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Attwell K, Turvey J, Wood L. COVID-19 vaccination of at-risk and marginalised groups: recentering the state in vaccine uptake. Soc Sci Med 2024; 348:116812. [PMID: 38636209 DOI: 10.1016/j.socscimed.2024.116812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
Recent studies have used the World Health Organization's new Behavioural and Social Drivers (BeSD) framework to analyse vaccine uptake. However, this study of COVID-19 vaccination among marginalised population groups highlights the framework's limitations regarding the centrality of the state in shaping people's vaccination intentions in high income countries. We conducted interviews and focus groups with service providers and community members to explore COVID-19 vaccination amongst Western Australians experiencing homelessness and/or from other marginalised populations (such as people with substance use dependence). Analysing this data iteratively to emphasise the state's role and functions, we elaborate how trauma and mistrust of government drive thoughts, feelings, and social interactions regarding vaccination programs, which are mutually reinforcing and which inhibit individuals' willingness to engage. Government systems that leave some populations behind increase those populations' susceptibility to misinformation. Policies may generate new unintended problems: social service providers worried about vaccine advocacy damaging clients' trust, especially in the context of vaccine mandates. Reframing the state's responsibility for designing culturally and socially appropriate services, we outline how end-users and trusted providers can lead this process. We share a new framework, "Recentering the State in Vaccine Uptake," arising from our analyses.
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Affiliation(s)
- Katie Attwell
- VaxPol Lab, Political Science and International Relations, School of Social Sciences, The University of Western Australia, Perth, WA, Australia.
| | - Jake Turvey
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
| | - Lisa Wood
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
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Kerman N, Marshall CA, Polillo A, Voronov J, de Pass T, Easton C, Ward B, Noble A, Hwang SW, Kozloff N, Stergiopoulos V, Kidd SA. Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry. Soc Sci Med 2024; 348:116831. [PMID: 38574591 DOI: 10.1016/j.socscimed.2024.116831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among people experiencing homelessness in two cities in Ontario, Canada. A total of 49 people experiencing homelessness who had been restricted from an emergency shelter program in the past year were recruited and included in the study analysis. A pragmatic and integrative approach was used for data analysis that involved the development of meta-matrices to identify prominent and divergent perspectives and experiences with regard to service restriction antecedents and consequences. Study findings underscored that service restrictions were often the result of violence and aggression, primarily between service users. There were regional differences in other service restriction reasons, including substance use and possession. Service restrictions affected the shelter status of almost all participants, with many subsequently experiencing unsheltered homelessness, and cycling through institutional health, social, and criminal justice services (i.e., institutional circuitry). Other health and social consequences included substance use relapses and hospitalizations; cold-related injuries due to post-restriction unsheltered homelessness; suicidality; food insecurity; diminished contact with support network and connections; and intense feelings of anger, fear, and hopelessness. Overall, the study findings advance our understanding of the role of homeless services in pathways into unsheltered homelessness and institutional circuitry, which raise critical questions about how to mitigate the harms associated with service restrictions, while concurrently facilitating safety and upholding the rights of people experiencing homelessness and emergency shelter staff.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada.
| | - Carrie Anne Marshall
- Western University, School of Occupational Therapy, 1201 Western Road, London, Ontario, Canada
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Joseph Voronov
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Timothy de Pass
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Corinna Easton
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada
| | - Brooklyn Ward
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, 1919 Riverside Drive, Ottawa, Ontario, Canada
| | - Amanda Noble
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Division of General Internal Medicine, 1 King's College Circle, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
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Rew L, Slesnick N, Kesler S, Rhee H. Mediation of Psychological Capital in Youth Experiencing Homelessness. Nurs Res 2024; 73:188-194. [PMID: 38652691 PMCID: PMC11047266 DOI: 10.1097/nnr.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Youth who experience homelessness engage in behaviors that place them at high risk for disease and injury. Despite their health risk behaviors, these youth display psychological capital, positive attributes of hope, efficacy, resilience, and optimism that motivate them to engage in health-promoting behaviors such as safer sex. However, this array of positive psychological attributes has not been studied in this vulnerable population. OBJECTIVES The specific aim of this analysis was to determine whether factors of psychological capital mediated the relationship between background risk factors (e.g., race/ethnicity, educational attainment, reason for being homeless, sexual abuse history, and HIV status) and outcomes of condom intention, safer sex behaviors, and life satisfaction among youth who participated in a longitudinal intervention study. METHODS Using a Solomon four-group design, 602 youth were recruited from drop-in centers in two large cities (Columbus, Ohio, and Austin, Texas) to participate in a brief intervention that included outcomes of enhanced communication skills, goal setting, safer sex behaviors, drug refusal skills, and life satisfaction. Using an autoregressive, cross-lagged, longitudinal mediation model, we tested the direct and indirect effects of background factors, psychological capital, and intervention outcomes. Models were tested for the intervention group alone and the total sample. RESULTS There were no significant direct or indirect effects of background factors on intervention outcomes among the intervention group, and the model fit was poor. There were also no significant mediating paths via factors of psychological capital and poor model fit for the combined group. DISCUSSION Findings provide important information about intrinsic strengths of youth experiencing homelessness and psychological capital as a significant construct for understanding health behaviors among disadvantaged and underserved youth. The lack of significant mediation effects may have been due, in part, to the lack of a robust measure of psychological capital. Further study with various background factors and outcomes would contribute further to our understanding of how best to support this population.
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Choudhury S, Choi SL, Lee Y, Manser SS. Examining the Role of Self-Harm in the Relationship between Emergency Department Service Utilization and Trauma-Induced Homelessness among Homeless Individuals in Texas. Health Soc Work 2024; 49:87-94. [PMID: 38478764 DOI: 10.1093/hsw/hlae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 04/30/2024]
Abstract
Homelessness is a complex public health problem in the United States. Current or ongoing history of trauma among individuals adds to the complexity and challenges of homelessness. Our study assessed the moderating role of self-harm in the association between emergency department (ED) service utilization and trauma-induced homelessness (TIH) among adults in Texas. Homeless adults (N = 282) who completed their baseline Vulnerability Index Service Prioritization Decision Assistance Prescreen Tool survey between February 2021 and February 2022 at a Local Mental Health Authority in Texas were selected. The outcome variable, TIH, was assessed by current period of homelessness due to experiencing trauma or abuse. The main independent variable was ED utilization, while self-harm in the past year was assessed as the moderating variable. A multivariate logistic regression with a moderation analysis was conducted while adjusting for the covariates. Individuals who utilized ED services and engaged in self-harm and risky behaviors had greater odds of experiencing current period of TIH. Male respondents were less likely to experience TIH. Finally, engaging in self-harm significantly moderated the association between ED service use and TIH. This study may help inform efforts to develop tailored interventions and promote resilience-based approaches to improve health outcomes among individuals experiencing homelessness due to TIH.
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Affiliation(s)
- Sumaita Choudhury
- MPH, is a doctoral candidate and research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, 1823 Red River Street, Austin, TX 78712, USA
| | - Sharon Lee Choi
- PhD, is a research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Yehyang Lee
- MS, is a graduate research assistant, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Stacey Stevens Manser
- PhD, is a research scientist and associate director, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Gaber SN, Rydeman IB, Mattsson E, Kneck Å. Asking about violence and abuse among patients experiencing homelessness: a focus group study with healthcare professionals. BMC Health Serv Res 2024; 24:531. [PMID: 38671423 PMCID: PMC11046839 DOI: 10.1186/s12913-024-10914-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND People experiencing homelessness are at increased risk of violence and abuse, however, there is insufficient knowledge about rates of inquiry or readiness of healthcare professionals to address violence and abuse among this population. This study aimed to explore healthcare professionals' experiences and perceptions of asking about violence and abuse among patients experiencing homelessness. METHODS This study used a qualitative, interpretive, and exploratory design. We performed focus group discussions with healthcare professionals (n = 22) working at an integrative healthcare unit for people experiencing homelessness. Data were analysed using reflexive thematic analysis, following Braun and Clarke's six-phase approach. Findings are reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS The overarching theme of the analysis is that addressing violence and abuse is at risk of "falling through the cracks". The theme is supported by three sub-themes: Hesitance to address violence and abuse, The complex dynamics of violence and abuse in homelessness, and Challenges in addressing violence and abuse amidst competing priorities and collaborative efforts. The normalisation of violence and abuse within the context of homelessness perpetuates a "cycle" where the severity and urgency of addressing violence and abuse are overlooked or minimised, hindering effective interventions. Moreover, healthcare professionals themselves may inadvertently contribute to this normalisation. The hesitance expressed by healthcare professionals in addressing the issue further reinforces the prevailing belief that violence and abuse are inherent aspects of homelessness. This normalisation within the healthcare system adds another layer of complexity to addressing these issues effectively. CONCLUSIONS The findings underscore the need for targeted interventions and coordinated efforts that not only address the immediate physical needs of people experiencing homelessness but also challenge and reshape the normalised perceptions surrounding violence and abuse. By prioritising awareness, education, and supportive interventions, we can begin to "break the cycle" and provide a safer environment where violence and abuse are not accepted or overlooked.
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Affiliation(s)
- Sophie Nadia Gaber
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden.
- Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden.
| | - Ing-Britt Rydeman
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Elisabet Mattsson
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
- Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
| | - Åsa Kneck
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
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Meehan AA, Milazzo KE, Bien M, Nall SK, Vickery KD, Mosites E, Barocas JA. Involuntary displacement and self-reported health in a cross-sectional survey of people experiencing homelessness in Denver, Colorado, 2018-2019. BMC Public Health 2024; 24:1159. [PMID: 38664800 PMCID: PMC11044435 DOI: 10.1186/s12889-024-18681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The number of people experiencing unsheltered homelessness in the U.S. is increasing. Municipalities have responded with punitive responses such as involuntary displacement (i.e., encampment sweeps, move along orders), but little is known about the impact of involuntary displacement on health. The purpose of this study was to investigate the association between broadly defined experiences of involuntary displacement and self-reported health conditions among people experiencing homelessness. METHODS We used logistic regression models to generate odds ratios using publicly available data from a cross-sectional sample of people experiencing homelessness in Denver, Colorado, during September 2018-February 2019. Hosmer-Lemeshow Goodness of Fit tests were used to assess model fit. RESULTS Among 397 people experiencing homelessness, involuntary displacement was significantly associated with self-reported infectious diseases (adjusted odds ratio (aOR) 2.09, 95% CI 1.27, 3.41), substance and alcohol use (aOR 2.83; 95% CI 1.70, 4.73), climate-related conditions (aOR 2.27; 95% CI 1.35, 3.83), and worsening mental health (aOR 2.00; 95% CI 1.24, 3.24) after controlling for potential confounders. No statistically significant associations were identified between involuntary displacement and injuries, musculoskeletal issues, chronic conditions, and chronic mental and emotional issues. CONCLUSIONS This research quantifies the association between involuntary displacement and multiple infectious and non-infectious health outcomes. While city officials attempt to grapple with increasing unsheltered homelessness, it is important to understand what harms are occurring that are associated with current policies. Our research adds to the growing body of literature that involuntary displacement is a harmful response to unsheltered homelessness. Alternative approaches focused on connections to housing and social services should be prioritized.
