and case management. In addition to patient services, many large-scale partnerships have policy advocates who inform local and state politicians of the current health state and needs of the community (Lincoln et al., 2009; Yaggy et al., 2006).

Large-scale partnerships are primarily state and federally funded through Medicaid and Medicare, which limit the sustainability of services that are not covered by insurance plans (Lincoln et al., 2009; Yaggy et al., 2006). To obtain funding for these partnerships from outside mechanisms such as the National Institute of Health and foundations, rigorous evaluation methods are necessary. A combination of multiple sectors addressing health is a comprehensive, feasible and sustainable approach to managing the health needs of vulnerable populations. Large-scale partnerships are critical to addressing acute needs, tackling systemic barriers and creating equitable health systems.

4.4 |. Partnerships addressing health needs of IPV survivors

Only one out of the seventeen articles included in the review addressed partnerships that promote health services for homeless survivors of IPV (Ragavan et al., 2016). This large gap in literature is especially concerning because experiences of IPV are highly prevalent among homeless women (Aratani, 2009). The paucity of literature discussing IPV shelter-based health services highlights the need for strong partnerships such as the one between a school of nursing and a shelter for IPV survivors discussed in detail below.

Our working example consists of a large-scale partnership between a school of nursing, school of medicine, school of dentistry, local health department and temporary shelter for survivors of IPV. This partnership goes a step further from other academic community partnerships that focus on creating opportunities for pre-licensure nursing students to practice public health nursing by providing sustained care by licensed registered nurses to shelter residents. Furthermore, a variety of care services are provided to clients; preventative and immediate needs are resolved by nurses and resources from the health department, while specialized and more acute needs are referred out to local health institutions.

Even with the strengths of the large-scale partnership in-shelter-based health clinic, it is not without limitations. While interactions with clients and health appointments attended by clients are recorded, more extensive evaluation measures are needed to determine whether patient-established goals are met by the programmes and services offered by this CIP. Person-centred care is critical, and measures of partner efficacy must not stop at number of clients met or care services provided, but also include perceived satisfaction and personal goal attainment by clients themselves.

5 |. LIMITATIONS

While the review has many strengths and critically reviewed existing community–institutional partnerships that seek to increase access to services for survivors of IPV living in transitional housing settings, it has some limitations. A main limitation of this review is that all studies took place in the United States, which constraints the overall generalizability of findings to countries outside of the United States. However, the samples of the articles included both women and men (n = 18), which may serve as a good representation of the U.S. population. Further, most of the articles discussed partnerships that occurred through creating service-learning opportunities for health students, which shows that community–institutional partnerships often occur as a need to meet school curriculum for students, rather than the sole purpose of improving the health of vulnerable populations. There is a significant need for more partnerships between hospitals and communities and an even greater need for large-scale partnerships that address the health needs of survivors of IPV. To include as many articles as possible, articles were not limited by publication year. This led to the inclusion of an article that was published in 1993, which may not reflect current practices with health infrastructures (Dahl et al., 1993). However, this article was included because it is an important example of a model that assisted the development of future collaborative partnership models. Many IPV and domestic violence centres conduct impactful health outreach and service work that is not recorded through publications or the grey literature. Therefore, this information was not available for the current review.

6 |. CONCLUSION

There is a critical need for community–institutional partnerships that promote the health of the homeless population, especially those with experiences of IPV. Our review of literature reveals that there are multiple types of partnerships: academic–community, hospital–community and large-scale partnerships that have been implemented to improve the health of the homeless population. However, the literature review shows there are few community–institutional partnerships offering health services in IPV emergency and transitional shelter settings.

Nursing practice is centred around providing holistic care, equipping nurses with the skills needed to address the complex health needs of IPV survivors experiencing homelessness. Through nurse-led community institutional partnerships and advocacy for IPV survivors’ health needs that are informed by trauma-informed care practices, disparities and systemic barriers can be decreased. Following existing frameworks of care for IPV survivors, such as the one between a transitional housing shelter and school of nursing, is beneficial in establishing successful partnerships. Future nursing research must focus on how services may be tailored to meet the needs of vulnerable populations, particularly survivors of abuse, who experience homelessness. Extensive measures to evaluate the efficacy of partnerships in improving the health of homeless populations are also needed to sustain these partnerships long-term and establish consistent funding mechanisms.

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