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Serchen J, Hilden DR, Beachy MW. Meeting the Health and Social Needs of America's Unhoused and Housing-Unstable Populations: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:514-517. [PMID: 38408358 DOI: 10.7326/m23-2795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Access to safe and stable housing has both a direct and indirect effect on health. Experiencing homelessness and housing instability can induce stress and trauma, worsening behavioral health and substance use. The absence of safe and stable living conditions can make it challenging to rest, recuperate, and recover from health ailments and can pose barriers to treatment adherence. Homelessness and housing instability is associated with high rates of numerous diseases and chronic conditions. Its cyclical relationship with other social drivers of health can exacerbate health disparities. As a result, unhoused persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. Physicians and other health professionals have a role in educating themselves about the needs of unhoused patients as well as making themselves aware of community and government resources available to these populations. Policymakers must support health professionals in these efforts by supporting the data infrastructure needed to facilitate these referrals to resources, supporting research into best practices for caring for these populations, and investing in community-based organization capacity. Policy action is needed to address the underlying drivers of homelessness, including a dearth of affordable housing, while also addressing the short-term need for safe shelter now. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfill one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of unhoused populations.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | | | - Micah W Beachy
- Nebraska Medicine-University of Nebraska Medical Center, Omaha, Nebraska (M.W.B.)
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Willison C, Unwala N, Singer PM, Creedon TB, Mullin B, Cook BL. Persistent Disparities: Trends in Rates of Sheltered Homelessness Across Demographic Subgroups in the USA. J Racial Ethn Health Disparities 2024; 11:326-338. [PMID: 36795291 PMCID: PMC9933811 DOI: 10.1007/s40615-023-01521-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 02/17/2023]
Abstract
CONTEXT Homelessness is a public health crisis affecting millions of Americans every year, with severe consequences for health ranging from infectious diseases to adverse behavioral health outcomes to significantly higher all-cause mortality. A primary constraint of addressing homelessness is a lack of effective and comprehensive data on rates of homelessness and who experiences homelessness. While other types of health services research and policy are based around comprehensive health datasets to successfully evaluate outcomes and link individuals with services and policies, there are few such datasets that report homelessness. METHODS Gathering archived data from the US Department of Housing and Urban Development, we created a unique dataset of annual rates of homelessness, nationally, as measured by persons accessing homeless shelter systems, for 11 years (2007-2017, including the Great Recession and prior to the start of the 2020 pandemic). Responding to the need to measure and address racial and ethnic disparities in homelessness, the dataset reports annual rates of homelessness across HUD selected, Census-based racial and ethnic categories. FINDINGS Between 2007 and 2017, across all types of sheltered homelessness, whether individual, family, or total, Black, American Indian or Alaska Native, and Native Hawaiian and Pacific Islander individuals and families were far more likely to experience homelessness than non-Hispanic White individuals and families. Particularly concerning about the rates of homelessness among these populations is the persistent and increasing nature of these disparities across the entire study period. CONCLUSIONS While homelessness is a public health problem, the hazard of experiencing homelessness is not uniformly distributed across different populations. Because homelessness is such a strong social determinant of health and risk factor across multiple health domains, it deserves the same careful annual tracking and evaluation by public health stakeholders as other areas of health and health care.
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Affiliation(s)
- Charley Willison
- Department of Public and Ecosystem Health, Cornell University, S2005 Schurman Hall, Ithaca, NY, 14850, USA.
