This article describes stressful life events experienced by a multi-shelter sample of 162 homeless adults in the Central Florida area. Participants included homeless single men (n = 54), homeless single women (n = 54), and homeless women with children (n = 54). Subjects were interviewed with a modified version of the List of Threatening…
Fargo, Jamison D.; Munley, Ellen A.; Byrne, Thomas H.; Montgomery, Ann Elizabeth; Culhane, Dennis P.
Objectives. We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic, and safety net characteristics. Methods. We entered community-level characteristics and US Department of Housing and Urban Development point-in-time counts for a single night in January 2009 into separate mixed-effects statistical analyses that modeled homelessness rates for 4 subpopulations: families and single adults in metropolitan and nonmetropolitan regions. Results. Community-level factors accounted for 25% to 50% of the variance in homelessness rates across models. In metropolitan regions, alcohol consumption, social support, and several economic indicators were uniquely associated with family homelessness, and drug use and homicide were uniquely associated with single-adult homelessness. In nonmetropolitan regions, life expectancy, religious adherence, unemployment, and rent burden were uniquely associated with family homelessness, and health care access, crime, several economic indicators, and receipt of Supplemental Security Income were uniquely associated with single-adult homelessness. Conclusions. Considering homeless families and single adults separately enabled more precise modeling of associations between homelessness rates and community-level characteristics, indicating targets for interventions to reduce homelessness among these subpopulations. PMID:24148057
Fargo, Jamison D; Munley, Ellen A; Byrne, Thomas H; Montgomery, Ann Elizabeth; Culhane, Dennis P
We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic, and safety net characteristics. We entered community-level characteristics and US Department of Housing and Urban Development point-in-time counts for a single night in January 2009 into separate mixed-effects statistical analyses that modeled homelessness rates for 4 subpopulations: families and single adults in metropolitan and nonmetropolitan regions. Community-level factors accounted for 25% to 50% of the variance in homelessness rates across models. In metropolitan regions, alcohol consumption, social support, and several economic indicators were uniquely associated with family homelessness, and drug use and homicide were uniquely associated with single-adult homelessness. In nonmetropolitan regions, life expectancy, religious adherence, unemployment, and rent burden were uniquely associated with family homelessness, and health care access, crime, several economic indicators, and receipt of Supplemental Security Income were uniquely associated with single-adult homelessness. Considering homeless families and single adults separately enabled more precise modeling of associations between homelessness rates and community-level characteristics, indicating targets for interventions to reduce homelessness among these subpopulations.
de Wit Matty A
Full Text Available Abstract Background To improve homelessness prevention practice, we met with recently homeless adults, to explore their pathways into homelessness, problems and service use, before and after becoming homeless. Methods Recently homeless adults (last housing lost up to two years ago and legally staying in the Netherlands were sampled in the streets, day centres and overnight shelters in Amsterdam. In April and May 2004, students conducted interviews and collected data on demographics, self reported pathways into homelessness, social and medical problems, and service use, before and after becoming homeless. Results among 120 recently homeless adults, (male 88%, Dutch 50%, average age 38 years, mean duration of homelessness 23 weeks, the main reported pathways into homelessness were evictions 38%, relationship problems 35%, prison 6% and other reasons 22%. Compared to the relationship group, the eviction group was slightly older (average age 39.6 versus 35.5 years; p = 0.08, belonged more often to a migrant group (p = 0.025, and reported more living single (p Conclusion the recently homeless fit the overall profile of the homeless population in Amsterdam: single (Dutch men, around 40 years, with a mix of financial debts, addiction, mental and/or physical health problems. Contacts with services were fragmented and did not prevent homelessness. For homelessness prevention, systematic and outreach social medical care before and during homelessness should be provided.
van Laere, Igor R; de Wit, Matty A; Klazinga, Niek S
To improve homelessness prevention practice, we met with recently homeless adults, to explore their pathways into homelessness, problems and service use, before and after becoming homeless. Recently homeless adults (last housing lost up to two years ago and legally staying in the Netherlands) were sampled in the streets, day centres and overnight shelters in Amsterdam. In April and May 2004, students conducted interviews and collected data on demographics, self reported pathways into homelessness, social and medical problems, and service use, before and after becoming homeless. among 120 recently homeless adults, (male 88%, Dutch 50%, average age 38 years, mean duration of homelessness 23 weeks), the main reported pathways into homelessness were evictions 38%, relationship problems 35%, prison 6% and other reasons 22%. Compared to the relationship group, the eviction group was slightly older (average age 39.6 versus 35.5 years; p = 0.08), belonged more often to a migrant group (p = 0.025), and reported more living single (p homelessness, in the total group, contacts with any social service were 38% and with any medical service 27%. Despite these contacts they did not keep their house. During homelessness only contacts with social work and benefit agencies increased, contacts with medical services remained low. the recently homeless fit the overall profile of the homeless population in Amsterdam: single (Dutch) men, around 40 years, with a mix of financial debts, addiction, mental and/or physical health problems. Contacts with services were fragmented and did not prevent homelessness. For homelessness prevention, systematic and outreach social medical care before and during homelessness should be provided.
Gelberg, L; Linn, L S
Recent studies have reported a high prevalence of mental illness among the homeless. As part of a community-based survey of 529 homeless adults, we developed and tested a model to increase our understanding of the factors related to their psychological distress. Using a previously validated and reliable scale of perceived psychological distress, we found that homeless adults were more likely to report psychological distress than the general population (80% vs. 49%). Distress levels were not associated with most demographic or homeless characteristics or general appearance. However, distress was related to unemployment, greater cigarette and alcohol use, worse physical health, fewer social supports, and perceived barriers to obtaining needed medical care. Since mental, physical, and social health are strongly related among homeless adults, alleviating distress among them may be most effectively done by implementing a broad-based health services package coupled with employment programs provided in an accessible service delivery setting.
van Laere, Igor R.; de Wit, Matty A. S.; Klazinga, Niek S.
ABSTRACT: OBJECTIVE: To improve homelessness prevention practice, we met with recently homeless adults, to explore their pathways into homelessness, problems and service use, before and after becoming homeless. METHODS: Recently homeless adults (last housing lost up to two years ago and legally
Ferguson, Kristin M.; Bender, Kimberly; Thompson, Sanna J.
This study identified predictors of transience among homeless emerging adults in three cities. A total of 601 homeless emerging adults from Los Angeles, Austin, and Denver were recruited using purposive sampling. Ordinary least squares regression results revealed that significant predictors of greater transience include White ethnicity, high…
Rebecca T Brown
Full Text Available Little is known about pathways to homelessness among older adults. We identified life course experiences associated with earlier versus later onset of homelessness in older homeless adults and examined current health and functional status by age at first homelessness. We interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling. Participants reported age at first episode of adult homelessness and their life experiences during 3 time periods: childhood (<18 years, young adulthood (ages 18-25, and middle adulthood (ages 26-49. We used a structured modeling approach to identify experiences associated with first adult homelessness before age 50 versus at age 50 or older. Participants reported current health and functional status, including recent mental health and substance use problems. Older homeless adults who first became homeless before 50 had more adverse life experiences (i.e., mental health and substance use problems, imprisonment and lower attainment of adult milestones (i.e., marriage, full-time employment compared to individuals with later onset. After multivariable adjustment, adverse experiences were independently associated with experiencing a first episode of homelessness before age 50. Individuals who first became homeless before age 50 had higher prevalence of recent mental health and substance use problems and more difficulty performing instrumental activities of daily living. Life course experiences and current vulnerabilities of older homeless adults with first homelessness before age 50 differed from those with later onset of homelessness. Prevention and service interventions should be adapted to meet different needs.
Brown, Rebecca T.; Goodman, Leah; Guzman, David; Tieu, Lina; Ponath, Claudia; Kushel, Margot B.
Little is known about pathways to homelessness among older adults. We identified life course experiences associated with earlier versus later onset of homelessness in older homeless adults and examined current health and functional status by age at first homelessness. We interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling. Participants reported age at first episode of adult homelessness and their life experiences during 3 time periods: childhood (homelessness before age 50 versus at age 50 or older. Participants reported current health and functional status, including recent mental health and substance use problems. Older homeless adults who first became homeless before 50 had more adverse life experiences (i.e., mental health and substance use problems, imprisonment) and lower attainment of adult milestones (i.e., marriage, full-time employment) compared to individuals with later onset. After multivariable adjustment, adverse experiences were independently associated with experiencing a first episode of homelessness before age 50. Individuals who first became homeless before age 50 had higher prevalence of recent mental health and substance use problems and more difficulty performing instrumental activities of daily living. Life course experiences and current vulnerabilities of older homeless adults with first homelessness before age 50 differed from those with later onset of homelessness. Prevention and service interventions should be adapted to meet different needs. PMID:27163478
Brown, Rebecca T; Goodman, Leah; Guzman, David; Tieu, Lina; Ponath, Claudia; Kushel, Margot B
Little is known about pathways to homelessness among older adults. We identified life course experiences associated with earlier versus later onset of homelessness in older homeless adults and examined current health and functional status by age at first homelessness. We interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling. Participants reported age at first episode of adult homelessness and their life experiences during 3 time periods: childhood (homelessness before age 50 versus at age 50 or older. Participants reported current health and functional status, including recent mental health and substance use problems. Older homeless adults who first became homeless before 50 had more adverse life experiences (i.e., mental health and substance use problems, imprisonment) and lower attainment of adult milestones (i.e., marriage, full-time employment) compared to individuals with later onset. After multivariable adjustment, adverse experiences were independently associated with experiencing a first episode of homelessness before age 50. Individuals who first became homeless before age 50 had higher prevalence of recent mental health and substance use problems and more difficulty performing instrumental activities of daily living. Life course experiences and current vulnerabilities of older homeless adults with first homelessness before age 50 differed from those with later onset of homelessness. Prevention and service interventions should be adapted to meet different needs.
Mar, Marissa Y; Linden, Isabelle A; Torchalla, Iris; Li, Kathy; Krausz, Michael
This study investigates 500 homeless adults and the associations between childhood maltreatment types and the age of first reported homelessness episode. Those first experiencing homelessness in youth (age 24 years or younger; 46%) were compared with those first experiencing homelessness at a later age (older than age 24 years). In individual models, physical abuse, emotional abuse, and emotional neglect were associated with first experiencing homelessness during youth (p homeless during youth (p homeless earlier in life and support the need for early interventions with at-risk families.
Nyamathi, Adeline; Slagle, Alexandra; Thomas, Alexandra; Hudson, Angela; Kahilifard, Farinaz; Avila, Glenna; Orser, Julie; Cuchilla, Manuel
Art has been shown to be an empowering and engaging entity with numerous benefits to vulnerable populations, including the homeless persons and young adults. However, little is known how homeless young adults perceive the use of art as messages that can communicate the danger of initiating or continuing drug and alcohol use. The purpose of this study was to solicit perspectives of homeless, drug-using young adults as to how art can be used to design messages for their peers about the danger of initiating or continuing drug and alcohol use. Qualitative methodology via focus group discussions was utilized to engage 24 homeless young adults enrolled from a drop-in site in Santa Monica, California. The findings revealed support for a myriad of delivery styles, including in-person communication, flyers, music, documentary film, and creative writing. The young adults also provided insight into the importance of the thematic framework of messages. Such themes ranged from empowering and hopeful messages to those designed to scare young homeless adults into not experimenting with drugs. The findings indicate that in addition to messages communicating the need to prevent or reduce drug and alcohol use, homeless young adults respond to messages that remind them of goals and dreams they once had for their future, and to content that is personal, real, and truthful. Our research indicates that messages that reinforce protective factors such as hope for the future and self-esteem may be as important to homeless young adults as information about the risks and consequences of drug use.
Lee, Kyoung Hag; Jun, Jung Sim; Kim, Yi Jin; Roh, Soonhee; Moon, Sung Seek; Bukonda, Ngoyi; Hines, Lisa
This study explored the role of mental health and substance abuse problems on the suicidal ideation and suicide attempts of 156 homeless adults. The logistic regression results indicated that homeless adults with anxiety were significantly more likely than those without anxiety to have both suicidal ideation and suicide attempts. Also, homeless adults with drug abuse were significantly more likely than those without drug abuse to have suicidal ideation. The study suggests that to reduce the suicide of the homeless, case managers need to screen mental health and substance abuse issues and to provide appropriate treatment services at homeless shelters.
Thompson, Sanna J.; Ryan, Tiffany N.; Montgomery, Katherine L.; Lippman, Angie Del Prado; Bender, Kimberly; Ferguson, Kristin
This study explored the perceptions of resilience and coping among homeless young adults, a focus that differs from previous research by considering the unconventional resilience and coping of this high-risk population. Semistructured qualitative interviews were conducted with 45 homeless young adults. Individual interviews were audio recorded,…
Brown, Molly; Vaclavik, Danielle; Watson, Dennis P; Wilka, Eric
Local and national evaluations of the federal Homelessness Prevention and Rapid Re-Housing Program (HPRP) have demonstrated a high rate of placement of program participants in permanent housing. However, there is a paucity of research on the long-term outcomes of HPRP, and research on rehousing and prevention interventions for single adults experiencing homelessness is particularly limited. Using Homeless Management Information System data from 2009 to 2015, this study examined risk of return to homeless services among 370 permanently housed and 71 nonpermanently housed single adult HPRP participants in Indianapolis, Indiana. Kaplan-Meier survival curves were conducted to analyze time-to-service re-entry for the full sample, and the homelessness prevention and rapid rehousing participants separately. With an average follow-up of 4.5 years after HPRP exit, 9.5% of the permanently housed HPRP participants and 16.9% of those nonpermanently housed returned to homeless services. By assistance type, 5.4% of permanently housed and 15.8% of nonpermanently housed homelessness prevention recipients re-entered services, and 12.8% of permanently housed and 18.2% of nonpermanently housed rapid rehousing recipients re-entered during the follow-up period. Overall, veterans, individuals receiving rapid rehousing services, and those whose income did not increase during HPRP had significantly greater risk of returning to homeless services. Veterans were at significantly greater risk of re-entry when prevention and rehousing were examined separately. Findings suggest a need for future controlled studies of prevention and rehousing interventions for single adults, aiming to identify unique service needs among veterans and those currently experiencing homelessness in need of rehousing to inform program refinement. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Brown, Rebecca T.; Thomas, M. Lori; Cutler, Deborah F.; Hinderlie, Mark
The homeless population is aging faster than the general population in the United States. As this vulnerable population continues to age, addressing complex care and housing needs will become increasingly important. This article reviews the often-overlooked issue of homelessness among older adults, including their poor health status and unique care needs, the factors that contribute to homelessness in this population, and the costs of homelessness to the U.S. health care system. Permanent sup...
Miao, Yinghui; Mitchell, Susan L.; Bharel, Monica; Patel, Mitkumar; Ard, Kevin L.; Grande, Laura J.; Blazey-Martin, Deborah; Floru, Daniella; Steinman, Michael A.
Objectives. We determined the impact of obtaining housing on geriatric conditions and acute care utilization among older homeless adults. Methods. We conducted a 12-month prospective cohort study of 250 older homeless adults recruited from shelters in Boston, Massachusetts, between January and June 2010. We determined housing status at follow-up, determined number of emergency department visits and hospitalizations over 12 months, and examined 4 measures of geriatric conditions at baseline and 12 months. Using multivariable regression models, we evaluated the association between obtaining housing and our outcomes of interest. Results. At 12-month follow-up, 41% of participants had obtained housing. Compared with participants who remained homeless, those with housing had fewer depressive symptoms. Other measures of health status did not differ by housing status. Participants who obtained housing had a lower rate of acute care use, with an adjusted annualized rate of acute care visits of 2.5 per year among participants who obtained housing and 5.3 per year among participants who remained homeless. Conclusions. Older homeless adults who obtained housing experienced improved depressive symptoms and reduced acute care utilization compared with those who remained homeless. PMID:25973822
Carlson, Emily; Holtyn, August F; Fingerhood, Michael; Friedman-Wheeler, Dara; Leoutsakos, Jeannie-Marie S; Silverman, Kenneth
A clinical trial demonstrated that a therapeutic workplace could promote alcohol abstinence in homeless, alcohol-dependent adults. This secondary-data analysis examined rates of homelessness and their relation to the therapeutic workplace intervention and alcohol use during the trial. In the trial, homeless, alcohol-dependent adults could work in a therapeutic workplace for 6 months and were randomly assigned to Unpaid Training, Paid Training, or Contingent Paid Training groups. Unpaid Training participants were not paid for working. Paid Training participants were paid for working. Contingent Paid Training participants were paid for working if they provided alcohol-negative breath samples. Rates of homelessness during the study were calculated for each participant and the three groups were compared. Mixed-effects regression models were conducted to examine the relation between alcohol use (i.e., heavy drinking, drinks per drinking day, and days of alcohol abstinence) and homelessness. Unpaid Training, Paid Training, and Contingent Paid Training participants did not differ in the percentage of study days spent homeless (31%, 28%, 17%; respectively; F(2,94)=1.732, p=0.183). However, participants with more heavy drinking days (b=0.350, phomeless. Reducing heavy drinking and alcohol use may help homeless, alcohol-dependent adults transition out of homelessness. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Sinatra, Richard; Lanctot, Melissa Kim
A university partnered with the New York City Department of Homeless Services (NYC DHS) to provide cohorts of adults a 60-credit Associate Degree Program in Business Administration over a 2-year period. Results of two cohorts of 30 Advantage Academy Program graduates revealed significant improvement in College Board AccuPlacer (ACPL) Arithmetic…
van Laere, Igor; de Wit, Matty; Klazinga, Niek
ABSTRACT: BACKGROUND: Adequate support for homeless populations includes shelter and care to recuperate from illness and/or injury. This is a descriptive analysis of diagnoses and use of shelter-based convalescence in a cohort of homeless adults in Amsterdam. METHODS: Demographics of ill homeless
Ecker, John; Aubry, Tim; Sylvestre, John
Little is known about lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults who experience homelessness. The current review critically analyzes the scant literature on LGBTQ adults who experience homelessness, with a particular focus on: (1) pathways into homelessness; (2) support needs; (3) targeted programming; and (4) exits out of homelessness. A total of 143 articles were identified, and 16 articles met the criteria of appropriate age range, article quality, and relevance of topic. Results from this review demonstrate that homeless LGBTQ adults have unique physical and mental health challenges, largely concerning HIV and substance use. Transgender and gender non-conforming adults who experience homelessness encounter several challenges in the homelessness system, particularly in regard to safety and gender-affirming supports. Recommendations focus on practical implications for support and suggestions for future research.
Taylor, Kathryn M; Sharpe, Louise
International studies indicate high prevalence rates of post-traumatic stress disorder within homeless populations. In Australia, studies indicate high rates of trauma among homeless adults, yet post-traumatic stress disorder has not been investigated in homeless Australian adults. The primary aim of this project was to determine the prevalence of post-traumatic stress disorder among homeless adults in Sydney. Further, another aim of the study was to determine whether the onset of post-traumatic stress disorder preceded the first episode of homelessness or was a consequence of homelessness. The sample consisted of 70 homeless men and women aged 18-73 years, who were randomly sampled through eight homeless services. A computer-assisted face-to-face structured clinical interview was conducted with each participant. Lifetime prevalence of post-traumatic stress disorder was determined via the Composite International Diagnostic Interview. The majority of the sample had experienced at least one traumatic event in their lifetime (98%). Indeed, the mean number of traumas per person was six. The 12 month prevalence of post-traumatic stress disorder was higher among homeless adults in Sydney in comparison to the Australian general population (41% vs 1.5%). But 79% of the sample had a lifetime prevalence of post-traumatic stress. In 59% of cases, the onset of post-traumatic stress disorder preceded the age of the first reported homeless episode. Homeless adults in Sydney frequently experience trauma and post-traumatic stress disorder. The study found that trauma and post-traumatic stress disorder more often precede homelessness, but re-victimization is common. These findings highlight the high mental health needs among homeless people and have implications for services for homeless people.
Ferguson, Kristin M; Bender, Kimberly; Thompson, Sanna J
This study examined gender differences among homeless young adults' coping strategies and homelessness stressors as they relate to legal (e.g., full-time employment, selling personal possessions, selling blood/plasma) and illegal economic activity (e.g., selling drugs, theft, prostitution). A sample of 601 homeless young adults was recruited from 3 cities (Los Angeles, CA [n = 200], Austin, TX [n = 200], and Denver, CO [n = 201]) to participate in semi-structured interviews from March 2010 to July 2011. Risk and resilience correlates of legal and illegal economic activity were analyzed using six Ordinary Least Squares regression models with the full sample and with the female and male sub-samples. In the full sample, three variables (i.e., avoidant coping, problem-focused coping, and mania) were associated with legal income generation whereas eight variables (i.e., social coping, age, arrest history, transience, peer substance use, antisocial personality disorder [ASPD], substance use disorder [SUD], and major depressive episode [MDE]) were associated with illegal economic activity. In the female sub-sample, three variables (i.e., problem-focused coping, race/ethnicity, and transience) were correlated with legal income generation whereas six variables (i.e., problem-focused coping, social coping, age, arrest history, peer substance use, and ASPD) were correlated with illegal economic activity. Among males, the model depicting legal income generation was not significant yet seven variables (i.e., social coping, age, transience, peer substance use, ASPD, SUD, and MDE) were associated with illegal economic activity. Understanding gender differences in coping strategies and economic activity might help customize interventions aimed at safe and legal income generation for this population. Copyright © 2015 Elsevier Ltd. All rights reserved.
Lee, Christopher Thomas; Guzman, David; Ponath, Claudia; Tieu, Lina; Riley, Elise; Kushel, Margot
Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. They may have different life trajectories and reside in different environments than do younger homeless adults. Although the environmental risks associated with homelessness are substantial, the environments in which older homeless individuals live have not been well characterized. We classified living environments and identified associated factors in a sample of older homeless adults. From July 2013 to June 2014, we recruited a community-based sample of 350 homeless men and women aged fifty and older in Oakland, California. We administered structured interviews including assessments of health, history of homelessness, social support, and life course. Participants used a recall procedure to describe where they stayed in the prior six months. We performed cluster analysis to classify residential venues and used multinomial logistic regression to identify individual factors prior to the onset of homelessness as well as the duration of unstable housing associated with living in them. We generated four residential groups describing those who were unsheltered (n = 162), cohabited unstably with friends and family (n = 57), resided in multiple institutional settings (shelters, jails, transitional housing) (n = 88), or lived primarily in rental housing (recently homeless) (n = 43). Compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Cohabiters and renters were significantly more likely to be women and have experienced a shorter duration of homelessness. Cohabiters were significantly more likely than unsheltered participants to have experienced abuse prior to losing stable housing. Pre-homeless social support appears to protect against street homelessness while low levels of social support may increase the risk for becoming homeless immediately after
Gattis, Maurice N; Larson, Andrea
There is a dearth of empirical evidence that addresses how racial minority, sexual minority, and homeless statuses, with their accompanying experiences of stigma and discrimination, are related to mental health in adolescent and young adult populations. The current study addresses this gap by examining the associations between multiple forms of discrimination, depressive symptoms, and suicidality in a sample of 89 Black adolescents and young adults (52% female; 47% nonheterosexual, ages 16-24) experiencing homelessness. Results from a series of ordinary least squares and logistic regressions suggested that perceived homelessness stigma and racial discrimination were associated with higher levels of depressive symptoms, controlling for gender, age, and other types of discrimination, while perceived sexual identity discrimination showed no association. Having ever spent a homeless night on the street, an indicator of homelessness severity, accounted for a substantial amount of the association between homelessness stigma and depressive symptoms. In contrast, suicidality was not significantly associated with any measure of discrimination, homelessness severity, or personal characteristics. We also found no indication that the associations between perceived discrimination targeted at racial and homelessness statuses and mental health differed by sexual minority status. Our results suggest that depressive symptoms and suicidality are prevalent among Black homeless youth, and that depressive symptoms are particularly associated with racial discrimination and indicators of homelessness. The roles of discrimination and a lack of safe housing may be taken into account when designing programs and policies that address the mental health of Black adolescents and young adults experiencing homelessness. (c) 2016 APA, all rights reserved).
Altena, Astrid M.; Krabbenborg, Manon A M; Boersma, Sandra N.; Beijersbergen, Mariëlle D.; van den Berg, Yvonne H. M.; Vollebergh, Wilma A.M.; Wolf, Judith R.L.M.
The development of a strong working alliance between homeless young adults and their social workers is seen as a critical component in the recovery process. The purpose of this study was to examine the composition of the working alliance between homeless young adults and their social workers, and
Winetrobe, H; Rice, E; Rhoades, H; Milburn, N
Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Runquist, Jennifer J; Reed, Pamela G
This study examines the relationships of spiritually and physically related variables to well-being among homeless adults. A convenience sample of 61 sheltered homeless persons completed the Spiritual Perspective Scale, the Self-Transcendence Scale, the Index of Well-Being, and items measuring fatigue and health status. The data were subjected to correlational and multiple regression analysis. Positive, significant correlations were found among spiritual perspective, self-transcendence, health status, and well-being. Fatigue was inversely correlated with health status and well-being. Self-transcendence and health status together explained 59% of the variance in well-being. The findings support Reed's theory of self-transcendence, in which there is the basic assumption that human beings have the potential to integrate difficult life situations. This study contributes to the growing body of evidence that conceptualizes homeless persons as having spiritual, emotional, and physical capacities that can be used by health care professionals to promote well-being in this vulnerable population.
Patterson, Michelle L; Currie, Lauren; Rezansoff, Stefanie; Somers, Julian M
This study examines key themes from narrative interviews conducted with 43 homeless adults with mental disorders 18 months after random assignment to Housing First with intensive supports or to treatment as usual (no housing or supports through the study). Coding and thematic analysis of semistructured interviews was based on 2 research questions from participants' perspectives: (a) What changes were perceived over time? (b) What factors facilitated or hindered change? The majority of participants assigned to Housing First reported positive change across multiple domains as a result of stable housing; whereas the majority of treatment as usual participants reported negative or neutral change. Key themes included feelings of security and pride; adjusting to living alone; housing as a learning process; and developing meaningful activity. The sense of security associated with stable housing was the most influential factor that supported change. Factors that helped or hindered change clustered into 4 key themes: the type and quality of services; the cumulative effects of trauma; social ties; and concurrent substance use. Our findings provide important context to the emerging body of quantitative research on Housing First and recovery from homelessness. Participants' experiences of recovery, particularly as it relates to housing and supports, shifts in identity, and meaningful activity must be acknowledged and incorporated into the design and evaluation of public services, and policy and service reforms. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Full Text Available There is increasing concern about family homelessness. Homeless mothers and their children are one of society’s most disadvantaged and at-risk populations. However, very little Australian research exploring mothers’ views on their homelessness experiences exists. Using semi-structured interviews with 14 mothers and four agency staff, this study explored homeless Australian mothers’ pathways into and out of homelessness, their specific needs and the services and supports that were (or would have been most helpful. In this sample of single mothers and their children, early experiences of homelessness and domestic violence contributed most commonly to homelessness episodes. Almost immediate engagement with welfare agencies seemed to be protective against re-experiencing homelessness, however Australian restrictions on length of program involvement and limited housing options for mothers exiting homelessness programs, may place such mothers and their children at high risk of re-entering homelessness. Younger mothers had greater needs and benefited most from personalised one-on-one support that addressed key parenting and life skills. The implications of these findings are considered in relation to service delivery to this vulnerable group and avenues for future research are noted.
Steinman, Michael A.
Objectives. We compared the characteristics of emergency department (ED) visits of older versus younger homeless adults. Methods. We analyzed 2005–2009 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of visits to hospitals and EDs, and used sampling weights, strata, and clustering variables to obtain nationally representative estimates. Results. The ED visits of homeless adults aged 50 years and older accounted for 36% of annual visits by homeless patients. Although demographic characteristics of ED visits were similar in older and younger homeless adults, clinical and health services characteristics differed. Older homeless adults had fewer discharge diagnoses related to psychiatric conditions (10% vs 20%; P = .002) and drug abuse (7% vs 15%; P = .003) but more diagnoses related to alcohol abuse (31% vs 23%; P = .03) and were more likely to arrive by ambulance (48% vs 36%; P = .02) and to be admitted to the hospital (20% vs 11%; P = .003). Conclusions. Older homeless adults’ patterns of ED care differ from those of younger homeless adults. Health care systems need to account for these differences to meet the needs of the aging homeless population. PMID:23597348
Full Text Available Abstract Background Adequate support for homeless populations includes shelter and care to recuperate from illness and/or injury. This is a descriptive analysis of diagnoses and use of shelter-based convalescence in a cohort of homeless adults in Amsterdam. Methods Demographics of ill homeless adults, diagnoses, referral pattern, length of stay, discharge locations, and mortality, were collected by treating physicians during outreach care provision in a shelter-based convalescence care facility in Amsterdam, from January 2001 through October 2007. Results 629 individuals accounted for 889 admissions to the convalescence care facility. 83% were male and 53% were born in the Netherlands. The mean age was 45 years (SD 10 years. The primary physical problems were skin disorders (37%, respiratory disorders (33%, digestive disorders (24% and musculoskeletal disorders (21%. Common chronic conditions included addictions 78%, mental health disorders 20%, HIV/AIDS 11% and liver cirrhosis 5%. Referral sources were self-referred (18%, general hospitals (21% and drug clinics (27%. The median length of stay was 20 days. After (selfdischarge, 63% went back to the previous circumstances, 10% obtained housing, and 23% went to a medical or nursing setting. By March 2008, one in seven users (n = 83; 13% were known to have died, the Standard Mortality Ratio was 7.5 (95% CI: 4.1-13.5. Over the years, fewer men were admitted, with significantly more self neglect, personality disorders and cocaine use. Lengths of stay increased significantly during the study period. Conclusion Over the last years, the shelter-based convalescence care facility users were mainly homeless single males, around 45 years of age, with chronic problems due to substance use, mental health disorders and a frail physical condition, many of whom died a premature death. The facility has been flexible and responsive to the needs of the users and services available.
William Wilberforce Amoah
Full Text Available Although homeless young adults are often seen on the streets of Ghana, little research had examined the nature of sexual behaviour among these homeless and runaway young adults. Due to the culturally sensitive nature of such studies in the Ghanaian setting, only fifty (50 respondents agreed to participate in the study. A thirty–five (35 item questionnaire, comprising of twenty-eight (28 closed-ended and seven (7 open-ended questions was used for data collection. The findings indicated poverty, inability of parents to cater for the young adult’s needs, peer pressure and lack of parental acceptance as the main causes of homelessness. Consequently, the findings also showed a trend of school dropout, teenage pregnancy and use of illicit drugs as effects of homelessness. These findings have implications for future studies, policy reform and care for homeless young adult.
Henwood, Benjamin F; Byrne, Thomas; Scriber, Brynn
Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population. Housing First (HF) is an evidence-based practice that effectively ends chronic homelessness, yet there has been virtually no research on premature mortality among HF enrollees. In the United States, this gap in the literature exists despite research that has suggested chronically homeless adults constitute an aging cohort, with nearly half aged 50 years old or older. This observational study examined mortality among formerly homeless adults in an HF program. We examined death rates and causes of death among HF participants and assessed the timing and predictors of death among HF participants following entry into housing. We also compared mortality rates between HF participants and (a) members of the general population and (b) individuals experiencing homelessness. We supplemented these analyses with a comparison of the causes of death and characteristics of decedents in the HF program with a sample of adults identified as homeless in the same city at the time of death through a formal review process. The majority of decedents in both groups were between the ages of 45 and 64 at their time of death; the average age at death for HF participants was 57, compared to 53 for individuals in the homeless sample. Among those in the HF group, 72% died from natural causes, compared to 49% from the homeless group. This included 21% of HF participants and 7% from the homeless group who died from cancer. Among homeless adults, 40% died from an accident, which was significantly more than the 14% of HF participants who died from an accident. HIV or other infectious diseases contributed to 13% of homeless deaths compared to only 2% of HF participants. Hypothermia contributed to 6% of homeless deaths, which was not a cause of death for HF participants. Results suggest HF participants face excess mortality in comparison to members of the general population and that mortality
Full Text Available Both homelessness and incarceration are associated with housing instability, which in turn can disrupt continuity of HIV medical care. Yet, their impacts have not been systematically assessed among people living with HIV/AIDS (PLWHA.We studied a retrospective cohort of 1,698 New York City PLWHA with both jail incarceration and homelessness during 2001-05 to evaluate whether frequent transitions between jail incarceration and homelessness were associated with a lower likelihood of continuity of HIV care during a subsequent one-year follow-up period. Using matched jail, single-adult homeless shelter, and HIV registry data, we performed sequence analysis to identify trajectories of these events and assessed their influence on engagement in HIV care and HIV viral suppression via marginal structural modeling.Sequence analysis identified four trajectories; 72% of the cohort had sporadic experiences of both brief incarceration and homelessness, whereas others experienced more consistent incarceration or homelessness during early or late months. Trajectories were not associated with differential engagement in HIV care during follow-up. However, compared with PLWHA experiencing early bouts of homelessness and later minimal incarceration/homelessness events, we observed a lower prevalence of viral suppression among PLWHA with two other trajectories: those with sporadic, brief occurrences of incarceration/homelessness (0.67, 95% CI = 0.50,0.90 and those with extensive incarceration experiences (0.62, 95% CI = 0.43,0.88.Housing instability due to frequent jail incarceration and homelessness or extensive incarceration may exert negative influences on viral suppression. Policies and services that support housing stability should be strengthened among incarcerated and sheltered PLWHA to reduce risk of adverse health conditions.
Full Text Available The prevalence of food insecurity and food insufficiency is high among homeless people. We investigated the prevalence and correlates of food insecurity among a cohort of homeless adults with mental illness in Vancouver, British Columbia, Canada.Data collected from baseline questionnaires in the Vancouver At Home study were analysed to calculate the prevalence of food insecurity within the sample (n = 421. A modified version of the U.S. Department of Agriculture's Adult Food Security Survey Module was used to ascertain food insecurity. Univariable and multivariable logistic regression were used to examine potential correlates of food insecurity.The prevalence of food insecurity was 64%. In the multivariable model, food insecurity was significantly associated with age (adjusted odds ratio [aOR] = 0.97; 95% CI: 0.95-0.99, less than high school completion (aOR = 0.57; 95% CI: 0.35-0.93, needing health care but not receiving it (aOR = 1.65; 95% CI: 1.00-2.72, subjective mental health (aOR = 0.97; 95% CI: 0.96-0.99, having spent over $500 for drugs and alcohol in the past month (aOR = 2.25; 95% CI: 1.16-4.36, HIV/AIDS (aOR = 4.20; 95% CI: 1.36-12.96, heart disease (aOR = 0.39; 95% CI: 0.16-0.97 and having gone to a drop-in centre, community meal centre or program/food bank (aOR = 1.65; 95% CI: 1.01-2.68.The prevalence of food insecurity was extremely high in a cohort with longstanding homelessness and serious mental illness. Younger age, needing health care but not receiving it, poorer subjective mental health, having spent over $500 for drugs and alcohol in the past month, HIV/AIDS and having gone to a drop-in centre, community meal centre or program/food bank each increased odds of food insecurity, while less than high school completion and heart disease each decreased odds of food insecurity. Interventions to reduce food insecurity in this population are urgently needed.
To, Matthew J; Palepu, Anita; Aubry, Tim; Nisenbaum, Rosane; Gogosis, Evie; Gadermann, Anne; Cherner, Rebecca; Farrell, Susan; Misir, Vachan; Hwang, Stephen W
Homelessness is a major concern in many urban communities across North America. Since vulnerably housed individuals are at risk of experiencing homelessness, it is important to identify predictive factors linked to subsequent homelessness in this population. The objectives of this study were to determine the probability of experiencing homelessness among vulnerably housed adults over three years and factors associated with higher risk of homelessness. Vulnerably housed adults were recruited in three Canadian cities. Data on demographic characteristics, chronic health conditions, and drug use problems were collected through structured interviews. Housing history was obtained at baseline and annual follow-up interviews. Generalized estimating equations were used to characterize associations between candidate predictors and subsequent experiences of homelessness during each follow-up year. Among 561 participants, the prevalence of homelessness was 29.2 % over three years. Male gender (AOR = 1.59, 95 % CI: 1.14-2.21) and severe drug use problems (AOR = 1.98, 95 % CI: 1.22-3.20) were independently associated with experiencing homelessness during the follow-up period. Having ≥3 chronic conditions (AOR = 0.55, 95 % CI: 0.33-0.94) and reporting higher housing quality (AOR = 0.99, 95 % CI: 0.97-1.00) were protective against homelessness. Vulnerably housed individuals are at high risk for experiencing homelessness. The study has public health implications, highlighting the need for enhanced access to addiction treatment and improved housing quality for this population.
Matthew J. To
Full Text Available Abstract Background Homelessness is a major concern in many urban communities across North America. Since vulnerably housed individuals are at risk of experiencing homelessness, it is important to identify predictive factors linked to subsequent homelessness in this population. The objectives of this study were to determine the probability of experiencing homelessness among vulnerably housed adults over three years and factors associated with higher risk of homelessness. Methods Vulnerably housed adults were recruited in three Canadian cities. Data on demographic characteristics, chronic health conditions, and drug use problems were collected through structured interviews. Housing history was obtained at baseline and annual follow-up interviews. Generalized estimating equations were used to characterize associations between candidate predictors and subsequent experiences of homelessness during each follow-up year. Results Among 561 participants, the prevalence of homelessness was 29.2 % over three years. Male gender (AOR = 1.59, 95 % CI: 1.14–2.21 and severe drug use problems (AOR = 1.98, 95 % CI: 1.22–3.20 were independently associated with experiencing homelessness during the follow-up period. Having ≥3 chronic conditions (AOR = 0.55, 95 % CI: 0.33–0.94 and reporting higher housing quality (AOR = 0.99, 95 % CI: 0.97–1.00 were protective against homelessness. Conclusions Vulnerably housed individuals are at high risk for experiencing homelessness. The study has public health implications, highlighting the need for enhanced access to addiction treatment and improved housing quality for this population.
Patterson, Michelle L; Moniruzzaman, Akm; Somers, Julian M
Background It is well documented that childhood abuse, neglect and household dysfunction are disproportionately present in the backgrounds of homeless adults, and that these experiences adversely impact child development and a wide range of adult outcomes. However, few studies have examined the cumulative impact of adverse childhood experiences on homeless adults with mental illness. This study examines adverse events in childhood as predictors of duration of homelessness, psychiatric and ...
Moya, Eva Margarita; Chavez-Baray, Silvia M.; Loweree, Jacqueline; Mattera, Brian; Martinez, Nahomi
Homelessness is a social, economic, and political crisis in the United States. In particular, the US–Mexico Border region has seen a surge of homelessness, specifically among veterans, women victims of intimate partner violence, and immigrants. In 2014, 12 persons in El Paso, TX, with experience of being homeless used the photovoice methodology to participate in a project titled, “The Voices and Images of the Residents of the Opportunity Center for the Homeless: A Visual Project on the Identity and Challenges Homeless Adults Face on the Border Region.” The project was led by faculty from the Department of Social Work and facilitated by graduate students from the Departments of Social Work, Sociology, and Anthropology at the University of Texas at El Paso. In partnership with the Opportunity Center for the Homeless, a community-based organization, a gallery of photographs with respective narratives was produced along with a video documentary. The participants identified four themes: broken systems, invisibility, opportunities and what works, and growth and determination. These themes represent participants’ life experiences with homelessness and their aspirations. In addition to the photo gallery, participants supported the development of a Call to Action asking the community, policy, and decision makers to commit to changing the current social, economic, and political conditions affecting individuals experiencing homelessness. The gallery, Call to Action, and overall participant experiences with photovoice were shared during local, regional, and national conferences and events, including three State of the Homeless Conferences led by the Opportunity Center for the Homeless in partnership with the university. PMID:28580355
Eva Margarita Moya
Full Text Available Homelessness is a social, economic, and political crisis in the United States. In particular, the US–Mexico Border region has seen a surge of homelessness, specifically among veterans, women victims of intimate partner violence, and immigrants. In 2014, 12 persons in El Paso, TX, with experience of being homeless used the photovoice methodology to participate in a project titled, “The Voices and Images of the Residents of the Opportunity Center for the Homeless: A Visual Project on the Identity and Challenges Homeless Adults Face on the Border Region.” The project was led by faculty from the Department of Social Work and facilitated by graduate students from the Departments of Social Work, Sociology, and Anthropology at the University of Texas at El Paso. In partnership with the Opportunity Center for the Homeless, a community-based organization, a gallery of photographs with respective narratives was produced along with a video documentary. The participants identified four themes: broken systems, invisibility, opportunities and what works, and growth and determination. These themes represent participants’ life experiences with homelessness and their aspirations. In addition to the photo gallery, participants supported the development of a Call to Action asking the community, policy, and decision makers to commit to changing the current social, economic, and political conditions affecting individuals experiencing homelessness. The gallery, Call to Action, and overall participant experiences with photovoice were shared during local, regional, and national conferences and events, including three State of the Homeless Conferences led by the Opportunity Center for the Homeless in partnership with the university.
Diane Santa Maria
Full Text Available While HIV disproportionately impacts homeless individuals, little is known about the prevalence of HIV risk behaviors in the southwest and how age factors and HIV risk perceptions influence sexual risk behaviors. We conducted a secondary data analysis (n = 460 on sexually active homeless adults from a cross-sectional study of participants (n = 610 recruited from homeless service locations, such as shelters and drop-in centers, in an understudied region of the southwest. Covariate-adjusted logistic regressions were used to assess the impact of age at homelessness onset, current age, age at first sex, and HIV risk perceptions on having condomless sex, new sexual partner(s, and multiple sexual partners (≥4 sexual partners in the past 12 months. Individuals who first experienced homelessness by age 24 were significantly more likely to report condomless sex and multiple sexual partners in the past year than those who had a later onset of their first episode of homelessness. Individuals who were currently 24 years or younger were more likely to have had condomless sex, new sexual partners, and multiple sexual partners in the past 12 months than those who were 25 years or older. Those who had low perceived HIV risk had lower odds of all three sexual risk behaviors. Social service and healthcare providers should consider a younger age at homelessness onset when targeting HIV prevention services to youth experiencing homelessness.
Larney, Sarah; Conroy, Elizabeth; Mills, Katherine L; Burns, Lucy; Teesson, Maree
To determine the prevalence and correlates of violent victimisation among homeless people in inner-Sydney. Cross-sectional design. Clients of a shelter for homeless, substance-using adults were interviewed about their drug use, mental health and violent victimisation in the previous 12 months. Logistic regression was used to identify factors associated with victimisation. Participants reported complex drug use histories and high levels of depression, post-traumatic stress disorder (PTSD) and schizophrenia or other psychotic disorders. Forty-eight per cent of participants reported past year victimisation. In univariate analyses, being female, schizophrenia/psychotic disorder, PTSD, depression and regular use of psychostimulants were associated with increased risk of victimisation. In multivariate analyses, regular use of psychostimulants (odds ratio [95% CI] 5.07 [1.53-16.84]), schizophrenia or other psychotic disorder (3.13 [1.24-7.9], and depression (2.65 [1.07-6.59]) were associated with increased risk of victimisation. This sample of homeless, substance-using adults experienced high levels of violence. People with poor mental health and regular psychostimulant users were at greater risk of victimisation. A longitudinal study to determine whether victimisation prolongs homelessness is warranted. Clinical staff working with homeless populations need to be aware of the likelihood of past and future victimisation and its effects on mental health. Homeless persons may benefit from learning to identify risk situations for victimisation and how to de-escalate potentially violent situations.
Krabbenborg, Manon A. M.; Boersma, Sandra N.; van der Veld, William M.; van Hulst, Bente; Vollebergh, Wilma A. M.; Wolf, Judith R. L. M.
Objective: To test the effectiveness of Houvast: a strengths-based intervention for homeless young adults. Method: A cluster randomized controlled trial was conducted with 10 Dutch shelter facilities randomly allocated to an intervention and a control group. Homeless young adults were interviewed when entering the facility and when care ended.…
Krabbenborg, M.A.M.; Boersma, S.N.; Veld, W.M. van der; Hulst, B. van; Vollebergh, W.A.M.; Wolf, J.R.L.M.
Objective: To test the effectiveness of Houvast: a strengths-based intervention for homeless young adults. Method: A cluster randomized controlled trial was conducted with 10 Dutch shelter facilities randomly allocated to an intervention and a control group. Homeless young adults were interviewed
Malone, Daniel K.; Clifasefi, Seema L.
Objectives. We studied housing retention and its predictors in the single-site Housing First model. Methods. Participants (n = 111) were chronically homeless people with severe alcohol problems who lived in a single-site Housing First program and participated in a larger nonrandomized controlled trial (2005–2008) conducted in Seattle, Washington. At baseline, participants responded to self-report questionnaires assessing demographic, illness burden, alcohol and other drug use, and psychiatric variables. Housing status was recorded over 2 years. Results. Participants were interested in housing, although a sizable minority did not believe they would be able to maintain abstinence-based housing. Only 23% of participants returned to homelessness during the 2-year follow-up. Commonly cited risk factors—alcohol and other drug use, illness burden, psychiatric symptoms, and homelessness history—did not predict resumed homelessness. Active drinkers were more likely to stay in this housing project than nondrinkers. Conclusions. We found that single-site Housing First programming fills a gap in housing options for chronically homeless people with severe alcohol problems. PMID:24148063
Baggett, Travis P.; Hwang, Stephen W.; O'Connell, James J.; Porneala, Bianca C.; Stringfellow, Erin J.; Orav, E. John; Singer, Daniel E.; Rigotti, Nancy A.
Background Homeless persons experience excess mortality, but U.S.-based studies on this topic are outdated or lack information about causes of death. No studies have examined shifts in causes of death for this population over time. Methods We assessed all-cause and cause-specific mortality rates in a cohort of 28,033 adults aged 18 years or older who were seen at Boston Health Care for the Homeless Program between January 1, 2003, and December 31, 2008. Deaths were identified through probabilistic linkage to the Massachusetts death occurrence files. We compared mortality rates in this cohort to rates in the 2003–08 Massachusetts population and a 1988–93 cohort of homeless adults in Boston using standardized rate ratios with 95% confidence intervals. Results 1,302 deaths occurred during 90,450 person-years of observation. Drug overdose (n=219), cancer (n=206), and heart disease (n=203) were the major causes of death. Drug overdose accounted for one-third of deaths among adults homeless adults in Boston remains high and unchanged since 1988–93 despite a major interim expansion in clinical services. Drug overdose has replaced HIV as the emerging epidemic. Interventions to reduce mortality in this population should include behavioral health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness. PMID:23318302
Stein, Judith A; Dixon, Elizabeth L; Nyamathi, Adeline M
Finding direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people was used to explore predictive relationships in a sample of homeless adults (N = 664) among (a) psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, (b) situational variables of homelessness history and quality of recent housing, and (c) outcomes of alcohol use, injection drug use (IDU), and non-IDU. Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors, including encouraging provision of permanent supportive housing. (c) 2008 APA, all rights reserved.
Thomas, Yvonne; Gray, Marion; McGinty, Sue; Ebringer, Sally
The Australian policy on homelessness identifies participation in structured activities as the first step towards social inclusion and increasing the likelihood of permanently leaving a homeless lifestyle. Art interventions increase interpersonal function and social participation and provide a means of expression and transformation with people who are homeless. This study explores the value of an art programme provided by a non-government agency for homeless adults. Qualitative methods including participant observation and purposive interviews were analysed inductively and thematically to gain an understanding of the participants' experience of art and its value. Interviews with stakeholders provided additional information and triangulation of the data. The study demonstrates that art occupations provide a starting point for participation in community and a positive experience that encourages the construction of new identities, routines and roles. Furthermore, art provides an alternative from the problems associated with homelessness, mental health and substance abuse and allows for public recognition and social inclusion. Health professionals should work towards the social inclusion of homeless people through providing occupational opportunities for participation in safe settings as a first step to community engagement. © 2011 The Authors. Australian Occupational Therapy Journal © 2011 Occupational Therapy Australia.
Patterson, Michelle L; Moniruzzaman, Akm; Somers, Julian M
It is well documented that childhood abuse, neglect and household dysfunction are disproportionately present in the backgrounds of homeless adults, and that these experiences adversely impact child development and a wide range of adult outcomes. However, few studies have examined the cumulative impact of adverse childhood experiences on homeless adults with mental illness. This study examines adverse events in childhood as predictors of duration of homelessness, psychiatric and substance use disorders, and physical health in a sample of homeless adults with mental illness. This study was conducted using baseline data from a randomized controlled trial in Vancouver, British Columbia for participants who completed the Adverse Childhood Experiences (ACE) scale at 18 months follow-up (n=364). Primary outcomes included current mental disorders; substance use including type, frequency and severity; physical health; duration of homelessness; and vocational functioning. In multivariable regression models, ACE total score independently predicted a range of mental health, physical health, and substance use problems, and marginally predicted duration of homelessness. Adverse childhood experiences are overrepresented among homeless adults with complex comorbidities and chronic homelessness. Our findings are consistent with a growing body of literature indicating that childhood traumas are potent risk factors for a number of adult health and psychiatric problems, particularly substance use problems. Results are discussed in the context of cumulative adversity and self-trauma theory. This trial has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374.
