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Gleason K, Martin J, Bernier E. Community narratives on rural homelessness: Tales of terror and tales of compassion. J Prev Interv Community 2024:1-30. [PMID: 38411157 DOI: 10.1080/10852352.2024.2315367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Homelessness is often assumed to be mostly confined to urban spaces, leaving experiences of homelessness in rural contexts largely unexamined. The present study aims to understand the discursive context, or public understanding, of homelessness in rural communities. We examined community narratives related to the idea of "homelessness" in rural spaces. Semi-structured qualitative interviews were conducted with 70 key stakeholders from four rural communities in the U.S. State of Maine. Participants were asked to give their impressions related to homelessness in their community. We conducted a systematic qualitative analysis of these interviews and our analysis was grounded in a critical discourse analysis perspective. Using Rappaport's framework for understanding helpful and harmful community narratives, we identified three community narratives that harm by stereotyping or erasing homelessness in rural communities: Not Here, That One Guy, and Mainly Outsiders. We also examined counter-narratives that worked against each of the three primary narratives: It Looks Different, It's More Hidden, and Local Struggle and Lack of Resources. The counter-narratives tell a different, more compassionate, story of homelessness in rural spaces. Our main goal was to analyze the "work" that each of these narratives were doing in terms of constructing different understandings of "rural homelessness." The implications for policy and practice are discussed.
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Affiliation(s)
- Kristen Gleason
- Psychology Department, University of Southern Maine, Portland, Maine, USA
| | - Jennifer Martin
- Psychology Department, University of New Haven, West Haven, Connecticut, USA
| | - Elizabeth Bernier
- Psychology Department, University of Southern Maine, Portland, Maine, USA
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Mejia-Lancheros C, Lachaud J, Aubry T, Wiens K, O’Campo P, Stergiopoulos V, Hwang SW. Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site. Soc Psychiatry Psychiatr Epidemiol 2022; 57:67-81. [PMID: 33866385 PMCID: PMC8761129 DOI: 10.1007/s00127-021-02093-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/07/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE To conduct a multi-dimensional and time-patterned analysis to identify distinct well-being trajectory profiles over a 6-year follow-up period among adults experiencing homelessness and mental illness. METHODS Data from 543 participants of the At Home Chez Soi study's Toronto site were examined over a 6-year follow-up period, including measures of quality of life, community functioning, housing stability, and substance use. Well-being trajectories were identified using Group-Based Trajectory Modelling. Multinomial regression was used to identify predictor variables that were associated with each well-being trajectory profile. RESULTS Four well-being profiles were identified: low well-being, moderate well-being, good well-being, and high well-being. Factors associated with a greater likelihood of following a better well-being profile included receiving Housing First, reporting female gender and non-white ethnicity, having post-secondary studies, and reporting a high resilience level. Concurrently, factors associated with a lower likelihood of better well-being profiles were having a history of chronic homelessness, experiences of discrimination in the healthcare setting, having comorbid mental disorders and a high level of symptom severity, and reporting a history of traumatic brain injury and childhood adversity. CONCLUSIONS Individuals experiencing homelessness follow distinct well-being profiles associated with their socio-demographic characteristics, health status, trauma history, resilience capabilities, and access to housing and support services. This work can inform integrated housing and support services to enhance the well-being trajectories of individuals experiencing homelessness. TRIAL REGISTRATION At Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374, http://www.isrctn.com/ISRCTN42520374 .
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Affiliation(s)
- Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON, M5B 1W8, Canada.
| | - James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada
| | - Tim Aubry
- School of Psychology, University of Ottawa, Ottawa, ON Canada
| | - Kathryn Wiens
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON Canada ,Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada ,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada
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Smith CM, Feigal J, Sloane R, Biederman DJ. Differences in Clinical Outcomes of Adults Referred to a Homeless Transitional Care Program Based on Multimorbid Health Profiles: A Latent Class Analysis. Front Psychiatry 2021; 12:780366. [PMID: 34987429 PMCID: PMC8721199 DOI: 10.3389/fpsyt.2021.780366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: People experiencing homelessness face significant medical and psychiatric illness, yet few studies have characterized the effects of multimorbidity within this population. This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups. Methods: We extracted administrative data from a health system electronic health record for adults referred to the Durham Homeless Care Transitions program from July 2016 to June 2020. We used latent class analysis to estimate classes in this cohort based on clinically important medical, psychiatric and substance use disorder diagnoses and compared health care utilization, overdose, and mortality at 12 months after referral. Results: We included 497 patients in the study and found 5 distinct groups: "low morbidity" (referent), "high comorbidity," "high tri-morbidity," "high alcohol use," and "high medical illness." All groups had greater number of admissions, longer mean duration of admissions, and more ED visits in the 12 months after referral compared to the "low morbidity" group. The "high medical illness" group had greater mortality 12 months after referral compared to the "low morbidity" group (OR, 2.53, 1.03-6.16; 95% CI, 1.03-6.16; p = 0.04). The "high comorbidity" group (OR, 5.23; 95% CI, 1.57-17.39; p < 0.007) and "high tri-morbidity" group (OR, 4.20; 95% CI, 1.26-14.01; p < 0.02) had greater 12-month drug overdose risk after referral compared to the referent group. Conclusions: These data suggest that distinct groups of people experiencing homelessness are affected differently by comorbidities, thus health care programs for this population should address their risk factors accordingly.
