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Clark SM, Reeb RN, Born CC, Hurley KE. Benefits of a health advocacy intervention intended to improve self-efficacy for self-care in residents of a homeless shelter. J Prev Interv Community 2024; 52:198-217. [PMID: 38178550 DOI: 10.1080/10852352.2023.2299895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Despite a great need for healthcare, unhoused individuals encounter significant barriers to utilizing public healthcare systems. Given the inequities in access to healthcare, accompanied by disabilities and health risks associated with homelessness, self-efficacy for self-care is particularly critical. As a primary purpose of this article, we describe a self-care intervention (Health Advocacy Behavioral Activation), which was implemented within a long-standing participatory community action research project for homeless shelters, and report evidence of the intervention's effectiveness in enhancing self-efficacy for self-care. Participants included 62 residents of the St. Vincent de Paul Gateway Shelter for Men (Dayton, Ohio). Shelter residents with disabilities and those without disability benefited approximately equally from the intervention and both showed statistically significant pre- to post-intervention improvements in self-efficacy for self-care. Recommendations for future research examining the effectiveness of the intervention are provided. As a secondary (supplementary) purpose, we report preliminary evidence of psychometric validation for a new instrument (Scale of Self-Efficacy for Self-Care), which was developed in service of our primary purpose (i.e., to examine the effects of intervention on self-efficacy for self-care) because a literature search did not identify an appropriate measure. Because this new instrument fills a void in the literature, we anticipate that it will be useful in practice and research, and so we delineate research recommendations for additional psychometric validation of this measure. Because of the barriers that unhoused people encounter with regard to access to healthcare in the community, self-care interventions provided (and evaluated) on-site (e.g., in homeless shelters) are necessary.
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Affiliation(s)
- Sarah M Clark
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Roger N Reeb
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Caroline C Born
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Kathryn E Hurley
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
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Barboza-Salerno GE, Kosloski A, Weir H, Thompson D, Bukreyev A. A Network Analysis of the Relationship Between Mental and Physical Health in Unsheltered Homeless Persons in Los Angeles County. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:5902-5936. [PMID: 36300615 DOI: 10.1177/08862605221127222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Homelessness is a public health crisis both nationally, in the United States, and internationally. Nevertheless, due to the hidden vulnerabilities of persons who are without shelter, little is known about their experiences during periods of homelessness. The present research adopts a network approach that conceptualizes how the major risk factors of homelessness interact, namely substance abuse problems, poor mental health, disability, and exposure to physical or sexual violence by an intimate partner. Our analysis draws on a large demographic survey of over 5,000 unsheltered homeless persons conducted in 2017 by the Los Angeles Homeless Services Authority. We estimated a network structure for 12 survey items tapping individual risk using the graphical least absolute shrinkage and selection operator algorithm. We then examined network centrality metrics and implemented a community detection algorithm to detect communities in the network. Our results indicated that mental illness and intimate partner violence (IPV) are central measures that connect all other mental and physical health variables together and that post-traumatic stress disorder and IPV are both highly affected by changes in any part of the network and, in turn, affect changes in other parts of the network. A community detection analysis derived four communities characterized by disability, sexual victimization and health, substance use, and mental health issues. Finally, a directed acyclic graph revealed that drug abuse and physical disability were key drivers of the overall system. We conclude with a discussion of the major implications of our findings and suggest how our results might inform programs aimed at homelessness prevention and intervention.
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Affiliation(s)
| | - Anna Kosloski
- School of Public Affairs, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Henriikka Weir
- School of Public Affairs, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | | | - Alexey Bukreyev
- College of Arts, Letters and Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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Lusk HM, Shaku D, Hemrajani A, Leverenz N, Moefu-Kaleopa J, Staley AF. Housing First: Harm Reduction at the Intersection of Homelessness and Substance Use. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:6-11. [PMID: 36660275 PMCID: PMC9783810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Despite a considerable overlap between people experiencing homelessness and people living with substance use disorder, there is a marked lack of integration between Hawai'i's systems of care for these populations. This gap in the current system of care often creates barriers to services for those living at the nexus of homelessness and substance use. This article describes Hawai'i's current homelessness and substance use systems of care, paying particular attention to the intersection between these two systems. With Hawai'i consistently ranking among the highest per capita rates of homelessness in the United States, this article argues that the intersection of homelessness and substance use is a pivotal site of intervention for addressing significant social problems. This article positions the Housing First paradigm as a critical model for bridging gaps and eliminating barriers in service provision through systems integration at the program level. Greater fidelity to the broader harm reduction principles underlying this model will effectively organize and equip programs to successfully address the needs of people experiencing homelessness and struggling with substance use.
