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Schiffler T, Kapan A, Gansterer A, Pass T, Lehner L, Gil-Salmeron A, McDermott DT, Grabovac I. Characteristics and Effectiveness of Co-Designed Mental Health Interventions in Primary Care for People Experiencing Homelessness: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:892. [PMID: 36613214 PMCID: PMC9820061 DOI: 10.3390/ijerph20010892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
People experiencing homelessness (PEH) face a disproportionately high prevalence of adverse mental health outcomes compared with the non-homeless population and are known to utilize primary healthcare services less frequently while seeking help in emergency care facilities. Given that primary health services are more efficient and cost-saving, services with a focus on mental health that are co-designed with the participation of users can tackle this problem. Hence, we aimed to synthesize the current evidence of such interventions to assess and summarize the characteristics and effectiveness of co-designed primary mental healthcare services geared towards adult PEH. Out of a total of 10,428 identified records, four articles were found to be eligible to be included in this review. Our findings show that co-designed interventions positively impacted PEH's mental health and housing situation or reduced hospital and emergency department admissions and increased primary care utilization. Therefore, co-designed mental health interventions appear a promising way of providing PEH with continued access to primary mental healthcare. However, as co-designed mental health interventions for PEH can improve overall mental health, quality of life, housing, and acute service utilization, more research is needed.
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Affiliation(s)
- Tobias Schiffler
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Ali Kapan
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Alina Gansterer
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Thomas Pass
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Lisa Lehner
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
- Department of Science & Technology Studies, Cornell University, 303 Morrill Hall, Ithaca, NY 14853, USA
| | - Alejandro Gil-Salmeron
- International Foundation for Integrated Care, Wolfson College, Linton Rd., Oxford OX2 6UD, UK
| | - Daragh T. McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham NG1 4FQ, UK
| | - Igor Grabovac
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
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Furbacher J, Fockele C, Del Buono B, Janneck L, March C, Molina M, Duber H, Doran K, Lin M, Cooper R, Modi P. 2021 SAEM Consensus Conference Proceedings: Research Priorities for Developing Emergency Department Screening Tools for Social Risks and Needs. West J Emerg Med 2022; 23:817-822. [DOI: 10.5811/westjem.2022.8.57271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: The Emergency Department (ED) acts as a safety net for our healthcare system. While studies have shown increased prevalence of social risks and needs among ED patients, there are many outstanding questions about the validity and use of social risks and needs screening tools in the ED setting.
Methods: In this paper, we present research gaps and priorities pertaining to social risks and needs screening tools used in the ED, identified through a consensus approach informed by literature review and external expert feedback as part of the 2021 SAEM Consensus Conference -- From Bedside to Policy: Advancing Social Emergency Medicine and Population Health.
Results: Four overarching research gaps were identified: (1) Defining the purpose and ethical implications of ED-based screening; (2) Identifying domains of social risks and needs; (3) Developing and validating screening tools; and (4) Defining the patient population and type of screening performed. Furthermore, the following research questions were determined to be of highest priority: (1) What screening tools should be used to identify social risks and needs? (2) Should individual EDs use a national standard screening tools or customized screening tools? (3) What are the most prevalent social risks and needs in the ED? and (4) Which social risks and needs are most amenable to intervention in the ED setting?
Conclusion: Answering these research questions will facilitate the use of evidence-based social risks and needs screening tools that address knowledge gaps and improve the health of our communities by better understanding the underlying determinants contributing to their presentation and health outcomes.
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Affiliation(s)
- Jacqueline Furbacher
- University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Callan Fockele
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Ben Del Buono
- Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
| | - Laura Janneck
- University of Oklahoma School of Community Medicine, Department of Emergency Medicine, Tulsa, Oklahoma
| | - Cooper March
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Melanie Molina
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Herbet Duber
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Kelly Doran
- NYU School of Medicine, Departments of Emergency Medicine and Population Health, New York, New York
| | - Michelle Lin
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Richelle Cooper
- UCLA School of Medicine, Department of Emergency Medicine, Los Angeles, California
| | - Payal Modi
- University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
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Vohra N, Paudyal V, Price MJ. Homelessness and the use of Emergency Department as a source of healthcare: a systematic review. Int J Emerg Med 2022; 15:32. [PMID: 35902803 PMCID: PMC9330962 DOI: 10.1186/s12245-022-00435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persons experiencing homelessness (PEH) often use hospital Emergency Department (ED) as the only source of healthcare. The aim of this study was to undertake a systematic review to identify the prevalence, clinical reasons and outcomes in relation to ED visits by PEH. METHODS A protocol-led (CRD42020189263) systematic review was conducted using search of MEDLINE, EMBASE, CINAHL and Google Scholar databases. Studies that reported either the prevalence of homelessness in the ED or clinical reasons for presentation to ED by PEH and published in English language were included. Definitions of homelessness used by study authors were accepted. RESULTS From the screening of 1349 unique titles, a total of 36 studies were included. Wide variations in the prevalence and key cause of presentations were identified across the studies often linked to differences in country, study setting, disease classification and data collection methods. The proportion of ED visits contributed by PEH ranged from 0.41 to 19.6%. PEH made an average of 0.72 visits to 5.8 visits per person per year in the ED [rate ratio compared to non-homeless 1.63 to 18.75]. Up to a third and quarter of the visits were contributed by alcohol-related diagnoses and substance poisoning respectively. The percentage of PEH who died in the ED ranged from 0.1 to 0.5%. CONCLUSIONS Drug-, alcohol- and injury-related presentations dominate the ED visits by PEH. Wide variations in the data were observed in regard to attendance and treatment outcomes. There is a need for prevention actions in the community, integrated discharge and referral pathways between health, housing and social care to minimise frequent usage and improve attendance outcomes.
