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Gaber SN, Franck J, Widing H, Hällgren J, Mattsson E, Westman J. Excess mortality among people in homelessness with substance use disorders: a Swedish cohort study. J Epidemiol Community Health 2024; 78:473-478. [PMID: 38772698 DOI: 10.1136/jech-2023-220989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/03/2023] [Indexed: 05/23/2024]
Abstract
BACKGROUND People in homelessness have an increased risk of substance use disorders (SUDs) and poor health outcomes. This cohort study aimed to investigate the association between homelessness and mortality in people with SUDs, adjusting for age, sex, narcotic use, intravenous drug use and inpatient care for SUDs. METHODS Data from the Swedish National Addiction Care Quality Register in the Stockholm region were used to analyse mortality risk in people with SUDs (n=8397), including 637 in homelessness, 1135 in precarious housing and 6625 in stable housing, at baseline. HRs and CIs were calculated using Cox regression. RESULTS Mortality was increased for people in homelessness (HR 2.30; 95% CI 1.70 to 3.12) and precarious housing (HR 1.23; 95% CI 0.86 to 1.75) compared with those in stable housing. The association between homelessness and mortality decreased (HR 1.27; 95% CI 0.91 to 1.78) after adjusting for narcotic use (HR 1.28; 95% CI 1.00 to 1.63), intravenous drug use (HR 1.98; 95% CI 1.52 to 2.58) and inpatient care for SUDs (HR 1.96; 95% CI 1.57 to 2.45). Standardised mortality ratios (SMRs) showed that mortality among people in homelessness with SUDs was 13.6 times higher than the general population (SMR=13.6; 95% CI 10.2 to 17.9), and 3.7 times higher in people in stable housing with SUDs (SMR=3.7; 95% CI 3.2 to 4.1). CONCLUSION Homelessness increased mortality, but the risk decreased after adjusting for narcotic use, intravenous drug use and inpatient care for SUDs. Interventions are needed to reduce excess mortality among people in homelessness with SUDs.
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Affiliation(s)
- Sophie Nadia Gaber
- Department of Healthcare Sciences, Marie Cederschiöld högskola-Campus Ersta, Stockholm, Sweden
- Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
- Faculty of Brain Sciences, Division of Psychiatry, University College London, London, UK
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Härje Widing
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hällgren
- Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
| | - Elisabet Mattsson
- Department of Healthcare Sciences, Marie Cederschiöld högskola-Campus Ersta, Stockholm, Sweden
- Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
| | - Jeanette Westman
- Department of Healthcare Sciences, Marie Cederschiöld högskola-Campus Ersta, Stockholm, Sweden
- Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Tuson M, Vallesi S, Wood L. Tracking deaths of people who have experienced homelessness: a dynamic cohort study in an Australian city. BMJ Open 2024; 14:e081260. [PMID: 38448076 PMCID: PMC10916087 DOI: 10.1136/bmjopen-2023-081260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Life expectancy and rates of premature death are fundamental markers of health and social equity globally, and measures on which people experiencing homelessness face enormous disparities. However, unlike for other population groups with similar disparities, concerted government action to reduce homeless mortality is rare, partly due to a lack of reliable, timely data. Contemporaneous tracking of homeless deaths is required to render such deaths less invisible and measure trends over time. Drawing on multiple data sources as recommended by the US National Health Care for the Homeless Council's seminal Homeless Mortality Data Toolkit, we routinely and contemporaneously capture, verify and report on deaths occurring among people who have experienced homelessness in the Australian city of Perth. DESIGN Dynamic cohort study. SETTING Perth, Western Australia, Australia, between 2016 and 2022, with deaths examined between 2020 and 2022. PARTICIPANTS For this study, the cohort comprised 8753 people who experienced homelessness in Perth, with 'recruitment' into the cohort governed by engagement with one or more local homelessness services and programmes over the period. OUTCOME MEASURES Number and median age-at-death statistics. RESULTS There were 360 deaths over the 3-year period, which is likely an undercount. The median age at death was 50 years, >3 decades below the current Australian median age at death of 82 years. Aboriginal people accounted for 30% of the deaths. CONCLUSION The ongoing poor health and premature death of people who have experienced homeless are indictments on our society. Triangulation of multiple data sources is required to identify and monitor deaths among homeless populations. Timely, verified data on homeless mortality are important for galvanising action and accountability, and targets should be set to reduce the observed three-decade life expectancy chasm.
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Affiliation(s)
- Matthew Tuson
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, Western Australia, Australia
| | - Shannen Vallesi
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Lisa Wood
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Martins ALJ, de Souza AA, da Silva GDM, Dantas ACDMTV, Marinho RA, Fernandes LDMM, Oliveira AMC, Magalhães Júnior HM, Paes-Sousa R. Access to health and social protection policies by homeless people during the COVID-19 pandemic: a mixed-methods case study on tailored inter-sector care during a health emergency. Front Public Health 2024; 12:1356652. [PMID: 38469268 PMCID: PMC10926274 DOI: 10.3389/fpubh.2024.1356652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction The article analyzed homeless people's (HP) access to health and social protection policies and tailored inter-sector care, including emergency measures, during the COVID-19 pandemic in Belo Horizonte (BH), capital of Minas Gerais state, Brazil. It intended to provide data on HP and evaluate existing public policies focused on vulnerable populations during this health emergency. Methods The study adopted a mixed-methods design with triangulation of quantitative and qualitative data. Results Social cartography showed that in the early months of the pandemic, the health administration had difficulty reordering the health system, which experienced constant updates in the protocols but was nevertheless consolidated over the months. The evidence collected in the study showed that important emergency interventions in the municipality of BH involved activities that facilitated access by HP to the supply of services. Discussion The existence of national guidelines for inter-sector care for HP cannot be ruled out as a positive influence, although the municipalities are responsible for their implementation. Significantly, a health emergency was necessary to intensify the relationship between health and social protection services. Roving services were among those with the greatest positive evidence, with the least need for infrastructure to be replicated at the local level. In addition, the temporary supply of various inter-sector services, simultaneously with the provision of day shelters by organized civil society, was considered a key factor for expanding and intensifying networks of care for HP during the emergency phase. A plan exists to continue and expand this model in the future. The study concluded that understanding the inter-sector variables that impact HP contributes to better targeting of investments in interventions that work at the root causes of these issues or that increase the effectiveness of health and social protection systems.
