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BackgroundHIV outbreaks among people who inject drugs (PWID) and experience homelessness are increasing across the USA. Despite high levels of need, multilevel barriers to accessing antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention persist for this population. The Boston Health Care for the Homeless Program (BHCHP) initiated a low-threshold, outreach-based program to support engagement in PrEP services among PWID experiencing homelessness.MethodsTo inform dissemination efforts, we explored patient and provider perspectives on key program components. From March to December 2020, we conducted semi-structured qualitative interviews with current and former BHCHP PrEP program participants and prescribers, patient navigators, and outreach workers (i.e., providers). Thematic analysis explored perspectives on key program components.ResultsParticipants (n = 21) and providers (n = 11) identified the following five key components of BHCHP's PrEP program that they perceived to be particularly helpful for supporting patient engagement in PrEP services: (1) community-driven PrEP education; (2) low-threshold, accessible programming including same-day PrEP prescribing; (3) tailored prescribing supports (e.g., on-site pharmacy, short-term prescriptions, medication storage); (4) intensive outreach and navigation; and (5) trusting, respectful patient-provider relationships.DiscussionFindings suggest that more patient-centered services formed the basis of BHCHP's innovative, successful PrEP program. While contextual challenges including competing public health emergencies and homeless encampment "sweeps" necessitate ongoing programmatic adaptations, lessons from BHCHP's PrEP program can inform PrEP delivery in a range of community-based settings serving this population, including syringe service programs and shelters.

Surveys of underserved patient populations are needed to guide quality improvement efforts but are challenging to implement. The goal of this study was to describe recruitment and response to a national survey of Veterans with homeless experience (VHE). We randomly selected 14,340 potential participants from 26 U.S. Department of Veterans Affairs (VA) facilities. A survey contract organization verified/updated addresses from VA administrative data with a commercial address database, then attempted to recruit VHE through 4 mailings, telephone follow-up, and a $10 incentive. We used mixed-effects logistic regressions to test for differences in survey response by patient characteristics. The response rate was 40.2% (n=5,766). Addresses from VA data elicited a higher response rate than addresses from commercial sources (46.9% vs 31.2%, p

BackgroundIn the context of increasing injection-related HIV outbreaks across the United States, particularly among people who inject drugs (PWID) experiencing homelessness, there is an urgent need to expand access to pre-exposure prophylaxis (PrEP) for HIV prevention. Peer-based interventions for PrEP could be helpful for promoting PrEP uptake, yet the social experiences of using PrEP among PWID experiencing homelessness have not been thoroughly explored.MethodsTo better understand social experiences surrounding PrEP use among PWID experiencing homelessness, we conducted qualitative interviews from March-December 2020 with current and former PrEP patients of an innovative, low-threshold program implemented by Boston Health Care for the Homeless Program (BHCHP) in Boston, MA. Thematic analysis of coded interview data explored participants' perspectives and experiences with PrEP disclosure and discussions within their social networks.ResultsAmong interviews with 21 participants, we identified the following four interrelated aspects of their social experiences using PrEP: (1) participants' were aware of increasing HIV transmission within their social networks, which motivated their PrEP use and disclosure; (2)  participants generally avoided disclosing their PrEP use within public spaces or casual conversations; (3)  participants expressed greater willingness to discuss PrEP with their close social contacts; and (4)  some participants self-identified as leaders or expressed interest in leading the dissemination of PrEP information within their social networks.ConclusionsFindings highlight the significance of PrEP disclosure and discussions within the social networks of PWID experiencing homelessness, suggesting a need for continued social network and intervention research-particularly to establish the feasibility and acceptability of peer-based interventions for promoting PrEP-with this marginalized population.

