{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:32:14Z","timestamp":1787067134421,"version":"build-2736575974"},"reference-count":75,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T00:00:00Z","timestamp":1718928000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Background<\/jats:title>\n Several youth staying at emergency youth shelters (EYSs) in Toronto experience poorly coordinated care for their health needs, as both the EYS and health systems operate largely in silos when coordinating care for this population. Understanding how each system is structurally and functionally bound in their healthcare coordination roles for youth experiencing homelessness (YEH) is a preliminary step to identify how healthcare coordination can be strengthened using a system thinking lens, particularly through the framework for transformative system change.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Forty-six documents, and twenty-four semi-structured interviews were analyzed to explore how the EYS and health systems are bound in their healthcare coordination roles. We continuously compared data collected from documents and interviews using constant comparative analysis to build a comprehensive understanding of each system\u2019s layers, and the niches (i.e., programs and activities), organizations and actors within these layers that contribute to the provision and coordination of healthcare for YEH, within and between these two systems.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The EYS and health systems are governed by different ministries, have separate mandates, and therefore have distinct layers, niches, and organizations respective to coordinating healthcare for YEH. While neither system takes sole responsibility for this task, several government, research, and community-based efforts exist to strengthen healthcare coordination for this population, with some overlap between systems. Several organizations and actors within each system are collaborating to develop relevant frameworks, policies, and programs to strengthen healthcare coordination for YEH. Findings indicate that EYS staff play a more active role in coordinating care for YEH than health system staff.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A vast network of organizations and actors within each system layer, work both in silos and collaboratively to coordinate health services for YEH. Efforts are being made to bridge the gap between systems to improve healthcare coordination, and thereby youths\u2019 health outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0303655","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T13:51:07Z","timestamp":1718977867000},"page":"e0303655","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Bounding systems: A qualitative study exploring healthcare coordination between the emergency youth shelter system and health system in Toronto, Canada"],"prefix":"10.1371","volume":"19","author":[{"given":"Alzahra","family":"Hudani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin","family":"Schwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0615-740X","authenticated-orcid":true,"given":"Ronald","family":"Labont\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6003-139X","authenticated-orcid":true,"given":"Sanni","family":"Yaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"key":"pone.0303655.ref001","article-title":"Without a home: the National Youth homelessness survey.","author":"S Gaetz","year":"2016","journal-title":"Canadian Observatory on Homelessness"},{"issue":"6","key":"pone.0303655.ref002","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1007\/BF03405183","article-title":"The Health of Street Youth: A Canadian Perspective","volume":"96","author":"JF Boivin","year":"2005","journal-title":"Can J Public Health"},{"key":"pone.0303655.ref003","first-page":"97","volume-title":"Surviving Crime and Violence: Street Youth and Victimization in Toronto","author":"S Gaetz","year":"2010"},{"issue":"5","key":"pone.0303655.ref004","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1001\/jama.292.5.569","article-title":"Mortality in a Cohort of Street Youth in Montreal","volume":"292","author":"\u00c9 Roy","year":"2004","journal-title":"JAMA"},{"issue":"3","key":"pone.0303655.ref005","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1023\/A:1024697706033","article-title":"Reductions in HIV Risk Among Runaway Youth.","volume":"4","author":"MJ Rotheram-Borus","year":"2003","journal-title":"Prev Sci."},{"issue":"5","key":"pone.0303655.ref006","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/S1054-139X(03)00332-X","article-title":"Prevalence and correlates of Chlamydia infection in Canadian street youth.","volume":"34","author":"SA Shields","year":"2004","journal-title":"J Adolesc Health Off Publ Soc Adolesc Med."},{"issue":"9","key":"pone.0303655.ref007","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1177\/1049732307307550","article-title":"Homelessness and Health in Adolescents.","volume":"17","author":"AM Haldenby","year":"2007","journal-title":"Qual Health Res."},{"issue":"2","key":"pone.0303655.ref008","first-page":"229","article-title":"Homelessness and health.","volume":"164","author":"SW Hwang","year":"2001","journal-title":"CMAJ"},{"issue":"6","key":"pone.0303655.ref009","first-page":"5","article-title":"Homeless youth\u2019s overwhelming health burden: A review of the literature.","volume":"16","author":"DM Kulik","year":"2011"},{"issue":"7","key":"pone.0303655.ref010","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1177\/0706743717702076","article-title":"The 2015 National Canadian Homeless Youth Survey: Mental Health and Addiction Findings.","volume":"62","author":"S Kidd","year":"2017","journal-title":"Can J Psychiatry"},{"issue":"10","key":"pone.0303655.ref011","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1177\/0706743721990310","article-title":"The Second National Canadian Homeless Youth Survey: Mental Health and Addiction Findings: La Deuxi\u00e8me Enqu\u00eate Nationale Aupr\u00e8s des Jeunes Sans Abri: R\u00e9sultats en Mati\u00e8re De Sant\u00e9 Mentale et de Toxicomanie","volume":"66","author":"S Kidd","year":"2021","journal-title":"Can J Psychiatry"},{"key":"pone.0303655.ref012","volume-title":"Chapter 2.1: The Relationship between Homelessness and Health: An overview of research in Canada. 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