Full Text Available BACKGROUND: Identification of high-risk populations for serious infection due to S. pneumoniae will permit appropriately targeted prevention programs. METHODS: We conducted prospective, population-based surveillance for invasive pneumococcal disease and laboratory confirmed pneumococcal pneumonia in homeless adults in Toronto, a Canadian city with a total population of 2.5 M, from January 1, 2002 to December 31, 2006. RESULTS: We identified 69 cases of invasive pneumococcal disease and 27 cases of laboratory confirmed pneumococcal pneumonia in an estimated population of 5050 homeless adults. The incidence of invasive pneumococcal disease in homeless adults was 273 infections per 100,000 persons per year, compared to 9 per 100,000 persons per year in the general adult population. Homeless persons with invasive pneumococcal disease were younger than other adults (median age 46 years vs 67 years, P<.001, and more likely than other adults to be smokers (95% vs. 31%, P<.001, to abuse alcohol (62% vs 15%, P<.001, and to use intravenous drugs (42% vs 4%, P<.001. Relative to age matched controls, they were more likely to have underlying lung disease (12/69, 17% vs 17/272, 6%, P = .006, but not more likely to be HIV infected (17/69, 25% vs 58/282, 21%, P = .73. The proportion of patients with recurrent disease was five fold higher for homeless than other adults (7/58, 12% vs. 24/943, 2.5%, P<.001. In homeless adults, 28 (32% of pneumococcal isolates were of serotypes included in the 7-valent conjugate vaccine, 42 (48% of serotypes included in the 13-valent conjugate vaccine, and 72 (83% of serotypes included in the 23-valent polysaccharide vaccine. Although no outbreaks of disease were identified in shelters, there was evidence of clustering of serotypes suggestive of transmission of pathogenic strains within the homeless population. CONCLUSIONS: Homeless persons are at high risk of serious pneumococcal infection. Vaccination, physical structure changes
Drake, M A
Data were collected on the nutrient intake and nutritional status of 96 single mothers and their 192 dependent children who had been displaced from their homes. The objective of the study was to provide information on the dietary adequacy of a newly identified subgroup of homeless persons, single women and their dependent children. Once situated in temporary housing, those participating in the study indicated that they believed that they were receiving sufficient food. However, a nutrient analysis found that the study subjects in all age groups were consuming less than 50 percent of the 1989 Recommended Dietary Allowances (RDA) for iron, magnesium, zinc, and folic acid. Adults were consuming less than 50 percent of the RDA for calcium. The type and amounts of fats consumed were in higher than desirable quantities for a significant number of subjects of all ages. The health risk factors of iron deficiency anemia, obesity, and hypercholesterolemia were prevalent. The findings indicate a need to examine and remedy nutrient intake deficiencies among single women who are heads of household and their dependent children in temporary housing situations. Diet-related conditions found included low nutrient intakes that may affect child growth and development, risk factors associated with chronic disease, and lack of appropriate foods and knowledge of food preparation methods in shelter situations.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1594741
Moore, David T; Rosenheck, Robert A
Homeless adults use emergency department (ED) services more frequently than other adults, but the relationships between homelessness, health status, outpatient service use, and ED utilization are poorly understood. Data from the Collaborative Initiative to Help End Chronic Homelessness (CICH) were used to compare ED use among chronically homeless adults receiving comprehensive housing, case management, mental health, addiction, and primary care services through CICH at 5 U.S. sites (n = 274) and ED use among comparison group clients receiving generally available community services (n = 116) at the same sites. Multiple imputation was used to account for missing data and differential rates of attrition between the cohorts. Longitudinal models were constructed to compare ED use between the 2 groups during the first year after initiation of CICH services. A mediation analysis was performed to determine the relative contributions of being housed, the receipt of outpatient services, and health status to group differences in ED utilization. Participants receiving CICH services were significantly less likely to report ED use (odds ratio = 0.78, 95% confidence interval [0.65, 0.93]) in the year after program entry. Decreased ED use was primarily mediated by decreased homelessness-not by increased access to other services or health status. This suggests that becoming housed is a key driver of reduced ED utilization and that efforts to provide housing for homeless adults may result in significantly decreased ED use. Further research is needed to determine the long-term effects of housing on health status and to develop services to improve health outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Discusses how gentrification, described as due to both a shift in middle class values and to government policy, has forced out the single room occupancy hotels, rooming houses, and shelters that serve marginal populations and thus contributed to the growing numbers of homeless people. (CMG)
MacKenzie, David; Chamberlain, Chris
The third national census of homeless school students, conducted in 2006, found that the number of homeless students had decreased since 2001. There were 9,389 homeless students in 2006 compared with 12,227 in 2001. Three groups were over-represented in the homeless population: Indigenous students, young people from single parent and blended…
Meurer, Linda N.; Plumb, Ellen J.; Jackson, Jeffrey L.
We estimated hypertension and diabetes prevalence among US homeless adults compared with the general population, and investigated prevalence trends. We systematically searched 5 databases for published studies (1980–2014) that included hypertension or diabetes prevalence for US homeless adults, pooled disease prevalence, and explored heterogeneity sources. We used the National Health Interview Survey for comparison. We included data from 97 366 homeless adults. The pooled prevalence of self-reported hypertension was 27.0% (95% confidence interval = 23.8%, 29.9%; n = 43 studies) and of diabetes was 8.0% (95% confidence interval = 6.8%, 9.2%; n = 39 studies). We found no difference in hypertension or diabetes prevalence between the homeless and general population. Additional health care and housing resources are needed to meet the significant, growing burden of chronic disease in the homeless population. PMID:25521899
Drury, Darrel; Koloski, Judy
A comprehensive study of the Adult Education for the Homeless Program (AEH) was conducted using data from the following sources: program files; focus groups conducted with state project administrators; site visits to 9 local programs in 3 states; surveys of 32 state projects, 230 local programs, 588 service delivery sites, and 2,943 program…
Wenzel, S L; Rhoades, H; Moore, H; Lahey, J; Henwood, B; La Motte-Kerr, W; Bird, M
Permanent supportive housing (PSH) is a widely-accepted solution to the challenge of chronic homelessness. While housing support and retention, physical health, and healthcare continue to be important for formerly homeless persons in PSH, "higher-order" and humanistic needs such as thriving have received less attention and as a result are less well understood in this population. One important indicator of thriving is the ability to establish and articulate life goals. This study utilizes longitudinal data from 421 formerly homeless adults prior to their move into PSH, and at 3-, 6- and 12-months after move-in (369 respondents completed all four interviews), to examine what life goals are articulated by this population and how those goals change over time. Prior to housing, most respondents articulated housing attainment as their primary life goal, whereas at follow-up interviews health goals, housing relocation, and financial goals became more prevalent. Aspirational goals (e.g., independence, self-improvement, artistic pursuits) were also common, but demonstrated a decrease over time in housing. Relationship goals remained common and consistent over time. Findings indicate that housing is a necessary, but perhaps not sufficient, step for improving thriving among formerly homeless adults. Implications for practice and future research are discussed. © Society for Community Research and Action 2018.
Vijayaraghavan, Maya; Hurst, Samantha; Pierce, John P
To examine attitudes toward smoke-free policies and perceptions of e-cigarette use among homeless adults. A cross-sectional qualitative study was conducted. Study setting comprised seven transitional homeless shelters with indoor smoke-free policies in San Diego County; facilities differed in outdoor restrictions on smoking. Sixty-six current or former smokers were the study participants. Participants completed a questionnaire on smoking behaviors, perceived antitobacco norms, and attitudes toward smoke-free policies, and attended a focus group interview that explored these topics. We used a directed content analysis approach to analyze the focus group transcripts. Clients in facilities with outdoor restrictions on smoking had stronger perceived antitobacco norms than those in facilities without such restrictions. We identified the following major themes: attitudes toward smoke-free policies, the use of e-cigarettes, the addictive potential of cigarettes, vulnerability to tobacco industry marketing, and interest in smoking cessation. The consensus was that smoke-free policies were important because they limited secondhand smoke exposure to nonsmokers and children. All were curious about e-cigarettes, particularly if they could be smoked in areas where smoking was prohibited and/or used as a cessation aid. In this study of homeless adults, there was strong support for indoor and outdoor smoke-free policies. However, misperceptions that e-cigarettes could be used indoors could threaten antitobacco norms, highlighting opportunities to educate about the potential risks of e-cigarette use among homeless individuals.
Pluck, Graham; Lee, Kwang-Hyuk; David, Rajan; Macleod, Diana C; Spence, Sean A; Parks, Randolph W
To describe levels of traumatic childhood events in a sample of homeless individuals and to assess the contribution of traumatic events to neurobehavioural traits (measured with the Frontal Systems Behaviour Scale, FrSBe) and general cognitive function (IQ). A sample of 55 homeless adults was recruited from homeless services in the city of Sheffield, UK. All were interviewed to acquire substance misuse information, record experiences of childhood trauma, and assess cognitive and neurobehavioural traits. Experiences of abuse and neglect were assessed with the Childhood Trauma Questionnaire. Participants also completed the Wechsler Abbreviated Scale of Intelligence and the FrSBe, which was completed with respect to current behaviour and conduct prior to homelessness. Around three-quarters of the sample scored in the clinically significant range for current neurobehavioural impairment. They also reported high levels of impairment when rating retrospectively for the period before they were homeless. The mean group IQ was below average at 88. Abuse or neglect during their upbringing was reported by 89% of the sample. Emotional abuse, emotional neglect, and physical neglect were all positively correlated with total FrSBe scores. Sexual abuse, emotional neglect, and physical neglect were all negatively correlated with IQ. The associations between trauma and IQ and neurobehavioural traits appear generally unrelated to the presence of substance misuse in the sample. Our homeless sample displayed relatively low IQ with high levels of neurobehavioural impairment. Our evidence suggests that these neuropsychological factors may, in part, constitute a long-term consequence of childhood trauma. ©2010 The British Psychological Society.
Tolomiczenko, G S; Sota, T; Goering, P N
The psychiatric status of homeless adults has been described primarily in terms of Axis I disorders. By adding a subset of the Personality Assessment Inventory, this study tests the feasibility and usefulness of a brief, self-administered questionnaire to obtain scores on several dimensions of personality. Cluster analysis sorted 112 tested subjects into four groups characterized by distinct profiles. Two of these were characterized by extreme scores on pathological dimensions of personality (borderline features, antisocial traits, and aggressivity) and differed primarily on the dimension of suicidality. The third reflected moderate levels of personality dysfunction and the fourth did not deviate from adult nonclinical norms. The validity of the clusters was supported by demographic, background, and diagnostic subgroup differences. Brief personality assessment can be a cost-effective approach to matching services with clinical needs of homeless adults by attending to interpersonal dimensions that will likely affect service provision.
Stergiopoulos, V; Cusi, A; Bekele, T; Skosireva, A; Latimer, E; Schütz, C; Fernando, I; Rourke, S B
This study examines neurocognitive functioning in a large, well-characterized sample of homeless adults with mental illness and assesses demographic and clinical factors associated with neurocognitive performance. A total of 1500 homeless adults with mental illness enrolled in the At Home Chez Soi study completed neuropsychological measures assessing speed of information processing, memory, and executive functioning. Sociodemographic and clinical data were also collected. Linear regression analyses were conducted to examine factors associated with neurocognitive performance. Approximately half of our sample met criteria for psychosis, major depressive disorder, and alcohol or substance use disorder, and nearly half had experienced severe traumatic brain injury. Overall, 72% of participants demonstrated cognitive impairment, including deficits in processing speed (48%), verbal learning (71%) and recall (67%), and executive functioning (38%). The overall statistical model explained 19.8% of the variance in the neurocognitive summary score, with reduced neurocognitive performance associated with older age, lower education, first language other than English or French, Black or Other ethnicity, and the presence of psychosis. Homeless adults with mental illness experience impairment in multiple neuropsychological domains. Much of the variance in our sample's cognitive performance remains unexplained, highlighting the need for further research in the mechanisms underlying cognitive impairment in this population. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Tsai, Jack; Edens, Ellen L; Rosenheck, Robert A
Studies of chronically homeless adults have not adequately investigated the impact of adverse childhood experiences. The current retrospective, longitudinal study profiles the childhood experiences reported by 738 participants in an 11-site supported housing initiative and examines how their childhood profile is related to their homeless history, their psychosocial status before entry into supported housing, and their outcomes once enrolled in supported housing. A two-step cluster analysis revealed three childhood profiles: Relatively Numerous Childhood Problems, Disrupted Family, and Relatively Few Childhood Problems. Results found that participants with Relatively Numerous Childhood Problems were significantly younger when they were first homeless and had worse drug use before entry into supported housing than other participants. There were no differences in housing, substance use, or mental and physical health outcomes once participants were enrolled in supported housing. Prevention of homelessness should focus, to the extent possible, on individuals with extensive childhood problems.
McQuistion, Hunter L; Gorroochurn, Prakash; Hsu, Eustace; Caton, Carol L M
Alcohol and drug use are commonly associated with the experience of homelessness. In order to better understand this, we explored the prevalence of drug and alcohol use as it related to successful re-housing within a sample of first-time single homeless adults at municipal shelters. From within this sample, we compared the features of recurrent homelessness with those of chronic homelessness and of being stably housed. We interviewed 344 subjects upon shelter entry and followed each one every six months for 18 months using standardized social and mental health measures. We analyzed baseline assessments relative to housing experiences during follow-up using Chi square and multinomial logistic regression. Eighty-one percent (N = 278) obtained housing over 18 months, of which 23.7 % (N = 66) experienced homelessness again. Recurrent homelessness was more common among those with a high school education and if initially re-housed with family. Bivariate analysis resulted in the observation of the highest rate of alcohol and other drug use among this recurrent group and multinomial logistic regression supported this only with the coupling of arrest history and diagnosed antisocial personality disorder. With relatively high rates of recurrent homelessness, there were differences between subjects who experienced recurrent homelessness compared to those who were stably housed and with chronic homelessness. That alcohol and other substance use disorders were associated with recurrent homelessness only if they were linked to other risk factors highlights the complexity of causes for homelessness and a resultant need to organize them into constellations of causal risk factors. Consistent with this, there should be initiatives that span bureaucratic boundaries so as to flexibly meet multiple complex service needs, thus improving outcomes concerning episodes of recurrent homelessness.
Layton, M C; Cantwell, M F; Dorsinville, G J; Valway, S E; Onorato, I M; Frieden, T R
Congregate facilities for homeless persons with the acquired immunodeficiency syndrome (AIDS) are often endemic for tuberculosis. We evaluated tuberculosis screening methods at single-room-occupancy hotels housing persons with AIDS. Residents were screened by cross matching the New York City Tuberculosis Registry, interviewing for tuberculosis history, skin testing, and chest radiography. Cases were classified as either previously or newly diagnosed. Among the 106 participants, 16 (15%) previously diagnosed tuberculosis cases were identified. Participants' tuberculosis histories were identified by the questionnaire (100%) or by registry match (69%). Eight participants (50%) were noncompliant with therapy. These findings prompted the establishment of a directly observed therapy program on site.
Chelvakumar, Gayathri; Ford, Nancy; Kapa, Hillary M; Lange, Hannah L H; McRee, Annie-Laurie; Bonny, Andrea E
Homeless and runaway youth are at disproportionate risk for adverse health outcomes. Many barriers to accessing healthcare have been documented; however, the relative impact of discrete barriers on homeless youth healthcare utilization behavior is not firmly established. We administered a survey examining reported barriers and healthcare utilization among adolescents and young adults accessing services at three community centers for homeless and runaway youth. Of 180 respondents, 57 % were male, 80 % non-White, and 21 % identified as a sexual minority. Stepwise logistic regression models, controlling for age and study site, explored associations between barriers and 3 healthcare utilization outcomes (doctor visit in past 12 months; regular care provider; frequent emergency department (ED) visits). The most commonly reported barriers were "don't have a ride" (27.2 %), "no insurance" (23.3 %), and "costs too much" (22.8 %). All fear-based barriers (e.g., "I don't trust the doctors") were reported by runaway youth as the impact of discrete barriers varies depending on outcome of focus.
Edalati, Hanie; Nicholls, Tonia L; Crocker, Anne G; Roy, Laurence; Somers, Julian M; Patterson, Michelle L
Exposure to adverse childhood experiences (ACEs) is highly prevalent among homeless individuals and is associated with negative consequences during homelessness. This study examined the effect of ACEs on the risk of criminal justice involvement and victimization among homeless individuals with mental illness. The study used baseline data from a demonstration project (At Home/Chez Soi) that provided Housing First and recovery-oriented services to homeless adults with mental illness. The sample was recruited from five Canadian cities and included participants who provided valid responses on an ACEs questionnaire (N=1,888). Fifty percent reported more than four types of ACE, 19% reported three or four types, 19% reported one or two, and 12% reported none. Rates of criminal justice involvement and victimization were significantly higher among those with a history of ACEs. For victimization, the association was significant for all ten types of ACE, and for justice involvement, it was significant for seven types. Logistic regression models indicated that the effect of cumulative childhood adversity on the two outcomes was significant regardless of sociodemographic factors, duration of homelessness, and psychiatric diagnosis, with one exception: the relationship between cumulative childhood adversity and criminal justice involvement did not remain significant when the analysis controlled for a diagnosis of posttraumatic stress disorder and substance dependence. Findings support the need for early interventions for at-risk youths and trauma-informed practice and violence prevention policies that specifically target homeless populations.
Bowen, Elizabeth A; Irish, Andrew
We aimed to examine the food-seeking experiences of homeless emerging adults (age 18-24 years) in a US urban context. The study used a qualitative descriptive design, combining semi-structured interviews with a standardized quantitative measure of food insecurity. Interview data were coded using constant comparative methods to identify patterns across and within interviews. Emerging themes were confirmed and refined through member checking. Buffalo, a mid-sized city in the Northeastern USA. A sample of thirty participants was recruited through community-based methods. Eligibility criteria specified that participants were aged 18-24 years and did not have a stable place to live. The sample was demographically diverse and included participants who were couch-surfing, staying on the streets and/or using shelters. Participants' food access strategies varied across their living circumstances. Common strategies included purchasing food with cash or benefits (reported by 77 %), using free meal programmes (70 %) and eating at friends' or relatives' homes (47 %). Although 70 % of participants received Supplemental Nutrition Assistance Program benefits, several reported access barriers, including initial denials of eligibility due to being listed on a parent's application even when the participant no longer resided in the household. Participants described a stigma associated with using food pantries and free meal programmes and expressed preference for less institutionalized programmes such as Food Not Bombs. Given endemic levels of food insecurity among homeless youth and young adults, policy modifications and service interventions are needed to improve food access for this population.
Nyamathi, Adeline; Liu, Yihang; Marfisee, Mary; Shoptaw, Steven; Gregerson, Paul; Saab, Sammy; Leake, Barbara; Tyler, Darlene; Gelberg, Lillian
Hepatitis B virus (HBV) infection constitutes a major health problem for homeless persons. Ability to complete an HBV vaccination series is complicated by the need to prioritize competing needs, such as addiction issues, safe places to sleep, and food, over health concerns. The objectives of this study were to evaluate the effectiveness of a nurse-case-managed intervention compared with that of two standard programs on completion of the combined hepatitis A virus (HAV) and HBV vaccine series among homeless adults and to assess sociodemographic factors and risk behaviors related to the vaccine completion. A randomized, three-group, prospective, quasi-experimental design was conducted with 865 homeless adults residing in homeless shelters, drug rehabilitation sites, and outdoor areas in the Skid Row area of Los Angeles. The programs included (a) nurse-case-managed sessions plus targeted hepatitis education, incentives, and tracking (NCMIT); (b) standard targeted hepatitis education plus incentives and tracking (SIT); and (c) standard targeted hepatitis education and incentives only (SI). Sixty-eight percent of the NCMIT participants completed the three-series vaccine at 6 months, compared with 61% of SIT participants and 54% of SI participants. NCMIT participants had almost 2 times greater odds of completing vaccination than those of participants in the SI program. Completers were more likely to be older, to be female, to report fair or poor health, and not to have participated in a self-help drug treatment program. Newly homeless White adults were significantly less likely than were African Americans to complete the vaccine series. The use of vaccination programs incorporating nurse case management and tracking is critical in supporting adherence to completion of a 6-month HAV/HBV vaccine. The finding that White homeless persons were the least likely to complete the vaccine series suggests that programs tailored to address their unique cultural issues are needed.
Koffarnus, Mikhail N.; Wong, Conrad J.; Fingerhood, Michael; Svikis, Dace S.; Bigelow, George E.; Silverman, Kenneth
The current study examined whether monetary incentives could increase engagement and achievement in a job-skills training program for unemployed, homeless, alcohol-dependent adults. Participants (n?=?124) were randomized to a no-reinforcement group (n?=?39), during which access to the training program was provided but no incentives were given; a…
Pedersen, Eric R; Ewing, Brett A; D'Amico, Elizabeth J; Miles, Jeremy N V; Haas, Ann C; Tucker, Joan S
Homeless young adults are at risk for alcohol and other drug (AOD) use and risky sexual behavior. Interventions are needed to help these young people reduce their risky behavior, but this population is often difficult to engage and retain in services. We offered a four-session AOD and risky sex reduction program to 100 participants and examined if retention in the program was predicted by a number of factors: demographics, homelessness severity, other service use, AOD behaviors, mental health symptoms, sexual risk behaviors, and readiness to change AOD and condom use. Nearly half (48%) of participants completed all sessions. In bivariate analyses, participants were significantly less likely to be retained in the program if they had slept outdoors in the past month, engaged in more alcohol and marijuana use, experienced more alcohol-related consequences, and received the program in an urban drop-in center (as opposed to a drop-in center near the beach). When controlling for all significant bivariate relationships, only sleeping outdoors and receipt of the program in the urban setting predicted fewer sessions completed. The most endorsed reasons for program non-completion were being too busy to attend and inconvenient day/time of the program. Findings can help outreach staff and researchers better prepare methods to engage higher risk homeless youth and retain them in services. Finding unique ways to help youth overcome barriers related to location of services appears especially necessary, perhaps by bringing services to youth where they temporarily reside or offering meaningful incentives for program attendance.
Gabrielian, Sonya; Young, Alexander S; Greenberg, Jared M; Bromley, Elizabeth
Objective: Research suggests that social supports are associated with housing retention among adults who have experienced homelessness. Yet, we know very little about the social support context in consumers find and retain housing. We examined the ways and identified the junctures in which consumers' skills and deficits in accessing and mobilizing social supports influenced their longitudinal housing status. Method: We performed semi-structured qualitative interviews with VA Greater Los Angeles consumers ( n = 19) with serious mental illness, substance use disorders, and a history of homelessness; interviews explored associations between longitudinal housing status (categorized as: stable, independent housing; sheltered housing, continually engaged in structured housing programs; and unstable housing) and social supports. We compared data from consumers in these 3 mutually exclusive categories. Results: All participants described social support as important for finding and maintaining housing. However, participants used formal (provider/case managers) and informal (family/friends) supports in different ways. Participants in stable housing relied on formal and informal supports to obtain/maintain housing. Participants in sheltered housing primarily used formal supports, for example, case management staff. Unstably housed participants used formal and informal supports, but some of these relationships were superficial or of negative valence. Interpersonal problems were prevalent across longitudinal housing status categories. Conclusions and Implications for Practice: Social context, including patterns of formal and informal support, was associated with participants' longitudinal housing status. Within interventions to end homelessness, these findings suggest the value of future research to identify, tailor, and implement practices that can help consumers improve their social resources. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Edens, Ellen L; Tsai, Jack; Rosenheck, Robert A
Recent research suggests low-demand housing (i.e., not contingent upon abstinence) is effective in helping people exit homelessness, even among recent active substance users. Whether active users of illicit drugs and stimulants have worse housing outcomes than primary alcohol users, however, is unknown. A total of 149 participants in a multisite supportive housing program who reported high levels of active substance use at program entry were classified as either (1) predominantly "Alcohol Use" (>10 of 30 days alcohol, but not >10 days of drug use) or (2) "Illicit Drug Use" (>10 of 30 days any single illicit drug use with or without alcohol use). Sub-analysis of the "Illicit Drug Use" group compared participants reporting high levels of "Stimulant Use" (>10 days cocaine, crack, or methamphetamine use) to those with high levels of "Non-stimulant Use" (>10 days marijuana or other non-stimulant drug use). Group differences in housing outcomes were examined with mixed model multivariate regression. During 24-month follow-up, days housed increased dramatically for both the "Alcohol Use" and the "Illicit Drug Use" groups without significant differences. Sub-analysis of illicit drug users showed stimulant use was associated with fewer days housed (p = .01) and more days homeless (p = .02) over time. Among illicit drug users, stimulant users have somewhat less successful housing outcomes than other active drug and alcohol users, though both groups maintained substantial housing improvements in low-demand housing. © American Academy of Addiction Psychiatry.
Riley, Elise D; Cohen, Jennifer; Dilworth, Samantha E; Grimes, Barbara; Marquez, Carina; Chin-Hong, Peter; Philip, Susan S
The social context of poverty is consistently linked to Trichomonas vaginalis infection, yet few studies regarding T. vaginalis have been conducted exclusively among low-income individuals. We identified social determinants of health associated with prevalent T. vaginalis infection among homeless and unstably housed adult women. Between April and October of 2010, we conducted cross-sectional T. vaginalis screening and behavioural interviews in an existing cohort of San Francisco homeless and unstably housed women. Data were analysed using multivariable logistical regression. Among 245 study participants, the median age was 47 years and 72% were of non-Caucasian race/ethnicity. T. vaginalis prevalence was 12%, compared to 3% in the general population, and 33% of infected individuals reported no gynaecological symptoms. In adjusted analysis, the odds of T. vaginalis infection were lower among persons older than 47 years, the population median (OR=0.14, 95% CI 0.04 to 0.38), and higher among those reporting recent short-term homeless shelter stays (OR=5.36, 95% CI 1.57 to 18.26). Race and income did not reach levels of significance. Sensitivity analyses indicated that testing all women who report recent unprotected sex would identify more infections than testing those who report gynaecological symptoms (20/30 vs 10/30; p=0.01). The prevalence of T. vaginalis is high among homeless and unstably housed adult women, over one-third of infected individuals have no gynaecological symptoms, and correlates of infection differ from those reported in the general population. Targeted screening and treatment among impoverished women reporting recent unprotected sex, particularly young impoverished women and all women experiencing short-term homelessness, may reduce complications related to this treatable infection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Hurstak, Emily; Johnson, Julene K; Tieu, Lina; Guzman, David; Ponath, Claudia; Lee, Christopher T; Jamora, Christina Weyer; Kushel, Margot
We evaluated cognitive function and factors associated with cognitive impairment in a cohort of older homeless adults. We hypothesized that substance use and a history of traumatic brain injury would be associated with cognitive impairment. We recruited 350 homeless individuals aged ≥50 years using population-based sampling and conducted structured interviews and neuropsychological testing. We evaluated alcohol use with the Alcohol Use Disorder Identification Test, defining high-severity alcohol use as a total score ≥16 or ≥4 on the alcohol dependency sub-scale. We assessed global cognition with the Modified Mini-Mental State Test (3MS) and processing speed and executive function with the Trail Making Test (TMTB), defining impairment as performing 1.5 standard deviations below the standardized mean. We used multivariable logistic regression to examine the association between alcohol use and cognition. Participants had a median age of 58 years [IQR 54-61], 76.7% were men, and 79.9% were African American. A quarter (25.1%) of participants met criteria for impairment on the 3MS; 32.9% met criteria for impairment on TMTB. In models adjusted for sociodemographic variables and health conditions, high-severity alcohol use was associated with global cognitive impairment (AOR 2.39, CI 1.19-4.79) and executive dysfunction (AOR 3.09, CI 1.61-5.92). Older homeless adults displayed a prevalence of cognitive impairment 3-4 times higher than has been observed in general population adults aged 70 and older. Impaired cognition in older homeless adults could impact access to housing programs and the treatment of health conditions, including the treatment of alcohol use disorders. Copyright © 2017 Elsevier B.V. All rights reserved.
Tyler, Kimberly A.; Melander, Lisa A.
Though research has examined risk factors associated with street victimization among homeless young people, little is known about dating violence experiences among this group. Given homeless youths' elevated rates of child maltreatment, it is likely that they are at high risk for dating violence. As such, the current study examined the association…
O'Connell, Maria; Sint, Kyaw; Rosenheck, Robert
Supported housing, combining rent subsidies with intensive case management, is associated with improvements in quality of life of homeless adults, but factors mediating their impact on quality of life have not been studied. Twelve-month outcome data from a randomized trial of the Housing and Urban Development- Veterans Affairs Supported Housing program (HUD-VASH) showed that access to a housing rent subsidy plus intensive case management (ICM) was associated with greater improvement in subjective quality of life than ICM alone. Multiple mediation analyses were applied to identify variables that significantly mediated the relationship between receipt of housing voucher and improvements in quality of life. Significant mediating covariates were those whose 95% bias-corrected confidence intervals, when added to the model predicting improvement in quality of life, did not overlap zero. Increases in the number of days housed, size of social network, and availability of emotional support appear to mediate improvement in quality of life and account for 71% of the benefit attributable to having a rent subsidy. Improvement in subjective quality of life though housing subsidies is mediated by gains in both material and psychosocial factors. Mediating factors deserve special attention in supported housing services. © Society for Community Research and Action 2018.
Fitzpatrick, Kevin M
Optimism has been noted as a primary protective factor in understanding mental health symptomatology in clinical and non-clinical settings. Any exploration of optimism has been absent in understanding mental health outcomes among homeless people. This study, using intensive interviews with 168 homeless adults in Northwest Arkansas, examines the role that social support and optimism play in lessening the negative impact of homeless circumstances/experiences on mental health symptomatology. Using OLS, findings support a mediating/protective role that social support and optimism play in lowering the negative effects of childhood life experiences on depressive symptoms among homeless persons. Despite the overwhelming conditions of homelessness, persons with higher levels of optimism and social support report lower depression and anxiety symptoms. The findings are discussed paying particular attention to the importance of developing and maintaining the perception of support and resiliency in preserving a positive outlook for the future among homeless persons facing often-debilitating circumstances. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Koh, Katherine A.; Hoy, Jessica S.; O’Connell, James J.; Montgomery, Paul
Despite stereotypes of the homeless population as underweight, the literature lacks a rigorous analysis of weight status in homeless adults. The purpose of this study is to present the body mass index (BMI) distribution in a large adult homeless population and to compare this distribution to the non-homeless population in the United States. Demographic, BMI, and socioeconomic variables from patients seen in 2007–2008 were collected from the Boston Health Care for the Homeless Program (BHCHP)....
Simons, Ronald L.; Whitbeck, Les B.
Studied 40 adolescent runaways and 95 homeless women to examine impact of early sexual abuse on prostitution and victimization. Findings suggest that early sexual abuse increases probability of involvement in prostitution irrespective of influence of running away, substance abuse, and other deviant acts; only indirectly affects chances of…
Tyler, Kimberly A.; Melander, Lisa A.; Noel, HarmoniJoie
One of the most prevalent forms of violence in contemporary society is the victimization of intimate partners. Although it has been established that homeless young people experience high levels of victimization on the street, little is known about partner violence (PV) experiences among this group, especially bidirectional violence. As such, the…
Tyler, Kimberly A.; Melander, Lisa A.
Although homeless youth with and without foster care histories both face adverse life circumstances, little is known about how these two groups compare in terms of their early histories and whether they face similar outcomes. As such, we compared those with and without a history of foster care placement to determine if the associations between a…
Tyler, Kimberly A.; Melander, Lisa A.
Although previous research documents high rates of child abuse, street victimization, and substance use among homeless youth, few studies have investigated these three constructs simultaneously, and thus little is known about how various forms of victimization are uniquely associated with substance use among this population. The purpose of this…
Krabbenborg, M.A.M.; Boersma, S.N.; van der Veld, A.M.; Vollebergh, W.A.M.; Wolf, Jürgen
The self-determination theory emphasizes the importance of satisfaction with autonomy, competence, and relatedness for a person’s psychological growth and well-being. This study examines associations between autonomy, competence, and relatedness with quality of life in homeless young adults; and
Ferguson, Kristin M.; Bender, Kimberly; Thompson, Sanna J.
This study used the risk and resilience framework to examine predictors of formal and informal sources of income among homeless young adults. Formal sources of income generation consisted of full-time, part-time, or paid, temporary work. Informal sources included earning money from selling personal possessions, selling drugs, and theft. In all,…
Nishio, Akihiro; Horita, Ryo; Sado, Tadahiro; Mizutani, Seiko; Watanabe, Takahiro; Uehara, Ryosuke; Yamamoto, Mayumi
Many studies have reported that the prevalence of mental illness and cognitive disability is higher among homeless individuals compared to the general population, and the rates of mental illness among the homeless population have recently increased. This study: (i) compares causes of homelessness or barriers to escaping homelessness for people with/without mental illness/cognitive disability; (ii) reveals problems with the Japanese homeless policy; and (iii) proposes an effective and necessary support system. The participants were 114 homeless individuals. A psychiatric diagnostic interview and the Wechsler Adult Intelligence Scale, version III were used to measure participants' mental health and cognitive abilities. A questionnaire was administered comprising 17 items related to the causes of their homelessness and barriers to escaping from it. Participants were divided into four groups - with/without mental illness or cognitive disability - and Fisher's exact test was used to compare the questionnaire results. Individuals with cognitive disabilities considered bad relationships with their family members to be the cause of their homelessness. Conversely, normal individuals considered their homelessness to be the result of debt more so than did individuals with mental problems. Individuals with mental illness had more difficulties escaping homelessness than did either normal individuals or individuals with cognitive disability. This tendency was observed most strongly among individuals with both mental illness and cognitive disability. Most homeless individuals considered economic problems to be the cause of their homelessness; however, difficulties with human relationships were also important factors and were more difficult for participants to acknowledge. Furthermore, these difficulties were exacerbated among those individuals with mental problems. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.
Koffarnus, Mikhail N.; Wong, Conrad J.; Diemer, Karly; Needham, Mick; Hampton, Jacqueline; Fingerhood, Michael; Svikis, Dace S.; Bigelow, George E.; Silverman, Kenneth
Aims: To assess the efficacy of the Therapeutic Workplace, a substance abuse intervention that promotes abstinence while simultaneously addressing the issues of poverty and lack of job skills, in promoting abstinence from alcohol among homeless alcoholics. Methods: Participants (n = 124) were randomly assigned to conditions either requiring abstinence from alcohol to engage in paid job skills training (Contingent Paid Training group), offering paid job skills training with no abstinence conti...
Attles, Henrietta S. Evans
This book is a study of the impact that changes in living environments (i.e. from homelessness in a shelter to a family's own dwelling unit) have on the academic achievement of school-age children. The study samples seven cases of public school children in grades 5 through 8 during the years 1988 to 1991. The children lived in the same shelter and…
Gray, Heather M; Nelson, Sarah E; Shaffer, Howard J; Stebbins, Patricia; Farina, Andrea Ryan
Among people experiencing homelessness, difficulty securing housing is often compounded by concurrent challenges including unemployment, chronic illness, criminal justice involvement, and victimization. The Moving Ahead Program (MAP) is a vocational rehabilitation program that seeks to help adults facing these challenges to secure competitive employment. We prospectively studied how MAP graduates (N = 97) changed from the beginning of MAP to about six months after graduation. We observed a variety of positive outcomes not just in employment and housing but also in health, substance use, and criminal justice involvement. However, these gains were not universal; for instance, participants were less likely to report positive outcomes at follow-up if they started MAP with a serious mental illness, made relatively small gains in work skills, or did not seek mental health treatment during the six months after they completed MAP. These findings might encourage program staff to devote additional resources toward supporting at-risk students.
Koffarnus, Mikhail N; Wong, Conrad J; Fingerhood, Michael; Svikis, Dace S; Bigelow, George E; Silverman, Kenneth
The current study examined whether monetary incentives could increase engagement and achievement in a job-skills training program for unemployed, homeless, alcohol-dependent adults. Participants (n=124) were randomized to a no-reinforcement group (n=39), during which access to the training program was provided but no incentives were given; a training reinforcement group (n=42), during which incentives were contingent on attendance and performance; or an abstinence and training reinforcement group (n=43), during which incentives were contingent on attendance and performance, but access was granted only if participants demonstrated abstinence from alcohol. abstinence and training reinforcement and training reinforcement participants advanced further in training and attended more hours than no-reinforcement participants. Monetary incentives were effective in promoting engagement and achievement in a job-skills training program for individuals who often do not take advantage of training programs. © Society for the Experimental Analysis of Behavior.
Henwood, Benjamin F; Derejko, Katie-Sue; Couture, Julie; Padgett, Deborah K
This mixed-methods study uses Maslow's hierarchy as a theoretical lens to investigate the experiences of 63 newly enrolled clients of housing first and traditional programs for adults with serious mental illness who have experienced homelessness. Quantitative findings suggests that identifying self-actualization goals is associated with not having one's basic needs met rather than from the fulfillment of basic needs. Qualitative findings suggest a more complex relationship between basic needs, goal setting, and the meaning of self-actualization. Transforming mental health care into a recovery-oriented system will require further consideration of person-centered care planning as well as the impact of limited resources especially for those living in poverty.
Palepu, Anita; Hubley, Anita M; Russell, Lara B; Gadermann, Anne M; Chinni, Mary
The aim of this study was to identify what is most important to the quality of life (QoL) of those who experience homelessness by directly soliciting the views of homeless and hard-to-house Canadians themselves. These individuals live within a unique social context that differs considerably from that of the general population. To understand the life areas that are most important to them, it is critical to have direct input from target populations of homeless and hard-to-house persons. Focus groups were conducted with 140 individuals aged 15 to 73 years who were homeless or hard-to-house to explore the circumstances in which they were living and to capture what they find to be important and relevant domains of QoL. Participants were recruited in Toronto, Ottawa, Montreal, and Vancouver. Content analysis was used to analyze the data. Six major content themes emerged: Health/health care; Living conditions; Financial situation; Employment situation; Relationships; and Recreational and leisure activities. These themes were linked to broader concepts that included having choices, stability, respect, and the same rights as other members of society. These findings not only aid our understanding of QoL in this group, but may be used to develop measures that capture QoL in this population and help programs and policies become more effective in improving the life situation for persons who are homeless and hard-to-house. Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study.
Full Text Available Abstract Background The aim of this study was to identify what is most important to the quality of life (QoL of those who experience homelessness by directly soliciting the views of homeless and hard-to-house Canadians themselves. These individuals live within a unique social context that differs considerably from that of the general population. To understand the life areas that are most important to them, it is critical to have direct input from target populations of homeless and hard-to-house persons. Methods Focus groups were conducted with 140 individuals aged 15 to 73 years who were homeless or hard-to-house to explore the circumstances in which they were living and to capture what they find to be important and relevant domains of QoL. Participants were recruited in Toronto, Ottawa, Montreal, and Vancouver. Content analysis was used to analyze the data. Results Six major content themes emerged: Health/health care; Living conditions; Financial situation; Employment situation; Relationships; and Recreational and leisure activities. These themes were linked to broader concepts that included having choices, stability, respect, and the same rights as other members of society. Conclusions These findings not only aid our understanding of QoL in this group, but may be used to develop measures that capture QoL in this population and help programs and policies become more effective in improving the life situation for persons who are homeless and hard-to-house. Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study.
Hunter, Charlotte E; Palepu, Anita; Farrell, Susan; Gogosis, Evie; O'Brien, Kristen; Hwang, Stephen W
Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barriers to medication adherence. This study aimed to determine the prevalence of, reasons for, and factors associated with medication nonadherence among homeless and vulnerably housed individuals. Additionally, we examined the association between medication nonadherence and subsequent emergency department utilization during a 1-year follow-up period. Data were collected as part of the Health and Housing in Transition study, a prospective cohort study tracking the health and housing status of 595 homeless and 596 vulnerably housed individuals in 3 Canadian cities. Logistic regression was used to identify factors associated with medication nonadherence, as well as the association between medication nonadherence at baseline and subsequent emergency department utilization. Among 716 participants who had been prescribed a medication, 189 (26%) reported nonadherence. Being ≥40 years old was associated with decreased likelihood of nonadherence (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.41-0.84), as was having a primary care provider (AOR = 0.49; 95% CI = 0.34-0.71). Having a positive screen on the AUDIT (Alcohol Use Disorders Identification Test; an indication of harmful or hazardous drinking) was associated with increased likelihood of nonadherence (AOR = 1.86; 95% CI = 1.31-2.63). Common reasons for nonadherence included side effects, cost, and lack of access to a physician. Self-reported nonadherence at baseline was significantly associated with frequent emergency department use (≥3 visits) over the follow-up period at the bivariate level (OR = 1.55; 95% CI = 1.02-2.35) but was not significant in a multivariate model (AOR = 1.49; 95% CI = 0.96-2.32). Homeless and vulnerably housed individuals face significant barriers to medication adherence. Health care
Schmitz, Rachel M; Tyler, Kimberly A
Familial responses to lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people's identities range on a spectrum from rejection to acceptance and these reactions strongly impact family relationships and young adult well-being. Less is known, however, about how family members' reactions may differ based on young people's contexts of socioeconomic status. Through a qualitative, life course analysis of in-depth interview data from 46 LGBTQ college students and LGBTQ homeless young adults, our study highlights the diverse, contextual nuances of young people's "linked lives" within their families. We find that the context of socioeconomic status influenced how a young person managed family rejection. Conversely, processes of familial acceptance were also connected to life course transitions that worked in some cases to enhance LGBTQ young adults' family relationships. Finally, the intricacy of familial reactions to a young person's LGBTQ identity transcended socioeconomic contexts as many respondents shared similar experiences of rejection and acceptance. These findings have implications for understanding how young people manage family relationships across different contexts of socioeconomic status and how these experiences can shape their life course trajectories. Results from this study can inform LGBTQ youth service providers by tailoring intervention programs that account for contextual social diversity.
National Center for Homeless Education at SERVE, 2012
Each year, more than a million young people in the United States experience homelessness; some of these young people, known as unaccompanied homeless youth, will face the challenges of homelessness while living on their own without the support of a caring adult. Unaccompanied homeless youth face the same struggles as other young people: trying to…
Reingle Gonzalez, Jennifer M; Businelle, Michael S; Kendzor, Darla; Staton, Michele; North, Carol S; Swartz, Michael
There is a significant revolving door of incarceration among homeless adults. Homeless adults who receive professional coordination of individualized care (ie, case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (eg, food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, and legal aid). Many barriers (eg, limited transportation, inability to schedule appointments, and limited knowledge of available services) prevent homeless adults who were recently released from incarceration from obtaining available case management, crisis management, substance abuse, and mental health services. The aim of the Link2Care study is to assess the effectiveness of a smartphone app for increasing case management and treatment service utilization, and in turn reduce homelessness and rearrest. The goals of this research are to (1) assess the impact of an innovative smartphone app that will prompt and directly link recently incarcerated homeless adults to community-based case management services and resources and (2) utilize in-person and smartphone-based assessments to identify key variables (eg, alcohol or drug use, social support, psychological distress, and quality of life) that predict continued homelessness and rearrest. Homeless adults (N=432) who enroll in a shelter-based Homeless Recovery Program after release from the Dallas County Jail will be randomly assigned to one of the three treatment groups: (1) usual case management, (2) usual case management plus smartphone, and (3) usual case management with a study-provided smartphone that is preloaded with an innovative case management app
This article analyses the risk of homelessness in the Danish adult population. The study is based on individual, administrative micro-data for about 4.15 million Danes who were 18 years or older on 1 January 2002. Homelessness is measured by shelter use from 2002 to 2011. Data also cover civil st...... that homelessness in Denmark is widely concentrated amongst individuals with complex support needs, rather than associated with wider poverty problems....
Being homeless in one’s homeland is a colonial legacy for many Indigenous people in settler societies. The construction of Commonwealth nation-states from colonial settler societies depended on the dispossession of Indigenous peoples from their lands. The legacy of that dispossession and related...... attempts at assimilation that disrupted Indigenous practices, languages, and cultures—including patterns of housing and land use—can be seen today in the disproportionate number of Indigenous people affected by homelessness in both rural and urban settings. Essays in this collection explore the meaning...... and scope of Indigenous homelessness in the Canada, Australia, and New Zealand. They argue that effective policy and support programs aimed at relieving Indigenous homelessness must be rooted in Indigenous conceptions of home, land, and kinship, and cannot ignore the context of systemic inequality...
The felt—as both methodology and experiential terrain—remains under-explored and under-theorised in research on homelessness. This experimental piece traces the multi-sensory engagement of ethnographic and biographic fieldwork undertaken for separate projects with homeless people in two capital cities on Australia’s east coast. The epistemological contributions and emotional dimensions of seeing, tasting, touching, smelling and listening are explored. Throu...
Henwood, Benjamin F; Matejkowski, Jason; Stefancic, Ana; Lukens, Jonathan M
This 1-year longitudinal study of adults who have recently transitioned from homelessness to Permanent Supportive Housing (PSH) focuses on quality of life as a primary outcome of interest. Eighty of 103 new tenants participated in structured interviews at the time of entry into their new home and at 12-months post-housing. t-tests assessed differences in community participation and quality of life measures at the 2 time points. Mixed effects models examined the impact of community participation on quality of life. Results show that time in independent housing was significantly associated with several domains of quality of life. Symptom severity was also significantly and negatively related to quality of life domains. Community participation was significantly related to frequency of social contacts only. These findings suggest that community participation is not critical to improving quality of life, and that despite concerns that individuals may feel isolated and lonely when living independently, satisfaction with one׳s living situation and family relationships nevertheless improves with housing tenure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Duberstein Lindberg, Laura; Singh, Susheela
Public policies promoting abstinence until marriage attempt to influence the sexual behavior of the more than 18 million American women who are currently single. An analysis of these women's behavior is needed to inform policies that are responsive to their sexual and reproductive health needs. Sexual behaviors, risk factors and reproductive health needs were examined among a nationally representative sample of 6,493 women aged 20-44 from the 2002 National Survey of Family Growth. Paired t tests were used to assess differences among single, married and cohabiting women by selected demographic, behavioral and risk measures. Thirty-six percent of women aged 20-44 are single, and nine in 10 single women are sexually experienced. Seventy percent of the latter women are currently sexually active; on average, they had intercourse in seven of the last 12 months. A higher proportion of single women (22%) than of cohabiting (9%) or married women (2%) have had two or more partners in the past year, and half of single women are at risk of unintended pregnancy. Furthermore, single women and cohabiting women are more likely to lack health insurance than are married women (21-25% vs. 12%). Because of the high level of sexual activity among single adult women, providers must address their reproductive health care needs and offer appropriate counseling and services. Government policies aimed at encouraging adult women to have sex only within marriage appear out of touch with the reality of the sexual behavior of single women.
Chan, Dara V; Gopal, Sucharita; Helfrich, Christine A
Although a desired rehabilitation goal, research continues to document that community integration significantly lags behind housing stability success rates for people of a variety of ages who used to be homeless. While accessibility to resources is an environmental factor that may promote or impede integration activity, there has been little empirical investigation into the impact of proximity of community features on resource use and integration. Using a Geographic Information Systems (GIS) approach, the current study examines how accessibility or proximity to community features in Boston, United States related to the types of locations used and the size of an individual's "activity space," or spatial presence in the community. Significant findings include an inverse relationship between activity space size and proximity to the number and type of community features in one's immediate area. Specifically, larger activity spaces were associated with neighborhoods with less community features, and smaller activity spaces corresponded with greater availability of resources within one's immediate area. Activity space size also varied, however, based on proximity to different types of resources, namely transportation and health care. Greater community function, or the ability to navigate and use community resources, was associated with better accessibility and feeling part of the community. Finally, proximity to a greater number of individual identified preferred community features was associated with better social integration. The current study suggests the ongoing challenges of successful integration may vary not just based on accessibility to, but relative importance of, specific community features and affinity with one's surroundings. Community integration researchers and housing providers may need to attend to the meaning attached to resources, not just presence or use in the community. Copyright © 2014 Elsevier Ltd. All rights reserved.
Tsai, Jack; Rosenheck, Robert A.
Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. PMID:25595171
First, Richard J.; And Others
This report is designed to present preliminary findings from the first comprehensive study of rural homelessness in the United States. The study was conducted during the first 6 months of 1990, and data were collected from interviews with 921 homeless adults in 21 randomly selected rural counties in Ohio. The sample counties represent 26% of the…
Full Text Available The felt—as both methodology and experiential terrain—remains under-explored and under-theorised in research on homelessness. This experimental piece traces the multi-sensory engagement of ethnographic and biographic fieldwork undertaken for separate projects with homeless people in two capital cities on Australia’s east coast. The epistemological contributions and emotional dimensions of seeing, tasting, touching, smelling and listening are explored. Through a series of short ‘felt’ reflections, consideration of the critical role of corporeality in coming to know and inscribe the experiences of others is prompted. The feeling, researching body is posited as central to new, productive and holistic intertwinings with felt-experience and the mixed trajectories of grief, humour, violence and trauma that often characterise persistent homelessness are made vivid.
Full Text Available The felt—as both methodology and experiential terrain—remains under-explored and under-theorised in research on homelessness. This experimental piece traces the multi-sensory engagement of ethnographic and biographic fieldwork undertaken for separate projects with homeless people in two capital cities on Australia’s east coast. The epistemological contributions and emotional dimensions of seeing, tasting, touching, smelling and listening are explored. Through a series of short ‘felt’ reflections, consideration of the critical role of corporeality in coming to know and inscribe the experiences of others is prompted. The feeling, researching body is posited as central to new, productive and holistic intertwinings with felt-experience and the mixed trajectories of grief, humour, violence and trauma that often characterise persistent homelessness are made vivid.
Pearson, Carol; Montgomery, Ann Elizabeth; Locke, Gretchen
This article presents findings from an exploratory study of three programs using the Housing First approach to provide permanent supportive housing for single, homeless adults with serious mental illness and often co-occurring substance-related disorders. This approach provides direct, or nearly direct, access to housing that is intended to be…
Full Text Available Housing First (HF is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM among ethnically diverse homeless adults in an urban setting. 378 participants were randomized to HF with ICM or treatment-as-usual (TAU in Toronto (Canada, and followed for 24 months. Measures of effectiveness included housing stability, physical (EQ5D-VAS and mental (CSI, GAIN-SS health, social functioning (MCAS, quality of life (QoLI20, and health service use. Two-thirds of the sample (63% was from racialized groups and half (50% were born outside Canada. Over the 24 months of follow-up, HF participants spent a significantly greater percentage of time in stable residences compared to TAU participants (75.1% 95% CI 70.5 to 79.7 vs. 39.3% 95% CI 34.3 to 44.2, respectively. Similarly, community functioning (MCAS improved significantly from baseline in HF compared to TAU participants (change in mean difference = +1.67 95% CI 0.04 to 3.30. There was a significant reduction in the number of days spent experiencing alcohol problems among the HF compared to TAU participants at 24 months (ratio of rate ratios = 0.47 95% CI 0.22 to 0.99 relative to baseline, a reduction of 53%. Although the number of emergency department visits and days in hospital over 24 months did not differ significantly between HF and TAU participants, fewer HF participants compared to TAU participants had 1 or more hospitalizations during this period (70.4% vs. 81.1%, respectively; P=0.044. Compared to non-racialized HF participants, racialized HF participants saw an increase in the amount of money spent on alcohol (change in mean difference = $112.90 95% CI 5.84 to 219.96 and a reduction in physical community integration (ratio of rate ratios = 0.67 95% CI 0.47 to 0.96 from baseline to 24 months. Secondary analyses found a significant reduction in the number of days
National Center for Homeless Education at SERVE, 2010
Each year, more than a million young people in the United States experience homelessness; some of these young people, known as unaccompanied homeless youth, will face the challenges of homelessness while living on their own without the support of a caring adult. Unaccompanied homeless youth face the same struggles as other young people: trying to…
Sarajlija, Marija; Jugović, Aleksandar; Zivaljević, Dragan; Merdović, Boro; Sarajlija, Adrijan
Homelessness is a problem with social, medical, economic, political and other implications. Despite a large number of studies, reports about health-related quality of life (HRQoL) of homeless persons remain sparse. There is a summary of consistent evidence that homeless people have higher prevalence of chronic disease (mental and somatic) than general population. The aim of this study was to assess HRQoL and depression in homeless persons in Belgrade, to describe their sociodemographic factors and health status (the presence of chronic mental and somatic diseases and addiction disorders) and analyse impact of sociodemographic factors and health status to HRQoL and depression of homeless persons. The study was conducted in the Shelter for Adult and Elderly Persons in Belgrade, from January 1 to January 31, 2012. A set of questionnaires used in survey included Serbian translation of SF-36 questionnaire, Serbian translation of Beck Depression Inventory-II (BDI-II) and sociodemographic questionnaire. Statistical analysis was performed by descriptive and analytic methods. Our study sample consisted of 104 adult participants. The majority of them were male (74%) and the mean age in the sample was 48.2 +/- 13.0 years. We have found that 35.6% participants had lifetime diagnosis of psychiatric disorder, most frequently depression (lifetime prevalence of 15.4% in the study group). The history of suicide attempts was registered in 28 (26.9%) participants. Lifetime illicit drugs use was reported by 12.5%, daily smoking by 82.7% and daily alcohol consumption by 8.7% of the participants. Most common somatic chronic diseases were cardiovascular while chronic lung diseases were the second most frequent. Single chronic disaese was present in 33 (31.7%) of the participants and comorbidity of 2 chronic diseases was present in 20 of them. A statistically significant difference between participants HRQoL SF-36 domain scores and norms of general population was found only for role
... Twitter Overdose Deaths Among Homeless Persons January 2013 Homelessness is a persistent problem—nearly 690,000 people ... will ultimately help address the tragic problem of homelessness too, as many homeless people cite drug or ...
Martijn, Claudine; Sharpe, Louise
Research documents high levels of psychopathology among homeless youth. Most research, however, has not distinguished between disorders that are present prior to homelessness and those that develop following homelessness. Hence whether psychological disorders are the cause or consequence of homelessness has not been established. The aim of this study is to investigate causal pathways to homelessness amongst currently homeless youth in Australia. The study uses a quasi-qualitative methodology to generate hypotheses for larger-scale research. High rates of psychological disorders were confirmed in the sample 35 homeless youth aged 14-25. The rates of psychological disorders at the point of homelessness were greater than in normative samples, but the rates of clinical disorder increased further once homeless. Further in-depth analyses were conducted to identify the temporal sequence for each individual with a view to establishing a set of causal pathways to homelessness and trajectories following homelessness that characterised the people in the sample. Five pathways to homelessness and five trajectories following homelessness were identified that accounted for the entire sample. Each pathway constituted a series of interactions between different factors similar to that described by Craig and Hodson (1998. Psychological Medicine, 28, 1379-1388) as "complex subsidiary pathways". The major findings were that (1) trauma is a common experience amongst homeless youth prior to homelessness and figured in the causal pathways to homelessness for over half of the sample; (2) once homeless, for the majority of youth there is an increase in the number of psychological diagnoses including drug and alcohol diagnoses; and (3) crime did not precede homelessness for all but one youth; however, following homelessness, involvement in criminal activity was common and became a distinguishing factor amongst youth. The implications of these findings for future research and service
Julian M Somers
Full Text Available BACKGROUND: Homelessness and mental illness have a strong association with public disorder and criminality. Experimental evidence indicates that Housing First (HF increases housing stability and perceived choice among those experiencing chronic homelessness and mental disorders. HF is also associated with lower residential costs than common alternative approaches. Few studies have examined the effect of HF on criminal behavior. METHODS: Individuals meeting criteria for homelessness and a current mental disorder were randomized to one of three conditions treatment as usual (reference; scattered site HF; and congregate HF. Administrative data concerning justice system events were linked in order to study prior histories of offending and to test the relationship between housing status and offending following randomization for up to two years. RESULTS: The majority of the sample (67% was involved with the justice system, with a mean of 8.07 convictions per person in the ten years prior to recruitment. The most common category of crime was "property offences" (mean=4.09. Following randomization, the scattered site HF condition was associated with significantly lower numbers of sentences than treatment as usual (Adjusted IRR=0.29; 95% CI 0.12-0.72. Congregate HF was associated with a marginally significant reduction in sentences compared to treatment as usual (Adjusted IRR=0.55; 95% CI: 0.26-1.14. CONCLUSIONS: This study is the first randomized controlled trial to demonstrate benefits of HF among a homeless sample with mental illness in the domain of public safety and crime. Our sample was frequently involved with the justice system, with great personal and societal costs. Further implementation of HF is strongly indicated, particularly in the scattered site format. Research examining interdependencies between housing, health, and the justice system is indicated. TRIAL REGISTRATION: ISRCTN57595077.
Nyamathi, Adeline; Salem, Benissa; Reback, Cathy J; Shoptaw, Steven; Branson, Catherine M; Idemundia, Faith E; Kennedy, Barbara; Khalilifard, Farinaz; Marfisee, Mary; Liu, Yihang
Homeless gay and bisexual (G/B) young men have multiple risk factors that increase their risk of contracting hepatitis B virus (HBV) and human immunodeficiency virus (HIV). This study used baseline information from structured instruments to assess correlates of knowledge to HIV and HBV infection from 267 young (18-39 year old) G/B active methamphetamine, cocaine, and crack-using homeless men enrolled in a longitudinal trial. The study is designed to reduce drug use and improve knowledge of hepatitis and HIV/AIDS in a community center in Hollywood, California. Regression modeling revealed that previous hepatitis education delivered to G/B men was associated with higher levels of HIV/AIDS and hepatitis knowledge. Moreover, higher HIV/AIDS knowledge was associated with combining sex and drinking alcohol. Associations with hepatitis B knowledge was found among G/B men who were engaging in sex while under the influence of marijuana, who were receiving support from non-drug users, and who had been homeless in the last 4 months. Although being informed about HIV/AIDS and hepatitis did not preclude risky sexual and drug use behavior, knowledge about the dangers of concurrent sex with substance use is important. As higher levels of knowledge of hepatitis was associated with more moderate drug use, early access to testing and teaching harm reduction strategies remain critical to reduce exposure and infection of HBV and HIV in this population.
Corman, Hope; Noonan, Kelly; Reichman, Nancy E.
We exploited an exogenous health shock—namely, the birth of a child with a severe health condition—to investigate the effect of a life shock on homelessness in large cities in the United States as well as the interactive effects of the shock with housing market characteristics. We considered a traditional measure of homelessness, two measures of housing instability thought to be precursors to homelessness, and a combined measure that approximates the broadened conceptualization of homelessness under the 2009 Homeless Emergency Assistance and Rapid Transition to Housing Act (2010). We found that the shock substantially increases the likelihood of family homelessness, particularly in cities with high housing costs. The findings are consistent with the economic theory of homelessness, which posits that homelessness results from a conjunction of adverse circumstances in which housing markets and individual characteristics collide. PMID:23868747
.... The Department of Veterans Affairs (VA) estimates that it has served approximately 300 returning veterans in its homeless programs and has identified over 1,000 more as being at risk of homelessness...
... People with Disabilities Share Ending Chronic Homelessness Among People with Disabilities Last updated on May 31, 2018 We can end homelessness for people with disabilities in our communities who experience recurring ...
Curtis, Marah A; Corman, Hope; Noonan, Kelly; Reichman, Nancy E
We exploited an exogenous health shock-namely, the birth of a child with a severe health condition-to investigate the effect of a life shock on homelessness in large cities in the United States as well as the interactive effects of the shock with housing market characteristics. We considered a traditional measure of homelessness, two measures of housing instability thought to be precursors to homelessness, and a combined measure that approximates the broadened conceptualization of homelessness under the 2009 Homeless Emergency Assistance and Rapid Transition to Housing Act (2010). We found that the shock substantially increases the likelihood of family homelessness, particularly in cities with high housing costs. The findings are consistent with the economic theory of homelessness, which posits that homelessness results from a conjunction of adverse circumstances in which housing markets and individual characteristics collide.
Swick, Kevin J.; Williams, Reginald; Fields, Evelyn
This article explores the dynamics of parenting while being in a homeless context. The mosaic of stressors involved in this homeless parenting process are explicated and discussed. In addition, resources and strategies that may support parenting are presented and discussed.
Seider, Scott C.
This past winter, the third student-run homeless shelter in the United States came into being. Two recent Harvard graduates, Sam Greenberg and Sarah Rosenkrantz, who had volunteered at the Harvard Square Homeless Shelter as college students, saw a need within the Boston and Cambridge communities for a homeless shelter serving young adults. Drawing…
Foyer Foundation, London (England).
Homelessness in the United Kingdom has very wide ramifications. Young homeless people face a difficult transition into adult life as poverty, low self-esteem, lack of family support, and lack of qualifications reinforce each others' effects. Homeless young people start behind their peers in educational achievement. Government policies put up…
Baumohl, Jim, Ed.
This book about homelessness in the United States offers 16 chapters in three parts. Part 1, "History Definitions, and Causes," includes: (1) "Redefining the Cursed Word: A Historical Interpretation of American Homelessness" (Kim Hopper and Jim Baumohl); (2) "Homelessness: Definitions and Counts" (Martha R. Burt); (3)…
Morrison, David S
Homelessness is associated with increased risks of mortality but it has not previously been possible to distinguish whether this is typical of other socio-economically deprived populations, the result of a higher prevalence of morbidity or an independent risk of homelessness itself. The aim of this study was to describe mortality among a cohort of homeless adults and adjust for the effects of morbidity and socio-economic deprivation. Retrospective 5-year study of two fixed cohorts, homeless adults and an age- and sex-matched random sample of the local non-homeless population in Greater Glasgow National Health Service Board area for comparison. Over 5 years of observation, 1.7% (209/12 451) of the general population and 7.2% (457/6323) of the homeless cohort died. The hazard ratio of all-cause mortality in homeless compared with non-homeless cohorts was 4.4 (95% CI: 3.8-5.2). After adjustment for age, sex and previous hospitalization, homelessness was associated with an all-cause mortality hazard ratio of 1.6 (95% CI: 1.3-1.9). Homelessness had differential effects on cause-specific mortality. Among patients who had been hospitalized for drug-related conditions, the homeless cohort experienced a 7-fold increase in risk of death from drugs compared with the general population. Homelessness is an independent risk factor for deaths from specific causes. Preventive programmes might be most effectively targeted at the homeless with these conditions.
Patterson, Michelle; Moniruzzaman, Akm; Palepu, Anita; Zabkiewicz, Denise; Frankish, Charles J; Krausz, Michael; Somers, Julian M
This study used an experimental design to examine longitudinal changes in subjective quality of life (QoL) among homeless adults with mental illness after assignment to different types of supported housing or to treatment as usual (TAU, no housing or supports through the study). We hypothesized that subjective QoL would improve over time among participants assigned to supported housing as compared to TAU, regardless of the type of supported housing received or participants' level of need. Participants (n = 497) were stratified by level of need ("high" or "moderate") and randomly assigned to Housing First (HF) in scattered-site apartments, HF in a congregate setting (high needs only), or TAU. Linear mixed-effects regression was used to model the association between study arm and self-reported QoL at baseline and at 6 and 12 months post-baseline by need level. Based on the adjusted overall score on the QoL measure, participants randomized to HF reported significantly greater overall QoL as compared to TAU, regardless of need level or type of supported housing at both 6 and 12 months post-baseline. Scores on the safety and living situation subscales were significantly greater for both high and moderate need participants assigned to supported housing regardless of type at both 6 and 12 months post-baseline as compared to TAU. Despite multiple health and social challenges faced by homeless individuals with mental illness, HF in both scattered-site and congregate models results in significantly greater perceived QoL as compared to individuals who do not receive HF even after a relatively short period of time.
Guzewicz, Tony D.; Takooshian, Harold
Compares attitudes toward the homeless in Japan and the United States through a survey of 268 Japanese and 254 U.S. adults and adolescents interviewed in public places. In Japan, homelessness is seldom discussed, and poverty, which may be as widespread as in the United States, is often not recognized. (SLD)
city homeless and marginally housed individuals in South Africa. Methods. We recruited 136 adults from a Johannesburg inner-city homeless clinic; mean age was 32.4 years, 129 (95%) were male, and 90 (66%) were of South African ...
Waxman, Laura DeKoven; Reyes, Lilia M.
This survey assesses the status of homelessness among families in cities. The data were collected from city officials during April 1987. The findings include the following: (1) the number of homeless families increased by 31 percent during the last two years; (2) families represented one-third of the homeless and a single parent headed two-thirds…
... raise awareness of the current state of child homelessness in the United States, documents the number of homeless children in every state, their well-being, their risk for child homelessness, and state level planning and policy efforts. Child ...
Institute for Children and Poverty, New York, NY.
This report describes family homelessness in New York City, which has risen sharply since 1980. Currently, the City's family shelter system is at capacity. Homeless children are typically raised by single mothers who receive no child support, are 27 years old, are unemployed and receiving welfare, and have had at least one public assistance…
Baggett, Travis P; Lebrun-Harris, Lydie A; Rigotti, Nancy A
We determined whether or not homelessness is associated with cigarette smoking independent of other socio-economic measures and behavioral health factors, and whether homeless smokers differ from non-homeless smokers in their desire to quit. We analyzed data from 2678 adult respondents to the 2009 Health Center Patient Survey, a nationally representative cross-sectional survey of homeless and non-homeless individuals using US federally funded community health centers. We used multivariable logistic regression to examine the association between homelessness and (i) current cigarette smoking among all adults, and (ii) past-year desire to quit among current smokers, adjusting for demographic, socio-economic and behavioral health characteristics. Adults with any history of homelessness were more likely than never homeless respondents to be current smokers (57 versus 27%, P homelessness was associated independently with current smoking [adjusted odds ratio (AOR) 2.09; 95% confidence interval (CI) = 1.49-2.93], even after adjusting for age, sex, race, veteran status, insurance, education, employment, income, mental illness and alcohol and drug abuse. Housing status was not associated significantly with past-year desire to stop smoking in unadjusted (P = 0.26) or adjusted (P = 0.60) analyses; 84% of currently homeless, 89% of formerly homeless and 82% of never homeless smokers reported wanting to quit. Among patients of US health centers, a history of homelessness doubles the odds of being a current smoker independent of other socio-economic factors and behavioral health conditions. However, homeless smokers do not differ from non-homeless smokers in their desire to quit and should be offered effective interventions. © 2013 Society for the Study of Addiction.
Full Text Available Multiple illnesses are common in all homeless populations. While most previous studies have focused on experiences of mental illness, there is a scarcity of studies about experiences of bodily illness among people who are homeless. This study aimed to explore illness narratives of people who are homeless, and how homelessness as a social context shapes the experience of multiple and/or advancing somatic conditions. The design was a qualitative single-case study, using interpretive description. Data were generated through interviews, with nine participants who were homeless rough sleepers in Stockholm, Sweden, recruited while receiving care in a support home for homeless people with complex care needs. The findings revealed experiences of illness embedded in narratives about falling ill, being ill, and the future. The particularity of these illness narratives and the way that they are shaped by homelessness give rise to several observations: the necessity of a capable body for survival; chaos and profound solitude in illness and self-care management; ambiguous feelings about receiving care, transitioning from independence, and “freedom” in the streets to dependency and being institutionalized; and finally, the absence of hope and desire for recovery or a better future. The narratives are discussed from the perspective of Frank's four types of illness stories (restitution, chaos, quest, and testimony. The findings stress that to provide appropriate care and support to people who are homeless and have multiple and/or advancing somatic conditions, health care professionals need to be informed both about the individual's biography and about the circumstances under which illness and self-care takes place in the streets.
John M. Quigley; Steven Raphael; Eugene Smolensky
It is generally believed that the increased incidence of homelessness in the United States has arisen from broad societal factors, such as changes in the institutionalization of the mentally ill, increases in drug addiction and alcohol usage, and so forth. This paper presents a comprehensive test of the alternate hypothesis that variations in homelessness arise from changed circumstances in the housing market and in the income distribution. We assemble essentially all the systematic informati...
Mercier, C; Picard, S
The association between poverty and intellectual disability (ID) has been well documented. However, little is known about persons with ID who face circumstances of extreme poverty, such as homelessness. This paper describes the situation of persons with ID who were or are homeless in Montreal and are currently receiving services from a team dedicated to homeless persons. (1) To describe the characteristics, history and current situation of these persons; and (2) to report within-group differences as a function of gender and current residential status. The data were collected from files using an anonymous chart summary. Descriptive statistics on the whole sample (n = 68) and inferential statistics on cross-tabulations by gender and residential status were performed. Persons with ID exhibited several related problems. Some of these persons, primarily women, experienced relatively short periods of homelessness and their situations stabilised once they were identified and followed up. Other persons with ID experienced chronic homelessness that appeared to parallel the number and severity of their other problems. When compared with a previous epidemiological study of the homeless in Montreal, the population of homeless persons with ID differed from the overall homeless population in a number of respects. The results suggest prevention and intervention targets. The need for epidemiological research appears particularly clear in light of the fact that below-average intellectual functioning has been identified as a risk factor for homelessness and a predisposing factor for vulnerability among street people. © 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.
Koch-Nielsen, Inger; Munk, Anders; Raun, Mette
This report has been produced for the Observatory on Homelessness, managed by FEANTSA: European Federation of National Organizations Working with the Homeless. The Observatory is supported financially by the Commission of the European Union. The paper is based on the guidelines set up by the Obse......This report has been produced for the Observatory on Homelessness, managed by FEANTSA: European Federation of National Organizations Working with the Homeless. The Observatory is supported financially by the Commission of the European Union. The paper is based on the guidelines set up...
Foster, Adriana; Gable, James; Buckley, John
The impact of mental illness, comorbid substance abuse, and medication nonadherence, coupled with disjointed psychiatric and social services, conspires to a disproportionately high rate of psychiatric disorders among people who are homeless in the United States. This article reviews the prevalence of homeless among the mentally ill as well as the prevalence of mental illness among the homeless and details barriers in access to care and the solutions that have been attempted. The need and solutions to introduce a new generation of physicians and allied health care workers to the unique health care needs of the homeless population are highlighted. Copyright © 2012 Elsevier Inc. All rights reserved.
Esen, Umo I
Women who are pregnant and homeless constitute a unique group at significant risk of adverse foetal and maternal outcomes. Despite this heightened risk profile, social housing support to this group of women is less than satisfactory. Concerted effort and more collaborative working is needed by all who provide social, and healthcare services to homeless pregnant women, to improve the lot of these women. Clear definitions and legislative provisions in respect of the homeless will go a long way in reducing ambiguity and close loopholes which currently act to deny the homeless pregnant woman social housing support at a time when it is most needed.
This booklet presents information concerning homelessness and the education of homeless children nationwide and in Illinois. Estimates of the number of homeless children vary widely. Reasons for homeless children's failure to attend school include school residency requirements, delays in transfer of documents, and lack of transportation. The…
Baggett, Travis P.; Lebrun-Harris, Lydie A.; Rigotti, Nancy A.
Aims We determined whether homelessness is associated with cigarette smoking independent of other socioeconomic measures and behavioral health factors, and whether homeless smokers differ from non-homeless smokers in their desire to quit. Design, Setting, and Participants We analyzed data from 2,678 adult respondents to the 2009 Health Center Patient Survey, a nationally representative cross-sectional survey of homeless and non-homeless individuals using U.S. federally-funded community health centers. Measurements We used multivariable logistic regression to examine the association between homelessness and (1) current cigarette smoking among all adults, and (2) past-year desire to quit among current smokers, adjusting for demographic, socioeconomic, and behavioral health characteristics. Findings Adults with any history of homelessness were more likely than never homeless respondents to be current smokers (57% vs. 27%, phomelessness was independently associated with current smoking (AOR 2.09; 95% CI 1.49-2.93), even after adjusting for age, sex, race, veteran status, insurance, education, employment, income, mental illness, and alcohol and drug abuse. Housing status was not significantly associated with past-year desire to stop smoking in unadjusted (p=0.26) or adjusted (p=0.60) analyses; 84% of currently homeless, 89% of formerly homeless, and 82% of never homeless smokers reported wanting to quit. Conclusions Among patients of U.S. health centers, a history of homelessness doubles the odds of being a current smoker independent of other socioeconomic factors and behavioral health conditions. However, homeless smokers do not differ from non-homeless smokers in their desire to quit and should be offered effective interventions. PMID:23834157
... make it worse. That's why the health of homeless people in the United States is worse than that of the general population. Common health problems include Mental health problems Substance abuse ... and skin infections Many homeless women are victims of domestic or sexual abuse. ...
Agans Robert P.
Full Text Available To receive federal homeless funds, communities are required to produce statistically reliable, unduplicated counts or estimates of homeless persons in sheltered and unsheltered locations during a one-night period (within the last ten days of January called a point-in-time (PIT count. In Los Angeles, a general population telephone survey was implemented to estimate the number of unsheltered homeless adults who are hidden from view during the PIT count. Two estimation approaches were investigated: i the number of homeless persons identified as living on private property, which employed a conventional household weight for the estimated total (Horvitz-Thompson approach; and ii the number of homeless persons identified as living on a neighbor’s property, which employed an additional adjustment derived from the size of the neighborhood network to estimate the total (multiplicity-based approach. This article compares the results of these two methods and discusses the implications therein.
France, Joseph B.
This paper summarizes reports and research on the homeless in the United States, presents findings of a survey of Red Cross chapters on services to the homeless, and describes programs for the homeless of selected Red Cross chapters. Section 1 discusses definitions of homelessness and methodologies used to count homeless people. The homeless are…
Paul, Sayani; Corneau, Simon; Boozary, Tanya; Stergiopoulos, Vicky
The multiple challenges that ethnoracial homeless individuals experiencing mental illness face are well documented. However, little is known about how this homeless subpopulation copes with the compounding stressors of racial discrimination, homelessness and mental illness. This study is an in-depth investigation of the personal perceived strengths, attitudes and coping behaviors of homeless adults of diverse ethnoracial backgrounds experiencing homelessness and mental illness in Toronto, Canada. Using qualitative methods, 36 in-depth semi-structured interviews were conducted to capture the perspectives of ethnoracial homeless participants with mental illness on coping and resilience. Transcripts were analyzed using thematic analysis. Similar to prior findings in the general homeless population, study participants recognized personal strengths and attitudes as great sources of coping and resilience, describing hope and optimism, self-esteem and confidence, insight into their challenges and spirituality as instrumental to overcoming current challenges. In addition, participants described several coping strategies, including seeking support from family, friends and professionals; socializing with peers; engaging in meaningful activities; distancing from overwhelming challenges; and finding an anchor. Findings suggest that homeless adults with mental illness from ethnoracial groups use similar coping strategies and sources of resilience with the general homeless population and highlight the need for existing services to foster hope, recognize and support individual coping strategies and sources of resilience of homeless individuals experiencing complex challenges.
Full Text Available Background/Aim. Homelessness is a problem with social, medical, economic, political and other implications. Despite a large number of studies, reports about health-related quality of life (HRQoL of homeless persons remain sparse. There is a summary of consistent evidence that homeless people have higher prevalence of chronic disease (mental and somatic than general population. The aim of this study was to assess HRQoL and depression in homeless persons in Belgrade, to describe their sociodemographic factors and health status (the presence of chronic mental and somatic diseases and addiction disorders and analyse impact of sociodemographic factors and health status to HRQoL and depression of homeless persons. Methods. The study was conducted in the Shelter for Adult and Elderly Persons in Belgrade, from January 1 to January 31, 2012. A set of questionnaires used in survey included Serbian translation of SF-36 questionnaire, Serbian translation of Beck Depression Inventory-II (BDI-II and sociodemographic questionnaire. Statistical analysis was performed by descriptive and analytic methods. Results. Our study sample consisted of 104 adult participants. The majority of them were male (74% and the mean age in the sample was 48.2 ± 13.0 years. We have found that 35.6% participants had lifetime diagnosis of psychiatric disorder, most frequently depression (lifetime prevalence of 15.4% in the study group. The history of suicide attempts was registered in 28 (26.9% participants. Lifetime illicit drugs use was reported by 12.5%, daily smoking by 82.7% and daily alcohol consumption by 8.7% of the participants. Most common somatic chronic diseases were cardiovascular while chronic lung diseases were the second most frequent. Single chronic disease was present in 33 (31.7% of the participants and comorbidity of 2 chronic diseases was present in 20 of them. A statistically significant difference between participants` HRQoL SF-36 domain scores and norms of
Boyce, Daniel E C; Tice, Alan D; Ona, Fernando V; Akinaka, Kenneth T; Lusk, Heather
It is estimated that as many as 21,000 people in the state of Hawai'i may be infected with HCV Most of those infected with viral hepatitis are unaware they are infected. Complications from viral hepatitis include liver cirrhosis and hepatocellular carcinoma. Hawai'i has the highest incidence of hepatocellular carcinoma in the United States. In 2003 there were over 6000 homeless and over 155,000 people at-risk of becoming homeless living in the state of Hawai'i. Risk factors for hepatitis, such as drug use, tattoos, sexual contact, and sharing of personal hygiene equipment are more prevalent in the homeless population. To determine the incidence of hepatitis B and C among a population of homeless individuals, a health fair was held at a Honolulu area homeless shelter with approximately 200 residents. The incidence of hepatitis B and C was determined by anti-HCV and HBsAg blood tests. A survey was also conducted regarding risk factors and basic demographics. Fifty-nine homeless adults volunteered for testing and took the survey. Thirty-one (52%) volunteers were born in Micronesia, twenty-four (41%) were born in the United States, two (3%) were born in Samoa, one (2%) was born in the Philippines, and one (2%) was born in the Marshall Islands. Forty adults were tested for Hepatitis C antibody, three of which tested positive. The primary risk factor among this group was jail time (100%), followed by illegal drug injection (67%), tattoos (67%), ear/body piercing (67%), snorting drugs (33%), blood transfusions (33%), and a sex partner with hepatitis (33%). Forty adults were also tested for HBsAg, One of which tested positive. This was a recent immigrant from Micronesia. Homeless people in Hawai'i are more likely to have hepatitis B or C because risk factors are common among this population. Additionally a large proportion of Hawai'i's homeless people come from the Pacific Islands, where the prevalence of hepatitis B is one of the highest in the world. In addition there
Wilma J Nusselder
Full Text Available BACKGROUND: Data on mortality among homeless people are limited. Therefore, this study aimed to describe mortality patterns within a cohort of homeless adults in Rotterdam (the Netherlands and to assess excess mortality as compared to the general population in that city. METHODS: Based on 10-year follow-up of homeless adults aged ≥ 20 years who visited services for homeless people in Rotterdam in 2001, and on vital statistics, we assessed the association of mortality with age, sex and type of service used (e.g. only day care, convalescence care, other within the homeless cohort, and also compared mortality between the homeless and general population using Poisson regression. Life tables and decomposition methods were used to examine differences in life expectancy. RESULTS: During follow-up, of the 2096 adult homeless 265 died. Among the homeless, at age 30 years no significant sex differences were found in overall mortality rates and life expectancy. Compared with the general Rotterdam population, mortality rates were 3.5 times higher in the homeless cohort. Excess mortality was larger in women (rate ratio [RR] RR 5.56, 95% CI 3.95-7.82 as compared to men (RR 3.31, 95% CI 2.91-3.77, and decreased with age (RR 7.67, 95% CI 6.87-8.56 for the age group 20-44 and RR 1.63, 95% CI 1.41-1.88 for the age group 60+ years. Life expectancy at age 30 years was 11.0 (95% CI 9.1-12.9 and 15.9 (95% CI 10.3-21.5 years lower for homeless men and women compared to men and women in the general population respectively. CONCLUSION: Homeless adults face excessive losses in life expectancy, with greatest disadvantages among homeless women and the younger age groups.
People who are homeless belong to some of the most vulnerable, dispersed and disorganized groups in welfare societies. Yet in 2001, a national interest organization of homeless people was formed for the first time in Denmark. This article identifies the processes that facilitated the formation...... of the organization. It focuses on the importance of ideological and institutional conditions and changes, and it stresses the importance of alliances between progressive actors in the field and in the political-administrative system, in addition to the presence of dedicated activists among people who are or have...... been homeless. The analysis may thus serve as a case of inspiration for activists and professionals who want to improve homeless people's opportunities for participation in other national settings....
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Børner Stax, Tobias
Based on a literature study this chapter reflects upon the existence of youth homelessness in Denmark. The chapter contains reflections upon the juridical measures directed towards youngsters living on the margin of the Danish society and presents two concrete project directed towards young people...... living rough. The chapter is taken form an anthology discussion youth homelessness in the different member states of the European Union....
Gasior, Sara; Forchuk, Cheryl; Regan, Sandra
Background Homeless youth are the fastest growing sub-group within the homeless population. They face impaired access to health services and are often left unsupported. They lack social and family support or relationships with service providers. Unsupported homeless youth often become homeless adults. Purpose To test a model based on Peplau's Theory of Interpersonal Relations, examining the influence of a network of service providers, perceptions of social supports, and family relations on a homeless youth's perceptions of recovery. Methods This study is a secondary analysis and used a sample (n = 187) of data collected as part of the original Youth Matters in London study. A cross-sectional design was used to analyze the relationship between variables. Participants were interviewed at 6-month intervals over a 2.5-year period. Hierarchical multiple regression analysis was used. Results Network of service providers, perceived social supports, and perceived family relations explained 21.8% of the variance in homeless youth perceptions of recovery. Perceived social support and family relations were significantly, positively correlated to perceptions of recovery. Network of service providers was not significantly correlated to perceptions of recovery. Conclusions The findings suggest that stronger social supports and family relations may contribute to increased perceptions of recovery among homeless youth.
South Dakota State Dept. of Education and Cultural Affairs, Pierre.
To study the number and status of homeless people in South Dakota, a questionnaire was mailed to approximately 701 persons who were likely to have knowledge of homeless people. Responses were received from 349 people. Estimated numbers of homeless people include those who live with others because they lack adequate resources to maintain a fixed,…
... Continues Support of National Campaign to End Veteran Homelessness Nov. 14, 2017 This Veterans Day, Harbor Freight ... support of the national campaign to end veteran homelessness through generous contributions to the National Coalition for ...
Parker, E J; Jamieson, L M; Steffens, M A; Cathro, P; Logan, R M
There is limited information on self-perceived oral health of homeless populations. This study quantified self-reported oral health among a metropolitan homeless adult population and compared against a representative sample of the metropolitan adult population obtained from the National Survey of Adult Oral Health. A total of 248 homeless participants (age range 17-78 years, 79% male) completed a self-report questionnaire. Data for an age-matched, representative sample of metropolitan-dwelling adults were obtained from Australia's second National Survey of Adult Oral Health. Percentage responses and 95% confidence intervals were calculated, with non-overlapping 95% confidence intervals used to identify statistically significant differences between the two groups. Homeless adults reported poorer oral health than their age-matched general population counterparts. Twice as many homeless adults reported visiting a dentist more than a year ago and that their usual reason for dental attendance was for a dental problem. The proportion of homeless adults with a perceived need for fillings or extractions was also twice that of their age-matched general population counterparts. Three times as many homeless adults rated their oral health as 'fair' or 'poor'. A significantly greater proportion of homeless adults in an Australian metropolitan location reported poorer oral health compared with the general metropolitan adult population. © 2011 Australian Dental Association.
Gabrielian, Sonya; Chen, Jennifer C; Minhaj, Beena P; Manchanda, Rishi; Altman, Lisa; Koosis, Ella; Gelberg, Lillian
Homeless adults have low primary care engagement and high emergency department (ED) utilization. Homeless-tailored, patient-centered medical homes (PCMH) decrease this population's acute care use. We studied the feasibility (focused on patient recruitment) and acceptability (conceptualized as clinicians' attitudes/beliefs) of a pilot initiative to colocate a homeless-tailored PCMH with an ED. After ED triage, low-acuity patients appropriate for outpatient care were screened for homelessness; homeless patients chose between a colocated PCMH or ED visit. To study feasibility, we captured (from May to September 2012) the number of patients screened for homelessness, positive screens, unique patients seen, and primary care visits. We focused on acceptability to ED clinicians (physicians, nurses, social workers); we sent a 32-item survey to ED clinicians (n = 57) who worked during clinic hours. Questions derived from an instrument measuring clinician attitudes toward homeless persons; acceptability of homelessness screening and the clinic itself were also explored. Over the 5 months of interest, 281 patients were screened; 172 (61.2%) screened positive for homelessness; 112 (65.1%) of these positive screens were seen over 215 visits. Acceptability data were obtained from 56% (n = 32) of surveyed clinicians. Attitudes toward homeless patients were similar to prior studies of primary care physicians. Most (54.6%) clinicians agreed with the homelessness screening procedures. Nearly all (90.3%) clinicians supported expansion of the homeless-tailored clinic; a minority (42.0%) agreed that ED colocation worked well. Our data suggest the feasibility of recruiting patients to a homeless-tailored primary care clinic colocated with the ED; however, the clinic's acceptability was mixed. Future quality improvement work should focus on tailoring the clinic to increase its acceptability among ED clinicians, while assessing its impact on health, housing, and costs.
Morton, Matthew H.; Dworsky, Amy; Matjasko, Jennifer L.; Curry, Susanna R.; Schlueter, David; Chávez, Raúl; Farrell, Anne F.
Purpose Unaccompanied youth homelessness is a serious concern. Response, however, has been constrained by the absence of credible data on the size and characteristics of the population and reliable means to track youth homelessness over time. We sought to address these gaps. Methods Using a nationally representative phone-based survey (N = 26,161), we solicited household and individual reports on different types of youth homelessness. We collected household reports on adolescents aged 13–17 and young adults aged 18–25, as well as self-reports from young adults aged 18–25. Follow-up interviews with a subsample (n = 150) provided additional information on youth experiences and enabled adjustment for inclusion errors. Results Over a 12-month period, approximately 3.0% of households with 13- to 17-year-olds reported explicit youth homelessness (including running away or being asked to leave) and 1.3% reported experiences that solely involved couch surfing, resulting in an overall 4.3% household prevalence of any homelessness, broadly defined. For 18- to 25-year-olds, household prevalence estimates were 5.9% for explicitly reported homelessness, 6.6% for couch surfing only, and 12.5% overall. The 12-month population prevalence estimates, available only for 18- to 25-year-olds, were 5.2%, 4.5%, and 9.7%, respectively. Incidence rates were about half as high as prevalence rates. Prevalence rates were similar across rural and nonrural counties. Higher risk of homelessness was observed among young parents; black, Hispanic, and lesbian, gay, bisexual, or transgender (LGBT) youth; and those who did not complete high school. Conclusions The prevalence and incidence of youth homelessness reveal a significant need for prevention and youth-centric systems and services, as well as strategies to address disproportionate risks of certain subpopulations. PMID:29153445
Morton, Matthew H; Dworsky, Amy; Matjasko, Jennifer L; Curry, Susanna R; Schlueter, David; Chávez, Raúl; Farrell, Anne F
Unaccompanied youth homelessness is a serious concern. Response, however, has been constrained by the absence of credible data on the size and characteristics of the population and reliable means to track youth homelessness over time. We sought to address these gaps. Using a nationally representative phone-based survey (N = 26,161), we solicited household and individual reports on different types of youth homelessness. We collected household reports on adolescents aged 13-17 and young adults aged 18-25, as well as self-reports from young adults aged 18-25. Follow-up interviews with a subsample (n = 150) provided additional information on youth experiences and enabled adjustment for inclusion errors. Over a 12-month period, approximately 3.0% of households with 13- to 17-year-olds reported explicit youth homelessness (including running away or being asked to leave) and 1.3% reported experiences that solely involved couch surfing, resulting in an overall 4.3% household prevalence of any homelessness, broadly defined. For 18- to 25-year-olds, household prevalence estimates were 5.9% for explicitly reported homelessness, 6.6% for couch surfing only, and 12.5% overall. The 12-month population prevalence estimates, available only for 18- to 25-year-olds, were 5.2%, 4.5%, and 9.7%, respectively. Incidence rates were about half as high as prevalence rates. Prevalence rates were similar across rural and nonrural counties. Higher risk of homelessness was observed among young parents; black, Hispanic, and lesbian, gay, bisexual, or transgender (LGBT) youth; and those who did not complete high school. The prevalence and incidence of youth homelessness reveal a significant need for prevention and youth-centric systems and services, as well as strategies to address disproportionate risks of certain subpopulations. Copyright © 2017 The Society for Adolescent Health and Medicine. All rights reserved.
Homelessness has become a visible part of Canada's urban landscape, infecting adult men and women, youths and families with children alike, and the issue becomes particularly serious as winter approaches. During a workshop in Toronto earlier this year, physicians, researchers and social workers examined the effects of homelessness on health, identifying many of the unique health needs of this vulnerable segment of society.
Kendzor, Darla E.; Reitzel, Lorraine R.; Businelle, Michael S.
This pilot study was conducted to explore the associations between stressors related to homelessness and modifiable health risk factors (poor diet, insufficient physical activity, and overweight/obesity) and to provide direction for future research. Participants (N = 57) were homeless adults enrolled in a smoking cessation program. Analyses were…
Kerman, Nick; Sylvestre, John; Aubry, Tim; Distasio, Jino
Housing First is an effective intervention to stably house and alter service use patterns in a large proportion of homeless people with mental illness. However, it is unknown whether there are differences in the patterns of service use over time among those who do or do not become stably housed and what effect, if any, Housing First has on these differing service use patterns. This study explored changes in the service use of people with mental illness who received Housing First compared to standard care, and how patterns of use differed among people who did and did not become stably housed. The study design was a multi-site randomized controlled trial of Housing First, a supported housing intervention. 2039 participants (Housing First: n = 1131; standard care: n = 908) were included in this study. Outcome variables include nine types of self-reported service use over 24 months. Linear mixed models examined what effects the intervention and housing stability had on service use. Participants who achieved housing stability, across the two groups, had decreased use of inpatient psychiatric hospitals and increased use of food banks. Within the Housing First group, unstably housed participants spent more time in prison over the study period. The Housing First and standard care groups both had decreased use of emergency departments and homeless shelters. The temporal service use changes that occurred as homeless people with mental illness became stably housed are similar for those receiving Housing First or standard care, with the exception of time in prison. Service use patterns, particularly with regard to psychiatric hospitalizations and time in prison, may signify persons who are at-risk of recurrent homelessness. Housing support teams should be alert to the impacts of stay-based services, such as hospitalizations and incarcerations, on housing stability and offer an increased level of support to tenants during critical periods, such as discharges. ISRCTN
Hanlon, Peter; Yeoman, Lynsey; Gibson, Lauren; Esiovwa, Regina; Williamson, Andrea E; Mair, Frances S; Lowrie, Richard
Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. Community. Adults (≥18 years) fulfilling European Typology of Homelessness criteria. Delivered by healthcare professionals managing NCD and LT-CDs. Primary outcome: unscheduled healthcare utilisation. mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. 11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94% male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease
Bhunu, C. P.
Homelessness and drug-misuse are known to exist like siamese twins. We present a model to capture the dynamics in the growth in the number of homeless (street kids and street adults) and drug misusers. The reproduction numbers of the model are determined and analyzed. Results from this study suggests that adult peer pressure plays a more significant role in the growth of drug-misuse and the number of street kids. This result suggests that in resource constrained settings intervention strategies should be tailor made to target adults whose behaviour influence others to misuse drugs and abuse children. Furthermore, numerical simulations show that homelessness and drug-misuse positively enhances, the growth of each other. Thus, to effectively control these two social problems require strategies targeting both of them.
Curry, Susanna R; Morton, Matthew; Matjasko, Jennifer L; Dworsky, Amy; Samuels, Gina M; Schlueter, David
Youth homelessness is a problem characterized by high levels of vulnerability. The extent to which couch surfing - moving from one temporary housing arrangement to another - is part of youth homelessness is not well understood. Chapin Hall's Voices of Youth Count, a national research initiative, involves a multicomponent approach to studying youth homelessness. This study reports emerging findings regarding couch surfing and homelessness primarily from a national survey of 13,113 adults with youth ages 13-25 in their households or who are themselves ages 18-25. Findings suggest that couch surfing is relatively common, particularly among the older age group. Among households with 13- to 17-year-olds and 18- to 25-year-olds, 4.0% and 20.5%, respectively, reported that any of them had couch surfed in the last 12 months. There are notable social, economic, and educational differences, on average, between youth reporting homelessness and those reporting only couch surfing. However, most youth who report experiencing homelessness also report couch surfing, and these youth who experience both circumstances present high levels of socioeconomic vulnerability. Couch surfing encompasses a range of experiences, some of which likely include need for services. Interviews currently in the field, and expanded analysis of data, will contribute more nuanced policy insights. © Society for Community Research and Action 2017.
Fryling, Lauren R; Mazanec, Peter; Rodriguez, Robert M
Medicaid expansion under the Affordable Care Act (ACA) is intended to provide a framework for increasing health care access for vulnerable populations, including the 1.2 million who experience homelessness each year in the United States. We sought to characterize homeless persons' knowledge of the ACA, identify barriers to their ACA enrollment, and determine access to various forms of communication that could be used to facilitate enrollment. At an urban county Level I trauma center, we interviewed all noncritically ill adults who presented to the emergency department (ED) during daytime hours and were able to provide consent. We assessed access to communication, awareness of the ACA, insurance status, and barriers preventing subjects from enrolling in health insurance and compared homeless persons' responses with concomitantly enrolled housed individuals. Of the 650 enrolled subjects, 134 (20.2%) were homeless. Homeless subjects were more likely to have never heard of the ACA (26% vs. 10%). "Not being aware if they qualify for Medicaid" was the most common (70%) and most significant (30%) barrier to enrollment reported by uninsured homeless persons. Of homeless subjects who were unsure if they qualified for Medicaid, 91% reported an income homeless subjects reported access. Homeless persons report having less knowledge of the ACA than their housed counterparts, poor understanding of ACA qualification criteria, and limited access to phone and internet. ED-based outreach and education regarding ACA eligibility may increase their enrollment. Copyright © 2015 Elsevier Inc. All rights reserved.
Clayton, Pamela; McGill, Paul
Two studies (of 105 Scottish adults returning to study and of social exclusion and lifelong learning) identified structural barriers in adult access to guidance services: rural location, disability, single parenthood, eldercare, homelessness, criminal record, and refugee status. Solutions include publicity, partnerships, outreach, and supportive…
Homeless treatment programs have focused on physical solutions rather than attending to all aspects of well-being. Support services that address overall well-being have demonstrated effectiveness. Previous research suggests that overall well-being is defined as satisfaction within all life spheres. Objective life indices have been the primary evidence of success among various programs, which include food, housing, income, leisure, health, access to psychiatric and medical services, and maintenance of positive support networks. This does not account for other important subjective components, such as psychiatric symptoms and quality of life. This study was designed to assess quality of life and psychiatric symptoms among the people who were chronically and formerly chronically homeless. The people who were formerly chronically homeless are defined as individuals who were chronically homeless in the past but have successfully remained in housing for 6 months or more and have access to intensive case management services. People who are chronically homeless are homeless individuals who have lacked a residence for a year or more or have had four or more episodes in three years, are single, and have a persistent disability. Participants completed the Oxford Happiness Scale, Brief Symptom Inventory, and a brief questionnaire. All participants were disabled in accordance with the definition of chronic homelessness adopted by the U.S. Department of Housing and Urban Development. This researcher hypothesized that high quality-of-life scores, low frequency of psychiatric symptoms, and greater access to basic life indices indicate happiness overall. Additionally, it was hypothesized that people who are chronically homeless have a higher foster care rate than the general population.
Full Text Available Abstract Background The Government of Cambodia has committed to supporting family care for vulnerable children, including homeless populations. Collecting baseline data on the numbers and characteristics of homeless adolescents was prioritized to illuminate the scope of the issue, mobilize resources and direct the response. Methods Administrative zones across seven cities were purposively selected to cover the main urban areas known to have homeless populations in Cambodia. A complete enumeration of homeless individuals between the ages of 13 and 17 was attempted in the selected areas. In addition, a second independent count was conducted to enable a statistical estimation of completeness based on overlap across counts. This technique is known as capture-recapture. Adolescents were also interviewed about their schooling, health and other circumstances. Results After adjustment by the capture-recapture corrective multipliers (range: 3.53 -27.08, the study yielded an estimate of 2,697 13–17 year old homeless adolescents across all seven cities. The total number of homeless boys counted was significantly greater than homeless girls, especially in older ages. Conclusions To the authors’ knowledge, this is the first time capture-recapture methods have been applied to a homeless estimation of this scale in a resource-limited setting. Findings suggest the number of homeless adolescents in Cambodia is much greater than one would expect if relying on single count data alone and that this population faces many hardships.
