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Adams CS, Roach CA, Berini CR, Cooper NA, Kahle RW, Player MS, Diaz VA. Health Needs Assessment of Unhoused Youth in Charleston, South Carolina. FAMILY & COMMUNITY HEALTH 2024; 47:280-287. [PMID: 39158174 DOI: 10.1097/fch.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
BACKGROUND Over 35 000 youth experience homelessness on any given night in the United States (US). Unhoused youth experience unique physical and mental health challenges and face barriers in every social determinant of health (SDoH), which may be amplified in the LGBTQ+ population. OBJECTIVE The objective of this study was to define characteristics of the unhoused youth population and their utilization of healthcare to inform programs to meet their needs. METHODS Secondary analysis of data from the College of Charleston's YOUth Count survey was conducted, focusing on health-related characteristics, challenges, healthcare utilization, and SDoH of youth aged 18 to 25 experiencing homelessness in Charleston, SC. RESULTS Almost three-quarters of respondents (74.6%) reported mental health challenges and 35% reported physical health challenges. A significantly higher proportion of those who engaged in survival sex were LGBTQ+ . More than half (68.4%) visited the emergency department (ED) and 29.3% were admitted to the hospital in the past 12 months. Housing status, safety, food insecurity, sexual orientation, prior foster care, and survival sex were all significantly associated with ED utilization. Housing status and survival sex were significantly associated with hospital admission. CONCLUSIONS Addressing SDoH is essential to improving health outcomes and healthcare utilization among unhoused youth, particularly in the LGBTQ+ population.
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Affiliation(s)
- Cristin S Adams
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Adams, Mss Berini and Cooper, and Drs Player and Diaz); Department of Family Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina (Dr Roach); and Kahle Strategic Insights, Charleston, South Carolina (Dr Kahle)
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Bowdring MA, Macia KS, Shaffer PM, Smelson D, Blonigen DM. Criminogenic Needs and Legal Problem Severity Among Legal System Involved Veterans. Mil Med 2024; 189:e1544-e1551. [PMID: 38140960 DOI: 10.1093/milmed/usad472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/06/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Many veterans seeking behavioral health services have history of criminal-legal involvement. Research on criminogenic needs of legal system involved veterans is burgeoning. However, most research has relied on cross-sectional examinations and the vast majority of prior work has focused assessment on just one criminogenic need per study. METHODS The present study evaluated seven key criminogenic needs of legal system involved veterans (N = 341) enrolled in one of three U.S. Veterans Health Administration residential behavioral health treatment programs. Criminogenic needs and legal problem severity were assessed at baseline, and at 6 months and 12 months post-baseline. Directionality of associations between participants' criminogenic needs and legal problem severity was examined using latent change score models. RESULTS Results revealed having more antisocial associates at a previous timepoint was associated with greater subsequent improvements in legal problem severity ($\beta $=-0.01, P < 0.02) and greater improvements in legal problem severity predicted greater subsequent improvements in alcohol problem severity ($\beta $=0.13, P < 0.01). CONCLUSIONS In one of the most comprehensive single-study assessments of criminogenic needs among a sample of legal system involved veterans, results highlight links between antisocial associates and alcohol problem severity with legal problem severity.
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Affiliation(s)
- Molly A Bowdring
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA 94304, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kathryn S Macia
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Paige M Shaffer
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
- VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - David Smelson
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
- VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Daniel M Blonigen
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
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Garney WR, Flores SA, Garcia KM, Panjwani S, Wilson KL. Adolescent Healthcare Access: A Qualitative Study of Provider Perspectives. J Prim Care Community Health 2024; 15:21501319241234586. [PMID: 38414252 PMCID: PMC10901052 DOI: 10.1177/21501319241234586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Adolescent access to quality healthcare is key to prevention and early intervention for health risk behaviors. This paper provides a healthcare provider perspective on barriers and facilitators to youth accessing care. METHODS Five focus groups were conducted from November to December 2020 with providers from a variety of healthcare settings. Participants were asked to describe their respective adolescent patient populations, adolescent-specific health concerns, and organizational accommodations specific for youth services. Transcripts were analyzed using Inductive Thematic Analysis and themes were grouped using a social-ecological framework. RESULTS At an individual level, providers noted that an adolescent's knowledge and ability to navigate services varied greatly across settings. Providers identified provider trust and parent/guardian support as key interpersonal factors that support adolescents' access to services. Organizational factors included bureaucratic barriers and the clinic's reputation among youth. Community factors centered on mistrust within healthcare systems and stigmatization of seeking certain types of services. Participants also described how state-level policies influence parent/guardian consent requirements, which can limit adolescents' access to care. CONCLUSION Adolescent access to and utilization of healthcare in the United States is a complex problem requiring systems-level change. Healthcare organizations and providers have the opportunity and capacity to positively influence adolescents' healthcare access and experiences, however a lack of standardized, clinic-level priorities and guidelines can limit adolescent-centered care.