Background: There is emerging agreement that living in a home designed to support healthy cognitive ageing can enable people to live better with dementia and cognitive change. However, existing literature has used a variety of outcome measures that have infrequently been informed by the perspectives of older people or of professional in design and supply of housing. The DesHCA (Designing Homes for Healthy Cognitive Ageing) study aimed to identify outcomes that were meaningful for these groups and to understand their content and meanings. Methods: A presurvey of older people and housing professionals (n = 62) identified potential outcomes. These were then used in three rounds of a modified e-Delphi exercise with a panel of older people and housing professionals (n = 74) to test meanings and identify areas of agreement and disagreement. Descriptive statistics were used to present findings from previous rounds. Results: The survey confirmed a wide range of possible outcomes considered important. Through the e-Delphi rounds, panellists prioritised outcomes relating to living at home that could be influenced by design, and clarified their understanding of the meanings of outcomes. In subsequent rounds, they commented on earlier results. The exercise enabled five key outcome areas to be identified – staying independent, feeling safe, living in an adaptable home, enabling physical activity and enabling enjoyed activities- which were then tested for their content and applicability in panellists' views. Conclusion: The five key outcome areas appeared meaningful to panellists, whilst also demonstrating nuanced meanings. They indicate useful outcomes for future research, though will require careful definition in each case to become measures. Importantly, they are informed by the views of those most immediately affected by better or poorer home design. [ABSTRACT FROM AUTHOR]

Background: Older adults experiencing homelessness (OAEH) age quickly and die earlier than their housed counterparts. Illness-related decisions are best guided by patients' values, but healthcare and homelessness service providers need support in facilitating these discussions. The Serious Illness Conversation Guide (SICG) is a communication tool to guide discussions but has not yet been adapted for OAEH. Methods: We aimed to adapt the SICG for use with OAEH by nurses, social workers, and other homelessness service providers. We conducted semi-structured interviews with homelessness service providers and cognitive interviews with OAEH using the SICG. Service providers included nurses, social workers, or others working in homeless settings. OAEH were at least 50 years old and diagnosed with a serious illness. Interviews were conducted and audio recorded in shelters, transitional housing, a hospital, public spaces, and over Zoom. The research team reviewed transcripts, identifying common themes across transcripts and applying analytic notetaking. We summarized transcripts from each participant group, applying rapid qualitative analysis. For OAEH, data that referenced proposed adaptations or feedback about the SICG tool were grouped into two domains: "SICG interpretation" and "SICG feedback". For providers, we used domains from the Toolkit of Adaptation Approaches: "collaborative working", "team", "endorsement", "materials", "messages", and "delivery". Summaries were grouped into matrices to help visualize themes to inform adaptations. The adapted guide was then reviewed by expert palliative care clinicians for further refinement. Results: The final sample included 11 OAEH (45% Black, 61 ± 7 years old) and 10 providers (80% White, 8.9 ± years practice). Adaptation themes included changing words and phrases to (1) increase transparency about the purpose of the conversation, (2) promote OAEH autonomy and empowerment, (3) align with nurses' and social workers' scope of practice regarding facilitating diagnostic and prognostic awareness, and (4) be sensitive to the realities of fragmented healthcare. Responses also revealed training and implementation considerations. Conclusions: The adapted SICG is a promising clinical tool to aid in the delivery of serious illness conversations with OAEH. Future research should use this updated guide for implementation planning. Additional adaptations may be dependent on specific settings where the SICG will be delivered. [ABSTRACT FROM AUTHOR]

This paper investigates a taken-for-granted institutional form, shelters for unhoused New Yorkers, through the neo-institutional lens of institutional inertia and critical case study methodology. It focuses on the external shock of COVID-19, NYC's use of unoccupied hotels for social distancing, and the return to shelters when COVID waned. For guidance, we examine other instances of interrupted institutional inertia following shocks. Using Lewin's force field analysis, we explore why changes to some institutional forms amidst COVID persisted while novel approaches to shelter dissipated. We conclude that directly involving unhoused people in the design and implementation of homeless services may improve outcomes. Human service professionals share a body of knowledge and assumptions – a kind of echo chamber that amplifies and confirms beliefs. It is important to look beyond traditional and familiar models of service delivery to find alternative ideas and approaches that may be effective. Returning to Kurt Lewin's concept of force fields provides opportunities to think effectively and holistically about how to modify or change services, policies, and organizations. People served by human services – those with lived experiences – possess unique expertise that can inform organizational decisions and planning in new and helpful ways. As practitioners, we need to find ways to be more inclusive of the perspectives and ideas of those our programs serve through participatory methods of planning, decision making, and evaluation. [ABSTRACT FROM AUTHOR]

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness. [ABSTRACT FROM AUTHOR]