Winetrobe, Hailey; Wenzel, Suzanne; Rhoades, Harmony; Henwood, Benjamin; Rice, Eric; Harris, Taylor
Background Permanent supportive housing (PSH) is the leading intervention to end chronic homelessness. Little is known, however, about gender differences, including potential disparities in physical and mental health and social support, that might inform services available through PSH. Methods 421 homeless adults, at least 39 years old, English- or Spanish-speaking, who were moving into PSH through 26 different agencies in the Los Angeles area participated. Results Compared to men entering PSH, homeless women (28% of the sample) were younger (phomeless adults moving into PSH. PSH cannot be a one-size-fits-all approach. Supportive services within housing should be tailored based on gender and other individual needs. PMID:28153741
Hansen, Brian Benjamin; Gemal, Carsten Høy
The article is based on the case of a group of homeless people who in the fall of 2013 occupied a central site in the Danish town of Aarhus. The authors argue that this specific case is an ideal object of investigation for casting light on a new situation in the field of public administration....... Public administration has recently moved from the paradigm of New Public Management to a new and still undetermined paradigm, which focuses on activating and engaging citizens, treating them as equal partners in the process of co-creating welfare services and the community itself as a brand. Using...... the case of the homeless, the authors argue that participatory citizenship should not only be viewed as “added value” to the field of public administration, but rather as emerging within a dynamic and conflict-ridden field between citizens and administration where new types of value are potentially created...
Robert L. Brawley
Full Text Available This article has located Jesus’ saying about homelessness in the context of the Roman Empire as it was experienced in Galilee. Homelessness is part of a broader picture that translates into loss of access to the resources of the land. The thesis is that in light of a theology of land resulting from the development of Abrahamic covenant traditions and the prophetic hope expressed especially in Isaiah, Ezekiel and Psalm 37, Jesus proclaimed God’s kingdom as God’s rule over heaven and earth, which implicates restoration of equitable access to the resources of the earth. The Lord’s Prayer, presumptions about the water of Jacob’s well in John 4 and the parable of the unjust steward in Luke 16 are used to demonstrate understandings of violations of equitable access according to Abrahamic covenant traditions and the hope for the restoration thereof.
Coohey, Carol; Easton, Scott D
Depression is a common problem among homeless men that may interfere with functional tasks, such as securing stable housing, obtaining employment, and accessing health services. Previous research on depression among homeless men has largely focused on current psychosocial resources, substance abuse, and past victimization. Guided by Ensel and Lin's life course stress process model, the authors examined whether distal stressors, including victimization and exposure to parent problems in childhood, contributed to men's depression above and beyond current (or proximal) stressors, such as substance abuse and health problems, and social resources. The sample consisted of 309 homeless men who had entered a federally funded emergency shelter. Using the Burns Depression Checklist, the authors found that one out of three men met the threshold for moderate to severe depression during the past week. The logistic regression showed that past exposure to parent problems was related to depression after accounting for current stressors and social resources (number of close adult relationships and whether their emotional support needs were met). Past victimization was not related to depression. To address men's depression, workers should concurrently provide services that meet men's basic needs (for example, housing) and address their relationship needs, including their need for emotional support.
An understanding of the close link between federal policy and family homelessness is critical for ensuring that one day no child in the United States is homeless. This article discusses the nature of family homelessness, the national policy framework that exists to help vulnerable families, the homeless assistance system that federal policy has…
Yamaguchi, Barbara J.; Strawser, Sherri; Higgins, Kyle
Reviews the definition and demographics of homeless students; the effects of homelessness on developmental, psychological, behavioral, and academic growth; the legal mandates regarding homeless students; and barriers to education. Recommendations for fostering success for homeless students are offered. (Author/DB)
Robertson, Donna Friedman
Describes a qualitative research project examining homelessness's effects on children's schooling, highlighting a South Carolina intervention program's success. Research disclosed an informal homelessness "caste system," the political unpopularity of providing homeless services, homeless kids' high rates of academic failure and problem…
Reganick, Karol A.
Notes that children and adolescents appear to suffer the most detrimental effects of homelessness. Discusses the problems faced by homeless youth and the educational systems that must respond to them, including causes and demographics of homelessness, detrimental effects of shelters, the victimization of homeless adolescents, and educational and…
This article aims to contribute to understandings of youth homelessness and subjectivity by analysing identity construction in terms of young people's negotiation of the structural and institutional environment of youth homelessness. I suggest that while existing literature on this topic concentrates mainly on micro-social encounters, the…
Bingham, Richard D.; And Others
This book consists of 15 chapters on understanding and helping the homeless. The first seven chapters present the "new" homeless in historical context and describe this population and its situation. The remaining eight chapters discuss policy and program options of the government and other organizations in attempting to alleviate the problems of…
Chamberlain, Chris; MacKenzie, David
The issue of youth homelessness in Australia is examined in the context of relevant social and educational policies. The exploration is based on 8 years of research into the situation of homeless youth in Australia involving several studies, including a study of school students in 9 communities and field visits to 100 schools. In 1994, researchers…
Smith, Natalie L; Smith, Thomas J; DeSantis, Diana; Suhocki, Marissa; Fenske, Danielle
Vision problems in homeless children can decrease educational achievement and quality of life. To estimate the prevalence and specific diagnoses of vision problems in children in an urban homeless shelter. A prospective series of 107 homeless children and teenagers who underwent screening with a vision questionnaire, eye chart screening (if mature enough) and if vision problem suspected, evaluation by a pediatric ophthalmologist. Glasses and other therapeutic interventions were provided if necessary. The prevalence of vision problems in this population was 25%. Common diagnoses included astigmatism, amblyopia, anisometropia, myopia, and hyperopia. Glasses were required and provided for 24 children (22%). Vision problems in homeless children are common and frequently correctable with ophthalmic intervention. Evaluation by pediatric ophthalmologist is crucial for accurate diagnoses and treatment. Our system of screening and evaluation is feasible, efficacious, and reproducible in other homeless care situations.
Erickson, Jennifer; Abbott, Kenneth; Susienka, Lucinda
Homeless patients face a variety of obstacles in pursuit of basic social services. Acknowledging this, the Social Security Administration directs employees to prioritize homeless patients and handle their disability claims with special care. However, under existing manual processes for identification of homelessness, many homeless patients never receive the special service to which they are entitled. In this paper, we explore address validation and automatic annotation of electronic health records to improve identification of homeless patients. We developed a sample of claims containing medical records at the moment of arrival in a single office. Using address validation software, we reconciled patient addresses with public directories of homeless shelters, veterans' hospitals and clinics, and correctional facilities. Other tools annotated electronic health records. We trained random forests to identify homeless patients and validated each model with 10-fold cross validation. For our finished model, the area under the receiver operating characteristic curve was 0.942. The random forest improved sensitivity from 0.067 to 0.879 but decreased positive predictive value to 0.382. Presumed false positive classifications bore many characteristics of homelessness. Organizations could use these methods to prompt early collection of information necessary to avoid labor-intensive attempts to reestablish contact with homeless individuals. Annually, such methods could benefit tens of thousands of patients who are homeless, destitute, and in urgent need of assistance. We were able to identify many more homeless patients through a combination of automatic address validation and natural language processing of unstructured electronic health records. Copyright © 2018. Published by Elsevier Inc.
Sultan, Asquad; McQuay, Henry J; Moore, R Andrew; Derry, Sheena
Background Flurbiprofen is a non-selective non-steroidal anti-inflammatory drug (NSAID), related to ibuprofen and naproxen, used to treat acute and chronic painful conditions. There is no systematic review of its use in acute postoperative pain. Objectives To assess efficacy, duration of action, and associated adverse events of single dose oral flurbiprofen in acute postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to January 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered flurbiprofen in adults with moderate to severe acute postoperative pain. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk (RR) and number needed to treat to benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected. Main results Eleven studies compared flurbiprofen (699 participants) with placebo (362 participants) in studies lasting 6 to 12 hours. Studies were of adequate reporting quality, and most participants had pain following dental extractions. The dose of flurbiprofen used was 25 mg to 100 mg, with most information for 50 mg and 100 mg. The NNT for at least 50% pain relief over 4 to 6 hours for flurbiprofen 50 mg compared with placebo (692 participants) was 2.7 (2.3 to 3.3) and for 100 mg (416 participants) it was 2.5 (2.0 to 3.1). With flurbiprofen 50 mg and 100 mg 65% to 70% of participants experienced at least 50% pain relief, compared with 25% to 30% with placebo. Rescue medication was used by 25
Businelle, Michael S; Poonawalla, Insiya B; Kendzor, Darla E; Rios, Debra M; Cuate, Erica L; Savoy, Elaine J; Ma, Ping; Baggett, Travis P; Reingle, Jennifer; Reitzel, Lorraine R
Homeless adults are exposed to more smokers and smoke in response to environmental tobacco cues more than other socioeconomically disadvantaged groups. Addressing the culture of smoking in homeless shelters through policy initiatives may support cessation and improve health in this vulnerable and understudied population. This study examined support for and expected/actual effects of a smoking ban at a homeless shelter. A 2-wave cross-sectional study with an embedded cohort was conducted in the summer of 2013 two weeks before (wave 1) and two months after (wave 2) a partial outdoor smoking ban was implemented. A total of 394 homeless adults were surveyed (i.e., wave 1 [n=155]; wave 2 [n=150]; and 89 additional participants completed both waves). On average, participants were 43 years old, primarily African American (63%), male (72%), and had been homeless for the previous 12 months (median). Most participants were smokers (76%) smoking 12 cigarettes per day on average. Most participants supported the creation of a large smoke-free zone on the shelter campus, but there was less support for a shelter-wide smoking ban. Average cigarettes smoked per day did not differ between study waves. However, participants who completed both study waves experienced a reduction in expired carbon monoxide at wave 2 (W1=18.2 vs. W2=15.8 parts per million, p=.02). Expected effects of the partial ban were similar to actual effects. Partial outdoor smoking bans may be well supported by homeless shelter residents and may have a positive impact on shelter resident health. Copyright © 2014 Elsevier Ltd. All rights reserved.
Perron, Brian Edward; Alexander-Eitzman, Ben; Gillespie, David F.; Pollio, David
Homeless persons are victims of violent and non-violent crime at higher rates than housed populations. While studies have suggested that victimization can induce or exacerbate mental health problems, there is very little known about factors that may buffer the effects of victimization. This cross-sectional study examined the influence of victimization on depressive symptoms in over 9600 homeless and mentally ill adults participating in the Access to Community Care and Effective Services and Supports study (ACCESS) conducted in multiple cities across the USA relationships between victimization, depressive symptoms, and perceived safety were tested within a structural equation modeling framework using data collected at the baseline interview. The overall model exhibited a good fit with the data. Non-physical victimization was associated with higher levels of depressive symptoms, and physical victimization was associated with lower levels of perceived safety. As hypothesized, perceived safety was a significant partial mediator of depressive symptoms. These results underscore the complexity of the relationships between victimization and depression in homeless adults and the importance of addressing different types of victimization in homeless and mentally ill adults. PMID:18703266
Perron, Brian Edward; Alexander-Eitzman, Ben; Gillespie, David F; Pollio, David
Homeless persons are victims of violent and non-violent crime at higher rates than housed populations. While studies have suggested that victimization can induce or exacerbate mental health problems, there is very little known about factors that may buffer the effects of victimization. This cross-sectional study examined the influence of victimization on depressive symptoms in over 9600 homeless and mentally ill adults participating in the Access to Community Care and Effective Services and Supports study (ACCESS) conducted in multiple cities across the USA relationships between victimization, depressive symptoms, and perceived safety were tested within a structural equation modeling framework using data collected at the baseline interview. The overall model exhibited a good fit with the data. Non-physical victimization was associated with higher levels of depressive symptoms, and physical victimization was associated with lower levels of perceived safety. As hypothesized, perceived safety was a significant partial mediator of depressive symptoms. These results underscore the complexity of the relationships between victimization and depression in homeless adults and the importance of addressing different types of victimization in homeless and mentally ill adults.
Ducq, H; Guesdon, I; Roelandt, J L
Because the visibility of homeless persons congregating in urban areas has increased since the 1980's, the relationship between homelessness and mental illness has caused more and more concern. A multitude of epidemiological surveys have been organized in Great Britain, Australia, Canada, and mainly in United States, and have attempted to evaluate scientifically the psychiatric morbidity of this population. This literature review reveals disparity of epidemiological methods in assessing the type and extent of mental illness among homeless adults. The lack of consensual definition of homelessness, the choice of different settings in which the research is organized (street, health centres, shelters), and the use of diverse instruments of psychiatric evaluation (diagnosis by clinician, by scale or by structured diagnostic interview) lead to a great disparity of the results. Thus, 1/3 of the homeless adults had prior history of psychiatric hospitalisation. Rates of psychosis range to 70% and it is estimated that 4% to 74% of the homeless persons suffer from affective disorders. Substance abuse disorder remains a problem for a significant number of these individuals, with a high frequency of dual diagnosis. Such divergent data highlight the anglo-saxon debate between those who accuse desinstitutionnalisation as a reason of homelessness, and those who blame the socioeconomic background.
Pleace, Nicholas; Fitzpatrick, Suzanne; Johnsen, Sarah; Quilgars, Deborah Jayne; Sanderson, Diana
The research involved a nationally representative survey, covering 2,000 adults in homeless families and 500 children aged eight and above within those families. Using a specially developed sampling methodology, the survey draws a representative sample of homeless families over the course of a six month 'time window'. The research also involved two further surveys. The first is a survey of 500 lone homeless 16-17 year-olds. The second is a survey of 500 families and lone 16-17 year-olds who h...
O'Campo, Patricia; Stergiopoulos, Vicky; Nir, Pam; Levy, Matthew; Misir, Vachan; Chum, Antony; Arbach, Bouchra; Nisenbaum, Rosane; To, Matthew J; Hwang, Stephen W
We studied the impact of a Housing First (HF) intervention on housing, contact with the justice system, healthcare usage and health outcomes among At Home/Chez Soi randomised trial participants in Toronto, a city with an extensive service network for social and health services for individuals who are experiencing homelessness and mental illness. Participants identified as high needs were randomised to receive either the intervention which provided them with housing and supports by an assertive community treatment team (HF+ACT) or treatment as usual (TAU). Participants (N=197) had in-person interviews every 3 months for 2 years. The HF+ACT group spent more time stably housed compared to the TAU group with the mean difference between the groups of 45.8% (95% CI 37.1% to 54.4%, phousing stability and selected health and justice outcomes over 2 years in a city with many social and health services. ISRCTN42520374. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
In this podcast, Ted Pestorius speaks with Dr. Marian McDonald, Associate Director for Minority and Womenâs Health at CDC about an article in September 2008 issue of Emerging Infectious Diseases on infectious diseases in the homeless. There are an estimated 100 million homeless people worldwide today, and this number is likely to grow. The homeless population is vulnerable to many diseases, including HIV, hepatitis, and tuberculosis. Dr. McDonald discusses why this population is so vulnerable.
In this podcast, Ted Pestorius speaks with Dr. Marian McDonald, Associate Director for Minority and Womenâs Health at CDC about an article in September 2008 issue of Emerging Infectious Diseases on infectious diseases in the homeless. There are an estimated 100 million homeless people worldwide today, and this number is likely to grow. The homeless population is vulnerable to many diseases, including HIV, hepatitis, and tuberculosis. Dr. McDonald discusses why this population is so vulnerable. Created: 8/26/2008 by Emerging Infectious Diseases. Date Released: 8/27/2008.
Greta Jean Yates; Michael Joseph Silverman
On a single night in January in 2014 there were 194,000 children living with their families in shelters in the United States (National Center on Family Homelessness, 2015). A typical family experiencing homelessness consists of a single mother with two to three children. Children experiencing homelessness are more likely to face academic, social, and emotional problems compared to children in poverty. As there is currently a dearth of peer reviewed publications related to music therapy with c...
Winetrobe, Hailey; Wenzel, Suzanne; Rhoades, Harmony; Henwood, Benjamin; Rice, Eric; Harris, Taylor
Permanent supportive housing (PSH) is the leading intervention to end chronic homelessness. Little is known, however, about gender differences, including potential disparities in physical and mental health and social support, that might inform services available through PSH. This study included 421 homeless adults, at least 39 years old, English- or Spanish-speaking, who were moving into PSH through 26 different agencies in the Los Angeles area. Compared with men entering PSH, homeless women (28% of the sample) were younger (p social networks (Coefficient, 0.79, p social support among homeless adults moving into PSH. PSH cannot be a one-size-fits-all approach. Supportive services within housing should be tailored based on gender and other individual needs. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Podymow, Tiina; Turnbull, Jeffrey; Coyle, Doug
The homeless have high rates of mortality, but live in environments not conducive to terminal care. Traditional palliative care hospitals may be reluctant to accept such patients, due to behavior or lifestyle concerns. The Ottawa Inner City Health Project (OICHP) is a pilot study to improve health care delivery to homeless adults. This is a retrospective analysis of a cohort of terminally ill homeless individuals and the effectiveness of shelter-based palliative care. As proof of principle, a cost comparison was performed. 28 consecutive homeless terminally ill patients were admitted and died at a shelter-based palliative care hospice. Demographics, diagnoses at admission and course were recorded. Burden of illness was assessed by medical and psychiatric diagnoses, addictions, Karnofsky scale and symptom management. An expert panel was convened to identify alternate care locations. Using standard costing scales, direct versus alternate care costs were compared. 28 patients had a mean age 49 years; average length of stay 120 days. DIAGNOSES: liver disease 43%, HIV/AIDS 25%, malignancy 25% and other 8%. Addiction to drugs or alcohol and mental illness in 82% of patients. Karnofsky performance score mean 40 +/- 16.8. Pain management with continuous opiates in 71%. The majority reunited with family. Compared to alternate care locations, the hospice projected 1.39 million dollars savings for the patients described. The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions. Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings.
White, Brandi; Ellis, Charles; Jones, Walter; Moran, William; Simpson, Kit
Objective Periods of economic instability may increase preventable hospitalizations because of increased barriers to accessing primary care. For underserved populations such as the homeless, these barriers may be more pronounced due to limited resources in the health care safety net. This study examined the impact of the global financial crisis of 2007-2008 on access to care for the homeless in New York State. Methods Hospitalizations for ambulatory care sensitive conditions (ACSCs) were used as a proxy measure for primary care access. Admissions for ACSCs were identified in the New York State Inpatient Database from 2006 to 2012. Hospitalization rates for ACSCs were calculated for the homeless and nonhomeless. Multivariable linear regression was used to investigate the impact of the financial crisis on hospitalization rates for ACSCs. Results The findings indicate that during the financial crisis, homeless adults had significantly higher preventable hospitalizations than nonhomeless adults, and the uninsured homeless had significantly higher preventable hospitalizations when compared to other homeless subgroups. After the financial crisis, preventable hospitalizations for the homeless stabilized but remained at higher rates than those for the nonhomeless. Conclusions These findings are important to developing health policies designed to provide effective care for underserved population such as the homeless.
In this podcast, Dr. Marina Eremeeva discusses an article about Bartonella quintana in homeless populations in San Francisco. Bartonella quintana is a bacterium that is transmitted by human body lice. Findings by the articleâs authors suggest that Bartonella quintana may be transmitted by head lice. This could mean that populations other than homeless populations, such as school children, might be at increased risk for Bartonella quintana.
For people who are disenfranchised from society for other reasons, especially homelessness, a paranoid delusional system can create an additional obstacle in the therapeutic engagement and treatment of such individuals. In this article, we describe a composite case of a homeless woman with paranoid schizophrenia. Through this case example, we will explore various obstacles to treatment and discuss strategies to overcome these hurdles to treatment, initiate a therapeutic alliance, and further facilitate and maintain therapy. PMID:20526407
McChesney, Kay Young
Synthesizes research findings from 10 studies on urban homeless families; and details their demographic characteristics, including the number of children, race, ethnicity, and family composition. Focus is on mothers with children and the effects of homelessness on children. (SLD)
The purpose of this short paper is to review articles or data on homelessness to grasp what it is and its status quo in Australia, including various allied problems. In this short paper, the definitions of homelessness and the related notion of home are reviewed at first because it is important to find the meaning and difference for development in understanding of and gaining an insight into the homelessness. After that, the present situations or characteristics of homelessness and its proble...
North, Carol S.; Pollio, David E.
Background: Cocaine use is highly prevalent among homeless populations, yet little is known about how it is financed. This study examined associations of income sources with cocaine use and financing of drugs in a longitudinal evaluation of a homeless sample. Methods: A homeless sample was recruited systematically in St. Louis in 1999–2001 and longitudinally assessed annually over two years using the Diagnostic Interview Schedule and the Homeless Supplement, with urine drug testing. Results: ...
Ropers, Richard H.
Contemporary homelessness is the result of increasing social and economic inequality faced by those in American society who are most vulnerable to individual, family, and economic instability. This case study of the homeless population of Los Angeles (California), based on two surveys conducted in 1984, views the homeless as a segment of the…
Seider, Scott C.
From 1983-2011, the Harvard Square Homeless Shelter (HSHS) in Cambridge, Massachusetts, was the only student-run homeless shelter in the United States. However, college students at Villanova, Temple, Drexel, the University of Pennsylvania, and Swarthmore drew upon the HSHS model to open their own student-run homeless shelter in Philadelphia,…
Milburn, Norweeta G.; Rosenthal, Doreen; Rotheram-Borus, Mary Jane; Mallett, Shelley; Batterham, Philip; Rice, Eric; Solorio, Rosa
165 newly homeless adolescents from Melbourne, Australia and 261 from Los Angeles, United States were surveyed and followed for two years. Most newly homeless adolescents returned home (70% U.S., 47% Australia) for significant amounts of time (39% U.S., 17% Australia more than 12 months) within two years of becoming homeless.
Homelessness influences every facet of children's lives, inhibiting their physical, emotional, cognitive, social, and behavioral development. Homeless women face such obstacles to healthy pregnancies as chemical abuse, chronic health problems, and lack of prenatal care. Homeless infants are more likely to have low birth weights and are at greater…
... 34 Education 2 2010-07-01 2010-07-01 false Homeless children. 300.19 Section 300.19 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.19 Homeless children. Homeless children has the...
Zabkiewicz, Denise M; Patterson, Michelle; Wright, Alexandra
Objectives This study draws on baseline data from the At Home/Chez Soi demonstration project to examine the association between parenting status and mental health among homeless women and whether the association varies by duration of homelessness. Setting Structured interviews were conducted with participants in five cities across Canada including Moncton, Montreal, Toronto, Vancouver and Winnipeg. Participants Eligibility criteria included those with legal adult status, with a mental illness, and who lacked a regular, fixed shelter. All 713 women who participated in the larger project were selected for inclusion in this analysis. Measures The mental health conditions of interest include depression, post-traumatic stress disorder (PTSD), alcohol dependence and substance dependence. Results The relationship between parenting status and depression, as well as PTSD, varied by duration of homelessness. Among women who had been homeless for less than 2 years, no relationship was found between parenting status and depression, or PTSD. However, among women who had been homeless for 2 or more years, the odds of depression was twice as high among parenting women compared with others (aOR=2.05, p≤0.05). A similar relationship was found between parenting status and PTSD (aOR=2.03, p≤0.05). The odds of substance dependence was found to be 2.62 times greater among parenting women compared with others and this relationship did not vary by duration of homelessness (aOR=2.62; 95% CI 1.86 to 3.69). No relationship was found between parenting and alcohol dependence. Conclusions Overall, the findings from this study suggest that there is a relationship between long-term homelessness and mothers’ risk of poor mental health. Given the multiple demands mothers face, a failure to recognise their unique needs is likely to contribute to intergenerational legacies of homelessness and mental health problems. Trial registration number World Health Organization's International Clinical
This study aimed to establish a profile of users of the mental health service for homeless in Cork, comparing this group with those attending a General Adult Service. The homeless group were significantly more likely to be male (89% v. 46%o), unemployed (96% v. 68%), unmarried (98% v. 75%) and under 65 (94% v. 83%). Diagnostically, there was a significantly higher prevalence of schizophrenia (50% v. 34%); personality disorder (37% v. 11%) and substance dependence (74% v. 19%) in the homeless service users. They were more likely to have a history of deliberate self harm (54% v. 21%) and violence (48% v. 10%). Severe mental illness has a high prevalence in the homeless population, with particularly high levels of factors associated with suicide and homicide. Poor compliance and complexity of illness lead to a requirement for significant input from multidisciplinary mental health teams members.
Lebrun-Harris, Lydie A; Baggett, Travis P; Jenkins, Darlene M; Sripipatana, Alek; Sharma, Ravi; Hayashi, A Seiji; Daly, Charles A; Ngo-Metzger, Quyen
Objective To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts. Data Sources/Study Setting Nationally representative data from the 2009 Health Center Patient Survey. Study Design Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients' health care experiences. Data Collection Computer-assisted personal interviews were conducted with health center patients. Principal Findings Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92). Conclusions There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use. PMID:23134588
Bourgault, Claire; Johnson, Erin E.; Redihan, Stephen G.; Borgia, Matthew; Aiello, Riccardo; Kane, Vincent
Objectives. We compared service use among homeless and nonhomeless veterans newly enrolled in a medical home model and identified patterns of use among homeless veterans associated with reductions in emergency department (ED) use. Methods. We used case–control matching with a nested cohort analysis to measure 6-month health services use, new diagnoses, and care use patterns in veterans at the Providence, Rhode Island, Veterans Affairs Medical Center from 2008 to 2011. Results. We followed 127 homeless and 106 nonhomeless veterans. Both groups had similar rates of chronic medical and mental health diagnoses; 25.4% of the homeless and 18.1% of the nonhomeless group reported active substance abuse. Homeless veterans used significantly more primary, mental health, substance abuse, and ED care during the first 6 months. Homeless veterans who accessed primary care at higher rates (relative risk ratio [RRR] = 1.46; 95% confidence interval [CI] = 1.11, 1.92) or who used specialty and primary care (RRR = 10.95; 95% CI = 1.58, 75.78) had reduced ED usage. Homeless veterans in transitional housing or doubled-up at baseline (RRR = 3.41; 95% CI = 1.24, 9.42) had similar reductions in ED usage. Conclusions. Homeless adults had substantial health needs when presenting for care. High-intensity primary care and access to specialty care services could reduce ED use. PMID:24148042
Fekadu, Abebaw; Hanlon, Charlotte; Gebre-Eyesus, Emebet; Agedew, Melkamu; Solomon, Haddis; Teferra, Solomon; Gebre-Eyesus, Tsehaysina; Baheretibeb, Yonas; Medhin, Girmay; Shibre, Teshome; Workneh, Abraham; Tegegn, Teketel; Ketema, Alehegn; Timms, Philip; Thornicroft, Graham; Prince, Martin
The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia. A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule. We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness. Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.
Arnautovska, U; Sveticic, J; De Leo, D
To study the incidence of suicide by homeless persons over a 20-year period, and identify demographic and clinical characteristics that distinguish these cases from those in non-homeless persons. A comparative analysis of homeless and non-homeless persons who died by suicide between 1990 and 2009 in Queensland, Australia. Ninety-two persons (82 males and 10 females) were identified from the Queensland Suicide Register as being homeless at the time of death. Suicide rates were calculated for the second decade only due to the lack of population numbers of homeless persons in the first decade. Homeless persons had almost twice higher suicide rate than non-homeless counterparts. They were more often male, of young age, single/never married, non-Indigenous, unemployed, had at least one physical illness or other stressful life event prior to death, had drug and alcohol abuse problems, and also were more likely to have evidence for an untreated mental illness. Regression analysis showed that being unemployed, having a history of legal problems and not being diagnosed with mental illness were strongly associated with suicide among homeless persons. This study is the first in Australia, and the second study internationally, to examine the characteristics of homeless people who died by suicide. Although based on a relatively small sample, the present work nonetheless carries practical implications for the development of targeted suicide prevention strategies in this peculiar population of individuals.
Christensen, Ivan; Koch-Nielsen, Inger
Due to an increased visibility in homelessness from the late 80s and onwards many political initiatives have been taken to reduce homelessness and to improve the situation for the homeless. The aim of this article is to try to describe the development in homelessness in Denmark since the late 80s...... in homelessness. The composition of the group has changed, as the proportion of young and elderly seems to have decreased and the proportion of the middle-aged to have increased. There is probably an increase in the proportion of ethnic minorities, whereas a change in the gender composition is difficult to verify...
Reviews discrepancies in the research on the learning and development of homeless children. Describes a child care program at a homeless shelter that enrolls both homeless and nonhomeless children; and presents case studies of two successfully adjusted homeless children. Discusses homeless children's resiliency and the need to assess their…
...) Homeless needs. The plan must provide a concise summary of the nature and extent of homelessness (including rural homelessness and chronically homeless persons), addressing separately the need for facilities and...) who are currently housed but threatened with homelessness. The plan also must contain a brief...
Chun Nok Lam
Full Text Available Introduction: Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital. Methods: We conducted a secondary analysis of administrative data on all adult ED visits in 2012 in an urban safety-net hospital. Patient demographics, mental health status, homelessness, insurance coverage, level of acuity, and ED disposition per ED visit were analyzed using multilevel modeling to control for multiple visits nested within patients. We performed multivariate logistic regressions to evaluate if homelessness moderated the likelihood of mental health patients’ 30-day ED revisits and hospital readmissions. Results: Study included 139,414 adult ED visits from 92,307 unique patients (43.5±15.1 years, 51.3% male, 68.2% Hispanic/Latino. Nearly 8% of patients presented with mental health conditions, while 4.6% were homeless at any time during the study period. Among patients with mental health conditions, being homeless contributed to an additional 28.0% increase in likelihood (4.28 to 5.48 odds of 30-day ED revisits and 38.2% increase in likelihood (2.04 to 2.82 odds of hospital readmission, compared to non-homeless, non-mental health (NHNM patients as the base category. Adjusted predicted probabilities showed that homeless patients presenting with mental health conditions have a 31.1% chance of returning to the ED within 30-day post discharge and a 3
Biederman, Donna J; Forlan, Nicole
Despite recent decreases, homelessness remains a substantial problem in the United States. Homelessness is associated with poor health, and homeless women experience earlier mortality than their housed counterparts. Understanding the aspirations of homeless women may offer service providers avenues for intervention to increase well-being among this vulnerable population. This study, a secondary analysis of transcribed interviews (n = 20), provides insight into the aspirations of homeless women. Opportunities for service providers to intervene on these aspirations within the context of homelessness are offered.
Law, Kate; John, William
The concepts of culture and homelessness are both complex and contested. This paper examines homelessness through the lens of transcultural nursing theory, increasing understanding of both homelessness and transcultural theory. We argue that homelessness can be usefully conceptualised as a culture and that the application of transcultural theory to caring for homeless people will add further to the utility of these theories. The application of transcultural theory can add to the repertoire of skills the nurse needs to care for not only homeless clients, but, for a diverse range of client groups. Copyright © 2012 Elsevier Ltd. All rights reserved.
In this podcast, Dr. Marina Eremeeva discusses an article about Bartonella quintana in homeless populations in San Francisco. Bartonella quintana is a bacterium that is transmitted by human body lice. Findings by the articleâs authors suggest that Bartonella quintana may be transmitted by head lice. This could mean that populations other than homeless populations, such as school children, might be at increased risk for Bartonella quintana. Created: 6/30/2009 by Emerging Infectious Diseases. Date Released: 6/30/2009.
Theunissen, T.P.M.; Meyer, T.; Memon, A.; Weinsheimer, C.C.
Reports from individuals who have witnessed multiple, similar emotional events may differ from reports from witnesses of only a single event. To test this, we had participants (N = 65) view a video of a road traffic accident. Half of the participants saw two additional (similar) aversive films.
van den Berk-Clark, Carissa; McGuire, James
We compared the characteristics of chronically homeless and acutely homeless elderly veterans to better understand precipitants of homelessness. We conducted interviews with 33 chronically and 26 acutely homeless veterans aged 65 years and older receiving transitional housing services in Los Angeles, California, between 2003 and 2005. We asked questions regarding their sociodemographic characteristics and other social status measures. Other precipitants of homelessness were acquired via observation and open-ended and structured questions. Both veterans groups were more similar than different, with substantial levels of physical, psychiatric, and social impairment. They differed significantly in homelessness history, with chronically homeless veterans having more homelessness episodes and more total time homeless. They were also less educated and had smaller social networks. In response to open-ended questioning, elderly homeless veterans revealed how health and substance use issues interacted with loss of social support and eviction to exacerbate homelessness. Assessment of a range of factors is needed to address risk factors and events leading to homelessness. Further research with larger samples is needed to confirm the characteristics and needs of the elderly homeless veteran population.
...-P-01] Homeless Management Information Systems Requirements AGENCY: Office of the Assistant Secretary... for the establishment of regulations for Homeless Management Information Systems (HMIS), which are the... community development, Homeless, Information technology system, Management system, Nonprofit organizations...
Panadero, Sonia; Guillén, Ana Isabel; Vázquez, José Juan
This article tests a hypothesized model of overall happiness among homeless people in Spain. The research was conducted based on a representative sample of homeless people in Madrid (n = 235), all adults, who had spent the night before the interview in a shelter for homeless people, on the street or in other places not initially designed for sleeping, or who were in supervised accommodation for homeless people at the time of the interview. Information was gathered using a structured interview. The results obtained show that around half of the homeless people in Madrid said that they were happy. A positive meta-stereotype and a better perceived general health were associated with a higher overall happiness, while feelings of loneliness were associated with a lower overall happiness. Happiness also showed a significant effect on future expectations. Disabilities and handicaps had a significant effect on perceived general health, which was in turn associated with overall happiness among homeless people. (c) 2015 APA, all rights reserved).
Janssens, Jean-Paul; Wuillemin, Timothee; Adler, Dan; Jackson, Yves
Whereas high risk groups such as asylum seekers are systematically screened for active tuberculosis (TB) upon entry in Switzerland, this strategy does not apply to homeless persons despite a reported high risk. Geneva health and social authorities implemented an intersectoral project to screen for active TB in homeless persons. We aimed to assess acceptability of this program and prevalence of active TB in this group. This prospective study targeted all homeless adults registering for shelter accommodation in Geneva during winter 2015. Applicants were proposed a questionnaire-based screening ( www.tb-screen.ch ) exploring epidemiological and clinical risk factors for active TB. Participants with a positive score underwent diagnostic procedures at Geneva University Hospital. Enhanced TB surveillance targeting homeless persons in the community was continued 3 months after the study termination. Overall, 726/832 (87.3%) homeless persons accepted the screening procedure. Most were young male migrants without access to care in Switzerland. Male gender (adjusted OR: 2.14; 95% confidence interval: 1.27-3.62), age below 25 years (aOR: 4.16; 95% CI: 1.27-13.64) and short duration of homelessness (aOR: 1.75; 95% CI: 1.06-2.87) were predictors of acceptance. Thirty (4.1%) had positive screening scores but none of the 24 who underwent further testing had active TB. Post-study surveillance did not identify any incident case in Geneva. Active TB screening targeting highly mobile homeless persons in shelters was well accepted and feasible. The participants' sociodemographic profile highlighted the heterogeneity of homeless groups in Europe and the null TB prevalence the variability of their active TB risks. These findings underline the feasibility of health programs targeting this hard to reach group and the need for close monitoring of this social group considering the rapid changes in international mobility patterns to tailor preventive and screening strategies to the local
Pavao, Joanne; Turchik, Jessica A; Hyun, Jenny K; Karpenko, Julie; Saweikis, Meghan; McCutcheon, Susan; Kane, Vincent; Kimerling, Rachel
Military sexual trauma (MST) is the Veteran Health Administration's (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans. To estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men. National, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010. All variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization. Of homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST. A substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless
Shinichiro Iwata; Koji Karato
This paper examines the location choices of homeless people in Osaka City, and finds them concentrated because of homeless networks. The paper also shows that different types of homeless networks operate in two different homeless groups: (1) peer networks that provide a social tie inside homeless communities are observed in groups that had not had work experience in the day labor market; (2) homed networks that provide a social tie outside homeless communities affect location choice in the ex...
The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study.
Stergiopoulos, Vicky; Schuler, Andrée; Nisenbaum, Rosane; deRuiter, Wayne; Guimond, Tim; Wasylenki, Donald; Hoch, Jeffrey S; Hwang, Stephen W; Rouleau, Katherine; Dewa, Carolyn
Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model. In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains. We observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures. Our findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.
Kidd, Sean A.
Building upon previous exploratory qualitative research (Kidd S.A. (2003) "Child Adol. Social Work J." 20(4):235-261), this paper examines the mental health implications of social stigma as it is experienced by homeless youth. Surveys conducted with 208 youths on the streets and in agencies in New York City and Toronto revealed…
The bank foreclosed on your home because your parents divorced and don't have enough money to pay the mortgage. You're locked out of your house. Where will the family sleep? Most families turn to friends and relatives at times like these. That's why about 75 percent of the 1,258,182 homeless students in the United States live…
Institute for Children and Poverty, New York, NY.
Roughly 600,000 families are homeless today in America, while over 2.7 million children are in foster care or out-of-home placements. Few policymakers have examined these issues together, or understood that they are interrelated and must be addressed jointly to break the cycle of family disintegration, violence, and poverty. A recent survey by the…
Describes the experiences of several families who are homeless in New York City, looking at what it is like for the children in these families, how the parents cope with trying to find work and a place to live, and how these families are treated by the system as they wait for various kinds of assistance. (SM)
Hadi, Indrawati; Roengvoraphoj, Olarn; Niyazi, Maximilian; Nachbichler, Silke Birgit [LMU Munich, Department of Radiation Oncology, University Hospital, Munich (Germany); Roeder, Falk [LMU Munich, Department of Radiation Oncology, University Hospital, Munich (Germany); German Cancer Research Center (DKFZ), Molecular Radiation Oncology, Heidelberg (Germany); Schueller, Ulrich [University Medical Center, Institute of Neuropathology, Hamburg-Eppendorf (Germany); Research Institute Children' s Cancer Center, Hamburg (Germany); University Medical Center, Department of Pediatric Hematology and Oncology, Hamburg-Eppendorf (Germany); Belka, Claus [LMU Munich, Department of Radiation Oncology, University Hospital, Munich (Germany); German Cancer Consortium (DKTK), Munich (Germany)
Adult medulloblastoma is a rare disease treated according to the current pediatric treatment guidelines. This retrospective analysis investigated the clinical outcomes and prognostic factors of adult medulloblastoma patients, who received multimodal therapy at our institution. Treatment charts of all patients over the age of 15 years of age with de novo medulloblastoma, who had been treated at our institution between 2001 and 2014, were retrospectively analyzed. Patients' demographic parameters, initial symptoms, treatment modalities, toxicities, and survival outcomes were investigated. In all, 21 patients with a median age of 30.2 years were identified. The most frequent histologies were desmoplastic and classic, and the most common molecular subtype was sonic hedgehog (SHH). After tumor resection, all patients received craniospinal irradiation (median dose 35.2 Gy) and a boost to the posterior fossa (median dose 19.8 Gy). Simultaneous chemotherapy with vincristine was given to 20 patients and sequential chemotherapy to 15 patients. The most common side effects were hematological toxicities. Median overall survival (OS) has not been reached after a median follow-up of 92 months. Estimated 5- and 10-year OS was 89 and 80%, respectively. Estimated 5- and 10-year progression-free survival (PFS) was 89 and 81%, respectively. In univariate analysis, a shorter interval between tumor resection and end of irradiation was significantly associated with improved OS and PFS, anaplastic histology with worse OS and PFS. The combined modality treatment showed a good outcome in adults with medulloblastoma. Treatment time was revealed to be prognostic and should be kept as short as possible. (orig.) [German] Das Medulloblastom des Erwachsenen ist eine seltene Erkrankung, die analog paediatrischer Behandlungsprotokolle therapiert wird. Diese retrospektive Analyse untersuchte die klinischen Ergebnisse und prognostischen Faktoren von erwachsenen Medulloblastompatienten, die eine
de Vet, Renée; van Luijtelaar, Maurice J. A.; Brilleslijper-Kater, Sonja N.; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D.
We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness. PMID:23947309
Austen, Tyrone; Pauly, Bernie
Homelessness is a serious and growing issue. Evaluations of systemic-level changes are needed to determine progress in reducing or ending homelessness. The report card methodology is one means of systems-level assessment. Rather than solely establishing an enumeration, homelessness report cards can capture pertinent information about structural…
Full Text Available This paper describes the potential suitability of case study methodology for inquiry with the homeless population. It references a research study that uses case study research method to build theory. This study's topic is the lived experience of destitute individuals who reside in homeless shelters, and explores the homeless shelter built environment's potential influence on resident satisfaction and recovery. Case study methodology may be appropriate because it explores real-life contextual issues that characterize homelessness and can also accommodate the wide range of homeless person demographics that make this group difficult to study in a generalized fashion. Further, case study method accommodates the need within research in this area to understand individualized treatments as a potential solution for homelessness.
Claire W. Herbert
Full Text Available The United States has experienced dramatic increases in both incarceration rates and the population of insecurely housed or homeless persons since the 1980s. These marginalized populations have strong overlaps, with many people being poor, minority, and from an urban area. That a relationship between homelessness, housing insecurity, and incarceration exists is clear, but the extent and nature of this relationship is not yet adequately understood. We use longitudinal, administrative data on Michigan parolees released in 2003 to examine returning prisoners’ experiences with housing insecurity and homelessness. Our analysis finds relatively low rates of outright homelessness among former prisoners, but very high rates of housing insecurity, much of which is linked to features of community supervision, such as intermediate sanctions, returns to prison, and absconding. We identify risk factors for housing insecurity, including mental illness, substance use, prior incarceration, and homelessness, as well as protective “buffers” against insecurity and homelessness, including earnings and social supports.
Full Text Available Urban poverty continues to prove itself a concern in cities’ territorial planning as it disrupts the quality of life and the development process in some cities. Homelessness emerges sometimes as extreme urban poverty even in developed European Union countries. The study assesses Bucharest urban space to differentiate characteristics that influence the homeless to locate in certain places. The analysis included a three-level urban space categorization. Functional types of space were correlated to homelessness presence according to three space characteristics: property type, physical structure and state of use. The main findings argue that homeless people localization in Bucharest depends on urban space capacity to meet homelessness housing and living needs. Analysis’ conclusions evidence homeless location patterns to urban planners and authorities that may use the information to improve policies and actions to alleviate extreme poverty in Bucharest.
Full Text Available Usually, the experience of living in the streets is associated with homeless people but other groups inherently related are forgotten such as police, gangs, neighbors and etcetera. The aim of this paper is to characterize the relationships that exist between the different groups who are involved, directly or indirectly, in the dynamics of homelessness. Adults who live in the streets (ALS were interviewed during the field work that finished with the writing of the phd thesis. In the network of relationships that is woven around homelessness is important to talk about the presence of the Big Other (the rest of society that does not sleep on the streets and how the adults who live in the streets build closeness and intimacy while keeping distances with Big Other; sympathies and conflicts.
Shulman, Caroline; Hudson, Briony F; Low, Joseph; Hewett, Nigel; Daley, Julian; Kennedy, Peter; Davis, Sarah; Brophy, Niamh; Howard, Diana; Vivat, Bella; Stone, Patrick
Being homeless or vulnerably housed is associated with death at a young age, frequently related to medical problems complicated by drug or alcohol dependence. Homeless people experience high symptom burden at the end of life, yet palliative care service use is limited. To explore the views and experiences of current and formerly homeless people, frontline homelessness staff (from hostels, day centres and outreach teams) and health- and social-care providers, regarding challenges to supporting homeless people with advanced ill health, and to make suggestions for improving care. Thematic analysis of data collected using focus groups and interviews. Single homeless people ( n = 28), formerly homeless people ( n = 10), health- and social-care providers ( n = 48), hostel staff ( n = 30) and outreach staff ( n = 10). This research documents growing concern that many homeless people are dying in unsupported, unacceptable situations. It highlights the complexities of identifying who is palliative and lack of appropriate places of care for people who are homeless with high support needs, particularly in combination with substance misuse issues. Due to the lack of alternatives, homeless people with advanced ill health often remain in hostels. Conflict between the recovery-focused nature of many services and the realities of health and illness for often young homeless people result in a lack of person-centred care. Greater multidisciplinary working, extended in-reach into hostels from health and social services and training for all professional groups along with more access to appropriate supported accommodation are required to improve care for homeless people with advanced ill health.
Ranzani, Otavio T; Carvalho, Carlos R R; Waldman, Eliseu A; Rodrigues, Laura C
Tuberculosis (TB) is a major public health problem requiring complex treatment, the success of which depends on biological, social, and institutional factors. São Paulo State (SPS), in Brazil, has a high TB burden. Because of high socioeconomic heterogeneity and chaotic urbanisation, homelessness might play an important role in the TB burden in SPS. Our aim was to determine the association between homelessness and outcome of treatment of pulmonary TB (PTB) in SPS. A historical cohort from the routine SPS TB database for 2009-2013 was analysed. The study population was newly diagnosed adult patients with PTB. Homelessness was ascertained at notification or when treatment started. Our outcome was unsuccessful outcome of treatment. We used logistic regression to adjust for potential confounders and multiple imputation for missing data. We analysed 61,817 patients; 1726 (2.8 %, 95%CI 2.7-2.9 %) were homeless. Homeless patients were concentrated in bigger cities, were more frequently middle-aged males, had black/brown skin colour, and had received less education (P homeless patients (43.2 % vs 14.4 %, 30.2 % vs. 9.4 %, P homeless, of whom 17.3 % were HIV positive compared with 8.5 % among the not homeless population (P homeless (91.6 % vs. 84.8 %, P homeless and 17.5 % among the not homeless (OR = 6.32, 95%CI 5.73-6.97, P homelessness remained strongly associated with lower treatment success (aOR = 4.96, 95 % CI 4.27-5.76, P homelessness: among HIV-infected patients, the aOR was 2.45 (95%CI 1.90-3.16, Pinteraction homelessness, alcohol and drug use was almost 20 %. Confirming our hypothesis, homelessness led to a marked reduction in the successful treatment of newly diagnosed pulmonary tuberculosis. Homelessness and associated conditions were important contributors to lack of treatment success in pulmonary tuberculosis in São Paulo. A multifaceted intervention must be implemented to target this vulnerable population.
Holloway, John H.
Reviews studies on the plight and needs of homeless students. Includes reports on family mobility and school attendance, dysfunctional families, and school intervention strategies. (Contains 11 references.) (PKP)
Full Text Available Purpose: Homeless adults have a higher prevalence of smoking compared to the general population. Most tobacco cessation efforts have focused on the general population, with limited attention paid to this vulnerable population. In this study, homeless adults as well as shelter staff were interviewed to understand their attitudes and beliefs about smoking and smoking cessation, and receptiveness to smoking cessation interventions. Methods: Semi-structured, one-on-one interviews were audio recorded and transcribed for 13 homeless adult smokers and 9 staff recruited from a homeless shelter in Charleston, South Carolina. Transcripts were analyzed in a systematic manner by independent investigators trained in grounded theory. The constant comparison method was used to code, categorize and synthesize the qualitative data. Results: The majority of smokers interviewed expressed the desire to stop smoking, but felt that stress from being homeless was a barrier to quitting. When asked about different tobacco cessation methods, there was no preferred method and there was skepticism regarding actual effectiveness of different methods, since many had previously been unsuccessful when tried by these smokers. Shelter staff acknowledged that tobacco cessation was important, but did not see it as a priority for shelter residents. Even though cessation medications are available in the shelter clinic, very few of the smokers or shelter staff interviewed were aware of the availability of these medications. Conclusions: This study suggests that adult smokers in a homeless shelter are interested in quitting smoking and receptive toward assistance, but that lack of awareness and perceived importance of cessation among staff is a significant barrier. Providing training to staff and encouraging them to take a proactive approach to tobacco cessation may be an area to focus future cessation interventions.
Mastropieri, Biagio; Schussel, Lorne; Forbes, David; Miller, Lisa
Homeless youth have particular need to develop inner resources to confront the stress, abusive environment of street life, and the paucity of external resources. Research suggests that treatment supporting spiritual awareness and growth may create a foundation for coping, relationships, and negotiating styles to mitigate distress. The current pilot study tests the feasibility, acceptability, and helpfulness of an interpersonal spiritual group psychotherapy, interpersonal psychotherapy (IPT) integrated with spiritual visualization (SV), offered through a homeless shelter, toward improving interpersonal coping and ameliorating symptoms of depression, distress, and anxiety in homeless youth. An exploratory pilot of integrative group psychotherapy (IPT + SV) for homeless young adults was conducted in a New York City on the residential floor of a shelter-based transitional living program. Thirteen young adult men (mean age 20.3 years, SD = 1.06) participated in a weekly evening psychotherapy group (55 % African-American, 18 % biracial, 18 % Hispanic, 9 % Caucasian). Measures of psychological functioning were assessed at pre-intervention and post-intervention using the General Health Questionnaire (GHQ-12), Patient Health Questionnaire (PHQ-9, GAD-7), and the Inventory of Interpersonal Problems (IIP-32). A semi-structured exit interview and a treatment satisfaction questionnaire were also employed to assess acceptability following treatment. Among homeless young adults to participate in the group treatment, significant decreases in symptoms of general distress and depression were found between baseline and termination of treatment, and at the level of a trend, improvement in overall interpersonal functioning and levels of general anxiety. High utilization and treatment satisfaction showed the intervention to be both feasible and acceptable. Offered as an adjunct to the services-as-usual model at homeless shelters serving young adults, interpersonal psychotherapy
Krameddine, Yasmeen I; Silverstone, Peter H
The police interact with homeless individuals frequently. However, there has been relatively little research on the attitudes of homeless individuals towards the police, and how police interactions may impact these. This is important since the attitudes of homeless individuals can impact how often they report crimes, and how well they support police when they are investigating crimes in this population. We interviewed 213 homeless individuals in a single city, representing approximately 10% of the total homeless population. They were interviewed at either homeless shelters, or events held specifically for the homeless population. Of these individuals, 75% were male, and 47% had interacted with a police officer within the past month. Self-reports suggested that 60% had a drug and/or alcohol issue and 78% had a mental illness. We found a highly statistically significant difference between the group that had been handcuffed and/or arrested compared to those that had not. This was across multiple domains and included how the individual regarded the police in terms of their empathy and communication skills, and how much they trusted the police. These changes were long-term, and if a homeless individual had been arrested or handcuffed (and verbal reporting suggested that being handcuffed was the by far the most important factor) then these negative attitudes lasted at least 2 years. The primary conclusion from this study is that when police handcuff a homeless individual, this can lead to long-term negative views about the police across several domains that appear to be long lasting, and were linked to feelings of not being respected by the police. It is therefore proposed that police officers should be made aware of the potential long-term negative consequences of this single action, and that police forces should consider providing specific training to minimize any unnecessary overuse of handcuffs. Copyright © 2015 Elsevier Ltd. All rights reserved.