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Affiliation(s)
- Heather M. Lusk
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
| | - David Shaku
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
| | | | - Nikos Leverenz
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
| | - Juliana Moefu-Kaleopa
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
| | - Andrea F. Staley
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
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Pruitt AS, Barile JP. Actionable research for understanding and addressing homelessness. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2051-2057. [PMID: 35545867 DOI: 10.1002/jcop.22878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Homelessness results from an interaction of structural determinants and individual vulnerabilities, creating various pathways into homelessness and having multilevel impacts. Understanding and addressing homelessness requires research that not only takes an ecological perspective but also can be translated into action. Despite research demonstrating differing needs and experience among various subpopulations, particularly marginalized groups, homeless service systems often take a one-size-fits-all approach. Additionally, homeless service systems' prioritization of the most vulnerable and chronically homeless for permanent housing programs results in a service system that operates in a state of triage, with minimal attention to prevention efforts. This special issue highlights actionable research focused on preventing homelessness and addressing disparities among marginalized groups. Included articles target homelessness at multiple levels using a combination of qualitative, quantitative, and mixed-methods approaches. Embedded in community psychology values, this study focuses on prevention, leverages participatory methods, relies on diverse lived experiences, and explores community-based solutions.
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Affiliation(s)
- Anna S Pruitt
- University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - John P Barile
- University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
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Samuel-Nakamura C, Brecht ML, Arbing R. Emergency Department Use by Women Experiencing Homelessness in Los Angeles, California, USA. WOMEN'S HEALTH REPORTS 2022; 3:593-600. [PMID: 35814610 PMCID: PMC9258795 DOI: 10.1089/whr.2021.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/13/2022]
Abstract
Background: This article reports on the use of hospital Emergency Departments (EDs) in women experiencing homelessness in Los Angeles, California. Women 18 years of age or older were recruited from homeless day centers in Los Angeles to participate in this study. Materials and Methods: A self-report questionnaire on health status, demographics, and emergency service use was completed by study participants. Results: In this study of women experiencing homelessness, 64% utilized the ED within the past year. The mean number of ED use was 3.63 (range 0–20) visits in the past year. Higher frequency visits were significantly associated with several mental health conditions (p = 0.016), physical disability (p = 0.001), and traumatic brain injury (p = 0.013). Conclusions: The physical and psychological impacts of the homelessness experience can be enormous, affecting the homeless individually and collectively. Study findings may help to understand how to improve services that support and meet the needs of women experiencing homelessness such as patient and family-centered care and trauma-informed care in the ED.
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Affiliation(s)
| | - Mary-Lynn Brecht
- School of Nursing, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Rachel Arbing
- School of Nursing, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Chiaramonte D, Clements KA, López‐Zerón G, Ayeni OO, Farero AM, Ma W, Sullivan CM. Examining contextual influences on the service needs of homeless and unstably housed domestic violence survivors. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1831-1853. [PMID: 34146356 PMCID: PMC8684560 DOI: 10.1002/jcop.22637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
Domestic violence (DV) is a leading cause of homelessness for women, yet many DV agencies are just beginning to focus on helping clients stabilize their housing situations. The purpose of this study was to better understand the contexts and service needs of unstably housed and homeless DV survivors, to promote more efficient and successful service matching from DV agencies. We examined whether DV survivors could be grouped by particular features, histories, and contextual factors, and how these group differences impacted what they needed from DV agencies. The sample included 406 homeless and unstably housed DV survivors who had recently sought DV services. Latent class analysis supported the identification of four distinct classes: (1) highest disadvantages service seeker, (2) moderate disadvantages-criminal legal system service seeker, (3) moderate disadvantages service seeker, and (4) lower disadvantages service seeker. Additionally, we were able to profile each class, and test the types of services survivors in each class needed from agencies.
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Affiliation(s)
- Danielle Chiaramonte
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | | | | | | | - Adam M. Farero
- Psychology DepartmentMichigan State UniversityEast LansingMichiganUSA
| | - Wenjuan Ma
- Center for Statistical Training and ConsultationMichigan State UniversityEast LansingMichiganUSA
| | - Cris M. Sullivan
- Psychology DepartmentMichigan State UniversityEast LansingMichiganUSA
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Greiman L, Koon L, Schulz JA, Nary D. A usable home: A qualitative investigation of the relationship between home usability and community participation for people with disabilities. Disabil Health J 2022; 15:101211. [PMID: 34521605 PMCID: PMC10792724 DOI: 10.1016/j.dhjo.2021.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with mobility disabilities frequently have unmet needs in their home environment, which can lead to difficulties completing daily living activities. Therefore, it is important that homes are not just accessible, but rather useable, meaning that the home complements an individual's functional, social, and psychological needs. Although previous research has shown the importance of home usability for people with mobility disabilities on health outcomes, this research explores the relationship between home usability and community participation both inside and outside the home. OBJECTIVE The objective of this study was to understand the perception of people with mobility disabilities on the relationship between community participation and home usability. METHOD Twelve participants completed in-person semi-structured interviews to answer questions related to home usability and community participation. A content analysis was used to identify emergent themes. RESULTS Results indicate that personal, social, and environment factors influence home usability and one's ability to participate in the community. CONCLUSION Home usability is a complex concept that is intertwined with a person's ability to participate in their community. Useable homes can facilitate community participation, both inside and outside the home. In fact, home usability is a critical component of community participation, as homes are not only located in the community but are sites from which people access community. Further research is needed to understand the significance of this interaction and the impact of changing home usability on one's ability to participate in the community.
