1
|
Cronley C, Fackler A, First JM, Lee S, Tsouris I. Persons Experiencing Homelessness during Extreme Temperatures: Lessons for Promoting Socially Inclusive Adaptive Capacity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:984. [PMID: 39200596 PMCID: PMC11353798 DOI: 10.3390/ijerph21080984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 09/02/2024]
Abstract
Climate change and increasing extreme temperatures present unique challenges to persons experiencing homelessness (PEH), including heightened physical and psychological harm. While green and urban infrastructure has emerged as one possible mitigation strategy, homeless populations are rarely included in municipal disaster planning or infrastructure research. This study used in-depth interviews with PEH (N = 42) during the summers of 2022 and 2023. Questions were designed around phenomenological methods to explore the individuals' firsthand descriptions of the lived experience of coping during extreme temperatures within a mid-size city in the Southeastern United States. Our findings highlight how social exclusion within the built environment reduces PEH's adaptive capacity and increases the physical and psychological risks of extreme temperatures, namely through limiting and policing scarce resources and restricting the mobility of PEH. In contrast, public transit provided relief from extreme temperatures. Implications from our findings include the need for attention on inclusive green urban infrastructure, including increased placement and access to shade, public water, mixed-use daytime sheltering models, and the installation of lockers to increase capacity to maintain supplies and gear necessary for enduring extreme temperatures. Findings also highlight the challenges of designing inclusive green infrastructure and the importance of de-stigmatizing homelessness and building more housing and income support to increase adaptive capacity for an entire community in the context of a rapidly warming climate.
Collapse
Affiliation(s)
- Courtney Cronley
- College of Social Work, University of Tennessee, Knoxville, TN 37996, USA; (A.F.); (S.L.)
| | - Amanda Fackler
- College of Social Work, University of Tennessee, Knoxville, TN 37996, USA; (A.F.); (S.L.)
| | - Jennifer M. First
- School of Social Work, University of Missouri, Columbia, MO 65201, USA;
| | - Sangwon Lee
- College of Social Work, University of Tennessee, Knoxville, TN 37996, USA; (A.F.); (S.L.)
| | | |
Collapse
|
2
|
Latimer A, Pope ND, Lin CY, Kang J, Sasdi O, Wu JR, Moser DK, Lennie T. Adapting the serious illness conversation guide for unhoused older adults: a rapid qualitative study. BMC Palliat Care 2024; 23:153. [PMID: 38886741 PMCID: PMC11181539 DOI: 10.1186/s12904-024-01485-5] [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: 03/25/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Older adults experiencing homelessness (OAEH) age quickly and die earlier than their housed counterparts. Illness-related decisions are best guided by patients' values, but healthcare and homelessness service providers need support in facilitating these discussions. The Serious Illness Conversation Guide (SICG) is a communication tool to guide discussions but has not yet been adapted for OAEH. METHODS We aimed to adapt the SICG for use with OAEH by nurses, social workers, and other homelessness service providers. We conducted semi-structured interviews with homelessness service providers and cognitive interviews with OAEH using the SICG. Service providers included nurses, social workers, or others working in homeless settings. OAEH were at least 50 years old and diagnosed with a serious illness. Interviews were conducted and audio recorded in shelters, transitional housing, a hospital, public spaces, and over Zoom. The research team reviewed transcripts, identifying common themes across transcripts and applying analytic notetaking. We summarized transcripts from each participant group, applying rapid qualitative analysis. For OAEH, data that referenced proposed adaptations or feedback about the SICG tool were grouped into two domains: "SICG interpretation" and "SICG feedback". For providers, we used domains from the Toolkit of Adaptation Approaches: "collaborative working", "team", "endorsement", "materials", "messages", and "delivery". Summaries were grouped into matrices to help visualize themes to inform adaptations. The adapted guide was then reviewed by expert palliative care clinicians for further refinement. RESULTS The final sample included 11 OAEH (45% Black, 61 ± 7 years old) and 10 providers (80% White, 8.9 ± years practice). Adaptation themes included changing words and phrases to (1) increase transparency about the purpose of the conversation, (2) promote OAEH autonomy and empowerment, (3) align with nurses' and social workers' scope of practice regarding facilitating diagnostic and prognostic awareness, and (4) be sensitive to the realities of fragmented healthcare. Responses also revealed training and implementation considerations. CONCLUSIONS The adapted SICG is a promising clinical tool to aid in the delivery of serious illness conversations with OAEH. Future research should use this updated guide for implementation planning. Additional adaptations may be dependent on specific settings where the SICG will be delivered.