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Affiliation(s)
- Ashley A Meehan
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | | | - Michael Bien
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samantha K Nall
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katherine Diaz Vickery
- Health, Homelessness, & Criminal Justice Lab, Hennepin Health Care Research Institute, Minneapolis, MN, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
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Foster M, Fix GM, Hyde J, Dunlap S, Byrne TH, Sugie NF, Kuhn R, Gabrielian S, Roncarati JS, Zhao S, McInnes DK. Capturing the Dynamics of Homelessness Through Ethnography and Mobile Technology: Protocol for the Development and Testing of a Smartphone Technology-Supported Intervention. JMIR Res Protoc 2024; 13:e53022. [PMID: 38648101 DOI: 10.2196/53022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/23/2024] [Accepted: 02/22/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND US military veterans who have experienced homelessness often have high rates of housing transition. Disruptions caused by these transitions likely exacerbate this population's health problems and interfere with access to care and treatment engagement. Individuals experiencing homelessness increasingly use smartphones, contributing to improved access to medical and social services. Few studies have used smartphones as a data collection tool to systematically collect information about the daily life events that precede and contribute to housing transitions, in-the-moment emotions, behaviors, geographic movements, and perceived social support. OBJECTIVE The study aims to develop and test a smartphone app to collect longitudinal data from veterans experiencing homelessness (VEH) and to evaluate the feasibility and acceptability of using the app in a population that is unstably housed or homeless. METHODS This study's design had 3 phases. Phase 1 used ethnographic methods to capture detailed data on day-to-day lived experiences of up to 30 VEH on topics such as housing stability, health, and health behaviors. Phase 2 involved focus groups and usability testing to develop and refine mobile phone data collection methods. Phase 3 piloted the smartphone mobile data collection with 30 VEH. We included mobile ethnography, real-time surveys through an app, and the collection of GPS data in phase 3. RESULTS The project was launched in June 2020, and at this point, some data collection and analysis for phases 1 and 2 are complete. This project is currently in progress. CONCLUSIONS This multiphase study will provide rich data on the context and immediate events leading to housing transitions among VEH. This study will ensure the development of a smartphone app that will match the actual needs of VEH by involving them in the design process from the beginning. Finally, this study will offer important insights into how best to develop a smartphone app that can help intervene among VEH to reduce housing transitions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53022.
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Affiliation(s)
- Marva Foster
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- Department of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Gemmae M Fix
- Department of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Justeen Hyde
- Department of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Shawn Dunlap
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Thomas H Byrne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
- Department of Social Welfare Policy, Boston University School of Social Work, Boston, MA, United States
| | - Naomi F Sugie
- Department of Criminology, Law and Society, University of California Irvine, Irvine, CA, United States
| | - Randall Kuhn
- Department of Community Health Services, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Sonya Gabrielian
- Department of Mental Health, VA Greater Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Jill S Roncarati
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, United States
- Boston Health Care for the Homeless Program, Boston, MA, United States
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
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So M, Davis L, Barnes AJ, Freese R, Atella J, Shlafer RJ. Health and care utilization among youth with a history of parental incarceration and homelessness. Fam Syst Health 2024; 42:90-100. [PMID: 37498706 DOI: 10.1037/fsh0000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Despite widespread recognition of the health and social risks posed by parental incarceration (PI) and homelessness, these challenges are rarely considered in unison. We sought to (a) assess the experiences of homelessness among youth with and without a history of PI and (b) compare the health and healthcare utilization among youth with a combined history of PI and homelessness. METHOD Examining data from eighth-, ninth-, and 11th-grade public school participants in the 2019 Minnesota Student Survey (N = 110,904), we calculated univariate and multivariate analyses to characterize the health status and care utilization of youth who have experienced PI, past-year homelessness, or both. RESULTS We observed higher prevalence of homelessness among youth with a history of PI compared to those without. The group with dual PI-homelessness experience had a higher proportion of youth that were younger, male, and non-White; and living in poverty or urban areas compared to youth with PI history only. Even after accounting for demographic factors, the dual PI-homelessness group evidenced higher expected odds for several physical health conditions (e.g., asthma, diabetes), and differences in care utilization indicators relative to individual PI and homelessness groups. DISCUSSION Findings suggest that PI may be overrepresented among recently homeless youth and that youth with such dual experience possess distinct, and often elevated, health service needs. Health, education, housing, and other systems may need intersectoral strategies to better identify and support this at-risk subset of youth through clinical and policy approaches. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Marvin So
- University of Minnesota Medical School
| | - Laurel Davis
- Department of Pediatrics, University of Minnesota Medical School
| | - Andrew J Barnes
- Department of Pediatrics, University of Minnesota Medical School
| | - Rebecca Freese
- Clinical and Translational Science Institute, University of Minnesota
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Porchak E, Oudshoorn A, Modanloo S, Gilliland J, McLean S, Thuemler N, Ariba O, Rolfe S. Permanent Supportive Housing for Those Experiencing Chronic Homelessness with High Health or Social Support Needs: A Scoping Review. J Health Care Poor Underserved 2023; 34:1178-1209. [PMID: 38661750 DOI: 10.1353/hpu.2023.a912712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Some populations have increased risks of experiencing chronic homelessness related to complex health and social needs combined with system failures. Permanent supportive housing (PSH) may improve housing and health outcomes for this population. To understand the scope of the literature on PSH, this scoping review uses Arksey and O'Malley's methodological framework enhanced by Levac and the Joanna Briggs Institute. A search was conducted across multiple databases for existing research on PSH. Forty-one studies were included, and five themes were generated: PSH sustains housing for most people; PSH is costly to implement, but costs can be recouped; PSH facilitates belonging and safety; single-site programs have social challenges but also provide efficiency and improve social networks; and visible on-site staff fundamentally helps those with highest support needs. Permanent supportive housing has been shown to be effective for those with the highest health and social support needs and is required to help prevent and end homelessness.
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Moorkath F, Vranda MN, Naveen Kumar C. Eventful past, stagnant present, and hopeful future: A time order analysis of experiences of homeless women with chronic mental illness residing in shelter care homes. Int J Soc Psychiatry 2022; 68:1790-1794. [PMID: 34865542 DOI: 10.1177/00207640211060148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In developing countries like India, many women with mental illness are residing in shelter care homes (SCHs) without their wish. SCHs are residential facilities provided to the socially and economically backward women for free of cost. These facilities are funded by government or voluntary organizations. AIM To understand the living experiences of homeless women with chronic mental illness (HWCMI) admitted in SCHs. METHOD This article highlights learning from a qualitative study, 17 HWCMI participated in the research. Along with their past experiences, present life, and expectations in the future, other socio-demographic details also recorded. Qualitative data were analyzed using thematic analysis approach with the Atlas ti-8 software. Findings: Three main themes were emerged from the analysis such as 'Eventful past', 'Stagnant present', and 'Hopeful future'. The theme 'Eventful past' shows clear pathways to homelessness. 'Stagnant present' reflects upon trapped present life and their concerns and care-related aspects. The final theme, 'hopeful future', depicts strong hope in future and readiness for changing their living situations. The findings are discussed in the background of current trends in psychiatric rehabilitation and what is lacking in the Indian context. CONCLUSION This study attempts to unveil the gender-specific and person-centric explanations of experiences associated with the combination of homelessness and mental illness.
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Affiliation(s)
- Febna Moorkath
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mysore Narasimha Vranda
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Babulal GM, Rani R, Adkins-Jackson P, Pearson AC, Williams MM. Associations between Homelessness and Alzheimer's Disease and Related Dementia: A Systematic Review. J Appl Gerontol 2022; 41:2404-2413. [PMID: 35750476 PMCID: PMC10018777 DOI: 10.1177/07334648221109747] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The homeless population in the United States is rapidly aging, with a parallel increase in Alzheimer's disease and related dementia (ADRD). During an evolving pandemic that jeopardizes employment and housing, assessing the relationship between ADRD and homelessness is critical since the latter is potentially intervenable. The objective of this study is to review the literature and determine whether there is an association between homelessness and dementia risk. A systematic review of existing studies was conducted through PubMED, SCOPUS, and EMBASE among others. Of the 228 results found, nine met inclusion criteria. Homeless studies mainly centered on veteran populations (n = 6/9). There is a complex relationship suggesting homelessness as a risk for and consequence of ADRD but also co-occurrence with psychiatric disorders, substance abuse, and traumatic injuries. Future studies should employ enumeration surveys with modular longitudinal tracking and measure social determinants of health, discrimination, chronic stress, and mood disorders.
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Affiliation(s)
- Ganesh M. Babulal
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rohan Rani
- Department of Molecular and Cellular Biology, University of California Santa Barbara, Santa Barbara, CA, USA
| | | | - Adam C. Pearson
- Peter & Paul Community Services, St. Louis, MO, USA
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Monique M. Williams
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
- New Horizons PACE, St. Louis, MO, USA
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Dost K, Heinrich F, Graf W, Brennecke A, Kowalski V, Leider A, Kraus A, van Rüth V, Ondruschka B, Püschel K, König HH, Bertram F, Hajek A. Predictors of Loneliness among Homeless Individuals in Germany during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:12718. [PMID: 36232018 PMCID: PMC9566392 DOI: 10.3390/ijerph191912718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim of the study was to identify the frequency of loneliness and to examine the factors associated with loneliness among homeless individuals in Germany during the COVID-19 pandemic. METHODS Data were taken from the 'national survey on the psychiatric and somatic health of homeless individuals during the COVID-19 pandemic'. The data collection took place from 26th July to 17th September 2021 (the analytical sample included n = 491 observations). The well-established UCLA-3 tool was used to quantify loneliness. Independent variables included sex, age, marital status, the existence of children and pets, level of education, country of origin, duration of homelessness, alcohol and drug consumption, mental health concerns and concerns regarding COVID-19 illness. Multiple logistic regressions were used to examine the predictors of loneliness. RESULTS The frequency of loneliness was 41.7% for the total sample. Multiple logistic regression analysis stratified by gender showed that a higher likelihood of loneliness was associated with being born in Germany, being middle aged (40 to 49 years compared to 18 to 29 years), having mental health problems and a short period of homelessness (1 month compared to longer periods) among women. In men, a higher likelihood of loneliness was associated with a higher fear of COVID-19 and a short period of homelessness. CONCLUSIONS Our study revealed a high frequency rate of loneliness among homeless individuals. The study results highlight the associations between some explanatory variables (i.e., the duration of homelessness and mental health problems). Identifying the factors associated with loneliness may help to adequately address the problems of homeless individuals at risk of loneliness. Longitudinal studies are required to confirm our findings.