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Affiliation(s)
- Ana Luisa Jorge Martins
- Health and Social Protection Policies Research Group, René Rachou Institute/Fiocruz Minas, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Anelise Andrade de Souza
- Health and Social Protection Policies Research Group, René Rachou Institute/Fiocruz Minas, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
- School of Nutrition, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Gabriela Drummond Marques da Silva
- Health and Social Protection Policies Research Group, René Rachou Institute/Fiocruz Minas, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | | | - Rafaela Alves Marinho
- Health and Social Protection Policies Research Group, René Rachou Institute/Fiocruz Minas, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Luísa da Matta Machado Fernandes
- Health and Social Protection Policies Research Group, René Rachou Institute/Fiocruz Minas, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Ana Maria Caldeira Oliveira
- Health and Social Protection Policies Research Group, René Rachou Institute/Fiocruz Minas, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Helvécio Miranda Magalhães Júnior
- Health and Social Protection Policies Research Group, René Rachou Institute/Fiocruz Minas, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Rômulo Paes-Sousa
- Health and Social Protection Policies Research Group, René Rachou Institute/Fiocruz Minas, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Plage S, Baker K, Parsell C, Stambe R, Kuskoff E, Mansuri A. Staying safe, feeling welcome, being seen: How spatio-temporal configurations affect relations of care at an inclusive health and wellness centre. Health Expect 2023; 26:2620-2629. [PMID: 37656503 PMCID: PMC10632618 DOI: 10.1111/hex.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND People experiencing homelessness also experience poorer health and frequently attend acute care settings when primary health care would be better equipped to meet their needs. Existing scholarship identifies a complex mix of individual and structural-level factors affecting primary health care engagement driving this pattern of health services utilisation. We build on this existing knowledge, by bringing the spatio-temporal configurations of primary health care into focus. Specifically, we interrogate how space and time inflect situated practices and relations of care. METHODS This study took an ethnographic approach and was conducted 2021-2022 at an inclusive health and wellness centre ("the Centre") in Southeast Queensland, Australia. The data consists of 46 interviews with 48 people with lived experience of homelessness, including participants who use the services offered at the Centre (n = 26) and participants who do not (n = 19). We also interviewed 20 clinical and non-clinical service providers affiliated with the Centre and observed how service delivery took place. Interviews and observations were complemented by visual data, including participant-produced photography. All data were analysed employing a narrative framework. RESULTS We present three interrelated themes demonstrating how space and time affect care, that is 'staying safe', 'feeling welcome' and 'being seen'. 'Staying safe' captures the perceptions and practices around safety, which sit in tension with making service users feel welcome. 'Feeling welcome' attends to the sense of being invited to use services free of judgment. 'Being seen' depicts capacities to see a health care provider as well as being understood in one's lived experience. CONCLUSION Spatio-temporal configurations, such as attendance policies, consultation modalities and time allocated to care encounters afford differential opportunities to nurture reciprocal relations. We conclude that flexible service configurations can leverage a relational model of care. PATIENT OR PUBLIC CONTRIBUTION Service providers were consulted during the design stage of the project and had opportunities to inform data collection instruments. Two service providers contributed to the manuscript as co-authors. People with lived experience of homelessness who use the services at the inclusive health centre contributed as research participants and provided input into the dissemination of findings. The photography they produced has been featured in an in-person exhibition, to which some have contributed as consultants or curators. It is hoped that their insights into experiences of welcomeness, safety and being seen will inform flexible and relational primary health care design, delivery, and evaluation to better cater for people experiencing housing instability and poverty.
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Affiliation(s)
- Stefanie Plage
- ARC Centre of Excellence for Children and Families over the Life CourseIndooroopillyAustralia
| | - Kirsten Baker
- Australian Research Centre in Complementary and Integrative MedicineThe University of Technology SydneyBroadwayAustralia
- Inclusive Health and Wellness HubSouth BrisbaneAustralia
| | - Cameron Parsell
- ARC Centre of Excellence for Children and Families over the Life CourseIndooroopillyAustralia
| | - Rose‐Marie Stambe
- ARC Centre of Excellence for Children and Families over the Life CourseIndooroopillyAustralia
| | - Ella Kuskoff
- ARC Centre of Excellence for Children and Families over the Life CourseIndooroopillyAustralia
| | - Arif Mansuri
- Inclusive Health and Wellness HubSouth BrisbaneAustralia
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Curiale C, Lenzi M, Gaboardi M, Marino C, Ronconi L, Demita S, Cosentino R, Disperati F, Santinello M. Homeless people's recovery in Housing First and Traditional Services: The role of working alliance in Italian housing services. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2758-2773. [PMID: 37209420 DOI: 10.1002/jcop.23055] [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: 10/07/2022] [Revised: 01/25/2023] [Accepted: 04/29/2023] [Indexed: 05/22/2023]
Abstract
This study aims to investigate whether a working alliance could represent a potential mechanism that explains the effectiveness of housing services in terms of user recovery, comparing the Housing First (HF) model with Traditional Services (TS). This study included 59 homeless service users in Italy (29 = HF; 30 = TS). Recovery was assessed upon entering the study (T0) and after 10 months (T1). Results indicate that participants inserted in HF services were more likely to report stronger working alliances with social service providers at T0 that, in turn, was directly associated with higher levels of users' recovery at the beginning of the study and indirectly (through recovery at T0) with recovery at T1. Implications of the results are discussed with respect to research and practice on homeless services.
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Affiliation(s)
- Chiara Curiale
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Michela Lenzi
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Marta Gaboardi
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Claudia Marino
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Lucia Ronconi
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Silvia Demita
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Roberta Cosentino
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Francesca Disperati
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Massimo Santinello
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
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Mitchell E, Waring T, Ahern E, O'Donovan D, O'Reilly D, Bradley DT. Predictors and consequences of homelessness in whole-population observational studies that used administrative data: a systematic review. BMC Public Health 2023; 23:1610. [PMID: 37612701 PMCID: PMC10463451 DOI: 10.1186/s12889-023-16503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Homelessness is a complex societal and public health challenge. Limited information exists about the population-level health and social care-related predictors and consequences of persons with lived experience of homelessness (PEH). Studies that focus on population subgroups or ad hoc questionnaires to gather data are of relatively limited generalisability to whole-population health surveillance and planning. The aim of this study was to find and synthesise information about the risk factors for, and consequences of, experiencing homelessness in whole-population studies that used routine administrative data. METHOD We performed a systematic search using EMBASE, MEDLINE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO research databases for English-language studies published from inception until February 2023 that reported analyses of administrative data about homelessness and health and social care-related predictors and consequences. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the 1224 articles reviewed, 30 publications met the inclusion criteria. The included studies examined a wide range of topic areas, and the homelessness definitions used in each varied considerably. Studies were categorised into several topic areas: Mortality, morbidity and COVID-19; health care usage and hospital re-admission; care home admission and shelter stay; and other (e.g. employment, crime victimisation). The studies reported that that the physical and mental health of people who experience homelessness was worse than that of the general population. Homeless individuals were more likely to have higher risk of hospitalisation, more likely to use emergency departments, have higher mortality rates and were at greater risk of needing intensive care or of dying from COVID-19 compared with general population. Additionally, homeless individuals were more likely to be incarcerated or unemployed. The effects were strongest for those who experienced being homeless as a child compared to those who experienced being homeless later on in life. CONCLUSIONS This is the first systematic review of whole-population observational studies that used administrative data to identify causes and consequences associated with individuals who are experiencing homelessness. While the scientific literature provides evidence on some of the possible risk factors associated with being homeless, research into this research topic has been limited and gaps still remain. There is a need for more standardised best practice approaches to understand better the causes and consequences associated with being homeless.
