Language ability and adult homelessness

Executive function and adult homelessness, true impairment or frontal lobology?

Homelessness is associated with multiple risk factors for neurocognitive impairment. Past research with people experiencing homelessness has described "frontal lobe" dysfunction including behavioral disorders and executive cognitive impairments. In the current study, 72 adults experiencing homelessness were assessed with a standardized assessment of executive function, and interviewed regarding neurological and psychiatric history. When compared to a control sample of 25 never-homeless participants, and controlling for level of education, there was little evidence for executive dysfunction in the sample of people experiencing homelessness. Levels of substance abuse, past head injury, and post-traumatic stress disorder were notably high. However, there were no statistically significant associations between cognitive task performance and clinical or substance abuse variables. Gambling was surprisingly infrequent, but risk-taking behavior among intravenous drug users was common. Though in neither case was it linked to executive function. Overall, there was little evidence for executive impairment in this sample of people experiencing homelessness. I suggest that past research has often used inappropriate criteria for "normal" performance, particularly comparing people experiencing homelessness to control data of relatively high education level. This has led to elements of "frontal lobology," that is, clinical neuroscience research that tends to overly link non-typical or pathological behavior to frontal lobe impairment. When appropriate comparisons are made, controlling for education level, as in this study, associations between executive function impairments and adult homelessness may be weaker than previously reported.

Communicating effectively with inclusion health populations: 2022 ICCH symposium

OBJECTIVE

To describe communication strategies for clinical practice that allow practitioners to work more effectively with marginalised population groups and to discuss how to incorporate these into medical practice.

METHODS

Active practitioners working in inclusion health and people with lived experience of homelessness and the asylum-seeking process shared their perspectives in the symposium at the 2022 International Conference on Communication in Healthcare (ICCH) and a subsequent conference on empathy in healthcare. The views of attendees were sought.

SYMPOSIUM DISCUSSION

We describe the perspectives shared at the symposia under two main themes: communication needs in people experiencing homelessness and migrant populations, and trauma-informed practice.

CONCLUSIONS

People experiencing homelessness have more communication challenges compared to the general adult population. Migrant, refugee, and asylum-seeking populations also face the complexity of negotiating unfamiliar healthcare, legal and social systems with the added burden of language barriers. Trauma-informed practice provides a useful framework that can improve communication with these groups.

Neuropsychological functioning of homeless people in Paris: An exploratory study

Homelessness is a multifactorial issue, influenced by structural and individual factors. These factors include health status, which has been reported to be poorer among people experiencing homelessness. Although the somatic and mental health of homeless individuals has already been studied in France, to our knowledge, no research has been conducted on neuropsychological functioning in this country. Studies out with France have identified cognitive impairments as highly prevalent among homeless people, and these impairments are likely affected by local structural factors, such as healthcare access. Therefore, we conducted an exploratory study in Paris to evaluate cognition and associated factors in homeless adults. The second objective was to identify methodological specificities to consider in a future larger-scale study and for the application of the outcomes. For this exploratory phase, 14 individuals were recruited from specific services and were interviewed regarding their social, neurological, and psychiatric history, before completing a set of cognitive tests. The results showed a high diversity of profiles in terms of demographic characteristics, including being a migrant and/or illiterate. A high proportion of participants had signs of traumatic brain injury, anxiety, depressive disorders, and post-traumatic stress disorders. Most cognitive scores were in the low average of normative data. No statistical association was found between identified risk factors and cognitive performance. Future studies should consider the sociodemographic specificities of the homeless population and design appropriate measurement tools to improve the understanding of neuropsychological profiles.