| | - Naquia Unwala
- Department of Public and Ecosystem Health, Cornell University, S2005 Schurman Hall, Ithaca, NY, 14850, USA
| | - Phillip M Singer
- Department of Political Science, University of Utah, Salt Lake City, UT, USA
| | - Timothy B Creedon
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Koh KA, Montgomery AE, O'Brien RW, Kennedy CJ, Luedtke A, Sampson NA, Gildea SM, Hwang I, King AJ, Petriceks AH, Petukhova MV, Stein MB, Ursano RJ, Kessler RC. Predicting Homelessness Among U.S. Army Soldiers No Longer on Active Duty. Am J Prev Med 2022; 63:13-23. [PMID: 35725125 PMCID: PMC9219110 DOI: 10.1016/j.amepre.2021.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/24/2021] [Accepted: 12/14/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The ability to predict and prevent homelessness has been an elusive goal. The purpose of this study was to develop a prediction model that identified U.S. Army soldiers at high risk of becoming homeless after transitioning to civilian life based on information available before the time of this transition. METHODS The prospective cohort study consisted of observations from 16,589 soldiers who were separated or deactivated from service and who had previously participated in 1 of 3 baseline surveys of the Army Study to Assess Risk and Resilience in Servicemembers in 2011-2014. A machine learning model was developed in a 70% training sample and evaluated in the remaining 30% test sample to predict self-reported homelessness in 1 of 2 Longitudinal Study surveys administered in 2016-2018 and 2018-2019. Predictors included survey, administrative, and geospatial variables available before separation/deactivation. Analysis was conducted in November 2020-May 2021. RESULTS The 12-month prevalence of homelessness was 2.9% (SE=0.2%) in the total Longitudinal Study sample. The area under the receiver operating characteristic curve in the test sample was 0.78 (SE=0.02) for homelessness. The 4 highest ventiles (top 20%) of predicted risk included 61% of respondents with homelessness. Self-reported lifetime histories of depression, trauma of having a loved one murdered, and post-traumatic stress disorder were the 3 strongest predictors of homelessness. CONCLUSIONS A prediction model for homelessness can accurately target soldiers for preventive intervention before transition to civilian life.
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Affiliation(s)
- Katherine A Koh
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Boston Health Care for the Homeless Program, Boston, Massachusetts.
| | - Ann Elizabeth Montgomery
- Department of Health Behavior, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama; VA Health Care System, Birmingham, U.S. Department of Veteran Affairs, Birmingham, Alabama
| | - Robert W O'Brien
- VA Health Services Research and Development Service, Washington, District of Columbia
| | - Chris J Kennedy
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Sarah M Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Andrew J King
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Maria V Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, San Diego, California; Department of Family Medicine & Public Health, University of California San Diego, San Diego, California
| | - Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Jafry MZ, Martinez J, Chen TA, Businelle MS, Kendzor DE, Reitzel LR. Perceived Social Support Attenuates the Association between Stress and Health-Related Quality of Life among Adults Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010713. [PMID: 34682458 PMCID: PMC8536194 DOI: 10.3390/ijerph182010713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
Health-related quality of life (HRQoL) is defined as a multidimensional subjective assessment of one’s physical and mental health. Homelessness is associated with numerous stressors that can reduce HRQoL. Social support is defined as the availability of individuals, or resources provided by individuals, to cope with stress. Interpersonal social support may be important in buffering HRQoL from the negative implications of stress. Here, we examine this association in a marginalized group known for high rates of physical and mental health comorbidities: adults experiencing homelessness. Participants (N = 581; 63.7% men; Mage = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Social support was measured with the 12-item Interpersonal Support Evaluation List (ISEL). HRQoL was measured by the Behavioral Risk Factor Surveillance System (BRFSS) survey using self-rated health, the number of poor mental and poor physical health days over the preceding 30 days, as well as the number of limited activity days as the result of poor mental and/or physical health. Perceived stress was assessed using the 4-item Perceived Stress Scale (PSS). The potential moderation effect of social support was examined by assessing the interaction term of social support and stress in a series of linear regression analyses, controlling for sex, age, months homeless, race, education, health insurance status, serious mental illness diagnosis, and recruitment agency/site. There was a significant interaction effect of social support and stress on the prediction of days of poor physical health, days of poor mental health, and days of limited activity (p in all cases ≤ 0.05). Results add to a growing literature on the potentially protective benefits of social support for HRQoL, extend them to a large sample of adults experiencing homelessness in the South, and demonstrate the significance of this moderating effect of social support over and above the influence of several prominent sociodemographic and diagnostic variables. Future work should determine if interventions designed to enhance social support can buffer HRQoL from the deleterious effects of stress among this vulnerable population.
