Homeless veterans' experiences with substance use, recovery, and treatment through photo elicitation

Investigating recovery from problem substance use using digital photovoice

This study investigates the complex process of recovery from problem substance use using a visual research method known as 'Photovoice'. Seven service users from a harm reduction drug service were given digital cameras and asked to photograph 'people, places, and things' meaningful to them in their recovery. These photographs were then used as a catalyst for discussion during two in-depth interviews. This study demonstrates the nuanced experiences of recovery as some participants expressed feeling isolated while others reflected upon their access to various forms of social capital. These findings recognise the link between social capital and recovery outcomes, while also reflecting upon how services might imbed the need for relationship quality within artificial recovery networks. The use of photographs is a novel way of providing voice to the lived experience of service users and adds to the discussion and debate concerning how recovery services may develop.

Primary Care for Veterans Experiencing Homelessness: a Narrative Review of the Homeless Patient Aligned Care Team (HPACT) Model

In 2011, the U.S. Department of Veterans Health (VA) implemented a homeless-tailored primary care medical home model called the Homeless Patient Aligned Care Teams (HPACTs). The impact of HPACTs on health and healthcare outcomes of veterans experiencing homelessness has not been adequately synthesized. This narrative review summarized peer-reviewed studies published in databases Ovid MEDLINE, Ovid EMBASE, and APA PsycInfo from 1946 to February 2022. Only original research studies that reported outcomes of the HPACT model were included in the review. Of 575 studies that were initially identified and screened, 26 studies met inclusion criteria and were included in this review. Included studies were categorized into studies that described the following: (1) early HPACT pilot implementation; (2) HPACT's association with service quality and utilization; and (3) specialized HPACT programs. Together, studies in this review suggest HPACT is associated with reductions in emergency department utilization and improvements in primary care utilization, engagement, and positive patient experiences; however, the methodological rigor of the included studies was low, and thus, these findings should only be considered preliminary. There is a need for randomized controlled trials assessing the impact of the PACT model on key outcomes of interest, as well as to determine whether the model is a viable way to manage healthcare for persons experiencing homelessness outside of the VA system.

Comparing Trauma Treatment Outcomes Between Homeless and Housed Veterans in a VA PTSD Clinical Program

Homeless veterans are likely to experience Post Traumatic Stress Disorder (PTSD). Homelessness itself is traumatic, and PTSD may exacerbate homelessness risk for veterans. Often, PTSD goes untreated in this subpopulation of veterans. Our study examined trauma-focused treatment (TFT) and non-TFT initiation and completion in a sample of housed and homeless veterans being served by a PTSD clinical team in Washington, DC. Findings included a high percentage of veterans who experienced homelessness in the sample and lower treatment completion rates among homeless veterans compared to housed veterans. This difference was no longer significant when comparing only those veterans who engaged in treatment, reinforcing the critical role of treatment engagement in successful treatment completion across populations.

A photoelicitation exploration on formally homeless people experience with Universal Credit: System error and 'the government don't care'

This article explores the impact of Universal Credit (UC) on a group of formerly homeless people who were forcibly made to experience a system of full of errors and government that, in their view, did not care. The experience of a marginalised and vulnerable group with complex needs allows one to consider the impacts of welfare reforms on vulnerable people. The research was conducted with formerly homeless contacted via organisations that support people who experienced homelessness in Brighton, Southeast of the UK. Five people (32 years and older) participated. Qualitative data were obtained in photo-elicitation interviews and were thematically analysed. Findings were that they faced a system of error as well as experiencing a sense the government did not care about their situation. The participants expressed their views on how the UC process made them 'struggle' and caused them to have to 'use food banks', and argued that the staff did not know the policy. The system is singled out as the cause of UC claimants' destitution. For the participants, policymakers' negligence, contempt, and detachment were not hard to understand. The article provides implications for practice and research.

Finding home: Community integration experiences of formerly homeless women with problematic substance use in Housing First

AIMS

This study explored community integration among women participating in a Housing First program. Physical, social, and psychological dimensions of community integration were examined.

METHODS

This study used neighborhood walk-along and photo-elicitation interviews to explore 16 formerly homeless women's experiences of community integration.

RESULTS

Participants described limited community integration. Health, poverty, service inaccessibility, and safety concerns shaped how they took part in activities in their neighborhoods. Participants primarily socialized with people in their buildings, though some preferred to keep to themselves. There was minimal sense of neighborhood belonging, with participants not interested in belonging to a community and being judged by others.