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Affiliation(s)
- Katharina Dost
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Fabian Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Wiebke Graf
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Anna Brennecke
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Veronika Kowalski
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Anna Leider
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Anika Kraus
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Victoria van Rüth
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Franziska Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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13
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Thulien NS, Amiri A, Hwang SW, Kozloff N, Wang A, Akdikmen A, Roglich J, Nisenbaum R. Effect of Portable Rent Subsidies and Mentorship on Socioeconomic Inclusion for Young People Exiting Homelessness: A Community-Based Pilot Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2238670. [PMID: 36301546 PMCID: PMC9614573 DOI: 10.1001/jamanetworkopen.2022.38670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE There have been no published randomized clinical trials with a primary outcome of socioeconomic inclusion for young people who have experienced homelessness. OBJECTIVE To explore whether young people exiting homelessness who received rent subsidies and adult mentorship experienced more socioeconomic inclusion relative to young people who received only rent subsidies. DESIGN, SETTING, AND PARTICIPANTS This was a convergent mixed-methods, unblinded, 2-group, parallel randomized clinical trial with 1:1 allocation embedded within a community-based framework in 3 cities in Ontario, Canada. Participants were enrolled between March 1 and September 30, 2019, and were followed up through March 31, 2022. INTERVENTIONS Participants (n = 24) were randomly assigned adult mentors (n = 13) who had been recruited and screened by community partner agencies. All participants received portable rent subsidies (subsidy not tied to a specific location) for 2 years. MAIN OUTCOMES AND MEASURES Primary quantitative outcomes were self-reported measures of community integration (psychological and physical) and self-esteem-proxy indicators of socioeconomic inclusion. Community integration was measured with the Community Integration Scale, with a score range of 1 to 7 for the physical component and 4 to 20 for the psychological component; higher scores indicate higher integration. Self-esteem was measured with the Rosenberg Self-Esteem Scale, with a score range of 0 to 30; higher scores indicate greater self-esteem. Secondary quantitative outcomes included social connectedness, hopelessness, and academic and vocational participation. All analyses followed the intention-to-treat principle. RESULTS A total of 24 youths (12 women [50.0%]; mean [SD] age, 21.8 [2.2] years [range, 18-26 years]; race and ethnicity: 10 White [41.7%], 8 Black [33.3%], 2 Asian [8.3%], 2 Indigenous [8.3%], and 2 different choice [8.3%]) transitioned out of homelessness and into market-rent housing. All youths in the group that received mentorship and in the group that did not receive mentorship had stable or nonsignificant improvements in all study outcomes at the primary end point of 18 months compared with baseline (mean [SD] Community Integration Scale psychological score: mentorship group, 11.3 [2.6] at baseline and 11.2 [3.9] at 18 months; no-mentorship group, 10.8 [4.1] at baseline and 13.2 [2.9] at 18 months; mean [SD] Rosenberg Self-Esteem Scale score: mentorship group, 16.0 [4.6] at baseline and 18.1 [5.2] at 18 months; no-mentorship group, 16.3 [6.1] at baseline and 19.6 [5.7] at 18 months). However, there were no significant differences between the 2 groups in the Community Integration Scale psychological score (adjusted mean difference, -2.0; 95% CI, -5.0 to 1.0; P = .18) and Rosenberg Self-Esteem Scale score (adjusted mean difference, -1.4; 95% CI, -5.0 to 2.3; P = .44) 18 months after randomization. Ancillary analysis suggested that youths with informal mentors (mentors outside the study) at baseline felt more psychologically integrated at 18 months relative to those with no informal mentors at baseline (adjusted mean difference, 3.6; 95% CI, 0.4-6.8; P = .03). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, COVID-19 pandemic-related restrictions made it challenging for mentors and mentees to connect, which may have affected the findings. Steady socioeconomic outcomes-potentially attributable to portable rent subsidies-are noteworthy, given the socioeconomic inequities this population has faced during the COVID-19 pandemic. The possible benefit of informal mentorship warrants further investigation. This small pilot study was designed with the intention of generating data and hypotheses for a full-scale study; findings should be interpreted with caution. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03779204.
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Affiliation(s)
- Naomi S. Thulien
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Amiri
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrea Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- School of Medicine, Boston University, Boston, Massachusetts
| | - Alex Akdikmen
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Julia Roglich
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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14
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Barnes H. The challenges homeless people face when accessing end-of-life care: what district nurses need to know. Br J Community Nurs 2022; 27:498-503. [PMID: 36194402 DOI: 10.12968/bjcn.2022.27.10.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
People experiencing homelessness have poorer physical and mental health compared with the rest of the population. Mortality rates are significantly higher, yet there is a dearth in suitable places for the delivery of palliative and end-of-life (EOL) care. Homeless people are being failed by the current healthcare system. The stigma associated with being homeless negatively impacts these marginalised people, affecting care given from healthcare professionals (HCP). Services are often inflexible and have little tolerance for substance misuse. District Nurses (DN) are often experienced EOL care practitioners and well-placed to give person-centred care with a focus on collaborative decision-making. However, many homeless people die without input from DNs or specialist palliative support. It is important to understand why this is happening to address what can be done to help.
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Affiliation(s)
- Helen Barnes
- District Nurse, Bolton NHS Foundation Trust, Greater Manchester
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15
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Lio G, Ghazzai M, Haesebaert F, Dubreucq J, Verdoux H, Quiles C, Jaafari N, Chéreau-Boudet I, Legros-Lafarge E, Guillard-Bouhet N, Massoubre C, Gouache B, Plasse J, Barbalat G, Franck N, Demily C. Actionable Predictive Factors of Homelessness in a Psychiatric Population: Results from the REHABase Cohort Using a Machine Learning Approach. Int J Environ Res Public Health 2022; 19:12268. [PMID: 36231571 PMCID: PMC9565981 DOI: 10.3390/ijerph191912268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a lack of knowledge regarding the actionable key predictive factors of homelessness in psychiatric populations. Therefore, we used a machine learning model to explore the REHABase database (for rehabilitation database-n = 3416), which is a cohort of users referred to French psychosocial rehabilitation centers in France. METHODS First, we analyzed whether the different risk factors previously associated with homelessness in mental health were also significant risk factors in the REHABase. In the second step, we used unbiased classification and regression trees to determine the key predictors of homelessness. Post hoc analyses were performed to examine the importance of the predictors and to explore the impact of cognitive factors among the participants. RESULTS First, risk factors that were previously found to be associated with homelessness were also significant risk factors in the REHABase. Among all the variables studied with a machine learning approach, the most robust variable in terms of predictive value was the nature of the psychotropic medication (sex/sex relative mean predictor importance: 22.8, σ = 3.4). Post hoc analyses revealed that first-generation antipsychotics (15.61%; p < 0.05 FDR corrected), loxapine (16.57%; p < 0.05 FWER corrected) and hypnotics (17.56%; p < 0.05 FWER corrected) were significantly associated with homelessness. Antidepressant medication was associated with a protective effect against housing deprivation (9.21%; p < 0.05 FWER corrected). CONCLUSIONS Psychotropic medication was found to be an important predictor of homelessness in our REHABase cohort, particularly loxapine and hypnotics. On the other hand, the putative protective effect of antidepressants confirms the need for systematic screening of depression and anxiety in the homeless population.
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Affiliation(s)
- Guillaume Lio
- Centre d’Excellence Autisme iMIND, pôle HU-ADIS, Hôpital le Vinatier, 69678 Bron, France
- Equipe «Disorders of the Brain», Institut Marc Jeannerod, UMR 5229, CNRS & Université Lyon 1, 69100 Villeurbanne, France
| | - Malek Ghazzai
- Centre d’Excellence Autisme iMIND, pôle HU-ADIS, Hôpital le Vinatier, 69678 Bron, France
| | | | - Julien Dubreucq
- Centre Hospitalier Universitaire de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Hélène Verdoux
- Hôpital Charles Perrens, Université de Bordeaux, 33405 Talence, France
| | - Clélia Quiles
- Hôpital Charles Perrens, Université de Bordeaux, 33405 Talence, France
| | - Nemat Jaafari
- CREATIV & URC Pierre Deniker, Centre Hospitalier Laborit, Université de Poitiers, 86000 Poitiers, France
| | - Isabelle Chéreau-Boudet
- Centre Référent Conjoint de Réhabilitation (CRCR), Centre Hospitalier Universitaire de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Emilie Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), 87000 Limoges, France
| | | | - Catherine Massoubre
- Centre Hospitalier Universitaire de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
- Faculté de Médecine, Université de Saint-Etienne, 42023 Saint-Etienne, France
| | | | - Julien Plasse
- Pôle Centre Rive Gauche, Hôpital Le Vinatier, 69678 Bron, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), CH le Vinatier et Institut Marc Jeannerod, UMR 5229 & Université Lyon 1, 69100 Bron, France
| | - Guillaume Barbalat
- Pôle Centre Rive Gauche, Hôpital Le Vinatier, 69678 Bron, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), CH le Vinatier et Institut Marc Jeannerod, UMR 5229 & Université Lyon 1, 69100 Bron, France
| | - Nicolas Franck
- Pôle Centre Rive Gauche, Hôpital Le Vinatier, 69678 Bron, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), CH le Vinatier et Institut Marc Jeannerod, UMR 5229 & Université Lyon 1, 69100 Bron, France
| | - Caroline Demily
- Centre d’Excellence Autisme iMIND, pôle HU-ADIS, Hôpital le Vinatier, 69678 Bron, France
- Equipe «Disorders of the Brain», Institut Marc Jeannerod, UMR 5229, CNRS & Université Lyon 1, 69100 Villeurbanne, France
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16
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Jeffers A, Meehan AA, Barker J, Asher A, Montgomery MP, Bautista G, Ray CM, Laws RL, Fields VL, Radhakrishnan L, Cha S, Christensen A, Dupervil B, Verlenden JV, Cassell CH, Boyer A, DiPietro B, Cary M, Yang M, Mosites E, Marcus R. Impact of Social Isolation during the COVID-19 Pandemic on Mental Health, Substance Use, and Homelessness: Qualitative Interviews with Behavioral Health Providers. Int J Environ Res Public Health 2022; 19:12120. [PMID: 36231422 PMCID: PMC9566547 DOI: 10.3390/ijerph191912120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
The United States is experiencing a syndemic of homelessness, substance use disorder, and mental health conditions, which has been further exacerbated by the COVID-19 pandemic. Although it is expected that mitigation strategies will curb community transmission of COVID-19, the unintended consequences of social isolation on mental health and substance use are a growing public health concern. Awareness of changing mental health and substance use treatment needs due to the pandemic is critical to understanding what additional services and support are needed during and post-pandemic, particularly among people experiencing homelessness who have pre-existing serious mental illness or substance use disorder. To evaluate these effects and support our understanding of mental health and substance use outcomes of the COVID-19 pandemic, we conducted a qualitative study where behavioral health providers serving people experiencing homelessness described the impact of COVID-19 among their clients throughout the United States. Behavioral health providers shared that experiencing social isolation worsened mental health conditions and caused some people to return to substance use and fatally overdose. However, some changes initiated during the pandemic resulted in positive outcomes, such as increased client willingness to discuss mental health topics. Our findings provide additional evidence that the social isolation experienced during the pandemic has been detrimental to mental health and substance use outcomes, especially for people experiencing homelessness.