Studies report a relatively high prevalence of childhood abuse experiences (CAE) among adult homeless people. Within homeless populations, people with CAE appear to be worse off than homeless people without such experiences. This study compares a broad set of factors influencing the quality of the daily lives of Dutch homeless people with and without CAE. It also examines the extent to which CAE are predictive of the rate of change in these factors 2.5 years after entering the social relief system. Data were used from an observational longitudinal multi-site cohort study following Dutch homeless people 2.5 years after entering the social relief system. The 4 constitutional conditions of the Social Quality Approach (living conditions, interpersonal embeddedness, societal embeddedness and self-regulation) were used to cluster the factors included in this study. Participants were interviewed twice, at baseline (N = 513) and at follow up (N = 378), using a quantitative questionnaire. At baseline and follow-up participants with CAE were more disadvantaged in each of the 4 conditions of social quality, except for societal embeddedness at follow-up. After 2.5 years, on average, all participants improved more or less at a similar rate on almost all factors, with a few exceptions: Significant differential changes over time were found regarding employment status, quality of relationships with family members and symptoms of depression and anxiety. Findings corroborate the broad, detrimental and persistent impact of CAE on the quality of daily lives of homeless people and the need for homelessness services to apply trauma-informed care. [ABSTRACT FROM AUTHOR]

Background Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) offers a novel drug delivery option for persons with human immunodeficiency virus (PWH) but requires administration every 4 or 8 weeks by a medical professional. Methods To facilitate LAI antiretroviral therapy (ART) scale-up, we evaluated patient interest in alternative administration approaches via a mixed-methods, serial cross-sectional study across 3 US HIV clinics. We surveyed PWH (December 2021 to May 2022) on appeal of self- or partner/friend/family-administered LAI-CAB/RPV; multivariable ordinal logistic regression explored associated characteristics. To contextualize survey results, we thematically analyzed semi-structured interview data collected from PWH (August 2020 to July 2021) on attitudes toward out-of-clinic LAI-ART administration. Results Among 370 surveyed PWH (median age, 46 years; 26% cisgender female, 59% Black, 56% sexual minority, 34% housing instability), self-administering LAI-CAB/RPV appealed to 67%. PWH who were White (adjusted odds ratio [aOR], 3.30 [95% confidence interval {CI}, 1.42–7.64]), stably housed (aOR, 2.16 [95% CI, 1.30–3.59]), or gay/bisexual (aOR, 1.81 [1.14–2.89]) were more likely to endorse self-administration. Fewer PWH (60%) reported partner/friend/family administration as appealing; adjusted models revealed similar sociodemographic preferences for this outcome. In 72 interviews, PWH noted that acceptability of out-of-clinic LAI-ART administration was qualified by convenience, prior injection experience, and potential fear of self-inflicted pain, dependence on others, and/or HIV disclosure. Conclusions In a multisite sample of PWH, self- and, to a lesser extent, partner/friend/family-administration of LAI-CAB/RPV appealed to most; however, was less appealing among populations more impacted by health disparities. Innovative LAI-ART delivery options could free up in-clinic resources to focus scale-up among marginalized populations. [ABSTRACT FROM AUTHOR]

Burn injuries among the homeless are increasing as record numbers of people are unsheltered and resort to unsafe heating practices. This study characterizes burns in homeless encounters presenting to US emergency departments (EDs). Burn encounters in the 2019 Nationwide Emergency Department Sample (NEDS) were queried. ICD-10 and CPT codes identified homelessness, injury regions, depths, total body surface area (TBSA %), and treatment plans. Demographics, comorbidities, and charges were analyzed. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate modeling. Of 316,344 weighted ED visits meeting criteria, 1919 (0.6%) were homeless. Homeless encounters were older (mean age 44.83 vs. 32.39 years), male-predominant (71% vs. 52%), and had more comorbidities, and were more often White or Black race (p < 0.001). They more commonly presented to EDs in the West and were covered by Medicaid (51% vs. 33%) (p < 0.001). 12% and 5% of homeless burn injuries were related to self-harm and assault, respectively (p < 0.001). Homeless encounters experienced more third-degree burns (13% vs. 4%; p < 0.001), though TBSA % deciles were not significantly different (34% vs. 33% had TBSA % of ten or lower; p = 0.516). Homeless encounters were more often admitted (49% vs. 7%; p < 0.001), and homelessness increased odds of admission (OR 4.779; p < 0.001). Odds of transfer were significantly lower (OR 0.405; p = 0.021). Homeless burn ED encounters were more likely due to assault and self-inflicted injuries, and more severe. ED practitioners should be aware of these patients' unique presentation and triage to burn centers accordingly. • Homeless burn encounters presenting to EDs resulted from assault and self-infliction more commonly. • Homeless burn encounters were has significantly greater burden of psychiatric illness and substance abuse. • Homeless burn encounters were correlated with higher odds of admission yet lower odds of transfer to burn centers. [ABSTRACT FROM AUTHOR]