Collapse
Affiliation(s)
- Abigail Latimer
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
| | - Natalie D Pope
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Chin-Yen Lin
- College of Nursing, University of Auburn, Auburn, Alabama, USA
| | - JungHee Kang
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Olivia Sasdi
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Jia-Rong Wu
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Terry Lennie
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
3
|
Ghatak S, Guchhait SK. The perspective of homeless space in the railway stations of India: A critical understanding through inter-personal network analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1678-e1689. [PMID: 34596299 DOI: 10.1111/hsc.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/11/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
There is a global recognition that the homeless in different clusters are isolated social groups. They are highly susceptible to loneliness and related psycho-physical health outcomes owing to their less supportive and fragmented social networks. The conditions are worse in the case of chronic or lifetime homelessness. Beyond this popular notion, other critical perspectives are also there. This paper attempts to analyse the differences in inter-personal social networks between the chronic and the non-chronic homeless groups at a railway junction in India. The data have been collected through structured and semi-structured questionnaires from 28 homeless people (15 chronically and 13 non-chronically homeless) of Burdwan Railway Junction - a vital railway junction of West Bengal, India. The chronically homeless group displays more supportive and compact inter-personal networks in this study than the non-chronic homeless group. Living in the station area for a long time, they have formed a society of their own. Barring some psychological stress and social abuse, the livelihood scenario of these people is relatively stress-free and social networks relations are more intensive and supportive. Considering the outcomes, instead of the housing-first approach of rehabilitation, we favour the development of community shelters with minimum basic amenities close to their present location.
Collapse
Affiliation(s)
- Subhajit Ghatak
- Department of Geography, The University of Burdwan, Burdwan, India
| | | |
Collapse
|
4
|
Ssegujja E, Mulumba Y, Guttmacher S, Andipatin M. The role and attributes of social networks in the provision of support to women after stillbirth: experiences from Uganda. BMC Womens Health 2021; 21:352. [PMID: 34615502 PMCID: PMC8496046 DOI: 10.1186/s12905-021-01498-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/17/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Communities exert stigma on mothers after stillbirth despite their potential to offer social support to the grieving family. Maternal healthcare-seeking behaviors are socially reinforced rendering a social network approach vital in understanding support dynamics which when utilized can improve community response to mothers experiencing stillbirth. However, the form and direction of social support for women when in need is not clear. The study explored the role and attributes of women's social networks in the provision of support to mothers who have experienced a stillbirth in Uganda. METHODS An exploratory cross-sectional study design adopting a social network approach was conducted. Data collection following established procedures was conducted on a convenient sample of 17 mothers who had experienced a stillbirth six months before the study. Frequencies and bivariate analysis were conducted to determine the factors influencing the provision of social support from 293 network members elicited during the alter generation. We then performed a Poisson regression on each of the social support forms and the explanatory variables. Network structure variables were calculated using UCINET version 6 while Netdraw facilitated the visualization of networks. RESULTS Overall, social support was available from all network relations mentioned by the respondents. No major variations were observed between the two time periods during pregnancy and following a stillbirth. The most common support received was in form of intangible support such as emotional and information support, mainly from females who were married and from the naturally occurring networks such as family and friends. We also observed that social support followed patterns of network relational characteristics including trust, frequency of contact and alters counted on for support more likely to provide the same. CONCLUSIONS A great potential for social support exists within women's social networks to help address stillbirth risk factors during pregnancy and cope after experiencing the same. Alter characteristics like being female, married, and from naturally occurring networks together with relational characteristics such as trust, frequency of contact, and count on alter for support were predictors of eventual social support. Interventions aiming at addressing stillbirth risks at the community level ought to harness these network characteristics for benefits to the mothers.
