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Hudani A, Schwan K, Labonté R, Yaya S. Bounding systems: A qualitative study exploring healthcare coordination between the emergency youth shelter system and health system in Toronto, Canada. PLoS One 2024; 19:e0303655. [PMID: 38905314 PMCID: PMC11192382 DOI: 10.1371/journal.pone.0303655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/26/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Several youth staying at emergency youth shelters (EYSs) in Toronto experience poorly coordinated care for their health needs, as both the EYS and health systems operate largely in silos when coordinating care for this population. Understanding how each system is structurally and functionally bound in their healthcare coordination roles for youth experiencing homelessness (YEH) is a preliminary step to identify how healthcare coordination can be strengthened using a system thinking lens, particularly through the framework for transformative system change. METHODS Forty-six documents, and twenty-four semi-structured interviews were analyzed to explore how the EYS and health systems are bound in their healthcare coordination roles. We continuously compared data collected from documents and interviews using constant comparative analysis to build a comprehensive understanding of each system's layers, and the niches (i.e., programs and activities), organizations and actors within these layers that contribute to the provision and coordination of healthcare for YEH, within and between these two systems. RESULTS The EYS and health systems are governed by different ministries, have separate mandates, and therefore have distinct layers, niches, and organizations respective to coordinating healthcare for YEH. While neither system takes sole responsibility for this task, several government, research, and community-based efforts exist to strengthen healthcare coordination for this population, with some overlap between systems. Several organizations and actors within each system are collaborating to develop relevant frameworks, policies, and programs to strengthen healthcare coordination for YEH. Findings indicate that EYS staff play a more active role in coordinating care for YEH than health system staff. CONCLUSION A vast network of organizations and actors within each system layer, work both in silos and collaboratively to coordinate health services for YEH. Efforts are being made to bridge the gap between systems to improve healthcare coordination, and thereby youths' health outcomes.
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Affiliation(s)
- Alzahra Hudani
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Kaitlin Schwan
- Women’s National Housing & Homelessness Network, Toronto, Ontario, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Danaher FS, Obando AM, Morris JE, Biskind H, Jasrasaria R, Bosson R, Gartland MG, Mohareb AM. Responding to the Health Needs of Newly Arrived Families Within Fractured Policy Environments. Pediatr Ann 2024; 53:e161-e166. [PMID: 38700920 DOI: 10.3928/19382359-20240306-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The increase in forcibly displaced populations seeking refuge in the United States has been met with fragmented, chaotic, and highly politicized responses to the detriment of migrants and receiving communities alike. Migrants encounter compounding systemic barriers to accessing basic resettlement resources. Expanding on pandemic-era innovations can strengthen social safety net infrastructure as a whole. Pediatricians are a potential early touchpoint for newly arrived families, providing an opportunity to support their specific health needs, refer to critical safety net services, and advocate for improved systems and policies. [Pediatr Ann. 2024;53(5):e161-e166.].
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Hudani A, Labonté R, Yaya S. Where's the Disconnect? Exploring Pathways to Healthcare Coordinated for Youth Experiencing Homelessness in Toronto, Canada, Using Grounded Theory Methodology. QUALITATIVE HEALTH RESEARCH 2024; 34:298-310. [PMID: 37948631 PMCID: PMC10905976 DOI: 10.1177/10497323231208417] [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] [Indexed: 11/12/2023]
Abstract
About 900 youth experiencing homelessness (YEH) reside at an emergency youth shelter (EYS) in Toronto on any given night. Several EYSs offer access to healthcare based on youths' needs, including access to primary care, and mental health and addictions support. However, youth also require healthcare from the broader health system, which is often challenging to navigate and access. Currently, little is known about healthcare coordination efforts between the EYS and health systems for YEH. Using grounded theory methodology, we interviewed 24 stakeholders and concurrently analyzed and compared data to explore pathways to healthcare coordinated for youth who reside at an EYS in Toronto. We also investigated fundamental parts (i.e., norms, resources, regulations, and operations) within the EYS and health systems that influence these pathways to healthcare using thematic analysis. A significant healthcare coordination gap was found between these two systems, typically when youth experience crises, often resulting in a recurring loop of transition and discharge between EYSs and hospitals. Several parts within each system act interdependently in hindering adequate healthcare coordination between the EYS and health systems. Incorporating training for system staff on how to effectively coordinate healthcare and work with homeless populations who have complex health needs, and rethinking information-sharing policies within circles of care are examples of how system parts can be targeted to improve healthcare coordination for YEH. Establishing multidisciplinary healthcare teams specialized to serve the complex needs of YEH may also improve healthcare coordination between systems, and access and quality of healthcare for this population.
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Affiliation(s)
- Alzahra Hudani
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Chapman AB, Scharfstein D, Byrne TH, Montgomery AE, Suo Y, Effiong A, Velasquez T, Pettey W, Dalrymple R, Tsai J, Nelson RE. Temporary Financial Assistance Reduced The Probability Of Unstable Housing Among Veterans For More Than 1 Year. Health Aff (Millwood) 2024; 43:250-259. [PMID: 38315929 DOI: 10.1377/hlthaff.2023.00730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The Department of Veterans Affairs (VA) aims to reduce homelessness among veterans through programs such as Supportive Services for Veteran Families (SSVF). An important component of SSVF is temporary financial assistance. Previous research has demonstrated the effectiveness of temporary financial assistance in reducing short-term housing instability, but studies have not examined its long-term effect on housing outcomes. Using data from the VA's electronic health record system, we analyzed the effect of temporary financial assistance on veterans' housing instability for three years after entry into SSVF. We extracted housing outcomes from clinical notes, using natural language processing, and compared the probability of unstable housing among veterans who did and did not receive temporary financial assistance. We found that temporary financial assistance rapidly reduced the probability of unstable housing, but the effect attenuated after forty-five days. Our findings suggest that to maintain long-term housing stability for veterans who have exited SSVF, additional interventions may be needed.
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Affiliation(s)
- Alec B Chapman
- Alec B. Chapman , University of Utah, Salt Lake City, Utah
| | | | - Thomas H Byrne
- Thomas H. Byrne, Bedford Veterans Affairs (VA) Medical Center and Boston University, Bedford, Massachusetts
| | - Ann Elizabeth Montgomery
- Ann Elizabeth Montgomery, Birmingham VA Medical Center and University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | | | - Jack Tsai
- Jack Tsai, Department of Veterans Affairs, Washington, D.C
| | - Richard E Nelson
- Richard E. Nelson, VA Salt Lake City and University of Utah, Salt Lake City, Utah
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Gin JL, Balut MD, Dobalian A. COVID-19 vaccination uptake and receptivity among veterans enrolled in homelessness-tailored primary health care clinics: provider trust vs. misinformation. BMC PRIMARY CARE 2024; 25:24. [PMID: 38216894 PMCID: PMC10785369 DOI: 10.1186/s12875-023-02251-x] [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: 06/09/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Compared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)'s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care. METHODS This study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic). RESULTS Four themes emerged from the interviews: (1) Vaccination uptake and timing- While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing- Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care- Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers' Conspiracy Theories and Objectivity Claims- Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources. CONCLUSIONS These findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans' beliefs, are also key to effectively delivering vaccine messaging to this population.
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Affiliation(s)
- June L Gin
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA.
| | - Michelle D Balut
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, 202 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
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6
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Siersbaek R, O'Donnell C, Parker S, Ford J, Burke S, Ní Cheallaigh C. Social exclusion and its impact on health over the life course: A realist review protocol. HRB Open Res 2023; 6:34. [PMID: 38357513 PMCID: PMC10864819 DOI: 10.12688/hrbopenres.13746.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Background Social exclusion is a process whereby certain individuals are born into or pushed to the margins of society and prevented from participating in social, cultural, economic, and political life. People who experience social exclusion are not afforded the same rights and privileges as other population groups. Socially excluded people often experience poorer outcomes in a variety of domains including health, education, employment, and housing than people with socio-economic privilege. People experiencing social exclusion frequently have higher and more complex health needs and poorer access to healthcare than the general population. The aim of this study is to better understand and explain how social exclusion occurs and how it impacts health over the life course. Methods A realist review will be undertaken. Data will be collected via a systematic search of databases of peer-reviewed literature and further iterative searches of peer-reviewed and other literatures as needed. The following data bases will be searched: MEDLINE, Embase, CINAHL, and ASSIA, using both indexed subject headings in each database and relevant key words. Grey literature will be searched via Google Scholar and relevant websites of organisations that work with populations affected by social exclusion. Conclusion A realist review will be conducted to explain the underlying societal mechanisms which produce social exclusion and related health outcomes in particular contexts affecting excluded population groups across the life course. The study has the potential to inform policy makers and service managers of how and why social exclusion occurs and potential key intervention points to prevent exclusion from happening.
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Affiliation(s)
- Rikke Siersbaek
- Clinical Medicine, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, D08 W9RT, Ireland
| | - Chris O'Donnell
- Safetynet Primary Care, Catherine Mc Auley Education & Research Centre, Dublin 7, D07 A8NN, Ireland
| | - Sarah Parker
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - John Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, England, EC1M 6BQ, UK
| | - Sara Burke
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Clíona Ní Cheallaigh
- Clinical Medicine, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, D08 W9RT, Ireland
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Chatterjee A, Obando A. LGBTQ+ Youth Experiencing Homelessness: Health Impacts and a Call to Action. Pediatrics 2023; 152:e2023063808. [PMID: 37981854 DOI: 10.1542/peds.2023-063808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Avik Chatterjee
- Boston Health Care for the Homeless Program, Boston Massachusetts
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Aura Obando
- Boston Health Care for the Homeless Program, Boston Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Aridomi H, Cartier Y, Taira B, Kim HH, Yadav K, Gottlieb L. Implementation and Impacts of California Senate Bill 1152 on Homeless Discharge Protocols. West J Emerg Med 2023; 24:1104-1116. [PMID: 38165193 PMCID: PMC10754197 DOI: 10.5811/westjem.60853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction In recent decades, there has been a growing focus on addressing social needs in healthcare settings. California has been at the forefront of making state-level investments to improve care for patients with complex social and medical needs, including patients experiencing homelessness (PEH). Examples include Medicaid 1115 waivers such as the Whole Person Care pilot program and California Advancing and Innovating Medi-Cal (CalAIM). To date, California is also the only state to have passed a legislative mandate to address concerns related to the hospital discharge of PEH who lack sufficient resources to support self-care. To this end, California enacted Senate Bill 1152 (SB 1152), a unique legislative mandate that requires hospitals to standardize comprehensive discharge processes for PEH by providing (and documenting the provision of) social and preventive services. Understanding the implementation and impact of this law will help inform California and other states considering legislative investments in healthcare activities to improve care for PEH. Methods To understand health system stakeholders' perceived impact of SB 1152 on hospital discharge processes and key barriers and facilitators to SB 1152's implementation, we conducted 32 semi-structured interviews with key informants across 16 general acute care hospitals in Humboldt and Los Angeles counties. Study data were coded and analyzed using thematic analysis informed by the Consolidated Framework for Implementation Research. Results Participants perceived several positive impacts of SB 1152, including streamlined services, increased accountability, and more staff awareness about homelessness. In parallel, participants also underscored concerns about the law's limited scope and highlighted multiple implementation challenges, including lack of clarity about accountability measures, scarcity of implementation supports, and gaps in community resources. Conclusion Our findings suggest that SB 1152 was an important step toward the goal of more universal safe discharge of PEH. However, there are also several addressable concerns. Recommendations to improve future legislation include adding targeted funding for social care staff and improving implementation training. Participants' broader concerns about the parallel need to increase community resources are more challenging to address in the immediate term, but such changes will also be necessary to improve the overall health outcomes of PEH.