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Affiliation(s)
| | | | | | - Sonya Panjwani
- Texas A&M University, College Station, TX, USA
- Integral Global, Tucker, GA, USA
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Bennett-Daly G, Maxwell H, Bridgman H. The Health Needs of Regionally Based Individuals Who Experience Homelessness: Perspectives of Service Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8368. [PMID: 35886228 PMCID: PMC9316847 DOI: 10.3390/ijerph19148368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/07/2022]
Abstract
The bidirectional relationship between homelessness and poor health and the barriers that individuals who experience homelessness face when trying to access healthcare are well documented. There is, however, little Australian research exploring the situation of individuals who experience homelessness in regional contexts and, moreover, from the perspective of service providers. A qualitative descriptive methodology underpinned this study, with in-depth semi-structured interviews being conducted with 11 service providers to identify barriers to care faced by people who experience homelessness and barriers that service providers themselves experience in supporting this population. The key barriers identified were client-level barriers: living day-by-day, financial, health literacy, mental health conditions, behaviour, safety and stigma; provider-level barriers: few bulk-billing doctors, fragmented services, limited resources, negative past experiences with healthcare; and system level barriers: transportation, over-stretched healthcare services. The combined impact of these barriers has significantly contributed to the desperate situation of people experiencing homelessness in Launceston. This situation is likely replicated in other regional populations in Australia. Given that individuals experiencing homelessness have higher rates of every measure in health inequality, steps need to be taken to reduce barriers, and a standardised approach to health care urgently needs to be implemented by governments at the state and national level to improve the health of regionally based individuals experiencing homelessness.
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Affiliation(s)
- Grace Bennett-Daly
- School of Nursing, University of Tasmania, Newnham, Launceston, TAS 7248, Australia;
| | - Hazel Maxwell
- School of Health Sciences, University of Tasmania, Rozelle, Sydney, NSW 2015, Australia
| | - Heather Bridgman
- Centre for Rural Health, University of Tasmania, Newnham, Launceston, TAS 7248, Australia;
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Fraser B, Chun S, Pehi T, Jiang T, Johnson E, Ombler J, McMinn C, Pierse N. Post-housing first outcomes amongst a cohort of formerly homeless youth in Aotearoa New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2088572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Brodie Fraser
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Saera Chun
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Tiria Pehi
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Terence Jiang
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Ellie Johnson
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | - Jenny Ombler
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
| | | | - Nevil Pierse
- Department of Public Health, Te Whare Wānanga o Otāgo ki Pōneke – University of Otago, Wellington, New Zealand
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Ferguson M, Peled M, Saewyc EM. Health and Healthcare Service Use: The Experiences of Runaway Trans Adolescents Compared to their Peers. JOURNAL OF HOMOSEXUALITY 2022; 69:821-835. [PMID: 33891528 DOI: 10.1080/00918369.2021.1892404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study is the first trans-inclusive exploration of the relation between running away from home, health, and access to healthcare and supportive figures as a function of gender among adolescents. Secondary data analysis of the 2013 BC Adolescent Health Survey found that trans adolescents were 4.25 times as likely as males, and 3.0 times as likely as females, to have run away. Logistic regressions indicated that runaway adolescents of all genders had greater odds of reporting poor or fair overall health (OR: 2.9) and mental health (OR: 4.5), and of foregoing needed physical (OR: 4.8) and mental health care (OR: 4.5) compared to adolescents who had not run away. The relation between running away and health was exacerbated among trans adolescents. Trans and female youth were also less likely than males to report receiving helpful support. Findings highlight the importance of offering trans-affirming services and care to mitigate harms associated with running away from home.
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Affiliation(s)
- Max Ferguson
- MAP Centre for Urban Health Solutions, St Michael's Hospital, London, UK
| | - Maya Peled
- McCreary Centre Society, Vancouver, Canada
| | - Elizabeth M Saewyc
- McCreary Centre Society, Vancouver, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
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Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312770. [PMID: 34886510 PMCID: PMC8657728 DOI: 10.3390/ijerph182312770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
People who are homeless experience significantly poorer health than the general population and often face multifaceted challenges engaging with public healthcare services. Mission Health Nurse-led Clinic (MHNC) was established in 2019 to meet the healthcare needs of this marginalised population in Launceston, Tasmania. This study examines barriers to healthcare access amongst individuals who experience homelessness, client and staff perceptions of the MHNC services and explored opportunities for service expansion. Descriptive statistics were drawn from administrative data, and all interviews were thematically analysed. A total of 426 presentations were reported for 174 individuals experiencing homelessness over 26 months. The median client age was 42 years and 60.9% were male; A total of 38.5% were homeless or lived in a supported accommodation. The predominant reasons for clinic visits included prescription requests (25.3%) and immunisations (20.1%). A total of 10 clients and 5 City Mission staff were interviewed with three themes emerging from the findings: personal vulnerability, disconnectedness and acceptability of the MHNC. The MHNC services were reported to be highly appreciated by all clients. Mental health and allied health, extra operating hours and maintaining the flexibility of walk-in appointments were suggested as expansion areas for the service and were highlighted as ways to increase engagement for improved health outcomes. Continued partnerships with interprofessional primary healthcare providers would contribute to addressing unmet healthcare needs in this vulnerable population.