Youth who have experienced homelessness are impacted by disproportionately high levels of mental health symptoms, which contribute to vastly decreased well-being and early mortality. Despite a salient need for mental health support, several recent reviews have shown that few, if any, interventions currently applied to this group appear to improve mental health consistently. Furthermore, community mental services present many barriers to access for this population, given the impacts of social determinants of health on youths' ability to engage in the available supports, the ongoing instability faced by many of these youths, and the lack of applicability of existing services to youth. A challenge exists for clinicians who work with this population of youth and wish to provide effective supports, given these obstacles and an inadequate evidence base on which to inform treatment. The purpose of this article is to propose a framework for care to inform psychotherapeutic treatment for clinicians providing mental health supports to youth with experiences of homelessness. This framework is cross-modality, transdiagnostic, and research-informed and seeks to provide a structure with which to frame treatment that acknowledges and responds to the various obstacles that practitioners frequently encounter in working with this population. The framework is accompanied by illustrative case studies to demonstrate how this framework may be applied using different treatment modalities. The hope in sharing this framework is to promote more intentional and effective interventions with this chronically underserved population of youth and also to increase the self-efficacy of those practitioners who are doing this important work. Public Significance Statement: Youth who have experiences of homelessness often face mental health challenges that significantly impact their well-being and overall life expectancy. This article addresses a critical gap in existing interventions by proposing a comprehensive framework for mental health professionals providing psychotherapy to this population. By offering evidence-informed strategies and case studies, this framework aims to support clinicians in providing more effective and tailored support, promoting clinician self-efficacy, and ultimately fostering improved mental health outcomes for this vulnerable population. [ABSTRACT FROM AUTHOR]

This study develops a practical method to triage Army transitioning service members (TSMs) at highest risk of homelessness to target a preventive intervention. The sample included 4,790 soldiers from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS) who participated in 1 of 3 Army STARRS 2011–2014 baseline surveys followed by the third wave of the STARRS-LS online panel surveys (2020–2022). Two machine learning models were trained: a Stage-1 model that used administrative predictors and geospatial data available for all TSMs at discharge to identify high-risk TSMs for initial outreach; and a Stage-2 model estimated in the high-risk subsample that used self-reported survey data to help determine highest risk based on additional information collected from high-risk TSMs once they are contacted. The outcome in both models was homelessness within 12 months after leaving active service. Twelve-month prevalence of post-transition homelessness was 5.0% (SE=0.5). The Stage-1 model identified 30% of high-risk TSMs who accounted for 52% of homelessness. The Stage-2 model identified 10% of all TSMs (i.e., 33% of high-risk TSMs) who accounted for 35% of all homelessness (i.e., 63% of the homeless among high-risk TSMs). Machine learning can help target outreach and assessment of TSMs for homeless prevention interventions. [ABSTRACT FROM AUTHOR]

This research aimed to inform approaches to increase access to secure housing and improve mental health outcomes for migrants from culturally and linguistically diverse backgrounds (hereafter migrants) who are generally invisible in health and social policy and service provision in Western Australia. We used semi-structured, in-depth interviews (n  = 11) and interpretative phenomenological analysis to explore service provider experiences and perspectives of issues impacting service provision and the needs of migrants in this context. Five superordinate themes reveal complex experiences for both service providers and the migrants with whom they work. Findings reflect tensions between contemporary notions of choice and control and a social service system that is difficult to navigate, reflects systemic racism and appears to rely heavily on the non-government sector. Insights have important and practical implications for health promotion policy, practice and research. Recommendations include improvements to housing access, provision, funding and policies; addressing service barriers via staff training and more accessible community resources; and co-design and community outreach approaches. [ABSTRACT FROM AUTHOR]