Fu, Yan-Nan; Cao, Xiao-Lan; Hou, Cai-Lan; Ng, Chee H; Ungvari, Gabor S; Chiu, Helen F K; Lin, Yong-Qiang; Wang, Lihui; Zheng, Xiaocong; Jia, Fu-Jun; Xiang, Yu-Tao
There are no published data on insight in homeless patients with psychiatric disorders in China. This study examined insight in homeless and non-homeless Chinese psychiatric inpatients in relation to demographic and clinical variables. A total of 278 homeless and 222 non-homeless inpatients matched in age and gender were included in the study. Demographic and clinical characteristics were collected based on a review of medical charts and a clinical interview with standardized instruments. Insight was evaluated with the Insight and Treatment Attitudes Questionnaire. Altogether 20.5% of homeless inpatients and 43.7% of the non-homeless controls had good insight. Compared with homeless inpatients with impaired insight, homeless inpatients with good insight had higher physical quality of life, longer duration of illness and less severe positive and negative symptoms. Impaired insight appeared more common in homeless psychiatric inpatients in China. Further studies should address the need for effective therapeutic interventions that promote homeless patients' insight. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Vandentorren, Stéphanie; Le Méner, Erwan; Oppenchaim, Nicolas; Arnaud, Amandine; Jangal, Candy; Caum, Carme; Vuillermoz, Cécile; Martin-Fernandez, Judith; Lioret, Sandrine; Roze, Mathilde; Le Strat, Yann; Guyavarch, Emmanuelle
The objectives were to estimate the size of homeless family population in Paris region, to describe their living conditions and health and to analyse the impact of homelessness on children's growth and development, which was never investigated in France. A cross-sectional survey was conducted on a random sample of homeless sheltered families in 2013. Families were interviewed in 17 languages and a nurse took anthropometric measures, blood samples and collected health data from child health reports. The population size was estimated at 10 280 families. Half were single-parent female families and 94% were born outside France. Most families had experienced housing instability and 94% were living below the poverty line (828 euros/month). Malnutrition was a major problem: the prevalence of food insecurity was high (77% of parents and 69% of children), as well as anaemia (50% of mothers and 38% of children), overweight (38% of mothers and 22% of children) and obesity (32% of mothers and 4% of children). High rates of depressive disorders were found in 30% of homeless mothers and 20% of children had signs of possible mental health disorders. These first results highlight the important number of families among the homeless population in Paris region. Families differed from other homeless people regarding social characteristics such as birthplace, single-parent status and residential instability that are likely to influence schooling, social ties, health and access to care. These results demonstrate the need for urgent actions targeting homeless families, in terms of reducing housing instability and providing adequate care, especially for children. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Stewart, Holly C; Stevenson, Terrell N; Bruce, Janine S; Greenberg, Brian; Chamberlain, Lisa J
The prevalence of smoking among homeless adults is approximately 70 %. Cessation programs designed for family shelters should be a high priority given the dangers cigarette smoke poses to children. However, the unique nature of smoking in the family shelter setting remains unstudied. We aimed to assess attitudes toward smoking cessation, and unique barriers and motivators among homeless parents living in family shelters in Northern California. Six focus groups and one interview were conducted (N = 33, ages 23-54). The focus groups and interviews were audiorecorded, transcribed verbatim, and a representative team performed qualitative theme analysis. Eight males and 25 females participated. The following major themes emerged: (1) Most participants intended to quit eventually, citing concern for their children as their primary motivation. (2) Significant barriers to quitting included the ubiquity of cigarette smoking, its central role in social interactions in the family shelter setting, and its importance as a coping mechanism. (3) Participants expressed interest in quitting "cold turkey" and in e-cigarettes, but were skeptical of the patch and pharmacotherapy. (4) Feelings were mixed regarding whether individual, group or family counseling would be most effective. Homeless parents may be uniquely motivated to quit because of their children, but still face significant shelter-based social and environmental barriers to quitting. Successful cessation programs in family shelters must be designed with the unique motivations and barriers of this population in mind.
Full Text Available The objective of this study was to describe patterns of medication use among homeless adults from the city of Porto, Portugal. We recruited 146 homeless participants in four social services institutions. Data on the use of medicines in the previous week were collected using face-to-face interviews. We described the prevalence and main correlates of use of medicines from different Anatomical Therapeutic Chemical classification (ATC groups. A total of 56.8% of the homeless reported to have used at least one medicine in the previous week. The most frequently reported were benzodiazepines (21.9% and antipsychotics (15.1%; socio-demographic characteristics, lifestyle variables and use of health care were not found to be significantly associated with their use. The prevalence was 1.4% for anti-inflammatory and antirheumatic products, and 6.2% for antihypertensives, diuretics and beta-blocking agents. Medicines pertaining to the nervous system ATC group were by far the most frequently used, while those for the treatment of other common chronic and acute conditions seem to be underused.
Full Text Available BackgroundHomeless adults frequently experience poor nutrition. Research suggests raising self-efficacy and nutritional knowledge can increase healthy eating but that the choice of specific behavioral change techniques (BCTs is also critical. This study investigated how BCTs, operationalized to increase nutrition knowledge and self-efficacy, might influence the choice of homeless adults when presented with a “healthy” and an “unhealthy” snack.MethodsA total of 125 homeless adults were randomly allocated to watch 1 of 4 brief films: “control,” “[nutrition] information only,” “self-efficacy” (aimed at increasing self-efficacy and general healthy eating knowledge, and “enhanced self-efficacy” (as “self-efficacy,” but the presenter identified themselves as a homeless adult. Post-film, participants were invited to choose between a healthy and an unhealthy snack. Data were analyzed using ANOVA and chi square.ResultsParticipants in the “enhanced self-efficacy” condition were significantly more likely to choose the healthy option compared to those in the control condition; for the “self-efficacy” condition, the difference was marginally significant. Perceived knowledge and self-efficacy were significantly associated and those with high self-efficacy were significantly more likely to choose a healthy snack regardless of condition.ConclusionHomeless adults are more likely to make healthy snack choices if their nutritional self-efficacy is increased through encouragement by a peer.
Murphy, Joseph; Tobin, Kerri
In this article, the authors examine homelessness across time and examine, in an introductory way, homelessness today. The authors start by examining important themes that ribbon homelessness in America over the last 300 years. Next, they provide a period analysis of homelessness from the birth of the country through the late 1970s. In the last…
Vissing, Yvonne M.
Despite stereotypes to the contrary, homelessness is as prevalent in rural as urban areas. This digest examines the implications of homelessness for rural children and youth and discusses possible actions by rural educators. An estimated half of the rural homeless are families with children. Compared to urban counterparts, rural homeless families…
Homelessness is a significant social problem in the United States, with an estimated 2.5 million homeless people in this country today. While criminal activity may become a means for the homeless to obtain resources needed for basic survival, little is known about the level of criminal activity among the homeless or about the types of crimnal…
Milburn, Norweeta; Liang, Li-Jung; Lee, Sung-Jae; Rotheram-Borus, Mary Jane; Rosenthal, Doreen; Mallett, Shelley; Lightfoot, Marguerita; Lester, Patricia
There is growing evidence to support developing new typologies for homeless adolescents. Current typologies focus on the risks associated with being homeless, with less consideration of the positive attributes of homeless adolescents. The authors examined both risk and protective factors in a sample of newly homeless adolescents. Using cluster…
North, Carol S; Wohlford, Sarah E; Dean, Denis J; Black, Melissa; Balfour, Margaret E; Petrovich, James C; Downs, Dana L; Pollio, David E
Tracking the movements of homeless populations presents methodological difficulties, but understanding their movements in space and time is needed to inform optimal placement of services. This pilot study developed, tested, and refined methods to apply global positioning systems (GPS) technology paired with individual narratives to chronicle the movements of homeless populations. Detail of methods development and difficulties encountered and addressed, and geospatial findings are provided. A pilot sample of 29 adults was recruited from a low-demand homeless shelter in the downtown area of Fort Worth, Texas. Pre- and post-deployment interviews provided participant characteristics and planned and retrospectively-reported travels. Only one of the first eight deployments returned with sufficient usable data. Ultimately 19 participants returned the GPS device with >20 h of usable data. Protocol adjustments addressing methodological difficulties achieved 81 % of subsequent participants returning with sufficient usable data. This study established methods and demonstrated feasibility for tracking homeless population travels.
Song, Hyun Jin; Park, Susan; Kwon, Jin-Won
The number of single households has increased worldwide with middle-aged people in such households indicating the highest increase. However, there is a lack of studies on the topic. This study estimated the quality of life (QOL) by household type for middle-aged Korean adults. We used the Korea National Health and Nutrition Examination Survey data from 2007 to 2015. QOL was analyzed using EQ-5D 3-level, and demographic and health-related variables were included as confounders. The households were divided into single household, married couple without child, other one-generation, married couple with child, single parent with child, other two-generation, and three-generation. Logistic regression using level, strata, and sample weight of data was performed based on average QOL. This study included 18,147 responders aged 45-64 years, with single households constituting 5.7%. Single households having average or less QOL were 48.4%, with men and women constituting 40.1 and 53.3%, respectively. After adjusting socioeconomic factors and health-related factors, the odds ratio (OR) of single households was 1.375 (95% CI 1.122-1.684) compared to the three-generation group. According to the sex, the OR of single households with men was higher (OR 1.552, 95% CI 1.121-2.149). However, no significance was found in women. The study results revealed that middle-aged people in single households had low QOL than those in multi-person households. The trend was significantly observable in men than in women. Because middle-aged adults might transform into elderly with low QOL, program development and social support for middle-aged adults in single households should be provided.
Roessger, Kevin M.; Greenleaf, Arie; Hoggan, Chad
To overcome situational hurdles when researching transformative learning in adults, we outline a research approach using single-case research designs and smartphone data collection apps. This approach allows researchers to better understand learners' current lived experiences and determine the effects of transformative learning interventions on…
Byers, E. Sandra; Nichols, Shana; Voyer, Susan D.
This study examined the sexual functioning of single adults (61 men, 68 women) with high functioning autism and Asperger syndrome living in the community with and without prior relationship experience. Participants completed an on-line questionnaire assessing autism symptoms, psychological functioning, and various aspects of sexual functioning. In…
Fors, Stuart W.; Jarvis, Sara
Evaluates the Drug Prevention in Youth risk reduction program that was implemented in shelters for runaway/homeless youths in the southeastern United States. An evaluation strategy was developed allowing for comparisons between peer-led, adult-led and nonintervention groups. Well-trained and motivated peer/near-peer leaders made particularly…
Schrader, Anne-Marie Voss
% are not flossing their teeth (32% in controls; OR = 1.32; P = 0.239); and 39% are not physically active (24% in controls; OR = 1.63; P = 0.069). CONCLUSIONS: While in general there was no significant differences in overall health behaviors between SVP patients and controls, SVP patients are less physically active......Substance Use, Dental Hygiene, and Physical Activity in Adult Patients with Single Ventricle Physiology. Overgaard D, Schrader AM, Lisby KH, King C, Christensen RF, Jensen HF, Moons P. Author information OBJECTIVES: The study aims to describe substance use, dental hygiene, and physical activity...... in adult survivors with single ventricle physiology (SVP) and to compare the behaviors with matched controls, while the patients are particularly at risk for general health problems. DESIGN: The present study is part of a larger research project on long-term outcomes in adult patients with SVP. A cross...
National Center on Family Homelessness (NJ1), 2012
The National Center on Family Homelessness is determined to end family homelessness. Sheltering families provides a temporary safe haven. Connecting families to permanent housing, essential services, and critical supports can change their lives forever. Through research the Center learns what families need to rebound from the housing, economic,…
Wilson, Allison B.; Squires, Jane
The increasing prevalence of homelessness among young children and families in the United States is described, as is the developmental impact on young children and cost to society. Although services are mandated for this population under the McKinney-Vento Act, Education of Homeless Children and Youth Program, and the Individuals With…
Nunez, Ralph da Costa
This book discusses homeless families in the United States and advocates the efforts of residential educational and employment training centers--American Family Inns--which provide comprehensive services education, job training, and parenting and life skills to address the poverty-related conditions that contribute to homelessness. Chapters of the…
Shaver, Debra M.; Dornbusch, Sanford M.
This paper presents findings of a study that investigated the extent to which homeless children in the United States receive the "free and appropriate education" to which they are entitled. Data were collected through several surveys conducted in two San Francisco Bay Area counties: (1) surveys of parents in homeless shelters with 313…
A survey of 102 urban school districts in large cities indicates that school districts have responded to the requirements of the Stewart B. McKinney Act for the education of homeless children to varying degrees. However, 69 percent of districts described the problem of homeless students as nonexistent or small. (SLD)
.... Funding Opportunity Description: Section 2021 of Title 38 of the United States Code (U.S.C.) reauthorizes the Homeless Veterans Reintegration Program (HVRP) through fiscal year (FY) 2012 and indicates: ``the... DEPARTMENT OF LABOR Homeless Veterans' Reintegration Program AGENCY: Veterans' Employment and...
Rafferty, Yvonne; Shinn, Marybeth
Reviews community-based research on the effects of homelessness on children. Homeless children face threats to their future well-being resulting from health problems, hunger, poor nutrition, developmental delays, anxiety, depression, behavioral problems, and educational underachievement. Contributing factors may include inadequate shelter,…
Full Text Available Reducing homelessness is an indisputable social good, and housing subsidies offer one way to do so. However, subsidies come in many different varieties and are intricately bound up with economic and social policies. This paper, written by one of North America’s leading urban economists, cuts through the tangle and argues that the simplest approach is the best. The ideal way to deter people from harmful acts is to reward them for abstaining. Thus, to combat homelessness, governments should offer housing allowances to people for every night they are not homeless. This optimal homelessness-reducing home allowance (OHRHA is open to adjustment to suit individual circumstances and the effects of homelessness on different demographics. It is meant to reduce homelessness by aligning individual and societal incentives, forcing people to bear the consequences or realize the benefits that their actions impose on others. The author explores methods for financing OHRHA, examines means for tailoring it to meet the diverse needs of the homeless and discusses the policy’s effect on urban housing markets, all while comparing and contrasting the proposal to existing homelessness-reduction measures in Alberta, Canada and the US.
This article has located Jesus' saying about homelessness in the context of the Roman Empire as it was experienced in Galilee. Homelessness is part of a broader picture that translates into loss of access to the resources of the land. The thesis is that in light of a theology of land resulting from the development of Abrahamic ...
Hodge, David R.; Moser, Stephanie E.; Shafer, Michael S.
Mothers are one of the fastest growing segments of the homeless population in the United States. Although mental health problems often contribute to homelessness, little is known about the factors that affect mothers' mental health. To help identify protective factors, this longitudinal study examined the relationship between spirituality and…
Kane, Michael N.; Green, Diane; Jacobs, Robin
Human service students were surveyed ("N" = 207) to determine their perceptions about homeless elders and communal responsibility for their well-being. Using a backward regression analysis, a final model ("F" = 15.617, "df" = 7, "p" < 0.001) for Perceptions about Homeless Persons and Community…
... Non-Urban Homeless Female Veterans and Homeless Veterans With Families' Reintegration Into Employment... addresses complex problems facing Homeless Female Veterans and/or Veterans with Families eligible to... (including job readiness, literacy training, and skills training) to expedite the reintegration of homeless...
Michelle L Patterson PhD, RPsych
Full Text Available Underlying the daily lives of people with experiences of homelessness and mental illness is a complex interplay of individual and structural factors that perpetuate cycles of inequity. The introduction of novel methodological combinations within qualitative research has the potential to advance knowledge regarding the experience of health equity by such individuals and to clarify the relationship between these experiences and broader structural inequities. To explore the lived experience of inequity, we present a thematic analysis of narrative interviews in conjunction with timelines from 31 adults experiencing homelessness and mental illness. Use of these methods together enabled a novel and expanded appreciation for the varied ways in which differential access to the social determinants of health influences the trajectories and experiences of inequity for people who are homeless and mentally ill. The further utility of these methods for better understanding the experience of inequity is explored and implications for research, policy, and practice are discussed.
Sajatovic, Martha; Levin, Jennifer; Ramirez, Luis F; Hahn, David Y; Tatsuoka, Curtis; Bialko, Christopher S; Cassidy, Kristin A; Fuentes-Casiano, Edna; Williams, Tiffany D
Treatment nonadherence in people with schizophrenia is associated with relapse and homelessness. Building on the usefulness of long-acting medication and our work in psychosocial interventions to enhance adherence, we conducted a prospective uncontrolled trial of customized adherence enhancement (CAE) plus long-acting injectable antipsychotic (LAI) using haloperidol decanoate in 30 homeless or recently homeless individuals with DSM-IV-defined schizophrenia or schizoaffective disorder. Participants received monthly CAE and LAI (CAE-L) for 6 months. Primary outcomes were adherence, as measured by the Tablets Routine Questionnaire, and housing status. Secondary outcomes included psychiatric symptoms, functioning, side effects, and hospitalizations. The study was conducted from July 2010 to December 2012. The mean age of participants was 41.8 years (SD = 8.6); they were mainly minorities (90%, n = 27 African-American) and mainly single/never married (70%, n = 21). Most (97%, n = 29) had past or current substance abuse and had been incarcerated (97%, n = 29). Ten individuals (33%) terminated the study prematurely. CAE-L was associated with good adherence to LAI (at 6 months, 76%) and dramatic improvement in oral medication adherence, which changed from missing 46% of medication at study enrollment to missing only 10% at study end (P = .03). There were significant improvements in psychiatric symptoms (P effect with LAI. While interpretation of findings must be tempered by the methodological limitations, CAE-L appears to be associated with improved adherence, symptoms, and functioning in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. Additional research is needed on effective and practical approaches to improving health outcomes for homeless people with serious mental illness. ClinicalTrials.gov identifier: NCT01152697. © Copyright 2013 Physicians Postgraduate Press, Inc.
Zabkiewicz, Denise M; Patterson, Michelle; Wright, Alexandra
This study draws on baseline data from the At Home/Chez Soi demonstration project to examine the association between parenting status and mental health among homeless women and whether the association varies by duration of homelessness. Structured interviews were conducted with participants in five cities across Canada including Moncton, Montreal, Toronto, Vancouver and Winnipeg. Eligibility criteria included those with legal adult status, with a mental illness, and who lacked a regular, fixed shelter. All 713 women who participated in the larger project were selected for inclusion in this analysis. The mental health conditions of interest include depression, post-traumatic stress disorder (PTSD), alcohol dependence and substance dependence. The relationship between parenting status and depression, as well as PTSD, varied by duration of homelessness. Among women who had been homeless for less than 2 years, no relationship was found between parenting status and depression, or PTSD. However, among women who had been homeless for 2 or more years, the odds of depression was twice as high among parenting women compared with others (aOR=2.05, p≤0.05). A similar relationship was found between parenting status and PTSD (aOR=2.03, p≤0.05). The odds of substance dependence was found to be 2.62 times greater among parenting women compared with others and this relationship did not vary by duration of homelessness (aOR=2.62; 95% CI 1.86 to 3.69). No relationship was found between parenting and alcohol dependence. Overall, the findings from this study suggest that there is a relationship between long-term homelessness and mothers' risk of poor mental health. Given the multiple demands mothers face, a failure to recognise their unique needs is likely to contribute to intergenerational legacies of homelessness and mental health problems. World Health Organization's International Clinical Trials Registry Platform (ISRCTN66721740 and ISRCTN57595077). Published by the BMJ
Edalati, Hanie; Krausz, Michael; Schütz, Christian G
We examined the hypothesis that exposure to childhood maltreatment increases the vulnerability to Adult Victimization (AV) in a homeless population (N = 500). We also investigated the effects of specific types (emotional, physical, and sexual) and cumulative experience of childhood maltreatment on AV, and whether gender moderates these relationships. All three groups with AV experience (emotional, physical, and sexual) indicated higher exposure to childhood abuse and cumulative maltreatment, and those who were sexually victimized as an adult showed higher exposure to childhood neglect. In addition, exposure to childhood maltreatment had type-specific and cumulative effects on AV. Exposure to all types of childhood abuse maintained a strong direct association with AV, regardless of demographic characteristics, including age, ethnicity, marital status, education level, and housing situation. In addition, exposure to physical neglect showed a significant relationship with Adult Sexual Victimization. Cumulative experience of childhood maltreatment was consistently associated with cumulative risk of experiencing AV. Gender had no significant effect on these relationships. Findings suggest that intervention programs in homeless population should consider the history of childhood maltreatment and its characteristics to increase the effectiveness of intervention strategies for AV in this population. © The Author(s) 2015.
Okamura, Tsuyoshi; Ito, Kae; Morikawa, Suimei; Awata, Shuichi
The purpose of this study is to investigate the frequency and correlates of suicidal behavior among homeless people in Japan. A face-to-face survey was conducted in two districts of Tokyo, Japan, with 423 subjects who resided on streets and riversides and in urban parks and stations (street homeless) or who were residents of shelters, cheap hotels, or welfare homes for homeless people (sheltered homeless). When questioned about suicidal ideation in the previous 2 weeks, 51 subjects (12.2% of valid responses) had a recurring wish to die, 29 (6.9%) had frequent thoughts of suicide, and 22 (5.3%) had made suicide plans. In addition, 11 (2.9%) subjects had attempted suicide in the previous 2 weeks and 74 (17.7%) reported that they had ever attempted suicide. In univariate logistic regression analyses, street homelessness, lack of perceived emotional social support, poor subjective health perception, visual impairment, pain, insomnia, poor mental well-being, and current depression were significantly associated with recurrent thoughts of suicide in the previous 2 weeks. Among these, current depression had the greatest significance. In multivariate logistic regression analyses after controlling for depression, street homelessness and lack of perceived emotional social support were significantly associated with recurrent thoughts of suicide in the previous 2 weeks. Comprehensive interventions including housing and social support as well as mental health services might be crucial as effective strategies for suicide prevention among homeless people.
Ensign, Josephine; Ammerman, Seth
This paper is a report of a study to document researcher, healthcare provider and programme administrators' experiences with ethical issues in research with homeless youths in North America. While there are legal and ethical guidelines for research with adolescents and with vulnerable populations in general, there are no specific guidelines for the ethical conduct of research with homeless youths. Using a web-based questionnaire, healthcare and social service providers, programme administrators and researchers working with homeless young people throughout the United States of America and Canada were surveyed in 2005. The survey group consisted of 120 individuals; a total of 72 individuals completed the survey. Survey questions included experiences with using incentives in research with homeless youths, consent and experiences with ethics review boards. Numerical data were analysed using frequencies and cross-tabulations. Text data were analysed qualitatively. Researchers doing mental health and/or substance use research tended to use money as a research incentive, whereas healthcare providers and programme administrators tended to use non-monetary incentives. The majority of respondents reported using written consent for research from homeless youths, including minors. Respondents reporting difficulties with ethics review boards were mainly involved with intervention research. Consensus is needed from a variety of stakeholders, including homeless youths and service providers, on use of various types of research incentives for different types of research, as well as use of consent for homeless youths who are minors.
Moquillaza-Risco, Marlene; León, Elsa; Dongo, Mario; Munayco, César V
Determine the socio-demographics characteristics and health conditions of older homeless persons at the time of enrollment into the National Program "Vida Digna" and the probability of functional dependency by age, and stratified by gender and cognitive impairment. MATERIALS ANDE METHODS: We performed a cross sectional study, reviewing all registration forms of the program in order to identify socio-demographic variables and health conditions of older homeless persons at the time of enrollment in the program. We did a descriptive analysis of the socio-demographic variables and we also determined the frequency of health conditions. Furthermore, we determined the probability of functional dependency by age, and stratified by gender and cognitive impairment through a logistic regression model. The older homeless persons at the time of enrollment in the program were mostly single men, with a primary education or no education. The study subjects had a high frequency of chronic and mental diseases. 50% of them had certain level of functional impairment and roughly 70% had a certain level of cognitive impairment. The probability of functional dependency increased by age, and it was higher in women than in men. This probability increased according to the level of cognitive impairment. This study shows that older homeless persons are a vulnerable population not only because they live outdoors but also because they a have also for the high prevalence of chronic and mental diseases. These diseases prevent the homeless persons from living by themselves special care to overcome their situations.
A group of homeless people living in the streets is described with the purpose of gaining the knowledge necessary to prevent development of homelessness and establishing programmes for the homeless. Out-reach work in the streets and cooperation with private and religious organisations was conducted during a two-year period and 59 homeless persons were interviewed. Fifteen were women and 44 were men. Upbringing, social conditions, daily living, physical and mental health and contact with health services, social security and private organisations were highlighted in a structured and semistructured interview. Compared with the background population the homeless had much more frequently childhood experience of parents' divorce or death of one of the parents. The women were significantly older than the men and the majority of the women were suffering from schizophrenia and had very little contact with network and public services. The majority of the men were abusing alcohol or drugs, many had had a troublesome childhood with stays in institutions. Many had had many contacts with different social institutions and a criminal record. Among the homeless in the streets of Copenhagen, the prevalence of mental illness, especially schizophrenia, is high. It is recommended that homelessness among the mentally ill is prevented by a special effort directed towards the patient group at risk of becoming homeless and through establishing different housing facilities with varying degrees of professional support. Out-reach work towards the homeless mentally ill should be carried out with the purpose of establishing contact with psychiatric services and securing the possibility of compulsory admission.
Chen, Jinliang; Chen, Jindong; Li, Shuchun; Liu, Jun; Ouyang, Guohua; Luo, Wenxuan; Guo, Xiaofeng; Li, Ting; Li, Kaijie; Li, Zhenkuo; Wang, Gan
Homelessness is an increasingly important problem for individuals with serious mental illness in China. Identify the characteristics of families that are associated with homelessness among individuals with schizophrenia. Participants were 1856 homeless individuals with schizophrenia (defined as those who had no place of residence or involved caregivers for 7 consecutive days) and 1728 non-homeless individuals with schizophrenia from Xiangtan, Hunan. The self-completion Family Environment Scale-Chinese Version (FES-CV) was administered to these participants after their acute psychotic symptoms resolved. Compared to individuals in the non-homeless group, those in the homeless group were older and more likely to be non-locals (i.e., from outside of Xiangtan), be residents of rural (versus urban) communities, have temporary (versus permanent) jobs, be married, and have a low level of education. After controlling for demographic differences using multivariate logistic regression models, homelessness was independently associated higher scores in the FES-CV intellectual-cultural orientation, organization, achievement orientation, and control subscales and with lower scores in the FES-CV cohesion, moralreligious emphasis, independence, and active-recreational orientation subscales. After controlling for sociodemographic factors, certain aspects of the family environment areassociated with being homeless among patients with schizophrenia in China. Further work is needed to identify interventions that can reduce the risk of homelessness in high-risk individuals.
Landefeld, John C; Miaskowski, Christine; Tieu, Lina; Ponath, Claudia; Lee, Christopher T; Guzman, David; Kushel, Margot
Individuals experiencing homelessness in the United States are aging; little is known about chronic pain in this population. In a cross-sectional, population-based study, we interviewed 350 homeless individuals aged 50 years and older to describe pain experienced by older persons experiencing homelessness and to assess factors associated with chronic moderate to severe pain, defined as pain lasting ≥3 months, with a past week average severity score of 5 to 10 (scale 0-10). The median age of participants was 58 years. Participants were predominantly African American (79.6%) and male (77.3%). Overall, 46.8% reported chronic moderate to severe pain. Almost half of participants reported a diagnosis of arthritis (44.3%) and one-third reported symptoms consistent with post-traumatic stress disorder (PTSD; 32.8%). Three-quarters (75.3%) endorsed a personal history of abuse. In multivariate analyses, PTSD (adjusted odds ratio [AOR]: 2.2, 95% confidence interval [CI], 1.4-3.7), arthritis (AOR: 4.8, 95% CI, 3.0-7.8), and history of experiencing abuse (AOR: 2.4, 95% CI, 1.3-4.3) were associated with chronic moderate to severe pain. HIV status, diabetes, depressive symptoms, and substance use were not associated with pain. Clinicians should consider the management of associated mental health conditions and the sequelae of experiencing abuse in the treatment of chronic pain in older adults experiencing homelessness. This article describes the prevalence and factors associated with chronic pain in older homeless adults. Almost half report chronic pain, which was associated with PTSD, arthritis, and personal history of abuse. Clinicians should address chronic pain, trauma, and the associated mental health conditions in this high-risk population. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.
Overgaard, Dorthe; Schrader, Anne-Marie; Lisby, Karen H
Objectives: Data on patient-reported outcomes (PROs) in patients with single-ventricle physiology (SVP) are scarce. We sought (1) to describe the perceived health status, quality of life, symptoms of anxiety and depression, and sense of coherence in adult survivors with SVP, (2) to compare PROs a...... of perceived health and quality of life. For patients in Ability Index class II and III, PROs were poorer. Conclusions: PROs in patients with SVP are generally good....
Kurz, Eduard; Faude, Oliver; Roth, Ralf; Zahner, Lukas; Donath, Lars
Incomplete maturation and aging-induced declines of the neuromuscular system affect postural control both in children and older adults and lead to high fall rates. Age-specific comparisons of the modulation of ankle muscle activation and behavioral center of pressure (COP) indices during upright stance have been rarely conducted. The objective of the present study was to quantify aging effects on a neuromuscular level. Thus, surface electromyography (SEMG) modulation and co-activity of ankle muscles during single-leg standing was compared in healthy children, young adults and seniors. Postural steadiness (velocity and mean sway frequency of COP), relative muscle activation (SEMG modulation) and co-activation of two ankle muscles (tibialis anterior, TA; soleus, SO) were examined during single-leg stance in 19 children [age, 9.7 (SD 0.5) years], 30 adults [23.3 (1.5) years] and 29 seniors [62.7 (6.1) years]. Velocity of COP in medio-lateral and anterior-posterior directions, mean sway frequency in anterior-posterior direction, relative muscle activation (TA and SO) and co-activation revealed large age effects (P 0.14). Post-hoc comparisons indicated higher COP velocities, anterior-posterior frequencies, relative SO activation and co-activation in children and seniors when compared with adults. Relative TA activation was higher in children and adults compared with seniors (P seniors seems to be counteracted with higher TA/SO co-activity and SO modulation. However, TA modulation is higher in children and adults, whereas seniors' TA modulation capacity is diminished. An aging-induced decline of TA motor units might account for deteriorations of TA modulation in seniors.
Feodor Nilsson, Sandra; Laursen, Thomas Munk; Hjorthøj, Carsten
Purpose: The purpose of this study was to examine the association between homelessness and psychiatric disorders, including substance use disorders, on one hand, and cause-specific and all-cause mortality on the other in a high-income country. Methods: A historical nationwide register-based cohort...... study of the Danish population from 15 years of age between 2000 and 2011 was conducted. The association between homelessness, psychiatric disorders, and mortality was analysed by Poisson Regression adjusting for important confounders. Standardised mortality ratios (SMRs) were calculated for people...... with a history of homelessness compared with the general population using direct age-standardisation. Results: During 51,892,324 person-years of observation, 656,448 died. People with at least one homeless shelter contact accounted for 173,592 person-years with 4345 deaths. The excess mortality in the population...
Nishio, Akihiro; Yamamoto, Mayumi; Ueki, Hirofumi; Watanabe, Takahiro; Matsuura, Kenshin; Tamura, Osamu; Uehara, Ryosuke; Shioiri, Toshiki
While it has been reported that the prevalence of mental illness is higher in homeless people than in the national population, few studies have investigated the prevalence of intellectual and developmental disability among the homeless. In this study, we conducted a survey to comprehensively assess these mental problems among homeless people in Nagoya, Japan. The subjects were 18 homeless men. Mental illness was diagnosed with semi-structured interviews conducted by psychiatrists. We used the Wechsler Adult Intelligence Scale III to diagnose intellectual disability. Discrepancies between Wechsler Adult Intelligence Scale III subtest scores were used as criteria for developmental disability. Eleven of the 18 participants were diagnosed with mental illness: six with mood disorder, two with psychotic disorder, and six with alcohol problems. The mean IQ of all subjects was 83.4 ± 27.4. The 95% confidence interval (CI) was 96.2-69.1. Seven participants were found to have intellectual disability. Three men showed discrepancies of more than 10 between subtest scores, and all of them were diagnosed with a mental illness. We divided the participants into four groups: those with mental illness only; those with intellectual disability only; those with both problems; and those without diagnosis. The men with intellectual disability only were significantly younger and had been homeless since a younger age than the other groups. Participants diagnosed with a mental illness had been homeless for longer than those without mental health problems. Although the sample size was limited, this study revealed the high prevalence of mental illness and intellectual disability, 61% (95%CI, 35-83%) and 39% (95%CI, 17-64%), respectively, in homeless people in Nagoya, Japan. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.
Herbert, CW; Morenoff, JD; Harding, DJ
The United States has experienced dramatic increases in both incarceration rates and the population of insecurely housed or homeless persons since the 1980s. These marginalized populations have strong overlaps, with many people being poor, minority, and from an urban area. That a relationship between homelessness, housing insecurity, and incarceration exists is clear, but the extent and nature of this relationship is not yet adequately understood. We use longitudinal, administrative data on M...
Thomas, Yvonne; Gray, M.; McGinty, S.
This paper reports findings of a study that utilised an occupational perspective to explore how wellbeing was achieved and sustained by the occupations of people experiencing homelessness in Australia. Thirty three in-depth qualitative interviews were conducted with homeless individuals in a regional city in Australia. Data from the interviews were thematically analysed to understand the relationship between wellbeing, as defined by the individual, and the occupations engaged in by people exp...
Coohey, Carol; Easton, Scott D.
Depression is a common problem among homeless men that may interfere with functional tasks, such as securing stable housing, obtaining employment, and accessing health services. Previous research on depression among homeless men has largely focused on current psychosocial resources, substance abuse, and past victimization. Guided by Ensel and Lin’s life course stress process model, the authors examined whether distal stressors, including victimization and exposure to parent problems in childh...
Urban poverty continues to prove itself a concern in cities’ territorial planning as it disrupts the quality of life and the development process in some cities. Homelessness emerges sometimes as extreme urban poverty even in developed European Union countries. The study assesses Bucharest urban space to differentiate characteristics that influence the homeless to locate in certain places. The analysis included a three-level urban space categorization. Functional types of space were correlated...
A prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder
Sajatovic, Martha; Levin, Jennifer; Ramirez, Luis F.; Hahn, David Y.; Tatsuoka, Curtis; Bialko, Christopher S.; Cassidy, Kristin A.; Fuentes-Casiano, Edna; Williams, Tiffany D.
Background Treatment non-adherence in people with schizophrenia is associated with relapse and homelessness. Building upon the usefulness of long-acting medication, and our work in psychosocial interventions to enhance adherence, we conducted a prospective uncontrolled trial of customized adherence enhancement (CAE) plus long-acting injectable antipsychotic (LAI) using haloperidol decanoate in 30 homeless or recently homeless individuals with schizophrenia and schizoaffective disorder. Methods Participants received monthly CAE and LAI (CAE-L) for 6 months. Primary outcomes were adherence as measured by the Tablets Routine Questionnaire (TRQ) and housing status. Secondary outcomes included psychiatric symptoms, functioning, side effects, and hospitalizations. Results Mean age of participants was 41.8 years (SD 8.6), mainly minorities (90% African-American) and mainly single/never married (70%). Most (97%) had past or current substance abuse, and had been incarcerated (97%). Ten individuals (33%) terminated the study prematurely. CAE-L was associated with good adherence to LAI (76% at 6 months) and dramatic improvement in oral medication adherence, which changed from missing 46% of medication at study enrollment to missing only 10% at study end (p = 0.03). There were significant improvements in psychiatric symptoms (pschizoaffective disorder. Additional research is needed on effective and practical approaches to improving health outcomes for homeless people with serious mental illness. PMID:24434094
National Center for Homeless Education at SERVE, 2013
Given the number of young children experiencing homelessness and its devastating impacts on development, preschool programs play a critical role in meeting these children's need for quality early care and education; yet, most young homeless children do not receive early childhood services. Many barriers limit access to early childhood programs for…
Hudson, Angela L; Nandy, Karabi
The purpose of this study was to compare prevalence of substance use, high-risk sexual behaviors, and depression symptoms between homeless youth with and without a history of foster care placement. Approximately 26,000 young persons exit foster care annually in the United States. Once they 'age out' of foster care, however, many young persons do not have access to comprehensive health care. They also are at risk for substance abuse, homelessness, or mental illness. Because persons with a history of foster care are at risk for negative psycho-social outcomes, it is unclear if these young people might be different than homeless youth without this history. The design is descriptive and cross-sectional. A total of 156 homeless young persons, of whom 44 had a history of foster care placement, were recruited from a drop-in center that caters to homeless youth and young adults. The sample was majority male and white; ages were 16-25. Significantly higher proportion of homeless former foster youth used methamphetamine within the last six months compared to non-fostered homeless youth p = 0.03). Homeless former foster youth were significantly older (p = 0.02) and less educated (p = 0.02) than their homeless counterparts without a history of foster care placement. Prevalence of using tobacco, marijuana, alcohol, crack cocaine, and powder cocaine were similar for both groups. Although not significant, a higher proportion of homeless former foster youth reported trading sex for money or drugs compared to non-fostered, homeless youth (19% versus 12% [trading sex for money], and 26% versus 14% [trading sex for drugs], respectively. Findings from this study show that, in general, homelessness is a negative outcome, irrespective of having a foster care history. However, those with that history need continued support when transitioning to independent living, such as access to health care, and encouragement to further their education. It is important that nurses, who serve homeless
Wrighting, Quentaxia; Businelle, Michael S; Kendzor, Darla E; LeBlanc, Hannah; Reitzel, Lorraine R
Cigarette purchasing patterns may be linked with greater readiness to make a quit attempt and more quit attempts among domiciled samples. However, little is known about the cigarette purchasing patterns of homeless smokers or their potential relations to quitting intention and behaviors. This study redressed this gap among a convenience sample of homeless adult smokers from a large shelter in Dallas, Texas. Participants (N = 207; Mage = 43; 71.5% male) smoked ≥100 cigarettes over the lifetime and endorsed current daily smoking. Variables assessed included cigarette dependence (time to first cigarette of the day), monthly income, quantity of cigarettes most recently purchased, average money spent on cigarettes weekly, readiness/motivation to quit smoking, and the number intentional quit attempts lasting ≥24h in the past year. Regression analyses were conducted to characterize associations of cigarette purchasing patterns with readiness to quit and quit attempts controlling for sex, age, cigarette dependence, and income. Most participants purchased cigarettes by the pack (61.4%), and more than half the sample spent ≤$20 on cigarettes per week. Results indicated that spending less money per week on cigarettes was associated with greater readiness to quit (P = .016), even when controlling for income, cigarette dependence, and other covariates. Stratified analyses indicated that this association was significant only for homeless smokers reporting no regular monthly income. Homeless daily smokers with no reported income who spend little money on cigarettes may make particularly apt targets for cessation interventions due to potential associations with quitting motivation. Adults who are homeless smoke at greater rates and quit at lower rates than domiciled adults, leading to significant smoking-related health disparities among this group. Findings suggest that cigarette purchasing patterns are linked with readiness to quit smoking among smokers who are homeless
Vázquez, José Juan; Panadero, Sonia; Zúñiga, Claudia
The study analyzes the differences in causal attributions of homelessness and attributions of responsibility among the members of 3 groups: homeless group, consisting of a representative sample of homeless people in Madrid, Spain (n = 188); domiciled service-users group, consisting of people at risk of homelessness (n = 164); and domiciled nonservice-users group, consisting of people at no imminent risk of homelessness (n = 180). The domiciled service-users group and domiciled nonservice-users group were matched to the homeless group or sex, age, and nationality. The article also analyzes homeless people's causal attributions as regards their own situation. The results show that compared with the domiciled nonservice-users group, a higher percentage of members of the homeless group and domiciled service-users group attributed homelessness to individualistic causes and they blamed homeless people for their situation to a greater extent. The results also show that there was no "actor-observer bias" in causal attributions for homelessness in Madrid. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
City and County of Durham, North Carolina — These raw data sets contain Point-in-Time (PIT) estimates and national PIT estimates of homelessness as well as national estimates of homelessness by state and...
Homelessness in the 21st century is an ongoing problem, increasing due to the country's recent economic downturn, especially in urban areas. This podcast discusses how homelessness impacts health and what public health professionals can do about it.
Homelessness in the 21st century is an ongoing problem, increasing due to the country's recent economic downturn, especially in urban areas. This podcast discusses how homelessness impacts policy and what public health professionals can do about it.
Homelessness in the 21st century is an ongoing problem, increasing due to the country's recent economic downturn, especially in urban areas. This podcast discusses how homelessness impacts policy and what public health professionals can do about it.
Homelessness in the 21st century is an ongoing problem, increasing due to the country's recent economic downturn, especially in urban areas. This podcast discusses how homelessness impacts health and what public health professionals can do about it.
Full Text Available In developed countries, falls in older people represent a rising problem. As effective prevention should start before the risk becomes evident, an early predictor is needed. Single stance instability would appear as a major risk factor. Aims of the study were to describe single stance stability, its sensory components, and their correlation with age and gender. A random sample of 597 older adults (319 men, 278 women living at home, aged 65–84, was studied. Stability tests were performed with an electronic postural station. The single stance test showed the impairment of single stance stability in older individuals (75–84 yrs. The significant decline of stability in the older subjects may be explained by the impairment of proprioceptive control together with the decrease in compensatory visual stabilization and emergency responses. Younger subjects (65–74 yrs exhibited better, but still inadequate, proprioceptive control with compensatory visual stabilization. Gender differences appeared in older subjects: women were significantly less stable than men. The measurement of the sensory components of single stance stability could aid in the early detection of a decay in antigravity movements many years before the risk of falling becomes evident. Adequate proprioceptive control could mitigate the effects of all other risks of falling.
Riva, Dario; Mamo, Carlo; Fanì, Mara; Saccavino, Patrizia; Rocca, Flavio; Momenté, Manuel; Fratta, Marianna
In developed countries, falls in older people represent a rising problem. As effective prevention should start before the risk becomes evident, an early predictor is needed. Single stance instability would appear as a major risk factor. Aims of the study were to describe single stance stability, its sensory components, and their correlation with age and gender. A random sample of 597 older adults (319 men, 278 women) living at home, aged 65–84, was studied. Stability tests were performed with an electronic postural station. The single stance test showed the impairment of single stance stability in older individuals (75–84 yrs). The significant decline of stability in the older subjects may be explained by the impairment of proprioceptive control together with the decrease in compensatory visual stabilization and emergency responses. Younger subjects (65–74 yrs) exhibited better, but still inadequate, proprioceptive control with compensatory visual stabilization. Gender differences appeared in older subjects: women were significantly less stable than men. The measurement of the sensory components of single stance stability could aid in the early detection of a decay in antigravity movements many years before the risk of falling becomes evident. Adequate proprioceptive control could mitigate the effects of all other risks of falling. PMID:23984068
Leibler, Jessica H.; Nguyen, Daniel D.; Le?n, Casey; Gaeta, Jessie M.; Perez, Debora
Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston,...
This article consists of several parts. The first part includes definitional considerations over the notion of homelessness. It also describes social situation of the homeless, whereas the second part concentrates on both the analysis of causes and effects of homelessness and on the attempt to show the scale of this phenomenon. The last part of the article focuses on the prevention of homelessness. It emphasizes the importance of interdisciplinarity of preventive and compensatory actions in t...
Manor, Iris; Rubin, Jonathan; Daniely, Yaron; Adler, Lenard A
To assess the first-dose effectiveness and tolerability of metadoxine extended release (MDX) in adults with predominantly inattentive attention-deficit/hyperactivity disorder (ADHD-PI). In this double-blind, placebo-controlled, crossover study, adults with ADHD-PI were randomized 1:1:1 to receive a single dose of MDX 1400 mg, MDX 700 mg, and placebo (ClinicalTrials.gov identifier: NCT01685281). The primary efficacy end point was the mean change in the Test of Variables of Attention (TOVA) ADHD score from baseline to 3 to 5 hours after drug administration. Secondary assessments included TOVA subscores, TOVA response rates (defined as an increase of 0.8 points in the TOVA ADHD score), and the Cambridge Neuropsychological Automated Test Battery. Safety assessments included adverse events and vital signs. The intention-to-treat population included 36 patients (52.8% men; mean age, 32 years). The efficacy of MDX 1400 mg was demonstrated by a statistically significant difference in the mean (± SD) change in the TOVA ADHD score at baseline to 3 to 5 hours after drug administration compared with placebo (2.0 [4.2]; P = 0.009). The TOVA response time variability subscore was significantly different between MDX 1400 mg and placebo (mean difference, 7.9 [19.2] points; P = 0.022). Significantly more adults responded to single-dose MDX 1400 mg versus placebo (97.1% vs 71.4%, P = 0.006). There were no statistically significant differences between MDX 700 mg and placebo on any measures. Exploratory analyses of the Cambridge Neuropsychological Automated Test Battery did not yield significant findings. Fatigue and headache were the 2 most frequently reported adverse events. There were no clinically significant abnormalities in laboratory values, vital signs measurements, Columbia-Suicide Severity Rating Scale scores, or electrocardiographic parameters. Single-dose MDX 1400 mg significantly improved sustained and selective attention in adults with ADHD-PI as measured by the TOVA
Nelson, Michael E.
A single Gray Wolf (Canis lupus) killed an adult male White-tailed Deer (Odocoileus virginianus) and cached the intact carcass in 76 cm of snow. The carcass was revisited and entirely consumed between four and seven days later. This is the first recorded observation of a Gray Wolf caching an entire adult deer.
Wagner, Julia; Diehl, Katharina; Mutsch, Livia; Löffler, Walter; Burkert, Nathalie; Freidl, Wolfgang
This case-control study describes the health situation, internal and external resources, and utilisation of healthcare facilities by a marginalised population consisting of homeless people in Vienna, Austria, compared with a non-homeless control population. Among the homeless group, participants lived in halfway houses (70%) or permanent housing (30%) in Vienna. Personal interviews were conducted in July 2010 with 66 homeless individuals, and their data were compared with data from non-homeless subjects from the Austrian Health Interview Survey using conditional logistic regression. Compared with the control group, homeless persons suffered more often from chronic diseases (P resources of homeless people, even though homeless people seek medical care at a higher rate than controls. Continuing health promotion projects for this high-risk group and the strengthening of social resources are recommended. © 2013 John Wiley & Sons Ltd.
Nash, Woods; Mixer, Sandra J; McArthur, Polly M; Mendola, Annette
Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives. We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a person or an action that overcomes fears or other challenges to achieve something of great moral worth. The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable. A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency. The study was approved by the Internal Review Board of the authors' university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary. Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person's dying and death, and the challenge of adequately conveying the advance directive's meaning and accurately recording a homeless person's end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants
Powers-Costello, Beth; Swick, Kevin J.
The focus of this article is on articulating the importance of teacher development of constructs about homeless children and families and examining factors that influence teachers' perceptions of children and families who are homeless or at high-risk of becoming homeless. The article also explores some strategies to support teachers in…
Chow, Kirby A.; Mistry, Rashmita S.; Melchor, Vanessa L.
This study examined elementary school teachers' experiences working with homeless students. Specifically, we focused on the psychosocial impacts of homelessness on students and their teachers. Qualitative, semi-structured interviews were conducted with 28 teachers who worked at designated public schools for family homeless shelters. A prominent…
Cumming, John M.; Gloeckner, Gene W.