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Decker MJ, Atyam TV, Zárate CG, Bayer AM, Bautista C, Saphir M. Adolescents' perceived barriers to accessing sexual and reproductive health services in California: a cross-sectional survey. BMC Health Serv Res 2021; 21:1263. [PMID: 34809640 PMCID: PMC8609799 DOI: 10.1186/s12913-021-07278-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Adolescents may forego needed sexual and reproductive health (SRH) services due to a variety of concerns and barriers. The purpose of this study is to compare adolescents’ perceptions of these barriers by participant characteristics including race/ethnicity, gender, sexual orientation, housing situation, and sexual experience. Methods Adolescents in a California-wide sexual health education program completed an anonymous survey at baseline (N = 10,015) about perceived barriers to using SRH services. Logistic regression analyses that accounted for the clustered data structure assessed differences by gender, age, sexual orientation, race/ethnicity, living situation, and sexual experience. Results The majority of participants were Hispanic/Latino (76.4%) with an average age of 14.9 years, and 28.8% had sexual experience. Half of the youth reported concerns about test results (52.7%), cost of services (52.0%), and confidentiality of services (49.8%). When controlling for other characteristics, youth identifying as transgender/non-binary/multiple genders had the highest odds of perceiving cost (odds ratio (OR) 1.89) and confidentiality (OR 1.51) as barriers. Increasing age was associated with decreasing odds of all barriers. Sexual orientation was a consistent predictor, with LGBQ+ youth having higher odds of perceiving test results (OR 1.21), cost (OR 1.36), and confidentiality (OR 1.24) as barriers. Asian or Pacific Islander/Native Hawaiian youth had higher odds of perceiving test results (OR 1.68) and cost (OR 1.37) as barriers. In contrast, Black youth had lower odds of reporting cost (OR 0.65) and confidentiality (OR 0.77) as barriers. Younger respondents and youth who identified as female, transgender/non-binary/multiple genders, LGBQ+, and Asian or Pacific Islander/Native Hawaiian had higher odds of reporting five or more barriers compared to reference groups. Conclusions The majority of adolescents face barriers to accessing appropriate SRH services, with females, gender-minority youth, younger adolescents, LGBQ+ youth, and Asian and Pacific Islander/Native Hawaiian youth more likely than others to report barriers. Access to SRH services can be improved through strengthening linkages between clinics and SRH education programs, providing youth-friendly clinical services, and ensuring youth have sufficient information, skills, and support to access care. Trial registration Approved by California Health and Human Services Agency’s Committee for the Protection of Human Subjects [12-08-0658, 11/30/2017]. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07278-3.
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Affiliation(s)
- Martha J Decker
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA. .,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois St, San Francisco, CA, 94107, USA. .,Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.
| | - Tara V Atyam
- California Department of Public Health, Maternal, Child and Adolescent Health Division, 1615 Capitol Ave, MS 8300, P.O. Box 997420, Sacramento, CA, 95899-7420, USA
| | - Catherine Gilmore Zárate
- California Department of Public Health, Maternal, Child and Adolescent Health Division, 1615 Capitol Ave, MS 8300, P.O. Box 997420, Sacramento, CA, 95899-7420, USA
| | - Angela M Bayer
- California Department of Public Health, Maternal, Child and Adolescent Health Division, 1615 Capitol Ave, MS 8300, P.O. Box 997420, Sacramento, CA, 95899-7420, USA
| | - Consuelo Bautista
- California Department of Public Health, Maternal, Child and Adolescent Health Division, 1615 Capitol Ave, MS 8300, P.O. Box 997420, Sacramento, CA, 95899-7420, USA
| | - Melissa Saphir
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois St, San Francisco, CA, 94107, USA
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Santa Maria D, Lightfoot M, Nyamathi A, Businelle M, Paul M, Quadri Y, Padhye N, Jones J, Calvo Armijo M. A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial. JMIR Res Protoc 2021; 10:e26716. [PMID: 34018967 PMCID: PMC8178739 DOI: 10.2196/26716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID) DERR1-10.2196/26716
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Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies and UCSF Prevention Research Center, University of California San Francisco, San Francisco, CA, United States
| | - Adey Nyamathi
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Mary Paul
- Baylor College of Medicine, Houston, TX, United States
| | - Yasmeen Quadri
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Jones
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Margarita Calvo Armijo
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
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Reddon H, Milloy MJ, Wood E, Nosova E, Kerr T, DeBeck K. High-intensity cannabis use and hospitalization: a prospective cohort study of street-involved youth in Vancouver, Canada. Harm Reduct J 2021; 18:53. [PMID: 34001159 PMCID: PMC8130127 DOI: 10.1186/s12954-021-00501-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is concern that cannabis use negatively affects vulnerable groups such as youth; however, the relationship between cannabis use and health care utilization has not been well characterized in this population. We longitudinally evaluated the association between daily cannabis use and hospitalization among a prospective cohort of street-involved youth. METHODS Data were collected from the At-Risk Youth Study (ARYS) in Vancouver, Canada, from September 2005 to May 2015. Participants were interviewed semi-annually and multivariable generalized estimating equation (GEE) logistic regression was used to examine the relationship between daily cannabis use and hospitalization. RESULTS A total of 1216 participants (31.2% female) were included in this analysis, and 373 (30.7%) individuals reported hospitalization at some point during the study period. In a multivariable GEE analysis, daily cannabis use was not significantly associated with hospitalization (Adjusted Odds Ratio [AOR] = 1.17, 95% Confidence interval [CI] = 0.84, 1.65). We did observe a significant interaction between daily cannabis use and sex (AOR = 0.51, 95% CI = 0.34, 0.77), whereby cannabis use was associated with a decreased odds of hospitalization among males (AOR = 0.60, 95% CI = 0.47, 0.78), yet was not significantly associated with hospitalization among females (AOR = 1.19, 95% CI = 0.84, 1.67). CONCLUSIONS The finding that daily cannabis use was not associated with hospitalization among street-involved youth is encouraging given the high rates of cannabis use in this population and the expansion of cannabis legalization and regulation. Future studies, however, are warranted to monitor possible changes in the consequences of cannabis use as cannabis legalization and regulation increase internationally.