Background Continuity of primary care (CPC) is associated with reduced mortality and improved health status. This study assessed the level of CPC and changes in CPC over 6 years among adults with experience of homelessness and mental illness who received a Housing First intervention. Methods Participants were adults (≥18 years old) with a serious mental disorder and experiencing chronic homelessness enrolled between October 2009 and June 2011 in the Toronto site of the Canadian At Home/Chez Soi study and followed until March 2017. Participants were randomized to Housing First with intensive case management (HF-ICM), Housing First with assertive community treatment (HF-ACT), or treatment as usual. For this report, 280 intervention group participants (HF-ICM, n = 193 and HF-ACT, n = 87) were analysed using data from health records. The main outcome was CPC measured by the Continuity of Care Index as a continuous and categorical variable among participants during 3 consecutive 2-year periods. Results Most HF-ICM participants had low levels of CPC, with 68%–74% of this group having low CPC across all time periods. Similarly, most HF-ACT participants had low levels of CPC, with 63%–78% of this group having low CPC across all time periods. Conclusions Among this group of individuals with mental illness who were experiencing homelessness, CPC remained low over 6 years of follow-up. This study highlights that housing and mental health interventions may need to place greater emphasis on improving CPC using effective strategies that are specifically geared towards this important goal among their clients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe syphilis treatment status and prenatal care among people with syphilis during pregnancy to identify missed opportunities for preventing congenital syphilis. METHODS: Six jurisdictions that participated in SET-NET (Surveillance for Emerging Threats to Pregnant People and Infants Network) conducted enhanced surveillance among people with syphilis during pregnancy based on case investigations, medical records, and linkage of laboratory data with vital records. Unadjusted risk ratios (RRs) were used to compare demographic and clinical characteristics by syphilis stage (primary, secondary, or early latent vs late latent or unknown) and treatment status during pregnancy (adequate per the Centers for Disease Control and Prevention’s “Sexually Transmitted Infections Treatment Guidelines, 2021” vs inadequate or not treated) and by prenatal care (timely: at least 30 days before pregnancy outcome; nontimely: less than 30 days before pregnancy outcome; and no prenatal care). RESULTS: As of September 15, 2023, of 1,476 people with syphilis during pregnancy, 855 (57.9%) were adequately treated and 621 (42.1%) were inadequately treated or not treated. Eighty-two percent of the cohort received timely prenatal care. Although those with nontimely or no prenatal care were more likely to receive inadequate or no treatment (RR 2.50, 95% CI, 2.17–2.88 and RR 2.73, 95% CI, 2.47–3.02, respectively), 32.1% of those with timely prenatal care were inadequately or not treated. Those with reported substance use or a history of homelessness were nearly twice as likely to receive inadequate or no treatment (RR 2.04, 95% CI, 1.82–2.28 and RR 1.83, 95% CI, 1.58–2.13, respectively). CONCLUSION: In this surveillance cohort, people without timely prenatal care had the highest risk for syphilis treatment inadequacy; however, almost a third of people who received timely prenatal care were not adequately treated. These findings underscore gaps in syphilis screening and treatment for pregnant people, especially those experiencing substance use and homelessness, and the need for systems-based interventions, such as treatment outside of traditional prenatal care settings. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal for the Study of Adult Education is the property of Canadian Journal for the Study of Adult Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

"Black Health: The Social, Political, and Cultural Determinants of Black People's Health" by Professor Keisha Ray is a comprehensive exploration of the factors contributing to health inequities among Black Americans. The book examines the role of medical professionals in perpetuating prejudice and the connection between bioethics, medicine, race, and racism. It addresses issues such as racism in maternity care, inadequate pain management, and the impact of housing and environmental factors on Black health. The author emphasizes that race is a social construct and highlights shared experiences of racism and social inequities. The book also examines the historical roots of Black maternal mortality and the complex issue of pain influenced by cultural beliefs and bias. It provides valuable insights for understanding health disparities and promoting health equity for marginalized groups. [Extracted from the article]