After interviewing homeless high school students, the research team in a Colorado school district discovered that many students had not revealed their true living conditions (homelessness) to anyone in the school district. This research team developed an anonymous survey written around the homeless categories identified in the McKinney-Vento…
Nott, Brooke Dolenc; Vuchinich, Samuel
Background: While some recent research has addressed homeless youth from a strengths-based approach, comparative studies of homeless and non-homeless youth from a strengths perspective are few; research that includes youth's views on positive youth development are also limited. Objective: Addressing these gaps and using an inductive approach,…
Bires, Carie; Garcia, Carmen; Zhu, Julia
Homelessness has a devastating impact on children. Research has shown that homelessness puts children at increased risk of health problems, developmental delays, academic underachievement and mental health problems. Homelessness also has a disproportionate impact on the youngest children, who account for more than half of all children in…
Axelson, Leland J.; Dail, Paula W.
Describes new form of homeless persons, a growing population of homeless individuals and families who are not mentally ill, not wanderers, and may be employed. Examines changing character of homelessness and makes recommendations for a public policy response to the problem. (Author/NB)
Homelessness is a growing problem in every part of the United States. Federal legislation requires state plans for educating homeless children, but will provide less than $23 per child. Summarizes some of the state plans and suggests steps school boards can take to provide homeless children with public education. (MLF)
The 1980s brought an unprecedented rise in the number of homeless families with children. That there may be as many as three million homeless persons in the United States, with families representing one-third of this population, indicates that homelessness is a social problem of catastrophic proportions. This paper finds that while Federal…
Hinton, Stephanie; Cassel, Darlinda
This study researched the experiences of homeless families with young children between the ages of four and eight. Many families experience homelessness every year; therefore, it is important for early childhood educators to have an understanding of how homelessness affects families with young children so that educators can effectively serve the…
McVicar, Duncan; Moschion, Julie; van Ours, Jan C
Homelessness is associated with substance use, but whether substance use precedes or follows homelessness is unclear. We investigate the nature of the relationship between homelessness and substance use using data from the unique Australian panel dataset Journeys Home collected in 4 surveys over the period from October 2011 to May 2013. Our data refer to 1325 individuals who were homeless or at risk of becoming homeless. We investigate dynamics in homelessness and substance use over the survey period. We find that the two are closely related: homeless individuals are more likely to be substance users and substance users are more likely to be homeless. These relationships, however, are predominantly driven by observed and unobserved individual characteristics which cause individuals to be both more likely to be homeless and to be substance users. Once we take these personal characteristics into account it seems that homelessness does not affect substance use, although we cannot rule out that alcohol use increases the probability that an individual becomes homeless. These overall relationships also hide some interesting heterogeneity by 'type' of homelessness. Copyright © 2015 Elsevier Ltd. All rights reserved.
McVicar, Duncan; Moschion, Julie; van Ours, Jan
Homelessness is associated with substance use, but whether substance use precedes or follows homelessness is unclear. We investigate the nature of the relationship between homelessness and substance use using data from the unique Australian panel dataset Journeys Home collected in 4 surveys over the
McKinney, Jennifer; Snedker, Karen A.
In response to increasing homelessness in our city, Seattle Pacific University invited a homeless encampment (Tent City) to reside on our university campus for three months. This provided an opportunity to engage students on issues of poverty and inequality. Building from a service-learning model, we devised course work around homelessness and…
We present simple mathematical models for modelling a homeless population and housing allocation. We look at a situation whereby the local authority makes temporary accommodation available for some of the homeless for a while and we examine how this affects the number of families homeless at any given time.
Koch-Nielsen, Inger; Børner Stax, Tobias
Based on a literature study this chapter reflects upon the concept of homelessness and related terms in a Danish context. We then presents different types of accommodations for the homeless that is currently used. The chapter is taken from an anthology which deals with understandings and measures...... directed towards the homeless people in different European countries....
Baggett, Travis P; Campbell, Eric G; Chang, Yuchiao; Magid, Leah M; Rigotti, Nancy A
Cigarette smoking and traumatic life experiences are each common among homeless adults, but the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms among homeless smokers are not known. We assessed symptoms of PTSD and their association with smoking outcome expectancies in a sample of homeless smokers in Boston. We used time-location sampling to conduct an in-person survey of homeless adult smokers using Boston Health Care for the Homeless Program clinical services. We assessed symptoms of PTSD with the PTSD Checklist-Civilian version and considered scores at least 14 as positive. We used the Smoking Effects Questionnaire to assess positive and negative smoking outcome expectancies. We modeled the associations between PTSD screening status and smoking expectancies using design-adjusted linear regression. Eighty-six percent of eligible individuals participated (N = 306). Sixty-eight percent of participants screened positive for PTSD. Screen-positive respondents were younger (P = .001), more likely to report fair/poor health (P = .01), chronic obstructive pulmonary disease (P = .02), and past-month hallucinations (P = .004), and had greater drug (P smokers and strongly associated with positive smoking outcome expectancies. Tobacco cessation programs for this population should consider screening for PTSD and fostering a trauma-sensitive treatment environment. In this study of homeless cigarette smokers in Boston, over two-thirds of participants screened positive for PTSD. PTSD screen-positive respondents more strongly endorsed multiple positive smoking outcome expectancies than screen-negative individuals. These findings suggest that the psychological sequelae of trauma may be a pervasive but under-recognized factor impacting the persistence of smoking among homeless people. Tobacco cessation programs for this population should consider screening for PTSD, fostering a trauma-sensitive treatment environment, and incorporating strategies that have
Zerger, Suzanne; Bacon, Sarah; Corneau, Simon; Skosireva, Anna; McKenzie, Kwame; Gapka, Susan; O'Campo, Patricia; Sarang, Aseefa; Stergiopoulos, Vicky
This mixed methods study explored the characteristics of and experiences with perceived discrimination in an ethnically diverse urban sample of adults experiencing homelessness and mental illness. Data were collected in Toronto, Ontario, as part of a 4-year national randomized field trial of the Housing First treatment model. Rates of perceived discrimination were captured from survey questions regarding perceived discrimination among 231 ethnoracially diverse participants with moderate mental health needs. The qualitative component included thirty six in-depth interviews which explored how individuals who bear these multiple identities of oppression navigate stigma and discrimination, and what affects their capacity to do so. Quantitative analysis revealed very high rates of perceived discrimination related to: homelessness/poverty (61.5%), race/ethnicity/skin colour (50.6%) and mental illness/substance use (43.7%). Immigrants and those who had been homeless three or more years reported higher perceived discrimination on all three domains. Analysis of qualitative interviews revealed three common themes related to navigating these experiences of discrimination among participants: 1) social distancing; 2) old and new labels/identities; and, 3) 'homeland' cultures. These study findings underscore poverty and homelessness as major sources of perceived discrimination, and expose underlying complexities in the navigation of multiple identities in responding to stigma and discrimination. Current Controlled Trials ISRCTN42520374 . Registered 18 August 2009.
Cai, Guilan; Wang, Yini; Liu, Xiaojing; Han, Yanfei; Wang, Zhao
Hemophagocytic lymphohistiocytosis (HLH) is a rare multisystem disorder characterized by proliferation and diffuse infiltration multiple organs with histiocytes, including the central nervous system (CNS). Neurological manifestations of HLH have been recognized in different studies with children, but they remain relatively ill-defined in adults with HLH. From March 2008 to October 2014, 289 adult patients with HLH were admitted to our center. Clinical, radiological, and cerebral spinal fluid (CSF) data of the patients with CNS involvement were reviewed, and a retrospective study in our single-center was carried out. CNS involvement was observed in 29 patients (10%) either in their diagnosis process or during disease course. CNS symptoms included disturbance of consciousness, cranial nerve palsies, seizures, headache, limb paralysis, irritability, meningism, and memory loss. CSF analysis was conducted in 17 patients (59%). Among them, 11 patients (65%) were reported as having abnormal CSF. Neuroradiological studies were performed in 25 patients (86%). Among the 13 cases that underwent CT scan, one patient hemorrhaged. Single or multiple hypodense foci were detected in the other 2 patients. Magnetic resonance imaging (MRI) abnormalities were found in 15 patients, including focal lesions in cortical and adjacent subcortical regions with or without variable nodular or ring contrast-enhancement, multiple lesions in white matter, diffuse white matter signal changes, and meningeal enhancement. Basal ganglia, cerebellum, and brainstem lesions were also observed. CNS involvement could also be found in adult patients with HLH, but not as frequent as it was in children. The clinical manifestations could be diversified. By carrying out rigorous CNS examinations, an early diagnosis could be made and it was of the utmost importance for the prevention of further lesions.
Hamilton, Alison B; Poza, Ines; Washington, Donna L
Veterans comprise a disproportionate fraction of the nation's homeless population, with women veterans up to four times more likely to be homeless than non-veteran women. This paper provides a grounded description of women veterans' pathways into homelessness. Three focus groups were held in Los Angeles, California, with a total of 29 homeless women veterans. Five predominant "roots" (precipitating experiences) initiated pathways toward homelessness: 1) childhood adversity, 2) trauma and/or substance abuse during military service, 3) post-military abuse, adversity, and/or relationship termination, 4) post-military mental health, substance abuse, and/or medical problems, and 5) unemployment. Contextual factors, which promoted development of homelessness in the setting of primary roots, included women veterans' "survivor instinct," lack of social support and resources, sense of isolation, pronounced sense of independence, and barriers to care. These contextual factors also reinforced persistence of the roots of post-military adversity and mental health and substance abuse problems, serving to maintain cycles of chronic homelessness. Collectively, these multiple, interacting roots and contextual factors form a "web of vulnerability" that is a target for action. Multiple points along the pathways to homelessness represent critical junctures for VA and community-based organizations to engage in prevention or intervention efforts on behalf of women veterans. Considering the multiple, interconnected challenges that these women veterans described, solutions to homelessness should address multiple risk factors, include trauma-informed care that acknowledges women veterans' traumatic experiences, and incorporate holistic responses that can contribute to healing and recovery. Published by Elsevier Inc.
The objective of this study was to examine the reasons for the most recent loss of housing and for continued homelessness as perceived by homeless persons with mental illness. A total of 2,974 currently homeless participants in the 1996 National Survey of Homeless Assistance Providers and Clients (NSHAPC) were asked about the reasons for their most recent loss of housing and continued homelessness. The responses of participants who had mental illness, defined both broadly and narrowly, were compared with responses of those who were not mentally ill. The broad definition of mental illness was based on a set of criteria proposed by NSHAPC investigators. The narrow definition included past psychiatric hospitalization in addition to the NSHAPC criteria. A total of 1,620 participants (56 percent) met the broad definition of mental illness, and 639 (22 percent) met the narrow definition; 1,345 participants (44 percent) did not meet any of these criteria and were categorized as not having a mental illness. Few differences in reasons for the most recent loss of housing were noted between the participants with and without mental illness. Both groups attributed their continued homelessness mostly to insufficient income, unemployment, and lack of suitable housing. Homeless persons with mental illness mostly report the same reasons for loss of housing and continued homelessness as those who do not have a mental illness. This finding supports the view that structural solutions, such as wider availability of low-cost housing and income support, would reduce the risk of homelessness among persons with mental illness, as among other vulnerable social groups.
Carol S. North
Full Text Available Background: Cocaine use is highly prevalent among homeless populations, yet little is known about how it is financed. This study examined associations of income sources with cocaine use and financing of drugs in a longitudinal evaluation of a homeless sample. Methods: A homeless sample was recruited systematically in St. Louis in 1999–2001 and longitudinally assessed annually over two years using the Diagnostic Interview Schedule and the Homeless Supplement, with urine drug testing. Results: More than half (55% of participants with complete follow-up data (N = 255/400 had current year cocaine use. Current users spent nearly $400 (half their income in the last month on drugs at baseline. Benefits, welfare, and disability were negatively associated and employment and income from family/friends, panhandling, and other illegal activities were positively associated with cocaine use and monetary expenditures for cocaine. Conclusions: Findings suggest that illegal and informal income-generating activities are primary sources for immediate gratification with cocaine use and public entitlements do not appear to be primary funding sources used by homeless populations. Policy linking drug testing to benefits is likely to have little utility, and public expenditures on measures to unlink drug use and income might be more effectively used to fund employment and treatment programs.
This toolkit serves as a comprehensive resource on the issue of higher education access and success for homeless students, including information on understanding homeless students, assisting homeless students in choosing a school, helping homeless students pay for application-related expenses, assisting homeless students in finding financial aid…
... [FNS-2008-0001] RIN 0584-AD60 Direct Certification and Certification of Homeless, Migrant and Runaway... concerning the certification of certain children who are homeless, runaway, or migratory. This rule affects... children who are homeless, runaway, or migratory, as determined by the homeless coordinator for homeless or...
Mårtensson, J; Groth, S; Rehling, M; Gref, M
In 1996, a committee on renal clearance recommended a mean sojourn time-based methodology for single-sample determination of plasma clearance of 99mTc-diethylenetriamine pentaacetic acid (DTPA) to be used on adults if the patient's glomerular filtration rate (GFR) is suspected to be >30 ml/min. The main purpose of this study was to derive a mean sojourn time-based formula for calculation of 51Cr-ethylenediamine tetraacetic acid (EDTA) clearance in adults. Two groups of patients with 51Cr-EDTA clearance (Cl) between 16 and 172 ml/min were studied. In Group I (n = 46), reference Cl was determined as a multiplasma sample, single-injection method (ClSM). Sixteen blood samples were drawn from 0 until 5 hr after a single intravenous injection of 51Cr-EDTA. In Group II (n = 1046), reference Cl was determined by the Brøchner-Mortensen four-sample clearance method (ClBM). The plasma time-activity curves of Group I were used to derive two mean sojourn time-based formulas (Formulas 1 and 2) for calculation of a single-sample clearance. Formula 1 was derived from the entire time-activity curve, whereas the derivation of Formula 2 used only the final slope of the time-activity curve. The accuracy of the two formulas and the Christensen and Groth 99mTc-DTPA formula was tested on Group II. Chromium-51-EDTA Cl calculated by Formula 1 was almost identical to the Cl calculated by the reference Cl method (r = 0.982; SDdiff = 5.82 ml/min). Both 51Cr-EDTA Cl calculated by Formula 2 and by the 99mTc-DTPA formula showed close correlation with the reference method (r = 0.976, r = 0.985, respectively) but systematically overestimated GFR for the whole range of clearance values by 3.5 and 3.2 ml/min (ptime methodology. The determination is marginally more accurate (ptime-activity curve than from only the final slope. The single-sample formula derived for determination of 99mTc-DTPA Cl tends slightly to overestimate GFR if used to calculate 51Cr-EDTA Cl.
Bearsley-Smith, Cate A; Bond, Lyndal M; Littlefield, Lyn; Thomas, Lyndal R
To contrast the psychosocial profile of adolescents with risk factors for homelessness, identified using Chamberlain and MacKenzie's self-report scale, compared to the profiles of homeless adolescents. Multinomial logistic regression analyses were conducted contrasting profiles for (a) 137 homeless adolescents, (b) 766 secondary students reporting risk factors for homelessness, and (c) 4,844 students not reporting risks for homelessness. Fourteen percent of a representative population of at-school adolescents, from Victoria, Australia, showed elevated risk of homelessness. These adolescents showed depressive symptoms at least equivalent to homeless adolescents (RR 6.0, 95% CI: 4.9, 7.3, and RR 3.5, 95% CI: 2.1, 5.8, respectively). In multivariate analyses, homeless and at risk adolescents reported equivalent levels of family conflict, early problem behaviour and low opportunities and rewards for family involvement. Compared to adolescents not at risk, at risk adolescents were more likely to be female and to show poorer social skills/assertiveness and depressive symptoms. Compared to at risk adolescents, homeless adolescents showed additional family, school, peer and individual risks, but lower depressive symptomatology. The findings highlight the potential we have to quickly and simply detect adolescents showing significant risk of homelessness. This sizable minority of adolescents report risks often equivalent to homeless adolescents. It is hoped that stakeholders working with young people will utilise this screening potential to identify and intervene effectively with this significant subpopulation of youth, and their families, while they are still at home and school.
van der Laan, Jorien; Boersma, Sandra N; van Straaten, Barbara; Rodenburg, Gerda; van de Mheen, Dike; Wolf, Judith R L M
Very little is known about the personal goals of homeless people and how these relate to their quality of life (QoL). By using survey data on 407 homeless adults upon entry to the social relief system in 2011, we examined the personal goals of homeless adults and the association between their perceived goal-related self-efficacy and their QoL. A hierarchical regression analysis was used to analyse the association between QoL and goal-related self-efficacy, relative to factors contributing to QoL, such as demographic characteristics, socioeconomic resources, health and service use. Results indicate that the majority of homeless adults had at least one personal goal for the coming 6 months and that most goals concerned housing and daily life (94.3%) and finances (83.6%). The QoL of homeless adults appeared to be lower in comparison with general population samples. General goal-related self-efficacy was positively related to QoL (β = 0.09, P = 0.042), independent of socioeconomic resources (i.e. income and housing), health and service use. The strongest predictors of QoL were psychological distress (β = -0.45, P people as the starting point of integrated service programmes and to promote their goal-related self-efficacy by strength-based interventions. © 2017 John Wiley & Sons Ltd.
Full Text Available This article describes a blog written by four men who were homeless in a western Canadian city in 2010. The blog was an attempt to promote communication between homeless people and the domiciled public, to assert the agency of homeless people, and to promote social integration through their participation in public discourse about homelessness. The bloggers explicitly set out to engage in civic action. In doing this they positioned themselves as advocates and therefore citizens—people with the right and responsibility to describe the “realities” of homelessness, critique existing social structures, take part in public dialogue about homelessness, advocate for change, and stand up for homeless people. This was a subject position that was not previously available to them. The blog project is an example of “lived citizenship,” citizenship as active participatory practice, and a way to achieve what Nancy Fraser calls a politics of recognition.
Stephanus F. de Beer
Full Text Available This article is reading ubuntu in the light of homelessness in the cities and towns of South Africa. It suggests that ubuntu itself is homeless and displaced as a way of being human together. Instead of the mediation of dignity and justice through an ubuntu-solidarity, street homeless people and others living vulnerably and in precarious circumstances are violated and excluded through a displacement of ubuntu-values. It also suggests a growing disconnect between the philosophy of ubuntu and its actual embodiment in the local urban political economy, local faith communities and local universities. Acknowledging the aspirational edge of ubuntu, the article then concludes to envision going beyond mere abstractions in the said spheres � the political economy, faith communities and local universities � in order to seek for concrete expressions of ubuntu-solidarity, asserting and mediating respect, dignity and justice.
Weinrich, Sally; Hardin, Sally; Glaser, Dale; Barger, Mary; Bormann, Jill; Lizarraga, Cabiria; Terry, Micheal; Criscenzo, Jeeni; Allard, Carolyn B
Almost 1 out of every 3 homeless women (32%) in the United States, United Kingdom, and Australia has experienced childhood sexual trauma. We assessed lifetime sexual trauma histories among 29 homeless women from three Southern California community sites: one residential safe house and two safe parking areas. More than half of the women (54%) reported a history of sexual trauma. That rate was higher (86%) among women living at the safe home than among women staying at the safe parking sites (only 42%). All four of the women who had served in the military reported having experienced military sexual trauma. The high percentages of sexual trauma found in homeless women highlight the need for effective interventions for sexual trauma.
O'Campo, Patricia; Hwang, Stephen W; Gozdzik, Agnes; Schuler, Andrée; Kaufman-Shriqui, Vered; Poremski, Daniel; Lazgare, Luis Ivan Palma; Distasio, Jino; Belbraouet, Slimane; Addorisio, Sindi
Individuals experiencing homelessness are particularly vulnerable to food insecurity. The At Home/Chez Soi study provides a unique opportunity to first examine baseline levels of food security among homeless individuals with mental illness and second to evaluate the effect of a Housing First (HF) intervention on food security in this population. At Home/Chez Soi was a 2-year randomized controlled trial comparing the effectiveness of HF compared with usual care among homeless adults with mental illness, stratified by level of need for mental health services (high or moderate). Logistic regressions tested baseline associations between food security (US Food Security Survey Module), study site, sociodemographic variables, duration of homelessness, alcohol/substance use, physical health and service utilization. Negative binomial regression determined the impact of the HF intervention on achieving levels of high or marginal food security over an 18-month follow-up period (6 to 24 months). Community settings at five Canadian sites (Moncton, Montreal, Toronto, Winnipeg and Vancouver). Homeless adults with mental illness (n 2148). Approximately 41 % of our sample reported high or marginal food security at baseline, but this figure varied with gender, age, mental health issues and substance use problems. High need participants who received HF were more likely to achieve marginal or high food security than those receiving usual care, but only at the Toronto and Moncton sites. Our large multi-site study demonstrated low levels of food security among homeless experiencing mental illness. HF showed promise for improving food security among participants with high levels of need for mental health services, with notable site differences.
Haddad, Maryam B.; Wilson, Todd W.; Ijaz, Kashef; Marks, Suzanne M.; Moore, Marisa
Context Tuberculosis (TB) rates among US homeless persons cannot be calculated because they are not included in the US Census. However, homelessness is often associated with TB. Objectives To describe homeless persons with TB and to compare risk factors and disease characteristics between homeless and nonhomeless persons with TB. Design and Setting Cross-sectional analysis of all verified TB cases reported into the National TB Surveillance System from the 50 states and the District of Columbia from 1994 through 2003. Main Outcome Measures Number and proportion of TB cases associated with homelessness, demographic characteristics, risk factors, disease characteristics, treatment, and outcomes. Results Of 185 870 cases of TB disease reported between 1994 and 2003, 11 369 were among persons classified as homeless during the 12 months before diagnosis. The annual proportion of cases associated with homelessness was stable (6.1%–6.7%). Regional differences occurred with a higher proportion of TB cases associated with homelessness in western and some southern states. Most homeless persons with TB were male (87%) and aged 30 to 59 years. Black individuals represented the highest proportion of TB cases among the homeless and nonhomeless. The proportion of homeless persons with TB who were born outside the United States (18%) was lower than that for non-homeless persons with TB (44%). At the time of TB diagnosis, 9% of homeless persons were incarcerated, usually in a local jail; 3% of nonhomeless persons with TB were incarcerated. Compared with nonhomeless persons, homeless persons with TB had a higher prevalence of substance use (54% alcohol abuse, 29.5% noninjected drug use, and 14% injected drug use), and 34% of those tested had coinfection with human immunodeficiency virus. Compared with nonhomeless persons, TB disease in homeless persons was more likely to be infectious but not more likely to be drug resistant. Health departments managed 81% of TB cases in homeless
Full Text Available There exists little scientific production on autolytic behaviour in homeless people, despite the fact that it is one of the groups that is more at risk. The aim of this study is to determine the prevalence of previous attempted suicide and suicide risk and its connection with the main risk factors. In order to do so, central tendency and dispersion measures, correlations, contingence tables, and average comparison tables according to type of variable and normality were used. The Plutchik suicide-risk test was used in order to determine the risk of suicide, and specific tests for the main risk factors analysed. The main results show a 24.7% suicide rate and 45.2% (n = 66 displayed suicide risk. The main predictive factor of the risk of suicide was the daily consumption of alcohol (OR = 1.011, p less than .001, followed by being a woman (OR = 1.381, p = .021. It is necessary to design and apply suicide prevention strategies for this population.
Baggett, Travis P; Campbell, Eric G; Chang, Yuchiao; Rigotti, Nancy A
We determined the prevalence and correlates of other tobacco product and electronic cigarette (e-cigarette) use in a clinic-based sample of homeless cigarette smokers. In April-July 2014, we used time-location sampling to conduct a cross-sectional, in-person survey of 306 currently homeless adult cigarette smokers recruited from 5 clinical sites at Boston Health Care for the Homeless Program. We assessed past-month use of large cigars, little cigars, smokeless tobacco, and e-cigarettes. Among those who had used e-cigarettes, we assessed the reasons for doing so. We used logistic regression analysis to identify the participant characteristics associated with the use of each product. Eighty-six percent of eligible individuals participated in the survey. In the past month, 37% of respondents used large cigars, 44% used little cigars, 8% used smokeless tobacco, 24% used an e-cigarette, and 68% used any of these products. Reasons for e-cigarette use included curiosity (85%) and to help quit conventional cigarettes (69%). In multivariable regression analyses, homeless smokers with greater subsistence difficulties were more likely to use little cigars (p=0.01) and less likely to use e-cigarettes (p=0.001). Non-Hispanic black (p=0.01), Hispanic (pcigars. Readiness to quit was not associated with other tobacco product use but was significantly associated with e-cigarette use to help quit smoking (p=0.02). Health care providers who serve homeless people should consider routine screening for the use of other tobacco products and e-cigarettes to help guide smoking cessation discussions and tobacco treatment planning. Copyright © 2016 Elsevier Ltd. All rights reserved.
Overgaard, Dorthe; King, Catriona; Christensen, Rie F
Background and Research Objective: Approximately 3% of children with congenital heart disease born in Denmark have single ventricle physiology (SVP). In previous decades, these children did not survive into adulthood. However, because of new surgical techniques and improved medical care, they now...... have a 90% survival rate. Several studies have described the somatic status of SVP patients using clinical parameters; however, only a few studies have researched the life perspectives and coping skills in this patient group. The aim of this study was to investigate how young adults with an SVP...... diagnosis are coping with adulthood and the emotional experiences of daily life. Subjects and Methods: Semistructured, qualitative interviews were held with 11 SVP respondents, selected by physical and psychological parameters identified in an earlier quantitative study. Data from the interviews were...
Byers, E Sandra; Nichols, Shana; Voyer, Susan D
This study examined the sexual functioning of single adults (61 men, 68 women) with high functioning autism and Asperger syndrome living in the community with and without prior relationship experience. Participants completed an on-line questionnaire assessing autism symptoms, psychological functioning, and various aspects of sexual functioning. In general participants reported positive sexual functioning. Participants without prior relationship experience were significantly younger and more likely to be male and identify as heterosexual. They reported significantly higher sexual anxiety, lower sexual arousability, lower dyadic desire, and fewer positive sexual cognitions. The men reported better sexual function than did the women in a number of areas. These results counter negative societal perceptions about the sexuality of high functioning individuals on the autism spectrum.
Collier, B.D.; Johnston, R.P.; Carrera, G.; Isitman, A.T.; Hellman, R.S.; Zielonka, J.S.
Twenty-one adult patients with the clinical diagnosis of avascular necrosis (AVN) of the femoral head were examined with planar bone scintigraphy (high resolution collimator) and single photon emission computed tomography (SPECT). The duration of hip pain ranged from 1 day to 18 months. Risk factors (including steroids, renal transplantation, alcoholism, and trauma) were present in 17 cases. A final diagnosis of AVN (20 hips), osteochondral facture, or stress fracture, was established for 17 patients. The 4 remaining patients, who were radiographically normal and did not complain of pain 3 months later, were thought to have no significant bone pathology. SPECT and planar bone scintigraphy were reported as positive for AVN only if a photopenic bony defect could be identified. In particular, uniformly increased activity throughout the femoral head was not considered to be diagnostic of AVN. The authors conclude that by identifying a photopenic defect which is not evident on planar bone scintigraphy, SPECT can contribute to accurate diagnosis of AVN
Litovsky, Ruth Y; Moua, Keng; Godar, Shelly; Kan, Alan; Misurelli, Sara M; Lee, Daniel J
In recent years, cochlear implants (CIs) have been provided in growing numbers to people with not only bilateral deafness but also to people with unilateral hearing loss, at times in order to alleviate tinnitus. This study presents audiological data from 15 adult participants (ages 48 ± 12 years) with single sided deafness. Results are presented from 9/15 adults, who received a CI (SSD-CI) in the deaf ear and were tested in Acoustic or Acoustic + CI hearing modes, and 6/15 adults who are planning to receive a CI, and were tested in the unilateral condition only. Testing included (1) audiometric measures of threshold, (2) speech understanding for CNC words and AzBIO sentences, (3) tinnitus handicap inventory, (4) sound localization with stationary sound sources, and (5) perceived auditory motion. Results showed that when listening to sentences in quiet, performance was excellent in the Acoustic and Acoustic + CI conditions. In noise, performance was similar between Acoustic and Acoustic + CI conditions in 4/6 participants tested, and slightly worse in the Acoustic + CI in 2/6 participants. In some cases, the CI provided reduced tinnitus handicap scores. When testing sound localization ability, the Acoustic + CI condition resulted in improved sound localization RMS error of 29.2° (SD: ±6.7°) compared to 56.6° (SD: ±16.5°) in the Acoustic-only condition. Preliminary results suggest that the perception of motion direction, whereby subjects are required to process and compare directional cues across multiple locations, is impaired when compared with that of normal hearing subjects. Copyright © 2018 Elsevier B.V. All rights reserved.
Wilhelmus, Micha Mm; Hay, Justin L; Zuiker, Rob Gja; Okkerse, Pieter; Perdrieu, Christelle; Sauser, Julien; Beaumont, Maurice; Schmitt, Jeroen; van Gerven, Joop Ma; Silber, Beata Y
Caffeine induces positive effects on sustained attention, although studies assessing the acute effects of low caffeine dose (caffeine on sustained attention in tests lasting up to 45 minutes using 82 low or non-caffeine-consuming healthy male ( n=41) and female ( n=41) adults aged between 40 and 60 years. Vigilance was measured using Mackworth Clock test, Rapid Visual Information Processing Test, adaptive tracking test, saccadic eye movement and attention switch test. Effects on mood and fatigue were analysed using Bond and Lader and Caffeine Research visual analogue scales, and Samn-Perelli questionnaire. Saliva sampling was performed for both compliance and caffeine pharmacokinetic analysis. Administration of a 60 mg caffeine dose resulted in a significant improvement in sustained attention compared with the placebo. Also a significantly improved peak saccadic velocity and reaction time performance was found, and decreased error rate. Significantly increased feelings of alertness, contentment and overall mood after caffeine treatment compared with placebo were observed. This study demonstrated that in healthy adult subjects oral administration of a single 60 mg caffeine dose elicited a clear enhancement of sustained attention and alertness, measured both in multiple objective performances and in subjective scales.
Full Text Available Nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA plays an important role in the epidemiology and pathogenesis of disease. Situations of close-quarter contact in groups are generally regarded as a risk factor for community acquired MRSA strains due to transmission via fomites and person to person contact. With these criteria for risk, homeless individuals using shelter facilities, including showers and toilets, should be considered high risk for colonization and infection. The aim of this study was to determine the prevalence of nasal colonization of MRSA in a homeless population compared to established rates of colonization within the public and a control group of subjects from a neighboring medical school campus, and to analyze phylogenetic diversity among the MRSA strains. Nasal samples were taken from the study population of 332 adult participants, and analyzed. In addition, participants were surveyed about various lifestyle factors in order to elucidate potential patterns of behavior associated with MRSA colonization. Homeless and control groups both had higher prevalence of MRSA (9.8% and 10.6% respectively when compared to the general population reported by previous studies (1.8%. However, the control group had a similar MRSA rate compared to healthcare workers (4.6% while the homeless population had an increased prevalence. Risk factors identified in this study included male gender, age over 50 years and use of antibiotics within the past 3 months. Phylogenetic relationships between 9 of the positive samples from the homeless population were analyzed, showing 8 of the 9 samples had a high degree of relatedness between the spaA genes of the MRSA strains. This indicates that the same MRSA strain might be transmitted from person to person among homeless population. These findings increase our understanding of key differences in MRSA characteristics within homeless populations as well as risks for MRSA associated with
Haddad, Maryam B; Wilson, Todd W; Ijaz, Kashef; Marks, Suzanne M; Moore, Marisa
Tuberculosis (TB) rates among US homeless persons cannot be calculated because they are not included in the US Census. However, homelessness is often associated with TB. To describe homeless persons with TB and to compare risk factors and disease characteristics between homeless and nonhomeless persons with TB. Cross-sectional analysis of all verified TB cases reported into the National TB Surveillance System from the 50 states and the District of Columbia from 1994 through 2003. Number and proportion of TB cases associated with homelessness, demographic characteristics, risk factors, disease characteristics, treatment, and outcomes. Of 185,870 cases of TB disease reported between 1994 and 2003, 11,369 were among persons classified as homeless during the 12 months before diagnosis. The annual proportion of cases associated with homelessness was stable (6.1%-6.7%). Regional differences occurred with a higher proportion of TB cases associated with homelessness in western and some southern states. Most homeless persons with TB were male (87%) and aged 30 to 59 years. Black individuals represented the highest proportion of TB cases among the homeless and nonhomeless. The proportion of homeless persons with TB who were born outside the United States (18%) was lower than that for nonhomeless persons with TB (44%). At the time of TB diagnosis, 9% of homeless persons were incarcerated, usually in a local jail; 3% of nonhomeless persons with TB were incarcerated. Compared with nonhomeless persons, homeless persons with TB had a higher prevalence of substance use (54% alcohol abuse, 29.5% noninjected drug use, and 14% injected drug use), and 34% of those tested had coinfection with human immunodeficiency virus. Compared with nonhomeless persons, TB disease in homeless persons was more likely to be infectious but not more likely to be drug resistant. Health departments managed 81% of TB cases in homeless persons. Directly observed therapy, used for 86% of homeless patients
Kuo, Yi-Liang; Huang, Kuo-Yuan; Chiang, Pei-Tzu; Lee, Pei-Yun; Tsai, Yi-Ju
The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP) and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above) with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. ...
Kock, M; Thompson, E; Vulliet, P R; Brooks, D L
Pharmacokinetic parameters of methadone were studied in adult dairy goats. Five goats were each given methadone hydrochloride as a single 0.2 mg/kg of body weight dosage by intramuscular (IM) administration. Plasma methadone concentrations were determined for 96 h after dosing. Plasma methadone concentrations after IM administration were best described by an open one-compartment model. Overall elimination half-life (t1/2) was 1.38 h. Peak plasma concentrations were reached 0.25 h after dosing, and the actual plasma concentration averaged 37.8 ng/ml (SD = 12.76) at that time. The data obtained from this study suggest that plasma concentrations, similar to those that are analgesic in humans, can be achieved after IM administration of methadone at a dose rate of 0.2 mg/kg of body weight. In addition, these plasma concentrations can be maintained for up to 3 h after a single injection and, therefore, may provide satisfactory analgesia for such period.
Bamrah, S.; Yelk Woodruff, R. S.; Powell, K.; Ghosh, S.; Kammerer, J. S.; Haddad, M. B.
SUMMARY OBJECTIVES 1) To describe homeless persons diagnosed with tuberculosis (TB) during the period 1994–2010, and 2) to estimate a TB incidence rate among homeless persons in the United States. METHODS TB cases reported to the National Tuberculosis Surveillance System were analyzed by origin of birth. Incidence rates were calculated using the US Department of Housing and Urban Development homeless population estimates. Analysis of genotyping results identified clustering as a marker for transmission among homeless TB patients. RESULTS Of 270 948 reported TB cases, 16 527 (6%) were homeless. The TB incidence rate among homeless persons ranged from 36 to 47 cases per 100 000 population in 2006–2010. Homeless TB patients had over twice the odds of not completing treatment and of belonging to a genotype cluster. US- and foreign-born homeless TB patients had respectively 8 and 12 times the odds of substance abuse. CONCLUSIONS Compared to the general population, homeless persons had an approximately 10-fold increase in TB incidence, were less likely to complete treatment and more likely to abuse substances. Public health outreach should target homeless populations to reduce the excess burden of TB in this population. PMID:24125444
Bamrah, S; Yelk Woodruff, R S; Powell, K; Ghosh, S; Kammerer, J S; Haddad, M B
1) To describe homeless persons diagnosed with tuberculosis (TB) during the period 1994-2010, and 2) to estimate a TB incidence rate among homeless persons in the United States. TB cases reported to the National Tuberculosis Surveillance System were analyzed by origin of birth. Incidence rates were calculated using the US Department of Housing and Urban Development homeless population estimates. Analysis of genotyping results identified clustering as a marker for transmission among homeless TB patients. Of 270,948 reported TB cases, 16,527 (6%) were homeless. The TB incidence rate among homeless persons ranged from 36 to 47 cases per 100,000 population in 2006-2010. Homeless TB patients had over twice the odds of not completing treatment and of belonging to a genotype cluster. US- and foreign-born homeless TB patients had respectively 8 and 12 times the odds of substance abuse. Compared to the general population, homeless persons had an approximately 10-fold increase in TB incidence, were less likely to complete treatment and more likely to abuse substances. Public health outreach should target homeless populations to reduce the excess burden of TB in this population.
Curtis, Marah A; Corman, Hope; Noonan, Kelly; Reichman, Nancy E
We estimated the effects of maternal depression during the postpartum year, which is often an unexpected event, on subsequent homelessness and risk of homelessness in a national sample of urban, mostly low-income mothers. We used logistic regression models to estimate associations between maternal depression during the postpartum year and both homelessness and risk of homelessness 2 to 3 years later, controlling for maternal and family history of depression, prenatal housing problems, and other covariates. Risk factors for homelessness included experiencing evictions or frequent moves and moving in with family or friends and not paying rent. We found robust associations between maternal depression during the postpartum year and subsequent homelessness and risk of homelessness, even among mothers who had no history of mental illness, whose own mothers did not have a history of depressive symptoms, and who had no previous housing problems. This study provides robust evidence that maternal mental illness places families with young children at risk for homelessness, contributes to the scant literature elucidating directional and causal links between mental illness and homelessness, and contributes to a stagnant but important literature on family homelessness.
Tornero Patricio, Sebastián; Fernández Ajuria, Alberto; Charris Castro, Liliana
The aim was to determine the characteristics of hospital admissions of homeless persons in Seville, Spain. Observational study of 103,802 hospital admissions of 71,756 patients admitted in the Hospitals "Virgen del Rocío" and "Virgen Macarena" (Seville), in 2013 and 2014. Bivariate analysis were performed using χ2 and t-Student tests and multivariate analysis using binomial logistic regression model. 0.16% (n=163) of admissions were homeless persons and 99.84% (n=103,639) were not. The mean age at admission in homeless patients was 48 years and 76.5% of them were men. Hospital deaths of homeless patients occurred being 23 years younger. 92% of hospital admissions came from emergency departments and 10.0% of their discharges were against medical advice. The average length of stay was 4.8 days longer in homeless persons and the most frequent diagnoses on admission were mental (27.0%), infectious (19.6%) and respiratory diseases (18.4%). Mental disorders were present on 83.7% of homeless patients as secondary diagnose and 77.6% referred drugs consumption. Hospital admissions characteristics of homeless persons were particularly different. Homeless patients were hospitalized and died at a younger age than non-homeless patients. The morbidity and mortality of homeless persons reflect their vulnerable health condition.
Amanda Stafford; Lisa Wood
Background: Homelessness is associated with enormous health inequalities, including shorter life expectancy, higher morbidity and greater usage of acute hospital services. Viewed through the lens of social determinants, homelessness is a key driver of poor health, but homelessness itself results from accumulated adverse social and economic conditions. Indeed, in people who are homeless, the social determinants of homelessness and health inequities are often intertwined, and long term homeless...
Gorban', Je.M.; Topol'nyikova, N.V.
The peculiarities of short-term (1 h, 1 day) adrenal glucocorticoid function in adult and old rats after single x-irradiation at different doses was studied. changes in the glucocorticoid function of the adrenal glands at studied terms after single x-irradiation at used doses were observed in adult but not in old animals. This testifies to an age-related decrease in the range of adaptive possibilities of this link of the organism adaptive system to x-irradiation effects
However much the recession might be receding, the effects remain deep and cruel to families living in poverty. Many have fallen through their communities' social safety nets. Today, families with young children comprise 41% of the nation's homeless population. According to the Institute of Children and Poverty, more than 1.35 million kids in the…
Cleverley, Kristin; Kidd, Sean A.
Homeless and street-involved youth are considered an extremely high risk group, with many studies highlighting trajectories characterized by abusive, neglectful, and unstable family histories, victimization and criminal involvement while on the streets, high rates of physical and mental illness, and extremely high rates of mortality. While there…
Polzer, Christopher M.
Recreation leaders recommend reaching out to homeless individuals and providing programs that may help improve their health, bring them some fun and happiness, and boost their quality of life. The paper describes how one North Carolina county addressed the issue through recreation programs and other activities. (SM)
Reitzel, Lorraine R; Short, Nicole A; Schmidt, Norman B; Garey, Lorra; Zvolensky, Michael J; Moisiuc, Alexis; Reddick, Carrie; Kendzor, Darla E; Businelle, Michael S
We examined associations between sleep problems, distress intolerance, and perceived stress and health in a convenience sample of homeless adults. Participants (N = 513, 36% women, Mage = 44.5 ±11.9) self-reported sleep adequacy, sleep duration, unintentional sleep during the daytime, distress tolerance, urban stress, and days of poor mental health and days of poor physical health over the last month. The indirect effects of sleep problems on stress and health through distress tolerance were examined using a non-parametric, bias-corrected bootstrapping procedure. Sleep problems were prevalent (eg, 13.0 ±11.4 days of inadequate sleep and 4.7 ±7.9 days of unintentionally falling asleep during the preceding month). Distress intolerance partially accounted for the associations of inadequate sleep and unintentionally falling asleep, but not sleep duration, with urban stress and more days of poor mental and physical health. Many homeless individuals endure sleep problems. Given the connections between sleep and morbidity and mortality, results further support the need for more attention directed toward facilitating improvements in sleep quality to improve the quality of life of homeless adults, potentially including attention to improving distress tolerance skills.
Watson, J; Crawley, J; Kane, D
Homelessness and poverty are extreme forms of social exclusion which extend beyond the lack of physical or material needs. The purpose of this study was to explore and expand the concept of social exclusion within the social determinants of health perspective - to understand how the social environment, health behaviours and health status are associated with material and social deprivation. Fundamental qualitative description with tones of focused ethnography. Participants who identified as hidden homeless described their everyday living conditions and how these everyday conditions were impacted and influenced by their social environments, coping/health behaviours and current health status. Research Ethics Board approval was granted and informed consents were obtained from 21 participants prior to the completion of individual interviews. Qualitative content analysis examined the descriptions of men and women experiencing hidden homelessness. Participants described the 'lack of quality social interactions and supports' and their 'daily struggles of street life'. They also shared the 'pain of addiction' and how coping strategies influenced health. Participants were hopeful that their insights would 'better the health of homeless people' by helping shape public policy and funding of community resources that would reduce barriers and improve overall health. Health professionals who understand health behaviours as coping mechanisms for poor quality social environments can provide more comprehensive and holistic care. The findings of this study can be used to support the importance of housing as a key factor in the health and well-being of people experiencing poverty, homelessness and social exclusion; and consequently, reinforces the need for a national housing strategy. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Gültekin, Laura; Brush, Barbara L; Baiardi, Janet M; Kirk, Keri; VanMaldeghem, Kelley
Homelessness threatens the health and well-being of thousands of families in the United States, yet little is known about their specific needs and how current services address them. To fill this knowledge gap, we explored the experiences of homelessness families in Detroit, Michigan. We targeted homeless mothers and their caseworkers for study to see if the perceptions of needs and services were in alignment. Using focus groups and content analysis, we identified four overarching themes that illustrate homeless mothers' experience with homelessness. We then analyzed data from caseworkers to look specifically for similarities and differences in their perceptions. Key findings included reports of family histories of violence, poverty, social isolation, and a lack of informal support as contributing to homelessness. The differing perspectives of mothers and their caseworkers regarding how best to move forward highlight how current programs and services may not be meeting the needs of this growing and vulnerable cohort. © The Author(s) 2014.
Shelton, Katherine H.; van den Bree, Marianne B. M.; Los, Férenc J.
Understanding mental health issues faced by young homeless persons is instrumental to the development of successful targeted interventions. No systematic review of recent published literature on psychopathology in this group has been completed. We conducted a systematic review of published research examining the prevalence of psychiatric problems among young homeless people. We examined the temporal relationship between homelessness and psychopathology. We collated 46 articles according to the PRISMA Statement. All studies that used a full psychiatric assessment consistently reported a prevalence of any psychiatric disorder from 48% to 98%. Although there was a lack of longitudinal studies of the temporal relationship between psychiatric disorders and homelessness, findings suggested a reciprocal link. Supporting young people at risk for homelessness could reduce homelessness incidence and improve mental health. PMID:23597340
Parker, R David; Dykema, Shana
Homeless persons are perceived as a highly mobile population, and have high rates of co-morbid conditions, including mental health and substance use issues. This study sought to determine the characteristics of the mobility and reported health conditions of homeless persons. The sample for this cross sectional study (n = 674) accounted for 88 % of the homeless population in a medium sized southern city in the United States. Participants were recruited from a homeless shelter operating during the winter season. Homeless persons were less mobile than the general state population (46.11 % were born in-state vs. 40.7 % of the general population) and less transient than the general state population (78 % reported an in-state zip code for the last permanent residence). 31.9 % reported a disabling condition of a serious and long term nature. These findings challenge the concept that homeless persons are primarily a mobile population. Furthermore, homeless persons in this sample were more likely to remain in the state where they lived after becoming homeless. Thus, provider perceptions that homeless persons would not benefit from referral to a regular source of outpatient care may be misinformed. As homeless persons often seek care in emergency departments for conditions that could be addressed through outpatient care, if a medical care system implemented standard practices specifically for homeless patients, this could decrease recidivism. Such interventions represent significant opportunities to reduce costs, conserve resources, and improve care through policy modification that ensures a focus on a successful, active linkage to outpatient care and programs specific to the homeless population.
Quigley, John M.; Raphael, Steven
It is generally believed that the increased incidence of homelessness in the US has arisen from broad societal factors â€“ changes in the institutionalization of the mentally ill, increases in drug addiction and alcohol usage, etc. This paper reports on a comprehensive test of the alternate hypothesis that variations in homelessness arise from changed circumstances in the housing market and in the income distribution. We utilize essentially all the systematic information available on homeless...
Malinauskas, Gedas; Blažytė, Vilma
Using the data of a pilot study, this article deals with unsuccessful cases of Lithuanian immigration, i.e., lifestyle peculiarities of Lithuanians who became homeless in the capital of Great Britain. While analyzing the phenomenon in a descriptive manner, the authors sought an answer the question of why Lithuanian emigrants who had family and work in their homeland became homeless after they had come to search for a better life. The issues of homeless Lithuanians‘ daily life and life princip...
Umigai, N; Murakami, K; Ulit, M V; Antonio, L S; Shirotori, M; Morikawa, H; Nakano, T
Crocetin, a unique carotenoid with a short carbon chain length, is an active compound of saffron and Gardenia jasminoides Ellis used as traditional herbal medicine. The present study was undertaken to investigate the pharmacokinetic profiles of crocetin in healthy adult subjects. The study was conducted as an open-label, single dose escalation with 10 Filipino volunteers (5 men and 5 women). The subjects received a single dose of crocetin at three doses (7.5, 15 and 22.5 mg) in one week interval. Blood samples were collected from the brachial vein before and at 1, 2, 4, 6, 8, 10 and 24 h after administration. Plasma concentrations of crocetin were determined by high-performance liquid chromatography (HPLC). Crocetin was rapidly absorbed and detected within an hour of administration with a mean time to reach maximum concentration (T(max)) of crocetin ranging from 4.0 to 4.8 h. The mean values of C(max) and AUC(0-24h) ranged from 100.9 to 279.7 ng/ml and 556.5 to 1720.8 ng. h/ml respectively. C(max) and AUC values increased with dose proportional manner. Crocetin was eliminated from human plasma with a mean elimination half life (T(½) of 6.1 to 7.5 h. In summary, there were no serious adverse events up to 22.5 mg dose of crocetin while crocetin was found to be absorbed more quickly than the other carotenoids such as β-carotene, lutein and lycopene. Copyright © 2010 Elsevier GmbH. All rights reserved.
Larson, Jeffry H.; LaMont, Craig
This study investigated the relationship of childhood sexual abuse to marital attitudes and perceived readiness for marriage in single young adult women. A total of 622 women from three universities in the United States completed questionnaires on sexual abuse, attitudes and feelings about marriage, and readiness for marriage. After controlling…
Crandall, C J; Karlamangla, A S; Merkin, S S; Binkley, N; Carr, D; Greendale, G A; Seeman, T E
Bone health may be negatively impacted by childhood socio-environmental circumstances. We examined the independent associations of single-parent childhood and parental death or divorce in childhood with adult bone strength indices. Longer exposure to a single-parent household in childhood was associated with lower bone strength in adulthood. Because peak bone mass is acquired during childhood, bone health may be negatively impacted by childhood socio-environmental disadvantage. The goal of this study was to determine whether being raised in a single-parent household is associated with lower bone strength in adulthood. Using dual-energy X-ray absorptiometry data from 708 participants (mean age 57 years) in the Midlife in the United States Biomarker Project, we examined the independent associations of composite indices of femoral neck bone strength relative to load (in three failure modes: compression, bending, and impact) in adulthood with the experience of single-parent childhood and parental death or divorce in childhood. After adjustment for gender, race, menopause transition stage, age, and body mass index, each additional year of single-parent childhood was associated with 0.02 to 0.03 SD lower indices of adult femoral neck strength. In those with 9-16 years of single-parent childhood, the compression strength index was 0.41 SD lower, bending strength index was 0.31 SD lower, and impact strength index was 0.25 SD lower (all p values divorce during childhood was not by itself independently associated with adult bone strength indices. The magnitudes of these associations were unaltered by additional adjustment for lifestyle factors and socioeconomic status in childhood and adulthood. Independent of parental death or divorce, growing up in a single-parent household is associated with lower femoral neck bone strength in adulthood, and this association is not entirely explained by childhood or adult socioeconomic conditions or lifestyle choices.
