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The article focuses on the reinterpretation of the research pathways through qualitative methods in homelessness research. It states that the research is distinguished as an example of sensitive social study which involves vulnerable participants as well as the field of difficult research practice. It discusses the efficiency of qualitative methods in enabling research participants to reshare experiences and contribute to the interpretation of knowledge on homelessness. It also highlights the effectiveness of various methodologies including one-to-one in-depth interviews, workshops, and formal and informal meetings.

Purpose: This study aims to explore the experiences of living through the COVID-19 pandemic for people who faced homelessness and dealt with mental health and/or substance use challenges. Design/methodology/approach: This qualitative study was comprised of 26 1:1 interviews (16 men and 10 women), conducted between February and May 2021 with people who experienced homelessness in North East England during the COVID-19 pandemic. An inductive reflexive thematic analysis was undertaken, with input from individuals with lived experience who were involved throughout the study. Findings: Four themes were developed. The first theme, lack of support and exacerbation of mental health and substance use difficulties, highlighted how the lack of in-person support and increased isolation and loneliness led to relapses or new challenges for many people's mental health and substance use. The second theme, uncertainty and fear during the pandemic, explored how the "surreal" experience of the pandemic led to many people feeling uncertain about the future and when things would return to normal. The third theme, isolation and impacts on social networks, discussed how isolation and changes to relationships also played a role in mental health and substance use. Finally, opportunity for reflection and self-improvement for mental health and substance use, explored how some people used the isolated time to re-evaluate their recovery journey and focus on self-improvement. Practical implications: The experiences shared within this study have important implications for planning the future delivery and commissioning of health and social care services for people facing homelessness, such as sharing information accessibly through clear, consistent and simple language. Originality/value: As one of the few papers to involve people with lived experience as part of the research, the findings reflect the unique narratives of this population with a focus on improving services. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to highlight the vulnerability of individuals living with tri-morbidity and the complexity of care required to serve this patient group, moreover to consider how a life course approach may assist. Design/methodology/approach: This paper uses a case study of a death of a young male adult experiencing homelessness and tri-morbidity in the UK and comparison of the mortality data for homeless adults in the UK with the general population. A synopsis of the mental health and health inclusion guidance for vulnerable adults is used. Findings: This paper found the importance of considering a life course approach and the impact of negative life events on individuals living with tri-morbidity and also the role of specialist services to support the complex needs of vulnerable adults including the importance of multi-disciplinary working and holistic care. Research limitations/implications: The research implications of this study are to consider how individuals living with tri-morbidity fit in to evidence-based care. Practical implications: The practical implication is to consider that those living with tri-morbidity have extra-ordinary lives often with a high concentration of negative life events. Therefore, an extra-ordinary approach to care maybe needed to ensure health inequalities are reduced. Social implications: This paper is an important case highlighting health inequalities, specifically mortality, in the homeless population. Originality/value: This paper is an original piece of work, with real cases discussed but anonymised according to guidance on reporting death case reports. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the impact of the Health and Social Care Act, 2012 on London’s rough sleepers as seen from the perspective of one former homeless service user (currently working as a support worker in a day centre providing outreach and “drop in” facilities for people who are street homeless and other vulnerable adults including female sex workers). The discussion centres on some of the unintended impacts of changes to healthcare commissioning; the new arrangements for patient, public representation; and the enhanced role of local councils.Design/methodology/approach This paper is grounded in front line practitioner reflection/opinion and draws on practical experience and observation at Spires, as well as research and government papers published by other service providers. The aspirations of the Health and Social Care Act, 2012 are set out before its practical application are examined from the rough sleeper’s dimension.Findings Putting clinicians and GPs centre stage in the commissioning and purchasing of healthcare may have some benefits for individual patient choice, but it can also dilute patient public involvement in health and social care with negative effects for vulnerable and excluded groups, including rough sleepers. The terms of reference ascribed to Local Healthwatch Organisations, the official representatives of the people, are narrower than previously and limit their ability to influence official policy. The Act centralises control whilst devolving operational responsibility, especially for public health provision on which rough sleepers often rely. It is suggested that local voluntary organisations and specialist “inclusion” health groups are increasingly being expected to take over responsibility for delivering health and social care and that mainstream collaboration is much reduced rather than enhanced by this fragmentation.Research limitations/implications This review is based on the opinion of an “expert by experience” which may not be representative.Originality/value This is one of few papers which present a front line service user/practitioner perspective on the impact of clinical commissioning on services for marginalised groups. [ABSTRACT FROM AUTHOR]

Purpose Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting people to safe and secure housing needs to be part of the health system response. The paper aims to discuss these issues.Design/methodology/approach This mixed-methods paper presents emerging findings from the collaboration between an inner city hospital, a specialist homeless medicine GP service and Western Australia's inaugural Housing First collective impact project (50 Lives 50 Homes) in Perth. This paper draws on data from hospitals, homelessness community services and general practice.Findings This collaboration has facilitated hospital identification and referral of vulnerable rough sleepers to the Housing First project, and connected those housed to a GP and after hours nursing support. For a cohort (n=44) housed now for at least 12 months, significant reductions in hospital use and associated costs were observed.Research limitations/implications While the observed reductions in hospital use in the year following housing are based on a small cohort, this data and the case studies presented demonstrate the power of care coordinated across hospital and community in this complex cohort.Practical implications This model of collaboration between a hospital and a Housing First project can not only improve discharge outcomes and re-admission in the shorter term, but can also contribute to ending homelessness which is itself, a social determinant of poor health.Originality/value Coordinated care between hospitals and programmes to house people who are homeless can significantly reduce hospital use and healthcare costs, and provides hospitals with the opportunity to contribute to more systemic solutions to ending homelessness. [ABSTRACT FROM AUTHOR]

Purpose: Considering the case study presented, the purpose of this paper is to analyse the impact of the pandemic in local services for homeless people. Drawing from the concept of ontological security, it will be discussed how different services' levels of "housing adequacy" shaped remarkably different experiences of the pandemic for homeless people and social workers in terms of health protection and agency. Design/methodology/approach: This paper focuses on a case study concerning homeless services for people during the COVID-19 pandemic in the metropolitan and suburban area of Turin, in Northern Italy. In-depth interviews with social workers and participant observation during online meetings of workers from the shelters constitute the empirical data that have been collected during the first wave of the pandemic in Italy. Findings: According to the findings, the pandemic showed shelters as unsafe places that reduce homeless people's decision power and separate them from the rest of the citizenship. Instead, Housing First projects emerged as imore inclusive and safermore inclusive and safer spaces, able to enhance people's power over their own lives. The pandemic did not create emerging issues in the homeless services system or discontinuities: rather, it amplified pre-existing problematic aspects. Originality/value: The case study presented provides empirical insights to recognise at the political and organisational level the importance of housing as a measure of individual and collective security, calling for an intervention to tackle homelessness in terms of housing policies rather than exclusively social and emergency treatment. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide a supply-side review of policies and practices that impact on the shortage of supply in the contemporary specialist housing market for older people in the UK.Design/methodology/approach The review is based on a review of academic literature, policy documents, reports and other sources.Findings There is a critical conflict between the key social purpose of specialist housing (i.e. living independent of socially provided care) and the values that underpin and ultimately limit the quantity of units in both the social and private sector. In the social sector, government policies prohibit rather than encourage local authorities and housing associations from increasing specialist housing stock. The nature of leasehold tenures in the private sector tends to commodify not only housing stock but also those who use it and therefore acts to instrumentalise housing supply in favour of the profit motive and the focus on the person and her or his needs is largely ignored.Originality/value While the shortage of specialist housing is well known, this paper is unique in that it provides a comprehensive and critical supply-side review of the factors that have created such conditions. [ABSTRACT FROM AUTHOR]