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Affiliation(s)
- Eileen Mitchell
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
- Public Health Agency, Belfast, UK.
| | - Tanisha Waring
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Diarmuid O'Donovan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Declan T Bradley
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
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Woodman L, Staples L, Karin E, Solterbeck K, Burns N, Mitchell R, Nielssen O. Rates and causes of mortality among the homeless in Sydney. Australas Psychiatry 2023; 31:469-474. [PMID: 37210640 DOI: 10.1177/10398562231176734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To report on the rate and causes of mortality, and associations with premature mortality among the homeless in inner city Sydney. METHOD Retrospective cohort study of 2,498 people who attended a psychiatric clinic conducted at the three main homeless hostels between 17 February 2008 and 19 May 2020. Cox's proportional hazards regression was used to identify factors associated with mortality. RESULTS A total of 324 of the 2498 (13.0%) clinic attenders were found to have died in the follow-up period, with a mean age at death of 50.7 years. Unnatural causes of death (119/324, 36.7%) included drug overdose (24.1%), suicide (6.8%) and other injuries (5.9%), at a younger age (44.4 years) than those who died from natural causes (54.4 years). There were 142 (43.8%) deaths from natural causes and 63 (19.4%) in which the cause of death was not determined. CONCLUSIONS The study confirms the high mortality of homeless clinic attenders in Sydney found in a study from 30 years earlier. The lower mortality among regular attenders supports the provision of accessible services to address the physical health needs of homeless people, as well as ready access to mental health and substance use services.
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Affiliation(s)
- Logan Woodman
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Lauren Staples
- Associate Professor, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences Macquarie University, Clinical Data Manager, MindSpot, MQ Health, Macquarie Park, NSW, Australia
| | - Eyal Karin
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences Macquarie University, Macquarie Park, NSW, Australia
| | - Kirra Solterbeck
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Nicholas Burns
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Rebecca Mitchell
- Associate Professor, Australian Institute of Health Innovation, Faculty of Medicine, Human and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Olav Nielssen
- Professor of Psychiatry, Faculty of Medicine, Health and Human Sciences, Macquarie University, Matthew Talbot Hostel Clinic, Macquarie Park, NSW, Australia
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Warburton TM, Rush LD, Cullen EGR, Wiener JH, McManus BTK, Heath L, Evans D. The Impact of Homelessness, Substance Use, and Mental Illness on Surgical Inpatient Outcomes in Australia. Asia Pac J Public Health 2023; 35:335-341. [PMID: 37198924 DOI: 10.1177/10105395231175563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
This study investigated inpatient surgical outcomes for people experiencing homelessness (PEH) in Australia. Retrospective administrative health data of emergency surgical admissions from a single center over five years, 2015 to 2020, was included. Independent associations between factors and outcomes were analyzed with binary logistic and log-linear regression. Of 11 229 admissions, 2% were experiencing homelessness. People experiencing homelessness were on average younger (49 vs 56 years), more likely to be males than females (77% vs 61%), suffer mental illness (10% vs 2%), and substance use disorders (54% vs 10%). People experiencing homelessness were not more likely to suffer surgical complications. However, male sex, older age, mental illness, and substance use were risk factors for poor surgical outcomes. Homelessness predicted greater odds of discharge against medical advice (4.3 times) and longer length of stay (1.25 times). These results highlighted the need for health interventions simultaneously addressing physical, mental health, and substance use issues in the care of PEH.
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Affiliation(s)
- Thomas Mostyn Warburton
- Department of Surgery, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Levon Delaney Rush
- Faculty of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Emma Grace Ruthven Cullen
- Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Department of Anaesthetics, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Jonathan Harry Wiener
- Department of Surgery, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Bryan Thomas Kelvin McManus
- Department of Surgery, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Lucienne Heath
- Department of Surgery, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - David Evans
- Department of Surgery, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
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Weightman AL, Kelson MJ, Thomas I, Mann MK, Searchfield L, Willis S, Hannigan B, Smith RJ, Cordiner R. Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta-analysis and thematic synthesis. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1329. [PMID: 37206622 PMCID: PMC10189499 DOI: 10.1002/cl2.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Adequate housing is a basic human right. The many millions of people experiencing homelessness (PEH) have a lower life expectancy and more physical and mental health problems. Practical and effective interventions to provide appropriate housing are a public health priority. Objectives To summarise the best available evidence relating to the components of case-management interventions for PEH via a mixed methods review that explored both the effectiveness of interventions and factors that may influence its impact. Search Methods We searched 10 bibliographic databases from 1990 to March 2021. We also included studies from Campbell Collaboration Evidence and Gap Maps and searched 28 web sites. Reference lists of included papers and systematic reviews were examined and experts contacted for additional studies. Selection Criteria We included all randomised and non-randomised study designs exploring case management interventions where a comparison group was used. The primary outcome of interest was homelessness. Secondary outcomes included health, wellbeing, employment and costs. We also included all studies where data were collected on views and experiences that may impact on implementation. Data Collection and Analysis We assessed risk of bias using tools developed by the Campbell Collaboration. We conducted meta-analyses of the intervention studies where possible and carried out a framework synthesis of a set of implementation studies identified by purposive sampling to represent the most 'rich' and 'thick' data. Main Results We included 64 intervention studies and 41 implementation studies. The evidence base was dominated by studies from the USA and Canada. Participants were largely (though not exclusively) people who were literally homeless, that is, living on the streets or in shelters, and who had additional support needs. Many studies were assessed as having a medium or high risk of bias. However, there was some consistency in outcomes across studies that improved confidence in the main findings. Case Management and Housing Outcomes Case management of any description was superior to usual care for homelessness outcomes (standardised mean difference [SMD] = -0.51 [95% confidence interval [CI]: -0.71, -0.30]; p < 0.01). For studies included in the meta-analyses, Housing First had the largest observed impact, followed by Assertive Community Treatment, Critical Time Intervention and Intensive Case Management. The only statistically significant difference was between Housing First and Intensive Case Management (SMD = -0.6 [-1.1, -0.1]; p = 0.03) at ≥12 months. There was not enough evidence to compare the above approaches with standard case management within the meta-analyses. A narrative comparison across all studies was inconclusive, though suggestive of a trend in favour of more intensive approaches. Case Management and Mental Health Outcomes The overall evidence suggested that case management of any description was not more or less effective compared to usual care for an individual's mental health (SMD = 0.02 [-0.15, 0.18]; p = 0.817). Case Management and Other Outcomes Based on meta-analyses, case management was superior to usual care for capability and wellbeing outcomes up to 1 year (an improvement of around one-third of an SMD; p < 0.01) but was not statistically significantly different for substance use outcomes, physical health, and employment. Case Management Components For homelessness outcomes, there was a non-significant trend for benefits to be greater in the medium term (≤3 years) compared to long term (>3 years) (SMD = -0.64 [-1.04, -0.24] vs. -0.27 [-0.53, 0]; p = 0.16) and for in-person meetings in comparison to mixed (in-person and remote) approaches (SMD = -0.73 [-1.25,-0.21]) versus -0.26 [-0.5,-0.02]; p = 