Ben W. Dulken
Full Text Available Neural stem cells (NSCs in the adult mammalian brain serve as a reservoir for the generation of new neurons, oligodendrocytes, and astrocytes. Here, we use single-cell RNA sequencing to characterize adult NSC populations and examine the molecular identities and heterogeneity of in vivo NSC populations. We find that cells in the NSC lineage exist on a continuum through the processes of activation and differentiation. Interestingly, rare intermediate states with distinct molecular profiles can be identified and experimentally validated, and our analysis identifies putative surface markers and key intracellular regulators for these subpopulations of NSCs. Finally, using the power of single-cell profiling, we conduct a meta-analysis to compare in vivo NSCs and in vitro cultures, distinct fluorescence-activated cell sorting strategies, and different neurogenic niches. These data provide a resource for the field and contribute to an integrative understanding of the adult NSC lineage.
Derry, Sheena; Cooper, Tess E; Phillips, Tudor
Combining two different analgesics in fixed doses in a single tablet can provide better pain relief than either drug alone in acute pain. This appears to be broadly true across a range of different drug combinations, in postoperative pain and migraine headache. A new combination of dexketoprofen (a nonsteroidal anti-inflammatory drug) plus tramadol (an opioid) has been tested in acute postoperative pain conditions. It is not yet licensed for use. This review is one of a series on oral analgesics for acute postoperative pain. Individual reviews have been brought together in two overviews to provide information about the relative efficacy and harm of the different interventions. To assess the analgesic efficacy and adverse effects of a single fixed-dose of oral dexketoprofen plus tramadol, compared with placebo, for moderate to severe postoperative pain in adults, using methods that permit comparison with other analgesics evaluated in standardised trials using almost identical methods and outcomes. A secondary objective was to compare the combination with the individual analgesics alone. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via CRSO, MEDLINE via Ovid, and Embase via Ovid from inception to 31 May 2016. We also searched the reference lists of retrieved studies and reviews, and two online clinical trial registries. Randomised, double-blind trials of oral dexketoprofen plus tramadol administered as a single oral dose, for the relief of acute postoperative pain in adults, and compared to placebo. Two review authors independently considered trials for inclusion in the review, examined issues of study quality and potential bias, and extracted data. For dichotomous outcomes, we calculated risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) for dexketoprofen plus tramadol, compared with placebo with 95% confidence intervals (CI). We collected information on the number of participants with at least 50% of
Jones, Marian Moser
POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net. A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda. Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together
Bower, Marlee; Conroy, Elizabeth; Perz, Janette
Both loneliness and a lack of social integration are associated with serious physical and psychological health issues. One population highly susceptible to social isolation and loneliness are individuals who are homeless, who also experience high rates of mental disorder and relationship breakdown. Despite this, little research has explored how social networks, isolation and loneliness are experienced for those with a history of homelessness. In-depth, semi-structured interviews were used to get a nuanced understanding of how social networks and isolation are experienced and understood by individuals experiencing homelessness. Sixteen participants who were either homeless (n = 11) or previously homeless (n = 5) in Sydney, Australia, completed one-off interviews that were audio-recorded and transcribed. Data were analysed using thematic analysis. Participants constructed their social networks as being both constrained and enabled by marginalisation. They experienced rejection from the non-homeless: the loss of critical network members, including rejection from family and a lack of companionship, and low quality and precarious relationships within the homeless community. These accounts were best conceptualised through loneliness theory. Participant's accounts signal that the homeless will likely continue feeling isolated if mainstream attitudes towards homelessness remain stigmatising and discriminatory. © 2017 John Wiley & Sons Ltd.
Rota-Bartelink, Alice; Lipmann, Bryan
A comparative study of the causes of new episodes of homelessness among people aged 50 years and over has been undertaken in Australia, the United States and England. Semi-structured questionnaires were used to collect information on the circumstances and problems that contributed to homelessness. This paper presents the findings from Australia, where information was obtained from 125 older homeless people (aged 50+ years) and their key workers in Melbourne. All three participating nations followed identical research methodologies. The factors most frequently reported by respondents as contributing to their homelessness were problems with people with whom they lived, followed by physical and mental ill-health and problems associated with the housing itself. The most frequently reported factors by case workers were problems with alcohol, followed by physical and mental health factors. This study demonstrates a significant under-utilisation of housing and support services among recently homeless older people and provides evidence that people who had previously been homeless appear to be more resigned to their homelessness than do those who had not experienced homelessness before. Significant issues relating to depression and gambling were also noted. The findings support the need for more targeted, specialised services to be developed or improved such that older homeless people can readily gain access to them and for improved collaboration or information exchange among housing providers and welfare agencies.
Full Text Available This article consists of several parts. The first part includes definitional considerations over the notion of homelessness. It also describes social situation of the homeless, whereas the second part concentrates on both the analysis of causes and effects of homelessness and on the attempt to show the scale of this phenomenon. The last part of the article focuses on the prevention of homelessness. It emphasizes the importance of interdisciplinarity of preventive and compensatory actions in the scope of the discussed phenomenon.
Horan, Sean A; Watson, Steven L; Carty, Christopher P; Sartori, Massimo; Weeks, Benjamin K
To determine the kinematic parameters that characterize good and poor single-leg squat (SLS) performance. A total of 22 healthy young adults free from musculoskeletal impairment were recruited for testing. For each SLS, both two-dimensional video and three-dimensional motion analysis data were collected. Pelvis, hip, and knee angles were calculated using a reliable and validated lower-limb (LL) biomechanical model. Two-dimensional video clips of SLSs were blindly assessed in random order by eight musculoskeletal physiotherapists using a 10-point ordinal scale. To facilitate between-group comparisons, SLS performances were stratified by tertiles corresponding to poor, intermediate, and good SLS performance. Mean ratings of SLS performance assessed by physiotherapists were 8.3 (SD 0.5), 6.8 (SD 0.7), and 4.0 (SD 0.8) for good, intermediate, and poor squats, respectively. Three-dimensional analysis revealed that people whose SLS performance was assessed as poor exhibited increased hip adduction, reduced knee flexion, and increased medio-lateral displacement of the knee joint centre compared to those whose SLS performance was assessed as good (p≤0.05). Overall, poor SLS performance is characterized by inadequate knee flexion and excessive frontal plane motion of the knee and hip. Future investigations of SLS performance should consider standardizing knee flexion angle to illuminate other influential kinematic parameters.
Full Text Available Despite the number of postpartum handling that a newborn experiences, few studies focus on their long-term consequences. In rats, regular long separations from the mother, during the early life, led to modifications of the locomotor activity when the animal is confronted to a stressor. In horses, one component of the behavioural response to stressful situation is active locomotion. We wondered if the routine postpartum handling undergone by foals, would affect their level of reactivity or the way they express their stress, when older. One single prolonged bout of handling just after birth clearly affected later adult expression of stress reactivity. In social separation associated with novelty, handled and unhandled horses produced an equal amount of whinnies, showing a similar vocal response to stress. However, both groups differed in their locomotor response to the situations. Early-handled foals expressed less of the active forms of locomotion than the control group. Our findings highlight the need of further reflections on long-term effects of routine handlings procedures close to birth.
Orla M Smith
Full Text Available Little is known about homeless patients in intensive care units (ICUs.To compare clinical characteristics, treatments, and outcomes of homeless to non-homeless patients admitted to four ICUs in a large inner-city academic hospital.63 randomly-selected homeless compared to 63 age-, sex-, and admitting-ICU-matched non-homeless patients.Compared to matched non-homeless, homeless patients (average age 48±12 years, 90% male, 87% admitted by ambulance, 56% mechanically ventilated, average APACHE II 17 had similar comorbidities and illness severity except for increased alcohol (70% vs 17%,p<0.001 and illicit drug(46% vs 8%,p<0.001 use and less documented hypertension (16% vs 40%,p = 0.005 or prescription medications (48% vs 67%,p<0.05. Intensity of ICU interventions was similar except for higher thiamine (71% vs 21%,p<0.0001 and nicotine (38% vs 14%,p = 0.004 prescriptions. Homeless patients exhibited significantly lower Glasgow Coma Scores and significantly more bacterial respiratory cultures. Longer durations of antibiotics, vasopressors/inotropes, ventilation, ICU and hospital lengths of stay were not statistically different, but homeless patients had higher hospital mortality (29% vs 8%,p = 0.005. Review of all deaths disclosed that withdrawal of life-sustaining therapy occurred in similar clinical circumstances and proportions in both groups, regardless of family involvement. Using multivariable logistic regression, homelessness did not appear to be an independent predictor of hospital mortality.Homeless patients, admitted to ICU matched to non-homeless patients by age and sex (characteristics most commonly used by clinicians, have higher hospital mortality despite similar comorbidities and illness severity. Trends to longer durations of life supports may have contributed to the higher mortality. Additional research is required to validate this higher mortality and develop strategies to improve outcomes in this vulnerable population.
Johnson, Guy; Pleace, Nicholas
The Homelessness Outcomes Star (HOS) is probably the most widespread form of outcome measurement employed by homelessness service providers. Developed in the UK, the HOS is now being used by homelessness services in other European countries and Australia, while being promoted internationally as a validated set of key performance indicators. This paper examines the ideological framework that underpins the HOS, as well as the theoretical and methodological approaches that inform its operation. ...
Barden, Jodie; Derry, Sheena; McQuay, Henry J; Moore, R Andrew
Ketoprofen is a non-selective non-steroidal anti-inflammatory drug (NSAID) used to treat acute and chronic painful conditions. Dexketoprofen is the (S)-enantiomer, which is believed to confer analgesia. Theoretically dexketoprofen is expected to provide equivalent analgesia to ketoprofen at half the dose, with a consequent reduction in gastrointestinal adverse events. To assess efficacy, duration of action, and associated adverse events of single dose oral ketoprofen and dexketoprofen in acute postoperative pain in adults. We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to August 2009. Randomised, double blind, placebo-controlled trials of single dose orally administered ketoprofen and dexketoprofen in adults with moderate to severe acute postoperative pain. Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected. Fourteen studies compared ketoprofen (968 participants) at mainly 25 mg and 50 mg with placebo (520 participants). Seven studies compared dexketoprofen (681 participants) at mainly 10 mg to 25 mg with placebo (289 participants). Studies were of adequate reporting quality, and participants had pain following dental, orthopaedic, obstetric, gynaecological and general surgery. There was considerable clinical heterogeneity between studies in dental and other types of surgery, particularly bunionectomy, which limited analysis.Ketoprofen at doses between 12.5 mg and 100 mg produced NNTs for at least 50% pain relief over 4 to 6
Lemos, J; Neuparth, T; Trigo, M; Costa, P; Vieira, D; Cunha, L; Ponte, F; Costa, P S; Metello, L F; Carvalho, A P
This study investigated to what extent a single exposure to low doses of ionizing radiation can induce genotoxic damage in irradiated adult zebrafish (Danio rerio) and its non-irradiated F1 progeny. Four groups of adult zebrafish were irradiated with a single dose of X-rays at 0 (control), 100, 500 and 1000 mGy, respectively, and couples of each group were allowed to reproduce following irradiation. Blood of parental fish and whole-body offspring were analysed by the comet assay for detection of DNA damage. The level of DNA damage in irradiated parental fish increased in a radiation dose-dependent manner at day 1 post-irradiation, but returned to the control level thereafter. The level of DNA damage in the progeny was directly correlated with the parental irradiation dose. Results highlight the genotoxic risk of a single exposure to low-dose ionizing radiation in irradiated individuals and also in its non-irradiated progeny.
Terui, Sachiko; Hsieh, Elaine
The meanings of homelessness are fluid and socially constructed, providing resources and limitations for individuals to negotiate their identities and relationships in everyday life. In this study, we examine the strategies and corresponding resources utilized by people who are homeless to cope with the labeling of a homeless identity and to redefine their identities. We used constant comparative analysis to examine in-depth interviews with 16 participants (male = 11, female = 5) who access a local homeless shelter in the southwest United States for resources. We identified three strategies that homeless people adopt to cope with the labeling of homeless identity: (a) differentiating oneself from others who are homeless, (b) prioritizing certain aspects of life, and (c) embracing the status of homelessness. Although these strategies have been identified in previous literature, the authors extend this line of research by identifying the common resources people who are homeless utilize when adopting these strategies, which entail important implications for theory development and practical implications.
Chung, Hyewon; Kim, Anhye; Lim, Kyoung Soo; Park, Sang-In; Yu, Kyung-Sang; Yoon, Seo Hyun; Cho, Joo-Youn; Chung, Jae-Yong
Escitalopram is the (S)-enantiomer of citalopram that has a potential QT prolonging effect. In this study, 12 healthy elderly individuals received a single oral dose of escitalopram (20 mg), and their pharmacokinetics and QT effect data were compared with data from 33 younger adults obtained in a previous study. Serial blood samples for pharmacokinetic analysis were collected and ECG was performed up to 48 h postdose. The elderly and younger adults showed similar pharmacokinetic profiles. The geometric mean ratios (90% confidence interval) of the elderly compared with the younger adults were 1.02 (0.89-1.17) and 1.01 (0.86-1.17) for the maximum plasma concentration and area under the concentration-time curve, respectively. The mean baseline-adjusted QT (dQT) time profiles were similar and the mean values of maximum dQT were not significantly different between the elderly and the younger adults. The linear mixed-effect model indicated a weak but positive relationship between the escitalopram concentration and dQT, with an estimated coefficient of concentration of 0.43-0.54. In conclusion, the pharmacokinetics and QT effect of a single dose of escitalopram observed in the elderly without comorbidities and younger adults were generally similar.
Benjaminsen, Lars; Birkelund, Jesper Fels
AIMS: This article analyses excess morbidity amongst homeless shelter users compared to the general Danish population. The study provides an extensive control for confounding and investigates to what extent excess morbidity is explained by homelessness or other risk factors. METHODS: Data set...... includes administrative micro-data for 4,068,926 Danes who were 23 years or older on 1 January 2007. Nationwide data on shelter use identified 14,730 individuals as shelter users from 2002 to 2006. Somatic diseases were measured from 2007 to 2011 through diagnosis data from hospital discharges. The risk...... of somatic diseases amongst shelter users was analysed through a multivariate model that decomposed the total effect into a direct effect and indirect effects mediated by other risk factors. RESULTS: The excess morbidity associated with shelter use is substantially lower than in studies that did not include...
Kendzor, Darla E; Reitzel, Lorraine R; Businelle, Michael S
This pilot study was conducted to explore the associations between stressors related to homelessness and modifiable health risk factors (poor diet, insufficient physical activity, and overweight/obesity) and to provide direction for future research. Participants (N = 57) were homeless adults enrolled in a smoking cessation program. Analyses were conducted to characterize the sample as well as the relations between relevant stressors (discrimination, chronic stress, and fear and mistrust) and health risk factors. Inadequate daily consumption of fruits, vegetables, and fiber was common. High-fat diet and insufficient physical activity were also prevalent, and the majority of participants were overweight/obese. Participants commonly endorsed discrimination, fear of victimization, mistrust of others, and several other stressors. Greater endorsement of stressors was associated with a high-fat diet. Results suggest that lifestyle interventions and policy changes may be warranted in homeless shelters to attenuate the potential effects of stressors on high-fat dietary consumption among smokers. © 2015 Society for Public Health Education.
Around ten homeless people were invited to take part in a programme of physical activities to improve their health status. Only motricity and walking pathways were followed assiduously for eight weeks. The assessment of the physical condition and quality of life showed an improvement in these areas, in particular for one of the participants. However, the lack of motivation and assiduity remains an obstacle to regular activity. Copyright © 2018 Elsevier Masson SAS. All rights reserved.
McQuay Henry J
Full Text Available Abstract Background Rofecoxib is a cyclo-oxygenase 2 selective inhibitor. This systematic review of rofecoxib in acute pain examined studies in adults of analgesic efficacy over six hours, the amount and quality of the evidence on extended duration of analgesia, and the quality and quantity of evidence on adverse events. Methods Cochrane Library (issue 4, 2001, Biological Abstracts (March 2002, MEDLINE (March 2002 and PubMed (March 2002 were searched using rofecoxib as a free text term. The area under the pain relief versus time curve was dichotomized using validated equations to derive the proportion of patients on rofecoxib 50 mg or placebo with at least 50% pain relief over six hours. This was used to calculate the number needed to treat for at least 50% pain relief over six hours for rofecoxib compared with placebo. Information on duration of analgesia and adverse events was also collected. Results Five included trials investigated 1,118 patients, of whom 211 received placebo and 464 received rofecoxib 50 mg. The NNT for rofecoxib 50 mg was 2.3 (95% confidence interval 2.0 to 2.6. The weighted mean remedication time was 1.9 hours for placebo (126 patients, 7.4 hours for ibuprofen 400 mg (97 patients and 13.6 hours for rofecoxib 50 mg (322 patients. Conclusion Rofecoxib at 2–4 times the standard daily dose for chronic pain is an effective single dose oral analgesic in acute pain. Limitations in trial reporting constrain conclusions about longer duration of analgesia and adverse event profile.
Warke, Amy L.
Homelessness is a growing phenomenon, especially among women and children (Hulchanski, 2009). This study was conducted because of the increase in families experiencing homelessness registering in my school. In none of the current studies about homelessness have the researchers spoken to the families and children experiencing homelessness. This…
Rosario, Margaret; Schrimshaw, Eric W.; Hunter, Joyce
Although lesbian, gay, and bisexual (LGB) youth with a history of homelessness (running away or being evicted from their homes by parents) report more psychological symptoms than homeless heterosexual peers, it is unclear whether symptoms are due to homelessness, given the absence of a non-homeless comparison group. This study longitudinally…
Hart, Linda M.
Homelessness is an increasing epidemic afflicting the United States. Of the millions of homeless in the United States, over two million are children (National Alliance to End Homelessness, 2009; Slesnick, Dashora, Letcher, Erden, & Serocivh, 2009). It is reported that over 1.2 million of homeless students are enrolled in public schools…
Swick, Kevin J.
Family homelessness has emerged as a serious global problem (Stronge, 2000). Over the past 25 years in the United States, the makeup of the homeless population has changed significantly. As De Angelis (1994) reports: The landscape of homelessness has changed since the early 1980s, when nearly all homeless people were men. Today,…
Miller, Peter; Schreiber, James
This mixed methods investigation of homeless education in a major urban region identified a number of significant developments and dilemmas amid the larger homeless crisis in the United States. We found that the wider community demographics of homelessness have shifted in recent years, resulting in a higher number of homeless families--many of…
Heflin, L. Juane; Rudy, Kathryn
This booklet examines the plight of homeless families who have children who need special educational services. It explores the magnitude of homelessness among families, provides empirical descriptions of homeless populations, and identifies factors contributing to the rising incidence of homelessness in the United States. Specific effects of…
Miller, Peter M.
Background/Context: This study contributes to the literature on the schooling of homeless and highly mobile students. Although previous work has detailed the demographics of homelessness, the effects of homelessness on academic progress, and particular legal issues in homeless education, this research focused on how individual and institutional…
Mulholland, Lori; Greene, Andrea
Homeless families with children comprise the fastest growing segment of the United States homeless population. This study evaluated Year 1 of the Arizona Head Start for Homeless Children and Families Project, designed to meet educational and social needs of homeless children and families, and to assist Head Start agencies in developing effective…
Homeless families with children constitute the fastest growing segment of the United States homeless population. This study evaluated Year 2 of the Arizona Head Start for Homeless Children and Families Project, designed to meet educational and social needs of homeless children and families, and to assist Head Start agencies in developing effective…
This paper explores the democratic potential for participatory filmmaking with homeless youth, as well as the constraints and dilemmas associated with this visual method. Theorizing democracy through the work of Hannah Arendt and Pierre Bourdieu, the paper approaches democracy not as an end, but rather as a process that seeks to lessen social injustice. Bourdieu's work helps us appreciate, however, that this process is constrained by structures of inequality that shape access to the political dispositions that enable such engagement. Consistent with other research on low-income and marginalized young people, this study found that homeless youth engage with democracy through forms of community participation and mutual support, and are disinclined to orient toward liberal democratic structures such as voting and political parties, which they see as harmful or problematic. With a focus on one particular dilemma faced by the research team-namely, the question of how to make sense of and represent the issue of legalizing marijuana, which had been signaled by the youth participants as of primary political importance to them-the paper uses Arendt and Bourdieu to discuss how participatory filmmaking can help to expand the space of appearances available to homeless youth in Canadian society, and create a space at a shared table of understanding with middle class power brokers. © 2018 Canadian Sociological Association/La Société canadienne de sociologie.
Grazioli, Véronique S; Hicks, Jennifer; Kaese, Greta; Lenert, James; Collins, Susan E
Chronically homeless individuals with alcohol dependence experience severe alcohol-related consequences. It is therefore important to identify factors that might be associated with reduced alcohol-related harm, such as the use of safer-drinking strategies. Whereas effectiveness of safer-drinking strategies has been well-documented among young adults, no studies have explored this topic among more severely affected populations, such as chronically homeless individuals with alcohol dependence. The aims of this study were thus to qualitatively and quantitatively document safer-drinking strategies used in this population. Participants (N=31) were currently or formerly chronically homeless individuals with alcohol dependence participating in a pilot study of extended-release naltrexone and harm-reduction counseling. At weeks 0 and 8, research staff provided a list of safer-drinking strategies for participants to endorse. Implementation of endorsed safer-drinking strategies was recorded at the next appointment. At both time points, strategies to buffer the effects of alcohol on the body (e.g., eating prior to and during drinking) were most highly endorsed, followed by changing the manner in which one drinks (e.g., spacing drinks), and reducing alcohol consumption. Quantitative analyses indicated that all participants endorsed safer-drinking strategies, and nearly all strategies were implemented (80-90% at weeks 0 and 8, respectively). These preliminary findings indicate that chronically homeless people with alcohol dependence use strategies to reduce harm associated with their drinking. Larger randomized controlled trials are needed to test whether interventions that teach safer-drinking strategies may reduce overall alcohol-related harm in this population. Copyright © 2015 Elsevier Inc. All rights reserved.
Hughes, J T; Maple-Brown, L J; Piers, L S; Meerkin, J; O'Dea, K; Ward, L C
To describe the development of a single-frequency bioimpedance prediction equation for fat-free mass (FFM) suitable for adult Aboriginal and Torres Strait Islander peoples with and without diabetes or indicators of chronic kidney disease (CKD). FFM was measured by whole-body dual-energy X-ray absorptiometry in 147 adult Indigenous Australians. Height, weight, body circumference and resistance were also measured. Adults with and without diabetes and indicators of CKD were examined. A random split sample with internal cross-validation approach was used to predict and subsequently validate FFM using resistance, height, weight, age and gender against measured FFM. Among 147 adults with a median body mass index of 31 kg/m(2), the final model of FFM was FFM (kg)=0.432 (height, cm(2)/resistance, ohm)-0.086 (age, years)+0.269 (weight, kg)-6.422 (if female)+16.429. Adjusted R(2) was 0.94 and the root mean square error was 3.33 kg. The concordance was high (rc=0.97) between measured and predicted FFM across a wide range of FFM (31-85 kg). In the context of the high burden of diabetes and CKD among adult Indigenous Australians, this new equation for FFM was both accurate and precise and based on easily acquired variables (height, weight, age, gender and resistance) among a heterogeneous adult cohort.
Gaskell, Helen; Derry, Sheena; Wiffen, Philip J; Moore, R Andrew
This review is an update of "Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults" last updated in Issue 4, 2009. Ketoprofen is a non-selective nonsteroidal anti-inflammatory drug (NSAID) used to treat acute and chronic painful conditions. Dexketoprofen is the (S)-enantiomer, which is believed to confer analgesia. Theoretically dexketoprofen is expected to provide equivalent analgesia to ketoprofen at half the dose, with a consequent reduction in gastrointestinal adverse events. This review is one of a series on oral analgesics for acute postoperative pain. Individual reviews have been brought together in two overviews to provide information about the relative efficacy and harm of the different interventions. To assess the efficacy and safety of single dose oral ketoprofen and oral dexketoprofen compared with placebo for acute postoperative pain, using methods that permit comparison with other analgesics evaluated in the same way, and criteria of efficacy recommended by an in-depth study at the individual patient level. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from 2009 to 28 March 2017. We also searched the reference lists of retrieved studies and reviews, and two online clinical trial registries. Randomised, double-blind, placebo-controlled trials of single dose orally administered ketoprofen or dexketoprofen in adults with moderate to severe acute postoperative pain. Two review authors independently considered studies for inclusion in the review, examined issues of study quality and potential bias, and extracted data. For dichotomous outcomes, we calculated risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or harmful outcome (NNH) with 95% confidence intervals (CI) for ketoprofen and dexketoprofen, compared with placebo, where there were sufficient data. We collected information on the number of participants with at least 50
Kabler, Brenda; Weinstein, Elana
Across America, the numbers of homeless children and families are growing as a result of many factors including the recent economic crisis, home foreclosures, and natural disasters. Because of an increase in the number of homeless children throughout the United States, this population has unmet needs that can be targeted in school settings under…
Objective: The unprecedented incidence of armed robberies and the involvement of young people in these crimes necessitated — as part of a comprehensive study on homelessness and criminal behaviour in Nigeria — an assessmet and comparison of homeless youths incarcerated in prisons with a control group of ...
Little contemporary research has examined young people's experiences of violence and homelessness in detail within the Australian context. This article draws upon qualitative research with 33 homeless youth in Melbourne and seeks to enhance understanding of the impact of violence on young people. It argues that everyday experiences of violence…
National Center on Family Homelessness (NJ1), 2011
This fact sheet was developed to help you understand the scope, causes, and impact of homelessness on children and families. You are encouraged to use it as well as the publications cited in its footnotes as tools more about homelessness. (Contains 78 endnotes.)
Tompsett, Carolyn J.; Toro, Paul A.
Parental deviance, parental monitoring, and deviant peers were examined as predictors of overt and covert antisocial behaviors. Homeless (N=231) and housed (N=143) adolescents were assessed in adolescence and again in early adulthood. Homelessness predicted both types of antisocial behaviors, and effects persisted in young adulthood. Parental…
Miller, Peter M.
Since the onset of the economic recession, rates of student homelessness have increased rapidly in urban, suburban, and rural school districts throughout the United States. Despite the widespread urgency of the issue, there is a lack of general coherence in the research about how diverse conditions of homelessness affect students and how schools…
Niedergang, Mark; McCoy, Martha, Ed.
This program guide provides a forum for discussing the different beliefs that influence public policy about homelessness as well as policy goals. The central question is addressed in two parts: (1) what society ought to do for homeless people; and (2) laying out a range of possible answers for part 1. Four possible answers are discussed: help only…
Miller, Peter M.
Purpose: This study sought deeper understanding of how sheltered families accessed and mobilized educationally related relationships and resources during periods of homelessness. Such work is posited to be especially relevant considering that there is a growing crisis of family homelessness in the United States and school- and community-based…
National Coalition for the Homeless, Washington, DC.
A 1989 national survey of the dimensions of homelessness found that at least three million Americans are homeless and that the shortage of affordable housing was cited as the chief cause. Information was gathered from a telephone survey of emergency shelter providers, housing advocacy organizations, and local governments in 26 communities, ranging…
Gregg, Melanie J.; Bedard, Andrea
Purpose: A pilot study was conducted to describe the physical activity experiences and perceived benefits of and barriers to physical activity participation for patrons of a homeless shelter. The resulting pilot data may be used to inform the creation of and support for physical activity and sport programs for those experiencing homelessness.…
Yamaguchi, Barbara J.; Strawser, Sherri; Higgins, Kyle
Families with children are the fastest growing group of persons who are homeless. To address their needs for education, this article discusses legal mandates, barriers to education presented by school requirements, effects of homelessness on children and youth, and the role of the educational diagnostician in providing services. Offers 14…
Molnar, Janice M.; And Others
Summarizes the small body of research to date that focuses on the effects of homelessness on children. In matters related to health, development, and education, homeless children are at a grave disadvantage, many from birth. Policy implications are outlined, concluding that children need permanent housing if they are to thrive. (DM)
Strawser, Sherri; Markos, Patricia A.; Yamaguchi, Barbara J.; Higgins, Kyle
Reviews the legislative provisions and mandates governing the education of children and youth who are homeless and the barriers to education presented by school requirements. Highlights the effects of homelessness on children and youth and the role the school counselor should play in the provision of services for them. (Contains 55 references.)…
Juchniewicz, Melissa M.
Despite calls for increased awareness of and sensitivity to diverse students and their in- and out-of-school literacies, the "invisible homeless"--those who often decline to self-identify--receive inadequate scholarly attention. They are often individuals who fear the stigma associated with homelessness as they navigate workplace, academic, and…
Mallett, Shelley; Rosenthal, Doreen; Keys, Deborah
Young people who experience homelessness, in Australia and in other western contexts (US, Canada, England), are widely perceived to use and abuse alcohol and drugs. The available research indicates that homeless young people use all drug types, whether injected or otherwise, more frequently than their home-based peers. Debate exists in the…
Hathazi, Dodi; Lankenau, Stephen E.; Sanders, Bill; Bloom, Jennifer Jackson
Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of…
Johnson, K.D.; Whitbeck, L.B.; Hoyt, D.R.
Recent research on the social support networks of homeless and runaway youth suggest the social networks of runaway youth are made up largely of transient deviant peer relationships. This paper examined social network characteristics of 428 homeless and runaway adolescents from small-to moderate-sized cities in four Midwestern states. We…
Tierney, William G.
In this commentary, the author reflects on a special issue that explores how educational institutions serve homeless and highly mobile students as well as their families. The number of homeless youth continues to rise, leading the author to question why structural constraints have not been removed. In addition to reflecting on the articles, he…
Morris, Rita I.; Strong, Linda
Qualitative research using the symbolic interactionism framework and grounded theory methodology was employed to discover the perceived health problems and dangers that homeless families with children endure. Data were collected using semistructured interviews from 34 homeless volunteer participants with 87 children. An in-depth analysis of the…
M.S. Richter (Solina); K. Kovacs Burns (Kathy); Y. Mao (Yuping); J. Chaw-Kant (Jean); M. Calder (Moira); S. Mogale (Shirley); L. Goin (Lyla); K. Schnell (Kerry)
textabstractThis article describes how the Canadian printed news media depicted the homeless and their situations between 1987 and 2007. Our study used a descriptive, cross-sectional design and a content analysis was conducted on selected newspaper articles on homelessness issues. The main themes
Horowitz, Sandra V.; And Others
Presents findings concerning conflict management and coping behavior of homeless adolescents. Interviews with 176 families (mother-adolescent dyads) indicate peer conflict was the worst problem of the previous month. Homeless adolescents demonstrated conflict management and coping patterns differing in certain aspects from that described in the…
The number of mothers with young children experiencing homelessness and seeking shelter has increased in the USA over the past decade. Shelters are often characterized as environments offering few opportunities for appropriate play experiences. This article delineates the important role of play for young children experiencing homelessness and…
Pavlakis, Alexandra E.; Goff, Peter; Miller, Peter M.
Background/Context: Students experiencing homelessness are also often living in poverty and may share many of the same characteristics and experiences with children in low-income housing. Scholars aim to understand the impacts of homelessness above and beyond the effects of poverty, but studies are mixed. Contextual factors--such as the localized…
Dufeu, P; Podschus, J; Schmidt, L G
Against the background of the complex relationship of alcoholism and homelessness, we investigated the question of whether homeless alcoholics and those with homes differed regarding biographical and clinical variables. Therefore, 49 of 72 (68.1%) homeless male visitors to a city kitchen in the center of Berlin, who had fulfilled the ICD-10 criteria for the alcohol-dependence syndrome, were compared with 141 outpatients of the addiction research unit of the Department of Psychiatry of the Free University of Berlin. It was found that homeless alcoholics had more psychosocial disadvantages than other alcoholics. They had been raised more frequently in families with an alcoholic father or mother and a higher number of children. The level of education and job qualification was lower in the homeless alcoholics. Early homelessness was predicted by a lack of sexual behavior (no partnership experienced) and a family history of alcoholism. In the interview, homeless alcoholics reported fewer symptoms of alcohol-dependence syndrome than other alcoholics; however, the first symptoms had been experienced earlier. Alcohol-related somatic and psychological consequences were reported more frequently in alcoholics with homes, whereas social problems were more common in the homeless subjects. The results are discussed in the light of methodological limitations and other reports on the topic.
Homelessness is a complex policy issue that all local governments face. But, at the same time, local authorities often have very little influence on the causes of homelessness, such as de-institutionalization, drug addiction, and release from detention or evictions. Seen in a European context,
Braun, Lisa Nelson
Describes experiences in using art with the homeless in an open studio approach. Discusses how offering open studio time with a range of materials showed that the homeless, each with a unique style and personal interests, were eager to create art objects and present them to the public. (RJM)
Green, Harold D; Tucker, Joan S; Golinelli, Daniela; Wenzel, Suzanne L
Homeless men are frequently unsheltered and isolated, disconnected from supportive organizations and individuals. However, little research has investigated these men's social networks. We investigate the structure and composition of homeless men's social networks, vis-a-vis short- and long-term homelessness with a sample of men drawn randomly from meal lines on Skid Row in Los Angeles. Men continuously homeless for the past six months display networks composed of riskier members when compared to men intermittently homeless during that time. Men who report chronic, long-term homelessness display greater social network fragmentation when compared to non-chronically homeless men. While intermittent homelessness affects network composition in ways that may be addressable with existing interventions, chronic homelessness fragments networks, which may be more difficult to address with those interventions. These findings have implications for access to social support from network members which, in turn, impacts the resources homeless men require from other sources such as the government or NGOs.
Zhang, Linda; Norena, Monica; Gadermann, Anne; Hubley, Anita; Russell, Lara; Aubry, Tim; To, Matthew J; Farrell, Susan; Hwang, Stephen; Palepu, Anita
Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorders, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having concurrent disorders on health care utilization among homeless or vulnerably housed individuals, using longitudinal data from the Health and Housing in Transition Study. In 2009, 1190 homeless or vulnerably housed adults were recruited in Ottawa, Toronto, and Vancouver, Canada. Participants completed baseline interviews and four annual follow-up interviews, providing data on sociodemographics, housing history, mental health diagnoses, problematic drug use with the Drug Abuse Screening Test (DAST-10), problematic alcohol use with the Alcohol Use Disorders Identification Test (AUDIT), chronic health conditions, and utilization of the following health care services: emergency department (ED), hospitalization, and primary care. Concurrent disorders were defined as the participant having ever received a mental health diagnosis at baseline and having problematic substance use (i.e., DAST-10 ≥ 6 and/or AUDIT ≥ 20) at any time during the study period. Three generalized mixed effects logistic regression models were used to examine the independent association of having concurrent disorders and reporting ED use, hospitalization, or primary care visits in the past 12 months. Among our sample of adults who were homeless or vulnerably housed, 22.6% (n = 261) reported having concurrent disorders at baseline. Individuals with concurrent disorders had significantly higher odds of ED use (adjusted odds ratio [AOR] = 1.71; 95% confidence interval [CI], 1.4-2.11), hospitalization (AOR = 1.45; 95% CI, 1.16-1.81), and primary care visits (AOR = 1.34; 95% CI, 1.05-1.71) in the past 12 months over the four-year follow-up period, after adjusting for potential confounders. Concurrent disorders were associated with
Paradis, E K
This paper presents a feminist and community psychology analysis of ethical concerns that can arise throughout the process of doing research with women who are homeless. The unique contexts of the lives of women who are homeless demand that researchers redefine traditional ethical constructs such as consent, privacy, harm, and bias. Research that fails to do this may perpetuate the stereotyping, marginalization, stigmatization, and victimization homeless women face. Feminist and community research ethics must go beyond the avoidance of harm to an active investment in the well-being of marginalized individuals and communities. Using feminist and community psychology ethics, this paper addresses some common problems in research with women who are homeless, and argues for the transformation of research from a tool for the advancement of science into a strategy for the empowerment of homeless women and their communities.
Rice, Alexander; Kim, Ji Youn Cindy; Nguyen, Christopher; Liu, William Ming; Fall, Kevin; Galligan, Patrick
This study explored the perceptions of fatherhood held by 11 men living in a homeless shelter. Using consensual qualitative research methodology (CQR; Hill, 2012), we investigated perceptions of masculinity and fatherhood among fathers experiencing homelessness. Participants described (a) their perceptions of masculinity and fatherhood and changes resulting from homelessness, (b) physical and psychological challenges of being a father experiencing homelessness, and (c) expectations of homeless fathers. The fathers generally expressed feelings of low self-esteem related to their perceived difficulty fulfilling the role of providers for their family; however, they also adapted their view of fatherhood to include roles suited to their situation, such as that of guide, teacher, and role model. Suggestions are made for clinicians in helping fathers navigate and develop these roles, and limitations and directions for future research are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Martens, W H
To review the physical and mental status in homeless people. A MEDLINE database search covering 5 decades was supplemented by tracing back through references from existing review work. Over 200 articles were extracted, and 106 were selected for review. Homeless persons suffer frequently from physical health problems like tuberculosis, asthma, bronchitis, HIV infection, and as a consequence, they run an increased risk for premature mortality. The prevalence of mental disorders among homeless individuals varies from 80-95% in the USA, Australia, Canada, Norway, and Germany to 25-33% in Ireland and Spain. The most prominent mental disorders among the homeless, which vary from country to country, are depression, affective disorders, substance abuse, psychotic disorders, schizophrenia, and personality disorders. Homelessness is a major public health problem that should have our special interest.
Roy, Laurence; Vallée, Catherine; Kirsh, Bonnie H; Marshall, Carrie Anne; Marval, Rebecca; Low, Alissa
Persons experiencing or at risk of homelessness have occupational needs that are seldom addressed in the Canadian system of care. The lack of documented evidence on occupational therapy practices in this field hinders the development of the profession. This article identifies current and potential practices that aim to enable or support the occupations of persons experiencing or at risk of homelessness. A scoping review was conducted, including evidence from both occupational therapy and non-occupational therapy sources. One hundred and seventy-eight papers were selected in the areas of occupational performance skills training, enrichment of occupational repertoire, employment/education, physical rehabilitation services, child/family services, community building, occupational transition from homeless to housed, literacy, and disaster relief. Occupational therapists can build environments and create opportunities that facilitate occupational engagement of individuals experiencing homelessness. Gaps in knowledge include the evaluation of occupational therapy practices, the Canadian context of family homelessness, and the cultural safety of occupational therapy interventions.
Feodor Nilsson, Sandra; Hjorthøj, Carsten Rygaard; Erlangsen, Annette
BACKGROUND: Homeless people have elevated mortality, especially due to external causes. We aimed to examine suicide and unintentional injury mortality levels and identify predictors in the homeless population. METHODS: A nationwide, register-based cohort study of homeless people aged 16 years...... and older was carried out using the Danish Homeless Register, 1999-2008. RESULTS: In all, 32 010 homeless people (70.5% men) were observed. For men, the mortality rate was 174.4 [95% confidence interval (CI) = 150.6-198.1] per 100 000 person-years for suicide and 463.3 (95% CI = 424.......6-502.0) for unintentional injury. For women, the corresponding rates were 111.4 (95% CI = 81.7-141.1) for suicide and 241.4 (95% CI = 197.6-285.1) for unintentional injury. Schizophrenia spectrum, affective, personality and substance use disorders were strongly associated with increased risk of suicide; the highest risk...
Clemens, Elysia; Hess, Robyn S.; Strear, Molly M.; Rue, Lisa; Rizzolo, Sonja; Henninger, Janessa
This Consensual Qualitative Research study explored experiences of youth, families, and homeless liaisons to better understand how educational environments can foster resilience among youth experiencing homelessness. The purpose of the study was to provide educational stakeholders with guidance on how to actualize the McKinney-Vento Homeless…
Trudy Laura Norman
Full Text Available Participation of people with experiences of homelessness is critical to the development of meaningful strategies to end homelessness. The purpose of this study was to gain insights from people who have been homeless in a mid-sized Canadian city, as to strategies that facilitate meaningful participation in solutions to end homelessness. Within an overarching framework of collaborative research, we collected data through seven focus groups and employed interpretive description as our approach to data analysis. In our analysis, we identified both exclusionary and inclusionary forces that impact participation. Exclusionary forces included being ‘caught in the homelessness industry’, ‘homelessness is a full time job’ and facing stigma/discrimination that make participation a ‘leap of faith’. Inclusionary forces included earning respect and building trust to address unequal power relations, and restoring often ‘taken for granted’ social relations. Specific strategies to enhance participation include listening, valuing skills and stories, and supporting advocacy efforts. The study findings illuminate ways in which power imbalances are lived out in the daily lives of people who experience homelessness, as well as mitigating forces that provide direction as to strategies for addressing power inequities that seek to make participation and social inclusion meaningful. Keywords: homelessness, social policy, social exclusion, social inclusion, advocacy
Background Montreal is Canada's second-largest city, where mean annual tuberculosis (TB) incidence from 1996 to 2007 was 8.9/100,000. The objectives of this study were to describe the epidemiology of TB among homeless persons in Montreal and assess patterns of transmission and sharing of key locations. Methods We reviewed demographic, clinical, and microbiologic data for all active TB cases reported in Montreal from 1996 to 2007 and identified persons who were homeless in the year prior to TB diagnosis. We genotyped all available Mycobacterium tuberculosis isolates by IS6110 restriction fragment length polymorphism (IS6110-RFLP) and spoligotyping, and used a geographic information system to identify potential locations for transmission between persons with matching isolates. Results There were 20 cases of TB in homeless persons, out of 1823 total reported from 1996-2007. 17/20 were Canadian-born, including 5 Aboriginals. Homeless persons were more likely than non-homeless persons to have pulmonary TB (20/20), smear-positive disease (17/20, odds ratio (OR) = 5.7, 95% confidence interval (CI): 1.7-20), HIV co-infection (12/20, OR = 14, 95%CI: 4.8-40), and a history of substance use. The median duration from symptom onset to diagnosis was 61 days for homeless persons vs. 28 days for non-homeless persons (P = 0.022). Eleven homeless persons with TB belonged to genotype-defined clusters (OR = 5.4, 95%CI: 2.2-13), and ten potential locations for transmission were identified, including health care facilities, homeless shelters/drop-in centres, and an Aboriginal community centre. Conclusions TB cases among homeless persons in Montreal raise concerns about delayed diagnosis and ongoing local transmission. PMID:22034944
Coles, Emma; Chan, Karen; Collins, Jennifer; Humphris, Gerry M; Richards, Derek; Williams, Brian; Freeman, Ruth
The objective of the study was to determine the effect of dental health status, dental anxiety and oral-health-related quality of life (OHRQoL) upon homeless people's experience of depression. A cross-sectional survey was conducted on a sample of homeless people in seven National Health Service Boards in Scotland. All participants completed a questionnaire to assess their depression, dental anxiety and OHRQoL using reliable and valid measures. Participants had an oral examination to assess their experience of tooth decay (decayed and missing teeth). Latent variable path analysis was conducted to determine the effects of dental health status on depression via dental anxiety and OHRQoL using intensive resampling methods. A total of 853 homeless people participated, of which 70% yielded complete data sets. Three latent variables, decayed and missing teeth, dental anxiety (Modified Dental Anxiety Scale: five items) and depression (Center for Epidemiological Studies Depression Scale: two factors), and a single variable for OHRQoL (Oral Health Impact Profile total scale) were used in a hybrid structural equation model. The variable decayed and missing teeth was associated with depression through indirect pathways (total standardised indirect effects=0.44, Pdental anxiety (χ²=75.90, df=40, comparative fit index=0.985, Tucker-Lewis index=0.977, root mean square error of approximation=0.051 [90% confidence interval: 0.037-0.065]). Depression in Scottish homeless people is related to dental health status and oral-health-related factors. Decayed and missing teeth may influence depression primarily through the psychological constructs of OHRQoL and, to a lesser extent, dental anxiety. Copyright © 2010 Elsevier Inc. All rights reserved.
Piche, Joshua; Kaylegian, Jaeson; Smith, Dale; Hunter, Scott J
Introduction: Almost 2 million U.S. youth are estimated to live on the streets, in shelters, or in other types of temporary housing at some point each year. Both their age and living situations make them more likely to engage in high-risk behaviors, particularly during adolescence, a time of increased risk taking. Much of self-control appears related to the development of the prefrontal cortex, which is at a particularly crucial period of elaboration and refinement during adolescence and emerging adulthood. Executive processes like decision-making, inhibition, planning, and reasoning may be vulnerable to adversity experienced as a result of homelessness and related impoverishment during childhood and adolescence. No study to date, to our knowledge, has directly investigated differences in risk-taking by homeless youth as it relates to their developing executive control. Objective: Examine the relationship between the level of self-reported executive function (EF) and engagement in risk taking behaviors among a sample of shelter-living urban homeless youth. We predicted that homeless youth who have lower levels of self-reported EF would more readily engage in risky behaviors that could lead to negative outcomes. Participants: One hundred and forty-nine youths between 18 and 22 years of age were recruited from homeless agencies in Chicago. Of this study sample, 53% were female and 76% African American. Measures: All participants completed, as part of a broader neuropsychological assessment, the Behavior Rating Inventory of Executive Functioning-Adult Version (BRIEF-A), the National Youth Risk Behavior Survey (YRBS), and the Mini-International Neuropsychiatric Interview (MINI). Analyses: Groups were separated based on level of self-reported EF, with two groups identified: High self-reported EF fell >1 SD above the normative average, and low self-reported EF fell >1 SD below the normative average. All analyses utilized Chi-square and Mann-Whitney tests. Results and
Pamukoff, Derek N; Haakonssen, Eric C; Zaccaria, Joseph A; Madigan, Michael L; Miller, Michael E; Marsh, Anthony P
Improving muscle strength and power may mitigate the effects of sarcopenia, but it is unknown if this improves an older adult's ability to recover from a large postural perturbation. Forward tripping is prevalent in older adults and lateral falls are important due to risk of hip fracture. We used a forward and a lateral single-step balance recovery task to examine the effects of strength training (ST) or power (PT) training on single-step balance recovery in older adults. Twenty older adults (70.8±4.4 years, eleven male) were randomly assigned to either a 6-week (three times/week) lower extremity ST or PT intervention. Maximum forward (FLean(max)) and lateral (LLean(max)) lean angle and strength and power in knee extension and leg press were assessed at baseline and follow-up. Fifteen participants completed the study (ST =7, PT =8). Least squares means (95% CI) for ΔFLean(max) (ST: +4.1° [0.7, 7.5]; PT: +0.6° [-2.5, 3.8]) and ΔLLean(max) (ST: +2.2° [0.4, 4.1]; PT: +2.6° [0.9, 4.4]) indicated no differences between groups following training. In exploratory post hoc analyses collapsed by group, ΔFLean(max) was +2.4° (0.1, 4.7) and ΔLLean(max) was +2.4° (1.2, 3.6). These improvements on the balance recovery tasks ranged from ~15%-30%. The results of this preliminary study suggest that resistance training may improve balance recovery performance, and that, in this small sample, PT did not lead to larger improvements in single-step balance recovery compared to ST.
Full Text Available OBJECTIVE: As almost any version of percutaneous nephrolithotomy (PCNL was safely and efficiently applied for adults as well as children without age being a limiting risk factor, the aim of the study was to compare the different characteristics as well as the efficacy, outcome, and safety of the pediatric and adult patients who had undergone mini-PCNL (MPCNL in a single institution. METHODS: We retrospective reviewed 331 renal units in children and 8537 renal units in adults that had undergone MPCNL for upper urinary tract stones between the years of 2000-2012. The safety, efficacy, and outcome were analyzed and compared. RESULTS: The children had a smaller stone size (2.3 vs. 3.1 cm but had smilar stone distribution (number and locations. The children required fewer percutaneous accesses, smaller nephrostomy tract, shorter operative time and less hemoglobin drop. The children also had higher initial stone free rate (SFR (80.4% vs. 78.6% after single session of MPCNL (p0.05. Both groups had low rate of high grade Clavien complications. There was no grade III, IV, V complications and no angiographic embolization required in pediatric group. One important caveat, children who required multiple percutaneous nephrostomy tracts had significant higher transfusion rate than in adults (18.8% vs. 4.5%, p = 0.007. CONCLUSIONS: This contemporary largest-scale analysis confirms that the stone-free rate in pediatric patients is at least as good as in adults without an increase of complication rates. However, multiple percutaneous nephrostomy tracts should be practiced with caution in children.
