BEGIN:VCALENDAR VERSION:2.0 PRODID:-//pretalx//conferences.acspri.org.au//2026//speaker//MZ8Z7Y BEGIN:VTIMEZONE TZID:AEST BEGIN:STANDARD DTSTART:20000326T040000 RRULE:FREQ=YEARLY;BYDAY=-1SU;BYMONTH=3;UNTIL=20050326T170000Z TZNAME:AEST TZOFFSETFROM:+1100 TZOFFSETTO:+1000 END:STANDARD BEGIN:STANDARD DTSTART:20060402T040000 RRULE:FREQ=YEARLY;BYDAY=1SU;BYMONTH=4;UNTIL=20060401T170000Z TZNAME:AEST TZOFFSETFROM:+1100 TZOFFSETTO:+1000 END:STANDARD BEGIN:STANDARD DTSTART:20070325T040000 RRULE:FREQ=YEARLY;BYDAY=4SU;BYMONTH=3;UNTIL=20070324T170000Z TZNAME:AEST TZOFFSETFROM:+1100 TZOFFSETTO:+1000 END:STANDARD BEGIN:STANDARD DTSTART:20080406T040000 RRULE:FREQ=YEARLY;BYDAY=1SU;BYMONTH=4 TZNAME:AEST TZOFFSETFROM:+1100 TZOFFSETTO:+1000 END:STANDARD BEGIN:DAYLIGHT DTSTART:20000827T030000 RRULE:FREQ=YEARLY;BYDAY=4SU;BYMONTH=8;UNTIL=20000826T170000Z TZNAME:AEDT TZOFFSETFROM:+1000 TZOFFSETTO:+1100 END:DAYLIGHT BEGIN:DAYLIGHT DTSTART:20011028T030000 RRULE:FREQ=YEARLY;BYDAY=-1SU;BYMONTH=10;UNTIL=20071027T170000Z TZNAME:AEDT TZOFFSETFROM:+1000 TZOFFSETTO:+1100 END:DAYLIGHT BEGIN:DAYLIGHT DTSTART:20081005T030000 RRULE:FREQ=YEARLY;BYDAY=1SU;BYMONTH=10 TZNAME:AEDT TZOFFSETFROM:+1000 TZOFFSETTO:+1100 END:DAYLIGHT END:VTIMEZONE BEGIN:VEVENT UID:pretalx-2026-8N8U7D@conferences.acspri.org.au DTSTART;TZID=AEST:20261125T173000 DTEND;TZID=AEST:20261125T173500 DESCRIPTION:Homelessness is not produced or resolved by a single service. I t is shaped by the interactions of health\, housing\, social care and comm unity systems\, yet policy and evaluation often treat implementation as if it occurs in a stable environment. This creates a methodological problem: how can research explain not only whether a homelessness policy works\, b ut how\, why\, for whom and under what changing conditions it produces sys tem-level effects?\nThis abstract reports an applied complex realist metho dology examining how health\, housing and community systems generate coord inated or fragmented responses to people experiencing homelessness. While realist review are scarce and often treated as the endpoint of evidence sy nthesis\, in this project\, it is the first cycle of an applied\, longitud inal methodology: explanatory theory is generated from the literature\, tr anslated into health-system development\, and then tested and refined as i mplementation unfolds. Its initial programme theory identifies two competi ng pathways. In the enabling and integrated pathway\, stable and flexible funding\, intersectoral collaboration\, explicit accountability and a non- judgemental\, person-centred culture activate mechanisms including staff s ecurity\, trust\, knowledge sharing\, cross-sector collaboration and flexi ble care. These mechanisms are expected to support engagement\, accessible and responsive services\, continuity of care\, reduced emergency departme nt use and improved health and wellbeing.\n\nIn contrast\, the fragmented and unaccountable pathway is associated with short-term funding\, siloed s ervices\, absent shared accountability and stigma. These contexts generate staff insecurity\, organisational workarounds\, poor information-sharing and responsibility-shifting. The resulting mechanisms contribute to incons istent care\, disengagement\, repeated emergency department presentations and the persistence of homelessness-related health inequities. Presenting these pathways together makes visible how the same broad policy objective —improving responses to people experiencing homelessness—may produce d ifferent outcomes depending on the conditions in which it is implemented. Cross-cutting mediators were also identified\, including population subgro up\, frequency and duration of service contact\, and digital interventions . These factors may influence how mechanisms are triggered and how outcome s develop across different groups and points of contact with services. Fou ndational capacities include housing and wraparound support\, workforce de velopment\, data learning and knowledge transfer. System accountability an d continuous learning are theorised as feedback loops capable of reinforci ng either the enabling and integrated pathway or the fragmented and unacco untable pathway.\n\nThese findings have already been fed into the developm ent stage of the South Western Sydney Local Health District Homelessness P lan\, demonstrating the review's purpose to not only to synthesise existin g evidence\, but support the development of a health-system response groun ded in an explicit account of context\, mechanism and outcome. Evidently\, realist methodology can move between evidence\, policy and practice while maintaining a focus on how and why system change occurs. Critically\, the initial programme theory will guide a Theory of Change\, participatory sy stems mapping\, documentary analysis\, ethnographic observation in Liverpo ol Hospital Emergency Department\, stakeholder interviews and later longit udinal analysis of changing governance and service responses. The methodol ogical contribution is a theory-to-practice-and-back-again model in which realist synthesis is both explanatory and formative\, and findings are vis ible and assessable. It demonstrates how realist findings can shape policy development while creating a structured basis for examining whether\, how and under what conditions system change occurs over time. By linking real ist review to the development and subsequent study of the SWSLHD Homelessn ess Plan\, the project offers a practical approach for investigating homel essness as a systems problem and for connecting evidence synthesis\, polic y development and longitudinal inquiry. DTSTAMP:20261013T070119Z LOCATION:Drawing Room SUMMARY:From theory to practice and back again: using realist review to co- develop and study homelessness-health system change - Jasmine Singh URL:https://conferences.acspri.org.au/2026/talk/8N8U7D/ END:VEVENT END:VCALENDAR