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Affiliation(s)
- Alexiss Jeffers
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Ashley A. Meehan
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Jordan Barker
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
- Oak Ridge Institute for Science and Education (ORISE) Fellow, Oak Ridge Associated Universities, 100 Orau Way, Oak Ridge, TN 37830, USA
| | - Alice Asher
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Martha P. Montgomery
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Greg Bautista
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Colleen M. Ray
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Rebecca L. Laws
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Victoria L. Fields
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Lakshmi Radhakrishnan
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Susan Cha
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Aleta Christensen
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Brandi Dupervil
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Jorge V. Verlenden
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Cynthia H. Cassell
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Alaina Boyer
- National Healthcare for the Homeless Council, 604 Gallatin Ave, Nashville, TN 37206, USA
| | - Barbara DiPietro
- National Healthcare for the Homeless Council, 604 Gallatin Ave, Nashville, TN 37206, USA
| | - Margaret Cary
- Oregon Health Authority, 500 Summer Street NE, Salem, OR 97301, USA
| | - Maria Yang
- Downtown Emergency Service Center, 515 3rd Ave, Seattle, WA 98114, USA
| | - Emily Mosites
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
| | - Ruthanne Marcus
- Centers for Disease Control and Prevention COVID-19 Emergency Response, 1600 Clifton Rd., Atlanta, GA 30329, USA
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17
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Taparra K, Egan A, Kanagusuku L. Mental Health and Substance Use Among US Homeless Adolescents. JAMA 2022; 328:889-890. [PMID: 36066525 DOI: 10.1001/jama.2022.11622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Stanford Health Care, Stanford, California
| | - Alana Egan
- Department of Clinical Psychology, University of Rhode Island, Kingston
| | - Leimomi Kanagusuku
- Department of Family Medicine and Community Health, University of Hawai'i, Aiea
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18
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Liu M, Wadhera RK. Mental Health and Substance Use Among US Homeless Adolescents-Reply. JAMA 2022; 328:890. [PMID: 36066522 DOI: 10.1001/jama.2022.11625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, Massachusetts
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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19
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Chikwava F, O’Donnell M, Ferrante A, Pakpahan E, Cordier R. Patterns of homelessness and housing instability and the relationship with mental health disorders among young people transitioning from out-of-home care: Retrospective cohort study using linked administrative data. PLoS One 2022; 17:e0274196. [PMID: 36054257 PMCID: PMC9439254 DOI: 10.1371/journal.pone.0274196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The study examined the relationship between mental health, homelessness and housing instability among young people aged 15–18 years old who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia with follow-up to 2018. We determined the various mental health disorders and other predictors that were associated with different levels of homelessness risk, including identifying the impact of dual diagnosis of mental health and substance use disorder on homelessness. Methodology Using retrospective de-identified linked administrative data from various government departments we identified various dimensions of homelessness which were mapped from the European Topology of Homelessness (ETHOS) framework and associated mental health variables which were determined from the WHO ICD-10 codes. We used ordered logistic regression and Poisson regression analysis to estimate the impact of homelessness and housing instability respectively. Results A total homelessness prevalence of 60% was determined in the care-leaving population. After adjustment, high risk of homelessness was associated with dual diagnosis of mental health and substance use disorder, intentional self-harm, anxiety, psychotic disorders, assault and maltreatment, history of involvement with the justice system, substance use prior to leaving care, residential and home-based OHC placement and a history of staying in public housing. Conclusions There is clearly a need for policy makers and service providers to work together to find effective housing pathways and integrated health services for this heterogeneous group of vulnerable young people with complex health and social needs. Future research should determine longitudinally the bidirectional relationship between mental health disorders and homelessness.
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Affiliation(s)
- Fadzai Chikwava
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa O’Donnell
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Anna Ferrante
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Eduwin Pakpahan
- Department of Mathematics, Physics & Electrical Engineering, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Reinie Cordier
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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20
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Bower M, Gournay K, Perz J, Conroy E. Do we all experience loneliness the same way? Lessons from a pilot study measuring loneliness among people with lived experience of homelessness. Health Soc Care Community 2022; 30:e1671-e1677. [PMID: 34595795 DOI: 10.1111/hsc.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 08/11/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Loneliness research has tended to focus on mainstream and older populations despite evidence that non-mainstream groups, like those experiencing homelessness, may experience loneliness differently. Limited existing research indicates that (a) people who have been homeless experience loneliness as multidimensional (as a pluralistic, non-unidimensional emotion, experienced specific to lacked relationships) and (b) mainstream loneliness scales may be inappropriate for this group. The current study piloted and appraised the feasibility the short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S) among 129 Australian adults with a lived experience of homelessness. Exploratory Factor Analysis and an observational questionnaire appraisal were used to assess factorial and content validity and showed the measure did not fit this sample as well as in mainstream samples. Removal of items that participants found difficult to comprehend/answer improved the factorial fit of the scale. In conclusion, the SELSA-S may be inappropriate for measuring loneliness among people who have experienced homelessness. Further research needs to explore the potentially different structure of loneliness among marginalised groups so that a better understanding of loneliness can be reached.
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Affiliation(s)
- Marlee Bower
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Kevin Gournay
- Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Elizabeth Conroy
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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21
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Ghatak S, Guchhait SK. The perspective of homeless space in the railway stations of India: A critical understanding through inter-personal network analysis. Health Soc Care Community 2022; 30:e1678-e1689. [PMID: 34596299 DOI: 10.1111/hsc.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/11/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
There is a global recognition that the homeless in different clusters are isolated social groups. They are highly susceptible to loneliness and related psycho-physical health outcomes owing to their less supportive and fragmented social networks. The conditions are worse in the case of chronic or lifetime homelessness. Beyond this popular notion, other critical perspectives are also there. This paper attempts to analyse the differences in inter-personal social networks between the chronic and the non-chronic homeless groups at a railway junction in India. The data have been collected through structured and semi-structured questionnaires from 28 homeless people (15 chronically and 13 non-chronically homeless) of Burdwan Railway Junction - a vital railway junction of West Bengal, India. The chronically homeless group displays more supportive and compact inter-personal networks in this study than the non-chronic homeless group. Living in the station area for a long time, they have formed a society of their own. Barring some psychological stress and social abuse, the livelihood scenario of these people is relatively stress-free and social networks relations are more intensive and supportive. Considering the outcomes, instead of the housing-first approach of rehabilitation, we favour the development of community shelters with minimum basic amenities close to their present location.
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Affiliation(s)
- Subhajit Ghatak
- Department of Geography, The University of Burdwan, Burdwan, India
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22
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Kaur S, Jagpal P, Paudyal V. Provision of services to persons experiencing homelessness during the COVID-19 pandemic: A qualitative study on the perspectives of homelessness service providers. Health Soc Care Community 2022; 30:e1805-e1814. [PMID: 34668258 PMCID: PMC8653035 DOI: 10.1111/hsc.13609] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 05/22/2023]
Abstract
This study aimed to explore the perspectives of homelessness service providers on the impact of the COVID-19 pandemic on service provision, barriers encountered and learning for the future. Semi-structured online interviews were conducted with homelessness service providers (n = 15) identified through the network of homelessness services operating within the United Kingdom. Data were transcribed verbatim and analysed thematically using framework technique. Six key themes were identified including the impact of the pandemic on health and well-being of persons experiencing homelessness (PEH); the changing needs of service users during the pandemic; impact of emergency provision of housing support on services offered; service adaptations; sustainability of services and learnings from the pandemic. Participants described that being able to offer accommodation through government schemes provided protection to PEH through 'wrap-around support'. The pandemic was deemed to have precipitated change and developed resilience in some services. However, lack of resources, donations and sponsors during the pandemic constrained the services forcing many to close or offer reduced services. Reduced face-to-face contact with PEH and lack of ability to offer skills sessions led to the exacerbation of mental health concerns amongst clients. The pandemic was also identified to have encouraged positive relationship building between clients and service providers, better communications between service providers and effective housing of PEH. There is a need to address the barriers, sustain the positive learnings and enable organisations and PEH to adapt to the transition when transient and emergency support from the government and local councils ends.
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Affiliation(s)
- Simran Kaur
- School of PharmacyInstitute of Clinical SciencesUniversity of BirminghamBirminghamUK
| | - Parbir Jagpal
- School of PharmacyInstitute of Clinical SciencesUniversity of BirminghamBirminghamUK
| | - Vibhu Paudyal
- School of PharmacyInstitute of Clinical SciencesUniversity of BirminghamBirminghamUK
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Straka K, Blacketer AR, Martinez RL, Glover A, Winiarski DA, Karnik NS, Schueller SM, Zalta AK. Rates and correlates of well-being among youth experiencing homelessness. J Community Psychol 2022; 50:3746-3759. [PMID: 35460583 PMCID: PMC9464689 DOI: 10.1002/jcop.22869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Mental health concerns have been well studied among youth experiencing homelessness, yet few studies have explored factors that contribute to well-being in this population. The current cross-sectional study examined rates and correlates of well-being among youth experiencing homelessness. This is a descriptive, secondary analysis of the baseline data from a clinical intervention study. Ninety-nine youth (aged 16-25) who were experiencing homelessness were recruited in Chicago. Approximately 40% of the sample reported average or above average well-being relative to existing benchmarks. Having medical insurance, a mobile phone, and a history of more severe childhood trauma were unique cross-sectional predictors of worse well-being (all ps < 0.034). A significant portion of our sample experienced well-being. Having access to certain resources may be counterintuitive indicators of poorer well-being among youth experiencing homelessness, perhaps because they are indicators of greater need or increased social comparison among these youth.
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Affiliation(s)
- Kelci Straka
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Alexis R. Blacketer
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Ramona L. Martinez
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Angela Glover
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Dominika A. Winiarski
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Niranjan S. Karnik
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Stephen M. Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Alyson K. Zalta
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Mostert F, Greeff AP. Experiences of homeless men in an affluent town in South Africa. J Community Psychol 2022; 50:3387-3401. [PMID: 35322437 DOI: 10.1002/jcop.22842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
The aim of this study was to explore experiences of homelessness in an affluent university town. Seven homeless men were recruited at a welfare program for homeless people to participate in in-depth, semistructured interviews that explored their experiences of homelessness in the town. The ages of the participants ranged from 36 to 52 years. There were three White participants, two of mixed race, and two Black participants. Thematic analysis was used to analyze the data, from a bottom-up systems perspective. The results revealed some of the participants' drug-related experiences, their structural experiences (e.g., shelter policy, low wages, and the poverty trap), their social experiences (e.g., the loss of their families and the lack of social standards in the homeless community), and their psychological experiences (i.e., fatalism, complacency, and responsibility). Subsidized housing and social grants are unlikely to effectively address the homelessness of men if other components of their experience, such as their drug-related experiences, their structural experiences, their social experiences, and their psychological experiences, are not attended to.
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Affiliation(s)
- Frederik Mostert
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Abraham P Greeff
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Noble A, Owens B, Thulien N, Suleiman A. “I feel like I’m in a revolving door, and COVID has made it spin a lot faster”: The impact of the COVID-19 pandemic on youth experiencing homelessness in Toronto, Canada. PLoS One 2022; 17:e0273502. [PMID: 35994505 PMCID: PMC9394800 DOI: 10.1371/journal.pone.0273502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
Research has shown that youth experiencing homelessness (YEH) face barriers to social inclusion and are at risk for poor mental health. With the COVID-19 pandemic threatening the health, wellbeing, and economic circumstances of people around the world, this study aims to assess the impacts of the pandemic on YEH in Toronto, Ontario, as well as to identify recommendations for future waves of COVID-19.