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Affiliation(s)
- Haruna Aridomi
- University of California San Francisco, School of Medicine, San Francisco, California
| | - Yuri Cartier
- Social Interventions Research Evaluation Network, San Francisco, California
| | - Breena Taira
- Olive View-UCLA Medical Center, Department of Emergency Medicine, Sylmar, California
| | - Hyung Henry Kim
- Olive View-UCLA Medical Center, Department of Emergency Medicine, Sylmar, California
| | - Kabir Yadav
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California
- The Lundquist Institute for Biomedical Research, West Carson, California
| | - Laura Gottlieb
- Social Interventions Research Evaluation Network, San Francisco, California
- University of California San Francisco, Department of Family and Community Medicine, San Francisco, California
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Padwa H, Henwood BF, Ijadi-Maghsoodi R, Tran-Smith B, Darby A, Bluthenthal R, Chinchilla M, Vickery KD, Kuhn R, Lawton A, Fenderson E, Galarza E, Haynes A, King D, Martiniuk E, Marshall P, Mendoza S, Patton T, Shaw S, Stevens R, Gelberg L. Bringing Lived Experience to Research on Health and Homelessness: Perspectives of Researchers and Lived Experience Partners. Community Ment Health J 2023; 59:1235-1242. [PMID: 37204566 PMCID: PMC10198013 DOI: 10.1007/s10597-023-01138-6] [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: 11/02/2022] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
Improving health and healthcare for people experiencing homelessness (PEH) has become a national research priority. It is critical for research related to homelessness to be guided by input from PEH themselves. We are a group of researchers and individuals who have personally experienced homelessness collaborating on a study focused on homelessness and housing. In this Fresh Focus, we describe our partnership, lessons learned from our work together, what we have gained from our collaboration, and considerations for future homelessness research-lived experience partnerships.
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Affiliation(s)
- Howard Padwa
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA, 90024, USA.
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Roya Ijadi-Maghsoodi
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA, 90024, USA
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Bikki Tran-Smith
- Department of Biomedical & Health Sciences, University of Vermont, 149 Beaumont Avenue, Burlington, VT, 05405, USA
| | - Anna Darby
- Department of Emergency Medicine, University of California, Los Angeles, 924 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Ricky Bluthenthal
- Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA
| | - Melissa Chinchilla
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Katherine Diaz Vickery
- Health, Homelessness, & Criminal Justice Lab, Hennepin Healthcare Research Institute, 825 8th St S., Minneapolis, MN, 55404, USA
| | - Randall Kuhn
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA
| | - Alexander Lawton
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA
| | | | | | - Anthony Haynes
- Skid Row Housing Trust, Los Angeles, CA, USA
- Corporation for Supportive Housing, Los Angeles, CA, USA
| | - Dennis King
- Skid Row Housing Trust, Los Angeles, CA, USA
- Corporation for Supportive Housing, Los Angeles, CA, USA
| | | | | | | | | | - Suzette Shaw
- National Alliance to End Homelessness, Los Angeles, CA, USA
- Los Angeles County Continuum of Care Board, Los Angeles, CA, USA
| | - Reba Stevens
- Los Angeles County Continuum of Care Board, Los Angeles, CA, USA
- Los Angeles County Mental Health Commission, Los Angeles, CA, USA
| | - Lillian Gelberg
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
- Department of Family Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
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Vickery KD, Ford BR, Gelberg L, Bonilla Z, Strother E, Gust S, Adair E, Montori VM, Linzer M, Evans MD, Connett J, Heisler M, O'Connor PJ, Busch AM. The development and initial feasibility testing of D-HOMES: a behavioral activation-based intervention for diabetes medication adherence and psychological wellness among people experiencing homelessness. Front Psychol 2023; 14:1225777. [PMID: 37794913 PMCID: PMC10546874 DOI: 10.3389/fpsyg.2023.1225777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Compared to stably housed peers, people experiencing homelessness (PEH) have lower rates of ideal glycemic control, and experience premature morbidity and mortality. High rates of behavioral health comorbidities and trauma add to access barriers driving poor outcomes. Limited evidence guides behavioral approaches to support the needs of PEH with diabetes. Lay coaching models can improve care for low-resource populations with diabetes, yet we found no evidence of programs specifically tailored to the needs of PEH. Methods We used a multistep, iterative process following the ORBIT model to develop the Diabetes Homeless Medication Support (D-HOMES) program, a new lifestyle intervention for PEH with type 2 diabetes. We built a community-engaged research team who participated in all of the following steps of treatment development: (1) initial treatment conceptualization drawing from evidence-based programs, (2) qualitative interviews with affected people and multi-disciplinary housing and healthcare providers, and (3) an open trial of D-HOMES to evaluate acceptability (Client Satisfaction Questionnaire, exit interview) and treatment engagement (completion rate of up to 10 offered coaching sessions). Results In step (1), the D-HOMES treatment manual drew from existing behavioral activation and lay health coach programs for diabetes as well as clinical resources from Health Care for the Homeless. Step (2) qualitative interviews (n = 26 patients, n = 21 providers) shaped counseling approaches, language and choices regarding interventionists, tools, and resources. PTSD symptoms were reported in 69% of patients. Step (3) trial participants (N = 10) overall found the program acceptable, however, we saw better program satisfaction and treatment engagement among more stably housed people. We developed adapted treatment materials for the target population and refined recruitment/retention strategies and trial procedures sensitive to prevalent discrimination and racism to better retain people of color and those with less stable housing. Discussion The research team has used these findings to inform an NIH-funded randomized control pilot trial. We found synergy between community-engaged research and the ORBIT model of behavioral treatment development to develop a new intervention designed for PEH with type 2 diabetes and address health equity gaps in people who have experienced trauma. We conclude that more work and different approaches are needed to address the needs of participants with the least stable housing.
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Affiliation(s)
- Katherine Diaz Vickery
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Becky R. Ford
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Zobeida Bonilla
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Ella Strother
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Susan Gust
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Edward Adair
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Victor M. Montori
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine and the Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States
| | - John Connett
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Michele Heisler
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Patrick J. O'Connor
- Center for Chronic Care Innovation, HealthPartners Institute, Bloomington, MN, United States
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
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Erickson BR, Ehrie J, Murray S, Dougherty RJ, Wainberg ML, Dixon LB, Goldman ML. A Rapid Review of "Low-Threshold" Psychiatric Medication Prescribing: Considerations for Street Medicine and Beyond. Psychiatr Serv 2023; 74:282-291. [PMID: 36039554 PMCID: PMC9971341 DOI: 10.1176/appi.ps.20220196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE No widely accepted clinical guidelines, and scant directly applicable pragmatic research, are available to guide the prescription of psychiatric medications in "low-threshold" outpatient settings, such as street outreach, urgent care, and crisis care, as well as walk-in, shelter, and bridge and transition clinics. Providers frequently prescribe medications in these settings without patients' having firm psychiatric diagnoses and without medical records to guide clinical decision making. Persons who receive medications in these settings often seek help voluntarily and intermittently for mental illness symptoms. However, because of structural and individual factors, such patients may not engage in longitudinal outpatient psychiatric care. The authors reviewed the literature on psychiatric medication prescribing in low-threshold settings and offer clinical considerations for such prescribing. METHODS The authors conducted a rapid literature review (N=2,215 abstracts), which was augmented with up-to-date clinical prescribing literature, the authors' collective clinical experience, and DSM-5 section II diagnostic criteria to provide considerations for prescribing medications in low-threshold settings. RESULTS For individuals for whom diagnostic uncertainty is prominent, a symptom-based diagnostic and treatment approach may be best suited to weigh the risks and benefits of medication use in low-threshold settings. Practical considerations for treating patients with clinical presentations of psychosis and trauma, as well as mood, anxiety, and substance use disorders, in low-threshold settings are discussed. CONCLUSIONS An urgent need exists to invest in pragmatic research and guideline development to delineate best-practice prescribing in low-threshold settings.
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Affiliation(s)
- Blake R Erickson
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Jarrod Ehrie
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Samuel Murray
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Ryan J Dougherty
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Milton L Wainberg
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Matthew L Goldman
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
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12
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Rasul TF, Morgan O, Elkhadem A, Henderson A. Soft tissue infection and follow-up for an unsheltered patient: the role of Street Medicine providers in bridging gaps in care. BMJ Case Rep 2023; 16:e251082. [PMID: 36737066 PMCID: PMC9899995 DOI: 10.1136/bcr-2022-251082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Street Medicine is a volunteer-run initiative for low-resource healthcare settings. Formed to bridge gaps in care for persons experiencing homelessness, these organisations work to provide preventative medicine through maintenance care and follow-up. However, there are limits to what Street Medicine can accomplish given the geographical radius covered, lack of available transportation options and vulnerable sleeping locations night to night for the patients served. The subject of this case report is a middle-aged Spanish-speaking unsheltered man who began his care with a Street Medicine team. He was unable to attend medical appointments due to relocation, complicating his disease course and resulting in hospital intervention for cellulitis. Post-discharge, he stayed within radius and was treated by the street team. Increased emphasis on the effects of housing insecurity and addressing social determinants of health could prevent deterioration of manageable diseases and should be an area of active interest for Street Medicine team expansion.
