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Abramson TM, Burner E, Arora S, Wenzel S, Gausche-Hill M. Prehospital Care for Persons Experiencing Homelessness: A Cross-Sectional Survey of the Challenges, Experiences, and Perspectives of Operational EMS Agency Medical Directors. PREHOSP EMERG CARE 2024:1-8. [PMID: 38771734 DOI: 10.1080/10903127.2024.2358146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE Persons experiencing homelessness (PEH) are among the most vulnerable populations and experience significant health disparities. Nationally, PEH utilize Emergency Medical Services (EMS) at disproportionately higher rates than their housed peers. Developing optimal strategies to care for PEH has become critically important. However, limited data exists on best practices, challenges, and experiences of providing care to PEH. The objective of this study was to describe the experiences, challenges and perspectives of operational EMS agency medical directors in Los Angeles (LA) County as they confront the homelessness crisis. METHODS We performed a cross-sectional survey of 9-1-1 operational EMS agency medical directors in LA County, which has one of the largest populations of PEH nationally. Twenty-nine 9-1-1 operational EMS agencies operate in LA County. The link to an anonymous, web-based survey examining documentation, training, resources, operational impact, and care challenges was emailed to medical directors with three reminders during the study period (4/19/2023-9/15/2023). RESULTS Three quarters (75.9%; 22/29) of operational EMS agencies responded to the survey, with all questions answered in 69% (20/29) of surveys. Of these, 68.2% (15/22) of agencies document housing status and 75% (15/20) agreed or strongly agreed that homelessness presents operational challenges. No operational EMS agency reported adequate EMS clinician training on homelessness. Operational EMS agencies most commonly utilized domestic violence resources (43%, 9/21), social services (38%, 8/21), and law enforcement (38%, 8/21) services to assist PEH. Referrals were limited by accessibility (86%, 18/21), time (52%, 11/21), lack of awareness (52% 11/21) and lack of mandates (52%, 11/21). All operational EMS agencies agreed or strongly agreed that mental health and substance use disorders are major issues for PEH. The most common daily challenges reported were mental health (55%, 11/20), substance use (55%, 11/20), and patient resistance (35%, 7/20). CONCLUSION In LA County, EMS agencies experience important operational and clinical challenges in caring for PEH, with limited resources, minimal training, and high rates of substance use disorders and mental health comorbidities. Further prehospital research is essential to standardize documentation of housing status, to identify areas for intervention, increase linkage to services, and define best practices.
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Affiliation(s)
- Tiffany M Abramson
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Marianne Gausche-Hill
- Los Angeles County EMS Agency, Los Angeles, California
- Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist Institute for Biomedical Innovation, Los Angeles, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
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Choudhury S, Choi SL, Lee Y, Manser SS. Examining the Role of Self-Harm in the Relationship between Emergency Department Service Utilization and Trauma-Induced Homelessness among Homeless Individuals in Texas. HEALTH & SOCIAL WORK 2024; 49:87-94. [PMID: 38478764 DOI: 10.1093/hsw/hlae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 04/30/2024]
Abstract
Homelessness is a complex public health problem in the United States. Current or ongoing history of trauma among individuals adds to the complexity and challenges of homelessness. Our study assessed the moderating role of self-harm in the association between emergency department (ED) service utilization and trauma-induced homelessness (TIH) among adults in Texas. Homeless adults (N = 282) who completed their baseline Vulnerability Index Service Prioritization Decision Assistance Prescreen Tool survey between February 2021 and February 2022 at a Local Mental Health Authority in Texas were selected. The outcome variable, TIH, was assessed by current period of homelessness due to experiencing trauma or abuse. The main independent variable was ED utilization, while self-harm in the past year was assessed as the moderating variable. A multivariate logistic regression with a moderation analysis was conducted while adjusting for the covariates. Individuals who utilized ED services and engaged in self-harm and risky behaviors had greater odds of experiencing current period of TIH. Male respondents were less likely to experience TIH. Finally, engaging in self-harm significantly moderated the association between ED service use and TIH. This study may help inform efforts to develop tailored interventions and promote resilience-based approaches to improve health outcomes among individuals experiencing homelessness due to TIH.
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Affiliation(s)
- Sumaita Choudhury
- MPH, is a doctoral candidate and research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, 1823 Red River Street, Austin, TX 78712, USA
| | - Sharon Lee Choi
- PhD, is a research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Yehyang Lee
- MS, is a graduate research assistant, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Stacey Stevens Manser
- PhD, is a research scientist and associate director, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Preti C, Poulos CJ, Poulos RG, Reynolds NL, Rowlands AC, Flakelar K, Raguz A, Valpiani P, Faux SG, O'Connor CM. Specialised residential care for older people subject to homelessness: experiences of residents and staff of a new aged care home in Australia. BMC Geriatr 2024; 24:249. [PMID: 38475717 DOI: 10.1186/s12877-024-04791-y] [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: 06/28/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The number of older people experiencing homelessness in Australia is rising, yet there is a lack of specialised residential care for older people subject to homelessness with high care and palliative needs. To address this significant gap, a purpose-built care home was recently opened in Sydney, Australia. METHODS This qualitative study explores the experiences of both residents and staff who were living and working in the home over the first twelve months since its opening. Residents were interviewed at baseline (n = 32) and after six months (n = 22), while staff (n = 13) were interviewed after twelve months. Interviews were analysed using a reflexive thematic analysis approach informed by grounded theory. RESULTS Three main themes emerged: (1) Challenges in providing care for older people subject to homelessness with high care needs; (2) Defining a residential care service that supports older people subject to homelessness with high care needs, and (3) Perception of the impact of living and working in a purpose-built care home after six months (residents) and twelve months (staff) since its opening. A key finding was that of the complex interplay between resident dependency and behaviours, referral pathways and stakeholder engagement, government funding models and requirements, staff training and wellbeing, and the need to meet operational viability. CONCLUSION This study provides novel insights into how the lives of older people subject to homelessness with high care needs are affected by living in a specifically designed care home, and on some of the challenges faced and solved by staff working in the care home. A significant gap in the healthcare system remains when it comes to the effective provision of high care for older people subject to homelessness.
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Affiliation(s)
- Costanza Preti
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- UCL Institute of Education (Culture, Communication and Media), London, England
| | - Christopher J Poulos
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | - Roslyn G Poulos
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | | | | | | | - Angela Raguz
- Centre for Positive Ageing, HammondCare, Sydney, Australia
| | - Peter Valpiani
- Haymarket Foundation, Sydney, Australia
- The End Street Sleeping Collaboration, Sydney, Australia
| | - Steven G Faux
- Departments of Rehabilitation Medicine and Pain Medicine, St Vincent's Hospital, Sydney, Australia
| | - Claire Mc O'Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia.
- School of Population Health, UNSW, Sydney, Australia.
- School of Psychology, UNSW, Sydney, Australia.
- Neuroscience Research Australia, Sydney, Australia.
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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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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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Clifford B, Wood L, Vallesi S, Macfarlane S, Currie J, Haigh F, Gill K, Wilson A, Harris P. Integrating healthcare services for people experiencing homelessness in Australia: key issues and research principles. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2020-000065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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