Objectives: People experiencing homelessness (PEH) have significant health needs and face significant obstacles when accessing health care. Hypertension can be a rough predictor of health care access; increased levels may reflect barriers to care. It is unknown whether problems stem from a lack of health insurance, as PEH enrollment data are scant, particularly in non-Medicaid expansion states. To begin to address existing literature gaps, we surveyed insurance status and collected blood pressure (BP) measurements of PEH presenting to a free clinic in Miami-Dade County, Florida. Study Design: We present trends from retrospective cohort data that include insurance status information and BP measurements obtained from 200 PEH receiving care at a free clinic. Methods: Recruitment encounters took place over 1 year. Participants were approached about the option of using deidentified data for research purposes and informed consent was obtained prior to being included in the study. Deidentified data were collected and stored in a Health Insurance Portability and Accountability Act-compliant REDCap then downloaded and analyzed in R 4.3.2. Results: A majority (61%) of PEH were insured. Mean (SD) systolic BP of uninsured PEH was 141.0 (23) mm Hg vs 135.4 (22) mm Hg for insured PEH. Independent 2-tailed t test found the mean systolic BP of insured PEH to be significantly lower than that of uninsured PEH (P = .00035). After stratifying the cohort into 10-year age groups (eg, 30-39 years, 40-49 years, etc), we discovered that uninsured participants aged 50 to 59 years had significantly increased systolic and diastolic BP. Conclusions: Insured PEH had lower systolic BP, despite an older mean age. After age stratification, a difference remained for those aged 50 to 59, representing the largest sample and oldest age group without Medicare. Still, the mean BP of insured PEH was elevated within range of hypertension, indicating that there are other barriers limiting the ability of PEH to access health care and that improvement is unlikely to be achieved solely by increasing insurance enrollment. Future studies should investigate additional factors, including why insured PEH choose free clinic care. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Planning Education & Research is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This is the protocol for an updated Campbell systematic review. The objectives are as follows: To evaluate the effect of behavioral interventions on smoking cessation among homeless individuals. [ABSTRACT FROM AUTHOR]

Population registries are the gateway to public services, benefits, and rights. However, despite clear formal rules and procedures, people eligible for registration may still face administrative burdens in obtaining access. In this article, we study the case of the municipal registration of people who experience homelessness in Belgium and the Netherlands—a group that typically suffers from administrative vulnerability. Using data from 61 interviews with social workers and civil servants, we find that burdens are constructed at the municipal level to disincentivize homeless people's access to registration. However, using the Institutional Analysis and Development Framework, we also identify mechanisms in the governance of population registrations and the decentralization of social policies that create incentives for strategic behavior by municipal policy makers and street‐level bureaucrats. By analyzing the interaction between multiple institutional levels, we contribute to understanding how structural mechanisms influence policymakers' agency in the construction of administrative burdens. [ABSTRACT FROM AUTHOR]

This essay considers the unique challenges that would likely follow Shakespearean veterans like Falstaff and Henry V's Agincourt soldiers after a life of military action. I explore the historical context of an increasing homeless population to argue that England's treatment of veterans, as evidenced in national legislation, offers insights into early modern understandings of gender, disability, and vagrancy. In the martial rhetoric of Shakespeare's Henry V, however, the promise of combat injury and the soldier's willingness to accept a disability future ensures his present claims to martial masculinity on the battlefield. Paradoxically, however, in accepting this future, the disabled veteran becomes vulnerable to heteronormative characterizations of queerness associated with amputation and rogue sexualities, a likely reality for an overwhelming number of injured servicemen returning home to England after war abroad. [ABSTRACT FROM AUTHOR]

This article discusses the relationship between low literacy and homelessness and the need for further research in this area. It highlights that approximately 50% of adults with experience of homelessness have inadequate literacy skills. The article also explores the barriers to learning faced by individuals experiencing homelessness, such as poor mental health. It emphasizes the importance of research in understanding the prevalence of low literacy among this population and the effectiveness of teaching methods. Additionally, the article suggests that technology can be a valuable tool in supporting literacy skills. Overall, the article calls for more research and evidence-based approaches to improve literacy provision for adults experiencing homelessness. [Extracted from the article]

