1
|
Kaufman RA, Mallick M, Louis JT, Williams M, Oriol N. The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:760. [PMID: 38929006 PMCID: PMC11204218 DOI: 10.3390/ijerph21060760] [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: 05/08/2024] [Revised: 06/08/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION An estimated 5800 to 46,500 lives are lost due to homelessness each year. Experiencing homelessness and poor health are cyclically related, with one reinforcing the other. Mobile programs, which include vehicles that travel to deliver care, and street medicine, the act of bringing care to spaces where PEH live, may play a role in alleviating this burden by providing trusted, affordable, and accessible care to this community. METHODS We conducted a scoping review of peer-reviewed literature on the role of mobile clinics and street medicine in providing care for PEH by searching PubMed, Embase, and Web of Science on 10 August 2023. Articles from 2013 to 2023 specific to programs in the United States were included. The protocol was developed following the PRISMA-ScR guidelines. The primary outcome was the role of mobile programs for persons experiencing homelessness. RESULTS A total of 15 articles were included in this review. The descriptive findings emphasized that street medicine and mobile clinics provide primary care, behavioral health, and social services. The utilization findings indicate that street medicine programs positively impact the health system through their ability to defer emergency department and hospital visits, providing financial benefits. The comparative findings between mobile programs and office-based programs indicate current successes and areas for improvement. DISCUSSION Mobile clinics and street medicine programs that serve PEH provide a wide range of services. While more significant structural change is needed to address healthcare costs and housing policies in the United States, mobile clinics and street medicine teams can improve healthcare access and the healthcare system.
Collapse
Affiliation(s)
- Rebekah A. Kaufman
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
| | - Mahwish Mallick
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jarvis Thanex Louis
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
| | - Mollie Williams
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
| | - Nancy Oriol
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| |
Collapse
|
2
|
Ganguly AP, Alvarez KS, Mathew SR, Soni V, Vadlamani S, Balasubramanian BA, Bhavan KP. Intersecting social determinants of health among patients with childcare needs: a cross-sectional analysis of social vulnerability. BMC Public Health 2024; 24:639. [PMID: 38424507 PMCID: PMC10902938 DOI: 10.1186/s12889-024-18168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Access to childcare is an understudied social determinant of health (SDOH). Our health system established a childcare facility for patients to address childcare barriers to healthcare. Recognizing that social risk factors often co-exist, we sought to understand intersecting social risk factors among patients with childcare needs who utilized and did not utilize the childcare facility and identify residual unmet social needs alongside childcare needs. METHODS We conducted a cross-sectional analysis of patients who enrolled in the childcare facility from November 2020 to October 2022 to compare parameters of the Social Vulnerability Index (SVI) associated with the census tract extracted from electronic medical record (EMR) data among utilizers and non-utilizers of the facility. Overall SVI and segmentation into four themes of vulnerability (socioeconomic status, household characteristics, racial/ethnic minority status, and housing type/transportation) were compared across utilizers and utilizers. Number of 90th percentile indicators were also compared to assess extreme levels of vulnerability. A sample of utilizers additionally received a patient-reported social needs screening questionnaire administered at the childcare facility. RESULTS Among 400 enrollees in the childcare facility, 70% utilized childcare services and 30% did not. Utilizers and non-utilizers were demographically similar, though utilizers were more likely to speak Spanish (34%) compared to non-utilizers (22%). Mean SVI was similar among utilizers and non-utilizers, but the mean number of 90th percentile indicators were higher for non-utilizers compared to utilizers (4.3 ± 2.7 vs 3.7 ± 2.7, p = 0.03), primarily driven by differences in the housing type/transportation theme (p = 0.01). Non-utilizers had a lower rate of healthcare utilization compared to utilizers (p = 0.02). Among utilizers who received patient-reported screening, 84% had one unmet social need identified, of whom 62% agreed for additional assistance. Among social work referrals, 44% were linked to social workers in their medical clinics, while 56% were supported by social work integrated in the childcare facility. CONCLUSIONS This analysis of SDOH approximated by SVI showed actionable differences, potentially transportation barriers, among patients with childcare needs who utilized a health system-integrated childcare facility and patients who did not utilize services. Furthermore, residual unmet social needs among patients who utilized the facility demonstrate the multifactorial nature of social risk factors experienced by patients with childcare needs and opportunities to address intersecting social needs within an integrated intervention. Intersecting social needs require holistic examination and multifaceted interventions.
Collapse
Affiliation(s)
- Anisha P Ganguly
- Center of Innovation and Value, Parkland Health, Dallas, TX, USA.