Methods
Semi-structured interviews were conducted with YEH (ages 16–24, n = 45) and staff who work in one of four downtown emergency shelters for youth (n = 31) in Toronto, Ontario.
Results
YEH experienced both structural changes and psychosocial impacts resulting from the pandemic. Structural changes included a reduction in services, barriers to employment and housing, and changes to routines. Psychosocial outcomes included isolation, worsened mental health, and increased substance use. Impacts were magnified and distinct for subpopulations of youth, including for youth that identified as Black, 2SLGBTQ+, or those new to Canada.
Conclusions
The COVID-19 pandemic increased distress among YEH while also limiting access to services. There is therefore a need to balance health and safety with continued access to in-person services, and to shift the response to youth homelessness to focus on prevention, housing, and equitable supports for subpopulations of youth.
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Affiliation(s)
- Amanda Noble
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Research and Evaluation Department, Covenant House Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Benjamin Owens
- Research and Evaluation Department, Covenant House Toronto, Toronto, Ontario, Canada
| | - Naomi Thulien
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Suleiman
- Research and Evaluation Department, Covenant House Toronto, Toronto, Ontario, Canada
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Damian AJ, Ponce D, Ortiz-Siberon A, Kokan Z, Curran R, Azevedo B, Gonzalez M. Understanding the Health and Health-Related Social Needs of Youth Experiencing Homelessness: A Photovoice Study. Int J Environ Res Public Health 2022; 19:ijerph19169799. [PMID: 36011440 PMCID: PMC9408072 DOI: 10.3390/ijerph19169799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 05/16/2023]
Abstract
PURPOSE Homelessness is a major public health problem facing millions of youths across the United States (U.S.), with lesbian gay, bisexual, transgender, questioning (LGBTQ+) youths and youths of color being disproportionately at higher risk. This study obtains an understanding of the health and health-related social needs of youths experiencing homelessness during the coronavirus disease (COVID-19) pandemic. METHODS A total of 14 youths between the ages of 14 and 24 who (a) lived, worked, or attended school in New Britain, Connecticut (CT) and (b) had at least one experience of homelessness or housing insecurity worked with the research team to conduct a needs assessment regarding youth homelessness. Using photovoice, a community-based participatory research method, participants created photo narratives to share their stories and recommendations for community change. The main goals of photovoice are to enable participants to (1) record and represent their everyday realities; (2) promote critical dialogue and knowledge about person and community strengths and concerns; and (3) reach policy makers. RESULTS Most of the participants identified as youths of color, and half of the participants identified as members of the LGBTQ+ community. Three major themes that appeared in the youths' narratives include the following: mental health and substance use challenges, trouble accessing basic human needs, and lack of a social support system. CONCLUSION This study uplifts and empowers a vulnerable population to increase visibility around a major public health challenge from their own lived experiences. Despite the challenges that were voiced, many participants shared a sense of hope and resiliency. The major themes endorsed by the youths has the potential of informing practitioners and policy makers of how to better address the needs of youths experiencing homelessness, particularly those most at risk.
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Affiliation(s)
- April Joy Damian
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
- Correspondence:
| | - Delilah Ponce
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Angel Ortiz-Siberon
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
| | - Zeba Kokan
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
| | - Ryan Curran
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
| | - Brandon Azevedo
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
| | - Melanie Gonzalez
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
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Patterson JG, Macisco JM, Glasser AM, Wermert A, Nemeth JM. Psychosocial factors influencing smoking relapse among youth experiencing homelessness: A qualitative study. PLoS One 2022; 17:e0270665. [PMID: 35881608 PMCID: PMC9321375 DOI: 10.1371/journal.pone.0270665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
In the United States, up to 70% of youth experiencing homelessness smoke cigarettes. Many are interested in quitting; however, little is known about psychosocial factors influencing smoking relapse in this population. This study, part of a larger project to develop an optimized smoking cessation intervention for youth experiencing homelessness, aimed to describe how psychosocial factors influence smoking relapse in this group.
Methods
This study describes the smoking relapse experiences of 26 youth tobacco users, aged 14–24 years, who were recruited from a homeless drop-in center in Ohio. We conducted semi-structured interviews to understand how stress, opportunity, and coping contribute to smoking relapse.
Results
Five themes emerged from the data: (1) smoking as a lapse in emotional self-regulation in response to stress; (2) smoking as active emotional self-regulation in response to stress; (3) social opportunities facilitate smoking in the context of emotion-focused stress coping; (4) problem-focused stress coping; and (5) opportunity facilitates smoking relapse.
Conclusions
Stress was a primary driver of smoking relapse among youth experiencing homelessness, yet social and environmental opportunities to smoke also precipitated relapse. Interventions to improve abstinence among this population should target foundational stressors, coping skills, social supports, and nicotine dependence.
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Affiliation(s)
- Joanne G. Patterson
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
- * E-mail:
| | - Joseph M. Macisco
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Allison M. Glasser
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Amy Wermert
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Julianna M. Nemeth
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
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Wrucke B, Bauer L, Bernstein R. Factors Associated with Cigarette Smoking in Homeless Adults: Findings From an Outpatient Counseling Clinic. WMJ 2022; 121:106-110. [PMID: 35857684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Those who are homeless are 4 times more likely to smoke cigarettes than the general population in the United States. Though research has investigated smoking risk factors among homeless individuals, further investigation is needed to understand factors that can be addressed by smoking cessation programs. This study seeks to understand characteristics associated with cigarette use in clients of the counseling clinic at a Midwest homeless shelter, including whether homeless individuals who smoke demonstrate lower self-efficacy, greater social isolation, poorer perception of therapy, and greater levels of chronic homelessness than nonsmokers. METHODS From 2014 through 2019, clients of the counseling clinic were invited to contribute to a data bank. Logistic regression was performed to determine predictors of smoking status. RESULTS No association was identified between smoking status and self-efficacy, social isolation, perception of therapy, or chronic homelessness. Compared to those without a high school degree, odds of being a smoker were 95% lower for those with a high school degree or equivalent and 93% lower for those with more than a high school education. Those with 3 or more episodes of prior substance abuse treatment were more likely to be smokers. CONCLUSION This study demonstrates that cigarette use among the homeless population is associated with low education level and prior substance abuse treatment. Smoking cessation programs would benefit from tailoring information to the education level of their audience. Further study could determine whether use of other substances may contribute to cigarette use in the homeless population and how this may be addressed by smoking cessation programs.
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Affiliation(s)
| | - Lauren Bauer
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rebecca Bernstein
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Khan BM, Reid N, Stergiopoulos V. Advancing recovery education for people experiencing housing instability: A qualitative analysis of service user and provider perspectives in Canada. Health Soc Care Community 2022; 30:1541-1549. [PMID: 34309106 DOI: 10.1111/hsc.13484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/14/2021] [Accepted: 05/29/2021] [Indexed: 06/13/2023]
Abstract
The recovery paradigm is increasingly being adopted within mental health services internationally, to support a process of personal change for affected individuals, with the aim of living a satisfying, hopeful, contributing life within the limitations of mental illness. In efforts to assist the process of recovery, Recovery Education Centres (REC), offering recovery supports through education rather than traditional service models, have been widely implemented; there is limited evidence to date with respect to the experiences and outcomes of disadvantaged populations, such as people experiencing homelessness, with recovery education. This study used qualitative methods to explore the perspectives and experiences of service users and providers of the Supporting Transitions and Recovery (STAR) Learning Centre in Toronto, Canada, focused on supporting the process of recovery for individuals with histories of homelessness. Between July 2017 and June 2018, semistructured interviews with 20 service users, one key informant, and a focus group comprising eight current and former REC staff and volunteers were conducted to explore opportunities to better tailor the curriculum, and key programmatic features, to the needs of the population. Interviews were analysed using inductive thematic analysis. Most participants described favourable experiences with the REC and suggested adding more challenging course content (n = 10) and increasing delivery options (n = 8), highlighting the diversity of participant needs. Others described the importance of improving accessibility through geographic expansion, offering transit subsidies, and using innovative media. In addition, the importance of delivering more courses in partnership with community partners, to maximise reach and impact, was also highlighted (n = 15). This study underscores the importance of engaging service users and providers, including peers, in ongoing adaptations to best serve the target populations. The expertise and lived experience of these key stakeholders offer a unique lens, supporting the process of recovery, through co-production of curriculum content and joint program planning and improvements. Findings can inform REC development for disadvantaged populations and potentially enhance recovery outcomes for those experiencing multiple barriers to recovery.
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Affiliation(s)
- Bushra M Khan
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nadine Reid
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Nelipovich S, Kotagiri N, Afreen E, Craft MA, Allen S, Davitt C, Ruffalo L, Diehr S. Impact Evaluation of Patient-Centered, Community-Engaged Health Modules for Homeless Pregnant Women. WMJ 2022; 121:99-105. [PMID: 35857683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Pregnant women who experience homelessness are at a greater risk for poor birth outcomes than the general population. This pilot study describes results of a service-learning program informed by previously identified unmet perinatal health needs. In this patient-centered service-learning program, medical students partnered with homeless women currently residing in a shelter in Milwaukee, Wisconsin. METHODS Medical students in the Health Advocacy in Pregnancy and Infancy (HAPI) project at the Medical College of Wisconsin developed and taught 6 service-learning modules to shelter residents: healthy cooking, mental health, perinatal nutrition, infant care/safety, breastfeeding, and contraception. Implemented between 2018 and 2021, modules were hosted in person and via electronic videoconferences. We gathered qualitative data on participants' perceived impact of the modules and used grounded theory analysis to examine written comments and verbal feedback. RESULTS A total of 141 participants attended 42 learning sessions. Participants included pregnant and postpartum mothers and women interested in learning about pregnancy-related health. Qualitative analysis revealed 3 universal themes regarding the impact of the sessions on participants: "Knowledge," "Intention to Change," and "Empowerment." CONCLUSIONS Our community-engaged health education partnership program between homeless pregnant women and medical students focused on perinatal health. This well-received, effective strategy cultivated new knowledge, empowering participants to not only change their own behaviors, but to teach and support others. This study demonstrates the ability of using community-based teaching sessions to enhance participants' understanding of pregnancy and postpartum health and empower others to implement changes.