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Affiliation(s)
- Taha Faiz Rasul
- Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Orly Morgan
- Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adam Elkhadem
- College of Arts and Sciences, Columbia University, New York City, New York, USA
| | - Armen Henderson
- Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
- Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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13
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Ramirez J, Petruzzi LJ, Mercer T, Gulbas LE, Sebastian KR, Jacobs EA. Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings. BMC PRIMARY CARE 2022; 23:338. [PMID: 36572847 PMCID: PMC9792313 DOI: 10.1186/s12875-022-01932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite the widespread implementation of Health Care for the Homeless programs that focus on comprehensive, integrated delivery systems of health care for people experiencing homelessness, engaging and retaining people experiencing homelessness in primary care remains a challenge. Few studies have looked at the primary care delivery model in non-traditional health care settings to understand the facilitators and barriers to engagement in care. The objective of our study was to explore the clinic encounters of individuals experiencing homelessness receiving care at two different sites served under a single Health Care for the Homeless program. METHODS Semi-structured interviews were conducted with people experiencing homelessness for an explorative qualitative study. We used convenience sampling to recruit participants who were engaged in primary care at one of two sites: a shelter clinic, n = 16, and a mobile clinic located in a church, n = 15. We then used an iterative, thematic approach to identify emergent themes and further mapped these onto the Capability-Opportunity-Motivation model. RESULTS Care accessibility, quality and integration were themes that were often identified by participants as being important facilitators to care. Psychological capability and capacity became important barriers to care in instances when patients had issues with memory or difficulty with perceiving psychological safety in healthcare settings. Motivation for engaging and continuing in care often came from a team of health care providers using shared decision-making with the patient to facilitate change. CONCLUSION To optimize health care for people experiencing homelessness, clinical interventions should: (1) utilize shared-decision making during the visit, (2) foster a sense of trust, compassion, and acceptance, (3) emphasize continuity of care, including consistent providers and staff, and (4) integrate social services into Health Care for the Homeless sites.
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Affiliation(s)
- Jahanett Ramirez
- grid.89336.370000 0004 1936 9924The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Liana J. Petruzzi
- grid.89336.370000 0004 1936 9924Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX USA
| | - Timothy Mercer
- grid.89336.370000 0004 1936 9924Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,CommUnityCare Health Centers, Austin, TX USA
| | - Lauren E. Gulbas
- grid.89336.370000 0004 1936 9924The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Katherine R. Sebastian
- grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA
| | - Elizabeth A. Jacobs
- grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,grid.416311.00000 0004 0433 3945Maine Medical Center Research Institute, MaineHealth Institute for Research, Scarborough, ME USA
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14
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Cohen A, Vakharia SP, Netherland J, Frederique K. How the war on drugs impacts social determinants of health beyond the criminal legal system. Ann Med 2022; 54:2024-2038. [PMID: 35852299 PMCID: PMC9302017 DOI: 10.1080/07853890.2022.2100926] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the "war on drugs" in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that "drug war logic" has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts. KEY MESSAGESA drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.The U.S. drug war's frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.
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Affiliation(s)
- Aliza Cohen
- Department of Research and Academic Engagement, Drug Policy Alliance, New York, NY, USA
| | - Sheila P Vakharia
- Department of Research and Academic Engagement, Drug Policy Alliance, New York, NY, USA
| | - Julie Netherland
- Department of Research and Academic Engagement, Drug Policy Alliance, New York, NY, USA
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15
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Gin JL, Balut MD, Dobalian A. COVID-19 Vaccine Hesitancy among U.S. Veterans Experiencing Homelessness in Transitional Housing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15863. [PMID: 36497937 PMCID: PMC9735876 DOI: 10.3390/ijerph192315863] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Little is known about COVID-19 vaccine hesitancy and acceptance among individuals experiencing homelessness, despite their higher risk for morbidity and mortality from SARS-CoV-2. This study examines COVID-19 vaccination attitudes and uptake among U.S. military Veterans experiencing homelessness enrolled in transitional housing programs funded by the U.S. Department of Veterans Affairs (VA). Telephone interviews were conducted with 20 Veterans in California, Florida, Iowa, Kentucky, and Massachusetts, USA (January-April 2021). A rapid analysis approach was used to identify and enumerate commonly occurring themes. Although 60% of interviewed Veterans either received the COVID-19 vaccine or were willing to do so, one-third expressed hesitancy to get vaccinated. COVID-19 vaccination attitudes (e.g., belief that the vaccines were inadequately tested), military experience, beliefs about influenza and other vaccines, and sources of information emerged as influential factors for COVID-19 vaccination uptake or hesitancy. Veterans in VA-funded homeless transitional housing programs are generally willing to be vaccinated. However, a substantial minority is reluctant to take the vaccine due to concerns about the COVID-19 vaccine and distrust of authority. Recommendations for increasing uptake include utilizing Veteran peers, homeless service providers, and healthcare providers as trusted messengers to improve confidence in the vaccine.
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Affiliation(s)
- June L. Gin
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA 91343, USA
| | - Michelle D. Balut
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA 91343, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA 91343, USA
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH 43210, USA
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16
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Cox SN, Rogers JH, Thuo NB, Meehan A, Link AC, Lo NK, Manns BJ, Chow EJ, Al Achkar M, Hughes JP, Rolfes MA, Mosites E, Chu HY. Trends and factors associated with change in COVID-19 vaccination intent among residents and staff in six Seattle homeless shelters, March 2020 to August 2021. Vaccine X 2022; 12:100232. [PMID: 36276877 PMCID: PMC9578969 DOI: 10.1016/j.jvacx.2022.100232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Achieving high COVID-19 vaccination coverage in homeless shelters is critical in preventing morbidity, mortality, and outbreaks, however, vaccination coverage remains lower among people experiencing homelessness (PEH) than the general population. Methods We conducted a cross-sectional study to retrospectively describe attitudes and identify factors associated with change in COVID-19 vaccination intent among shelter residents and staff during March 2020 - August 2021. To identify factors associated with change in COVID-19 vaccine intent becoming more positive overall compared to other attitudes, we utilized a Poisson model to calculate Risk Ratios with robust standard errors, adjusting for confounding by shelter site and demographic variables determined a priori. Results From July 12 - August 2, 2021, 97 residents and 20 staff participated in surveys across six shelters in Seattle King County, Washington. Intent to be vaccinated against COVID-19 increased from 45.3 % (n = 53) when recalling attitudes in March 2020 to 74.4 % (n = 87) as of August 2021, and was similar among residents and staff. Many participants (43.6 %, n = 51) indicated feeling increasingly accepting about receiving a COVID-19 vaccine since March 2020, while 13.7 % (n = 16) changed back and forth, 10.3 % (n = 12) became more hesitant, and 32.5 % (n = 38) had no change in intent. In the model examining the relationship between becoming more positive about receiving a COVID-19 vaccine compared to all other attitudes (n = 116), we found a 57.2 % increase in vaccine acceptability (RR 1.57; 95 % CI: 1.01, 2.45) among those who reported worsening mental health since the start of the pandemic. Conclusions Findings highlight opportunities to improve communication with residents and staff about COVID-19 vaccination and support a need for continued dialogue and a person-centered approach to understanding the sociocultural complexities and dynamism of vaccine attitudes at shelters.Clinical Trial Registry Number: NCT04141917.
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Affiliation(s)
- Sarah N. Cox
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle, WA, USA,Corresponding author at: UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA.
| | - Julia H. Rogers
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Nicholas B. Thuo
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Ashley Meehan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy C. Link
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Natalie K. Lo
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Brian J. Manns
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric J. Chow
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Emily Mosites
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helen Y. Chu
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
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17
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Patel CG, Williams SP, Tao G. Access to Healthcare and the Utilization of Sexually Transmitted Infections Among Homeless Medicaid Patients 15 to 44 Years of Age. J Community Health 2022; 47:853-861. [PMID: 35819549 PMCID: PMC10167755 DOI: 10.1007/s10900-022-01119-y] [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] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
Homelessness poses a direct threat to public health in the US as many individuals face debilitating health outcomes and barriers to adequate health care. Access to STI care for the homeless Medicaid population of USA has not been well-studied using administrative claims data. Our study aims to compare health services utilization, STI screening and diagnoses among people experiencing homelessness (PEH) vs. those who are non-PEH using ICD10 codes. We used 2019 MarketScan Medicaid claims data to analyze men and women aged 15-44 years with a diagnosis code for PEH (Z59.0), non-PEH (without Z59.0) and assessed their emergency department and outpatient visits and STI/HIV diagnoses and screening rates. We identified 5135 PEH men and 3571 PEH women among 1.3 million men and 2.1 million women in the 2019 US Medicaid database. PEH patients were more likely to have ED visits (94.80% vs 33.04%) and ≥ 20 outpatient clinic visits (60.29% vs 16.16%) than non-PEH patients in 2019. Higher diagnoses were observed for syphilis 1.57% (CI 1.32-1.86) vs 0.11% (CI 0.11-0.11), HIV 3.93% (CI 3.53-4.36) vs 0.41% (CI 0.41-0.42), chlamydia 1.94% (CI 1.66-2.25) vs 0.85% (CI 0.84-0.86) and gonorrhea 1.26% (CI 1.04-1.52) vs. 0.33% (CI 0.33-0.34) (p < 0.0001) among PEH compared to non-PEH. Among PEH, higher STI/HIV diagnoses rates indicate an increase in STI burden and suboptimal STI testing indicates an underutilization of STI services despite having a higher percentage of health care visits compared to non-PEH patients. Focused STI/HIV interventions are needed to address health care needs of PEH patients.
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Affiliation(s)
- Chirag G Patel
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA.
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, MS-E8030316, USA.
| | - Samantha P Williams
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA
| | - Guoyu Tao
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA
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18
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Augustine D, Kushel M. Community Supervision, Housing Insecurity, & Homelessness. THE ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE 2022; 701:152-171. [PMID: 36540854 PMCID: PMC9762769 DOI: 10.1177/00027162221113983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In recent decades, the United States has seen the simultaneous rise of mass incarceration and homelessness. The two crises interact with and worsen one another. Mass incarceration and homelessness are driven by the same structural factors and exacerbate one another in a feedback loop. People on community supervision face many barriers to housing, putting them at high risk of experiencing homelessness in the months following release. People experiencing homelessness are at heightened risk of criminal justice involvement, including violating the terms of their community supervision, for engaging in survival behaviors in public spaces. This paper presents evidence-based approaches to improving housing strategies for reentry populations, preventing homelessness among those in community supervision, and rehousing members of the reentry community experiencing homelessness. It concludes with recommendations for policymakers interested in improving housing outcomes and overall reentry success for people on community supervision.
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Affiliation(s)
- Dallas Augustine
- Benioff Homelessness and Housing Initiative at the University of California, San Francisco
| | - Margot Kushel
- Corresponding author. Benioff Homelessness and Housing Initiative, UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, Box 1339, 2789 25 Street, Ste. 350, San Francisco, CA 94110,
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19
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Gin JL, Levine CA, Canavan D, Dobalian A. Including Homeless Populations in Disaster Preparedness, Planning, and Response: A Toolkit for Practitioners. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E62-E72. [PMID: 32701792 DOI: 10.1097/phh.0000000000001230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Context:
People experiencing homelessness are often the first and most severely affected group during disasters. Nonetheless, communities across the United States have frequently failed to adequately address the needs of homeless populations in disaster planning, response, and recovery. Communities must build multisector collaborative relationships and ensure that homeless service providers are adequately resourced. However, constraints in funding and staffing, combined with a lack of guidance about how to achieve an integrated approach to disaster planning for people experiencing homelessness, have hindered communities' ability to accomplish these goals.