The paper addresses the political and cultural problem underpinning mainstream narratives on homelessness. The absence of data, in conjunction with the misconceptions associated with homelessness, translate into the criminalization and stigmatization of homelessness, both at the local level and in fragmented policies at national and international levels. Section one presents an overview of homelessness as a cultural and political problem; section two then introduces the Italian situation and Bologna as a case study. After a presentation of the method followed in section three, sections four and five describe and then discuss two projects initiated by a political collective in the city of Bologna that directly involve homeless people in the deconstruction of imageries and narratives around homelessness. Finally, section six draws conclusions about the need to generate new narratives capable of accounting for the intersectional and complex nature of the phenomenon of homelessness: new narratives capable of restoring to the homeless their articulate human identity. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness are more likely to experience poor health with physical functioning deficits and frailty commonly reported. It is not well known how strategies to target physical functioning deficits and frailty work in practice in this group. The primary aim of this study was to explore the feasibility of an exercise intervention with protein supplementation to target physical functioning and frailty in people experiencing homelessness evaluated by recruitment and retention rates, adherence to the exercise sessions and protein supplement, adverse effects, programme feedback and characteristics of non-returners, sporadic and frequent attenders. The secondary aim was to evaluate changes in effectiveness outcomes of grip strength, muscle mass, lower extremity physical function, pain, frailty, and risk of malnutrition. Method: This prospective single-arm study evaluated the feasibility of a 16-week rolling, low-threshold, 'drop-in' once weekly exercise programme with protein supplementation. The main recruitment site was a day-service centre for people who are homeless. Feasibility was assessed by the recruitment and retention rates, adherence to the exercise sessions and protein supplement as well as adverse effects, programme feedback and evaluation of characteristics of non-returners, sporadic (≤50% of available sessions) and frequent attenders (≥50% of available sessions). Effectiveness outcomes included pain (Visual Analogue Scale), physical functioning and performance (hand-grip dynamometry, limb circumference, the Short Physical Performance Battery), frailty (SHARE-FI and Clinical Frailty Scale) and nutritional status (Mini Nutritional Assessment). Results: Thirty-one participants were recruited mean (SD) age 45(16) years. There was a recruitment rate of a median (IQR) of 2(1–3) new participants per week. The retention rate was 45% (n = 14) to the main recruitment site. Adherence to the exercise sessions and nutritional intervention was 90% and 100% respectively. Three adverse events were recorded during 74 interventions over the 16-week programme. The acceptability of the programme was highlighted in participant feedback. Characteristics of frequent returners (≥50%) were older age, female, more stably housed and more stable in addiction. The programme did not induce any changes in effectiveness outcomes. Conclusion: The feasibility of this programme was demonstrated. Overall, the programme was well received with higher retention rates in older participants, females, those more stably housed and those stable in addiction. A higher powered, more intense programme is needed to demonstrate programme effectiveness. [ABSTRACT FROM AUTHOR]

Personality disorders in homeless people pose a challenge to the medical community and society, requiring specialized approaches for these superdifficult patients. The prevalence of personality disorders is higher in homeless populations than in the general population. However, there is a knowledge gap regarding personality disorders among people experiencing homelessness, and the implications of this lack of recognition are substantial. This paper provides a brief narrative review of personality disorders among homeless individuals. The primary importance and specificity of these disorders in this population remain unexplored. We searched PubMed and Web of Science databases in February and November 2023 using the keywords 'homeless' and 'personality disorder', and selected fifty-eight studies to be included in this literature review. The main themes of the results were personality disorders in homeless individuals and comorbid psychiatric disorders; risk factors and other psychological and behavioral data; clinical and intervention outcomes; and challenges linked to assessment, treatment, and intervention. The homeless population experiences significant diagnostic variability and the diagnosis of personality disorders is still evolving, contributing to difficulties in diagnosis, assessment, and treatment. A future challenge is to raise clinical awareness and optimize research knowledge, assessment, and intervention in personality disorders among homeless individuals with comorbid psychiatric disorders. [ABSTRACT FROM AUTHOR]