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Affiliation(s)
- Hudson Reddon
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- CIHR Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC, V6B 3E6, Canada
| | - M-J Milloy
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, ,Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, ,Vancouver, BC, V6Z 1Y6, Canada
| | - Ekaterina Nosova
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, ,Vancouver, BC, V6Z 1Y6, Canada
| | - Kora DeBeck
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.
- School of Public Policy, SFU Harbour Centre, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
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Bath EP, Godoy SM, Perris GE, Morris TC, Hayes MD, Bagot K, Barnert E, Tolou-Shams M. Perspectives of Girls and Young Women Affected by Commercial Sexual Exploitation: mHealth as a Tool to Increase Engagement in Care. J Health Care Poor Underserved 2021; 32:128-147. [PMID: 34194195 PMCID: PMC8238115 DOI: 10.1353/hpu.2021.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective We gathered the perspectives of girls and young women affected by commercial sexual exploitation (CSE) to understand the acceptability and feasibility of mobile health (mHealth) for enhancing access and engagement in health and social services during judicial involvement. Methods We conducted four focus groups with 14 girls and young women (ages 14 to 21) with self-identified CSE histories. Results Participants perceived mHealth as viable for accessing and engaging providers, and health and social services, and navigating judicial systems. Participants expressed that mHealth tools increased self-efficacy and self-navigation of required services. Recommendations to improve mHealth functionality included push-notification appointment reminders, wellness and safety promotion, enhancement of provider communication, peer-to-peer support, and access to health education and community resources. Conclusions Findings provide insight for how mHealth may be leveraged to increase self-management skills, fulfill judicial obligations, and improve access and engagement in health and social services for CSE-affected girls and young women.
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Affiliation(s)
- Eraka P Bath
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Sarah M Godoy
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Georgia E Perris
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Taylor C Morris
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Madison D Hayes
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Kara Bagot
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Elizabeth Barnert
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
| | - Marina Tolou-Shams
- ERAKA P. BATH, SARAH M. GODOY, GEORGIA E. PERRIS, TAYLOR C. MORRIS, and MADISON D. HAYES are affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the UCLA Semel Neuropsychiatric Institute. MARINA TOLOU-SHAMS is affiliated with the Department of Psychiatry and Behavioral Sciences at David Geffen School of Medicine at UCLA and the Zuckerberg San Francisco General Hospital and Trauma Center. KARA BAGOT is affiliated with the Addiction Institute at Mount Sinai-Center on Addiction Alliance and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. ELIZABETH BARNERT is affiliated with the Department of Pediatrics at the David Geffen School of Medicine at UCLA
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Garney W, Wilson K, Ajayi KV, Panjwani S, Love SM, Flores S, Garcia K, Esquivel C. Social-Ecological Barriers to Access to Healthcare for Adolescents: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4138. [PMID: 33919813 PMCID: PMC8070789 DOI: 10.3390/ijerph18084138] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022]
Abstract
Access to healthcare for adolescents is often overlooked in the United States due to federal and state-sponsored insurance programs such as Medicaid and the Children's Health Insurance Program. While these types of programs provide some relief, the issue of healthcare access goes beyond insurance coverage and includes an array of ecological factors that hinder youths from receiving services. The purpose of this scoping review was to identify social-ecological barriers to adolescents' healthcare access and utilization in the United States. We followed the PRISMA and scoping review methodological framework to conduct a comprehensive literature search in eight electronic databases for peer-reviewed articles published between 2010 and 2020. An inductive content analysis was performed to thematize the categories identified in the data extraction based on the Social-Ecological Model (SEM). Fifty studies were identified. Barriers across the five SEM levels emerged as primary themes within the literature, including intrapersonal-limited knowledge of and poor previous experiences with healthcare services, interpersonal-cultural and linguistic barriers, organizational-structural barriers in healthcare systems, community-social stigma, and policy-inadequate insurance coverage. Healthcare access for adolescents is a systems-level problem requiring a multifaceted approach that considers complex and adaptive behaviors.
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Affiliation(s)
- Whitney Garney
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Kelly Wilson
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
| | - Kobi V. Ajayi
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
- Education, Direction, Empowerment, & Nurturing (EDEN) Foundation, Abuja 900211, Nigeria
| | - Sonya Panjwani
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Skylar M. Love
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Sara Flores
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Kristen Garcia
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Christi Esquivel
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
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Giannouchos TV, Gary JC, Anyatonwu S, Kum HC. Emergency Department Utilization by Adolescents Experiencing Homelessness in Massachusetts. Med Care 2021; 59:S187-S194. [PMID: 33710094 DOI: 10.1097/mlr.0000000000001436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescents who experience homelessness rely heavily on emergency departments (EDs) for their health care. OBJECTIVES This study estimates the relationship between homelessness and ED use and identifies the sociodemographic, clinical, visit-level, and contextual factors associated with multiple ED visits among adolescents experiencing homelessness in Massachusetts. RESEARCH DESIGN We used the Healthcare Cost and Utilization Project State Emergency Department Databases on all outpatient ED visits in Massachusetts from 2011 to 2016. We included all adolescents who were 11-21 years old. We estimated the association between homelessness and ED utilization and investigated predictors of multiple ED visits among adolescents who experience homelessness using multivariate logistic and negative binomial regressions. RESULTS Our study included 1,196,036 adolescents, of whom about 0.8% experienced homelessness and this subset of adolescents accounted for 2.2% of all ED visits. Compared with those with stable housing, adolescents who were homeless were mostly covered through Medicaid (P<0.001), diagnosed with 1 or more comorbidities (P<0.001), and visited the ED at least once for reasons related to mental health; substance and alcohol use; pregnancy; respiratory distress; urinary and sexually transmitted infections; and skin and subcutaneous tissue diseases (P<0.001). Homeless experience was associated with multiple ED visits (incidence rate ratio=1.18; 95% confidence intervals, 1.16-1.19) and frequent ED use (4 or more ED visits) (adjusted odds ratio=2.21; 95% confidence interval, 2.06-2.37). Factors related to clinical complexity and Medicaid compared with lack of coverage were also significant predictors of elevated ED utilization within the cohort experiencing homelessness. CONCLUSIONS Adolescents who experience homelessness exhibit higher ED use compared with those with stable housing, particularly those with aggravated comorbidities and chronic conditions. Health policy interventions to integrate health care, housing, and social services are essential to transition adolescents experiencing homelessness to more appropriate community-based care.