Program:
The US Department of Veterans Affairs, the US Department of Health and Human Services, and the US Department of Housing and Urban Development created an interagency workgroup to identify resources to help communities address the disaster needs of homeless populations. This workgroup created a toolkit to address this gap: Disaster Preparedness to Promote Community Resilience.
This article describes the development of the toolkit. The toolkit is divided into 3 sections:
Section 1 provides guidance to homeless service providers and government entities in identifying collaborative relationships to ensure that services are available to address homeless populations' disaster needs. Section 2 offers nonprofit homeless service providers guidance in creating their disaster response plans. Section 3 aims to ensure that public health officials and health care systems have the capacity to provide health care to homeless populations during disasters.
Implementation:
Efforts are under way to develop a disaster preparedness training manual to assist nonprofit homeless service organizations.
Discussion:
Homeless service providers are vital partners in disaster response. Integrating them into emergency management and ensuring that they are adequately prepared for disasters will effectively enable them to contribute their unique skill sets to community disaster recovery.
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Affiliation(s)
- June L Gin
- Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, California (Drs Gin and Dobalian); Division for At-Risk Individuals, Behavioral Health & Community Resilience (ABC), Office of the Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services, Washington, District of Columbia (Dr Levine); Canavan Associates, Cambridge, Massachusetts (Mr Canavan); and Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, Tennessee (Mr Dobalian)
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20
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Gin JL, Balut MD, Alenkin NR, Dobalian A. Responding to COVID-19 While Serving Veterans Experiencing Homelessness: The Pandemic Experiences of Healthcare and Housing Providers. J Prim Care Community Health 2022; 13:21501319221112585. [PMID: 35833646 PMCID: PMC9289898 DOI: 10.1177/21501319221112585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The U.S. Department of Veterans Affairs (VA) provides essential care through
transitional housing and healthcare for Veterans experiencing homelessness
through the Grant and Per Diem (GPD) program and the Homeless Patient Aligned
Care Team (HPACT), respectively. At the onset of the SARS-CoV-2 pandemic, GPD
organizations and HPACT clinics faced the challenge of being essential providers
tasked with ensuring the well-being of Veterans under their care. Through
semi-structured interviews with 13 providers (6 HPACT health care providers
representing 2 HPACT programs, and 7 GPD staff members) across the U.S., this
study explored their experiences navigating the tasks of keeping Veterans safe
and providing ongoing care from the start of the pandemic up to the 2021
interview dates. Both GPD and HPACT providers reported amplified safety concerns
about COVID-19 infection among staff at the start of the pandemic, which
diminished to a lower, stable level after a few months as adaptations made for
safety became embedded in their routines. However, ongoing challenges included
isolation and mental health challenges among Veterans, inherent limitations of
telehealth as a care delivery avenue, provider frustration and burnout due to
increased workload and frequent change, and the logistics of administering
testing for Veterans to enter GPD housing. Enhanced pandemic preparedness
planning for GPD organizations, funding for personal protective equipment (PPE)
and providing technology to facilitate Veterans’ telehealth access, and
strategies for preventing provider burnout are critical to both sustaining
homeless providers’ capabilities during this pandemic and enhancing readiness to
respond to the next public health emergency.
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Affiliation(s)
- June L Gin
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Michelle D Balut
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Nikola R Alenkin
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA.,Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
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21
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Thurman W, Semwal M, Moczygemba LR, Hilbelink M. Smartphone Technology to Empower People Experiencing Homelessness: Secondary Analysis. J Med Internet Res 2021; 23:e27787. [PMID: 34586073 PMCID: PMC8726764 DOI: 10.2196/27787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the United States, the number of people experiencing homelessness has continually increased over the last 3 years. Homelessness is associated with poor health, and people experiencing homelessness are often burdened with high rates of chronic and mental health conditions, functional limitations, and cognitive impairment. Despite the high burden of chronic illness and functional limitations, there is limited literature exploring self-management among homeless populations. OBJECTIVE This study aims to investigate how access to smartphone technology facilitates self-management, including the attainment of social needs within the context of homelessness. METHODS A secondary analysis of 33 exit interviews from 2 feasibility studies related to mobile health interventions among people experiencing homelessness was conducted. Iterative thematic analysis was used to identify themes representative of participants' experiences using smartphone technology. RESULTS Collectively, participants revealed not only how the context of homelessness constrained their ability to engage in activities necessary to self-manage health and meet social needs but also how consistent and predictable access to the tools available through a smartphone changed their behaviors and outlook. The global theme of empowered by technology was identified and defined as how having a smartphone with a plan for unlimited text, calling, data, and transportation allowed participants to navigate homelessness and facilitated self-management. CONCLUSIONS People experiencing homelessness used the tools on a smartphone to make decisions, take action, solve problems, and use the resources-skills necessary for fulfilling tasks required for effective self-management. Further, consistent access to smartphone technology and transportation empowered participants to meet the requirements for the attainment of social needs.
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Affiliation(s)
- Whitney Thurman
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Monika Semwal
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Leticia R Moczygemba
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Mark Hilbelink
- Sunrise Homeless Navigation Center, Austin, TX, United States
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22
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Homelessness during COVID-19: challenges, responses, and lessons learned from homeless service providers in Tippecanoe County, Indiana. BMC Public Health 2021; 21:1657. [PMID: 34507565 PMCID: PMC8432956 DOI: 10.1186/s12889-021-11687-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023] Open
Abstract
Background The COVID-19 pandemic laid bare some of the United States’ most devastating health and social inequities faced by people experiencing homelessness. Homeless populations experience disproportionate rates of underlying health conditions, stigma and marginalization that often disenfranchise them from health and social services, and living conditions that potentiate the risk of COVID-19 transmission and adverse outcomes. Methods Guided by the socio-ecological model, this community-based participatory research study examined the impacts of the COVID-19 public health crisis on people experiencing homelessness in Tippecanoe County, Indiana, and the ways in which homeless service providers prepared for, experienced, and responded to the pandemic. Eighteen (18) semi-structured interviews were conducted with representatives of 15 community-based organizations, including shelters and other homeless service providers. Results Qualitative content analysis revealed myriad challenges at the individual and interpersonal levels faced by people experiencing homelessness as a result of the pandemic, and multilevel responses for COVID-19 impact mitigation in this community. Many of the emergency measures put in place by homeless service providers in Tippecanoe County, Indiana created opportunities for innovative solutions to longstanding challenges faced by homeless populations that are informing better service delivery moving forward, even beyond the COVID-19 pandemic. Conclusions Community-based organizations, including homeless shelters, are uniquely qualified to inform pandemic response and disaster risk mitigation in order to respond appropriately to the specific needs of people experiencing homelessness. The lessons learned and shared by homeless service providers on the frontline during the COVID-19 pandemic have important implications to improve future disaster response for homeless and other vulnerable populations.
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D'Souza MS, Mirza NA. Towards Equitable Health Care Access: Community Participatory Research Exploring Unmet Health Care Needs of Homeless Individuals. Can J Nurs Res 2021; 54:451-463. [PMID: 34387510 PMCID: PMC9605994 DOI: 10.1177/08445621211032136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Community and health services often overlook health care needs of persons experiencing homelessness, which leads to deterioration in health and increased utilization of emergency services. Since homeless people are underrepresented in health service research, little is known about their unmet health care needs, particularly in smaller cities where resources are limited. This community-based participatory research explored the experiences of small-city homeless service users (HSUs) with unmet health care needs and community service providers (CSPs) who work with them to determine barriers to health care access affecting them. Structured interviews were conducted with 65 HSUs and 15 CSPs in interior British Columbia, Canada. These interviews were audio-recorded, and the retrieved data were analyzed thematically. The three themes uncovered included: a lack of access to health care and risk of stigma, a lack of trust and fear of discrimination, and a need for community navigation and social support. The findings indicate that HSUs do not receive equitable care and face challenges in accessing appropriate and timely foot care, which contributes to increased foot-related emergency visits, loss of trust in the health care system, and disabilities due to worsening foot conditions. Various social determinants of health also impact HSUs, such as low socioeconomic status, lack of housing, decreased social support, unhealthy behaviors, and inequitable access to health services. By collaborating with HSUs, community and health services need to develop innovative outreach programs that provide better community resources as the first step toward equitable access to health care.
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Affiliation(s)
| | - Noeman Ahmad Mirza
- Faculty of Nursing, 8637University of Windsor, Toldo Health Education Centre, Windsor, ON, Canada
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24
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McLaughlin MF, Li R, Carrero ND, Bain PA, Chatterjee A. Opioid use disorder treatment for people experiencing homelessness: A scoping review. Drug Alcohol Depend 2021; 224:108717. [PMID: 33985863 PMCID: PMC9758007 DOI: 10.1016/j.drugalcdep.2021.108717] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The opioid-related overdose epidemic remains a persistent public health problem in the United States and has been accelerated by the 2019 coronavirus disease pandemic. Existing, evidence-based treatment options for opioid use disorder (OUD) are broadly underutilized, particularly by people experiencing homelessness (PEH). PEH are also more likely to misuse and overdose on opioids. To better understand current gaps and disparities in OUD treatment experienced by PEH and efforts to address them, we synthesized the literature reporting on the intersection of housing status and OUD treatment. METHODS We conducted a scoping review of the literature from the electronic databases MEDLINE, Embase, PsycINFO, and Web of Science Core Collection. We included studies describing treatment-related outcomes specific to PEH and articles assessing OUD treatment interventions tailored to this population. Relevant findings were compiled via thematic analysis and narratively synthesized. RESULTS 60 articles met our inclusion criteria, including 43 descriptive and 17 intervention-focused studies. These studies demonstrated that PEH experience more barriers to OUD treatment than their housed counterparts and access inpatient and detoxification treatment more commonly than pharmacotherapy. However, the reviewed literature indicated that PEH have similar outcomes once engaged in pharmacotherapy. Efficacious interventions for PEH were low-barrier and targeted, with housing interventions also demonstrating benefit. CONCLUSIONS PEH have diminished access to evidence-based OUD treatment, particularly medications, and require targeted approaches to improve engagement and retention. To mitigate the disproportionate opioid-related morbidity and mortality PEH experience, innovative, flexible, and interdisciplinary OUD treatment models are necessary, with housing support playing an important role.
