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Housing vacancy is a significant issue in developed countries' decaying and densely populated cities. Comparisons are made between the number of 'vacant housing' and 'homeless people' stressing the existence of inequalities in access to housing. The reasons for addressing vacancy are manifold, ranging from mitigating urban blight to mobilising latent resources in tight markets. Little attention is paid to vacancy in municipal housing strategies. Still, mapping vacant units appears to be complex and resource-demanding, likely discouraging municipalities from planning further operations against vacancy. Given the lack of methodological support in the literature, this paper discusses how to identify housing vacancy units. Through a case study in Wallonia (Belgium), this paper highlights the benefits of combining visual surveys and processing data provided by utilities and registered addresses. Our results suggest that housing vacancy is underestimated through official statistics and that data mining would help mitigate the administrative burden related to identification and help to prioritise operations designed to reduce housing vacancy. [ABSTRACT FROM AUTHOR]

Homelessness is a complex public health problem in the United States. Current or ongoing history of trauma among individuals adds to the complexity and challenges of homelessness. Our study assessed the moderating role of self-harm in the association between emergency department (ED) service utilization and trauma-induced homelessness (TIH) among adults in Texas. Homeless adults (N = 282) who completed their baseline Vulnerability Index Service Prioritization Decision Assistance Prescreen Tool survey between February 2021 and February 2022 at a Local Mental Health Authority in Texas were selected. The outcome variable, TIH, was assessed by current period of homelessness due to experiencing trauma or abuse. The main independent variable was ED utilization, while self-harm in the past year was assessed as the moderating variable. A multivariate logistic regression with a moderation analysis was conducted while adjusting for the covariates. Individuals who utilized ED services and engaged in self-harm and risky behaviors had greater odds of experiencing current period of TIH. Male respondents were less likely to experience TIH. Finally, engaging in self-harm significantly moderated the association between ED service use and TIH. This study may help inform efforts to develop tailored interventions and promote resilience-based approaches to improve health outcomes among individuals experiencing homelessness due to TIH. [ABSTRACT FROM AUTHOR]

Background: Youth who experience homelessness engage in behaviors that place them at high risk for disease and injury. Despite their health risk behaviors, these youth display psychological capital, positive attributes of hope, efficacy, resilience, and optimism that motivate them to engage in health-promoting behaviors such as safer sex. However, this array of positive psychological attributes has not been studied in this vulnerable population. Objectives: The specific aim of this analysis was to determine whether factors of psychological capital mediated the relationship between background risk factors (e.g., race/ethnicity, educational attainment, reason for being homeless, sexual abuse history, and HIV status) and outcomes of condom intention, safer sex behaviors, and life satisfaction among youth who participated in a longitudinal intervention study. Methods: Using a Solomon four-group design, 602 youth were recruited from drop-in centers in two large cities (Columbus, Ohio, and Austin, Texas) to participate in a brief intervention that included outcomes of enhanced communication skills, goal setting, safer sex behaviors, drug refusal skills, and life satisfaction. Using an autoregressive, cross-lagged, longitudinal mediation model, we tested the direct and indirect effects of background factors, psychological capital, and intervention outcomes. Models were tested for the intervention group alone and the total sample. Results: There were no significant direct or indirect effects of background factors on intervention outcomes among the intervention group, and the model fit was poor. There were also no significant mediating paths via factors of psychological capital and poor model fit for the combined group. Discussion: Findings provide important information about intrinsic strengths of youth experiencing homelessness and psychological capital as a significant construct for understanding health behaviors among disadvantaged and underserved youth. The lack of significant mediation effects may have been due, in part, to the lack of a robust measure of psychological capital. Further study with various background factors and outcomes would contribute further to our understanding of how best to support this population. [ABSTRACT FROM AUTHOR]

Background and Objectives The concept of aging in place is acknowledged as the preference of older adults, yet without consideration of the intersections of diversity in later life, it is critiqued as unattainable, unrealistic, or even undesirable. This gave rise to the exploration of what is needed to age in the right place (AIRP). Building on existing research, we examined the meaning of AIRP to older adults (aged 55+ years) who have experienced homelessness. Research Design and Methods We conducted photovoice interviews with 11 residents of a temporary housing program in Metro Vancouver (Canada). Results Using thematic analysis, we organized meanings of AIRP according to (1) Where one lives—the physical and social environment, (2) Where one goes and what one does, and (3) How one feels in "the right place." Discussion and Implications Participants meanings' of AIRP are applied to Maslow's hierarchy of needs. That is, when basic needs of shelter are met, participants' considerations of "the right place to age" extend beyond affordable housing to include feeling safe and comfortable in one's home and neighborhood and having access to meaningful engagement and activities—both in vibrant urban districts and naturescapes—enabled by affordable transportation. Our examination of what AIRP means to this group of older adults broadens current conceptualizations. Given the increase in homelessness among older adults, it is imperative that policymakers and practitioners are cognizant of meanings of AIRP so diverse older adults can not only age in place, but can thrive in the right place. [ABSTRACT FROM AUTHOR]