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Health Equity Fellow, Parkland Health, 5200 Harry Hines Blvd, Dallas, TX, 75235, USA.
| | | | - Sheryl R Mathew
- Center of Innovation and Value, Parkland Health, Dallas, TX, USA
| | - Virali Soni
- Center of Innovation and Value, Parkland Health, Dallas, TX, USA
| | - Suman Vadlamani
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Kavita P Bhavan
- Center of Innovation and Value, Parkland Health, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
3
|
Omaleki V, Vo AV, Flores M, Majnoonian A, Le T, Nguyen M, Duong D, Hassani A, Wijaya FC, Gonzalez-Zuniga PE, Gaines T, Garfein RS, Fielding-Miller R. "It's hard for everyone" systemic barriers to home confinement to prevent community spread of COVID-19. Transl Behav Med 2023; 13:64-72. [PMID: 36271869 PMCID: PMC9620324 DOI: 10.1093/tbm/ibac074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Rapid identification and isolation/quarantine of COVID-19 cases or close contacts, respectively, is a vital tool to support safe, in-person learning. However, safe isolation or quarantine for a young child also necessitates home confinement for at least one adult caregiver, as well as rapid learning material development by the teacher to minimize learning loss. The purpose of this study is to better understand barriers and supports to student home confinement. We conducted a mixed-methods study using focus group discussions and a self-administered online survey with parents and staff members from 12 elementary schools and childcare sites across San Diego County serving low-income and socially vulnerable families. Focus group participants reported that mental distress and loneliness, learning loss, childcare, food, income loss, and overcrowded housing were major barriers related to home confinement. The experiences described by FGD participants were prevalent in a concurrent community survey: 25% of participants reported that isolation would be extremely difficult for a household member who tested positive or was exposed to COVID-19, and 20% were extremely concerned about learning loss while in isolation or quarantine. Our findings suggest that there are serious structural impediments to safely completing the entire recommended course of isolation or quarantine, and that the potential for isolation or quarantine may also lead to increased hesitancy to access diagnostic testing.
Collapse
Affiliation(s)
- Vinton Omaleki
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Anh V Vo
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
- Johns Hopkins Bloomberg School of Public Health-International Health, Baltimore, MD, USA
| | - Marlene Flores
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Araz Majnoonian
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Joint Doctoral Program in Public Health-Global Health, San Diego State University, San Diego, CA, USA
| | - Tina Le
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Megan Nguyen
- Johns Hopkins Bloomberg School of Public Health-International Health, Baltimore, MD, USA
| | - Dawn Duong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Ashkan Hassani
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Fitri C Wijaya
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Patricia E Gonzalez-Zuniga
- Division of Infectious Disease and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Tommi Gaines
- Division of Infectious Disease and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Richard S Garfein
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Division of Infectious Disease and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| |
Collapse
|
4
|
Ehlke SJ, Cohn AM, Boozary LK, Alexander AC, Waring JJC, Businelle MS, Kendzor DE. Discrimination, Substance Use, and Mental Health among Sexual and Gender Minority Adults Accessing Day Shelter Services. Subst Use Misuse 2022; 57:1237-1247. [PMID: 35603487 PMCID: PMC10428822 DOI: 10.1080/10826084.2022.2076874] [Citation(s) in RCA: 4] [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: 12/14/2022]
Abstract
BACKGROUND Sexual and gender minority (SGM) adults are overrepresented in the population of individuals experiencing homelessness, and high rates of substance use are common in this group. Plausibly, poor mental health and discrimination may contribute to substance use among SGM adults experiencing homelessness. This study described participant characteristics, and the interrelations among sociodemographic variables, substance use, mental health, and discrimination experiences among 87 SGM adults seeking services at a day shelter in Oklahoma City, OK. Discrimination experiences were characterized by race (White vs. non-White), sex (female vs. male), sexual identity (heterosexual vs. sexual minority), and gender identity (gender conforming vs. gender minority). METHODS Participants reported their past 30-day tobacco (cigarette/cigarillos, alternative tobacco products [ATP]), alcohol, and marijuana use, as well as everyday and lifetime major discrimination experiences, substance use problems, depression, anxiety, and post-traumatic stress disorder (PTSD). Independent samples t-tests examined differences in discrimination based on substance use and mental health. RESULTS Participants had high rates of tobacco and marijuana use, substance use problems, depression, anxiety, and PTSD. Over 80% reported experiencing everyday or lifetime major discrimination. Depression and PTSD were associated with ATP use, and anxiety was associated with alcohol use. All mental health variables were associated with substance use problems and everyday discrimination. Depression was associated with lifetime major discrimination. CONCLUSIONS SGM adults accessing shelter services frequently experienced discrimination and poor mental health, and substance use was common. Future research should examine the causal impact of discrimination on mental health and substance use among SGM adults experiencing homelessness.