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Affiliation(s)
- Theodoros V Giannouchos
- Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, UT
- Population Informatics Lab, Texas A&M University, College Station
| | | | - Sophia Anyatonwu
- Population Informatics Lab, Texas A&M University, College Station
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX
| | - Hye-Chung Kum
- Population Informatics Lab, Texas A&M University, College Station
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX
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Cernadas A, Fernández Á. Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain). Int J Equity Health 2021; 20:84. [PMID: 33743729 PMCID: PMC7980324 DOI: 10.1186/s12939-021-01409-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Spain, homeless individuals have lower perceived quality of health than the rest of the population and their life expectancy is 30 years lower than the national average. While the Spanish health system provides universal access and coverage, homeless individuals do not access or use public care enough to maintain their health. The objective of this study is to determine if homeless individuals can access public health services in conditions of equality with the rest of the population, as established in healthcare legislation, and to better understand the causes of observed inequalities or inequities of access. METHODS A detailed qualitative study was carried out in the city of Barcelona (Spain) from October 2019 to February 2020. A total of nine open and in-depth interviews were done with homeless individuals along with seven semi-structured interviews with key informants and two focus groups. One group was composed of eight individuals who were living on the street at the time and the other consisted of eight individuals working in healthcare and social assistance. RESULTS The participants indicated that homeless individuals tend to only access healthcare services when they are seriously ill or have suffered some kind of injury. Once there, they tend to encounter significant barriers that might be 1) administrative; 2) personal, based on belief that that will be poorly attended, discriminated against, or unable to afford treatment; or 3) medical-professional, when health professionals, who understand the lifestyle of this population and their low follow-through with treatments, tend towards minimalist interventions that lack the dedication they would apply to other groups of patients. CONCLUSIONS The conclusions derived from this study convey the infrequent use of health services by homeless individuals for reasons attributable to the population itself, to healthcare workers and to the entire healthcare system. Accordingly, to reduce inequities of access to these services, recommendations to healthcare service providers include adapting facilities to provide more adequate care for this population; increasing sensitivity/awareness among healthcare workers; developing in situ care systems in places where the homeless population is most concentrated; and establishing healthcare collaboration agreements with entities that work with this population.
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Affiliation(s)
- Andrés Cernadas
- Department of Political Science and Administration, Faculty of Political Science, Universidad de Santiago de Compostela, Campus Vida, S/N, 15782, Santiago de Compostela, Spain
| | - Ángela Fernández
- Department of Political Science and Administration, Faculty of Political Science, Universidad de Santiago de Compostela, Campus Vida, S/N, 15782, Santiago de Compostela, Spain. .,Graduate in Political Science and Master in Equality, Gender and Education, Universidad de Santiago de Compostela, Santiago de Compostela, Spain.
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Neeki MM, Dong F, Archambeau B, Cerda M, Ratliff S, Goff A, Roloff K, Tran L. San Bernardino County Youth Opioid Response: Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder. Cureus 2020; 12:e9781. [PMID: 32821635 PMCID: PMC7431298 DOI: 10.7759/cureus.9781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/16/2020] [Indexed: 11/10/2022] Open
Abstract
Opioid use disorder (OUD) and related overdose deaths have become a crisis of epidemic proportions in the United States. In 2018, over 10 million people age 12 years or older misused opioids.Substance use is also correlated with increased physical and mental health disorders, and developmental challenges among youths. Medication-assisted treatment (MAT) has been reported to reduce mortality, opioid use, and human immunodeficiency virus and hepatitis C virus transmission while increasing treatment retention in adults. The San Bernardino County Youth Opioid Response (SBCYOR) program was formed to explore best practices for youths at risk of opioid use disorders and/or overdose. SBCYOR is a coalition of professionals in healthcare, behavioral health, public education, law enforcement, emergency medical services (EMS) agencies, and juvenile detention centers throughout San Bernardino County, California. SBCYOR focuses on high-risk and addicted individuals between the ages of 12 to 24 years in San Bernardino County's correctional system. It utilizes a strategy of collaboration, prevention, risk mitigation, medication, psychological treatment, and community outreach. This study aimed to evaluate the implementation and progress of SBCYOR.