0.13). There was no evidence from meta-analyses to suggest that an individual case manager led to better outcomes then a team, and interventions with no dedicated case manager may have better outcomes than those with a named case manager (SMD = -0.36 [-0.55, -0.18] vs. -1.00 [-2.00, 0.00]; p = 0.02). There was not enough evidence from meta-analysis to assess whether the case manager should have a professional qualification, or if frequency of contact, case manager availability or conditionality (barriers due to conditions attached to service provision) influenced outcomes. However, the main theme from implementation studies concerned barriers where conditions were attached to services. Characteristics of Persons Experiencing Homelessness No conclusions could be drawn from meta-analysis other than a trend for greater reductions in homelessness for persons with high complexity of need (two or more support needs in addition to homelessness) as compared to those with medium complexity of need (one additional support need); effect sizes were SMD = -0.61 [-0.91, -0.31] versus -0.36 [-0.68, -0.05]; p = 0.3. The Broader Context of Delivery of Case Management Programmes Other major themes from the implementation studies included the importance of interagency partnership; provision for non-housing support and training needs of PEH (such as independent living skills), intensive community support following the move to new housing; emotional support and training needs of case managers; and an emphasis on housing safety, security and choice. Cost Effectiveness The 12 studies with cost data provided contrasting results and no clear conclusions. Some case management costs may be largely off-set by reductions in the use of other services. Cost estimates from three North American studies were $45-52 for each additional day housed. Authors' Conclusions Case management interventions improve housing outcomes for PEH with one or more additional support needs, with more intense interventions leading to greater benefits. Those with greater support needs may gain greater benefit. There is also evidence for improvements to capabilities and wellbeing. Current approaches do not appear to lead to mental health benefits. In terms of case management components, there is evidence in support of a team approach and in-person meetings and, from the implementation evidence, that conditions associated with service provision should be minimised. The approach within Housing First could explain the finding that overall benefits may be greater than for other types of case management. Four of its principles were identified as key themes within the implementation studies: No conditionality, offer choice, provide an individualised approach and support community building. Recommendations for further research include an expansion of the research base outside North America and further exploration of case management components and intervention cost-effectiveness.
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Affiliation(s)
| | - Mark J. Kelson
- Department of Mathematics and Statistics, Faculty of Environment, Science and EconomyUniversity of ExeterExeterUK
| | - Ian Thomas
- Wales Institute of Social and Economic Research and Data (WISERD)Cardiff UniversityCardiffUK
| | - Mala K. Mann
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Lydia Searchfield
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Simone Willis
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Ben Hannigan
- Mental Health Nursing, School of Healthcare SciencesCardiff UniversityCardiffUK
| | | | - Rhiannon Cordiner
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
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10
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Currie J, McWilliams L, Venkataraman V, Paisi M, Shawe J, Thornton A, Larkin M, Taylor J, Middleton S. Nurses’ perceptions on the skills, knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia: A qualitative study. Collegian 2023. [DOI: 10.1016/j.colegn.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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11
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Heerde J, Borschmann R, Young J, Kinner SA, Sawyer SM, Patton GC. Mortality among people who have experienced homelessness: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e067182. [PMID: 36806070 PMCID: PMC9943969 DOI: 10.1136/bmjopen-2022-067182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Homelessness is a major contributor to health inequalities. People who experience homelessness are at markedly increased risk of multiple and complex health morbidities which likely increase their susceptibility to early, preventable death. Despite this, the mortality burden in this group remains poorly understood, limited in part by insufficient synthesis of data at a global level. This systematic review will synthesise international literature examining rates of risk and protective factors for mortality among people who have experienced homelessness. METHODS AND ANALYSIS We will search MEDLINE, PsycINFO, Embase and PubMed for peer-reviewed cohort studies examining mortality among people who have experienced homelessness. No study eligibility restrictions will be placed on the date, country of origin, or language of publications, or age of the sample. We will assess the quality of included studies using the Methodological Standards for Epidemiological Research scale. Our measures of mortality will include: (A) incidence-all cause and cause specific, expressed as a crude mortality rate (CMR) per 1000 person-years, with 95% CI and (B) all cause and cause specific, indirectly standardised mortality ratios (SMRs) with 95%CI. Associations between risk and protective factors and all-cause and cause-specific mortality will be reported using pooled relative risk ratios with 95% CI. Where there are sufficient data, the influence of subgroup and methodological factors on CMRs, SMRs and predictive factors will be examined using meta-regression. ETHICS AND DISSEMINATION This study does not require institutional ethics review or approval as it will synthesise findings from published studies that have previously been granted relevant ethics approvals. Study findings will be disseminated through a peer-reviewed journal article, conference and seminar presentations. A plain language summary will be distributed through the authors' academic and professional networks. PROSPERO REGISTRATION NUMBER CRD42021272937.
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Affiliation(s)
- Jessica Heerde
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- School of Social Work, The University of Melbourne, Parkville, Victoria, Australia
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jesse Young
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Susan M Sawyer
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - George C Patton
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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12
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Deaths of profound despair: A retrospective cohort study of mortality among people experiencing homelessness. PLoS One 2023; 18:e0281912. [PMID: 36795773 PMCID: PMC9934450 DOI: 10.1371/journal.pone.0281912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION The number of people dying while unhoused is increasing nationally. In Santa Clara County (SCC), deaths of unhoused people have almost tripled in 9 years. This is a retrospective cohort study examining mortality trends among unhoused people in SCC. The objective of the study is to characterize mortality outcomes in the unhoused population, and compare these to the SCC general population. MATERIALS AND METHODS We obtained data from the SCC Medical Examiner-Coroner's Office on unhoused people's deaths that occurred between 2011-2019. We analyzed demographic trends and cause of death, compared to mortality data on the SCC general population obtained from CDC databases. We also compared rates of deaths of despair. RESULTS There were a total of 974 unhoused deaths in the SCC cohort. The unadjusted mortality rate among unhoused people is higher than the general population, and unhoused mortality has increased over time. The standardized mortality ratio for unhoused people is 3.8, compared to the general population in SCC. The most frequent age of death among unhoused people was between 55-64 years old (31.3%), followed by 45-54 (27.5%), compared to 85+ in the general population (38.3%). Over ninety percent of deaths in the general population were due to illness. In contrast, 38.2% of unhoused deaths were due to substance use, 32.0% illness, 19.0% injury, 4.2% homicide, and 4.1% suicide. The proportion of deaths of despair was 9-fold higher in the unhoused cohort compared to the housed cohort. DISCUSSION Homelessness has profound impacts on health, as people who are unhoused are dying 20 years younger, with higher rates of injurious, treatable, and preventable causes, than people in the general population. System-level, inter-agency interventions are needed. Local governments need to systematically collect housing status at death to monitor mortality patterns among unhoused people, and adapt public health systems to prevent rising unhoused deaths.