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Affiliation(s)
| | | | - Esha Afreen
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Sara Allen
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Leslie Ruffalo
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sabina Diehr
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Fleming MD, Evans JL, Graham-Squire D, Cawley C, Kanzaria HK, Kushel MB, Raven MC. Association of Shelter-in-Place Hotels With Health Services Use Among People Experiencing Homelessness During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2223891. [PMID: 35895061 PMCID: PMC9331083 DOI: 10.1001/jamanetworkopen.2022.23891] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Some jurisdictions used hotels to provide emergency noncongregate shelter and support services to reduce the risk of COVID-19 infection among people experiencing homelessness (PEH). A subset of these shelter-in-place (SIP) hotel guests were high users of acute health services, and the association of hotel placement with their service use remains unknown. OBJECTIVE To evaluate the association of SIP hotel placements with health services use among a subset of PEH with prior high acute health service use. DESIGN, SETTING, AND PARTICIPANTS This study used a matched retrospective cohort design comparing health services use between PEH with prior high service use who did and did not receive a SIP hotel placement, from April 2020 to April 2021. The setting was 25 SIP hotels in San Francisco, California, with a daily capacity of 2500 people. Participants included PEH who were among the top 10% high users of acute medical, mental health, and substance use services and who had 3 or more emergency department (ED) visits in the 9 months before the implementation of the SIP hotel program. Data analysis for this study was performed from February 2021 to May 2022. EXPOSURES SIP hotel placement with on-site supportive services. MAIN OUTCOMES AND MEASURES The primary outcomes were ED visits, hospitalizations and bed days, psychiatric emergency visits, psychiatric hospitalizations, outpatient mental health and substance use visits, and outpatient medical visits. RESULTS Of 2524 SIP guests with a minimum of 90-day stays, 343 (13.6%) met criteria for high service use. Of 686 participants with high service use (343 SIP group; 343 control), the median (IQR) age was 54 (43-61) years, 485 (70.7%) were male, 283 (41.3%) were Black, and 337 (49.1%) were homeless for more than 10 years. The mean number of ED visits decreased significantly in the high-user SIP group (1.84 visits [95% CI, 1.52-2.17 visits] in the 90 days before SIP placement to 0.82 visits [95% CI, 0.66-0.99 visits] in the 90 days after SIP placement) compared with high-user controls (decrease from 1.33 visits [95% CI, 1.39-1.58 visits] to 1.00 visits [95% CI, 0.80-1.20 visits]) (incidence rate ratio [IRR], 0.60; 95% CI, 0.47-0.75; P < .001). The mean number of hospitalizations decreased significantly from 0.41 (95% CI, 0.30-0.51) to 0.14 (95% CI, 0.09-0.19) for SIP guests vs 0.27 (95% CI, 0.19-0.34) to 0.22 (95% CI, 0.15-0.29) for controls (IRR, 0.41; 95% CI, 0.27-063; P < .001). Inpatient hospital days decreased significantly from a mean of 4.00 (95% CI, 2.44-5.56) to 0.81 (95% CI, 0.40-1.23) for SIP guests vs 2.27 (95% CI, 1.27-3.27) to 1.85 (95% CI, 1.06-2.65) for controls (IRR, 0.25; 95% CI, 0.12-0.54; P < .001), as did psychiatric emergency visits, from a mean of 0.03 (95% CI, 0.01-0.05) to 0.01 (95% CI, 0.00-0.01) visits for SIP guests vs no change in the control group (IRR, 0.25; 95% CI, 0.11-0.51; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that in a population of PEH with high use of acute health services, SIP hotel placement was associated with significantly reduced acute care use compared with high users without a placement.
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Affiliation(s)
| | - Jennifer L. Evans
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco
| | - Dave Graham-Squire
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco
| | - Caroline Cawley
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
| | - Hemal K. Kanzaria
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Margot B. Kushel
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco
| | - Maria C. Raven
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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Gabrielian S, Koosis ER, Cohenmehr J, Hellemann G, Tuepker A, Green MF, Vazzano JK, Young AS. Factors associated with recovery from homelessness among veterans in permanent supportive housing. J Community Psychol 2022; 50:2144-2162. [PMID: 34862803 DOI: 10.1002/jcop.22760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
AIMS We sought to identify person- and program-level factors distinguishing permanent supportive housing (PSH) residents with higher versus lower social integration; and higher versus lower instrumental functioning. METHODS Among 60 PSH residents at Los Angeles' VA, surveys and medical records captured person-level factors. Using a median split, we dichotomized participants with higher versus lower social integration; and higher versus lower instrumental functioning. Recursive partitioning (RP) identified variables that best-differentiated these subgroups. Interviews with 26 participants captured their perceptions on social integration and instrumental functioning. RESULTS Using RP, health-related quality of life, psychiatric symptoms and case management frequency best-differentiated the social integration subgroups. Few perceived that PSH affected social integration. RP did not yield a stable model to differentiate the instrumental functioning subgroups; participants perceived that PSH addressed most functional deficits. CONCLUSIONS Services that enhance social integration may benefit PSH residents with poor health; existing services may adequately address instrumental functioning.
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Affiliation(s)
- Sonya Gabrielian
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ella R Koosis
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
| | - Jennifer Cohenmehr
- Department of Psychiatry, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Gerhard Hellemann
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Anaïs Tuepker
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care, Portland, Oregon, USA
- Division of General Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael F Green
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jesse K Vazzano
- Care Management and Social Work, VA Western Colorado Health Care System, Grand Junction, Colorado, USA
| | - Alexander S Young
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Novacek DM, Wynn JK, McCleery A, Reavis EA, Senturk D, Sugar CA, Tsai J, Green MF. Racial differences in the psychosocial response to the COVID-19 pandemic in veterans with psychosis or recent homelessness. Am J Orthopsychiatry 2022; 92:590-598. [PMID: 35737567 PMCID: PMC9958263 DOI: 10.1037/ort0000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic continues to disproportionately impact people of color and individuals experiencing psychosis and homelessness. However, it is unclear whether there are differences by race in psychosocial responses to the pandemic in vulnerable populations. The double jeopardy hypothesis posits that multiply marginalized individuals would experience worse psychosocial outcomes. The present study investigated the clinical and functional initial responses to the pandemic in both Black (n = 103) and White veterans (n = 98) with psychosis (PSY), recent homelessness (RHV), and in a control group (CTL) enrolled in Department of Veterans Affairs (VA) healthcare services. Clinical interviews were administered via phone at two time points: baseline (mid-May through mid-August 2020) and follow-up (mid-August through September 2020). The baseline interview also included retrospective measures of pre-COVID status from January 2020. There were no significant differences between Black and White veterans in depression, anxiety, or loneliness. However, Black veterans did endorse more fears of contamination, F(1, 196.29) = 9.48, p = .002. Across all groups, Black veterans had better family integration compared to White veterans, F(1, 199.98) = 7.62, p = .006. There were no significant differences by race in social integration, work/role productivity, or independent living. In sum, there were few significant differences between Black and White veterans in initial psychosocial response to the pandemic. The lack of racial disparities might reflect the presence of VA's wrap-around services. The findings also highlight the robust nature of social support in Black veterans, even in the context of a global pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Derek M. Novacek
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Jonathan K. Wynn
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Amanda McCleery
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA
| | - Eric A. Reavis
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Damla Senturk
- Department of Biostatistics, University of California, Los Angeles, CA
| | - Catherine A. Sugar
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
- Department of Biostatistics, University of California, Los Angeles, CA
| | - Jack Tsai
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
- National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Tampa, FL
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Michael F. Green
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
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Buck-McFadyen E. Rural homelessness: how the structural and social context of small-town living influences the experience of homelessness. Can J Public Health 2022; 113:407-416. [PMID: 35325443 PMCID: PMC8944177 DOI: 10.17269/s41997-022-00625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022]
Abstract
Objectives Homelessness is increasingly recognized as a crisis beyond Canada’s largest cities where it is most visible, yet little is known about the experience and outcomes associated with rural homelessness. The aims of this study were to explore the experience of housing insecurity and its impact on the health of rural residents, identify the various factors contributing to homelessness in a rural Ontario context, and give voice to people with lived experience about their needs, challenges, and potential solutions to the housing crisis. Methods This exploratory qualitative study used interpretive description and a critical theory lens. Interviews were conducted with people who were currently experiencing homelessness and key informants in a rural community experiencing a housing crisis. Data collection took place between August 2020 and May 2021. Analysis was inductive and concurrent. Results Findings from interviews with 27 participants (16 with lived experience and 11 key informants) revealed how the structural and social context contributed to rural homelessness. Barriers to securing rental housing in a tight market were influenced by small-town dynamics and discrimination. These experiences led to feelings of hopelessness, which combined with daily stressors of managing unsuitable living conditions to contribute to deteriorating physical and mental health. Opportunities for tailoring interventions to the rural context include increasing awareness, expanding transportation, improving access to local services, and applying Housing First principles. Conclusion Interventions to prevent and manage homelessness must be tailored to the unique rural context.
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Affiliation(s)
- Ellen Buck-McFadyen
- Trent/Fleming School of Nursing, Trent University, 1600 West Bank Drive, Peterborough, ON, K9L 0G2, Canada.
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Abstract
This study uses data from the state-level Youth Risk Behavioral Survey to evaluate mental health and substance use outcomes among homeless and nonhomeless adolescents in 2019.
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Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, Massachusetts
| | - Katherine A. Koh
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Rai B, Kobashigawa L, Amarnani A, Ward NKZ, Feldman C, Feldman B, Panush RS. Challenges of caring for homeless patients with inflammatory arthritis: 12-month follow-up observations and identification of certain barriers to care. Clin Rheumatol 2022; 41:1653-1657. [PMID: 35499771 PMCID: PMC9058743 DOI: 10.1007/s10067-022-06167-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 04/03/2022] [Indexed: 11/26/2022]
Abstract
Homelessness is a public health crisis and there is a paucity of information about patients with rheumatic disease experiencing homelessness. We sought to develop approaches to improve care for this unique patient population. We previously reported observations on 17 homeless patients with inflammatory arthritis (15 rheumatoid arthritis (RA), 2 psoriatic arthritis (PsA)). We obtained follow-up information from our original 17 patients and compared this to data summarized and published about them from 12 months previously. We also created and administered a 100-question needs assessment survey. Follow-up 12-month clinical information was available from 13/17 homeless and 13/17 non-homeless controls. Homeless patients remained less well with more disease than non-homeless patients-poorer access to clinic appointments (80% vs 91%, p < 0.05), more emergency services use (20 vs 5 ED visits), less DMARDs use (43% vs 100%, p < 0.01), and more steroid use (29% vs 0%, p < 0.01). Homeless patients also had higher inflammatory markers than non-homeless patients (ESR 32 vs 26 mm/h and CRP 17 vs 5 mg/L), although these findings were not statistically significantly different. Seventy-eight percent of homeless patients were stable, 14% improved, and 7% worse; 21% had stable controlled and 57% stable active disease vs 62% and 0% of non-homeless (p < 0.01). Among the homeless, 6 (4 RA, 2 PsA) completed the survey, 2 declined, and 9 could not be reached. All 6 had found housing although all still had housing insecurity; 4 (67%) were homeless in the past. Three out of six (50%) obtained housing from social assistance during hospitalization following disease exacerbation while homeless. The average monthly income was $873. 5/6 (83.3%), were unable to work due to health, and were in considerable pain that adversely impacted their physical and mental health and ability to perform ADLs. Their perceived "greatest need" included dental care, physical therapy, knee surgery, employment, socialization secondary to isolation, and stable housing. Our understanding of the unique challenges of patients with rheumatic disease experiencing homelessness is improved, but not complete. Strengthened collaboration between street medicine providers and rheumatologists is necessary to improve care for homeless patients, especially given poorer outcomes compared with non-homeless counterparts. Key Points • We report 12-month follow-up information from our original 17 homeless patients with inflammatory arthritis (related in this journal in 2021) and their responses to an extensive needs assessment survey designed to identify barriers to care. • Homeless patients with inflammatory arthritis continued to have worse disease outcomes, use more corticosteroids and less DMARDs, and be seen less often in rheumatology clinics and more frequently in emergency departments than their non-homeless counterparts. • Survey data indicated that social assistance during hospitalization was a key area where healthcare providers could intervene to provide housing security for homeless patients and improve outcomes. Patients perceived "greatest needs" went beyond housing and rheumatological care and critically included access to social/specialty services. • Street medicine is the direct delivery of healthcare to people experiencing homelessness wherever they reside. Our observations, obtained in collaboration with street medicine colleagues, suggest important and salutary opportunities for this partnership to improve care for these particular patients.