Purpose: With the temporary housing of rough sleepers in response to the Covid-19 emergency, some commentators have been tempted to believe that the rising population of rough sleepers in the UK has finally been reversed. This paper aims to examine the choices made by persistent rough sleepers and how far they are influenced by the perverse incentives of social policies, in order to challenge the view that they sleep rough out of choice. Design/methodology/approach: Evidence for this paper is derived from two teams of frontline service providers with routine familiarity with the rough sleeping population: a street outreach team and a team of support workers working with adults with multiple and complex needs. Primary data from focus groups were combined with the secondary analysis of both numerical and narrative accounts routinely recorded by both teams. Findings: The exercise of agency by persistent rough sleepers is constrained by a mixed baggage of complex needs, past negative risk assessments, limited resources and regulatory deterrents to generate choices to reject help that appear irrational. These need to be understood if recent policy initiatives to end rough sleeping are to be effective. Originality/value: The paper draws on the experience and comprehensive records of practitioners with intimate knowledge of the rough sleeping population. It extends narrative accounts of causes by focusing on key choices to show how the perverse incentives of policy combine with personal factors to incline rough sleeping to persist. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents the results of a thematic analysis of safeguarding adults reviews (SARs) where homelessness was a factor to illuminate and improve safeguarding practice and the support of adults who are homeless in England. Design/methodology/approach: SARs were identified from a variety of sources and a thematic analysis was undertaken using data extraction tables. Findings: In addition to identifying shortcomings in inter-agency co-operation, SARs highlighted a failure to recognize care needs and self-neglect among people with experience of homelessness and evidenced difficulties in engagement between professionals and people with experience of homelessness. Research limitations/implications: The authors may have failed to find some SARs in this category (there is no central registry). SARs vary in quality and in detail; some were not full reports. The approach to people's experience of homelessness was broad and covered more than the circumstances of people who were rough sleeping or living on the streets. Originality/value: This paper contributes to the current practice debates and policy initiatives in respect of homelessness and safeguarding in England. It may have wider relevance in the rest of the UK and internationally. [ABSTRACT FROM AUTHOR]

Purpose This paper explores service provision for young fathers through analysis of data from the three-year ESRC funded project Following Young Fathers. The purpose of this paper is to explore the idea that young fathers are a “hard to reach” group. It begins with a discussion of literature and research evidence on this theme. The empirical discussion draws on data collected in interviews and focus groups with practitioners, service managers and those working to develop and deliver family support services.Design/methodology/approach The ESRC Following Young Fathers study used qualitative longitudinal methods to research the perspectives of fathers under the age of 25, mapping the availability of services to support them and investigating professional and policy responses to their needs. The strand reported on here focussed on the perspectives of a range of practitioners, service managers and those involved in developing and commissioning services.Findings The research findings, and those of other projects discussed in the paper, challenge the idea that young fathers are “hard to reach”, suggesting that we should, conversely, consider that many services are actually hard to access. Thus, increasing young fathers’ engagement requires better understanding of their often complex needs and a reshaping of service design and delivery to account for them. The paper highlights how the configuration, funding and delivery of services can inhibit young fathers’ use of them, and identifies ways in which they could be made more accessible.Originality/value The ESRC Following Young Fathers Study filled an important gap in knowledge about the lives of young fathers, developing understandings of their experiences and support needs. The strand reported on here draws on research with practitioners to provide an in-depth discussion of how services currently support young fathers, and how they could be better configured to address their often complex and diverse needs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report the findings of a scoping review on the health challenges of families experiencing homelessness. There is a bi-directional relationship between health and homelessness in that poor health can increase the risk of housing loss, and experiencing homelessness is bad for one's health. The experience of homelessness differs between populations and this review focuses on families as one of the fastest growing segments of the homeless population. While research has been integrated on the causes of homelessness for families, this same integration has not been conducted looking at health challenges of families experiencing homelessness. Design/methodology/approach: A scoping review methodology is utilized in the paper. As the goal of this work is to ultimately develop interventions for a Canadian context, primacy is given to Canadian sources, but other relevant literature is also included. Findings: A clear distinction is seen in the literature between health challenges of children of homeless families and health challenges of parents. These themes are explored separately, and preliminary recommendations are made for potential points of intervention as personal, program and policy levels. Originality/value: This review of current evidence is an important first step in building a foundation for interventions to improve health outcomes for those experiencing housing loss. [ABSTRACT FROM AUTHOR]

Purpose: The United Nations continues to identify street children as one of the most vulnerable sub-populations of children and youth globally. The purpose of this paper is to present social and contextual perspectives of 11 girls living on the streets of Abidjan, Côte d'Ivoire. Implications with respect to the development and delivery of effective sexual/reproductive and mental health interventions and services are discussed. Design/methodology/approach: Through semi-structured interviews and applied qualitative thematic analysis, this paper aims to achieve in-depth understanding about the lives of 11 girls living on the street. A socio-ecological framework is utilized to interpret the experiences of the girls at the individual (micro), community (mezzo) and structural (macro) levels. Findings: Six main themes evolved from the thematic analysis of interview transcripts: exposure to violence and abuse before and on the street, exposure to violence and sex work, risk and vulnerability to HIV, substance use and sex work, substance use and physical and reproductive health and ways of coping and future planning. Originality/value: The interplay of experiences illustrates how girls navigate their lives, and along with an appreciation of intersectionality validates the need for an integrated approach to health and social care related to health and mental health services. Integrated interventions should focus on common issues such as improving access to HIV testing and contraceptives for young girls living on the street. [ABSTRACT FROM AUTHOR]

Purpose Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia.Design/methodology/approach This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage.Findings Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support.Research limitations/implications The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality.Social implications MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions.Originality/value There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless. [ABSTRACT FROM AUTHOR]