Introduction: In Scotland, a third of all deaths of people experiencing homelessness (PExH) are street-drug-related, and less than half of their multiple physical- and mental health conditions are treated. New, holistic interventions are required to address these health inequalities. PHOENIx (Pharmacist Homeless Outreach Engagement and Non-medical Independent prescribing Rx) is delivered on outreach by National Health Service (NHS) pharmacist independent prescribers in partnership with third sector homelessness charity workers. We describe participant's perspectives of PHOENIx. Methods: This study aims to understand experiences of the PHOENIx intervention by participants recruited into the active arm of a pilot randomised controlled trial (RCT). Semi-structured in-person interviews explored participants' evaluation of the intervention. In this study, the four components (coherence, cognitive participation, collective action, reflexive monitoring) of the Normalisation Process Theory (NPT) framework underpinned data collection and analyses. Results: We identified four themes that were interpreted within the NPT framework that describe participant evaluation of the PHOENIx intervention: differentiating the intervention from usual care (coherence), embedding connection and consistency in practice (cognitive participation), implementation of practical and emotional operational work (collective action), and lack of power and a commitment to long-term support (reflexive monitoring). Participants successfully engaged with the intervention. Facilitators for participant motivation included the relationship-based work created by the PHOENIx team. This included operational work to fulfil both the practical and emotional needs of participants. Barriers included concern regarding power imbalances within the sector, a lack of long-term support and the impact of the intervention concluding. Conclusions: Findings identify and describe participants' evaluations of the PHOENIx intervention. NPT is a theoretical framework facilitating understanding of experiences, highlighting both facilitators and barriers to sustained engagement and investment. Our findings inform future developments regarding a subsequent definitive RCT of PHOENIx, despite challenges brought about by challenging micro and macro-economic and political landscapes. [ABSTRACT FROM AUTHOR]

Over the past two decades, homelessness has become more visible, and with it are increased demands for law enforcement to minimise the visibility of people experiencing homelessness, and manage, or ultimately remove, local encampments. While scholarship exists on police responses to homelessness, the role that other security actors, such as municipal bylaw officers, play in managing and regulating homelessness is largely unknown. In this paper, we explore municipal bylaw officers' perceptions of their roles and responsibilities related to homelessness in Ontario, Canada. Our analysis reveals how bylaw officers have become important players in the security governance of homelessness. We demonstrate how bylaw officers' policies, which focus on the regulation of space, are loosely coupled with, or disconnected from, their frontline activities, which require the regulation of people. This loose coupling situates bylaw officers in a perceived regulatory grey zone, requiring them to use discretionary solutions informed by their subjective experiences to govern people experiencing homelessness. The reliance on subjectivity and discretion expands security networks regulating and governing people experiencing homelessness. [ABSTRACT FROM AUTHOR]

This article examines the low adoption of long-acting injectable (LAI) antiretroviral therapy (ART) among individuals living with HIV in Washington, DC. Despite the recent approval of LAI by the FDA, only a small number of eligible participants in the DC Cohort study have started LAI. Barriers to implementation include the requirement for viral suppression prior to treatment initiation, cost and insurance approval, and logistical challenges. Concerns about safety, effectiveness, and medical mistrust also contribute to the low uptake. The study emphasizes the need for effective strategies to increase the use of LAI and improve viral suppression rates among individuals living with HIV. [Extracted from the article]

Transitional age youth experiencing homelessness (TAY-EH) represent an underserved and understudied population. While an increasing number of empirical interventions have sought to address the high burden of psychopathology in this population, findings remain mixed regarding intervention effectiveness. In this systematic review of behavioral health interventions for TAY-EH, we sought to examine the structural framework in which these interventions take place and how these structures include or exclude certain populations of youth. We also examined implementation practices to identify how interventions involving youth and community stakeholders effectively engage these populations. Based on PRISMA guidelines, searches of Medline, PsycInfo, Embase, Cochrane Central, Web of Science, and ClinicalTrials.gov databases were conducted, including English language literature published before October 2022. Eligible studies reported on interventions for adolescent or young adult populations ages 13–25 years experiencing homelessness. The initial search yielded 3850 citations; 353 underwent full text review and 48 met inclusion criteria, of which there were 33 unique studies. Studies revealed a need for greater geographic distribution of empirically based interventions, as well as interventions targeting TAY-EH in rural settings. Studies varied greatly regarding their operationalizations of homelessness and their method of intervention implementation, but generally indicated a need for increased direct-street outreach in participant recruitment and improved incorporation of youth feedback into intervention design. To our knowledge, this is the first systematic review to examine the representation of various groups of TAY-EH in the literature on substance use and mental health interventions. Further intervention research engaging youth from various geographic locations and youth experiencing different forms of homelessness is needed to better address the behavioral health needs of a variety of TAY-EH. [ABSTRACT FROM AUTHOR]