Feasibility of telehealth counselling pilot for people experiencing homelessness and/or complex needs: During COVID-19 and beyond

Abstract

Issues addressed: People experiencing homelessness and/or complex needs often require targeted health services to address unique vulnerabilities. COVID-19 restrictions acted as a barrier for this group accessing health and alcohol and other drug (AOD) treatment services. The Haymarket Foundation, an accommodation and health facility in Australia, transitioned from in-person AOD-counselling services to online consultations. Clients accessing these services were tracked, from March 2019 to November 2020, to assess the impact of the switch to telehealth on client retention. Methods: Qualitative analysis of Haymarket clients' service experience surveys and quantitative descriptives of “no-show” (nonattended sessions) rates and survival analysis of client treatment separations were completed to assess the impact of transitioning to telehealth on client retention. Results: Although the initial transition to telehealth in March 2020 minimally impacted client no-show rates, reinstated government restrictions in June/July 2020 coincided with increasing no-shows and a substantial increase in treatment exits without notice, especially amongst males. Qualitative analysis showed clients had mixed feelings towards telehealth: some attributed their dissatisfaction to the inability to build rapport with their counsellor online, or with COVID-19 in general. Others appreciated the availability and genuine care of their counsellors through either setting. Conclusions: Telehealth may be a feasible replacement for face-to-face AOD counselling for people experiencing homelessness, however further investigation needs to be conducted to understand factors associated with improved client retention. So what?: This pilot demonstrates telehealth may be a feasible ongoing feature of health promotion for vulnerable high-needs populations, including people experiencing homelessness who use substances.