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Affiliation(s)
- Matthew F. McLaughlin
- Harvard College, Massachusetts Hall, Cambridge, MA, 02138, United States,Corresponding author. Present address at: San Francisco Department of Public Health, 25 Van Ness Ave. Suite 500, San Francisco, CA, 94102, United States
| | - Rick Li
- Harvard College, Massachusetts Hall, Cambridge, MA, 02138, United States
| | | | - Paul A. Bain
- Countway Library, Harvard Medical School, 10 Shattuck St., Boston, MA, 02115, United States
| | - Avik Chatterjee
- Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA, 02118, United States,Boston University School of Medicine/Boston Medical Center, 72 E. Concord St., Boston, MA, 02118, United States
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25
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Gabrielian S, Jones AL, Hoge AE, deRussy AJ, Kim YI, Montgomery AE, Blosnich JR, Gordon AJ, Gelberg L, Austin EL, Pollio D, Holmes SK, Varley AL, Kertesz SG. Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey. J Prim Care Community Health 2021; 12:2150132721993654. [PMID: 33543675 PMCID: PMC7871055 DOI: 10.1177/2150132721993654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. Methods: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. Results: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely (P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7). Conclusions: Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.
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Affiliation(s)
- Sonya Gabrielian
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Audrey L Jones
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - April E Hoge
- Birmingham VA Medical Center, Birmingham, AL, USA
| | | | - Young-Il Kim
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - John R Blosnich
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Adam J Gordon
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Erika L Austin
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - David Pollio
- University of Alabama at Birmingham College of Letters and Sciences, Birmingham, AL, USA
| | | | | | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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26
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O'Carroll A, Wainwright D. Doctor-patient interactions that exclude patients experiencing homelessness from health services: an ethnographic exploration. BJGP Open 2021; 5:BJGPO.2021.0031. [PMID: 33785567 PMCID: PMC8278504 DOI: 10.3399/bjgpo.2021.0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND People experiencing homelessness have poor health indices and poor access to health care. Their health service utilisation (HSU) is typified by: late illness presentations; poor attendance rates at appointments; low usage of primary care services and outpatient departments; and high utilisation of emergency departments and inpatient services. Why people experiencing homelessness have these particular HSU patterns is poorly understood. AIM This research sought to explore barriers to health service usage for people experiencing homelessness. DESIGN & SETTING The authors conducted critical realist ethnography over 13 months in Dublin with people experiencing homelessness at four purposively chosen sites (a food hall, a drop-in centre, an emergency department, and an outreach service for rough sleepers). METHOD Ethnographic research was supplemented with focus groups of hospital doctors and people experiencing homelessness, and with 50 semi-structured interviews with people experiencing homelessness. The epistemological framework was critical realism. RESULTS One of the factors identified in the research as contributing to the HSU pattern of people experiencing homelessness was recurrent interactions between health professionals and patients, whereby patients were either excluded or discouraged from attending health services, or self-excluded themselves from services. These interactions were described as 'conversations of exclusion'. Four such conversations were described: 'the benzodiazepine conversation'; 'the mistrustful conversation'; 'the blaming conversation'; and 'the assertive conversation'. CONCLUSION There are certain recurrent interactions between people experiencing homelessness and doctors that result in the exclusion of people experiencing homelessness from health services.
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Affiliation(s)
- Austin O'Carroll
- Programme Director, North Dublin City General Practice Training Programme, Catherine McAuley Centre, Dublin, Republic of Ireland
- Doctoral Graduate, University of Bath, Department for Health, Bath, UK
- GP, Grangegorman Primary Care Centre, Dublin, Republic of Ireland
| | - David Wainwright
- Senior Lecturer, University of Bath, Department for Health, Bath, UK
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Lanese BG, Birmingham L, Alrubaie N, Hoornbeek J. Healthcare for the Homeless (HCH) Projects and Medicaid Expansion. J Community Health 2021; 46:1139-1147. [PMID: 33983537 DOI: 10.1007/s10900-021-01000-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
Medicaid expansion was ruled optional in 2012 by the Supreme Court, which allowed some states to adopt it while others did not. This study examines the differences in the percent uninsured, healthcare utilization by service type, and clinical quality of care measures at HCH (Healthcare for the Homeless) projects between expansion and non-expansion states. An exploratory state-level retrospective analysis of annual Uniform Data System data limited to HCHs from 2012 to 2019 from 50 states plus Washington DC is presented. Using descriptive statistics and linear mixed models, we found that the percentage of uninsured HCH patients decreased across all states, but the decrease was greater in states that expanded Medicaid compared to states that did not (- 8.23, p < .0.0001). This implies HCH projects can rely less on grants and more on insurance reimbursement. When examining specific service categories, medical services in expansion states increased at a statistically significant rate post expansion as compared to non-expansion states (2.52, p = 0.0085). The percentage of substance use visits were lower in expansion states compared to non-expansion states (- 0.79, p = 0.0267). Finally, there were three preventive clinical quality of care measures at HCH projects that showed significant improvement in expansion states post expansion: colorectal cancer screening, blood pressure control, and diabetes control. Maintaining Medicaid expansion is advantageous given its association with reductions in uninsured, increased medical services utilization, and improvement in some clinical quality of care measures for homeless populations receiving services at HCH projects in expansion states.
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Affiliation(s)
- Bethany G Lanese
- Center for Public Policy and Health, College of Public Health, Kent State University, 750 Hilltop Drive, 339 Lowry Hall, P.O. Box 5190, Kent, OH, 44242, USA.
| | - Lauren Birmingham
- Rebecca D. Considine Research Institute, Akron Children's Hospital, College of Public Health, Kent State University, Kent, USA
| | - Nora Alrubaie
- College of Public Health, Kent State University, Kent, 44242, USA
| | - John Hoornbeek
- Center for Public Policy and Health, College of Public Health, Kent State University, 800 Hilltop Drive, Kent, OH, 44242, USA
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28
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Vickery KD, Winkelman TNA, Ford BR, Busch A, Robertshaw D, Pittman B, Gelberg L. Trends in Trimorbidity Among Adults Experiencing Homelessness in Minnesota, 2000-2018. Med Care 2021; 59:S220-S227. [PMID: 33710099 PMCID: PMC7958979 DOI: 10.1097/mlr.0000000000001435] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Earlier and more severe onset of chronic health conditions contributes to the increased risk of premature death among adults experiencing homelessness. Trimorbidity, a subset of multimorbidity representing overlap of physical health, mental health, and substance use conditions, disproportionately impacts adults experiencing homelessness. We know of no longitudinal data comparing trimorbidity trends among adults experiencing homelessness. OBJECTIVE To characterize 19-year trimorbidity trends among adults experiencing homelessness. RESEARCH DESIGN Repeated longitudinal, statewide survey administered every 3 years. SUBJECTS Adults living throughout Minnesota experiencing homelessness. MEASURES Reported diagnoses of chronic health conditions within 3 categories: physical health conditions (hypertension, heart disease, asthma, diabetes); mental health conditions (depression, posttraumatic stress disorder, bipolar disorder, schizophrenia/other paranoid, and delusional disorders); and substance use conditions (alcohol and illicit substances). RESULTS A total of 25,552 surveys were completed by adults at 3-year intervals in a total of 7 waves. Participants reported increasing frequency and duration of homelessness, and more nights slept outside/in a car. 77.3% of adults experiencing homelessness in 2018 had one or more chronic health condition in any domain. From 2000 to 2018, bimorbidity and trimorbidity surpassed morbidity within a single domain. This was driven by increases in mental health conditions. In 2018, 31.7% of participants reported bimorbidity and 16.3% of adults reported trimorbidity. CONCLUSIONS Adults experiencing homelessness bear a substantial and growing burden of bimorbidity and trimorbidity. Ensuring accessible, high quality care that includes robust services that can address all 3 categories of health is critical. Such care is best delivered in combination with affordable supportive housing.
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Affiliation(s)
- Katherine Diaz Vickery
- Division of General Internal Medicine, Hennepin Healthcare, Health,
Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research
Institute, Health Care for the Homeless, Hennepin County Public Health
Department, Minneapolis, MN
| | - Tyler N. A. Winkelman
- Division of General Internal Medicine, Hennepin Healthcare, Health,
Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research
Institute, Minneapolis, MN
| | - Becky R. Ford
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare
Research Institute, Minneapolis, MN
| | - Andrew Busch
- Department of Medicine, Hennepin Healthcare, Department of
Medicine, University of MN, Minneapolis, MN
| | - Danielle Robertshaw
- Division of General Internal Medicine, Hennepin Healthcare, Health
Care for the Homeless, Hennepin County Public Health Department,
Minneapolis, MN
| | - Brian Pittman
- Research Scientist, Wilder Research, Amherst H. Wilder Foundation,
St. Paul, MN
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at
UCLA, Department of Health Policy and Management, UCLA Fielding School of
Public Health, Los Angeles, CA
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29
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Canham SL, Humphries J, Danielsen C, Small S, Bosma H. Design Considerations for the Development and Implementation of a Medical Respite for Older Adults Experiencing Homelessness in Metro Vancouver. Med Care 2021; 59:S146-S153. [PMID: 33710087 DOI: 10.1097/mlr.0000000000001335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Older persons with lived or living experience of homelessness (PWLEs) often live with complex physical and/or mental health conditions which are challenged by poor access to health services, especially primary care. To fill the gap in the continuum of care following hospital discharge for PWLEs, medical respite provides health and shelter support for PWLEs who do not have acute care needs that qualify for a stay in a hospital bed, yet are too sick or frail to recover on the streets or in a traditional shelter. OBJECTIVE This study examines how a medical respite could be designed for older PWLEs in Metro Vancouver, BC. RESEARCH DESIGN Using a community-based participatory research approach, in-depth interviews and focus groups were conducted with PWLE (n=15) and service provider (n=11) participants. RESULTS Participants offered rich suggestions about (a) the culture of the medical respite, (b) the physical design of a medical respite, (c) individuals who should be involved in medical respite delivery, (d) services a medical respite should provide, and (e) who the medical respite should serve. CONCLUSIONS When designing a medical respite for older PWLEs, considerations include providing an environment where patients can rest, but also feel safe and be surrounded by persons who they trust and who care for them. Developing a medical respite that adheres to the tenets of trauma-informed and patient-centered care acknowledges the mistrust and traumatization that often accompanies homeless patients presenting to health care.