Purpose Homeless people experience extreme health inequalities and high rates of morbidity and mortality (Aldridge et al., 2017). Use of primary care services are low, while emergency healthcare use is high (Mathie, 2012; Homeless Link, 2014). Duration of admission has been estimated to be three times longer for homeless patients who often experience poor hospital discharge arrangements (; ). This reflects ongoing and unaddressed care and housing needs (Blackburn et al., 2017). The paper aims to discuss these issues.Design/methodology/approach This paper reveals how GPs employed in secondary care, as part of Pathway teams, support improved health and housing outcomes and safe transfer of care into community services. It draws on published literature on role of GPs in working with excluded groups, personal experience of working as a GP in secondary care, structured interviews with Pathway GPs and routine data collected by the team to highlight key outcomes.Findings The expertise of GPs is highlighted and includes holistic assessment, management of multimorbidity or "tri-morbidity" – the combination of addictions problems, mental illness and physical health (Homeless Link, 2014; Stringfellow et al., 2015) and research and teaching.Originality/value The role of the GP in the care of patients with complex needs is more visible in primary care. This paper demonstrates some of the ways in which in-reach GPs play an important role in the care of multiply excluded groups attending and admitted to secondary care settings. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe the delivery of the first clinically led, inter-professional Pathway Homeless team in a mental health trust, within the King's Health Partners hospitals in South London. The Kings Health Partners Pathway Homeless teams have been operating since January 2014 at Guy's and St Thomas' (GStT) and Kings College Hospital and expanded to the South London and Maudsley in 2015 as a charitable pilot, now continuing with short-term funding.Design/methodology/approach This paper outlines how the team delivered its key aim of improving health and housing outcomes for inpatients. It details the service development and integration within a mental health trust incorporating the experience of its sister teams at Kings and GStT. It goes on to show how the service works across multiple hospital sites and is embedded within the Trust's management structures.Findings Innovations including the transitional arrangements for patients' post-discharge are described. In the first three years of operation the team saw 237 patients. Improved housing status was achieved in 74 per cent of patients with reduced use of unscheduled care after discharge. Early analysis suggests a statistically significant reduction in bed days and reduced use of unscheduled care.Originality/value The paper suggests that this model serves as an example of person centred, value-based health that is focused on improving care and outcomes for homeless inpatients in mental health settings, with the potential to be rolled-out nationally to other mental health Trusts. [ABSTRACT FROM AUTHOR]

Purpose--The purpose of this paper is to explore agency pathways and the management of risk for economically disadvantaged adolescent victims and perpetrators of domestic violence and abuse (DVA). In spite of recent national and international initiatives to raise the profile of this issue, significant gaps within DVA services exist within an urban district situated in the North West of England, UK. The study aims to present qualitative data gathered from service-users and service managers who have knowledge of referral pathways within the district. The paper also aims to examine the discursive relationships between the context, the intersectional significance of age, gender and class and the high levels of risk for survivors and perpetrators. Design/methodology/approach--A purposive sampling strategy utilises phenomenology to explore participants lived experience of DVA. The study seeks to unite phenomenology and hermeneutics to help develop an understanding of adolescent DVA and participant's experiences of available services. Knowledge of these experiences was garnered through shared narratives. Findings--Through privileging the experiences and knowledge of survivors and practitioners, this study found current DVA service provision for survivors and perpetrators is limited and practitioner interventions can be oppressive without adequate training. These limitations are clearly at odds with national and international efforts to prevent violence against women and girls. This paper highlights significant risks for adolescent survivors and suggests ways in which targeted support might be improved. The findings conclude that central government and local councils might confront the impact of intersecting oppressions by addressing "classed sexism" in early intervention and educational strategies to effect lasting change. Research limitations/implications--Although the study is limited by a lack of participation from perpetrators, the data reveals worrying levels of risk, a reduction in funding pathways and a need for training for all statutory professionals. Additionally, another possible limitation of this study is that terms such as class, gender and heterosexuality were not defined by participants. Practical implications--The paper considers the macroeconomic legacy of neoliberalism, suggesting that investing in early educational approaches, young person focused programmes and appropriate "classed sexism" training for statutory services is crucial for minimising risk. Social implications--To understand the experience of DVA, the intersections of class, gender and age warrants further consideration, particularly in light of claims that socio-economic and ethnic marginalisation has the potential to increase the risk of exposure to interpersonal violence. Originality/value--This original research project prioritises participant knowledge and expertise in the hope of minimising risks for adolescent survivors and perpetrators of domestic violence (DVA). This paper privileges the voices and lived experiences of survivors and professionals who have expertise in DVA. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present evaluation results. People exiting incarceration who use opioids are at an elevated risk for overdose following release. People living with HIV (PLWH) who use drugs are also at increased overdose risk. Overdose education and naloxone distribution (OEND) is an effective community-based intervention, but few OEND programs have been evaluated in a correctional setting and none have specifically targeted PLWH.Design/methodology/approach: An OEND pilot program was implemented in the Philadelphia jail from December 2017 to June 2019. OEND was provided through an HIV case management program and naloxone given at release. Participants (n = 68) were assessed for changes in overdose knowledge and beliefs in their ability to respond to an overdose from baseline to one month later while still incarcerated. Other demographic variables were assessed via publicly available records and case manager chart abstraction.Findings: A total of 120 incarcerated PLWH were OEND trained; 68 (56.7%) were still incarcerated one month later and received post-tests. The 68-person sample was predominantly male (79.4%) and Black (64.7%). One-fifth reported heroin use, a third reported cocaine use and nearly 2/3 reported use of any illegal drug on date of arrest. Among these 68, overdose knowledge and overdose attitudes improved significantly (p = 0.002 and p < 0.001, respectively).Originality/value: OEND in correctional settings is feasible and knowledge and overdose attitudes improved significantly from baseline. OEND programs should be implemented within the general population of incarcerated people but, as with PLWH, can be extended to other vulnerable populations within correctional settings, such as persons with mental health conditions and a history of homelessness. [ABSTRACT FROM AUTHOR]

Purpose – Homelessness often results from the loss of social networks and individuals are tested in being able to sustain or develop new positive social networks necessary to rebuild lives. The purpose of this paper is to present findings from an exploratory study which investigated how different agencies and professionals support people experiencing multiple exclusion homelessness (MEH) to develop and maintain their social networks amid other competing priorities, such as reducing substance misuse and re-offending. Design/methodology/approach – The study was undertaken in England 2010-2011 in three case study sites. Data were collected in 76 interviews with practitioners and managers, from disciplines including housing support, social work, criminal justice, mental health and substance misuse services. Totally, 56 interviews and five focus groups were also undertaken with people with experiences of MEH. Data were analysed thematically. Data from one site in particular permitted a focus on personal relationships and social networks which were seen as beneficial but also potentially problematic. These data are drawn upon to reflect on the implications for housing providers and practitioners. Findings – While multiple factors had often led to the loss of social networks among homeless people, findings revealed that practitioners working with homeless people may be able to promote existing social networks, such as partnerships, help develop new ones, and support people withdrawing from less positive relationships. The authors conclude that practitioners should be alert to structural changes that threaten social networks and may need to enhance skills in creating opportunities to foster existing positive relationships in direct work with their clients and in collaboration with other professionals. The need to be careful of blurring professional boundaries is also observed. Practical implications – This paper suggests approaches that may encourage practitioner reflection and commissioning practice in achieving good outcomes for people with experiences of MEH by highlighting the importance of social networks and the potential for practitioners to foster supportive relationships. Originality/value – This paper considers the often under-researched area of day-to-day engagement with social networks and the implications of working to support these as part of the role of homelessness services. While drawing primarily on recent research in England the themes raised will have wider relevance to housing and care services generally. [ABSTRACT FROM AUTHOR]