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Affiliation(s)
- Colin M Smith
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jacob Feigal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Richard Sloane
- Center for the Study of Aging, Duke University Medical Center, Durham, NC, United States
| | - Donna J Biederman
- Clinical Health Systems & Analytics Division, Duke University School of Nursing, Durham, NC, United States
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Chu CMT, Moodie EEM, Streiner DL, Latimer EA. Trajectories of Homeless Shelter Utilization in the At Home/Chez Soi Trial of Housing First. Psychiatr Serv 2020; 71:648-655. [PMID: 32264800 DOI: 10.1176/appi.ps.201900260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Studies have shown that Housing First, a recovery-oriented housing intervention, is effective in reducing service utilization among homeless individuals with mental illness, but less is known about how Housing First affects patterns of service use over time and about characteristics associated with various utilization trajectories. This analysis aimed to explore latent class trajectories of shelter utilization in a randomized controlled trial of Housing First conducted across five Canadian cities. METHODS Data from the At Home/Chez Soi trial were analyzed (N=2,058). Latent class growth analysis was performed using days of shelter utilization to identify trajectories over 24 months. Multinomial logistic regression was used to determine which baseline variables, including treatment group, could predict class membership. RESULTS Four shelter use trajectories were identified: consistently low (N=1,631, 79%); mostly low (N=120, 6%); early temporary increase (N=179, 9%); and higher use, late temporary increase (N=128, 6%). Treatment group was a significant predictor of class membership. Those enrolled in Housing First had lower odds of experiencing higher shelter use trajectories (mostly low: odds ratio [OR]=0.50, 95% confidence interval [CI]=0.34-0.72; early temporary increase: OR=0.21, 95% CI=0.15-0.31; higher use, late temporary increase: OR=0.14, 95% CI=0.09-0.22). Other variables associated with trajectory classes included older age and longer time homeless, both of which were associated with higher shelter use. CONCLUSIONS Several participant characteristics were associated with different shelter use patterns. Knowledge of variables associated with more favorable trajectories may help to inform service planning and contribute to modeling efforts for homelessness.
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Affiliation(s)
- Cherry M T Chu
- Department of Epidemiology, Biostatistics, and Occupational Health (Chu, Moodie), and Department of Psychiatry (Latimer), McGill University, Montreal; Douglas Mental Health University Institute, Montreal (Chu, Latimer); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada (Streiner)
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health (Chu, Moodie), and Department of Psychiatry (Latimer), McGill University, Montreal; Douglas Mental Health University Institute, Montreal (Chu, Latimer); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada (Streiner)
| | - David L Streiner
- Department of Epidemiology, Biostatistics, and Occupational Health (Chu, Moodie), and Department of Psychiatry (Latimer), McGill University, Montreal; Douglas Mental Health University Institute, Montreal (Chu, Latimer); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada (Streiner)
| | - Eric A Latimer
- Department of Epidemiology, Biostatistics, and Occupational Health (Chu, Moodie), and Department of Psychiatry (Latimer), McGill University, Montreal; Douglas Mental Health University Institute, Montreal (Chu, Latimer); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada (Streiner)
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Yoo C. Classifying the sense of community trajectories among South Korea adolescents. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2019. [DOI: 10.1002/casp.2449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Changmin Yoo
- Department of Social WelfareHannam University 70, Hannam‐ro, Daedeok‐gu Daejeon Republic of Korea
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Barile JP, Pruitt AS, Parker JL. Identifying and understanding gaps in services for adults experiencing homelessness. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2019. [DOI: 10.1002/casp.2440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- John P. Barile
- Department of PsychologyUniversity of Hawai'i at Mānoa Honolulu HI USA
| | - Anna S. Pruitt
- Department of PsychologyUniversity of Hawai'i at Mānoa Honolulu HI USA
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Barile JP, Pruitt AS, Parker JL. A latent class analysis of self-identified reasons for experiencing homelessness: Opportunities for prevention. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2018. [DOI: 10.1002/casp.2343] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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