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13
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Tominc BL, Francis KL, Sawyer SM, Heerde JA, O’Neill J, Henning D. Immunization Coverage in Young People Experiencing Homelessness and the Impact of a Nurse-led Program. J Prim Care Community Health 2023; 14:21501319231204581. [PMID: 37846075 PMCID: PMC10583520 DOI: 10.1177/21501319231204581] [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: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES To identify the proportion of young people experiencing homelessness who are immunized against vaccine-preventable diseases, and to evaluate the impact of a nurse-led immunization program to improve vaccination coverage in this population. METHODS A retrospective audit of electronic medical records included 400 participants aged 15 to 24 years who had an encounter with the Young People's Health Service, a nurse-led clinic co-located with a specialist youth homelessness service in Melbourne, Australia, between February 2019 and May 2021. RESULTS Integrating an immunization nurse within a youth specialist homelessness service increased the percentage of young people who were up-to-date with routine vaccinations from 6.0% (n = 24) to 38.8% (n = 155). Intersecting social determinants of health that increased participants' risk of vaccine preventable diseases, and of missing routine vaccines, were common. CONCLUSIONS Incomplete coverage of routine vaccines is common in young people accessing homelessness services, and this coverage was improved when young people encountered an immunization nurse while accessing support from a specialist youth homelessness service. As a service model, nurse-led community health clinics co-located within homelessness providers can improve vaccination coverage, and therefore health outcomes, of young people experiencing or at risk of homelessness.
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Affiliation(s)
- Belinda L. Tominc
- The Royal Children’s Hospital, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Kate L. Francis
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Susan M. Sawyer
- The Royal Children’s Hospital, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Jessica A. Heerde
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Jenny O’Neill
- The Royal Children’s Hospital, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Dot Henning
- The Royal Children’s Hospital, Melbourne, VIC, Australia
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14
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Currie J, Grech E, Yee J, Aitkenhead A, Jones L. Multistage Psychometric Testing of the Homeless Health Access to Care Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15928. [PMID: 36498002 PMCID: PMC9738957 DOI: 10.3390/ijerph192315928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
People experiencing homelessness find it challenging to access the healthcare they so desperately need. To address this, we have developed the Homeless Health Access to Care Tool, which assesses health related vulnerability (burden of injury and/or illness and ability to access healthcare) and can be used to prioritize people for access to healthcare. Here, we report the initial psychometrics of the Homeless Health Access to Care Tool. To assess interrater reliability, clinician participants were invited to instinctually rate the health-related vulnerability of 18-fictional case studies and then apply the Homeless Health Access to Care Tool to these same case studies. To assess convergent validity, the Homeless Health Access to Care Tool and the tool it was adapted from, the Australian Vulnerability Index Service Prioritization Decision Assistance Tool were administered to people experiencing homelessness. Feedback was sought from the participants receiving these two tools and from those administering them. The Homeless Health Access to Care Tool demonstrated a high interrater reliability and internal consistency. Participants using and receiving the Homeless Health Access to Care Tool reported it as straightforward, unintrusive and clear. Median time of administration was 7 min 29 s (SD 118.03 s). Convergent validity was established for the Homeless Health Access to Care Tool with a moderate correlation (r = 0.567) with the total score of the Australian Vulnerability Index Service Prioritization Decision Assistance Tool. Findings suggest that the Homeless Health Access to Care Tool is feasible and reliable. Larger samples are required to report construct validity.
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Affiliation(s)
- Jane Currie
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Homeless Health Service, St Vincent’s Hospital Sydney, Sydney, NSW 2010, Australia
| | - Elizabeth Grech
- Homeless Health Service, St Vincent’s Hospital Sydney, Sydney, NSW 2010, Australia
| | - Jasmine Yee
- Homeless Health Service, St Vincent’s Hospital Sydney, Sydney, NSW 2010, Australia
| | - Amy Aitkenhead
- Homeless Health Service, St Vincent’s Hospital Sydney, Sydney, NSW 2010, Australia
| | - Lee Jones
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4000, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4000, Australia
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15
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Currie J, Hollingdrake O, Grech E, McEnroe G, McWilliams L, Le Lievre D. Optimizing Access to the COVID-19 Vaccination for People Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15686. [PMID: 36497787 PMCID: PMC9736191 DOI: 10.3390/ijerph192315686] [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] [Received: 10/07/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The success of the Australian COVID-19 vaccination strategy rested on access to primary healthcare. People experiencing or at risk of homelessness are less likely to access primary healthcare services. Therefore, leaders in homeless health service delivery in Sydney identified the need to develop a vaccine hub specifically for this vulnerable population. The aim of this study was to develop an evidenced based model of care to underpin the Vaccine Hub and optimize access to vaccination for people experiencing or at risk of homelessness. A mixed methods study was conducted that included interviews with key stakeholders involved in establishing and delivering the Inner City COVID-19 Vaccine Hub, and a survey with people receiving COVID-19 vaccination. Over the 6-month period of this study, 4305 COVID-19 vaccinations were administered. Participants receiving vaccination reported feeling safe in the Vaccine Hub and would recommend it to others. Stakeholders paid tribute to the collective teamwork of the Vaccine Hub, the collaboration between services, the 'no wrong door' approach to increasing access and the joy of being able to support such a vulnerable population in challenging times. The study findings have been populated into a Vaccination Hub Blueprint document that can be used as a template for others to improve access to vaccinations for vulnerable populations.