Collapse
Affiliation(s)
- Eric Ssegujja
- Makerere University School of Public Health, Kampala, Uganda.
- School of Public Health, University of the Western Cape, Cape Town, South Africa.
| | - Yusuf Mulumba
- Uganda Cancer Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Sally Guttmacher
- School of Global Public Health, New York University, New York, NY, USA
| | - Michelle Andipatin
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
5
|
The Relational Vulnerability of People Experiencing Multiple Exclusion Homelessness (MEH) in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910275. [PMID: 34639573 PMCID: PMC8507713 DOI: 10.3390/ijerph181910275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022]
Abstract
This paper draws on research analyzing the emotional and relational impacts of poverty and exclusion on charities’ clients in Spain since the 2008–2009 economic crisis, including people experiencing multiple exclusion homelessness (MEH). The study adopts a mixed-methods approach in which twenty in-depth cases were collected in different geographical locations, including twelve cases experiencing MEH. Unlike other disadvantaged groups, those affected by MEH suffer material shortages, traumatic experiences, psychological disorders, physical illnesses, and a high degree of relational vulnerability, as reflected in the structure and composition of their personal networks, which tend to be smaller in size, with just a few weak and temporary contacts, and with care professionals playing an important role. These charity users often need long-term socio-sanitary care, which challenges public and private health-care systems. Therefore, our contribution to this Special Issue is directed toward improving understanding of the relational characteristics of severely excluded people, how social support affects their personal networks, and the challenges this assistance poses to care services.
Collapse
|
6
|
The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147328. [PMID: 34299779 PMCID: PMC8306744 DOI: 10.3390/ijerph18147328] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022]
Abstract
People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered PEH (n = 246) in Nashville, TN, from August 2018–June 2019. Using multivariate fixed-effects linear regression models, we examined associations between biophysical and social environments and self-reported general health and emotional well-being. We found that study participants reported the lowest general health scores during winter months—Nashville’s coldest season. We also found a positive association between the number of nights participants spent indoors during the previous week and general health. Participants who spent even one night indoors during the past week had 1.8-point higher general health scores than participants who spent zero nights indoors (p < 0.01). Additionally, participants who experienced a conflict with a social contact in the past 30 days had lower emotional well-being scores than participants who experienced no conflict. Finally, women had worse general health and emotional well-being than men. Ecologically framed research about health and well-being among PEH is critically needed, especially as climate change threatens to increase the danger of many homeless environments.
Collapse
|
7
|
Rhoades H, Hsu HT, Rice E, Harris T, LaMotte-Kerr W, Winetrobe H, Henwood B, Wenzel S. Social Network Change after Moving into Permanent Supportive Housing: Who Stays and Who Goes? NETWORK SCIENCE (CAMBRIDGE UNIVERSITY PRESS) 2021; 9:18-34. [PMID: 34026210 PMCID: PMC8135224 DOI: 10.1017/nws.2020.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Social relationships are important among persons experiencing homelessness, but there is little research on changes in social networks among persons moving into permanent supportive housing (PSH). Using data collected as part of a longitudinal study of 405 adults (aged 39+) moving into PSH, this study describes network upheaval during this critical time of transition. Interviews conducted prior to and after three months of living in PSH assessed individual-level characteristics (demographics, homelessness history, health and mental health) and included a social network component that assessed network size and composition (demographics, relationship type, social support); interviewers utilized network member characteristics to assess whether network members were new or sustained between baseline and 3 months post-housing. Multilevel logistic regression models assessed what characteristics of network members were associated with being newly-gained or persisting in networks 3 months after moving into PSH. We found that only one-third of social networks were retained during the transition to PSH, and that veterans, African Americans and other persons of racial/ethnic minorities, and those living in scattered-site housing were more likely to experience network disruption. Relatives, romantic partners, and service providers were most likely to be retained after move-in. Some network change was moderated by tie strength, including the retention of street-met persons. Implications are discussed.
