Public knowledge, attitudes, and beliefs about homeless people: evidence for compassion fatigue

Attitudes toward Homelessness Inventory: A psychometric analysis

The Attitudes toward Homelessness Inventory (ATHI) was developed due to a lack of psychometrically sound instruments to measure the nature and change in attitudes toward homelessness. Given inconsistencies in its use and internal reliability, this study evaluates the psychometric properties of the ATHI. Participants (n = 899) were selected using a random-digit-dial telephone survey to complete the ATHI. Results demonstrated that the four-factor solution suggested by the ATHI developers was the best fit for the data, but factor loadings and reliability coefficients were not sufficient for ensuring adequate measurement of attitudes toward homelessness. The poor psychometrics found in this study were likely the result of now outdated items. While the ATHI was developed using well-regarded and rigorous methods, results from this study suggest that it may be necessary to either make edits to the ATHI or to develop a new conceptually and psychometrically-sound measure.

Criminalization as a justification for violence against the homeless in Hungary

Criminalization of social groups can create new norms for intergroup relations. An example for this is the 2018 amendment to the Hungarian Fundamental Law, which openly criminalizes homeless people. In our research, we investigated whether criminalization of homelessness can become a source of justifying violence against homeless people in the Hungarian context. We assumed that right-wing authoritarianism and social dominance orientation would positively predict support for violence against the homeless, and the acceptance of a criminalizing law can serve as a justification for this. Our hypotheses were tested using a convenience (N = 196) and a representative sample of the population of Budapest (N = 674). We found that both RWA and SDO predicted support for violence, and this connection was mediated by the new law. We also found that justification was influenced by educational level, as the association between SDO and violence increased with higher levels of education.

Pursuing the Promise of Preschool: An Exploratory Investigation of the Perceptions of Parents Experiencing Homelessness

Rates of homelessness are worsening in the United States, with a third of individuals experiencing homelessness being families with children. These families face many challenges, including limited social supports, insufficient access to services, and mental health concerns. These challenges inform a nuanced worldview, leading parents experiencing homelessness to understand their child's school life in unique ways. The purpose of this study is to explore how parents experiencing homelessness understand their children's participation in Head Start and publicly funded 4 K programs. We utilized semi-structured interviews with parents of 4 K students and applied an iterative approach for analysis to identify emergent themes and concepts. Results suggest families enter homelessness through several avenues and struggle with many aspects of homelessness, including stigma directed at parents and children. Parents identified many strengths in their children's school programs, including education and support from faculty, as well as areas for growth, such as more comprehensive transportation and meal services. Overall, these results suggest families experiencing homelessness encounter many barriers to finding stable housing. Additionally, parents of children experiencing homelessness value their child's education and access to resources in schools while still fearing the potential for their child to experience stigmatization and discrimination in schools.

"It's Just a Band-Aid on Something No One Really Wants to See or Acknowledge": A Photovoice Study with Transitional Aged Youth Experiencing Homelessness to Examine the Roots of San Diego's 2016-2018 Hepatitis A Outbreak

San Diego, California is consistently ranked among regions with the highest rates of homelessness in the United States. From 2016 to 2018, San Diego experienced an unprecedented outbreak of hepatitis A virus (HAV), largely attributed in media and public health discourse to the region’s growing population of people experiencing homelessness. Little attention, however, was devoted to examining the experiences and needs of this population, particularly transitional aged youth (TAY, aged 18–24) experiencing homelessness who may have been uniquely affected by the outbreak. This community-based participatory research study leveraged diverse qualitative methods, principally photovoice, to explore how the social and built environment shapes health among TAY experiencing homelessness in San Diego, how these environments may have contributed to the HAV outbreak, and TAY’s perceptions of HAV-related public health interventions. Emergent findings include stigmatization of TAY and other people experiencing homelessness, interventions that failed to address root causes of the outbreak, and interactions with housing-related and other social support resources that limit rather than support economic and social mobility. Findings have implications for understanding how media and public discourse, public health interventions, and availability and delivery of resources can contribute to and perpetuate stigma and health inequities faced by TAY experiencing homelessness.