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Affiliation(s)
- Jane Currie
- School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane 4059, Australia
- Homeless Health Service, St Vincent’s Hospital Sydney, 390 Victoria Street, Darlinghurst, Sydney 2010, Australia
| | - Olivia Hollingdrake
- School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane 4059, Australia
| | - Elizabeth Grech
- School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane 4059, Australia
| | - Georgia McEnroe
- School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane 4059, Australia
| | - Lucy McWilliams
- Homeless Health Service, St Vincent’s Hospital Sydney, 390 Victoria Street, Darlinghurst, Sydney 2010, Australia
| | - Dominic Le Lievre
- Homeless Health Service, St Vincent’s Hospital Sydney, 390 Victoria Street, Darlinghurst, Sydney 2010, Australia
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Wormley K, Dickson D, Alter H, Njoku N, Imani P, Anderson E. Association of Social Needs and Housing Status Among Urban Emergency Department Patients. West J Emerg Med 2022; 23:802-810. [PMID: 36409947 PMCID: PMC9683759 DOI: 10.5811/westjem.2022.8.55705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 08/08/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction People experiencing homelessness have high rates of social needs when presenting for emergency department (ED) services, but less is known about patients with housing instability who do not meet the established definitions of homelessness. Methods We surveyed patients in an urban, safety-net ED from June–August 2018. Patients completed two social needs screening tools and responded to additional questions on housing. Housing status was determined using validated questions about housing stability. Results Of the 1,263 eligible patients, 758 (60.0%) completed the survey. Among respondents, 40% identified as Latinx, 39% Black, 15% White, 5% Asian, and 8% other race/ethnicities. The median age was 42 years (interquartile range [IQR]: 29–57). and 54% were male. Of the 758 patients who completed the survey, 281 (37.1%) were housed, 213 (28.1%) were unstably housed, and 264 (34.8%) were homeless. A disproportionate number of patients experiencing homelessness were male (63.3%) and Black (54.2%), P <0.001, and a disproportionate number of unstably housed patients were Latinx (56.8%) or were primarily Spanish speaking (49.3%), P <0.001. Social needs increased across the spectrum of housing from housed to unstably housed and homeless, even when controlling for demographic characteristics. Conclusion Over one in three ED patients experience homelessness, and nearly one in three are unstably housed. Notable disparities exist by housing status, and there is a clear increase of social needs across the housing spectrum. Emergency departments should consider integrating social screening tools for patients with unstable housing.
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Affiliation(s)
- Kadia Wormley
- Department of Emergency Medicine, Alameda Health System, Oakland, California
| | - Drusia Dickson
- Department of Emergency Medicine, Alameda Health System, Oakland, California
| | - Harrison Alter
- Department of Emergency Medicine, Alameda Health System, Oakland, California; Andrew Levitt Center for Social Emergency Medicine, Berkeley, California
| | - Ndidi Njoku
- Howard University College of Medicine, Washington, DC
| | - Partow Imani
- University of California Berkeley, School of Public Health, Berkeley, California
| | - Erik Anderson
- Department of Emergency Medicine, Alameda Health System, Oakland, California; Substance Use Disorder Treatment Program, Alameda Health System, Oakland, California
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Marthick-Hone D, Doyle AK, Kennedy GA, Vindigni D, Polus BI. The importance of setting and therapeutic relationships when delivering chiropractic care to those living with disadvantage. Chiropr Man Therap 2022; 30:47. [PMID: 36274135 PMCID: PMC9590208 DOI: 10.1186/s12998-022-00456-y] [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: 02/16/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chiropractic is a mostly privatised health profession within Australia, with people experiencing disadvantage typically having limited access due to financial barriers. However, some universities within Australia offer community outreach clinics where students provide chiropractic care to people living with disadvantage. This demographic experiences higher rates of chronic conditions including musculoskeletal complaints and requires subsidisation to access privatised care. This need also offers opportunity for the chiropractic profession to work within community healthcare teams. A mixed-methods observational study was used to investigate how the unique setting of a student chiropractic community clinic may influence the experience and outcomes of those who attend. METHODS Three patient-reported outcome measures (PROMs) investigated client outcomes: Measure Yourself Medical Outcome Profile (MYMOP); European Five Domain Five Level Quality of Life Questionnaire (EQ-5D-5L); and the Patient Enablement Instrument. The PROMs data were analysed descriptively and inferentially. Interviews were conducted with clients who had received chiropractic care, chiropractic students, clinical supervisors and staff of the centre. Interview data were coded using thematic analysis, and themes were formed using Bronfenbrenner's socio-ecological systems framework and non-participant observations. RESULTS Thirty-seven participants completed baseline PROMs and 17 completed follow-ups after four treatments. Seventy-two percent of participants nominated their primary complaint as chronic. Significant change was noted in general health and wellbeing for the MYMOP, pain and disability for the EQ-5D-5L and index scores for the EQ-5D-5L suggested improved health and wellbeing. Most clients experienced higher levels of enablement post treatment. Twelve participants were interviewed (four were clients), with five themes emerging from the interview data. Clients reported their lived experiences impacted their health problems and attending the clinic offered benefits beyond improvement of pain and disability. CONCLUSIONS Interview data suggested that these benefits were due to a combination of therapy, the setting and the relationships formed within that setting. Complementing this, PROM data suggested clients experienced better levels of health and wellbeing and decreased levels of pain and disability. Findings indicated that people who experienced disadvantage may receive broader benefits from attending community centres offering chiropractic care. Services such as chiropractic may be complementary in meeting the healthcare needs of those experiencing disadvantage.
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Affiliation(s)
- Dan Marthick-Hone
- Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia.
| | - Aunty Kerrie Doyle
- grid.1029.a0000 0000 9939 5719Indigenous Health School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - Gerard A. Kennedy
- grid.1040.50000 0001 1091 4859Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Dein Vindigni
- grid.1017.70000 0001 2163 3550Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Barbara I. Polus
- grid.1017.70000 0001 2163 3550School of Engineering, RMIT University, Bundoora, Australia
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Vandenberg B, Livingstone C, Carter A, O'Brien K. Gambling and homelessness in older adults: a qualitative investigation. Addiction 2022; 117:1702-1712. [PMID: 34817109 DOI: 10.1111/add.15756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Homelessness is one of the most significant harms associated with gambling and appears to affect older adults disproportionately, but the relationship has received little research attention. This exploratory study investigated how gambling and homelessness is linked in older adults. METHODS Using qualitative research methods, we undertook in-depth semi structured face-to-face individual and group interviews to gather data from a purposive sample (n = 48) of key informants working in service provision for older adults (aged 50+ years) experiencing gambling-related harm and/or homelessness in Victoria, Australia. Thematic analysis of data focused on evaluating mechanisms and identifying contextual conditions that activate pathways between gambling and homelessness. RESULTS The relationship between gambling and homelessness in older adults is often indirect and non-linear, and can represent a reflexive cycle. Experiencing periods of homelessness into older age can contribute to gambling, often because the adverse impacts of homelessness on older adults' mental and material wellbeing increase the appeal of gambling. Additionally, comorbidities (e.g. substance use, mental illness, past trauma) and structural conditions (e.g. gambling accessibility, poverty, housing insecurity) can activate gambling. Furthermore, because gambling in the older homeless adult population is frequently hidden and regularly overlooked by service providers, it often continues unabated. Gambling in older adults can also contribute to the onset of first-time homelessness. Large and rapid losses from high-intensity gambling frequently characterize this route to homelessness. Such gambling is often triggered by major life events and changes (e.g. bereavement, job loss, relationship difficulties), and the outcomes are often worsened by the conduct of gambling operators and creditors. CONCLUSIONS The link between gambling and homelessness in older adults is complex, with connecting mechanisms often contingent upon individual, interpersonal and structural conditions and contexts. There is potential for preventative and ameliorative action given many of the underlying conditions appear modifiable through policy intervention.