Purpose Foreign-born families face challenges following migration to Canada that may impact their well-being and lead them to homelessness. Yet, there is limited research on the experience of homelessness in this population. The purpose of this paper is to examine the health of foreign-born families staying in the emergency shelter system in Ottawa, Ontario, Canada, and compare their experiences to Canadian-born homeless families who are also living in shelters.Design/methodology/approach Interviews were conducted with 75 adult heads of families who were residing in three family shelters. This study focused on mental and physical health functioning, chronic medical conditions, access to care and diagnoses of mental disorders.Findings Foreign-born heads of families reported better mental health than did Canadian-born heads of families with a significantly lower proportion of foreign-born participants reporting having been diagnosed with a mental disorder. Foreign-born heads of families also reported fewer chronic medical conditions than did Canadian-born heads of families.Research limitations/implications This study relied on self-reported health and access to healthcare services. Data were drawn from a small, non-random sample.Originality/value This study is one of the first studies to examine the health and well-being of homeless foreign-born heads of families. Moreover, this paper also focuses on disparities in health, diagnoses of mental disorders, and access to healthcare services between foreign-born and Canadian-born families – a comparison that has not been captured in the existing literature. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore keyworkers’ experience and perceptions working with people experiencing homelessness and the use of psychologically informed approaches in an Irish context.Design/methodology/approach In this paper a qualitative descriptive methodology was employed and face-to-face in-depth semi-structured interviews were conducted. Data collected were analysed using a thematic framework and transcribed by the researcher.Findings It was the view of the keyworkers psychological approaches allowed them greater understanding of psychological trauma and its effects promotes safe physical and emotional environments builds rapport between staff and clients and enables keyworkers to work more effectively with people with complex needs. There was also convincing evidence staff are quite receptive to training.Originality/value Given there is no research exploring the use of psychologically informed approaches in homelessness service settings, this study researched an area that has not yet been explored in Ireland. This qualitative descriptive research provides a platform from which further research can be conducted. It is hoped that highlighting the psychological issues of homeless people, the data obtained will help improve Irish homeless services, and the findings extracted beneficial in terms of future service developments, professional training and education. [ABSTRACT FROM AUTHOR]

Purpose Little is known about how harm reduction is practiced in Norwegian housing first (HF) projects. The purpose of this paper is to explore, describe, and interpret how providers apply a harm reduction approach within a housing project focused on individuals who are homeless with co-morbid substance use and mental health problems.Design/methodology/approach This qualitative study was part of a larger evaluation study of a three-year HF project in a Norwegian municipality. Data were collected using four multi-stage focus groups with five providers working in the HF project. Focus group interviews were transcribed verbatim and analyzed using thematic analysis.Findings Analysis resulted in three main themes: “Letting the service user sit in the driver’s seat,” “We don’t follow service provision contracts, we do everything,” and “Collaborating with the local community.”Research limitations/implications There is a need to develop increased knowledge about service users’ experiences within the harm reduction approach.Practical implications To practice effective harm reduction, treatment providers must have open authorizations and the opportunity to exercise professional judgment. Harm reduction practice must also focus on social, political, and economic factors influencing users’ everyday lives.Originality/value The paper contributes to the knowledge base on harm reduction within HF practice that differs from a traditional model wherein clients are expected to abstain from substance use. It highlights important preconditions for challenges practitioners might encounter at both individual and service system levels. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to positively confirm a new and different approach used to engage with entrenched rough sleepers, using the more personalised approach already adopted in social care. Design/methodology/approach – This is a first hand experience of the impact of the approach. Findings – That a personalised approach can achieve positive results with a hard to reach client group. Originality/value – This is the first published paper on this particular project. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to assess the programmatic effectiveness of a post-incarceration support service, Jail In-Reach, to rapidly and permanently re-house newly released offenders with a documented history of homelessness, substance abuse and mental health disorders.Design/methodology/approach Data were obtained from SEARCH Homeless Services using the Adult Texas Recommended Assessment Guidelines survey instrument by the Texas Department of State Health Services. Repeated measures analysis of variance were performed to determine the effects of select predictors on the likelihood of permanent housing, which, for this research, is considered programmatic success.Findings Results indicate clients exhibited decreased risks of self-harm, employment problems, housing instability, co-occurring substance use, and criminal justice involvement as well as increased social support. Over half of the program participants either disappeared from the program or only secured temporary housing.Research limitations/implications This was a small pilot project with limited generalizability. There have been no follow-up studies to examine long term permanent housing success. No data were available as to why participants dropped out of the program.Practical implications Intensive advocacy and support services provided pre- and post-institutional release could provide formerly homeless inmates with co-occurring substance abuse and mental health issues with positive outcomes.Social implications Housing stability and connections to social service agencies are key factors for ensuring ex-offenders do not become re-incarcerated.Originality/value This paper contributes to the literature related to reducing homelessness among ex-offenders, to the effectiveness of critical time intervention-based programming, and the need for building social capital amongst this unique and underserved population. [ABSTRACT FROM AUTHOR]

Purpose Notwithstanding heightened awareness of the issues faced by homeless people, the notion that homelessness is the result of individual failings and weaknesses persists. The purpose of this paper is to challenge that perception by giving voice to this marginalised group and exploring the mechanisms through which they made and remade as homeless and may be protected.Design/methodology/approach Semi-structured interviews (n=23) were carried out with a sample of homeless people who had accessed a range of homelessness services in the study area.Findings It is argued that largely deprived of the private sphere, which arguably renders them in most need of public space, homeless people find themselves most subject to scrutiny, surveillance, social disapprobation and exclusion.Research limitations/implications The authors reiterate that rather than simply being associated with rooflessness, homelessness is as a function of ongoing geographical marginalisation and social alienation.Practical implications The authors suggest that dedicated spaces for homeless people to occupy during the day continue to be in need of development because, whilst not unproblematic, they can disrupt processes associated with homelessness.Social implications Further resources should be directed towards homelessness and the issues that arise during daytime for homeless people.Originality/value The paper supports the literature which highlights the spatial practices by which stigmatised groups come to be separated from mainstream society. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe a qualitative study using an idiographic approach to explore professionals' experience of working with homeless people. The paper took account of the approaches taken by these professionals and the perceived affects and influences inherent in their work. Design/methodology/approach – The paper used semi-structured interviews and an interpretative phenomenological analysis methodology to explore the professionals' experience of working with homeless people, with a sample of ten participants (professionals) working within the field. Findings – Three major themes emerged: helplessness; awareness of early traumas; and frustration at the response of mainstream mental health services. These findings support the view that a specialised personality disorder clinic would help professionals to refer complex cases to mental health services for a comprehensive package of support and care. Originality/value – There is limited research into the emotions of professionals working in a difficult clinical settings associated with homeless clients. The paper will help clinicians, health professionals and commissioners identify the coping skills and the resources and tools to support the needs and demands of these service users. [ABSTRACT FROM AUTHOR]