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Affiliation(s)
- Neha Vohra
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Vibhu Paudyal
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Odoh C, Businelle MS, Chen TA, Kendzor DE, Obasi EM, Reitzel LR. Association of Fear and Mistrust with Stress Among Sheltered Homeless Adults and the Moderating Effects of Race and Sex. J Racial Ethn Health Disparities 2019; 7:458-467. [PMID: 31802428 DOI: 10.1007/s40615-019-00674-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/22/2022]
Abstract
In shelter settings, homeless individuals often congregate and sleep in proximity to one another, with limited secure places for belongings: a living environment that may engender perceived vulnerability to victimization. Fear of victimization and mistrust of others in the shelter environment may result in greater stress, and racial minority residents and women may be particularly affected. Here, we aimed to examine the associations between fear, mistrust, and fear and mistrust, and stress among sheltered homeless adults, and explore moderation by race and sex. Data were from a convenience sample of adults from a homeless shelter in Dallas, TX (N = 225; 67% black; 27% women). Participants completed the fear and mistrust scale and the urban life stressors scale. Linear regressions were used to measure associations of fear, mistrust, and fear and mistrust with stress, adjusted for age, education, sex, race, history of schizophrenia/schizoaffective disorder, and discrimination. Moderation was assessed with interaction terms. Adjusted results indicated that fear, mistrust, fear and mistrust was positively associated with stress (p < 0.001). Race, but not sex, was a significant moderator of associations between fear and stress, whereby black adults with high levels of fear were more likely than white adults to experience high stress levels. Thus, although more research is needed, results suggest that interventions aimed at reducing fear of victimization may reduce stress for black adults. Given the association of stress with myriad undesirable health outcomes that can further exacerbate known health disparities, further work in this area is critical. Future research should investigate environmental sources of fear to provide further direction for interventions.
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Affiliation(s)
- Chisom Odoh
- College of Education, Department of Psychological, Health, and Learning Sciences, The University of Houston, 491 Farish Hall, Houston, TX, 77204-5029, USA.
- College of Health and Public Services, Department of Rehabilitation and Health Services, The University of North Texas, 1155 Union Circle #311456, Denton, TX, 76203, USA.
- HEALTH Research Institute, University of Houston, Houston, TX, USA.
| | - Michael S Businelle
- Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
- Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Tzu-An Chen
- College of Education, Department of Psychological, Health, and Learning Sciences, The University of Houston, 491 Farish Hall, Houston, TX, 77204-5029, USA
- HEALTH Research Institute, University of Houston, Houston, TX, USA
| | - Darla E Kendzor
- Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
- Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Ezemenari M Obasi
- College of Education, Department of Psychological, Health, and Learning Sciences, The University of Houston, 491 Farish Hall, Houston, TX, 77204-5029, USA
- HEALTH Research Institute, University of Houston, Houston, TX, USA
| | - Lorraine R Reitzel
- College of Education, Department of Psychological, Health, and Learning Sciences, The University of Houston, 491 Farish Hall, Houston, TX, 77204-5029, USA
- HEALTH Research Institute, University of Houston, Houston, TX, USA
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Abstract
The US homeless population is predisposed to serious complications of influenza with increased likelihood of hospitalization and death. This quality improvement project sought to increase influenza vaccination in the homeless population of a rural area in the Midwest and improve provider knowledge of risks and preventive care responsibilities.
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García-Andrade RF, Rendón-Luna BS, Martínez VV, De Meneses EMT, Prieto BR. Transgender Women with Severe Mental Illness and Homelessness: A Retrospective Case Series. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/jss.2019.78030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Randers MB, Marschall J, Nielsen TT, Møller A, Zebis MK, Krustrup P. Heart rate and movement pattern in street soccer for homeless women. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2018. [DOI: 10.1007/s12662-018-0503-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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