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Affiliation(s)
- Brian Vandenberg
- Behavioural Sciences Research Laboratory, School of Social Sciences, Monash University, Clayton, VIC, Australia
| | - Charles Livingstone
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adrian Carter
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Kerry O'Brien
- Behavioural Sciences Research Laboratory, School of Social Sciences, Monash University, Clayton, VIC, Australia
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Currie J, Grech E, Longbottom E, Yee J, Hastings R, Aitkenhead A, Larkin M, Jones L, Cason A, Obrecht K. Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia. BMJ Open 2022; 12:e058893. [PMID: 35314477 PMCID: PMC8938696 DOI: 10.1136/bmjopen-2021-058893] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES In this paper, we report the development of the Homeless Health Access to Care Tool. This tool aims to improve the gap in assessing health need and capacity to access healthcare of people experiencing homelessness. Tools exist that prioritise people experiencing homelessness for housing, but none specifically designed to prioritise for healthcare, or that are succinct enough to be easily implemented to emergency department or primary healthcare settings. DESIGN AND SETTING The Homeless Health Access to Care Tool has been adapted from an existing tool, the Vulnerability Index Service Prioritisation Decision Assistance Tool through a five-step process: (1) domain identification, (2) literature review, (3) analysis of hospital admission data, (4) expert judges, and (5) Delphi study. PARTICIPANTS The tool was adapted and developed by homeless health clinicians, academics and people with lived experience of homelessness. The Delphi study (n=9) comprised emergency department and homeless health clinicians. RESULTS Consensus was gained on all but one item, five new items were added, and wording changes were made to six items based on expert feedback. Participants perceived the tool would take between 5 to 11 min to complete, the number of items were appropriate, and the majority agreed it would facilitate the assessment of health needs and capacity to access healthcare. CONCLUSION Robust development of the Homeless Health Access to Care Tool through the Delphi is the first phase of its development. The Homeless Health Access to Care Tool offers an opportunity to assess both health need and capacity to access healthcare with the aim to improve access to healthcare for people experiencing homelessness. This tool will facilitate standardised data collection to inform service design and data linkage regarding access to healthcare of people experiencing homelessness. The next stages of testing include construct validity, feasibility, usability and inter-rater reliability, and pilot implementation.
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Affiliation(s)
- Jane Currie
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Elizabeth Grech
- Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Erin Longbottom
- Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Jasmine Yee
- Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Ruth Hastings
- Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Amy Aitkenhead
- Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Matthew Larkin
- Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Lee Jones
- School of Public Health and Social Work and Center for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amy Cason
- Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Karin Obrecht
- Homeless Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
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Corey J, Lyons J, O’Carroll A, Stafford R, Ivers JH. A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063219. [PMID: 35328907 PMCID: PMC8954292 DOI: 10.3390/ijerph19063219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.
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Affiliation(s)
- Julia Corey
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | - James Lyons
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | | | - Richie Stafford
- HSE Community Healthcare Organisation Dublin North City & County, D09C8P5 Dublin, Ireland;
| | - Jo-Hanna Ivers
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
- Correspondence:
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21
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Weightman AL, Kelson MJ, Thomas I, Mann MK, Searchfield L, Hannigan B, Smith RJ, Willis S, Cordiner R. PROTOCOL: Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta-analysis and thematic synthesis. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1220. [PMID: 36908653 PMCID: PMC8866910 DOI: 10.1002/cl2.1220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This is the protocol for a Campbell review. The objectives are as follows: To carry out a mixed methods review to summarise current evidence relating to the components of case-management interventions for people experiencing homelessness.
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Affiliation(s)
| | - Mark J. Kelson
- Alan Turing Institute, School of MathematicsUniversity of ExeterUK
| | - Ian Thomas
- Wales Institute of Social and Economic Research and Data (WISERD)Cardiff UniversityCardiffUK
| | - Mala K. Mann
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Lydia Searchfield
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Ben Hannigan
- Mental Health Nursing, School of Healthcare SciencesCardiff UniversityCardiffUK
| | | | - Simone Willis
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Rhiannon Cordiner
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
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22
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Becker JN, Foli KJ. Health-seeking behaviours in the homeless population: A concept analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e278-e286. [PMID: 34250681 DOI: 10.1111/hsc.13499] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
This concept analysis aims to define the concept of health-seeking behaviour in relation to the homeless population. The altered experiences of individuals who are homeless suggest that the concept of health-seeking behaviours has distinct attributes and therefore, a new definition of this concept is needed when compared with other populations. The framework outlined by Walker and Avant was used for this analysis with model, borderline and contrary cases. Databases searched were: CINAHL, Sociological Abstracts, PsycInfo, Google Scholar and PubMed. Because of the limited literature on the overall health-seeking behaviours of the homeless population, the most relevant 15 sources were selected from these databases for the literature review. Critical attributes derived from the literature were: (a) distrust in healthcare services, emerging from feelings of judgement or stigma from healthcare providers; (b) prioritising physiological needs such as food, shelter and clothing over the safety needs of health; (c) delaying seeking care until physical symptoms are severe; and (d) having decreased access to healthcare because of being uninsured or having no money, requiring transportation, experiencing long wait times for appointments, or lacking knowledge of available healthcare services. We define health-seeking behaviours in the homeless population as a complex process where a homeless individual seeks out healthcare for a problem or illness, but must first meet his or her physiological needs and then deem current symptoms severe enough to seek medical treatment despite his or her distrust in the healthcare system and barriers to accessing healthcare. Homeless individuals may face unique physiological hardships and emotional stressors compared to the general population, which results in distinct attributes surrounding health-seeking behaviours. Healthcare providers need to be aware of current barriers to care and perceived access to care in order to reduce the barriers to care that the homeless population faces.
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Affiliation(s)
- Jenna N Becker
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
| | - Karen J Foli
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
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23
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Onapa H, Sharpley CF, Bitsika V, McMillan ME, MacLure K, Smith L, Agnew LL. The physical and mental health effects of housing homeless people: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:448-468. [PMID: 34423491 DOI: 10.1111/hsc.13486] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 05/25/2023]
Abstract
Housing is a significant determinant of health and is widely accepted as a key solution to address some of the health disparities that exist among the homeless. It is estimated that 150 million people worldwide are homeless, and approximately 1.8 billion lack adequate housing. However, understanding of how housing has a positive impact on the health of the homeless remains unclear and underdeveloped. This systematic review investigates intervention studies that report on the physical and mental health effects of housing homeless persons. A search of PubMed, PsycINFO, EBSCOHost-Academic Search Complete and the Cochrane Library was conducted for peer-reviewed articles published in English from 1999 to 2020 that had a combination of at least one housing intervention and health outcome, with a homeless sample. Three previous reviews and 24 studies were included for analysis. Most of the studies (n = 20) encompassed permanent supportive housing interventions that emphasised placing homeless people with mental illness directly into affordable housing with access to support services. The primary health outcomes reported were general physical and mental health, well-being, and quality of life. Despite inconsistent findings and significant issues identified in the reviewed literature, housing (in the short term) improves some aspects of health in homeless populations with human immunodeficiency virus, anxiety and depression.