European public perceptions of homelessness: A knowledge, attitudes and practices survey

Background

Addressing Citizen’s perspectives on homelessness is crucial for the design of effective and durable policy responses, and available research in Europe is not yet substantive. We aim to explore citizens’ opinions about homelessness and to explain the differences in attitudes within the general population of eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden.

Methods

A nationally representative telephone survey of European citizens was conducted in 2017. Three domains were investigated: Knowledge, Attitudes, and Practices about homelessness. Based on a multiple correspondence analysis (MCA), a generalized linear model for clustered and weighted samples was used to probe the associations between groups with opposing attitudes.

Results

Response rates ranged from 30.4% to 33.5% (N = 5,295). Most respondents (57%) had poor knowledge about homelessness. Respondents who thought the government spent too much on homelessness, people who are homeless should be responsible for housing, people remain homeless by choice, or homelessness keeps capabilities/empowerment intact (regarding meals, family contact, and access to work) clustered together (negative attitudes, 30%). Respondents who were willing to pay taxes, welcomed a shelter, or acknowledged people who are homeless may lack some capabilities (i.e. agreed on discrimination in hiring) made another cluster (positive attitudes, 58%). Respondents living in semi-urban or urban areas (ORs 1.33 and 1.34) and those engaged in practices to support people who are homeless (ORs > 1.4; p<0.005) were more likely to report positive attitudes, whereas those from France and Poland (p<0.001) were less likely to report positive attitudes.

Conclusion

The majority of European citizens hold positive attitudes towards people who are homeless, however there remain significant differences between and within countries. Although it is clear that there is strong support for increased government action and more effective solutions for Europe’s growing homelessness crisis, there also remain public opinion barriers rooted in enduring negative perceptions.

Public exposure and attitudes about homelessness

In this study, we conducted a survey among a large sample of U.S. adults to assess attitudes and beliefs about the causes of homelessness, policies to address homelessness, and programs for homeless individuals. In 2016, we surveyed a national sample of 541 adults from 47 different U.S. states using Amazon Mechanical Turk. Of the total sample, 78% reported that homelessness was a problem in their communities and 60% believed homelessness would increase in the next 5 years. The majority expressed compassion for homeless individuals and endorsed structural, intrinsic, and health factors as causes of homelessness. Most participants (73%-88%) believed the federal government should dedicate more funds and policies for homeless individuals. These attitudes were substantially more likely to be reported by participants who were female, lower income, Democrat, and personally exposed to homelessness. Most Americans care about homelessness as a major problem but there are divergent perspectives on solutions to address homelessness based on gender, income level, and political affiliation.

Rethinking compassion fatigue

Purpose The purpose of this paper is to argue for a revision of the concept of compassion fatigue in light of both its history and psychodynamics. Design/methodology/approach This paper calls into question conventional interpretations of compassion fatigue and the assumptions underlying them. As an alternative, a psychoanalytic interpretation is offered that sheds light on the phenomenon's unconscious and organizational dynamics. This interpretation also aligns with the concept's historical use in media and politics. Findings In contrast to the assumption that compassion fatigue arises from too much compassion, historical use of the term suggests just the opposite: compassion fatigue is the result of too little compassion. Healthcare literature on compassion fatigue has not only failed to account for this opposing view, but also the underlying psychodynamics at play. By attending to these neglected dimensions, healthcare scholars and practitioners can gain new insights into compassion fatigue and devise more sustainable interventions. Originality/value This paper reveals hidden dimensions to compassion fatigue that call into question conventional interpretations and offer novel perspectives on a core concern of healthcare work.

Public attitudes and literacy about posttraumatic stress disorder in U.S. adults

There has been little study of public literacy regarding posttraumatic stress disorder (PTSD). Public knowledge and attitudes about PTSD are important for encouraging treatment, prevention, and informing policies. Using a national online survey of 541 adults across 47 U.S. states in November 2016, we assessed attitudes and knowledge about PTSD. Most notably with respect to attitudes, 76-94% of the sample endorsed more federal funding for research, training, and practice for PTSD; and 76% of the sample also believed people with PTSD should have restricted access to firearms. With respect to knowledge, participants demonstrated good general knowledge about PTSD, but tended to overestimate the rate of PTSD and trauma exposure, and demonstrated little knowledge about effective treatments. Sociodemographic characteristics and political affiliation were associated with PTSD knowledge and attitudes, but clinical characteristics did not explain much additional variance. Together, these findings suggest that there is strong public support for research and practice related to PTSD, but little public knowledge about evidence-based treatments for this disorder.