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Affiliation(s)
- Sarah L Canham
- College of Social Work
- College of Architecture and Planning, Department of Community Metropolitan Planning
- University Health Interprofessional Education, University of Utah, Salt Lake City, UT
| | | | | | - Scott Small
- Catholic Charities, Roman Catholic Archdiocese of Vancouver
| | - Harvey Bosma
- Providence Health Care
- School of Social Work, University of British Columbia, Vancouver, BC, Canada
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30
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Affiliation(s)
- Kelly M Doran
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Alaina P Boyer
- Director of Implementation Research, National Health Care for the Homeless Council, Nashville, Tennessee
| | - Maria C Raven
- Department of Emergency Medicine, UCSF School of Medicine, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, San Francisco, California
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Rogers JH, Link AC, McCulloch D, Brandstetter E, Newman KL, Jackson ML, Hughes JP, Englund JA, Boeckh M, Sugg N, Ilcisin M, Sibley TR, Fay K, Lee J, Han P, Truong M, Richardson M, Nickerson DA, Starita LM, Bedford T, Chu HY. Characteristics of COVID-19 in Homeless Shelters : A Community-Based Surveillance Study. Ann Intern Med 2021; 174:42-49. [PMID: 32931328 PMCID: PMC7517131 DOI: 10.7326/m20-3799] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Homeless shelters are a high-risk setting for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission because of crowding and shared hygiene facilities. OBJECTIVE To investigate SARS-CoV-2 case counts across several adult and family homeless shelters in a major metropolitan area. DESIGN Cross-sectional, community-based surveillance study. (ClinicalTrials.gov: NCT04141917). SETTING 14 homeless shelters in King County, Washington. PARTICIPANTS A total of 1434 study encounters were done in shelter residents and staff, regardless of symptoms. INTERVENTION 2 strategies were used for SARS-CoV-2 testing: routine surveillance and contact tracing ("surge testing") events. MEASUREMENTS The primary outcome measure was test positivity rate of SARS-CoV-2 infection at shelters, determined by dividing the number of positive cases by the total number of participant encounters, regardless of symptoms. Sociodemographic, clinical, and virologic variables were assessed as correlates of viral positivity. RESULTS Among 1434 encounters, 29 (2% [95% CI, 1.4% to 2.9%]) cases of SARS-CoV-2 infection were detected across 5 shelters. Most (n = 21 [72.4%]) were detected during surge testing events rather than routine surveillance, and most (n = 21 [72.4% {CI, 52.8% to 87.3%}]) were asymptomatic at the time of sample collection. Persons who were positive for SARS-CoV-2 were more frequently aged 60 years or older than those without SARS-CoV-2 (44.8% vs. 15.9%). Eighty-six percent of persons with positive test results slept in a communal space rather than in a private or shared room. LIMITATION Selection bias due to voluntary participation and a relatively small case count. CONCLUSION Active surveillance and surge testing were used to detect multiple cases of asymptomatic and symptomatic SARS-CoV-2 infection in homeless shelters. The findings suggest an unmet need for routine viral testing outside of clinical settings for homeless populations. PRIMARY FUNDING SOURCE Gates Ventures.
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Affiliation(s)
- Julia H Rogers
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
| | - Amy C Link
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
| | - Denise McCulloch
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
| | - Elisabeth Brandstetter
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
| | - Kira L Newman
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (M.L.J.)
| | - James P Hughes
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
| | - Janet A Englund
- Seattle Children's Research Institute, University of Washington, Seattle, Washington (J.A.E.)
| | - Michael Boeckh
- Fred Hutchinson Cancer Research Center, Seattle, Washington (M.B., M.I., T.R.S., K.F., J.L., T.B.)
| | - Nancy Sugg
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
| | - Misja Ilcisin
- Fred Hutchinson Cancer Research Center, Seattle, Washington (M.B., M.I., T.R.S., K.F., J.L., T.B.)
| | - Thomas R Sibley
- Fred Hutchinson Cancer Research Center, Seattle, Washington (M.B., M.I., T.R.S., K.F., J.L., T.B.)
| | - Kairsten Fay
- Fred Hutchinson Cancer Research Center, Seattle, Washington (M.B., M.I., T.R.S., K.F., J.L., T.B.)
| | - Jover Lee
- Fred Hutchinson Cancer Research Center, Seattle, Washington (M.B., M.I., T.R.S., K.F., J.L., T.B.)
| | - Peter Han
- University of Washington and Brotman Baty Institute for Precision Medicine, Seattle, Washington (P.H., M.T., L.M.S.)
| | - Melissa Truong
- University of Washington and Brotman Baty Institute for Precision Medicine, Seattle, Washington (P.H., M.T., L.M.S.)
| | - Matthew Richardson
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
| | - Deborah A Nickerson
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
| | - Lea M Starita
- University of Washington and Brotman Baty Institute for Precision Medicine, Seattle, Washington (P.H., M.T., L.M.S.)
| | - Trevor Bedford
- Fred Hutchinson Cancer Research Center, Seattle, Washington (M.B., M.I., T.R.S., K.F., J.L., T.B.)
| | - Helen Y Chu
- University of Washington, Seattle, Washington (J.H.R., A.C.L., D.M., E.B., K.L.N., J.P.H., N.S., M.R., D.A.N., H.Y.C.)
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Ha YP, McDonald N, Hersh S, Fenniri SR, Hillier A, Cannuscio CC. Using Informational Murals and Handwashing Stations to Increase Access to Sanitation Among People Experiencing Homelessness During the COVID-19 Pandemic. Am J Public Health 2021; 111:50-53. [PMID: 33211587 PMCID: PMC7750595 DOI: 10.2105/ajph.2020.305961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Yoonhee P Ha
- Yoonhee P. Ha, Amy Hillier, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. Nicole McDonald is with Broad Street Ministry, Philadelphia. Shari Hersh is with Mural Arts Philadelphia, Philadelphia. Stephanie R. Fenniri is with the Center for Social Impact Strategy, University of Pennsylvania
| | - Nicole McDonald
- Yoonhee P. Ha, Amy Hillier, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. Nicole McDonald is with Broad Street Ministry, Philadelphia. Shari Hersh is with Mural Arts Philadelphia, Philadelphia. Stephanie R. Fenniri is with the Center for Social Impact Strategy, University of Pennsylvania
| | - Shari Hersh
- Yoonhee P. Ha, Amy Hillier, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. Nicole McDonald is with Broad Street Ministry, Philadelphia. Shari Hersh is with Mural Arts Philadelphia, Philadelphia. Stephanie R. Fenniri is with the Center for Social Impact Strategy, University of Pennsylvania
| | - Stephanie R Fenniri
- Yoonhee P. Ha, Amy Hillier, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. Nicole McDonald is with Broad Street Ministry, Philadelphia. Shari Hersh is with Mural Arts Philadelphia, Philadelphia. Stephanie R. Fenniri is with the Center for Social Impact Strategy, University of Pennsylvania
| | - Amy Hillier
- Yoonhee P. Ha, Amy Hillier, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. Nicole McDonald is with Broad Street Ministry, Philadelphia. Shari Hersh is with Mural Arts Philadelphia, Philadelphia. Stephanie R. Fenniri is with the Center for Social Impact Strategy, University of Pennsylvania
| | - Carolyn C Cannuscio
- Yoonhee P. Ha, Amy Hillier, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. Nicole McDonald is with Broad Street Ministry, Philadelphia. Shari Hersh is with Mural Arts Philadelphia, Philadelphia. Stephanie R. Fenniri is with the Center for Social Impact Strategy, University of Pennsylvania
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Holmes CT, Holmes KA, MacDonald A, Lonergan FR, Hunt JJ, Shaikh S, Cheeti R, D'Etienne JP, Zenarosa NR, Wang H. Dedicated homeless clinics reduce inappropriate emergency department utilization. J Am Coll Emerg Physicians Open 2020; 1:829-836. [PMID: 33145527 PMCID: PMC7593501 DOI: 10.1002/emp2.12054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The homeless patient population is known to have a high occurrence of inappropriate emergency department (ED) utilization. The study hospital initiated a dedicated homeless clinic targeting patients experiencing homelessness with a combination of special features. We aim to determine whether this mode of care can reduce inappropriate ED utilization among homeless patients. METHODS We conducted a retrospective observational study from July 1, 2017 to Dec 31, 2017. The study enrolled all homeless patients who visited any hospital regular clinic, dedicated homeless clinic, and ED at least once during the study period. ED homeless patients were divided into four groups (A: no clinic visits; B: those who only visited hospital regular clinic; C: those who only visited dedicated homeless clinic; and D: those who visited both hospital regular clinic and dedicated homeless clinic). The New York University algorithm was used to determine appropriate ED utilization. We compared inappropriate ED utilization among patients from these groups. Multivariate logistic regression was used to determine the risks of different clinical visits in association with inappropriate ED utilization. RESULTS A total of 16,323 clinic and 8511 ED visits occurred among 5022 unique homeless patients, in which 2450 unique patients were seen in hospital regular clinic, 784 patients in dedicated homeless clinic, 688 patients in both hospital regular clinic and dedicated homeless clinic, and 1110 patients with no clinic visits. Twenty-nine percent (230/784) of patients from dedicated homeless clinic utilized the ED, among which 21% (175/844) of their ED visits were considered inappropriate. In contrast, 40% of patients from hospital regular clinic utilized the ED, among which 29% were inappropriate (P < 0.001). The adjusted odds ratio (OR) was 0.61 (95% confidence interval [CI] = 0.50-0.74, P < 0.001) on dedicated homeless clinic predicting inappropriate ED visits in multivariate logistic regression. CONCLUSION Implementing a dedicated homeless clinic with these features can reduce ED inappropriate utilization among patients experiencing homelessness.
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Affiliation(s)
- Chad T. Holmes
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Katherine A. Holmes
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Andrew MacDonald
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Frank R. Lonergan
- Department of Family MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Joel J. Hunt
- Department of Family MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Sajid Shaikh
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTexas
| | - Radhika Cheeti
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTexas
| | - James P. D'Etienne
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Nestor R. Zenarosa
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Hao Wang
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
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Glick ID, Shader RI. The problem of medical-psychiatric illness in the homeless and its occurrence in the midst of a viral pandemic: A commentary. Psychiatry Res 2020; 290:113118. [PMID: 32593807 DOI: 10.1016/j.psychres.2020.113118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Abstract
This article has the purpose of examining the problem of getting help for the medical-psychiatric-substance use group of "homeless" people on the streets of our cities, who refuse treatment. The problem has gradually worsened since closure of state hospitals and subsequent lack of community resources. It has been stalemated, in part, by advocates, who argue for personal autonomy and freedom rather than involuntary diagnosis and treatment over the life of these people. It has reached a crisis situation secondary to such potential patients being imprisoned and/or sick with COVID-19 being potential health and legal threats. We review A) the nature of the problem, B) the current social-legal availability of treatment and long-term management (or lack of one) in the context of societal rejection of these potential patients, and C) suggest what might be done, locally and nationally. Mandating scientifically-based medical orders to citizens regardless of personal freedom - are now being implemented to manage the COVID-19 pandemic. We argue for creating a similar med-psych short- and long-term system as a new approach to help this group. They are now mostly being ignored "to die on the streets."