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Affiliation(s)
- Hebaat Onapa
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Christopher F Sharpley
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Vicki Bitsika
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Mary E McMillan
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
| | | | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Linda L Agnew
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW, Australia
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24
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Sutherland G, Bulsara C, Robinson S, Codde J. Older women's perceptions of the impact of homelessness on their health needs and their ability to access healthcare. Aust N Z J Public Health 2021; 46:62-68. [PMID: 34710257 DOI: 10.1111/1753-6405.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study explored the healthcare needs and barriers to health services in older homeless women in the Perth metropolitan area, Western Australia. METHODS Twenty-two older women experiencing homelessness completed a questionnaire and semi-structured interview. Data were analysed using descriptive statistics and thematic analysis. RESULTS The study highlighted that these women had complex and inter-related issues that affected their health. The nine major themes that emerged from the interview data consisted of: safe accommodation; financial insecurity; experience of trauma and abuse; stigma, embarrassment and fear of being judged; the health impact of not fulfilling their role as family nurturer; mental health; complex interaction of physical and mental health issues; healthcare costs; and the need for ongoing psychosocial and healthcare support once housed. CONCLUSION Provision of safe and secure accommodation is pivotal to women's health, as is the need for greater understanding of the impact of poverty, women's traditional roles, social disconnection and domestic violence, and ongoing access to healthcare and support services. Implications for public health: A structural and systemic approach based on a social determinants of health framework is required to address the health needs of the increasing numbers of older women becoming homeless in this country.
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Affiliation(s)
- Gloria Sutherland
- Institute for Health Research, The University of Notre Dame Australia, Western Australia
| | - Caroline Bulsara
- School of Health Sciences, The University of Notre Dame Australia, Western Australia
| | | | - Jim Codde
- Institute for Health Research, The University of Notre Dame Australia, Western Australia
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25
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Phipps M, Dalton L, Maxwell H, Cleary M. A qualitative exploration of women's resilience in the face of homelessness. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1212-1227. [PMID: 33855717 DOI: 10.1002/jcop.22574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study was to examine the experiential perspectives of women becoming and experiencing homelessness. Situated in the qualitative interpretative tradition, data were collected using auto-driven photo-elicitation and in-depth face-to-face interviews. Eleven Australian women used photographs that represented their experiences of being homeless to guide their interview discussion. The findings revealed that homelessness for women is a period often preceded by a series of adverse incidents in their lives, characterised by progressive resilience building in the face of trauma, finding hope and building strength to work towards exiting homelessness. After becoming homeless, five stages of resilience transition emerged: The trauma of homelessness, Finding hope and surviving, Finding help, Finding connection and Taking control. Women experiencing homelessness are resilient and capable of enacting competence and autonomy in seeking help to exit homelessness. Changes to service delivery are recommended to improve trauma-informed, person-centred housing and social services that are integrated and easy to navigate.
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Affiliation(s)
- Monique Phipps
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Lisa Dalton
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Hazel Maxwell
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Michelle Cleary
- School of Nursing, University of Tasmania, Sydney, New South Wales, Australia
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26
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Rosa WE, Andersen LJ, Frierson E, Fulton C, Moryl N. Fostering Trust With a Young Man Experiencing Homelessness and Advanced Cancer. J Palliat Care 2021; 37:265-269. [PMID: 33904342 DOI: 10.1177/08258597211013957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Persons experiencing homelessness (PEH) face countless barriers to equitable health, social, and palliative care across all settings. Brandon was a 23-year-old male, well-spoken, groomed, and polite despite difficult circumstances. He was severely abused then abandoned as a child, living in multiple foster homes until 18. With no consistent caring adult figure, he predictably fell into a chaotic lifestyle, had 3 children by different mothers, and became homeless in New York City. He presented with newly diagnosed renal cell carcinoma metastatic to lung, lymph nodes, and bone. Spine and pelvic metastases caused paralyzing somatic pain that interfered with walking and sitting and prevented Brandon from performing the activities of daily living essential for his survival on the streets and safekeeping of opioids. Lack of basic social support and a history of multiple abandonments made a care plan for this young, homeless, and truly isolated man very challenging. The inpatient and outpatient interdisciplinary team members partnering with Brandon each earned his trust with time. A "safe place" opened hearts on all sides of the therapeutic relationship and led to a plan that was acceptable for both the patient and the palliative care team. Clinicians are often challenged to provide sustained and pragmatic palliative care services for PEH due to complex barriers. Continued advocacy for equitable and tailored services that ensure high-quality palliative care for PEH is critical at individual, institutional, and system levels to promote health equity and dignified care.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laurie J Andersen
- Supportive Care Service, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ethel Frierson
- Department of Nursing, Supportive Care Service, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carolyn Fulton
- Palliative Care Service, 22095University of Colorado Hospital, Denver, CO, USA
| | - Natalie Moryl
- Department of Medicine, Supportive Care Service, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
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27
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Nagy-Borsy E, Vági Z, Skerlecz P, Szeitl B, Kiss I, Rákosy Z. Health status and health behaviour of the Hungarian homeless people. ACTA ACUST UNITED AC 2021; 79:15. [PMID: 33531045 PMCID: PMC7852122 DOI: 10.1186/s13690-021-00534-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Homelessness has risen recently in Europe, but there is lack of comprehensive health data on this population. Our aim was to characterize the health of the Hungarian homeless population. METHODS We performed a health survey with 453 homeless individuals. The results were compared to the age and sex standardized data of the general Hungarian population and its lowest income quintile from the European Health Interview Survey 2014. The differences by the ETHOS classification within the homeless population were also studied. RESULTS Significantly fewer homeless people reported good health status than in the general population or in its lowest income quintile (p< 0.001). Of the participants 70% had at least one chronic disease, only 41% of them visited a GP and 35% took medication in the previous 12 months. While 59% of the lowest income quintile and 50% of the general population had at least one chronic disease, almost all of them visited a physician and took medication. The highest prevalence of morbidity (80%) and multimorbidity (46%) was reported in the houseless group. The majority of the homeless people were current smokers, the prevalence was much higher than in the two reference populations (p< 0.001). The prevalence of heavy drinkers was the highest among the roofless participants (40%). CONCLUSIONS Homeless people have much poorer health and they utilize health services less than the most disadvantaged quintile of the general population. There is a clear social gradient within the homeless population, as well, which calls for integrated approaches for specific interventions to improve their health.
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Affiliation(s)
- Emese Nagy-Borsy
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | - Zsolt Vági
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | - Petra Skerlecz
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | | | - István Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | - Zsuzsa Rákosy
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary.
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