Collapse
Affiliation(s)
- Harmony Rhoades
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Montgomery Ross Fisher Building, Los Angeles, CA 90089
| | - Hsun-Ta Hsu
- University of Missouri, School of Social Work, 709 Clark Hall, Columbia, MO 65211
| | - Eric Rice
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Montgomery Ross Fisher Building, Los Angeles, CA 90089
| | - Taylor Harris
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Montgomery Ross Fisher Building, Los Angeles, CA 90089
| | - Wichada LaMotte-Kerr
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Montgomery Ross Fisher Building, Los Angeles, CA 90089
| | - Hailey Winetrobe
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Montgomery Ross Fisher Building, Los Angeles, CA 90089
| | - Benjamin Henwood
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Montgomery Ross Fisher Building, Los Angeles, CA 90089
| | - Suzanne Wenzel
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Montgomery Ross Fisher Building, Los Angeles, CA 90089
| |
Collapse
|
8
|
Yoshioka-Maxwell A. Social Work in Action: Social Connectedness and Homelessness Amidst a Pandemic: Are the Social Impacts of Quarantine on Homeless Populations Being Adequately Addressed? HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:329-331. [PMID: 33205051 PMCID: PMC7668111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Amanda Yoshioka-Maxwell
- Department of Social Work, Myron B. Thompson School of Social Work, University of Hawai'i at Mānoa, Honolulu, HI
| |
Collapse
|
9
|
Jones PW, Thornton AE, Jones AA, Knerich VM, Lang DJ, Woodward ML, Panenka WJ, Su W, Barr AM, Buchanan T, Honer WG, Gicas KM. Amygdala Nuclei Volumes Are Selectively Associated With Social Network Size in Homeless and Precariously Housed Persons. Front Behav Neurosci 2020; 14:97. [PMID: 32612516 PMCID: PMC7309349 DOI: 10.3389/fnbeh.2020.00097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The amygdala is a brain region comprised of a group of functionally distinct nuclei that play a central role in social behavior. In homeless and precariously housed individuals, high rates of multimorbidity, and structural aspects of the environment may dysregulate social functioning. This study examined the neurobiological substrates of social connection in homeless and precariously housed persons by examining associations between amygdala nuclei volumes and social network size. Methods: Sixty participants (mean age 43.6 years; 73.3% male) were enrolled from an ongoing study of homeless and precariously housed adults in Vancouver, Canada. Social network size was assessed using the Arizona Social Support Interview Schedule. Amygdala nuclei volumes were extracted from anatomic T1-weighted MRI data. The central and basolateral amygdala nuclei were selected as they are implicated in anxiety-related and social behaviors. The hippocampus was included as a control brain region. Multivariable regression analysis investigated the relationship between amygdala nuclei volumes and social network size. Results: After controlling for age, sex, and total brain volume, individuals with the larger amygdala and central nucleus volumes had a larger network size. This association was not observed for the basolateral amygdala complex, though subsequent analysis found the basal and accessory basal nuclei of the basolateral amygdala were significantly associated with social network size. No association was found for the lateral amygdala nucleus or hippocampus. Conclusions: These findings suggest that select amygdala nuclei may be differentially involved in the social connections of persons with multimorbid illness and social marginalization.