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Affiliation(s)
- Michael M Neeki
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
- Probation Department, San Bernardino County Department of Probation, San Bernardino, USA
- Emergency Medicine, California University of Science and Medicine, Colton, USA
| | - Fanglong Dong
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Melinda Cerda
- Probation Department, San Bernardino County Department of Probation, San Bernardino, USA
| | - Sireyia Ratliff
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Alan Goff
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Kristina Roloff
- Obstetrics and Gynecology, Arrowhead Regional Medical Center, Colton, USA
- Obstetrics and Gynecology, California University of Science and Medicine, Colton, USA
| | - Louis Tran
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
- Emergency Medicine, California University of Science and Medicine, Colton, USA
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16
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Simpson EK, McDermott CP, Hild LE. Needs of Transitionally Housed Young People to Promote Occupational Participation. Occup Ther Health Care 2020; 34:62-80. [PMID: 32153251 DOI: 10.1080/07380577.2020.1737895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This qualitative descriptive study explored what young people who are transitionally housed need to promote occupational participation. Nine young people and four staff members from a transitional living facility participated in interviews and focus groups. Results suggested that the young people need opportunities to practice independent living skills, develop routines to support employment, housing, and education, and receive more individualized support from service providers. Findings also reveal that service providers experience a range of barriers to meeting young people's needs. This study underscores the importance of occupational therapy practitioners being informed of national and regional policies as well as emerging evidence of innovative approaches with populations, communities, and individuals so as to ultimately develop novel, collaborative, occupation-based programs to help young people set goals and transition out of homelessness.
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Affiliation(s)
- Emily K Simpson
- Occupational Therapy Program, Midwestern University, Downers Grove, IL, USA
| | - Callan P McDermott
- Occupational Therapy Program, Midwestern University, Downers Grove, IL, USA
| | - Lauren E Hild
- Occupational Therapy Program, Midwestern University, Downers Grove, IL, USA
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Gill F, Appley M, Nix L, Green G, Gribbon M, Divagaran A, Huo S, Avegno J, Jones C. The Homeless Hospital Liaison Program: An Interprofessional Program to Improve Students' Skills at Facilitating Transitions of Care for Patients Experiencing Homelessness. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:378-381. [PMID: 31567157 PMCID: PMC7044069 DOI: 10.1097/acm.0000000000003004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PROBLEM Traditional medical school curricula lack specific training on caring for individuals experiencing homelessness, and the literature suggests that medical students' attitudes toward these individuals become increasingly negative during medical school. APPROACH To increase discharge planning support for individuals experiencing homelessness, the Homeless Hospital Liaison (HHL) program was developed at the University Medical Center New Orleans in January 2017-May 2017. Student liaisons are recruited from all 4 years of medical school and a graduate-level social work program. Liaisons administer a social needs questionnaire to assess patients' connections to services and identify gaps in care, coordinate with hospital social workers to avoid duplicating work, coordinate with the medical team, help patients complete any needed documentation or applications for social benefits, provide patients with referrals to outpatient resources, and provide patients assistance with a variety of basic needs. OUTCOMES As of December 2017, HHL has trained 70 students (65 medical students and 5 social work students) to serve as liaisons and has enrolled 99 patients. For the majority of these patients, student liaisons were able to facilitate successful referrals to community-based services. NEXT STEPS Future directions of the HHL program include developing a formal, staffed consult service at the hospital (e.g., the HHL program was awarded hospital funding for 2 full-time staff in the summer of 2019, which will increase the HHL's capacity); assessing the program's effect on student knowledge, attitudes, and proficiency related to individuals experiencing homelessness and/or interprofessional collaboration; and assessing the impact of the program on patients' experiences.
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Affiliation(s)
- Frances Gill
- F. Gill is a medical student, Tulane University School of Medicine, New Orleans, Louisiana. M. Appley is an internal medicine resident, University of California, San Francisco, San Francisco, California. L. Nix is a psychiatry resident, Rush University, Chicago, Illinois. G. Green is a family medicine resident, Aria Jefferson, Philadelphia, Pennsylvania. M. Gribbon is a social worker, New Orleans, Louisiana. A. Divagaran is a medical student, Tulane University School of Medicine, New Orleans, Louisiana. S. Huo is an emergency medicine resident, Temple University Hospital, Philadelphia, Pennsylvania. J. Avegno is director, Department of Health, City of New Orleans, New Orleans, Louisiana. C. Jones is assistant professor of medicine, Department of General Internal Medicine, and associate program director for the internal medicine residency program, Tulane University School of Medicine, New Orleans, Louisiana
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18
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Robards F, Kang M, Luscombe G, Sanci L, Steinbeck K, Jan S, Hawke C, Kong M, Usherwood T. Predictors of young people's healthcare access in the digital age. Aust N Z J Public Health 2019; 43:582-588. [PMID: 31577863 DOI: 10.1111/1753-6405.12936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To quantify barriers to healthcare for young people (12-24 years) and identify socio-demographic correlates and predictors. METHODS This cross-sectional survey targeted young people living in New South Wales, Australia, with oversampling of marginalised groups. Principles Component Analysis (PCA) identified clusters of barriers. Ordinal regression identified predictors of each barrier cluster. RESULTS A total of 1,416 young people completed surveys. Participants with chronic conditions and increasing psychological distress reported a greater number of barriers. Of 11 potential barriers to visiting a health service, cost was most common (45.8%). The PCA identified three clusters: structural barriers (61.3%), attitudinal barriers (44.1%) and barriers relating to emerging autonomy (33.8%). CONCLUSIONS Barriers to healthcare reported by young people are multi-dimensional and have changed over time. Structural barriers, especially cost, are the most prominent among young people. Approaches to overcome structural barriers need to be addressed to better support marginalised young people's healthcare access. Implications for public health: Understanding predictors of different barrier types can inform more targeted approaches to improving access. Equitable access to healthcare is a priority for early diagnosis and treatment in young people, especially reducing out of pocket costs.