Assad, Salman; Rahat Aleman Bhatti, Joshua; Hasan, Aisha; Shabbir, Muhammad Usman; Akhter, Saeed
Objective To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. Materials and methods From January 2011 to January 2015 (four years), ESWL was performed in 104 children and 300 adults for urolithiasis. MODULITH® SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) equipment was used for ESWL. The stone-free rates, the number of ESWL sessions required, complication rates and ancillary procedures used were evaluated in a comparative manner. Results The mean age ± standard deviation (SD) of children was 7.84±4.22 years and of adults was a 40.22±1.57 years. Mean ± SD of the stone size was 1.28±61 cm in the adults while 1.08 ± 0.59 cm in the children. In adults, the complications included steinstrasse in six (1.98%) patients, fever in 15 (4.95%), hematuria in 19 (6.28%) and sepsis in six (1.98%) patients. In children, steinstrasse was observed in two (1.9%), mild fever in two (1.9%), hematuria in six (5.7%) and sepsis was seen in four (3.8%) patients. The overall complication rate in the adults and in the children, it was found to be 46/300 (15%) and in the children, it was seen to be 14/104 (13%). No statistical difference was found in post-ESWL complications between children and adults (P>0.05). Ancillary procedures including double J (DJ) stent were used in 13 (12.5%) children and 87 (29%) adults. There was a better stone clearance rate in children i.e. 79% as compared to 68% in adults (X2: P=0.036). Conclusion Children can achieve high stone-free rates after ESWL with a lower need for repeat ancillary procedures as compared to adults. However, there is a difference in the post-ESWL complications between these groups. PMID:27800291
Korzeniewska-Koseła, Maria; Kuś, Jan; Lewandowska, Katarzyna; Siemion-Szcześniak, Izabela
The fall in rates of tuberculosis (TB) in many countries has been accompanied by the concentration of cases in the social risk groups including homeless persons. Comparison of TB features in homeless persons and in non-homeless patients. TB cases reported to National TB Register in Poland in whom information about the social status was available (the data about the social status were collected obligatorily in the years 2004-2013 only) were analysed. The results of DSTs were obtained from laboratory records and were available for the cases reported since 2010. Treatment outcome after 12 months was analysed for the cases registered between 2004-2012. The significance (Si) of the differences in proportions was assessed with chi-square test. Phomeless persons (HP) and 72,989 other patients (OP) with TB were included. In the group of HP, there was a greater proportion of males in comparison with OP (90.5% vs. 66.3%) (Si). The mean age of HP was 49.8 years (SD±10.9); of OP-52.9 years (SD±17.5) (Si). 16.6% of HP and 10.4% of OP were previously treated for TB (Si). The previous treatment was adequate in 62.2% of HP and in 85.8% of OP (Si). Pulmonary TB was in 98.0%, extrapulmonary TB in 2.0% of HP and, respectively, in 92.5% and 7.5% of OP (Si). Pulmonary TB was confirmed by culture in 76.3% of HP and in 64.5% of OP (Si). Sputum smears were positive in 70.7% of HP and in 62.5% of OP (Si). Caseous pneumonia occurred in 2.7% of homeless subjects and in 1.1% of OP (Si); infiltrative TB in 95.5% of HP and in 97.5% of OP (Si). Resistance to isoniazid was observed in 2.9% of HP and in 3.1% of OP; to rifampicin in 0.0% of HP and in 0.2% of OP; to isoniazid and rifampicin in 0.4% of HP and in 0.8% of OP. These differences were not Si. Treatment success rate among HP was 44.1%; default rate 24.8%; 4.0% of HP died from tuberculosis; 3.2% died from other causes; 5.2% were transferred and their outcomes were unknown; 0.4% were still on treatment; 0.4% had treatment failure; in 17
Several jurisdictions in the United States (e.g., Florida and Washington) have recently incorporated the status of "homeless" under the protection of hate crime legislation. This was largely promoted by new data and reports by the National Coalition for the Homeless urging added protection for the homeless. The issue of whether the homeless belong under hate crime provisions raises the following question: What criteria must a group meet to be eligible for its inclusion? What similarities do the homeless have with other protected groups? Finally, what implications does the recognition of economic status have on other economic groups, particularity the top wealthy 1%? In this article, I explore some of the issues raised by including the homeless as a protected group. I survey several rationales offered for the selection of protected characteristics. I argue that the rationales currently offered suffer from descriptive inadequacy by either being under- or over-inclusive. I turn instead to the political conception of "disadvantage" for an identity marker that better explains the link between the various protected groups and identities under hate crime legislation. Moreover, the use of disadvantage allows for the inclusion of the homeless without the need for incorporating other socio-economic identities. © The Author(s) 2014.
Ennis, Naomi; Roy, Sylvain; Topolovec-Vranic, Jane
Cognitive impairment may interfere with an individual's ability to function independently in the community and may increase the risk of becoming and remaining homeless. The purpose of this study was to systematically review the literature on memory deficits among people who are homeless in order to gain a better understanding of its nature, causes and prevalence. Studies that measured memory functioning as an outcome among a sample of homeless persons were included. Data on sampling, outcome measures, facet of memory explored and prevalence of memory impairment were extracted from all selected research studies. Included studies were evaluated using a critical appraisal process targetted for reviewing prevalence studies. Eleven studies were included in the review. Verbal memory was the most commonly studied facet of memory. Potential contributing factors to memory deficits among persons who are homeless were explored in seven studies. Memory deficits were common among the samples of homeless persons studied. However, there was a great deal of variation in the methodology and quality of the included studies. Conceptualisations of "homelessness" also differed across studies. There is a need for more controlled research using validated neuropsychological tools to evaluate memory impairment among people who are homeless.
Desai, R A; Lam, J; Rosenheck, R A
It has been suggested that criminal justice involvement among the homeless, particularly those with mental illness, is largely situational. The objective of this study was to assess, in a sample of homeless seriously mentally ill people, the prevalence of childhood conduct disorder behaviors as a risk factor for adult criminal activity as well as the extent and types of adult criminal justice contact. Data were taken from the national ACCESS program, which conducted extensive baseline interviews with 7,222 homeless seriously mentally ill adults. The interview assessed demographics, childhood risk factors for criminal activity such as conduct disorder behaviors, foster care, and parental abuse, as well as current illness severity and recent criminal justice contact. The 2-month arrest rate in this sample was much higher than national rates (11% compared with 1% annually in the general population). Although most arrests were for minor crimes (10.8%), there were also substantial rates of arrest for major (2.7%) and substance-related charges (2.0%). The prevalence of a history of conduct disorder behavior was also substantial (55% in male subjects, 40% in female subjects), and conduct disorder was a strong predictor of recent criminal justice involvement, even after controlling for other predictors of arrest (odds ratio = 1.76 for major crimes, 1.49 for minor crimes, and 1.98 for substance-related crimes). Recent literature has criticized a trend to criminalize homeless mentally ill persons for attempting to get needed food, shelter, or medical attention. However, these data indicate that at least some proportion of arrests in this population are of people who have been exhibiting antisocial behavior since early adolescence, and that early antisocial behavior is a strong predictor of all types of recent arrests in this population.
Full Text Available While the prevalence of mental illness or cognitive disability is higher among homeless people than the general population in Western countries, few studies have investigated its prevalence in Japan or other Asian countries. The present study conducted a survey to comprehensively assess prevalence of mental illness, cognitive disability, and their overlap among homeless individuals living in Nagoya, Japan.Participants were 114 homeless individuals. Mental illness was diagnosed based on semi-structured interviews conducted by psychiatrists. The Wechsler Adult Intelligence Scale-III (WAIS-III, simplified version was used to diagnose intellectual/ cognitive disability.Among all participants, 42.1% (95% CI 33.4-51.3% were diagnosed with a mental illness: 4.4% (95% CI 1.9-9.9% with schizophrenia or other psychotic disorder, 17.5% (95% CI 11.6-25.6% with a mood disorder, 2.6% (95% CI 0.9-7.5% with an anxiety disorder, 14.0% (95% CI 8.8-21.6% with a substance-related disorder, and 3.5% (95% CI 1.4-8.8% with a personality disorder. Additionally, 34.2% (95% CI 26.1-43.3% demonstrated cognitive disability: 20.2% (95% CI 13.8-28.5% had mild and 14.0% (95% CI 8.8-21.6% had moderate or severe disability. The percent overlap between mental illness and cognitive disability was 15.8% (95% CI 10.2-23.6%. Only 39.5% (95% CI 26.1-43.3% of the participants were considered to have no psychological or cognitive dysfunction. Participants were divided into four groups based on the presence or absence of mental illness and/or cognitive disability. Only individuals with a cognitive disability reported a significant tendency toward not wanting to leave their homeless life.This is the first report showing that the prevalence of mental illness and/or cognitive disability among homeless individuals is much higher than in the general Japanese population. Appropriate support strategies should be devised and executed based on the specificities of an individual's psychological
Nishio, Akihiro; Yamamoto, Mayumi; Horita, Ryo; Sado, Tadahiro; Ueki, Hirofumi; Watanabe, Takahiro; Uehara, Ryosuke; Shioiri, Toshiki
While the prevalence of mental illness or cognitive disability is higher among homeless people than the general population in Western countries, few studies have investigated its prevalence in Japan or other Asian countries. The present study conducted a survey to comprehensively assess prevalence of mental illness, cognitive disability, and their overlap among homeless individuals living in Nagoya, Japan. Participants were 114 homeless individuals. Mental illness was diagnosed based on semi-structured interviews conducted by psychiatrists. The Wechsler Adult Intelligence Scale-III (WAIS-III, simplified version) was used to diagnose intellectual/ cognitive disability. Among all participants, 42.1% (95% CI 33.4-51.3%) were diagnosed with a mental illness: 4.4% (95% CI 1.9-9.9%) with schizophrenia or other psychotic disorder, 17.5% (95% CI 11.6-25.6%) with a mood disorder, 2.6% (95% CI 0.9-7.5%) with an anxiety disorder, 14.0% (95% CI 8.8-21.6%) with a substance-related disorder, and 3.5% (95% CI 1.4-8.8%) with a personality disorder. Additionally, 34.2% (95% CI 26.1-43.3%) demonstrated cognitive disability: 20.2% (95% CI 13.8-28.5%) had mild and 14.0% (95% CI 8.8-21.6%) had moderate or severe disability. The percent overlap between mental illness and cognitive disability was 15.8% (95% CI 10.2-23.6%). Only 39.5% (95% CI 26.1-43.3%) of the participants were considered to have no psychological or cognitive dysfunction. Participants were divided into four groups based on the presence or absence of mental illness and/or cognitive disability. Only individuals with a cognitive disability reported a significant tendency toward not wanting to leave their homeless life. This is the first report showing that the prevalence of mental illness and/or cognitive disability among homeless individuals is much higher than in the general Japanese population. Appropriate support strategies should be devised and executed based on the specificities of an individual's psychological and
professionals including a psychiatrist, a nurse, an addiction councilor, and social workers with administrative authority from the social office and the job center. In the international research literature ACT has been shown in randomized controlled trials to be a very effective method in bringing individuals...... out of homelessness and into a stable housing situation. The study is based on quantitative outcome measurement on about 80 citizens who have been assigned to the programme and who have received both a housing solution and support from the ACT-team. The study is not a randomized controlled trial...
Sharman, Steve; Dreyer, Jenny; Clark, Luke; Bowden-Jones, Henrietta
Backgrounds and aims Problem gambling occurs at higher levels in the homeless than the general population. Past work has not established the extent to which problem gambling is a cause or consequence of homelessness. This study sought to replicate recent observations of elevated rates of problem gambling in a British homeless sample, and extend that finding by characterizing (a) the temporal sequencing of the effect, (b) relationships with drug and alcohol misuse, and (c) awareness and access of treatment services for gambling by the homeless. Methods We recruited 72 participants from homeless centers in Westminster, London, and used the Problem Gambling Severity Index to assess gambling involvement, as well as DSM-IV criteria for substance and alcohol use disorders. A life-events scale was administered to establish the temporal ordering of problem gambling and homelessness. Results Problem gambling was evident in 23.6% of the sample. In participants who endorsed any gambling symptomatology, the majority were categorized as problem gamblers. Within those problem gamblers, 82.4% indicated that gambling preceded their homelessness. Participants displayed high rates of substance (31.9%) and alcohol dependence (23.6%); these were not correlated with PGSI scores. Awareness of treatment for gambling was significantly lower than for substance and alcohol use disorders, and actual access of gambling support was minimal. Discussion and conclusions Problem gambling is an under-recognized health issue in the homeless. Our observation that gambling typically precedes homelessness strengthens its role as a causal factor. Despite the elevated prevalence rates, awareness and utilization of gambling support opportunities were low compared with services for substance use disorders.
Sharman, Steve; Dreyer, Jenny; Clark, Luke; Bowden-Jones, Henrietta
Backgrounds and aims Problem gambling occurs at higher levels in the homeless than the general population. Past work has not established the extent to which problem gambling is a cause or consequence of homelessness. This study sought to replicate recent observations of elevated rates of problem gambling in a British homeless sample, and extend that finding by characterizing (a) the temporal sequencing of the effect, (b) relationships with drug and alcohol misuse, and (c) awareness and access of treatment services for gambling by the homeless. Methods We recruited 72 participants from homeless centers in Westminster, London, and used the Problem Gambling Severity Index to assess gambling involvement, as well as DSM-IV criteria for substance and alcohol use disorders. A life-events scale was administered to establish the temporal ordering of problem gambling and homelessness. Results Problem gambling was evident in 23.6% of the sample. In participants who endorsed any gambling symptomatology, the majority were categorized as problem gamblers. Within those problem gamblers, 82.4% indicated that gambling preceded their homelessness. Participants displayed high rates of substance (31.9%) and alcohol dependence (23.6%); these were not correlated with PGSI scores. Awareness of treatment for gambling was significantly lower than for substance and alcohol use disorders, and actual access of gambling support was minimal. Discussion and conclusions Problem gambling is an under-recognized health issue in the homeless. Our observation that gambling typically precedes homelessness strengthens its role as a causal factor. Despite the elevated prevalence rates, awareness and utilization of gambling support opportunities were low compared with services for substance use disorders. PMID:27348556
Montgomery, Ann E; Dichter, Melissa E; Thomasson, Arwin M; Roberts, Christopher B
The Veterans Health Administration seeks to reduce homelessness among Veterans by identifying, and providing prevention and supportive services to, patients with housing concerns. The objectives of this study were to assess the proportion of Veterans Health Administration patients who received homeless or social work services within 6 months of a positive screen for homelessness or risk in the Veterans Health Administration and the demographic and clinical characteristics that predicted services utilization. Data were from a cohort of 27,403 Veteran outpatients who screened positive for homelessness or risk between November 1, 2012 and January 31, 2013. During 2013, AORs were calculated using a mixed-effects logistic regression to estimate the likelihood of patients' receipt of VHA homeless or social work services based on demographic and clinical characteristics. The majority of patients received services within 6 months post-screening; predictors of services utilization varied by gender. Among women, diagnosis of drug abuse and psychosis predicted receipt of services, being unmarried increased the odds of using services among those screening positive for homelessness, and a diagnosis of post-traumatic stress disorder increased the odds of receiving services for at-risk women. Among men, being younger, unmarried, not service-connected/Medicaid-eligible, and having a medical or behavioral health condition predicted receipt of services. Receipt of housing support services among Veterans post-homelessness screening differs by patient demographic and clinical characteristics. Future research should investigate the role that primary and secondary prevention interventions play in Veterans' resolution of risk for homelessness and experience of homelessness. Published by Elsevier Inc.
Chong, Foong Yen; Jenstad, Lorienne M
Single-microphone noise reduction (SMNR) is implemented in hearing aids to suppress background noise. The purpose of this article was to provide a critical review of peer-reviewed studies in adults and children with sensorineural hearing loss who were fitted with hearing aids incorporating SMNR. Articles published between 2000 and 2016 were searched in PUBMED and EBSCO databases. Thirty-two articles were included in the final review. Most studies with adult participants showed that SMNR has no effect on speech intelligibility. Positive results were reported for acceptance of background noise, preference, and listening effort. Studies of school-aged children were consistent with the findings of adult studies. No study with infants or young children of under 5 years old was found. Recent studies on noise-reduction systems not yet available in wearable hearing aids have documented benefits of noise reduction on memory for speech processing for older adults. This evidence supports the use of SMNR for adults and school-aged children when the aim is to improve listening comfort or reduce listening effort. Future research should test SMNR with infants and children who are younger than 5 years of age. Further development, testing, and clinical trials should be carried out on algorithms not yet available in wearable hearing aids. Testing higher cognitive level for speech processing and learning of novel sounds or words could show benefits of advanced signal processing features. These approaches should be expanded to other populations such as children and younger adults. Implications for rehabilitation The review provides a quick reference for students and clinicians regarding the efficacy and effectiveness of SMNR in wearable hearing aids. This information is useful during counseling session to build a realistic expectation among hearing aid users. Most studies in the adult population suggest that SMNR may provide some benefits to adult listeners in terms of listening
Godbout, Natacha; Sabourin, Stephane; Lussier, Yvan
This study compared the usefulness of single- and multiple-indicator strategies in a model examining the role of child sexual abuse (CSA) to predict later marital satisfaction through attachment and psychological distress. The sample included 1,092 women and men from a nonclinical population in cohabiting or marital relationships. The single-item…
Castellow, Jennifer; Kloos, Bret; Townley, Greg
This paper argues that the experience of homelessness is inherently traumatic and thus has the potential to affect the manifestation of mental illness. The experiences related to being homeless might act as specific and unique sources of vulnerability. This study included 424 people diagnosed with serious mental illnesses living in supported housing programs in South Carolina. Three hierarchical regression analyses measuring the impact of homelessness on three types of outcomes revealed the following: (1) ever experiencing homelessness as well as the amount of time spent homeless were related to higher levels of psychiatric distress, (2) ever experiencing homelessness was related to higher levels of reported alcohol use, and (3) total amount of time spent homeless was related to lower perceived recovery from mental illness. These findings suggest that experiencing homelessness might contribute to psychosocial vulnerability to negative mental health outcomes. Future investigations examining this concept of risk and vulnerability as a result of homelessness are in order.
Rahman, Mai Abdul; Turner, J. Fidel; Elbedour, Salman
Background: The drastic surge in the number of homeless families in the United States (U.S.) has resulted in an increase in the number of homeless students attending U.S. public schools. Meanwhile, the U.S. public school system is struggling to meet the educational needs of their homeless students. Objective: This study examined the historical…
PREP/TECH is a skill development, academic enrichment program of U. of Toledo in Toledo OH and The Engineers Foundation of Ohio; it addresses the mathematics, science, language, and intellectual needs of about 100 African-American and Hispanic-American 7th, 8th, and 9th graders in Toledo. This summer, after 3 weeks of classes, the 80 students returned for a second 3 week session and were divided into two groups, one studying the growing problem of homelessness in America. This group researched and published a pamphlet on homelessness. This report is divided into: myths, causes, descriptions, and solutions. Finally, a brief account is given of the homelessness project.
TERRY, Marisa J; BEDI, Gurpreet; PATEL, Neil
Approximately 1.6 - 2.8 million youth at any given time in the United States are considered homeless and at high risk for poor social and health outcomes. It is estimated that in the United States homelessness overall is expected to rise 10 -20 percent in the next year. While governmental and private programs exist to address the tribulations faced by homeless persons, youth continue to be underserved. The 2009, $787 billion economic stimulus package includes $1.5 billion to address issues...
Csaba, G; Karabélyos, Cs
Hormonal imprinting develops during the perinatal critical period, when the target hormone meets the yet unmatured receptor. As a consequence of imprinting the receptor accomplishes its maturation reaching the binding capacity characteristic to adults. In this period in the presence of foreign molecules similar to the target hormone faulty imprinting may occur with life-long consequences. Soy bean contains phytosteroids which can mimic estrogen effects. In the present experiments single genistein (20 microg) or combined genistein + benzpyrene (20 microg) treatments were done neonatally and the sexual behavior of male and female adult animals was studied. Genistein significantly increased the lordosis quotient of females, which was compensated by neonatal benzpyrene treatment. Genistein also enhanced the sexual activity of males, and this was significantly not reduced by parallel benzpyrene treatment. The results show that neonatal genistein exposure can imprint sexual activity for life and the presence of a second imprinter can modify genistein's behavioral effect.
Full Text Available The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis during single-leg standing including relative holding time (RHT and relative standstill time (RST, and clinical balance tests (timed up and go test and 5-repetition sit to stand test. The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests.
Shah, A R
Single coronary artery arising from aortic root, is a rare congenital anomaly. A 30-year-old male presented with acute myocardial infarction (MI) complaining of chest pain and raised troponin levels. Emergency angiography showed no coronary lesions but both left and right coronary arteries arising from single ostium. Patient was operated electively and perioperative findings confirmed the diagnosis of single coronary artery, as left coronary artery after taking origin from right sinus of valsalva runs through the septum, before dividing into left anterior descending and circumflex branches. The single coronary ostium opened with a slit like incision over the course of left main coronary, making the size of ostium three to four times bigger than the native one. In addition left internal mammary artery was harvested and grafted to the left anterior descending branch distally. Patient made successful recovery. Four months follow up dobutamine stress echo showed no inducible ischemia.
The Adult-Adolescent Parenting Inventory (AAPI) is a 32-item inventory widely used to identify adolescents and adults at risk for inadequate parenting behaviors. It includes four subscales representing the most frequent patterns associated with abusive parenting: (a) Inappropriate Expectations; (b) Lack of Empathy; (c) Parental Value of Corporal Punishment; and (d) Parent-Child Role Reversal. Although it has been used in a variety of samples, the psychometric properties of the AAPI have not been examined in low-income single mothers. The purposes of this study were to: (a) examine the reliability and validity of the Adult-Adolescent Parenting Inventory (AAPI) in a sample of 206 low-income single mothers; (b) assess the mother's risk for inadequate parenting by comparing their AAPI subscale scores with normative subscale scores on the AAPI; (c) assess the construct validity of the AAPI by testing the hypothesis that mothers with lower AAPI scores have a higher level of depressive symptoms and lower self-esteem in comparison to mothers with higher AAPI scores; and (d) determine whether the 4-factor structure proposed by Bavolek (1984) could be replicated. AAPI scores indicated these mothers were at high risk for child abuse when compared with normative data for parents with no known history of abuse. Higher risk for abusive parenting was associated with a higher level of depressive symptoms, less education, and unemployment. The subscales, Inappropriate Expectations and Parental Value of Corporal Punishment demonstrated poor internal consistency with Cronbach's alphas of .40 and .54, respectively. Hypothesis testing supported the construct validity of the AAPI. Bavolek's 4-factor structure was not supported. A 19-item modified version of the AAPI with three dimensions was identified. This modified version of the AAPI may provide a more efficacious tool for use with low-income single mothers.
This study investigated the possible differences between single individuals and individuals in nonmarital romantic relationships in the domains of emotional (romantic and family) and social loneliness, and of perceived social support from family, friends and significant others. Based on a Polish university-student sample of 315 participants (167 women and 148 men) aged 19 to 25?years (M?=?21.90, SD?=?2.15), single relationship status was related to greater romantic and family loneliness, and ...
Department of Housing and Urban Development — This report displays the data communities reported to HUD about the nature of and amount of persons who are homeless as part of HUD's Point-in-Time (PIT) Count. This...
Full Text Available Research utilizing the individual case study method examined the complex issues related to pathways into and out of home-lessness for an Aboriginal man from a First Nation community on the western James Bay in Canada. This instrumental case study focused on an individual's story, rather than on a site or a group of individuals, an incident or a series of incidents, or a program  . First, as a research tool, it provides insight into the issue of homelessness and some of its causes from the perspective of an Aboriginal person. Second, the in-depth data gathered allowed us to understand some of the factors that work and those that do not work in facilitating transitions out of homelessness. Third, as an educational tool, it allows people from the outside to have a better understanding of how systemic disadvantages contribute to individuals falling into homelessness.
Attempts to demonstrate the value of conjunctural interpretive analysis (which is multilevel, multimodal, and explicitly theoretical and political) through an interpretation of the culture of homelessness in the United States. Addresses differences between positivist epistemologies. (SR)
... and skills training) to expedite the reintegration of homeless Veterans into the labor force.'' HVRP... of Labor/VETS. Applications submitted through http://www.grants.gov or hard copy will be accepted. If...
JHON J. SANABRIA
Full Text Available In this paper, I review the prevention and intervention efforts addressing youth homelessness in the fieldof psychology between 1994 and 2004. Analyses of the literature revealed that the majority of papersincluding homeless youth as a population for study have focused on issues other than homelessness.These issues include HIV/AIDS and substance abuse prevention. Eleven journal articles addressing youthhomelessness were reviewed. These articles focused on outcomes, interventions, and recommendationsfor clinical practice. Literature findings revealed that demographic variables did not predict outcomesfor homeless youth; youth returning home with their parents have more positive outcomes than youthmoving into other locations, emergency shelter services improve youth’s mental health and social condition,and services should be comprehensive and move beyond the individuals. Implications for communitypsychology, policy makers, and shelters are discussed.
... visit our Internet site, Social Security Online, at http://www.socialsecurity.gov . SUPPLEMENTARY... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2011-0087] Supplemental Security Income and Homeless Individuals AGENCY: Social Security Administration. ACTION: Notice; Request for Comments. SUMMARY...
Nath, Veena; Hallett, Ronald E.
Stereotypical notions of who experiences homelessness frame how educational institutions approach policy and program development. This life history of a teacher challenges assumptions by providing an in-depth look at a mother's struggle to find stability.
Jetelina, Katelyn K; Reingle Gonzalez, Jennifer M; Cuccaro, Paula M; Peskin, Melissa F; Elliott, Marc N; Coker, Tumaini R; Mrug, Sylvie; Davies, Susan L; Schuster, Mark A
The purpose of this study was to evaluate the relationship between the number of periods children were exposed to familial homelessness and childhood aggression and victimization. Survey data were obtained from 4,297 fifth-grade children and their caregivers in three U.S. cities. Children and primary caregivers were surveyed longitudinally in 7th and 10th grades. Family homelessness, measured at each wave as unstable housing, was self-reported by the caregiver. Children were categorized into four mutually exclusive groups: victim only, aggressor only, victim-aggressor, and neither victim nor aggressor at each time point using validated measures. Multinomial, multilevel mixed models were used to evaluate the relationship among periods of homelessness and longitudinal victimization, aggression, and victim aggression compared to children who were nonvictims and nonaggressors. Results suggest that children who experienced family homelessness were more likely than domiciled children to report aggression and victim aggression but not victimization only. Multivariate analyses suggested that even brief periods of homelessness were positively associated with aggression and victim aggression (relative to neither) compared to children who were never homeless. Furthermore, childhood victimization and victim aggression significantly decreased from 5th grade to 10th grade while aggression significantly increased in 10th grade. Children who experienced family homelessness for brief periods of time were significantly more likely to be a victim-aggressor or aggressor compared to those who were never homeless. Prevention efforts should target housing security and other important factors that may reduce children's likelihood of aggression and associated victimization. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Retno Woro Kaeksi
The factors that cause them to he homeless are the economic factor 77.78%, lack of family attention (13.33% and the willingness to he independent (80.89%. Based on the result this research, we know that the poverty has made the children become homeless. The strategis to survive are: they are thrif (40%, add their time to work (13.13%, move to other place (11.11% and save their money (15.56%.
Homes for the Homeless, Inc., New York, NY.
In the early part of 1999, the Institute for Children and Poverty surveyed almost 2,000 families with more than 4,000 children in 24 locations to assess the state of homeless children across the United States. This report tells their story. Families account for almost 40% of U.S. homeless people, and in some cities that percentage is even higher.…
Tweed, Roger G.; Biswas-Diener, Robert; Lehman, Darrin R.
This study examined self-perceived strengths among 116 people who were homeless. Those who had experienced a longer period of current homelessness tended to report fewer personal strengths (r = −0.23). Nonetheless, in spite of their marginalized position in society, the vast majority of participants (114 out of 116) perceived personal strengths. A prior diagnosis with mental illness was not associated with the number of strengths reported, but self-perception of strengths was associated with ...
Homelessness in the 21st century is an ongoing problem, increasing due to the country's recent economic downturn, especially in urban areas. This podcast discusses how homelessness impacts health and what public health professionals can do about it. Created: 11/19/2010 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) and National Center for Environmental Health (NCEH). Date Released: 11/19/2010.
Homelessness in the 21st century is an ongoing problem, increasing due to the country's recent economic downturn, especially in urban areas. This podcast discusses how homelessness impacts policy and what public health professionals can do about it. Created: 11/19/2010 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) and National Center for Environmental Health (NCEH). Date Released: 11/19/2010.
Homelessness in the 21st century is an ongoing problem, increasing due to the country's recent economic downturn, especially in urban areas. This podcast discusses how homelessness impacts policy and what public health professionals can do about it. Created: 11/19/2010 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) and National Center for Environmental Health (NCEH). Date Released: 11/19/2010.
Homelessness in the 21st century is an ongoing problem, increasing due to the country's recent economic downturn, especially in urban areas. This podcast discusses how homelessness impacts health and what public health professionals can do about it. Created: 11/19/2010 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) and National Center for Environmental Health (NCEH). Date Released: 11/19/2010.
Leibler, Jessica H; Nguyen, Daniel D; León, Casey; Gaeta, Jessie M; Perez, Debora
Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA ( n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population. Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink. Heavy drinking, injection drug use, and sleeping outdoors were identified as significant risk factors for reduced hygiene practices. People experiencing homelessness who also engage in these activities may be among the most difficult to reach for intervention, yet targeted efforts may decrease illness risk associated with reduced hygiene. Housed friends and family play a critical role in assisting homeless individuals maintain hygiene by providing showers and laundry facilities.
Kermode, M; Crofts, N; Speed, B; Miller, P; Streeton, J
To describe tuberculosis infection among persons experiencing homelessness in inner Melbourne, Australia. Homeless people were surveyed during late 1995 and early 1996. In stage one of the study 284 homeless people from crisis and long-term accommodation sites were recruited by means of stratified, systematic, random sampling. In stage two a convenience sample of 100 homeless people from squats and the streets were recruited. Participants completed a questionnaire and Mantoux testing was performed. A past history of tuberculosis was reported by 3%. Thirty-seven per cent had a Mantoux > or =10 mm; 21% > or =15 mm; and 11% > or =20 mm. A Mantoux > or =15 mm was independently associated with being aged > or =40 years, coming from the accommodated sample, overseas birth, and a past history of tuberculosis. Using logistic regression modelling, a Mantoux > or =15 mm was predicted by being aged > or =40 years, overseas birth, and past history of tuberculosis. Mantoux test results suggest that this group of homeless people had a high prevalence of infection with the tubercle bacillus. Many aspects of the physical and social circumstances of homeless people predispose to reactivation and have the potential to enhance rapid spread should latent infection become active disease.
Full Text Available Carlos Salavera,1 José M Tricás,2 Orosia Lucha21Faculty of Education, University of Zaragoza, Zaragoza, Spain; 2Physiotherapy Research Unit, University of Zaragoza, Zaragoza, SpainAbstract: The homeless drop out of treatment relatively frequently. Also, prevalence rates of personality disorders are much higher in the homeless group than in the general population. We hypothesize that when both variables coexist – homelessness and personality disorders – the possibility of treatment drop out grows. The aim of this study was to analyze the hypotheses, that is, to study how the existence of personality disorders affects the evolution of and permanence in treatment. One sample of homeless people in a therapeutic community (N = 89 was studied. The structured clinical interview for the diagnostic and statistical manual of mental disorders (DSM-IV-TR was administered and participants were asked to complete the Millon Clinical Multiaxial Inventory-II (MCMI-II. Cluster B personality disorders (antisocial, borderline, and narcissistic avoided permanence in the treatment process while cluster C disorders, as dependent, favored adhesion to the treatment and improved the prognosis. Knowledge of these personality characteristics should be used to advocate for better services to support homeless people and prevent their dropping out before completing treatment.Keywords: MCMI-II, abandonment, personality disorder, homeless
Full Text Available The demographics of the homeless population in many countries are currently shifting, and this cannot be explained by the different welfare systems to be found in these countries. Nevertheless, there is some evidence that the homelessness policies of some countries are converging, and we observe a combination of decentralisation, housing first, and a taylor-made, individualised approach. However, what is interesting is the question as to what extent these policies are based on a punitive dimension or on a justice dimension. This aspect is little discussed in the Netherlands where policies to combat homelessness are intended to put an end to public nuisance and to get the homeless off the street. Research into evicted families demonstrates that combining elements of (mild coercion with efforts to solve homelessness leads to problems in at least three domains: the motivation of homeless families to accept help and support, the quality of life in the individualised approach, and the matter of registration. These problems need investigating, also from an international perspective.
Douthitt, Robin A.
A study found that, over time, married women employed full time have not decreased the time spent working in the home. Married men with young children have increased the time spent on home work. Single parents' time most closely resembled that of married women. (JOW)
Armin D. Goralczyk
Full Text Available Adult living donor liver transplantations (ALDLTs across the ABO blood group barrier have been reported in Asia, North Americas, and Europe, but not yet in Germany. Several strategies have been established to overcome the detrimental effects that are attached with such a disparity between donor and host, but no gold standard has yet emerged. Here, we present the first experiences with three ABO-incompatible adult living donor liver transplantations in Germany applying different immunosuppressive strategies. Four patient-donor couples were considered for ABO-incompatible ALDLT. In these patients, resident ABO blood group antibodies (isoagglutinins were depleted by plasmapheresis or immunoadsorption and replenishment was inhibited by splenectomy and/or B-cell-targeted immunosuppression. Despite different treatments ALDLT could safely be performed in three patients and all patients had good initial graft function without signs for antibody-mediated rejection (AMR. Two patients had long-term graft survival with stable graft function. We thus propose the feasibility of ABO-incompatible ALDLT with these protocols and advocate further expansion of ABO incompatible ALDLT in multicenter trials to improve efficacy and safety.
White, Brandi M; Jones, Walter J; Moran, William P; Simpson, Kit N
Primary care access (PCA) for the homeless can prove challenging, especially during periods of economic distress. In the United States, the most recent recession may have presented additional barriers to accessing care. Limited safety-net resources traditionally used by the homeless may have also been used by the non-homeless, resulting in delays in seeking treatment for the homeless. Using hospitalizations for ambulatory care sensitivity (ACS) conditions as a proxy measure for PCA, this study investigated the recession's impact on PCA for the homeless and non-homeless in four states. The State Inpatient Databases were used to identify ACS admissions. Findings from this study indicate the recession was a barrier to PCA for homeless people who were uninsured. Ensuring that economically-disadvantaged populations have the ability to obtain insurance coverage is crucial to facilitating PCA. With targeted outreach efforts, the Affordable Care Act provides an opportunity for expanding coverage to the homeless.
...-0001] RIN 0584-AD60 Direct Certification and Certification of Homeless, Migrant and Runaway Children... interim rule entitled Direct Certification and Certification of Homeless, Migrant and Runaway Children for...
Abbas Ostad Taghi Zadeh
Conclusions: This study supports the idea that injection drug use is contributing to the increased spread of HIV among Iranian homeless. Harm reduction programs should be expanded, particularly among homeless injection drug users.
Swick, Kevin J.
Homeless parents of young children face many stressors that erode their self-esteem. This article articulates these stressors and how they negatively impact homeless parents and their children. Strategies for helping parents empower themselves and their children are explained.
Linton, Sabriya L; Cooper, Hannah Lf; Kelley, Mary E; Karnes, Conny C; Ross, Zev; Wolfe, Mary E; Friedman, Samuel R; Jarlais, Don Des; Semaan, Salaam; Tempalski, Barbara; Sionean, Catlainn; DiNenno, Elizabeth; Wejnert, Cyprian; Paz-Bailey, Gabriela
Housing instability has been associated with poor health outcomes among people who inject drugs (PWID). This study investigates the associations of local-level housing and economic conditions with homelessness among a large sample of PWID, which is an underexplored topic to date. PWID in this cross-sectional study were recruited from 19 large cities in the USA as part of National HIV Behavioral Surveillance. PWID provided self-reported information on demographics, behaviours and life events. Homelessness was defined as residing on the street, in a shelter, in a single room occupancy hotel, or in a car or temporarily residing with friends or relatives any time in the past year. Data on county-level rental housing unaffordability and demand for assisted housing units, and ZIP code-level gentrification (eg, index of percent increases in non-Hispanic white residents, household income, gross rent from 1990 to 2009) and economic deprivation were collected from the US Census Bureau and Department of Housing and Urban Development. Multilevel models evaluated the associations of local economic and housing characteristics with homelessness. Sixty percent (5394/8992) of the participants reported homelessness in the past year. The multivariable model demonstrated that PWID living in ZIP codes with higher levels of gentrification had higher odds of homelessness in the past year (gentrification: adjusted OR=1.11, 95% CI=1.04 to 1.17). Additional research is needed to determine the mechanisms through which gentrification increases homelessness among PWID to develop appropriate community-level interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available Insuring the access to an adequate housing is frequently a pre-condition for the exercise of many other basic rights that any individual must gain. Lacking the access to civilized living conditions probably signifies the most serious manifestation of social exclusion. Lacking a home is synonymous to the extreme poverty, in fact, representing more than a life contingency but the extreme frame of a deficit of means and opportunities. The term ”homeless” defines a human condition which is hard to believe that someone would have problems in understanding it. However, almost everybody who uses this term uses a different definition to define it. These definitions become mere ”instruments” which justify the action or the lack of it depending on who uses it. The condition of an adult homeless person presupposes a series of attributes which define it. Therefore, the state of isolation, marginalization, alienation and social exclusion have extreme outcomes within the frame of emotional, relational and social integration. In this respect, there must be built and improved new programmes and social services for the benefit of the homeless persons. As a result of the work experience with these homeless persons I identified some stages of the adaptation to the street life. It is self-evident that the psycho-social degradation is a process and not a gradual evolution. The intervention of the specialists through the specialized services is vital for the improvement of the quality of life for these beneficiaries of welfare work. The present research develops a strategy related to the social services in Braila offered as a method of social reinsertion of the street life, especially those from the municipality of Braila.
Full Text Available Abstract Background Homelessness is a critical social issue, both a product of, and contributing to, poor mental and physical health. Over 150,000 young Canadians live on the streets. Homeless youth experience a high incidence of infectious diseases, many of which are vaccine preventable. Early departure from school and limited access to public health services makes them a particularly vulnerable high-risk group. This study explores challenges to obtaining essential vaccines experienced by homeless youth. Methods A qualitative research study to explore knowledge, attitudes, beliefs, and experiences surrounding immunization of hard-to-reach homeless youth was designed. Participants were recruited for focus groups from Phoenix House and Shelter, a non-profit, community-based organization assisting homeless youth in Halifax, Nova Scotia, Canada. An experienced facilitator guided the recorded discussions. Transcripts of audiotapes were analyzed using a constant comparative method until data revealed a set of exemplars and themes that best captured participants’ knowledge, attitudes, beliefs and experiences surrounding immunization and infectious diseases. Results Important themes emerged from our analysis. Considerable variability in knowledge about immunization and vaccine preventable diseases was found. The homeless youth in the study had limited awareness of meningitis in contrast to a greater knowledge about sexually transmitted infections and influenza, gained during the H1N1/09 public health campaign. They recognized their poverty as a risk for contracting infectious diseases, along with their inability to always employ known strategies to prevent infectious diseases, due to circumstances. They showed considerable insight into the detrimental effects of poor hygiene, sleeping locations and risk behaviour. Interviewed homeless youth regarded themselves as good compliers of health professional advice and offered valuable suggestions to improve
Abstract This article gives voice to refugee young people experiencing homelessness. It is based on a project that conducted interviews with refugee young people and consultations with service providers. The research reveals that the profoundly under-recognised phenomenon of homelessness experienced by young people of refugee background is often hidden and does not match commonly held beliefs about homeless young people. The article examines the nexus between migration and homelessness in...
Golay, Vishal; Trivedi, Mayuri; Kurien, Anila Abraham; Sarkar, Dipankar; Roychowdhary, Arpita; Pandey, Rajendra
The etiology of nephrotic syndrome (NS) in adults varies depending on the geographical location and is poorly studied in the Indian subcontinent. Patients (≥16 years old) with NS presenting to our center and undergoing a kidney biopsy from April 2010 to September 2012 were included for this study. All biopsies were subjected to light and immunofluorescence microscopy, and electron microscopy in selected cases. The histopathological spectrum was analyzed according to the various clinical parameters. A total of 410 kidney biopsies were included for analysis. Two hundred and thirty seven (57.8%) patients were male and 173 (42.19%) patients were female. The average age at presentation was 33.68 ± 13.88 years. Among the patients, 88.05% (n = 361) were diagnosed with primary glomerular diseases (PGD) and 11.95% (n = 49) with secondary glomerular diseases (SGD). The most common histological lesions were focal segmental glomerulosclerosis (FSGS) (24.63%) followed by minimal change disease (MCD) (23.9%) and membranous nephropathy (MN) (22.44%). The most common form of SGD was lupus nephritis (LN) (6.58% of all cases). FSGS (28.27%) and MCD (21.96%) were the most common lesions in males and females, respectively. In the age groups of 16-29 years, 30-59 years, and ≥60 years, MCD (28.96%), MN (24%), and MN (40.74%) were the most common lesions, respectively, followed by FSGS in all groups (25.68%, 24.5%, and 18.52%, respectively). Among the patients, 27.07% had serum creatinine ≥1.5 mg/dL and 28.54% had either macroscopic or microscopic hematuria. FSGS is increasingly becoming the most common cause of adult NS. This trend in Asia is seen predominantly in countries of the Indian subcontinent.
Huang, Tzu-Hao; Kuo, Junne-Yih; Huang, Yi-Hsiu; Chung, Hsiao-Jen; Huang, William J S; Wu, Howard H H; Chang, Yen-Hwa; Lin, Alex T L; Chen, Kuang-Kuo
In the general population, prostate adenocarcinoma affects predominately older men. If fact, most current guidelines suggest that males over the age of 50 years should undergo prostate cancer screening. However, the clinical behavior and prognosis of prostate cancer in young adults is not well defined. The aim of this study was to evaluate the clinical behavior, pathological characteristics, and prognosis of prostate cancer in young adults. We retrospectively reviewed the records of young patients (age, ≤50 years) in our hospital with prostate adenocarcinoma between 1997 and 2013. We compared data including initial presentation, cancer cell type, Gleason score, disease stage, prostate-specific antigen (PSA) level, prostate volume, treatment, and survival between patients both younger and older than 50 years. Data were analyzed using the Kaplan-Meier method to assess survival. Twenty-six patients were enrolled in our study, accounting for 0.55% of all patients with a diagnosis of prostate cancer at our facility. All 26 patients had a pathology diagnosis of adenocarcinoma, with a mean age on diagnosis of 46.8±2.8 years (range, 39-50 years). On initial presentation, patients older than 50 years more frequently displayed lower urinary tract symptoms (LUTS) than younger patients (62.3% vs. 30.4%, p=0.008). There was no statistical difference in histological grade, disease stage, PSA level, overall survival, and biochemical-free survival between the two groups. The result of our investigation indicated that prostate adenocarcinoma patients younger than 50 years had similar histological grade, disease stage, PSA level, overall survival, and biochemical-free survival as the older population. However, patients younger than 50 years with prostate cancer less frequently showed initial symptoms of LUTS. Copyright © 2016. Published by Elsevier Taiwan LLC.
Wenzel, Suzanne L; Rhoades, Harmony; Harris, Taylor; Winetrobe, Hailey; Rice, Eric; Henwood, Ben
Homeless persons suffer disproportionately high rates of HIV infection, and moving into permanent supportive housing (PSH) can provide a stable base from which to access needed prevention services. However, little is known about HIV risk or prevention behavior during this critical time of transition. The current study investigated STI and HIV risk and prevention behavior and recent use of prevention and treatment services (i.e., education, testing, medication) among homeless persons preparing to move into PSH. Data come from interviews with 421 homeless adults before they moved into PSH. Thirty-seven percent of the respondents were sexually active; of those, 75.7% reported unprotected sex. Nearly two-thirds (64%) reported past year HIV testing and 40% reported testing for another STI. Fewer than one-third (31%) of respondents reported receiving posttest counseling at their last HIV test. HIV seropositivity was self-reported by 10%. Among those persons who were HIV-positive, 57.1% reported less than 100% antiretroviral (ARV) adherence. Among HIV-negative respondents, less than 1% had been prescribed preexposure prophylaxis (PrEP). Less than half (46.4%) of the sample reported any HIV prevention education in the past year. This population of homeless adults about to move into PSH report high rates of HIV risk behavior, but low rates of HIV prevention education and very little PrEP utilization. Further, low rates of ARV adherence among HIV-positive respondents indicate significant risk for HIV transmission and acquisition. Entering PSH is a period of transition for homeless persons when integrated care is critically important to ensure positive health outcomes, but these data suggest that PrEP and other HIV prevention services are poorly accessed among this population. As such, multipronged services that integrate PrEP and other HIV prevention services are needed to prevent transmission and acquisition of HIV in this high-risk, vulnerable population and ensure the
Siebel, Nancy L.; Bassuk, Ellen; Medeiros, Debra
This article was originally published (November 2011) as a brief created on behalf of the Strengthening At Risk and Homeless Young Mothers and Children Coordinating Center, which is a partnership of The National Center on Family Homelessness, National Alliance to End Family Homelessness, and ZERO TO THREE. The article offers a definition of…
Wilkins, Brittany Taylor; Mullins, Mary H.; Mahan, Amber; Canfield, James P.
The federal government enacted the McKinney--Vento Homeless Assistance Act (MVA) to equip schools with services to help alleviate the many barriers students experiencing homelessness face in pursuit of educational opportunities. Educational agencies use federally mandated liaisons to uphold the provisions of the MVA. Despite the homeless liaisons'…
Haskett, Mary E.; Armstrong, Jenna Montgomery; Tisdale, Jennifer
The developmental status and social-emotional functioning of young children who are homeless has received inadequate attention in spite of high rates of homelessness among families with young children and the potentially negative impact of homelessness and associated stressors on children's well-being. The aim of this study was to gain…
Ruttan, Lia; Laboucane-Benson, Patricia; Munro, Brenda
Homeless young women experience high levels of stress, challenges to mental health, substance use and abuse, and a lack of housing or of secure housing. This article explores one of the findings from a longitudinal qualitative study designed to follow homeless young women for a 2-year period as they make efforts to transition out of homelessness.…
Schindler, Holly S.; Coley, Rebekah L.
The present qualitative research focuses on homeless fathers living with their children in family shelters. Data were collected through semistructured, face-to-face interviews with homeless fathers (n = 9) and shelter directors (n = 3). Findings suggest that how fathers made meaning of their experiences in a homeless shelter was related to…
Although the topic of homelessness receives a great deal of attention in journalism and throughout popular culture, the discourse of homelessness remains largely unexamined and unquestioned. This discourse creates stereotypes and perpetuates homelessness by portraying it as an inevitability rather than a contingency. Rhetoric and composition…
Edidin, Jennifer P.; Ganim, Zoe; Hunter, Scott J.; Karnik, Niranjan S.
Youth homelessness is a growing concern in the United States. Despite difficulties studying this population due to inconsistent definitions of what it means to be a youth and homeless, the current body of research indicates that abuse, family breakdown, and disruptive family relationships are common contributing factors to youth homelessness.…
Homes for the Homeless, Inc., New York, NY.
In 1997, the Institute for Children and Poverty of Homes for the Homeless joined with more than 58 organizations from 10 cities across the country to develop a national snapshot of family homelessness in the United States. Nearly 800 families were surveyed. This report presents the results of this research. The typical homeless family in the…
de Bradley, Ann Aviles
Many homeless children and youth have difficulty in school due to their loss of stable housing, and lack of consistent contact with family and friends. When a child becomes homeless, schools are federally mandated to identify these students and provide the same access to a free and appropriate education as their non-homeless counterparts. Within a…
Gargiulo, Richard M.
Homelessness is a growing social problem in the United States. Especially vulnerable to this phenomenon are young children because homelessness is viewed as a breeding ground for disabilities. Despite federal legislation ensuring educational opportunities, the educational needs of children who are homeless are frequently unfulfilled. This article…
McDaniel, Grace Ann
The number of homeless children in the United States is increasing. The National Center on Family Homelessness (2010) reports that on average one in 50 children in the United States have experienced homelessness, defined as unstable housing. The needs of this student demographic are varied and complex. For the purpose of this study, the homeless…