Collapse
Affiliation(s)
- Paul W. Jones
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Verena M. Knerich
- Department of Computer Science, Ludwig Maximilians University, Munich, Germany
| | - Donna J. Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L. Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kristina M. Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| |
Collapse
|
10
|
Durbin A, Nisenbaum R, Kopp B, O'Campo P, Hwang SW, Stergiopoulos V. Are resilience and perceived stress related to social support and housing stability among homeless adults with mental illness? HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1053-1062. [PMID: 30734374 DOI: 10.1111/hsc.12722] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24-month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the trial, and (b) the association between levels of resilience and perceived stress with measures of social support, social functioning and percentage of days stably housed over the study period. This longitudinal study (2009-2013) that used trial data included 575 participants in Toronto, Ontario. Of these individuals, 507 were included in this study. Connor-Davidson Resilience Scale and Perceived Stress Scales (PSS) measured the two outcomes, resilience and perceived stress. Time (baseline, 12 and 24 months), housing stability and three measures of social support and social functioning were the main predictors. A longitudinal analysis was done with repeated measures analysis of resilience and perceived stress using linear mixed models with random intercepts. Mean resilience scores increased (baseline: 5.1 [95% CI: 4.9, 5.2], 12 months: 5.5 [95% CI: 5.3, 5.7], 24 months: 5.6 [95% CI: 5.4, 5.8]), and PSS scores decreased (baseline: 22.3 [95% CI: 21.5, 23.0], 24 months: 18.6 [95% CI: 17.9, 19.4]). In the multivariable analyses, increased resilience was associated with higher scores on the three social support and social functioning measures, (estimates = 0.12, 0.04, 0.02) but not percentage days stably housed. Lower PSS scores were associated with higher scores on all three social support and social functioning measures (-0.20, -0.33, -0.21) and higher percentages of days stably housed (-0.015). Strong social support and social functioning may minimise the harmful effects of stressful life events on homeless individuals by increasing resilience and reducing stress. Interventions to help homeless people build appropriate support networks should be delivered in parallel to efforts that increase housing stability.
Collapse
Affiliation(s)
- Anna Durbin
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions and Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brianna Kopp
- Research and Evaluation, algo+med, Calgary, AB, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
11
|
Harris T, Dunton G, Henwood B, Rhoades H, Rice E, Wenzel S. Los Angeles Housing Models and Neighborhoods' Role in Supportive Housing Residents' Social Integration. HOUSING STUDIES 2018; 34:609-635. [PMID: 31371845 PMCID: PMC6675468 DOI: 10.1080/02673037.2018.1462308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/28/2018] [Indexed: 05/11/2023]
Affiliation(s)
- Taylor Harris
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| | - Genevieve Dunton
- University of Southern California, Keck School of Medicine, Institute for Health Promotion & Disease Prevention, 2001 N. Soto Street, Los Angeles, CA 90032
| | - Benjamin Henwood
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| | - Harmony Rhoades
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| | - Eric Rice
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| | - Suzanne Wenzel
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| |
Collapse
|
12
|
Harris T, Winetrobe H, Rhoades H, Castro CA, Wenzel S. Moving Beyond Housing: Service Implications for Veterans Entering Permanent Supportive Housing. CLINICAL SOCIAL WORK JOURNAL 2018; 46:130-144. [PMID: 30416223 PMCID: PMC6219637 DOI: 10.1007/s10615-018-0648-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As a result of efforts to end homelessness among U.S. veterans, more former service members are entering permanent supportive housing (PSH). While PSH has been successfully used to house homeless veterans, more research is needed about services beyond housing placement and retention. This study uses the Gelberg-Andersen behavioral model for vulnerable populations to determine associations between predisposing, enabling, and need characteristics and recent service use (i.e., services to satisfy basic needs, occupational development, financial, healthcare, mental health) among unaccompanied homeless veterans (N=126) entering PSH in Los Angeles. Among the significant findings, as indicated using univariable logistic regression models, were veterans who had incarceration histories were more likely to utilize basic needs services, compared to those without incarceration histories. Veterans who received an honorable discharge were more likely to utilize occupational development services, compared to veterans with other discharge statuses. Veterans who had a case manager were more likely to utilize mental health services than those without a case manager, while those who received social security were less likely to utilize mental health services compared to veterans who did not receive social security. Veterans who met criteria for a psychological disability and veterans who met criteria for probable PTSD were more likely to use basic needs services and mental health services than veterans who fell below these thresholds. Clinical implications for social workers including "equal access to services," "enhancing economic stability," "providing safe and affordable housing with trauma-informed services," and "training service social workers to deliver well-informed linkages and services" are discussed.