Changes in Public Attitudes and Perceptions about Homelessness Between 1990 and 2016

Public attitudes on homelessness can and has influenced policies and services for homeless populations. This study surveyed national public attitudes about homelessness in the 21st century and examined changes in attitudes in the past two decades. An online survey of public attitudes about homelessness was conducted with 541 U.S. adults across 47 states in November 2016 using Amazon Mechanical Turk. Survey results were compared to two public surveys conducted in 1990. Compared to previous surveys, the current sample endorsed more compassion, government support, and liberal attitudes about homelessness. The largest changes were related to increased support for homeless individuals to use public spaces for sleeping and panhandling. When asked about the demographic composition of the homeless population, the contemporary sample tended to overestimate the proportions who were young and racial/ethnic minorities, while underestimating the proportions who were married, or had mental health or substance abuse problems. Together, the findings suggest there has been an increase in compassion and liberal attitudes toward homelessness in the past two decades. Greater support for homeless individuals during an era of economic recessions and governmental homeless initiatives presents opportunities for new public health approaches to address homelessness.

Acute Alcohol Use, History of Homelessness, and Intent of Injury Among a Sample of Adult Emergency Department Patients

BACKGROUND

The literature is clear that adults who are currently homeless also have higher rates of intentional injuries, such as assault and suicide attempts. No study has assessed whether intentional injuries are exacerbated because of substance use among adults with a history of homelessness.

METHODS

Data were obtained from a cohort of adults admitted to 3 urban emergency departments (EDs) in Texas from 2007 to 2010 (N = 596). Logistic regression analyses were used to determine whether a history of homelessness was associated with alcohol use at time of injury in intentional violent injuries (gunshot, stabbing, or injury consistent with assault).

RESULTS

39% adults with a history of homelessness who were treated at trauma centers for a violent injury. Bivariate analyses indicated that adults who had ever experienced homelessness have 1.67 increased odds, 95% confidence interval (CI) [1.11, 2.50], of any intentional violent injury and 1.95 increased odds (95% CI [1.12, 3.40]) of a stabbing injury than adults with no history of homelessness.

CONCLUSIONS

Adults who experienced homelessness in their lifetime were more likely to visit EDs for violencerelated injuries. Given our limited knowledge of the injuries that prompt ED use by currently homeless populations, future studies are needed to understand the etiology of injuries, and substance-related injuries specifically, among adults with a history of homelessness.

Experiences of prison officers on a Lifer Psychologically Informed Planned Environment

Purpose

– Psychologically Informed Planned Environments (PIPEs) provide a pathway facility for offenders with complex needs, such as personality disorder; to maintain and develop the progress made on offending behaviour programmes (Ministry of Justice and Department of Health, 2012). The purpose of this paper is to explore the experiences of prison officers who work on a PIPE in a Lifer prison.

Design/methodology/approach

– Interpretative Phenomenological Analysis was used to explore the experiences of five prison officers working on a PIPE in a Lifer prison.

Findings

– Main themes identified were labelled “Role Conflict”, “Growth”, “Relationships” and “Impact”. A rich and detailed account of the experience of the “voyage of discovery” and the personal challenges, costs and rewards of the PIPE work was achieved.

Research limitations/implications

– Limitations include the small number of participants, limited focus of the researchers, both Forensic Psychologists, and the uniqueness of the context, a Lifer prison. Limitations might be addressed by future research that could expand on the current findings. Implications for future research include further exploration of the psychological impact of the work, dynamics within the PIPE and the value of attachment theory in work with personality disordered offenders. Implications for future policy and practice concern training, support and the development of new PIPEs.

Originality/value

– The research adds a rich account of what it is like for these prison officers to work on a PIPE in a Lifer prison. The experiences shared reveal the personal challenge, costs and rewards of the work through which ideas to develop the staff, residents and the PIPE model emerged.