Purpose – Housing First has been upheld as an evidence-based best practice for transitioning homeless individuals into permanent housing in a maximally cost-effective and humane manner. However, there is much variance in the implementation and structure of Housing First programming in the USA. This paper aims to focus on a collaborative, interdisciplinary Housing First effort to house and provide case management and ancillary services to chronically homeless individuals in The City of San Mateo, California. Design/methodology/approach – The paper is a case study in which the philosophy, structure, and impact of San Mateo's outreach and housing team are discussed. To explore the project's impact, data concerning arrests and other criminal justice contacts, as well as health costs associated with these clients, both prior to and post housing and services, were collected and analyzed. These are corroborated with qualitative data on client outcomes. Findings – After participants received housing and wrap-around supportive services provided through the collaboration of police, local stakeholders, and non-profits, the cost of medical care and criminal justice interventions were dramatically reduced. While challenges such as the availability of housing units remain, the findings of this study strongly support the interdisciplinary outreach team as a model for Housing First programming. Research limitations/implications – This is an in-depth study, derived from a particularly innovative project; and therefore the sample size is limited by the size of the project. Originality/value – The originality of this study lies in its analysis of a Housing First model which incorporates an interdisciplinary outreach team designed to provide highly individualized care for clients. The San Mateo permanent supportive housing pilot project is itself unique in that it incorporates a Homeless Outreach Team (HOT) comprised of the police, other government entities, local stakeholders, and other non-profits engaged with homelessness. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to consider the potential for public library policies that specifically target "the homeless" to undermine their own objectives, and seeks to suggest alternative approaches to extend inclusion and ensure that all demographics are served equally. Design/methodology/approach – The paper was written for a satellite meeting of the 78th IFLA Congress entitled "The Homeless and the Libraries – the Right to Information and Knowledge For All". Drawing on previous research detailed in Muggleton, and Muggleton and Ruthven, the author presents a discursive perspective on the impact that assumptions about homelessness might have for policymaking. Findings – Extant prejudices and the tendency to create a homeless "other" mean that policies specifically addressing the homeless have the potential to accentuate difference and patronise and alienate the intended beneficiaries of these policies. Moreover, political opposition to more inclusive, accommodating policymaking makes it important to reject assumptions and prejudices that weaken one's own position. Grounding policymaking in the empirical experience of homeless library users is argued to be the most effective way to extend inclusion, and also avoid false dichotomies and the perpetuation of prejudice. Originality/value – Insights into unconscious assumptions gathered from previous research have been applied to the conceptualisation and implementation of public library policy. The arguments presented in the paper will hopefully be of use both for developing effective policies and for defending policies relating to homeless library users. [ABSTRACT FROM AUTHOR]

Purpose The housing sector in Egypt represents a considerable share of the gross domestic product (GDP) and accordingly the economy. Further, it is considered vital for any population around the world, because it provides the shelter needed by people. Egyptian housing market is facing many problems which need to be solved. The paper aims to discuss these issues.Design/methodology/approach This research reviews and analyzes the Egyptian public and private housing market’s key variables. As such, it highlights the importance of informed decision making through detailed analysis and study of the market, especially when planning for the future by any housing market stakeholder. The research proposes the use of system dynamics (SD) modeling to analyze the market by creating a stock and flow model using STELLA modeling and simulation software.Findings The results reveal that the expected newly established families will be nearly 800,000 families in year 2015/2016. Out of these numbers, 600,000 families require economic housing units, while the expected supply is nearly 300,000 units.Originality/value A study is made for the economic housing market, which is a very big housing market and population segment that has been suffering from negligence for years. [ABSTRACT FROM AUTHOR]

Purpose: Trusting and empathic relationships between project workers and people experiencing homelessness (PEH) form the cornerstone for their needs to be met. However, under the UK austerity agenda project workers practice in a context of increasing pressure and limited resources; with relationships often characterised by conditionality and disconnection. The purpose of this paper is to report on a study investigating project workers' experiences of building relationships with PEH living in supported housing projects. Design/methodology/approach: A qualitative design was employed in which focus groups were carried out in six projects, using an opportunity sample of 22 project workers. Data were analysed using thematic analysis, within a social constructionist epistemology. Findings: Three main themes were identified: "Working hard to build connection", "Supporting each other within an unsupportive context" and "Draining but sustaining". Project workers acted out of strong value systems in building relationships with residents against a backdrop of systemic disconnection. Originality/value: Clear clinical implications are put forward with in a Psychologically Informed Environment framework. Services supporting PEH need to be psychologically informed and organisations need to embed reflection within their policies and every day practice. In developing services for PEH interdependence not in/dependence needs to be the aim. Finally, the responsibility for improving the lives of PEH should be placed back on society to provide a context in which PEH can thrive. [ABSTRACT FROM AUTHOR]

Purpose The authors' interest in the discharge of patients with no fixed abode (NFA) arose through repeatedly seeing patients discharged back to the streets. In 2017, the Royal United Hospital (RUH) treated 155 separate individuals with NFA, making up 194 admissions. Given these numbers, the best practice according to Inclusion Health's tiered approach to secondary care services suggests that the hospital should be providing a dedicated housing officer and a coordinated discharge pathway. As this is currently lacking, the purpose of this paper is to establish a Homeless Healthcare Team (HHT) and design a hospital protocol for the discharge of NFA patients with strong links into community support.Design/methodology/approach The literature review identified six elements that make up a successful HHT, which has provided the structure for the implementation of the authors' model at the RUH.Findings Along the way, the authors have faced a number of challenges whilst attempting to transform the model into a reality, including: securing funding; allocating responsibility; balancing conflicting priorities; coordinating schedules; developing staff knowledge and challenging prejudice. The authors are now working collaboratively with invested parties from the third sector, specialist primary and secondary care health services and local government to overcome these barriers and work towards the long-term goals.Originality/value Scarce literature exists on the practicalities of attempting to set up an HHT in a District General Hospital. The authors hope that the documentation of the authors' experience will encourage others to broaden their horizons and persist through the challenges that arise. [ABSTRACT FROM AUTHOR]