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Affiliation(s)
- Lillie Greiman
- The University of Montana Research and Training Center on Disability in Rural Communities (RTC:Rural), USA.
| | - Lyndsie Koon
- The University of Kansas Research and Training Center on Independent Living (KU-RTCIL), USA.
| | - Johnathan A Schulz
- The University of Kansas Research and Training Center on Independent Living (KU-RTCIL), USA.
| | - Dot Nary
- The University of Kansas Research and Training Center on Independent Living (KU-RTCIL), USA.
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Resource allocation for depression management in general practice: A simple data-based filter model. PLoS One 2021; 16:e0246728. [PMID: 33606746 PMCID: PMC7894811 DOI: 10.1371/journal.pone.0246728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to illustrate the potential utility of a simple filter model in understanding the patient outcome and cost-effectiveness implications for depression interventions in primary care. Methods Modelling of hypothetical intervention scenarios during different stages of the treatment pathway was conducted. Results Three scenarios were developed for depression related to increasing detection, treatment response and treatment uptake. The incremental costs, incremental number of successes (i.e., depression remission) and the incremental costs-effectiveness ratio (ICER) were calculated. In the modelled scenarios, increasing provider treatment response resulted in the greatest number of incremental successes above baseline, however, it was also associated with the greatest ICER. Increasing detection rates was associated with the second greatest increase to incremental successes above baseline and had the lowest ICER. Conclusions The authors recommend utility of the filter model to guide the identification of areas where policy stakeholders and/or researchers should invest their efforts in depression management.
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Dickson-Gomez J, Quinn K, McAuliffe T, Bendixen A, Ohlrich J. Placement of chronically homeless into different types of permanent supportive housing before and after a coordinated entry system: The influence of severe mental illness, substance use disorder, and dual diagnosis on housing configuration and intensity of services. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:2410-2427. [PMID: 32789923 DOI: 10.1002/jcop.22428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
AIMS Permanent supportive housing (PSH) is designed to house people who experience chronic homelessness with one or more of the following: serious mental illness (SMI), substance use disorders (SUD) or human immunodeficiency virus. The Department of Housing and Urban Development has required major metropolitan areas to develop a coordinated entry system (CES) to prioritize access to PSH to those who need it the most. The aim of this paper is to determine whether PSH residents with SMI, SUD, or dual diagnosis were more likely to be housed after implementation of CES and were more likely to be housed in housing models with more intensive services provided. METHODS A cross-sectional survey with 855 residents of different PSH models. RESULTS Those with SMI, SUD, or dual diagnosis were not more likely to be housed using the CES but were more likely to be housed in higher intensity service programs. CONCLUSIONS Those with SMI are more likely to be housed in PSH with high-intensity services.
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Affiliation(s)
- Julia Dickson-Gomez
- Division of Epidemiology, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine Quinn
- Department of Psychiatry, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy McAuliffe
- Department of Psychiatry, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Arturo Bendixen
- Division of Epidemiology, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jessica Ohlrich
- Division of Epidemiology, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Mabhala MA, Yohannes A. Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4620. [PMID: 31766338 PMCID: PMC6926508 DOI: 10.3390/ijerph16234620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 11/17/2022]
Abstract
Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, the reasons that led to their homelessness, and propose a conceptual explanation. Method: We conducted 26 semi-structured interviews in three centres for homeless people in Cheshire, North West of England. Results: Three categories-education, employment, and health-emerged from the data and provided a theoretical explanation for the reasons that led to their homelessness. These are vital not only for the successful negotiation of one's way out of homelessness, but also for achieving other social goods, including social connections, social mobility, and engaging in positive social relationships. Conclusion: Participants catalogued the adverse childhood experiences, which they believe limited their capacity to meaningfully engage with the social institution for social goods, such as education, social services, and institutions of employment. Since not all people who have misfortunes of poor education, poor health, and loss of job end up being homeless, we contend that a combination of these with multiple adverse childhood experiences may have weakened their resilience to traumatic life changes, such as loss of job and poor health.
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Affiliation(s)
- Mzwandile A. Mabhala
- Department of Public Health and Wellbeing, Faculty of Health and Social Care, University of Chester, Riverside Campus, Chester CH1 1SL, UK
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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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