Collapse
Affiliation(s)
- Sarah J. Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amy M. Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Laili K. Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Psychology, Cellular and Behavioral Neurobiology, The University of Oklahoma, Norman, OK
| | - Adam C. Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joseph J. C. Waring
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| |
Collapse
|
5
|
Yakubovich AR, Bartsch A, Metheny N, Gesink D, O'Campo P. Housing interventions for women experiencing intimate partner violence: a systematic review. Lancet Public Health 2022; 7:e23-e35. [DOI: 10.1016/s2468-2667(21)00234-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 12/01/2022]
|
6
|
Calvo F, Watts B, Panadero S, Giralt C, Rived-Ocaña M, Carbonell X. The Prevalence and Nature of Violence Against Women Experiencing Homelessness: A Quantitative Study. Violence Against Women 2021; 28:1464-1482. [PMID: 34213398 DOI: 10.1177/10778012211022780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals experiencing homelessness-an extreme form of social exclusion-have considerably higher risk of being victims of violence than the general population. We analyze the episodes of violence suffered by 504 individuals experiencing homelessness in Spain, as well as the differences between men and women. The results indicate high levels of violence and suggest that gender (specifically, being a woman) is the primary factor driving exposure to violence among this group. Highlighting the reality of women experiencing homelessness can help social, mental health, and addiction services adjust responses to better address the needs of this group and offer comprehensive care.
Collapse
Affiliation(s)
- Fran Calvo
- Departament de Pedagogia, Institut de Recerca sobre Qualitat de Vida, Universitat de Girona, Spain
| | - Beth Watts
- Institute for Social Policy, Housing, Equalities Research (I-SPHERE), Heriot-Watt University, Edinburgh, UK
| | - Sonia Panadero
- Facultad de Psicología, Universidad Complutense de Madrid, Spain
| | - Cristina Giralt
- Centre d'Atenció Primària de Blanes, Institut Català de la Salut, Blanes, Spain
| | - Mercè Rived-Ocaña
- Escola Universitària d'Infermeria i Teràpia Ocupacional, EUIT, Universitat Autònoma de Barcelona, Spain
| | | |
Collapse
|
7
|
Magwood O, Hanemaayer A, Saad A, Salvalaggio G, Bloch G, Moledina A, Pinto N, Ziha L, Geurguis M, Aliferis A, Kpade V, Arya N, Aubry T, Pottie K. Determinants of Implementation of a Clinical Practice Guideline for Homeless Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7938. [PMID: 33138054 PMCID: PMC7663114 DOI: 10.3390/ijerph17217938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
Clinical practice guidelines can improve the clinical and social care for marginalized populations, thereby improving health equity. The aim of this study is to identify determinants of guideline implementation from the perspective of patients and practitioner stakeholders for a homeless health guideline. We completed a mixed-method study to identify determinants of equitable implementation of homeless health guidelines, focusing on the Grading of Recommendations Assessment, Development and Evaluation Feasibility, Acceptability, Cost, and Equity Survey (GRADE-FACE) health equity implementation outcomes. The study included a survey and framework analysis. Eighty-eight stakeholders, including practitioners and 16 persons with lived experience of homelessness, participated in the study. Most participants favourably rated the drafted recommendations' priority status, feasibility, acceptability, cost, equity impact, and intent-to-implement. Qualitative analysis uncovered stakeholder concerns and perceptions regarding "fragmented services". Practitioners were reluctant to care for persons with lived experience of homelessness, suggesting that associated social stigma serves as a barrier for this population to access healthcare. Participants called for improved "training of practitioners" to increase knowledge of patient needs and preferences. We identified several knowledge translation strategies that may improve implementation of guidelines for marginalized populations. Such strategies should be considered by other guideline development groups who aim to improve health outcomes in the context of limited and fragmented resources, stigma, and need for advocacy.
Collapse
Affiliation(s)
- Olivia Magwood
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada; (A.H.); (A.S.); (L.Z.)
| | - Amanda Hanemaayer
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada; (A.H.); (A.S.); (L.Z.)
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Ammar Saad
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada; (A.H.); (A.S.); (L.Z.)
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Ginetta Salvalaggio
- Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Gary Bloch
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada;
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
| | - Aliza Moledina
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Nicole Pinto
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Layla Ziha
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada; (A.H.); (A.S.); (L.Z.)
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Michael Geurguis
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (M.G.); (N.A.)
| | - Alexandra Aliferis
- Michael C. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Victoire Kpade
- Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Neil Arya
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (M.G.); (N.A.)
- Department of Family Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Tim Aubry
- School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Kevin Pottie
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada; (A.H.); (A.S.); (L.Z.)
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| |
Collapse
|