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Affiliation(s)
- Midhat Z. Jafry
- Department of Biology and Biochemistry, College of Natural Sciences & Mathematics, University of Houston, Science & Research Building 2, 3455 Cullen Blvd Room 342, Houston, TX 77204, USA;
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
| | - Jayda Martinez
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
- HEALTH Research Institute, University of Houston, 1100 Health 2, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | - Michael S. Businelle
- HEALTH Research Institute, University of Houston, 1100 Health 2, 4849 Calhoun Rd., Houston, TX 77204, USA;
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, University of Oklahoma, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, University of Oklahoma, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
- HEALTH Research Institute, University of Houston, 1100 Health 2, 4849 Calhoun Rd., Houston, TX 77204, USA;
- Correspondence: ; Tel.: +1-713-743-6679
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Kertesz SG, DeRussy AJ, Riggs KR, Hoge AE, Varley AL, Montgomery AE, Austin EL, Blosnich JR, Jones AL, Gabrielian SE, Gelberg L, Gordon AJ, Richman JS. Characteristics Associated With Unsheltered Status Among Veterans. Am J Prev Med 2021; 61:357-368. [PMID: 34419233 PMCID: PMC8864732 DOI: 10.1016/j.amepre.2021.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Unsheltered homelessness is a strongly debated public issue. The study objective is to identify personal and community characteristics associated with unsheltered homelessness in veterans and to test for interactions between these characteristics. METHODS In a 2018 national survey of U.S. veterans with homeless experiences; investigators assessed unsheltered time; psychosocial characteristics; and community measures of shelter access, weather, and rental affordability. Associations between these characteristics and unsheltered status were tested in July-August 2020. This study also tested whether the count of personal risk factors interacted with community characteristics in predicting unsheltered status. RESULTS Among 5,406 veterans, 481 (8.9%) reported ≥7 nights unsheltered over 6 months. This group was more likely to report criminal justice history, poor social support, medical and drug problems, financial hardship, and being unmarried. Their communities had poorer shelter access and warmer temperatures. The likelihood of unsheltered experience rose with risk factor count from 2.0% (0-1) to 8.4% (2-3) and to 24.2% (4-11). Interaction tests showed that the increase was greater for communities with warmer weather and higher rents (p<0.05). CONCLUSIONS Among veterans experiencing homelessness, unsheltered experiences correlate with individual and community risk factors. Communities wishing to address unsheltered homelessness will need to consider action at both levels.
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Affiliation(s)
- Stefan G Kertesz
- Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Health Behavior, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama.
| | - Aerin J DeRussy
- Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama
| | - Kevin R Riggs
- Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - April E Hoge
- Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama
| | - Allyson L Varley
- Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Ann Elizabeth Montgomery
- Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Health Behavior, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Erika L Austin
- Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - John R Blosnich
- Department of Social Change and Innovation, University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sonya E Gabrielian
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Lillian Gelberg
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Family Medicine, University of California Los Angeles, Los Angeles, California
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joshua S Richman
- Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Surgery, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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Giano Z, Williams A, Hankey C, Merrill R, Lisnic R, Herring A. Forty Years of Research on Predictors of Homelessness. Community Ment Health J 2020; 56:692-709. [PMID: 31858333 DOI: 10.1007/s10597-019-00530-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
Homelessness is a chronic public health issue in the U.S. This paper reviews the endurance and evolution of individual, youth, and family homelessness over the past 40-plus years. Thematic findings detail research on predictors of homelessness among adolescents, runaway youth, veterans, older adults, sheltered families, and female-headed families. Results provide a summary of contributors to homelessness, including issues related to family instability, unemployment and poverty, mental illness, substance use, unstable living arrangements, child maltreatment, social support, crime, and violence. Findings highlight key and persistent predictors of homelessness found across decades, as well as more recently identified and nuanced precursors to individual or family displacement. The goal of this work was to summarize what is known about predictors of homelessness to inform targeted research, practice, and policies.