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Affiliation(s)
- Baljeet Rai
- Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
| | - Laura Kobashigawa
- Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Abhimanyu Amarnani
- Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Nicole K Zagelbaum Ward
- Division of Rheumatology, Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Corinne Feldman
- Division of Street Medicine, Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brett Feldman
- Division of Street Medicine, Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Richard S Panush
- Division of Rheumatology, Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
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Brott H, Kornbluh M, Banfield J, Boullion AM, Incaudo G. Leveraging research to inform prevention and intervention efforts: Identifying risk and protective factors for rural and urban homeless families within transitional housing programs. J Community Psychol 2022; 50:1854-1874. [PMID: 34254319 DOI: 10.1002/jcop.22663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
This mixed method study spotlights hardships and supportive factors for unhoused families led by single mothers who have successfully graduated from two transitional housing programs, one rural and one urban. Data collection consisted of entry and exit surveys (n = 241) as well as qualitative interviews (n = 11). Binary logistic regression results indicated education and social support as significant predictors of successful program completion. Qualitative findings further illustrate narratives surrounding supportive factors and program supports (i.e., assistance securing employment, education courses, sense of community), as well as policy implications. Implications stress the need for enhancing supportive factors (i.e., education and social capital) in early prevention efforts (e.g., schools and community centers), as well as an intentional integration of addressing socio-emotional needs and resources within housing programs and services unique to rural and urban communities.
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Affiliation(s)
| | | | | | | | - Gary Incaudo
- University of California, Davis, California, USA
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Harris T, Semborski S, Rhoades H, Wenzel S. Service utilisation changes in the transition to permanent supportive housing: The role of the housing environment and case management. Health Soc Care Community 2022; 30:e781-e792. [PMID: 34145674 DOI: 10.1111/hsc.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
This study examines whether routine, low-cost service use changes in the transition from homelessness to permanent supportive housing (PSH) and explores whether housing model, neighbourhood and level of case management engagement affect utilisation of routine services. Data come from a prospective longitudinal study of adults experiencing homelessness who entered PSH in Los Angeles between 2014 and 2016 and participated in four interviews: pre-housing (i.e., while experiencing homelessness), and 3, 6 and 12 months after move-in. Mixed effects logistic regression assessed the effects of demographics, case management, housing model and neighbourhood location on service utilisation at each time point across five domains: basic needs, financial, educational, mental health and physical health. Longitudinal unmet need for services and onsite service use contextualised findings. Service utilisation significantly decreased at each time point in the domains of basic needs, financial and mental health. Neighbourhood was significantly associated with basic needs and mental health service use, while housing model was associated with financial service utilisation. Case management was associated with all service use outcomes with all relationships demonstrating more case management visits was associated with greater odds of routine service utilisation. Unmet service needs were consistent over time. Onsite service utilisation was low across all residents. Results indicate that routine service use declines with length of tenancy while unmet need for services remain prevalent. Case management appears to be critical in facilitating routine service use, while the housing environment should be considered to ensure residents have accessible and proximal routine care.
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Affiliation(s)
- Taylor Harris
- Suzanne Dworak-Peck School of School Work, University of Southern California, Los Angeles, CA, USA
- US Department of Veteran's Affairs, National Center on Homelessness among Veterans, Los Angeles, CA, USA
| | - Sara Semborski
- Suzanne Dworak-Peck School of School Work, University of Southern California, Los Angeles, CA, USA
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of School Work, University of Southern California, Los Angeles, CA, USA
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of School Work, University of Southern California, Los Angeles, CA, USA
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Vandenburg T, Groot S, Nikora LW. "This isn't a fairy tale we're talking about; this is our real lives": Community-orientated responses to address trans and gender diverse homelessness. J Community Psychol 2022; 50:1966-1979. [PMID: 34048607 DOI: 10.1002/jcop.22606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/07/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
Globally, trans and gender diverse people contend with day-to-day exclusion, discrimination, and marginalisation, often culminating in experiences of poverty and homelessness. In this discussion article, we outline a bricolage research orientation rooted in liberation and Indigenous approaches brought into dialogue with the broader cannon of community psychology for meaningful research with homeless trans and gender diverse people. Such an approach transcends rigid disciplinary divides and shapes a framework for collaborative action, advocacy, and social change. We argue that scholar-activism, social justice, and relationality and collaboration should inform every stage of the research process and beyond when engaging with minoritized communities.
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Affiliation(s)
- Tycho Vandenburg
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Shiloh Groot
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Linda W Nikora
- School of Psychology, University of Auckland, Auckland, New Zealand
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40
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Lei Q, Brown M. Identifying a typology of homelessness based on self-sufficiency: Implications for rapid re-housing interventions. J Community Psychol 2022; 50:2031-2044. [PMID: 34002403 DOI: 10.1002/jcop.22596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/22/2021] [Accepted: 04/18/2021] [Indexed: 06/12/2023]
Abstract
Limited research exists on the characteristics of individuals experiencing homelessness who achieve positive housing outcomes in rapid re-housing (RRH) interventions. We aimed to identify a typology of homelessness based on Self-Sufficiency Matrix (SSM) domains and examine its relation to sociodemographic characteristics and housing placement through RRH. Homeless Management Information System data, including sociodemographics, SSM domains, and housing outcomes, were obtained for 261 Homelessness Prevention and Rapid Re-housing Program participants in Indianapolis, Indiana, from 2009 to 2012. Latent class analysis (LCA) and latent class regression (LCR) were used to identify subgroups and predict associations between the identified typology and sociodemographic variables and housing placement outcome, respectively. LCA revealed three classes based on SSM domains: "High Self-Sufficiency," "Low Socioeconomic Self-Sufficiency," and "Low Psychosocial Self-Sufficiency." LCR revealed that race significantly predicted class membership such that Black individuals had a significantly higher probability of being in the High Self-Sufficiency class than the other two classes. Latent class membership significantly predicted immediate housing placement. The Low Psychosocial Self-Sufficiency group was the least likely to exit RRH to a permanent housing placement compared to the two other subgroups. Results affirm that individuals with greater psychosocial self-sufficiency have better housing outcomes through RRH than those with more complex support needs. Future research is needed to understand factors influencing differential self-sufficiency, as measured by the SSM, among Black and White individuals.
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Affiliation(s)
- Quinmill Lei
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| | - Molly Brown
- Department of Psychology, DePaul University, Chicago, Illinois, USA
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Pilla D, Park-Taylor J. "Halfway Independent": Experiences of formerly homeless adults living in permanent supportive housing. J Community Psychol 2022; 50:1411-1429. [PMID: 34561888 DOI: 10.1002/jcop.22724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/05/2021] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
Permanent supportive housing (PSH), which combines affordable public housing with social services, has become the dominant model in the United States for providing housing to formerly homeless people. PSH has been effective in reducing re-entry to homelessness, yet has shown limited evidence of improving formerly homeless individuals' mental health and quality of life. This study aimed to understand the lived experiences of formerly homeless adults' adjustment to tenancy in PSH, with a focus on how living in PSH has affected their meaningful activity and social engagement. Based on a phenomenological approach, a thematic analysis was conducted using semi-structured interviews with 17 individuals living in three PSH buildings in New York City. Results suggested that PSH was beneficial in fulfilling formerly homeless individual's basic needs and facilitating lifestyle improvements, yet many were dissatisfied with their living conditions and lacked meaningful activity, social integration, and community belongingness. These issues were found to develop in large part as a result of formerly homeless individuals' disharmonious relationships within the social context of PSH, consisting of staff members, other residents, and people in the surrounding community. The effects of the COVID-19 pandemic and implications for PSH social services are discussed.
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Affiliation(s)
- David Pilla
- Division of Psychological and Educational Services, Department of Counseling Psychology, Graduate School of Education, Fordham University, New York City, New York, USA
| | - Jennie Park-Taylor
- Division of Psychological and Educational Services, Department of Counseling Psychology, Graduate School of Education, Fordham University, New York City, New York, USA
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Ferreiro IC, Cuadra MAR, Serqueda FA, Abad JMH. Impact of Housing First on Psychiatric Symptoms, Substance Use, and Everyday Life Skills Among People Experiencing Homelessness. J Psychosoc Nurs Ment Health Serv 2022; 60:46-55. [PMID: 35316121 DOI: 10.3928/02793695-20220316-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current unblinded, randomized controlled trial analyzed psychiatric symptoms, substance use, and life skills outcomes in participants after 21 months in the Housing First (HF) program. The HF group (intervention) comprised 46 participants and the treatment-as-usual (TAU) group (control) comprised 41 participants. Quantitative outcome measures were collected at baseline and 8 and 21 months. Primary outcomes were mental health and substance use. Secondary outcomes were everyday life skills. Descriptive and comparative analyses and linear regression models are presented. At 21 months, the HF group presented significantly better outcomes regarding alcohol and cannabis use than the TAU group. Moreover, the subgroup of HF participants with severe mental illness had significant improvements in psychotic symptoms, anxiety, depression, social relations, and cannabis use compared to TAU participants. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Brown HA, Roberts RD, Chen TA, Businelle MS, Obasi EM, Kendzor DE, Reitzel LR. Perceived Disease Risk of Smoking, Barriers to Quitting, and Cessation Intervention Preferences by Sex Amongst Homeless Adult Concurrent Tobacco Product Users and Conventional Cigarette-Only Users. Int J Environ Res Public Health 2022; 19:ijerph19063629. [PMID: 35329321 PMCID: PMC8948934 DOI: 10.3390/ijerph19063629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
Abstract
Adults experiencing homelessness smoke conventional cigarettes and engage in concurrent tobacco product use at very high rates; however, little is known about how use patterns, perceived disease risk, barriers to quitting smoking, and smoking cessation intervention preferences differ by sex in this group. Participants comprised a convenience sample of 626 adult conventional cigarette smokers experiencing homelessness. Participants self-reported their sex, smoking history, mental health and substance use diagnosis history, other concurrent tobacco product use (CU), disease risk perceptions, perceived barriers to quitting smoking, and preferences regarding tobacco cessation interventions via a computer-administered survey. CU rates were 58.1% amongst men and 45.3% amongst women smokers. In both sexes, CUs started smoking earlier (p-values < 0.001) and were more likely to have been diagnosed with a non-nicotine substance use disorder (p-values < 0.014) relative to cigarette-only users. Among men only, CUs were younger, smoked more cigarettes per day and were more likely to identify as non-Hispanic White (p-values < 0.003) than cigarette-only users. Additionally, male CUs reported a greater risk of developing ≥1 smoking-related disease if they did not quit for good; were more likely to endorse craving cigarettes, being around other smokers, habit, stress/mood swings, and coping with life stress as barriers for quitting smoking; and were less likely to prefer medications to quit smoking relative to male cigarette-only users (p-values < 0.04). On the other hand, female CUs reported a greater risk of developing ≥1 smoking-related disease even if they quit for good; were more likely to endorse stress/mood swings and coping with life stress as barriers for quitting smoking relative to female cigarette-only users (p-values < 0.05); and did not differentially prefer one cessation medication over another. Overall, findings confirm high rates of CU among both sexes, characterize those who may be more likely to be CUs, and reveal opportunities to educate men and women experiencing homeless on the benefits of evidence-based interventions for smoking cessation.