Exploring and Mapping Screening Tools for Cognitive Impairment and Traumatic Brain Injury in the Homelessness Context: A Scoping Review

Cognitive impairment is common amongst people experiencing homelessness, yet cognitive screening and the collection of history of brain injury rarely features in homelessness service delivery practice. The purpose of this research was to scope and map strategies for screening for the potential presence of cognitive impairment or brain injury amongst people experiencing homelessness and identify instruments that could be administered by homelessness service staff to facilitate referral for formal diagnosis and appropriate support. A search was conducted across five databases, followed by a hand search from relevant systematic reviews. A total of 108 publications were included for analysis. Described in the literature were 151 instruments for measuring cognitive function and 8 instruments screening for history of brain injury. Tools that were described in more than two publications, screening for the potential presence of cognitive impairment or history of brain injury, were included for analysis. Of those regularly described, only three instruments measuring cognitive function and three measuring history of brain injury (all of which focused on traumatic brain injury (TBI)) may be administered by non-specialist assessors. The Trail Making Test (TMT) and the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) are both potentially viable tools for supporting the identification of a likely cognitive impairment or TBI history in the homelessness service context. Further population-specific research and implementation science research is required to maximise the potential for practice application success.

Multicomponent Intervention Associated with Improved Emotional and Cognitive Outcomes of Marginalized Unemployed Youth of Latin America

Mass migration and people seeking political refuge are critical social issues facing Latin America. Ecuador has the largest population of recognized refugees in the region. Youths from a migration background have an increased risk of becoming NEET (Young people not in employment, education, or training). Such youths struggle more with mental health problems than non-NEET peers. Being a refugee, NEET further increases the risk of having mental health problems and may be linked to lower cognitive functioning, which could maintain exclusion and unemployment. This intervention study was performed with a group of young people of different nationalities who were refugees or belonged to other vulnerable groups attending a six-week employability-support intervention in Ecuador. In order to assess the impact of the intervention, a range of measures of executive cognitive function, mental health, and the potential for positive change were used. We found that post-intervention, the group reported significantly less psychological distress and better self-esteem, self-efficacy, and cognitive response inhibition than before the intervention. We conclude that multicomponent interventions may effectively improve the psychological functioning of vulnerable NEET groups in the Latin American context.

Theory of Mind Ability and Socioeconomic Status, a Study of Street-Connected Children and Adolescents in Ecuador

Family socioeconomic status (SES) is closely associated with cognitive ability in children and adolescents. However, most of the research has come from high-income countries. There is only limited research on ‘street children’, who represent an aspect of low-SES particularly associated with low- and middle-income counties. The current research in Quito, Ecuador, compared a group of street-connected youth with a not street-connected control group on two different measures of theory of mind ability and verbal comprehension. Initial analysis revealed that the street-connected sample scored significantly below the level of the control sample for verbal comprehension. For the main analysis, street-connected youth were matched to control participants for age, sex, and verbal comprehension scores. The street-connected sample was found to perform significantly below the control sample on both measures of theory of mind. Furthermore, worse performance appeared to be linked to severity of symptoms of post-traumatic stress disorder (PTSD) within the street-connected sample. In conclusion, the association of relatively poor verbal comprehension with street-connectedness is consistent with existing research from high-income countries on SES gradients and cognitive development. In contrast, theory of mind ability, a core aspect of social cognition, may be particularly linked to the street-connectedness form of low SES that exists in many low- and middle-income countries.

Communications in the time of a pandemic: the readability of documents for public consumption

OBJECTIVE

Government communications in a crisis can influence public health outcomes. This research aimed to investigate if written communications of the most commonly sought sources of COVID-19 information available on the internet have readability levels commensurate with those of the general public.

METHODS

Online documents from the World Health Organization (WHO), and the governments of Australia, the UK and the US were assessed for readability using an online instrument that calculated scores for the Flesch Reading Ease Score, the SMOG Index and the Readability Consensus Grade Level.

RESULTS

Similar to the previous research, most documents assessed had a readability standard that was at or above the recommended grade level, and as such inaccessible to substantial portions of the general public. A one-way ANOVA with post hoc tests revealed significant differences among the data, with Australian documents significantly more difficult to read than those from the UK and US.

CONCLUSIONS

Government departments need to consider their audience and monitor readability of the documents they produce to ensure that readers can understand them. Implications for public health: Health communications need to be written at a level appropriate for the targeted population in order to be fit for purpose.