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Affiliation(s)
- Zachary Giano
- School of Human Environmental Sciences, University of Arkansas, Fayetteville, USA
| | - Amanda Williams
- School of Human Environmental Sciences, University of Arkansas, Fayetteville, USA.
| | - Carli Hankey
- School of Child and Family Sciences, University of Southern Mississippi, Hattiesburg, USA
| | - Renae Merrill
- School of Human Environmental Sciences, University of Arkansas, Fayetteville, USA
| | - Rodica Lisnic
- School of Human Environmental Sciences, University of Arkansas, Fayetteville, USA
| | - Angel Herring
- School of Child and Family Sciences, University of Southern Mississippi, Hattiesburg, USA
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Fowler PJ, Hovmand PS, Marcal KE, Das S. Solving Homelessness from a Complex Systems Perspective: Insights for Prevention Responses. Annu Rev Public Health 2019; 40:465-486. [PMID: 30601718 PMCID: PMC6445694 DOI: 10.1146/annurev-publhealth-040617-013553] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Homelessness represents an enduring public health threat facing communities across the developed world. Children, families, and marginalized adults face life course implications of housing insecurity, while communities struggle to address the extensive array of needs within heterogeneous homeless populations. Trends in homelessness remain stubbornly high despite policy initiatives to end homelessness. A complex systems perspective provides insights into the dynamics underlying coordinated responses to homelessness. A constant demand for housing assistance strains service delivery, while prevention efforts remain inconsistently implemented in most countries. Feedback processes challenge efficient service delivery. A system dynamics model tests assumptions of policy interventions for ending homelessness. Simulations suggest that prevention provides a leverage point within the system; small efficiencies in keeping people housed yield disproportionately large reductions in homelessness. A need exists for policies that ensure reliable delivery of coordinated prevention efforts. A complex systems approach identifies capacities and constraints for sustainably solving homelessness.
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Affiliation(s)
- Patrick J Fowler
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , ,
| | - Peter S Hovmand
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , ,
| | - Katherine E Marcal
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , ,
| | - Sanmay Das
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
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Brown M, Klebek L, Chodzen G, Scartozzi S, Cummings C, Raskind A. Housing status among single adults following Homelessness Prevention and Rapid Re-housing Program participation in Indianapolis. EVALUATION AND PROGRAM PLANNING 2018; 69:92-98. [PMID: 29751144 DOI: 10.1016/j.evalprogplan.2018.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/27/2018] [Accepted: 04/29/2018] [Indexed: 06/08/2023]
Abstract
The Homelessness Prevention and Rapid Re-housing Program (HPRP) was a federally-funded program in the United States that provided short-term financial and support services to individuals and families who were at-risk or currently experiencing homelessness. There is limited research on factors that predict placement in permanent housing following prevention and rapid rehousing interventions, particularly for single adult populations. The present study examined demographic and program-related predictors of permanent housing upon program exit among two groups of adults enrolled in HPRP in Indianapolis, IN: Homelessness Prevention (HP) recipients (n = 219) and Rapid Re-housing (RRH) recipients (n = 296). Results revealed that 76.3% of HP and 68.8% of RRH recipients were living in permanent housing when they exited HPRP. For HP recipients, completion of HPRP and outreach and engagement services were significant predictors of remaining in permanent housing. For RRH recipients, individuals who were African American, did not have a disabling condition, completed HPRP, received a greater amount of financial assistance, and received case management services had significantly greater odds of permanent housing. Findings have implications for informing short-term housing support programs for precariously housed or homeless single adults and highlight the need for future research on prevention and rehousing interventions.
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Affiliation(s)
- Molly Brown
- DePaul University, Department of Psychology, United States.