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Affiliation(s)
- Haleem A. Brown
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (H.A.B.); (R.D.R.); (T.A.C.); (E.M.O.)
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA;
| | - Rachel D. Roberts
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (H.A.B.); (R.D.R.); (T.A.C.); (E.M.O.)
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA;
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (H.A.B.); (R.D.R.); (T.A.C.); (E.M.O.)
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA;
| | - Michael S. Businelle
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA;
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Ezemenari M. Obasi
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (H.A.B.); (R.D.R.); (T.A.C.); (E.M.O.)
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA;
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (H.A.B.); (R.D.R.); (T.A.C.); (E.M.O.)
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA;
- Correspondence: ; Tel.: +1-713-743-6679
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Smelson DA, Yakovchenko V, Byrne T, McCullough MB, Smith JL, Bruzios KE, Gabrielian S. Testing implementation facilitation for uptake of an evidence-based psychosocial intervention in VA homeless programs: A hybrid type III trial. PLoS One 2022; 17:e0265396. [PMID: 35298514 PMCID: PMC8929696 DOI: 10.1371/journal.pone.0265396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare systems face difficulty implementing evidence-based practices, particularly multicomponent interventions. Additional challenges occur in settings serving vulnerable populations such as homeless Veterans, given the population’s acuity, multiple service needs, and organizational barriers. Implementation Facilitation (IF) is a strategy to support the uptake of evidence-based practices. This study’s aim was to simultaneously examine IF on the uptake of Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking-Veterans Edition (MISSION-Vet), an evidence-based multicomponent treatment engagement intervention for homeless Veterans with co-occurring mental health and substance abuse, and clinical outcomes among Veterans receiving MISSION-Vet. Methods This multi-site hybrid III modified stepped-wedge trial involved seven programs at two Veterans Affairs Medical Centers comparing Implementation as Usual (IU; training and educational materials) to IF (IU + internal and external facilitation). Results A total of 110 facilitation events averaging 27 minutes were conducted, of which 85% were virtual. Staff (case managers and peer specialists; n = 108) were trained in MISSION-Vet and completed organizational readiness assessments (n = 77). Although both sites reported being willing to innovate and a desire to improve outcomes, implementation climate significantly differed. Following IU, no staff at either site conducted MISSION-Vet. Following IF, there was a significant MISSION-Vet implementation difference between sites (53% vs. 14%, p = .002). Among the 93 Veterans that received any MISSION-Vet services, they received an average of six sessions. Significant positive associations were found between number of MISSION-Vet sessions and outpatient treatment engagement measured by the number of outpatient visits attended. Conclusions While staff were interested in improving patient outcomes, MISSION-Vet was not implemented with IU. IF supported MISSION-Vet uptake and increased outpatient service utilization, but MISSION-Vet still proved difficult to implement particularly in the larger healthcare system. Future studies might tailor implementation strategies to organizational readiness. Trial registration ClinicalTrials.gov, NCT02942979.
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Affiliation(s)
- David A. Smelson
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
| | - Vera Yakovchenko
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
| | - Thomas Byrne
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- School of Social Work, Boston University, Boston, Massachusetts, United States of America
| | - Megan B. McCullough
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
| | - Jeffrey L. Smith
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, United States of America
| | - Kathryn E. Bruzios
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Sonya Gabrielian
- Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California, United States of America
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
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Adams EA, Parker J, Jablonski T, Kennedy J, Tasker F, Hunter D, Denham K, Smiles C, Muir C, O’Donnell A, Widnall E, Dotsikas K, Kaner E, Ramsay SE. A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19. Int J Environ Res Public Health 2022; 19:ijerph19063459. [PMID: 35329147 PMCID: PMC8950841 DOI: 10.3390/ijerph19063459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.
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Affiliation(s)
- Emma A. Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
- Correspondence:
| | - Jeff Parker
- HeathNow, Crisis, City House 1 City Road, Newcastle upon Tyne NE1 2AF, UK
- Pathway, 4th Floor East, 250 Euston Road, London NW1 2PG, UK
- Crisis Pie Team, 66 Commercial Street, London E1 6LT, UK
| | - Tony Jablonski
- HeathNow, Crisis, City House 1 City Road, Newcastle upon Tyne NE1 2AF, UK
- Pathway, 4th Floor East, 250 Euston Road, London NW1 2PG, UK
- Crisis Pie Team, 66 Commercial Street, London E1 6LT, UK
| | - Joanne Kennedy
- Expert by Experience Network, Fulfilling Lives Newcastle Gateshead, Gateshead NE8 4DY, UK
| | - Fiona Tasker
- Expert by Experience Network, Fulfilling Lives Newcastle Gateshead, Gateshead NE8 4DY, UK
| | - Desmond Hunter
- HeathNow, Crisis, City House 1 City Road, Newcastle upon Tyne NE1 2AF, UK
- Expert by Experience Network, Fulfilling Lives Newcastle Gateshead, Gateshead NE8 4DY, UK
| | - Katy Denham
- Newcastle University Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
| | - Claire Smiles
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
| | - Cassey Muir
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
| | - Emily Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK;
| | | | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
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Corey J, Lyons J, O’Carroll A, Stafford R, Ivers JH. A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe. Int J Environ Res Public Health 2022; 19:ijerph19063219. [PMID: 35328907 PMCID: PMC8954292 DOI: 10.3390/ijerph19063219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.
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Affiliation(s)
- Julia Corey
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | - James Lyons
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | | | - Richie Stafford
- HSE Community Healthcare Organisation Dublin North City & County, D09C8P5 Dublin, Ireland;
| | - Jo-Hanna Ivers
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
- Correspondence:
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Gama Marques J. Mortification and shelterization of homeless psychiatric patients in Portugal. Eur Rev Med Pharmacol Sci 2022; 26:1431-1432. [PMID: 35302227 DOI: 10.26355/eurrev_202203_28204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- J Gama Marques
- Serviço de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa; Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
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48
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Chun SY, Yoo JW, Park H, Hwang J, Kim PC, Park S, Shen JJ. Trends and age-related characteristics of substance use in the hospitalized homeless population. Medicine (Baltimore) 2022; 101:e28917. [PMID: 35212298 PMCID: PMC8878700 DOI: 10.1097/md.0000000000028917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/24/2022] [Indexed: 01/04/2023] Open
Abstract
We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20-1.26], cocaine 2.55 [2.50-2.60], marijuana 1.43 [1.40-1.46], and heroin 1.57 [1.29-1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55-0.58] for other patients and 0.60 [0.50-0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81-6.90] and heroin 5.86 [2.08-16.52] in comparison with other hospitalized patients.Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.
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Affiliation(s)
- Sung-youn Chun
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Ji W. Yoo
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV
| | - Hyeki Park
- Department of International Cooperation, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Pearl C. Kim
- Department of Healthcare Administration and Policy, University of Nevada Las Vegas School of Public Health, Las Vegas, NV
| | - Seong Park
- Department of Criminal Justice, University of Nevada Greenspun College of Urban Affairs, Las Vegas, NV
| | - Jay J. Shen
- Department of Criminal Justice, University of Nevada Greenspun College of Urban Affairs, Las Vegas, NV
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49
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Kaltsidis G, Grenier G, Cao Z, Bertrand K, Fleury MJ. Predictors of change in housing status over 12 months among individuals using emergency shelters, temporary housing or permanent housing in Quebec, Canada. Health Soc Care Community 2022; 30:631-643. [PMID: 32985755 DOI: 10.1111/hsc.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/16/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
Homelessness is an ongoing societal and public health problem in Canada and other countries. Housing services help homeless individuals along the transition towards stable housing, yet few studies have assessed factors that predict change in individual housing trajectories. This study identified predictors of change in housing status over 12 months for a sample of 270 currently or formerly homeless individuals using emergency shelters, temporary housing (TH) or permanent housing (PH) resources in Quebec. Participants recruited from 27 community or public organisations were interviewed between January and September 2017, and again 12 months later. Sociodemographic variables, housing history, health conditions, service use and client satisfaction were measured. Directors and programme coordinators from the selected organisations also completed a baseline questionnaire measuring strictness in residential codes of living/conduct, interorganisational collaboration and overall budget. Independent variables were organised into predisposing, enabling and needs factors, based on the Gelberg-Andersen Behavioral Model. Multilevel logistic regressions were used to test associations with the dependent variable: change in housing status over 12 months, whether positive (e.g. shelter to TH) or negative (e.g. PH to shelter). Predictors of positive change in housing status were as follows: residing in PH, being female, having children (predisposing factors); having consulted a psychologist, higher frequency in use of public ambulatory services (enabling factors); and not having physical illnesses (needs factor). The findings support strategies for helping this clientele obtain and maintain stable housing. They include deploying case managers to promote access to public ambulatory services, mainly among men or individuals without children who are less likely to seek help; greater use of primary care mental health teams; the establishment of more suitable housing for accommodating physical health problems; and reinforcing access to subsidised PH programmes.
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Affiliation(s)
- Gesthika Kaltsidis
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Karine Bertrand
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Longueuil, QC, Canada
- Institut Universitaire sur les Dépendances, Montréal, QC, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
- Institut Universitaire sur les Dépendances, Montréal, QC, Canada
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50
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Onapa H, Sharpley CF, Bitsika V, McMillan ME, MacLure K, Smith L, Agnew LL. The physical and mental health effects of housing homeless people: A systematic review. Health Soc Care Community 2022; 30:448-468. [PMID: 34423491 DOI: 10.1111/hsc.13486] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 05/25/2023]
Abstract
Housing is a significant determinant of health and is widely accepted as a key solution to address some of the health disparities that exist among the homeless. It is estimated that 150 million people worldwide are homeless, and approximately 1.8 billion lack adequate housing. However, understanding of how housing has a positive impact on the health of the homeless remains unclear and underdeveloped. This systematic review investigates intervention studies that report on the physical and mental health effects of housing homeless persons. A search of PubMed, PsycINFO, EBSCOHost-Academic Search Complete and the Cochrane Library was conducted for peer-reviewed articles published in English from 1999 to 2020 that had a combination of at least one housing intervention and health outcome, with a homeless sample. Three previous reviews and 24 studies were included for analysis. Most of the studies (n = 20) encompassed permanent supportive housing interventions that emphasised placing homeless people with mental illness directly into affordable housing with access to support services. The primary health outcomes reported were general physical and mental health, well-being, and quality of life. Despite inconsistent findings and significant issues identified in the reviewed literature, housing (in the short term) improves some aspects of health in homeless populations with human immunodeficiency virus, anxiety and depression.
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Affiliation(s)
- Hebaat Onapa
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Christopher F Sharpley
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Vicki Bitsika
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Mary E McMillan
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
| | | | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Linda L Agnew
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
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