Collapse
Affiliation(s)
- Taylor Harris
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Hailey Winetrobe
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Harmony Rhoades
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Carl Andrew Castro
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Suzanne Wenzel
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| |
Collapse
|
13
|
Winetrobe H, Wenzel S, Rhoades H, Henwood B, Rice E, Harris T. Differences in Health and Social Support between Homeless Men and Women Entering Permanent Supportive Housing. Womens Health Issues 2017; 27:286-293. [PMID: 28153741 DOI: 10.1016/j.whi.2016.12.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/17/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
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 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. RESULTS Compared with men entering PSH, homeless women (28% of the sample) were younger (p < .01), less likely to have achieved at least a high school education (p < .05), and had lower incomes (p < .01). Women had more chronic physical health conditions (p < .01), were more likely to have any chronic mental health condition (odds ratio, 2.5; p < .01), and had more chronic mental health conditions than men (p < .01). Women had more relatives in their social networks (Coefficient, 0.79, p < .01) and more relatives who provided support (coefficient, 0.38; p < .05), but also more relatives with whom they had conflict (coefficient, 0.19; p < .01). Additionally, women were less likely to have caseworkers (coefficient, -0.59; p < .001) or physical and mental health care providers in their networks (coefficient, -0.23 [p < .01]; coefficient, -0.37 [p < .001], respectively). However, after correcting for multiple testing, three outcomes lost significance: number of chronic physical health conditions, number of relatives who provided any support, and number of relatives with whom there was conflict. CONCLUSIONS There is evidence of gender differences in mental health and 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.
Collapse
Affiliation(s)
- Hailey Winetrobe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Benjamin Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Taylor Harris
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| |
Collapse
|
14
|
Osilla KC, Kennedy DP, Hunter SB, Maksabedian E. Feasibility of a computer-assisted social network motivational interviewing intervention for substance use and HIV risk behaviors for housing first residents. Addict Sci Clin Pract 2016; 11:14. [PMID: 27604543 PMCID: PMC5015231 DOI: 10.1186/s13722-016-0061-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/11/2016] [Indexed: 11/17/2022] Open
Abstract
Background Social networks play positive and negative roles in the lives of homeless people influencing their alcohol and/or other drug (AOD) and HIV risk behaviors. Methods We developed a four-session computer-assisted social network motivational interviewing intervention for homeless adults transitioning into housing. We examined the acceptability of the intervention among staff and residents at an organization that provides permanent supportive housing through iterative rounds of beta testing. Staff were 3 men and 3 women who were residential support staff (i.e., case managers and administrators). Residents were 8 men (7 African American, 1 Hispanic) and 3 women (2 African American, 1 Hispanic) who had histories of AOD and HIV risk behaviors. We conducted a focus group with staff who gave input on how to improve the delivery of the intervention to enhance understanding and receptivity among new residents. We conducted semi-structured qualitative interviews and collected self-report satisfaction data from residents. Results Three themes emerged over the course of the resident interviews. Residents reported that the intervention was helpful in discussing their social network, that seeing the visualizations was more impactful than just talking about their network, and that the intervention prompted thoughts about changing their AOD use and HIV risk networks. Conclusions This study is the first of its kind that has developed, with input from Housing First staff and residents, a motivational interviewing intervention that targets both the structure and composition of one’s social network. These results suggest that providing visual network feedback with a guided motivational interviewing discussion is a promising approach to supporting network change. ClinicalTrials.gov Identifier NCT02140359
Collapse
Affiliation(s)
- Karen Chan Osilla
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - David P Kennedy
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Ervant Maksabedian
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| |
Collapse
|
15
|
Kennedy DP, Hunter SB, Chan Osilla K, Maksabedian E, Golinelli D, Tucker JS. A computer-assisted motivational social network intervention to reduce alcohol, drug and HIV risk behaviors among Housing First residents. Addict Sci Clin Pract 2016; 11:4. [PMID: 26979982 PMCID: PMC4791809 DOI: 10.1186/s13722-016-0052-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals transitioning from homelessness to housing face challenges to reducing alcohol, drug and HIV risk behaviors. To aid in this transition, this study developed and will test a computer-assisted intervention that delivers personalized social network feedback by an intervention facilitator trained in motivational interviewing (MI). The intervention goal is to enhance motivation to reduce high risk alcohol and other drug (AOD) use and reduce HIV risk behaviors. METHODS/DESIGN In this Stage 1b pilot trial, 60 individuals that are transitioning from homelessness to housing will be randomly assigned to the intervention or control condition. The intervention condition consists of four biweekly social network sessions conducted using MI. AOD use and HIV risk behaviors will be monitored prior to and immediately following the intervention and compared to control participants' behaviors to explore whether the intervention was associated with any systematic changes in AOD use or HIV risk behaviors. DISCUSSION Social network health interventions are an innovative approach for reducing future AOD use and HIV risk problems, but little is known about their feasibility, acceptability, and efficacy. The current study develops and pilot-tests a computer-assisted intervention that incorporates social network visualizations and MI techniques to reduce high risk AOD use and HIV behaviors among the formerly homeless. CLINICALTRIALS. GOV IDENTIFIER NCT02140359.