Purpose – The critical potential of hospital discharge policies and practices to ameliorate the health and social care needs of homeless people has become the focus of considerable interest in England. Central to this rise in policy formation and practice development is an acute understanding of the multiple exclusions homeless people face in navigating public health and social care systems. In ways small and large this nascent landscape is serving to redefine and reshape hospital arrangements for homeless people, and opening-up new ways to deliver care across clinical, social and therapeutic boundaries. The purpose of this paper is to seek to add empirical vigour and theoretical rigour to this unfolding policy and practice terrain. Design/methodology/approach – This paper draws on findings from a case study concerned with exploring and explaining how statutory and voluntary sector organisations use specialist hospital discharge policies and practices to coordinate pathways of care for homeless people. Findings – This paper illustrates how people affected by homelessness and ill-health are routinely denied access to statutory housing support, social work assessments and district nursing provision through acts of institutional gatekeeping and professional abrogation. Originality/value – This paper makes an important contribution to understandings of the connections between hospital discharge arrangements for homeless people and statutory housing, social work and district nursing provision. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to explore integration and complexity through the evaluation of a case study service which supports multiply excluded homeless people. Design/methodology/approach - A mixed methods theory based evaluation. Data gathering included semi-structured interviews with external stakeholders, analysis of referral and outcome data, focus groups with frontline staff members and managers, and interviews with people living in the service. Findings - The service was highly rated by its stakeholders due to its ability to meet the immediate needs of many individuals and to facilitate access and engagement with community and specialist resources. However, not every individual responded to the support that was an offer, and a number were unable to access the service due to the nature of their needs or a lack of capacity in the service. Whilst the service was able to engage community and specialist services this often appeared to be within the parameters set by these services rather than flexibly around the needs of the individual. Research limitations/implications - The research is based in one case study service and findings may not be transferable to different local contexts and providers. However, the findings are consistent with previous studies. Practical implications - It is possible for commissioners to intervene in the complexities that multiply excluded homeless people experiences through the introduction of a new service. However, this is unlikely to address all of the gaps and fragmentation that people in these circumstances face. It is therefore important that partners are sensitive to such limitations and have a shared willingness to respond to continuing gaps and shortfalls. Social implications - Despite specific national policies people continue to experience multiple exclusion homelessness which suggest that more still needs to be done to prevent people from this extremely disadvantaged social circumstance. Whilst specialist services can provide excellent support the response is still fragmented for some people meaning that work to better integrate their responses must continue. Originality/value - The paper contributes to the evidence base of support models for multiple excluded homeless people and the factors that can enable a housing support service to respond to such needs. It also provides comment on the relevance of the concept of complex adaptive systems to the study of integration. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to share knowledge and observations of the Trauma-Informed Care (TIC) approach being used to engage “chronically” homeless people in the USA. Design/methodology/approach – This paper describes a placement with an organisation in New York City observing how the TIC approach is being implemented across outreach, housing and support services. The author then reflects on the lessons, for the work in the UK context. Findings – TIC empowers staff and clients to understand psychological trauma and its effects and to use this knowledge to create safe, supportive environments for all involved; improving relationships and nurturing recovery. It appears that clients use services more effectively, with staff stating that they behave more appropriately and move towards independence more quickly. Staff consider the emotional needs of the individuals they support and it was reported that they are less reliant on managers and have a higher tolerance to their clients. Research limitations/implications – TIC is an easily replicable and seemingly cost-effective way of empowering frontline staff to deliver holistic services to survivors of trauma. Practical implications – Psychologically informed practice is gaining momentum within the homelessness sector in the UK, and whilst TIC has many similarities to it, this approach specifically focuses on providing a pre-therapy approach for trauma survivors to prepare them to engage appropriately with mainstream services. Originality/value – Although there is no quantifiable data, it seems that the approach improves the well-being of service users and may ultimately reduce the cost in public spending of ineffective service use. [ABSTRACT FROM AUTHOR]

Purpose – Part One of this duo of papers outlined the appreciative inquiry (AI) philosophy, a strengths-based “positive psychology” and organisational development (OD) approach which is intrinsically creative and generative, and has been found to work well in many fields. The purpose of this paper is to describe its application in homeless hostels and demonstrates the benefits of using AI with the staff and residents, as both a personal development and an OD tool for hostels who want to become a psychologically informed environment (PIE). Design/methodology/approach – This is a case study exploring a new approach to the development of a PIE. The background of the approach and the way it contributes to a PIE as described in Part One is briefly summarised, and the implementation pilot project is discussed; the appreciative conversation and the 5 D cycle are key AI “tools” which were used. The inclusion of positive psychology approaches is referenced. In addition, in the spirit of evidence-generating practice in PIEs, preliminary quantitative and qualitative findings are reported to identify the outcomes of the approach – including client motivation, desire to build positive relationships, and increased emotional awareness. Findings – Residents responded very well to the approach, and a high proportion continued to apply their learning, making major steps towards independent living. This was backed up by quantitative data demonstrating effective outcomes for the supported housing sector, and qualitative themes start to illuminate the psychological processes behind the outcomes. The openness of PIEs to alternative psychologies is further demonstrated. The model was rolled out to other Westminster hostels. Originality/value – AI is well-established as an OD process and less well known as a personal development approach; but has not previously been articulated as a tool for working with hostel residents or for developing PIEs. This strength-based approach is an alternative to some of the problem-based psychological approaches that have been used. In addition, the AI intervention illustrated defining features of a PIE such as reflective awareness. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to discuss the current state of provision for homeless people in Prague. Design/methodology/approach – This is primarily a narrative account, though supported by and referenced with contemporary Czech social policy scholarship. It first traces the roots of the current situation through the history of the Czech legal framework for citizenship; the effects of communist-era ideology, when homelessness was simply hidden; and the post-communist (new-era) economic and political climate. The range of existing services is then described and analysed with respect to the difficulties in the demands posed for people in this situation. Findings – The paper outlines the current approach with outreach (“terrain”), engagement (“threshold”) and “accommodation” (support and rehab) services; and the challenges in transition from one to the next. Many systemic barriers remain for the re-integration of homeless people, stemming from attitudes within the community and amongst professionals, as much as a sheer lack of resources, or the psychological and emotional difficulties of the homeless themselves. Originality/value – There are few papers published internationally on homelessness in the new EU states. The similarity in the structure of services to what are sometimes called “staircase models” may therefore be instructive. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the attempts by one youth homelessness service to implement the conceptual ideas of the psychologically informed environment (PIE) into a practical and beneficial service for very challenging young people who have been homeless, are leaving care or have left custody. Design/methodology/approach -- The approach of the paper is descriptive, outlining the thinking behind a PIE with young people and the operationalising of this understanding in the day-to-day practice of the service. Findings -- Although homelessness and housing support staff are not therapists, the nature of the work entails a need for understanding and sensitivity, and the activities of the service are designed to create positive opportunities and relationships. Reflective practice, supervision and evaluation are then essential tools in developing a "learning organisation", where the collective dynamics at an organisational level support the psychological work of the PIE. Research limitations/implications -- The implications for homelessness work that can be drawn from the outcome of this project is to better understand how the PIE linked to the concept of a learning organisation can provide a truly robust framework for providing a service that can evolve harmoniously, tying in disparate funding streams to offer very challenging young people an outstanding service that addresses their homelessness and its underlying causes. Practical implications -- The practical implications shown are the psychological skills that can be developed in housing workers; the limits of those skills and how they are complemented by partnership work with other voluntary sector organisations and mainstream health providers; how the ideas of the learning organisation can naturally underpin the work of the PIE. Originality/value -- The combination of the concept of the learning organisation, reflective practice and the PIE provides a highly original and truly robust framework for providing housing workers with the psychological tools to make a transformative difference in the lives of especially vulnerable young homeless people. [ABSTRACT FROM AUTHOR]