Homelessness in schizophrenia

The impact of mental illness, comorbid substance abuse, and medication nonadherence, coupled with disjointed psychiatric and social services, conspires to a disproportionately high rate of psychiatric disorders among people who are homeless in the United States. This article reviews the prevalence of homeless among the mentally ill as well as the prevalence of mental illness among the homeless and details barriers in access to care and the solutions that have been attempted. The need and solutions to introduce a new generation of physicians and allied health care workers to the unique health care needs of the homeless population are highlighted.

Increasing social support for depressed individuals: a cross-cultural assessment of an affect-expectancy approach

Depression is a mental illness affecting 121 million people. The Substance Abuse and Mental Health Services Administration recently launched a national, bilingual (English and Spanish) campaign to motivate young adults to support friends with mental illness. This article highlights and assesses the usefulness of two theoretically derived variables for increasing the social support received by all depressed individuals: (a) affect and (b) social support outcome expectations. In accord with the Substance Abuse and Mental Health Services Administration's bilingual campaign, the authors conducted two studies using intercepts at 2 swap meets in the U.S. Southwest. One study sample consisted of Spanish-dominant Hispanics, the other non-Hispanics. For both samples, results indicate that affect, social support outcome expectations, and their interaction accounted for more than 50% of the variance of social support intentions (67% in the Hispanic sample when familism was considered). Affect is commonplace in the helping behavior literature; results indicate social support outcome expectations deserve equal consideration. Moreover, an unexpected finding emerged: Perceiving a lack of willpower, need for attention, and lack of moral character to be the cause of depression resulted in increased sympathy among the Hispanic sample but increased anger among non-Hispanics.

"Near and far": social distancing in domiciled characterisations of homeless people

For domiciled individuals, homeless people provide a disturbing reminder that all is not right with the world. Reactions to seeing homeless people frequently encompass repulsion, discomfort, sympathy and sometimes futility. This paper considers domiciled constructions of homeless people drawn from interviews with 16 participants recruited in the central business district of a New Zealand city. It documents how, when trying to make sense of this complex social problem, domiciled people draw on shared characterizations of homeless people. The concept of "social distance" is used to interrogate the shifting and sometimes incongruous reactions evident in participant accounts. "Social distancing" is conceptualised as a dynamic communal practice existing in interactions between human beings and reflected in the ways that domiciled people talk about their experiences with homeless individuals.

The New Homelessness Revisited

The 'new homelessness' has drawn sustained attention from scholars over the past three decades. Definitional inconsistencies and data limitations rendered early work during this period largely speculative in nature. Thanks to conceptual, theoretical, and methodological progress, however, the research literature now provides a fuller understanding of homelessness. Contributions by sociologists and other social scientists since the mid-1990s differentiate among types of homelessness, provide credible demographic estimates, and show how being homeless affects a person's life chances and coping strategies. Agreement also exists about the main macro- and micro-level causes of homelessness. Active lines of inquiry examine public, media, and governmental responses to the problem as well as homeless people's efforts to mobilize on their own behalf. Despite the obstacles faced when studying a stigmatized population marked by high turnover and weak anchors to place, recent investigations have significantly influenced homelessness policy. A greater emphasis on prevention should further strengthen the research-policy nexus.

The effects of interactivity on information processing and attitude change: implications for mental health stigma

Interactive media such as the Web have become a popular and important vehicle for communicating health information. However, little attention has been given to theorizing and empirically testing the effects of interactive media and the theoretical construct of interactivity. In this paper, we clearly identify and define the nature of interactivity examined. We then develop and test a theoretical model of website interactivity on information processing, involvement with communication, and attitude change in the context of stigma of mental illness. The results of an experiment revealed that interactivity of the website had positive main and moderating effects on dependent variables, while involvement with communication played a significant role in explaining the effects of interactivity. Implications for future research and for health communication campaigns for mental illness stigma are discussed.