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Affiliation(s)
- Ira D Glick
- Professor Emeritus, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA.
| | - Richard I Shader
- Professor Emeritus, Departments of Immunology and Psychiatry, Tufts University School of Medicine, USA
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Henry ML, Lichtman JH, Hanlon K, Keene DE. Clinical management of Type II Diabetes among the unstably housed: a qualitative study of primary care physicians. Fam Pract 2020; 37:418-423. [PMID: 31781768 PMCID: PMC7377290 DOI: 10.1093/fampra/cmz085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Housing is a growing challenge for US adults in an increasingly unaffordable housing market. These housing challenges can create barriers to effective management and control of Type II Diabetes. However, little is known about how housing challenges are perceived and navigated by clinicians who care for patients with Type II Diabetes. OBJECTIVE To examine how primary care clinicians perceive and navigate their patients' housing challenges in the context of Type II Diabetes management. METHODS We conducted semi-structured interviews with 18 primary care clinicians practising in four clinical settings in New Haven, Connecticut. Two investigators systematically coded the interviews. Analysis of coded data was used to determine themes. RESULTS Participants considered housing as significant to their patients' health and a potential barrier to optimal diabetes management. Participants sought to improve their patients' housing through advocacy, referrals and interdisciplinary collaborations. They also adjusted clinical decisions to adapt to patients' housing challenges. In making clinical adjustments, participants struggled to find a balance between what they perceived to be feasible for unstably housed patients and maintaining a standard of care. Some participants navigated this balanced by employing creative strategies and individualized care. CONCLUSION In highlighting the challenges that clinicians face in maintaining a standard of care for unstably housed diabetes patients, our findings speak to the need for more guidance, resources and support to address housing in a clinical setting.
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Affiliation(s)
- Mariana L Henry
- Department of Chronic Disease Epidemiology, New Haven, CT, USA
| | | | - Kendra Hanlon
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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Schaffer KB, Wang J, Nasrallah FS, Bayat D, Dandan T, Ferkich A, Biffl WL. Disparities in triage and management of the homeless and the elderly trauma patient. Inj Epidemiol 2020; 7:39. [PMID: 32654664 PMCID: PMC7358191 DOI: 10.1186/s40621-020-00262-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Trauma systems are designed to provide specialized treatment for the most severely injured. As populations change, it is imperative for trauma centers to remain dynamic to provide the best care to all members of the community. Methods A retrospective review of all trauma patients treated at one Level II trauma center in Southern CA over 5 years. Three cohorts of patients were studied: geriatric (> 65 years), the homeless, and all other trauma patients. Triage, hospitalization, and outcomes were collected and analyzed. Results Of 8431 patients treated, 30% were geriatric, 3% homeless and 67% comprised all other patients. Trauma activation criteria was met for 84% of all other trauma patients, yet only 61% of homeless and geriatric patients combined. Injury mechanism for homeless included falls (38%), pedestrian/bicycle related (27%) and assaults (24%), often while under the influence of alcohol and drugs. Average length of hospital stay (LOS) was greater for homeless and geriatric patients and frequently attributed to discharge planning challenges. Both the homeless and geriatric groups demonstrated increased complications, comorbidities, and death rates. Conclusions Homeless trauma patients reflect similar challenges in care as with the elderly, requiring additional resources and more complex case management. It is prudent to identify and understand the issues surrounding patients transported to our trauma center requiring a higher level of care yet are under-triaged upon arrival to the Emergency Department. Although a monthly review is done for all under-triaged patients, and geriatric patients are acknowledged to be a cohort continually having delays, the homeless cohort continues to be under-triaged. The admitted homeless trauma patient has similar complex case management issues as the elderly related to pre-existing health issues and challenges with discharge planning, both which can add to longer lengths of hospital stay as compared to other trauma patients. Given the lack of social support that is endemic to both populations, these cohorts represent a unique challenge to trauma centers. Further research into specialized care is required to determine best practices to address disparities evident in the homeless and elderly, and to promote health equity in marginalized populations.
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Affiliation(s)
- Kathryn B Schaffer
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA.
| | - Jiayan Wang
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Fady S Nasrallah
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Dunya Bayat
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Tala Dandan
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Anthony Ferkich
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Walter L Biffl
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
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" I Felt Safe": The Role of the Rapid Rehousing Program in Supporting the Security of Families Experiencing Homelessness in Salt Lake County, Utah. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134840. [PMID: 32635606 PMCID: PMC7369730 DOI: 10.3390/ijerph17134840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
Homelessness is a public health issue that many organizations are addressing through a Housing First Model. One such organization is The Road Home (TRH), which provides services to homeless individuals and families in Salt Lake County. TRH is perhaps best known for their emergency shelters, but the organization also administers the Rapid Rehousing Program (RRHP), designed to help families experiencing homelessness transition back into stable housing. Those experiencing homelessness tend to have high rates of chronic mental/physical disabilities as well as issues related to substance abuse. Having a home is the first step toward achieving some kind of stability in their lives. The RRHP allows families to find housing in the private rental market and will cover the initial costs and several months of rent for clients. While the program has been praised by policymakers and social service providers for helping homeless families find rental housing, there is no empirical research about participant perspectives regarding their residential (in)security. The research question of this article is: what is the role of the RRHP in supporting the security of families experiencing homelessness? Researchers collected qualitative data through focus groups and interviews with 31 participants, 23 families experiencing homelessness, two landlords, six case managers, and service providers. Lastly, we identify recommendations for program improvements based on information gathered from research participants. It is our hope that the information presented in this article can and will be used in a way that improves public health by increasing the residential security of families experiencing homelessness.
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Wang LY, Lin LP, Chen YC, Wang TW, Lin JD. Correlates of Depressive Symptoms among Middle-Aged and Older Homeless Adults Using the 9-Item Patient Health Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134754. [PMID: 32630635 PMCID: PMC7370065 DOI: 10.3390/ijerph17134754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 01/01/2023]
Abstract
This study investigates the screening for depressive symptoms among middle-aged and older homeless adults based on Patient Health Questionnaire-9 (PHQ-9) and examines the possible factors associated with their major depressive symptoms. A cross-sectional survey was employed, and research subjects included 129 homeless people aged 45 years old and over in Taipei Wanhua District and Taipei Main Station. We used a structured questionnaire and face-to-face interview conducted by three social workers to collect data in the analyses. The content of the questionnaire included an informed consent form, demographic characteristics, enabling and need factors of healthcare, and PHQ-9 of homeless people. Results revealed that 15.5% respondents were free of depressive symptoms, 16.3% had mild level (score 5–9), 31.8% had moderate level (score 10–14), 26.4% had moderately severe level (score 15–19), and 10.1% had severe level of depressive symptoms (score 20–27). Adopting a PHQ-9 score 10 as a cut-off point for major depressive symptoms, 68.3% of middle-aged and older homeless adults were the cases needing to be referred to healthcare settings for further recheck in the near future. A multiple regression analysis found gender, age, and usage of psychiatric outpatient care were associated with major depressive symptom occurrence. The female participants were less likely to have major depressive symptoms than the male participants (OR = 0.29, 95% CI = 0.09–0.96). The elderly participants were more likely to have major depressive symptoms than the aged 45–54 years (OR = 5.29, 95% CI = 1.44–19.41). Those participants who have ever used psychiatric outpatient care were significantly more correlated with the occurrence of major depressive symptoms than their counterparts (OR = 3.65, 95% CI = 1.46–9.09). The present study suggests that in the future health policy should eliminate the risk factors of depressive symptoms and improve mental healthcare access, to improve the health and wellbeing of the homeless population.
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Affiliation(s)
- Lin-Yun Wang
- Department of Family Studies and Child Development, Shih Chien University, Taipei 104, Taiwan;
| | - Lan-Ping Lin
- Department of Senior Citizen Care and Welfare, Ching Kuo Institute of Management and Health, Keelung 203, Taiwan;
| | - Yun-Cheng Chen
- School of Public Health, National Defense Medical Center, Taipei 144, Taiwan; (Y.-C.C.); (T.-W.W.)
| | - Tai-Wen Wang
- School of Public Health, National Defense Medical Center, Taipei 144, Taiwan; (Y.-C.C.); (T.-W.W.)
| | - Jin-Ding Lin
- Institute of Long-Term Care, Mackay Medical College, New Taipei City 252, Taiwan
- Correspondence: ; Tel.: +886-2-2636-0303-1816
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Dickins KA, Buchholz SW, Ingram D, Braun LT, Hamilton RJ, Earle M, Karnik NS. Supporting Primary Care Access and Use among Homeless Persons. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:335-357. [PMID: 32865153 DOI: 10.1080/19371918.2020.1809589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With the implementation of the Affordable Care Act (ACA), many homeless persons who previously lacked health insurance gained medical coverage. This paper describes the experiences of homeless persons in accessing and using primary care services, post-implementation of the ACA. Twenty-six semi-structured interviews were completed with homeless persons and primary care providers/staff. Via thematic analysis, themes were identified, categorized by: factors which influence primary care access and use patterns, and strategies to promote consistent primary care use. Maintaining insurance and leveraging systems-based strategies to support primary care access and use may address health disparities and promote health equity.
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Affiliation(s)
- Kirsten A Dickins
- Massachusetts General Hospital, Yvonne L. Munn Center for Nursing Research , Boston, Massachusetts, USA
| | | | - Diana Ingram
- Rush University College of Nursing , Chicago, Illinois, USA
| | - Lynne T Braun
- Rush University College of Nursing , Chicago, Illinois, USA
| | | | - Melinda Earle
- Rush University College of Nursing , Chicago, Illinois, USA
| | - Niranjan S Karnik
- Rush Medical College Department of Psychiatry, Rush University College of Nursing , Chicago, Illinois, USA
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Affiliation(s)
- Katherine A Koh
- Boston Health Care for the Homeless Program, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston
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Varley A, Montgomery AE, Steward J, Stringfellow E, Austin E, Gordon A, Pollio D, deRussy A, Hoge A, Gelberg L, Riggs K, Kim TW, Rubens SL, Kertesz S. Exploring Quality of Primary Care for Patients Who Experience Homelessness and the Clinicians Who Serve Them: What Are Their Aspirations? QUALITATIVE HEALTH RESEARCH 2020; 30:865-879. [PMID: 31894725 PMCID: PMC9271358 DOI: 10.1177/1049732319895252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
To develop and evaluate an effective model of patient-centered, high-quality, homeless-focused primary care, our team explored key domains of primary care that may be important to patients. We anchored our conceptual framework in two reports from the Institute of Medicine (IOM) that defined components of primary care and quality of care. Using questions developed from this framework, we conducted semistructured interviews with 36 homeless-experienced individuals with past-year primary care engagement and 24 health care professionals (clinicians and researchers) who serve homeless-experienced patients in the primary care setting. Template analysis revealed factors important to this population. These included stigma, respect, and perspectives on patient control of medical decision-making in regard to both pain and addiction. For patients experiencing homelessness, the results suggest that quality primary care may have different meanings for patients and professionals, and that services should be tailored to meet homeless-specific needs.