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Affiliation(s)
- Fiona Robards
- Department of General Practice, The University of Sydney, Westmead Clinical School, New South Wales
| | - Melissa Kang
- Department of General Practice, The University of Sydney, Westmead Clinical School, New South Wales.,Australian Centre for Public and Population Health Research, University of Technology Sydney, New South Wales
| | | | - Lena Sanci
- Department of General Practice, University of Melbourne, Victoria
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, The University of Sydney, New South Wales
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales
| | - Catherine Hawke
- School of Rural Health, The University of Sydney, New South Wales
| | - Marlene Kong
- The Kirby Institute, University of New South Wales
| | - Tim Usherwood
- Department of General Practice, The University of Sydney, Westmead Clinical School, New South Wales.,The George Institute for Global Health, University of New South Wales
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Hoffman S, Rueda HA, Beasley L. Youth Perspectives of Healthcare in Central Mexico: An Application of Massey's Critical Health Literacy Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E896. [PMID: 30871111 PMCID: PMC6427344 DOI: 10.3390/ijerph16050896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 12/25/2022]
Abstract
Attention to health literacy is essential more now than ever given the recognition, attention, and resources being dedicated to addressing health disparities throughout the world. Unfortunately, health literacy research is scarce in many parts of the world, particularly among youth. Using focus group discussions with junior high school students (N = 98) in a rural town of Central Mexico, we sought to learn about their experiences utilizing healthcare services at a local health clinic. The themes that naturally emerged from focus group discussions aligned with Massey's framework on critical health literacy among US youth, and included problems navigating the health system, embarrassment speaking to doctors about sensitive issues, and minimal importance being placed on preventative care. This suggests that Massey's framework may be appropriate to use when seeking to understand and promote health literacy among youth in Mexico. Furthermore, the challenges faced by adolescent participants in this study suggest that additional research is needed to assess how youth in other areas of Mexico are faring in efforts to understand and access their new and evolving universal healthcare system.
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Affiliation(s)
- Steven Hoffman
- School of Social Work, Brigham Young University, Provo, UT 84660, USA.
| | - Heidi Adams Rueda
- Department of Social Work, University of Texas at San Antonio, San Antonio, TX 78207, USA.
| | - Lauren Beasley
- Knoxville Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA.
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20
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Robards F, Kang M, Steinbeck K, Hawke C, Jan S, Sanci L, Liew YY, Kong M, Usherwood T. Health care equity and access for marginalised young people: a longitudinal qualitative study exploring health system navigation in Australia. Int J Equity Health 2019; 18:41. [PMID: 30832651 PMCID: PMC6399978 DOI: 10.1186/s12939-019-0941-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Young people have unique social, emotional and developmental needs that require a welcoming and responsive health system, and policies that support their access to health care. Those who are socially or culturally marginalised may face additional challenges in navigating health care, contributing to health inequity. The aim of this study was to understand health system navigation, including the role of technology, for young people belonging to one or more marginalised groups, in order to inform youth health policy in New South Wales, Australia. Methods This qualitative longitudinal study involved 2–4 interviews each over 6 to 12 months with marginalised young people aged 12–24 years living in NSW. The analysis used Nvivo software and grounded theory. Results We interviewed 41 young people at baseline who were living in rural or remote areas, sexuality and/or gender diverse, refugee, homeless, and/or Aboriginal. A retention rate of over 85% was achieved. Nineteen belonged to more than one marginalised group allowing an exploration of intersectionality. General practitioners (family physicians) were the most commonly accessed service throughout the study period. Participants were ambivalent about their healthcare journeys. Qualitative analysis identified five themes:Technology brings opportunities to understand, connect and engage with services Healthcare journeys are shaped by decisions weighing up convenience, engagement, effectiveness and affordability. Marginalised young people perceive and experience multiple forms of discrimination leading to forgone care. Multiple marginalisation makes health system navigation more challenging The impact of health system complexity and fragmentation may be mitigated by system knowledge and navigation support
Conclusions The compounding effects of multiple discrimination and access barriers were experienced more strongly for young people belonging to mutiple marginalised groups. We identify several areas for improving clinical practice and policy. Integrating technology and social media into processes that facilitate access and navigation, providing respectful and welcoming services that recognise diversity, improving health literacy and involving professionals in advocacy and navigation support may help to address these issues. Electronic supplementary material The online version of this article (10.1186/s12939-019-0941-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fiona Robards
- Department of General Practice, Westmead Clinical School, The University of Sydney, PO Box 154, Westmead, NSW, 2145, Australia.