The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV

HIV-related stigma negatively affects the lives of persons living with HIV/AIDS (PLWHA). Homeless/unstably housed PLWHA experience myriad challenges and may be particularly vulnerable to the effects of HIV-related stigma. Homeless/unstably housed PLWHA from 3 U.S. cities (N = 637) completed computer-assisted interviews that measured demographics, self-assessed physical and mental health, medical utilization, adherence, HIV disclosure, and risk behaviors. Internal and perceived external HIV stigma were assessed and combined for a total stigma score. Higher levels of stigma were experienced by women, homeless participants, those with a high school education or less, and those more recently diagnosed with HIV. Stigma was strongly associated with poorer self-assessed physical and mental health, and perceived external stigma was associated with recent non-adherence to HIV treatment. Perceived external stigma was associated with decreased HIV disclosure to social network members, and internal stigma was associated with drug use and non-disclosure to sex partners. Interventions are needed to reduce HIV-related stigma and its effects on the health of homeless/unstably housed PLWHA.

Humanizing the homeless: does contact erode stereotypes?

This paper employs a field experiment to assess whether interpersonal contact changes domiciled individuals' attitudes of the homeless. Volunteers for Project Homeless Connect-a one-day event that provides social services to the homeless-were asked to complete a pre- and post-survey. The results provide mixed support for the contact hypothesis. After volunteering, respondents were far less likely to see homelessness as the result of individual characteristics, such as substance abuse or work aversion. However, opinion was remarkably stable when it came to policy preferences. The results cast doubt on the conventional wisdom that individuals' perceptions of the causes of homelessness track closely with their preferences for governmental policy.

Homelessness in the United States: assessing changes in prevalence and public opinion, 1993-2001

A national survey was administered in 1993-1994 (N = 360) and repeated in 2001 (N = 435) to assess the prevalence of homelessness as well as attitudes, opinions and knowledge regarding homelessness. No significant changes in prevalence were found, despite a strong US economy during most of the 7-8 year period. Respondents in 2001 had less stereotyped views of homeless people and were more supportive of services, but came to see homelessness as a less serious problem that was less often due to economic factors. This "mixed" set of findings may reflect both beliefs on the benefits of a good economy and an increased awareness of the complexity of homelessness. Across the surveys, younger, female, liberal, and less wealthy respondents demonstrated more sympathetic attitudes towards homeless people.

Lay understandings of the effects of poverty: a Canadian perspective

Although there is a large body of research dedicated to exploring public attributions for poverty, considerably less attention has been directed to public understandings about the effects of poverty. In this paper, we describe lay understandings of the effects of poverty and the factors that potentially influence these perceptions, using data from a telephone survey conducted in 2002 on a random sample (n=1671) of adults from eight neighbourhoods in two large Canadian cities (Edmonton and Toronto). These data were supplemented with interview data obtained from 153 people living in these same neighbourhoods. Multivariate linear and logistic regressions were used to determine the effects of basic demographic variables, exposure to poverty and attribution for poverty on three dependent variables relating to the effects of poverty: participation in community life, the relationship between poverty and health and challenges facing low-income people. Ninety-one per cent of survey respondents agreed that poverty is linked to health, while 68% agreed that low-income people are less likely to participate in community life. Affordable housing was deemed especially difficult to obtain by 96%, but other resources (obtaining healthy food, giving children a good start in life, and engaging in healthy behaviours) were also viewed as challenging by at least 70% of respondents. The regression models revealed that when controlling for demographics, exposure to poverty explained some of the variance in recognising the effects of poverty. Media exposure positively influenced recognition of the poverty-health link, and attending formal talks was strongly related to understanding challenges of poverty. Attributions for poverty accounted for slightly more of the variance in the dependent variables. Specifically, structural and sociocultural attributions predicted greater recognition of the effects of poverty, in particular the challenges of poverty, while individualistic attributions predicted less recognition. Older and female respondents were more likely to acknowledge the effects of poverty. Income was positively associated with recognition of the poverty-health link, negatively associated with understanding the challenges of low-income people, and unrelated to perceptions of the negative effect of poverty on participation in community life.

Transformation in Family Nurse Practitioner Students' Attitudes Toward Homeless Individuals After Participation in a Homeless Outreach Clinic

PURPOSE

To use a retrospective pre/post self-assessment survey to determine the attitudes of family nurse practitioner (FNP) students toward homeless individuals before and after participating in a homeless outreach clinic (HOC) and to elicit, through focus groups, their perspectives on the homeless population after their HOC participation.

DATA SOURCES

A mixed-methods study using focus group tapes and transcripts of 15 FNP students who were divided into two separate focus groups as well as three completed survey measures: Demographic Data Form, Attitudes Toward Homelessness Inventory, and HOC Attendance Form.