CONCLUSION

Housing First promoted housing stability but did not contribute to community integration. Participants did not express a strong desire to integrate in their communities. Future research should consider the extent to which community integration remains a priority for marginalized populations, such as formerly homeless women.

Smoking and Unemployment: A Photo Elicitation Project

Introduction:

Research has documented higher smoking prevalence with unemployment and greater difficulty with gaining re-employment for those who smoke. Using photo elicitation methods, we sought to gain a deeper understanding of the connection between job-seeking and tobacco use.

Methods:

Unemployed daily smokers (18 men, 1 woman) were recruited from the San Francisco Employment Development Department (EDD) and provided disposable cameras with 27 exposures and a list of 20 photo prompts related to job-seeking and tobacco. Study staff reviewed the photos with the participants and audio-recorded their narratives. The photos and narratives were coded for themes.

Results:

Of 363 photos, the most frequent photo imagery related to transportation (n = 56, 15.4%), work or education (n = 39, 10.7%), and littered cigarettes (n = 39, 10.7%). Narrated themes centered on motivators to quit smoking (255 mentions from 15 participants); people, places, and things associated with smoking (248 mentions, 16 participants); and motivators to secure work (157 mentions, 13 participants). The intersection of smoking and unemployment received 92 mentions from 11 participants, with 60 mentions (8 participants) identifying smoking as a barrier to re-employment.

Conclusions:

Both motivators to quit and associated smoking cues were salient in the environments of job-seeking smokers. Struggles with quitting and perceptions that smoking is harming re-employment success suggest the potential for offering tobacco treatment in EDD settings. With permission, the photos and themes have been incorporated into a tobacco treatment intervention for job-seeking smokers.

Spice, vulnerability, and victimization: Synthetic cannabinoids and interpersonal crime victimization among homeless adults

Background: Although the physiologic and psychological harms associated with the use of synthetic cannabinoids, such as spice, are well-described, researchers have yet to examine how spice abuse affects exposure to crime. This paper describes the dangerous social environment where spice is used and delineates how synthetic cannabinoid abuse increases the risk of victimization. Methods: This qualitative study used semi-structured interviews to examine crime- and victimization-related experiences of 22 homeless adults. Transcripts were analyzed for emergent themes using a two-tiered qualitative coding process. Results: Those experiencing homelessness describe synthetic cannabinoids as powerful intoxicants. Substances such as spice are sought for their ability to detach those under the drug's influence from reality. Participants illustrated their understanding of how synthetic cannabinoids affect the health and safety of unsheltered persons. Spice use frequently results in rapid intoxication; individuals under the influence of spice are thereby physically vulnerable to crime, particularly theft and robbery. Conclusion: Findings add to previous research on the harms of synthetic cannabinoid abuse. This study suggests a victimization process common among homeless persons who use spice: Incapacitation often rapidly follows use, which in turn precipitates victimization.

Veteran-centered barriers to VA mental healthcare services use

BACKGROUND

Some veterans face multiple barriers to VA mental healthcare service use. However, there is limited understanding of how veterans' experiences and meaning systems shape their perceptions of barriers to VA mental health service use. In 2015, a participatory, mixed-methods project was initiated to elicit veteran-centered barriers to using mental healthcare services among a diverse sample of US rural and urban veterans. We sought to identify veteran-centric barriers to mental healthcare to increase initial engagement and continuation with VA mental healthcare services.

METHODS

Cultural Domain Analysis, incorporated in a mixed methods approach, generated a cognitive map of veterans' barriers to care. The method involved: 1) free lists of barriers categorized through participant pile sorting; 2) multi-dimensional scaling and cluster analysis for item clusters in spatial dimensions; and 3) participant review, explanation, and interpretation for dimensions of the cultural domain. Item relations were synthesized within and across domain dimensions to contextualize mental health help-seeking behavior.

RESULTS

Participants determined five dimensions of barriers to VA mental healthcare services: concern about what others think; financial, personal, and physical obstacles; confidence in the VA healthcare system; navigating VA benefits and healthcare services; and privacy, security, and abuse of services.

CONCLUSIONS

These findings demonstrate the value of participatory methods in eliciting meaningful cultural insight into barriers of mental health utilization informed by military veteran culture. They also reinforce the importance of collaborations between the VA and Department of Defense to address the role of military institutional norms and stigmatizing attitudes in veterans' mental health-seeking behaviors.