| | - Melissa Kang
- Department of General Practice, Westmead Clinical School, The University of Sydney, PO Box 154, Westmead, NSW, 2145, Australia.,University of Technology Sydney, Discipline of Public Health, Sydney, Australia
| | - Katharine Steinbeck
- The University of Sydney, Discipline of Paediatrics and Adolescent Health, Sydney, Australia
| | - Catherine Hawke
- The University of Sydney, School of Rural Health, Orange, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - Ying Ying Liew
- Department of General Practice, Westmead Clinical School, The University of Sydney, PO Box 154, Westmead, NSW, 2145, Australia
| | - Marlene Kong
- The Kirby Institute, University of New South Wales, Randwick, Australia
| | - Tim Usherwood
- Department of General Practice, Westmead Clinical School, The University of Sydney, PO Box 154, Westmead, NSW, 2145, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Senayah EA, Mprah WK, Opoku MP, Edusei AK, Torgbenu EL. The accessibility of health services to young deaf adolescents in Ghana. Int J Health Plann Manage 2018; 34:e634-e645. [PMID: 30311956 DOI: 10.1002/hpm.2679] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/09/2022] Open
Abstract
Quality health care is a fundamental human right, which is enshrined in several international and domestic legislative instruments. In the Ghanaian context, there are reports that adults with disabilities encounter barriers in their attempts to access health care. However, scholarly attention is yet to explore the perspectives of young people and adolescents with disabilities. Therefore, this quantitative study was conducted from the perspective of critical disability studies, where young deaf adolescents (YDAs) were regarded as right bearers, and where they shared their perspectives on health accessibility decisions, barriers, and needs. Sixty-seven participants, made up of 44 male and 23 female students, took part in this quantitative study. Although many YDAs who took part in this study indicated that it was not difficult to access health facilities, they claim to have encountered communication barriers. Sign language interpreters in health facilities and introduction of sign language courses in health training institutions to improve communication between health professionals and deaf patients have been suggested as ways of addressing the barriers faced by YDAs in Ghana.
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Affiliation(s)
- Ebenezer Alfa Senayah
- Centre for Disability Rehabilitation Studies, Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Kwadwo Mprah
- Centre for Disability Rehabilitation Studies, Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Anthony Kweku Edusei
- Centre for Disability Rehabilitation Studies, Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Lawer Torgbenu
- Department of Physiotherapy and Rehabilitation Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
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Robards F, Kang M, Usherwood T, Sanci L. How Marginalized Young People Access, Engage With, and Navigate Health-Care Systems in the Digital Age: Systematic Review. J Adolesc Health 2018; 62:365-381. [PMID: 29429819 DOI: 10.1016/j.jadohealth.2017.10.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/08/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE This systematic review examines how marginalized young people access and engage with health services and navigate health-care systems in high-income countries. METHODS Medline, CINAHL, PsychInfo, The University of Sydney Library database, and Google Scholar were searched to identify qualitative and quantitative original research, published from 2006 to 2017, that focused on selected definitions of marginalized young people (12 to 24 years), their parents/carers, and/or health professionals working with these populations. A thematic synthesis was undertaken identifying themes across and between groups on barriers and/or facilitators to access, engagement, and/or navigation of health-care systems. RESULTS Of 1,796 articles identified, 68 studies in the final selection focused on marginalized young people who were homeless (n = 20), living in rural areas (n = 14), of refugee background (n = 11), gender and/or sexuality diverse (n = 11), indigenous (n = 4), low income (n = 4), young offenders (n = 2), or living with a disability (n = 2). Studies were from the United States, Australia, Canada, United Kingdom, New Zealand, and Portugal, including 44 qualitative, 16 quantitative, and 8 mixed-method study types. Sample sizes ranged from 3 to 1,388. Eight themes were identified relating to ability to recognize and understand health issues; service knowledge and attitudes toward help seeking; structural barriers; professionals' knowledge, skills, attitudes; service environments and structures; ability to navigate the health system; youth participation; and technology opportunities. CONCLUSIONS Marginalized young people experience barriers in addition to those common to all young people. Future studies should consider the role of technology in access, engagement, and health system navigation, and the impact of intersectionality between marginalized groups.
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Affiliation(s)
- Fiona Robards
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Westmead, New South Wales, Australia.
| | - Melissa Kang
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Westmead, New South Wales, Australia; Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Usherwood
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Westmead, New South Wales, Australia; The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
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Chang DC, Rieb L, Nosova E, Liu Y, Kerr T, DeBeck K. Hospitalization among street-involved youth who use illicit drugs in Vancouver, Canada: a longitudinal analysis. Harm Reduct J 2018; 15:14. [PMID: 29558943 PMCID: PMC5859496 DOI: 10.1186/s12954-018-0223-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/13/2018] [Indexed: 01/19/2023] Open
Abstract
Background Street-involved youth who use illicit drugs are at high risk for health-related harms; however, the profile of youth at greatest risk of hospitalization has not been well described. We sought to characterize hospitalization among street-involved youth who use illicit drugs and identify the most frequent medical reasons for hospitalization among this population. Methods From January 2005 to May 2016, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada. Multivariable generalized estimating equation (GEE) was used to identify factors associated with hospitalization. Results Among 1216 participants, 373 (30.7%) individuals reported hospitalization in the previous 6 months at some point during the study period. The top three reported medical reasons for hospital admission were the following: mental illness (37.77%), physical trauma (12.77%), and drug-related issues (12.59%). Factors significantly associated with hospitalization were the following: past diagnosis of a mental illness (adjusted odds ratio [AOR] = 1.85; 95% confidence interval [95% CI] 1.47–2.33), frequent cocaine use (AOR = 2.15; 95% CI 1.37–3.37), non-fatal overdose (AOR = 1.76; 95% CI 1.37–2.25), and homelessness (AOR = 1.40; 95% CI 1.16–1.68) (all p < 0.05). Conclusions Findings suggest that mental illness is a key driver of hospitalization among our sample. Comprehensive approaches to mental health and substance use in addition to stable housing offer promising opportunities to decrease hospitalization among this vulnerable population.
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Affiliation(s)
- Derek C Chang
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Launette Rieb
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Yang Liu
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,School of Public Policy, SFU Harbour Centre, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC, V6B 5K3, Canada.
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