CONCLUSIONS

Overall, the FNP students revealed no stigmatizing attitudes toward homeless people prior to their HOC participation, but a significant positive change in their attitudes occurred after the experience. There were significant mean differences in 6 out of the 11 scale items and in the overall total mean scores after the HOC experience (p = .013). The focus groups revealed the transformation of the students' attitudes toward homeless individuals after their HOC participation, supporting and illuminating the survey findings.

IMPLICATIONS FOR PRACTICE

The study findings underscore the importance of including the care of homeless patients in FNP educational programs. Such exposure provides FNP students with an opportunity to develop the social responsibility to care for all segments of society, especially homeless people, in keeping with nursing's social contract as a helping profession.

State mental hospitals and their host communities: the origins of hostile public reactions

This article examines the hostile public reactions of a community that, through a state policy to consolidate all long-term behavioral health services, was to become the site of the state's only mental hospital. A telephone survey conducted in the host community (n = 800) and a matched community (n = 800) was used to test whether the origins of hostility toward consolidation were related to the public's negative attitudes toward mental illness and homelessness or to the beliefs about the discharge and supervisory behavior of the hospital. The host community was not found to have more negative views of mental illness, although it did have significantly more negative views about the homeless. Disapproval of consolidation was unrelated to negative views of mental illness or homelessness but was strongly related to the expected "bad" behavior of the hospital. These results suggest that the best way to improve relations between hospitals and their host communities is for hospitals to behave like "good" neighbors.

Educating the public about mental illness and homelessness: a cautionary note

OBJECTIVE

To determine whether the viewing of a video depicting the successful struggles of homeless persons with mental illness in finding and maintaining housing can have a positive impact on attitudes toward homeless persons with mental illness.

METHOD

Five hundred and seventy-five high school students attending a brief educational session on mental illness participated in 1 of 3 comparison versions of the 2-hour program (control, video, video plus discussion). All completed an "Attitudes toward Homelessness and Mental Illness Questionnaire." Demographic and prior exposure variables were entered as a covariates in between-group analyses of variance.

RESULTS

Females and subjects who had more prior encounters with homeless persons were found to have the most positive attitudes. After controlling for these effects, the video alone had a negative impact on attitudes relative to the other groups, while the video followed by a discussion with one of the people featured in it had a largely positive impact.

CONCLUSIONS

The apparent immediacy and the evocative power of video presentations cannot substitute for direct contact for the purpose of promoting positive attitude change. The findings are consistent with prior research emphasizing the importance of direct interaction with members of stigmatized groups to reduce negative attitudes. Education programs trying to destigmatize mental illness and homelessness using videos should proceed with caution.

Health status and resources of rural homeless women and children. Iowa Homeless Research Team

The purpose of this research is to describe the health status and health resources for homeless women and children in a Midwestern rural community. A group of 31 rural homeless women in a shelter participated in the study by answering questions on the Rural Homeless Interview developed by the investigators. The findings revealed higher than expected rates of illness, accidents, and adverse life events, with the incidence of substance abuse and mental illness being comparable to data from other homeless populations. The data on children were limited by lack of knowledge on the part of their mothers. Some mothers reported that their children were in foster care, had been adopted, or were being cared for by others. The inability to access health and dental care was reported by half of the participants.

Let's ask the homeless people themselves: a needs assessment based on a probability sample of adults

A probability sample of 301 homeless adults from Buffalo, NY, was followed over 6 months to document the utilization of a variety of community services, examine services desired, and identify factors associated with service utilization, preference, and satisfaction. The following needs were all rated as at least equally important as the need for affordable housing: safety, education, transportation, medical/dental treatment, and job training/placement (most of these needs were also rated as difficult to obtain). Needs for formal mental health and substance abuse services were rated as relatively unimportant and easy to obtain, and for those who actually used them, respondents were often dissatisfied with them. Of 16 predictor variables examined in multivariate analyses, several showed consistent relationships with subsequent service use, preference, and satisfaction. Younger adults, persons of color, those with dependent children, and persons having fewer social supports reported less service utilization, less satisfaction with services received, different perceived needs for particular services, and/or greater difficulty obtaining services.