Purpose Homelessness has been a growing problem in many countries since the 1980s. The purpose of this paper is to examine homeless peoples’ perspectives on public library services, and to compare these with the attitudes of library staff.Design/methodology/approach Eight interviews have been conducted with rough sleepers and formerly homeless library patrons to examine their experiences, needs and expectations or the library. In addition, four library staff have been interviewed about their attitudes to services for members of the homeless community.Findings Most rough sleepers and formerly homeless patrons who participated in this research viewed the public library as a safe place because it offered a welcoming atmosphere, access to a variety of resources and services targeted at the homeless. Nonetheless, sleeping has always been a major reason for their use of the library. Most staff members agreed that providing services targeted toward rough sleepers changed the dynamic between staff and the homeless patrons, but there was some disagreement between staff members about whether targeted services were the most appropriate approach.Practical implications Understanding homeless and rough sleepers’ expectations for public library services may be useful in revising policy and developing services for this community. In particular, developing partnerships with organisations supporting the homeless is an effective way of developing relevant services for this often-marginalised group.Originality/value Little research has considered public library services from the perspective of homeless people. This research is intended to fill that gap. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to propose a practice framework for disaster resilience education (DRE) with homeless communities.Design/methodology/approach A survey with 163 homeless service providers together with 45 interviews with people with a lived experience of homelessness, homeless service providers and emergency services.Findings Key principles for DRE with the homeless community were: safe relationships, collaboration, strengths-based, empowerment, providing essential resources, and inclusivity. Recommendations for the design of DRE foregrounded partnerships and knowledge sharing between the homeless community and emergency services. Locally relevant risk information and material supports, together with sharing stories and eliciting values were important considerations for developing DRE content. Preferred delivery methods were outreach to build on trusted relationships and existing services, together with written material in large font emphasising images for distribution through drop in centres, food vans and new tenancy packages.Practical implications The key principles, together with the detailed suggestions outlining ways to translate the principles into actions, can be used by emergency and homeless services to develop effective DRE materials and programmes.Social implications The proposed DRE framework aims to not only enhance disaster risk knowledge, but also address the exclusion, isolation and disempowerment experienced by people who are homeless. By building on an effective intervention models within homeless services (Trauma-Informed Care) DRE can enhance the social connection, self-confidence and well-being goals of homeless services and clients.Originality/value The DRE framework is based on the first comprehensive Australian research with homeless services, clients and emergency managers on best practice for improving extreme weather preparedness in the homeless community. [ABSTRACT FROM AUTHOR]

Purpose – This study aims to focus on a qualitative and quantitative assessment of how homeless people in the USA use libraries. Libraries, especially in urban areas, have a complicated relationship with homeless patrons. It is easy to assume that homeless populations use libraries as a safe place to avoid the elements or to sleep. This paper considers the other ways that people without permanent housing are using libraries, how they perceive libraries, and what their specific information needs might be. Design/methodology/approach – The primary method of data collection involved surveys conducted with over 100 homeless individuals in central Michigan in 2009, supplemented with information about area library policies that specifically affect this population. Findings – Many homeless people in central Michigan use libraries frequently. They most often read for entertainment and use the internet. Survey respondents tended to be appreciative of library services. Local social service agencies are a primary source of information for homeless people in this area. Research limitations/implications – The challenges of identifying homeless people led to a respondent pool which seemed to be very high-functioning. Homeless people who are mentally ill or struggling with serious substance abuse may not have been as prevalent at the venues which were used to survey respondents. Originality/value – Most articles regarding homelessness in the library literature focus on how librarians can handle these "problem patrons." However, little substantive information is known about how homeless people themselves view libraries. This paper provides insight into the needs of homeless people and how US libraries might best serve them. It also references international studies on the homeless and libraries. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to explore how homelessness affects access to information serving higher-level needs such as identity formation and social interaction. Design/methodology/approach – A multi-disciplinary literature review informed the design of 18 semi-structured interviews as well as their subsequent analysis. The interview data were intended to be qualitative and exploratory since they addressed a perceived gap in the information and library science literature. Findings – Findings present the ways in which interviewees managed to access information and the way such information helps socialisation and well-being. Research limitations/implications – The study focused on individuals who were potentially more confident and resourceful. The study is also limited to Glasgow which has relatively good provision for the homeless. Further research in a different locale and among less confident individuals would be necessary to corroborate findings in this regard. Practical implications – The findings confirmed a fundamental research assumption that homeless individuals would pursue higher-level needs alongside more basic physiological needs. This has practical implications for public libraries' service provision to homeless populations, and also suggests there is greater room for collaboration between libraries and homeless service agencies. Originality/value – The paper addresses a gap in the literature concerning homelessness and higher-level needs. This has implications for the provision of information and services within both public libraries and organisations serving the homeless. Findings also challenge widespread assumptions regarding the "otherness" or distinctiveness of people who are homeless. [ABSTRACT FROM AUTHOR]

Purpose - Previous research has made it clear that homelessness is a social condition that finds its origins in structural causes such as poverty, lack of affordable housing, chronic unemployment, and reductions in welfare support. However, in the author's view, the exclusive focus upon these structural variables fails to provide a comprehensive account of the social forces that contribute to and shape the homeless experience. The paper's aim is to contend that homelessness can also be viewed as the result of continued subordinate institutional experiences. Design/methodology/approach - The present paper examines in depth some of the inner practices of various normative institutions, namely morality, family, and the prison and uncover the ways in which they operate in producing acute states of social and moral disempowerment, and how they affect the faculties of subordinate members to competently fend for themselves in the wider society. It relies on a set of concepts coined by authors such as E. Goffman, M. Douglas, P. Boss, and M. Foucault in looking at the incapacitating nature of the aforementioned institutions. The study compares homelessness in two national contexts - that of the USA and Japan - in aiming to demonstrate that different institutional contexts tend to produce different patterns of homelessness. The research employs both secondary quantitative and secondary qualitative data. The quantitative data are used to establish the association of homelessness and subordinate institutional experience, the quantitative to illustrate the human experience of being homeless and to present cases that illustrate the continuity chains" formed by those experiences. Findings - The paper finds that different institutional settings will produce different patterns of homelessness. Originality/value - The institutional approach to homelessness advocated opens new avenues of concern and research in both the comprehensive understanding and the acting upon this vital problematic. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to analyze the nation's first hospital to housing for homeless individuals. The Chicago Housing for Health Partnership (CHHP), a Housing First and Harm Reduction model, creates a new comprehensive system of health care, housing and supportive services. Design/methodology/approach - The researchers conducted a year long process evaluation of the housing program using a multi-method approach, which involved qualitative interviews, focus groups, document analysis and observations. The paper examined the CHHP system at three different levels (the administrative, service provision and the client levels). Findings - The study allowed the organizational participants the ability to better understand their program by visually modeling the system for the first time and documenting its effectiveness. It also furthered the understanding of how and why the housing first model is best accompanied by a harm reduction approach. Finally, the paper was able to show how and why organizational system design is important in creating the most effective environment in which programs have a real impact. Originality/value - The authors were able to help CHHP program leaders conduct strategic planning and to present their program as an effective model future funding agencies and to policy makers. CHHP has incorporated the recommendations into their permanent model. In addition, the CHHP leadership, in a network with other Housing First advocates, has disseminated the findings at national conferences and networking meetings. The authors' relationship with CHHP will continue with the design of a second stage research strategy in order to continue research on Harm Reduction Housing and policy advocacy. [ABSTRACT FROM AUTHOR]

People who are homeless and have a learning disability tend to be more vulnerable and have greater health needs than homeless people who do not have a learning disability (Leedham, 2002). However, the literature on the experiences of this population is very limited. This paper investigates the experiences and views of professionals from a range of settings who work with people who are homeless and have a learning disability. Semi-structured interviews were conducted with 23 professionals working for health, social care, probation, employment and voluntary agencies. Professionals described how people who are homeless and have a learning disability have a range of complex personal, health and social needs that are often not met by current accommodation and support provision. Improvements to the quality of temporary accommodation and the on-site support offered are needed in order to react effectively to episodes of homelessness. In addition, improvements in the quality of outreach support and a greater choice of suitable housing might help to prevent homelessness among this client group. Another paper on a difference aspect of this research (Hebblethwaite et al, this issue) will report on the personal experiences of homeless people with a learning disability. [ABSTRACT FROM AUTHOR]