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Affiliation(s)
- Allyson Varley
- Birmingham VA Medical Center
- University of Alabama at Birmingham
| | | | | | - Erin Stringfellow
- Missouri Institute of Mental Health, University of Missouri, St. Louis
| | - Erika Austin
- Birmingham VA Medical Center
- University of Alabama at Birmingham
| | | | | | | | | | | | - Kevin Riggs
- Birmingham VA Medical Center
- University of Alabama at Birmingham
| | | | | | - Stefan Kertesz
- Birmingham VA Medical Center
- University of Alabama at Birmingham
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Gonzalez SM, Fullilove RE. Building Up Housing to Break Down Health Disparities. Am J Public Health 2020; 110:301-302. [PMID: 32023114 DOI: 10.2105/ajph.2019.305521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Selena M Gonzalez
- Selena M. Gonzalez is with the Collaborative for Homeless Healthcare, New York, NY. Robert E. Fullilove is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Robert E Fullilove
- Selena M. Gonzalez is with the Collaborative for Homeless Healthcare, New York, NY. Robert E. Fullilove is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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Kamke K, Widman L, Haskett ME. Safer Sex Communication and Sexual Health Behaviors Among a Representative Statewide Sample of Homeless Adolescents. JOURNAL OF SEX RESEARCH 2020; 57:137-144. [PMID: 30810384 DOI: 10.1080/00224499.2019.1577945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Homeless adolescents are at substantial risk of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), and unplanned pregnancy; however, little research has assessed factors, such as safer sex communication, that may protect homeless adolescents against these negative outcomes. Using the 2015 North Carolina Youth Risk Behavior Survey (YRBS; unweighted N = 5,486; ages 12 to 18; 5% homeless), we compared homeless adolescents' primary safer sex communication sources (i.e., health care providers, parents, teachers, peers, religious leaders) to housed adolescents' communication sources and assessed how these sources relate to sexual health behaviors, including condom use, HIV testing, and number of sexual partners. Most homeless adolescents (61%), and 46% of housed adolescents reported having questions about sex. Further, twice as many homeless adolescents communicated primarily with health care providers compared to housed adolescents. Importantly, among homeless adolescents, communicating primarily with health care providers or teachers was related to greater likelihood of condom use and communicating primarily with religious leaders was related to greater likelihood of HIV testing. Parent communication was unrelated to homeless adolescents' sexual health behaviors. Last, communicating primarily with peers was associated with reduced likelihood of HIV testing. Having nonparental adult communication sources, including health care providers, teachers, and religious leaders, may be critical for encouraging safer sex behaviors among homeless adolescents.
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Affiliation(s)
- Kristyn Kamke
- Department of Psychology, North Carolina State University
| | - Laura Widman
- Department of Psychology, North Carolina State University
| | - Mary E Haskett
- Department of Psychology, North Carolina State University
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Raven MC. Homelessness and the Practice of Emergency Medicine: Challenges, Gaps in Care, and Moral Obligations. Ann Emerg Med 2019; 74:S33-S37. [DOI: 10.1016/j.annemergmed.2019.08.440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ungpakorn R, Rae B. Health‐related street outreach: Exploring the perceptions of homeless people with experience of sleeping rough. J Adv Nurs 2019; 76:253-263. [DOI: 10.1111/jan.14225] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
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Changes in Physical Health After Supported Housing: Results from the Collaborative Initiative to End Chronic Homelessness. J Gen Intern Med 2019; 34:1703-1708. [PMID: 31161570 PMCID: PMC6712193 DOI: 10.1007/s11606-019-05070-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/14/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The permanent supported housing model is known to improve housing outcomes, but there has been sparse research on the effects of supported housing on physical health. Various organizations including the National Academy of Sciences have called for research in this area. OBJECTIVE This observational multi-site outcome study examined changes in physical health among chronically homeless adults participating in a comprehensive supported housing program and the associations between changes in physical health, housing status, and trust in primary care providers. DESIGN Data are presented from an observational outcome study analyzed with mixed linear modeling and regression analyses. PARTICIPANTS A total of 756 chronically homeless adults across 11 sites were assessed every 3 months for 1 year. INTERVENTIONS The Collaborative Initiative to End Chronic Homelessness provided adults who were chronically homeless with permanent housing and supportive primary healthcare and mental health services. MAIN MEASURES Days housed, physical health-related quality of life (HRQOL) measured by the Short Form-12 health survey, number of medical conditions, number of treated medical conditions, and number of preventive medical procedures received. KEY RESULTS Participants showed reduced number of medical problems and receipt of more preventive procedures over time, but there was no statistically significant change in physical HRQOL. Changes in housing were not significantly associated with changes in any physical health outcomes. Over time, participants' trust in primary care providers was positively associated with increased numbers of reported medical problems and preventive procedures received but not with physical HRQOL. CONCLUSIONS Entry into supported housing with linked primary care services was not associated with improvements in physical HRQOL. Improvement in other medical outcome measures was not specifically associated with improved housing status.
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Health and Psychosocial Needs of Older Adults Who Are Experiencing Homelessness Following Hospital Discharge. THE GERONTOLOGIST 2019; 60:715-724. [DOI: 10.1093/geront/gnz078] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Though hospitals are a common location where older adults experiencing homelessness receive health care, an understanding of the types of supports needed upon hospital discharge is limited. We examined the unique characteristics of older homeless adults and the health and psychosocial supports required upon hospital discharge.
Design and Methods
Guided by principles of community-based participatory research (CBPR), we conducted 20 in-depth, semi-structured interviews with shelter/housing and health care providers in Metro Vancouver.
Results
Thematic analyses revealed 6 themes: (a) older people experiencing homelessness have unique vulnerabilities upon hospital discharge; (b) following hospital discharge, general population shelters are inappropriate for older adults; (c) shelter/housing options for older adults who have complex health and social needs are limited; (d) shelter/housing for older adults who require medical stabilization and convalescence after hospital discharge is needed; (e) a range of senior-specific shelter/housing options are needed; and (f) unique community supports are needed for older adults upon hospital discharge.
Discussion and Implications
As the population of older adults increases across North America, there is a parallel trend in the increased numbers of older adults who are experiencing homelessness. Not only is there often a need for ongoing medical care and respite, but there is a need for both shelter and housing options that can appropriately support individual needs.
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Davies A, Wood LJ. Homeless health care: meeting the challenges of providing primary care. Med J Aust 2019; 209:230-234. [PMID: 30157413 DOI: 10.5694/mja17.01264] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/19/2018] [Indexed: 11/17/2022]
Abstract
People experiencing homelessness have multiple complex health conditions yet are typically disengaged from primary health care services and place a significant burden on the acute health system. Barriers preventing people who are homeless from accessing primary care can be both personal and practical and include competing needs and priorities, illness and poor health, physical access to health services, difficulty in contacting services, medication security, and the affordability of health care. Differences in social status and perceptions of being judged can lead to relationship barriers to accessing primary care. Key solutions include prioritising access to stable housing, continuity of health care, specialised homeless general practice, hospital inreach, discharge planning and coordinated care, general practice outreach, and medical recovery centres.
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Collins JM, Onwubiko U, Holland DP. QuantiFERON-TB Gold Versus Tuberculin Screening and Care Retention Among Persons Experiencing Homelessness: Georgia, 2015-2017. Am J Public Health 2019; 109:1028-1033. [PMID: 31095412 DOI: 10.2105/ajph.2019.305069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To characterize the cascade of care for latent tuberculosis infection (LTBI) in persons experiencing homelessness (PEH) and evaluate the effect of screening by QuantiFERON-TB Gold (QFT) versus tuberculin skin test (TST). Methods. We performed a retrospective cohort study of all PEH screened for LTBI by QFT and TST from May 2015 to April 2017 in Fulton County, Georgia. Results. There were 3504 PEH screened by QFT and 5509 by TST, with 2925 TSTs administered on site at community shelters and 2584 at the health department. More valid test results were obtained in those screened by QFT (99.0% vs 69.0%; P < .001) because of low return rates for reading in both TST arms. For tests administered on site, testing by QFT versus TST improved retention in care with significantly more estimated LTBI cases following up for a medical examination (67.8% vs 51.0%; P < .001) and starting LTBI treatment (58.4% vs 39.8%; P < .001). Conclusions. A QFT-based screening strategy in PEH improved diagnosis and retention in care for new LTBI cases compared with TST and may be an effective strategy to limit progression to active tuberculosis.
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Affiliation(s)
- Jeffrey M Collins
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
| | - Udodirim Onwubiko
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
| | - David P Holland
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
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Canham SL, Davidson S, Custodio K, Mauboules C, Good C, Wister AV, Bosma H. Health supports needed for homeless persons transitioning from hospitals. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:531-545. [PMID: 30011102 DOI: 10.1111/hsc.12599] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/01/2018] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
Being homeless has a negative effect on health and the health needs of individuals experiencing homelessness are complex and challenging to address. As a result of limited access to and use of primary healthcare, the main point of entry into the healthcare system for individuals experiencing homelessness is often hospitals and emergency departments. Persons experiencing homelessness are commonly discharged from hospital settings to locations that do not support recovery or access to follow-up care (e.g. shelters or the street). This can be costly to both the healthcare system and to individuals' health and quality of life. We conducted a scoping review of the literature published between 2007 and 2017 to identify the types of health supports needed for persons experiencing homelessness who are discharged from the hospital. Thirteen literature sources met inclusion criteria and thematic data analyses by two researchers resulted in the identification of six themes related to the types of health supports needed for persons experiencing homelessness who are transitioning (i.e. being discharged) from the hospital. Using a community consultation approach, the scoping review themes were validated with 23 health and shelter service providers and included in our integrated findings. Themes included: (a) a respectful and understanding approach to care, (b) housing assessments, (c) communication/coordination/navigation, (d) supports for after-care, (e) complex medical care and medication management, and (f) basic needs and transportation. These themes were found to resonate with participants of the community consultation workshop. Recommendations for trauma-informed care and patient- or client-centred care approaches are discussed.
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Affiliation(s)
- Sarah L Canham
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Shelly Davidson
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Karen Custodio
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Celine Mauboules
- Homelessness Services Association of British Columbia, Burnaby, British Columbia, Canada
| | - Chloe Good
- Homelessness Services Association of British Columbia, Burnaby, British Columbia, Canada
| | - Andrew V Wister
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Harvey Bosma
- Providence Health Care, Vancouver, British Columbia, Canada
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