| | - Lauren Klebek
- DePaul University, Department of Psychology, United States
| | - Gia Chodzen
- DePaul University, Department of Psychology, United States
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Bryant-Stephens T, Reed-Wells S, Canales M, Perez L, Rogers M, Localio AR, Apter AJ. Home visits are needed to address asthma health disparities in adults. J Allergy Clin Immunol 2016; 138:1526-1530. [PMID: 27777181 DOI: 10.1016/j.jaci.2016.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/10/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022]
Abstract
Research on asthma frequently recruits patients from clinics because the ready pool of patients leads to easy access to patients in office waiting areas, emergency departments, or hospital wards. Patients with other chronic conditions, and with mobility problems, face exposures at home that are not easily identified at the clinic. In this article, we describe the perspective of the community health workers and the challenges they encountered when making home visits while implementing a research intervention in a cohort of low-income, minority patients. From their observations, poor housing, often the result of poverty and lack of social resources, is the real elephant in the chronic asthma room. To achieve a goal of reduced asthma morbidity and mortality will require a first-hand understanding of the real-world social and economic barriers to optimal asthma management and the solutions to those barriers.
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Affiliation(s)
- Tyra Bryant-Stephens
- Children's Hospital of Philadelphia, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | | | | | - Luzmercy Perez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, Philadelphia, Pa
| | - Marisa Rogers
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - A Russell Localio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa
| | - Andrea J Apter
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, Philadelphia, Pa
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Loopstra R, Reeves A, Barr B, Taylor-Robinson D, McKee M, Stuckler D. The impact of economic downturns and budget cuts on homelessness claim rates across 323 local authorities in England, 2004-12. J Public Health (Oxf) 2015; 38:417-425. [PMID: 26364320 PMCID: PMC5072163 DOI: 10.1093/pubmed/fdv126] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background It is unclear why rates of homelessness claims in England have risen since 2010. We used variations in rates across local authorities to test the impact of economic downturns and budget cuts. Methods Using cross-area fixed effects models of data from 323 UK local authorities between 2004 and 2012, we evaluated associations of changes in statutory homelessness rates with economic activity (Gross Value Added per capita), unemployment, and local and central government expenditure. Results Each 10% fall in economic activity was associated with an increase of 0.45 homelessness claims per 1000 households (95% CI: 0.10–0.80). Increasing rates of homelessness were also strongly linked with government reductions in welfare spending. Disaggregating types of welfare expenditure, we found that strongest associations with reduced homelessness claims were spending on social care, housing services, discretionary housing payments and income support for older persons. Conclusions Recession and austerity measures are associated with significant increases in rates of homelessness assistance. These findings likely understate the full burden of homelessness as they only capture those who seek aid. Future research is needed to investigate what is happening to vulnerable groups who may not obtain assistance, including those with mental health problems and rough sleepers.
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Affiliation(s)
- Rachel Loopstra
- Department of Sociology, Oxford University, Oxford OX1 3UQ, UK
| | - Aaron Reeves
- Department of Sociology, Oxford University, Oxford OX1 3UQ, UK
| | - Ben Barr
- Department of Public Health & Policy, University of Liverpool, Liverpool L69 3GB, UK
| | - David Taylor-Robinson
- Department of Public Health & Policy, University of Liverpool, Liverpool L69 3GB, UK
| | - Martin McKee
- Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - David Stuckler
- Department of Sociology, Oxford University, Oxford OX1 3UQ, UK Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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Personal, dyadic, and contextual resilience in parents experiencing homelessness. Clin Psychol Rev 2015; 36:56-69. [PMID: 25687153 DOI: 10.1016/j.cpr.2015.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 11/21/2022]
Abstract
Adopting a developmental psychopathology (DP) perspective, the present study systematically reviewed the quantitative literature on positive functioning and outcomes in parents experiencing homelessness. Studies were identified from PubMed, PsycInfo, and Web of Science using an exhaustive list of key terms. Of 3443 total studies screened, 219 were inspected, 176 were excluded, and 43 were included. Included studies fell into three outcome categories: the ability to function well personally (cope effectively, meet basic family needs, experience reduced psychopathology); dyadically (demonstrate positive parenting practices and promote child adjustment); and contextually (exit episodes of homelessness and avoid shelter re-entry). Results also reflected personal, dyadic, and contextual independent variables associated with each positive outcome category. Many parents experiencing homelessness display positive outcomes, and many factors support positive functioning. Future research should replicate these findings and examine multilevel parental functioning to help bridge the gap between the DP theoretical perspective and the quantitative evidence for parental resilience as a process.
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