Purpose - Runaway and homeless youth (RHY) are among the most vulnerable youth globally. The United Nations Convention on the Rights of the Child (UNCRC) states that all children have the right to the highest level of health, and that universal healthcare rights are afforded to RHY and all children. Social determinants of health (SDH) are universal factors that frame the experiences of RHY as facilitators or barriers for accessing healthcare. The purpose of this paper is to describe practical best approaches, and policy recommendations, for improving clinical care systems to make healthcare more accessible to RHY. Design/methodology/approach - The authors describe and apply an adapted socio-ecological framework that includes SDH specific to RHY around the globe. Findings - There are multiple and complex factors in the social ecology of RHY that determine their chances of accessing healthcare. While many intrapersonal reasons for homelessness are the same globally, systems of care vary by country and by developing/developed country status. Structurally competent care systems offer a new lens for how to best provide care to RHY to take into account SDH and the unique needs of RHY. Originality/value - The UNCRC serves as a moral guide and frame of universal child healthcare provision for countries around the world. The authors uniquely argue for UNCRC, tailored-SDH, and care delivered in a structurally competent manner to make a moral case for both physical and mental health for all RHY. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to critically evaluate an innovative collaboration between health, housing and social care by exploring the “short stay project” apartments from service users’ perspectives and considering the effectiveness of this service model as part of enabling provision locally.Design/methodology/approach The qualitative methodology for this evaluation was interpretative phenomenological analysis (Smith, 2011), critically exploring service users’ personal lived experience of the “short stay project”. Three service users (n=3) participated in semi-structured interviews.Findings This study has identified the “short stay project” can prevent admission into and facilitate discharge from care and health services by offering a temporary stay in self-contained, adapted accommodation. Service users found value in staying at the apartments for differing reasons. However, practitioners must address service users’ emotional and social needs as well as physical needs to reduce the risk of occupational deprivation.Research limitations/implications Sample size is not fully representative of the total population making transferability limited.Practical implications This research found there is demand for temporary housing provision for service users with health, housing and/or social care needs.Social implications Key drivers of demand for the service are social inequalities relating to homelessness, poverty and gender-based violence rather than the health-related issues that could have been expected. Further research into the development of effective integrated services which maximise service users’ wellbeing and occupational performance is recommended.Originality/value Service models which integrate health, housing and social care can be innovative and maintain service users’ independence and wellbeing in the community. Commissioners across health, housing and social care could utilise the Better Care Fund to deliver integrated services to meet rising demands. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to evaluate the effectiveness of the dialectical behavior therapy (DBT) training which was provided to community agency staff (N=18) implementing DBT in the community with street-involved youth.Design/methodology/approach Staff participated in a multi-component approach to training which consisted of webinars, online training, self-study manuals, and ongoing peer consultation. To evaluate assess the effectiveness of the training, questionnaires assessing evaluating DBT skills knowledge, behavioral anticipation and confidence, and DBT skills use, were completed at baseline, immediately post-training, four to six months post-training, and 12-16 months post-training. Additionally, the mental health outcomes for youth receiving the DBT intervention are reported to support the effectiveness of the training outcomes.Findings Results demonstrate that the DBT skills, knowledge, and confidence of community agency staff improved significantly from pre to post-training and that knowledge and confidence were sustained over time. Additionally, the training was clinically effective as demonstrated by the significant improvement in mental health outcomes for street-involved youth participating in the intervention.Practical implications Findings suggest that this evidence-based intervention can be taught to a range of staff working in community service agencies providing care to street-involved youth and that the intervention can be delivered effectively.Originality/value These findings help to close the knowledge-practice gap between evidence-based treatment (EBT) research and practice while promoting the implementation of EBT in the community to enhance positive youth outcomes. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to extend our understanding of the issues facing those who experience multiple moves around homelessness projects. It considers these issues and how they relate to best practice, informing the delivery of psychologically informed environments (PIEs).Design/methodology/approach A qualitative design was employed, with interviews undertaken with men currently residing in hostels for those with additional needs. These men had already experienced multiple moves within the hostel system. Interpretative phenomenological analysis was used to analyse the data.Findings Main themes consider issues and challenges associated with hope and moving forward; help and the conditional or temporal nature of this; identity and stigma; and intimacy and relationships. Clinical implications of these findings are discussed.Research limitations/implications Implications include best practice for future planning with service users, the relational nature of hope, how best to manage endings and practical guidance for service developments in these settings.Originality/value These findings further the understanding of the challenges faced by service users with complex needs and how best to address them. They build on PIE guidance, offering tangible advice for practice. [ABSTRACT FROM AUTHOR]

Purpose Many homeless people have significant levels of early adverse experiences and consequent mental health difficulties. The purpose of this paper is to examine the experiences of residents and staff living and working in a psychologically informed environment (PIE), a new model of hostel for homeless people which aims to update and make more flexible the principles of the therapeutic community, thereby meeting the psychological and emotional needs of residents.Design/methodology/approach Semi-structured interviews were carried out with nine residents, ten staff and five psychotherapists at two PIE hostels in London. The data were analysed using thematic analysis with a phenomenological epistemological approach.Findings Analysis generated 18 themes for residents and staff combined, organised into five domains: what makes a home, resident needs, managing relationships, reflective practice and theory vs practice of PIEs. The study suggests that PIEs broadly meet their aim in providing a different type of environment from standard hostels. Efforts to build relationships with residents are particularly prioritised. This work can be challenging for staff and reflective practice groups provide a supportive forum. There are limits to the extent to which the theoretical PIE can be put into practice in the current political and economic climate.Originality/value This is one of the first qualitative studies of PIEs. It provides perspectives on their theoretical background as well as how they operate and are experienced in practice. It may be informative to services intending to establish a PIE and to commissioners in assessing appropriate resources. [ABSTRACT FROM AUTHOR]

Purpose Veterans with post-traumatic stress disorder (PTSD) have high lifetime rates of smoking and often have substantial difficulty quitting. However, relatively little research has focussed on the use of Veterans Health Administration (VHA) intensive tobacco cessation counseling services by veterans with PTSD and the characteristics of veterans with PTSD who do and do not use these services. The paper aims to discuss these issues.Design/methodology/approach The present study is an analysis of national VHA administrative data fiscal year 2012 that identified utilization rates of VHA intensive tobacco cessation counseling among veterans with diagnoses of both PTSD and tobacco use disorder (TUD) (N=144,990) and the correlates of tobacco cessation counseling use.Findings Altogether, 7,921 veterans with PTSD diagnosed with TUD used VHA tobacco cessation services (5.5 percent). Veterans with PTSD who used tobacco cessation counseling services were more likely to have been homeless, to have a comorbid drug use disorder, and had used other VHA services more frequently than their counterparts who did not access tobacco cessation counseling. The use of outpatient mental health and substance use services was the strongest correlate of tobacco cessation counseling use by veterans in this sample. Notably, veterans with PTSD, TUD and HIV were more likely to engage in tobacco cessation services.Originality/value This study demonstrates that future efforts should focus on increasing provider and veteran awareness of and accessibility to VHA intensive tobacco cessation counseling for veterans with PTSD. [ABSTRACT FROM AUTHOR]