Collapse
Affiliation(s)
| | - Sarah B Hunter
- RAND, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | | | | | - Joan S Tucker
- RAND, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| |
Collapse
|
16
|
Kennedy DP, Jackson GL, Green HD, Bradbury TN, Karney BR. The Analysis of Duocentric Social Networks: A Primer. JOURNAL OF MARRIAGE AND THE FAMILY 2015; 77:295-311. [PMID: 27182084 PMCID: PMC4864858 DOI: 10.1111/jomf.12151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Marriages and other intimate partnerships are facilitated or constrained by the social networks within which they are embedded. To date, methods used to assess the social networks of couples have been limited to global ratings of social network characteristics or network data collected from each partner separately. In the current article, the authors offer new tools for expanding on the existing literature by describing methods of collecting and analyzing duocentric social networks, that is, the combined social networks of couples. They provide an overview of the key considerations for measuring duocentric networks, such as how and why to combine separate network interviews with partners into one shared duocentric network, the number of network members to assess, and the implications of different network operationalizations. They illustrate these considerations with analyses of social network data collected from 57 low-income married couples, presenting visualizations and quantitative measures of network composition and structure.
Collapse
|
17
|
Salem BE, Nyamathi Anp A, Reback C, Shoptaw S, Zhang S, Nudelman O. Unmet physical and mental healthcare needs among stimulant-using gay and bisexual homeless men. Issues Ment Health Nurs 2015; 36:685-92. [PMID: 26440871 PMCID: PMC4801108 DOI: 10.3109/01612840.2015.1021938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to gain a greater understanding of predictors of the unmet physical and mental healthcare needs of homeless, stimulant-using, gay and bisexual (G/B) men. This study correlated baseline self-reported unmet physical and mental healthcare needs among stimulant-using homeless G/B men (n = 422, 18-46 years of age). A structured questionnaire was administered at baseline and data were collected from October 2009 to January 2013. The study was approved by the University of California Human Subjects' Protection committee and the Friends Research Institute Human Research Protection Committee. Logistic regression revealed that those who self-reported ever being married, being in fair or poor health and in moderate-to-very severe pain, were more likely to experience unmet needs for physical health care. In terms of unmet mental health needs, those who self-reported moderate-to-very severe pain and/or those reporting having sex while high, were more likely to report unmet needs for mental health care. In contrast, those reporting receiving social support from others were less likely to have an unmet mental healthcare need. Research implications are discussed as they relate to access to healthcare needs among this vulnerable population.
Collapse
Affiliation(s)
| | | | - Cathy Reback
- b Friends Research Institute; University of California; Integrated Substance Abuse Programs and Semel Institute for Neuroscience and Human Behavior , Los Angeles , California , USA
| | - Steven Shoptaw
- c University of California , Los Angeles , California , USA
| | - Sheldon Zhang
- d San Diego State University , Los Angeles , California , USA
| | - Olga Nudelman
- a UCLA School of Nursing , Los Angeles , California , USA
| |
Collapse
|