aim,3,4 Ioana Munteanu,2,3,6 Cristina Popa,2,3 Mădălina Burecu,2,3 Paula Rusu,3 Andreea Cioacată,2 Ioana Mădălina Moșteanu,2,7 Antonela Dragomir1– 31Pneumology II Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; 2Pneumology Clinic, "Marius Nasta" Institute of Pneumology, Bucharest, Romania; 3Tuberculosis Screening Program, "Marius Nasta" Institute of Pneumology, Bucharest, Romania; 4Research Department, "Marius Nasta" Institute of Pneumology, Bucharest, Romania; 5Faculty of Economic Cybernetics, Statistics and Informatics, The Bucharest University of Economic Studies, Bucharest, Romania; 6Faculty of Medicine, "Titu Maiorescu" University, Bucharest, Romania; 7Faculty of Medicine, University of Medicine and Pharmacy Craiova, Craiova, Romania Correspondence: Dragoș Băiceanu; Alexandru Stoichiță, "Marius Nasta" Institute of Pneumology, 90 Viilor Street, Bucharest, 050159, Romania, Tel +4 0749 574 412, Email [email protected] ; [email protected] Introduction: Tuberculosis (TB) remains a global health challenge, requiring enhanced active case finding (ACF) through screening strategies. This study assesses the effectiveness of such an approach in locating TB cases among vulnerable groups, such as homeless persons, injecting drug users, those detained in prison, and people living in rural areas. Methods: The study focuses on socio-economic characteristics and TB detection rates across Romanian counties using modern techniques including computer-aided detection of lesions on chest X-ray and GeneXpert tests. Results: The results highlight the disproportionate burden of TB in vulnerable groups, by revealing significant differences in TB detection rates between regions. Notably, the TB detection rates among these vulnerable groups (250.85 per 100,000 population) are five times higher than the national incidence rate (46.1). Discussion: These findings underscore the imperative integration of ACF into National TB Program to provide customized and efficient solutions for diverse vulnerable groups, thereby informing crucial public health initiatives and interventions. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Administración Pública is the property of Centro de Estudios Politicos y Constitucionales 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.)

Introduction: The objective of this analysis is to describe patient demographics, the context, characteristics and outcomes of a substance-related poisoning, and the recorded mental disorder of people with housing and those experiencing homelessness. Methods: Hospitalization data for Canada (except Quebec) from 1 April 2019 to 31 March 2020 were retrieved from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database using ICD-10-CA codes for up to 25 diagnoses for substance- related poisonings, homelessness status and other characteristics relevant to the patient's hospitalization. We compared the characteristics of people experiencing homelessness with those of people who were housed, and their substance-related poisoning hospitalizations, using chi-square, t tests and Fisher exact test. Results: There was a higher proportion of males, younger individuals and people with recorded mental disorders among people experiencing homelessness hospitalized for a substance-related poisoning than among their housed counterparts. Substance-related poisonings among people experiencing homelessness were more likely to be accidental, involve opioids and stimulants (most frequently fentanyl and its analogues and heroin), result in lengthier hospitalizations and end with leaving the hospital against medical advice. Conclusion: These findings can be used to strengthen strategies and interventions to reduce substance-related harms in priority populations, particularly those experiencing homelessness. [ABSTRACT FROM AUTHOR]

Copyright of Odeere is the property of Edicoes UESB 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 study examined how the state of homelessness can influence the perception and willingness of the homeless population to participate in the 2023 housing and population census in Nigeria. The research adopted an exploratory case study drawn from field experiences. The accidental sampling technique was employed in selecting eight homeless persons in the Ajegunle locality in Lagos. Observational notes and interview data were collected and analyzed thematically. The findings showed that most participants were of the Hausa–Fulani ethnicity and were engaged in menial jobs for survival. Having participated in previous censuses, people who are homeless persons perceived the exercise as influenced by political issues and less essential to their well-being and state of homelessness. The study showed that the failed expectations from the previous census deterred the homeless persons from continued participation in the exercise. In conclusion, the study suggests the need for government to ensure the translation of census data into development to boost public confidence in census participation and outcome. [ABSTRACT FROM AUTHOR]

This scoping review investigates the characteristics included in the Behavioural Model for Vulnerable Populations applied to people experiencing homelessness. This review underpins the development of a novel tool to assess the health needs and capacity of people experiencing homelessness to access health care in Australia. Included papers were primary studies, written in English, published from 2000 onwards, participants aged 18 years and over and experiencing homelessness. Databases searched were CINAHL, MEDLINE, Embase, Scopus, Web of Science, and PubMed, between March to June 2020. The Joanna Briggs Appraisal criteria were used to quality appraise included studies. Fifteen papers met the eligibility criteria and were included. The total participant sample size was 42,152. Provision of professional support and case management were significant factors in increasing access to care for people experiencing homelessness. Findings suggest that the Behavioural Model for Vulnerable Populations is a valuable tool in identifying health needs and predicting health service use. Included studies indicate that using the Behavioural Model for Vulnerable Populations can facilitate provision of targeted health services to people experiencing homelessness by identifying unmet needs. The findings of this review are valuable to health service design and policy, to increase access to care for people experiencing homelessness. [ABSTRACT FROM AUTHOR]

The current study explores perceived difficulty accessing transportation among persons experiencing homelessness in two communities, one with and one without a public bus system. Researchers administered a survey (N = 164) containing nine items measured on a 5-point Likert scale; higher scores indicated greater difficulty with transportation access. The scale, with the omission of one item, was found to demonstrate adequate validity and reliability in this sample. In addition, a higher percentage of participants reported finding it difficult or very difficult to cover the cost of transportation, get places quickly, find transportation, and find transportation at night and on the weekends. Residents in the community lacking public transit scored statistically significantly higher difficulties than the community with public transit. Findings can inform federal and state spending focused on transportation equity and disadvantaged communities. [ABSTRACT FROM AUTHOR]

Using linked data from emergency shelters and a dental program in Canada, we sought to determine whether dental care is associated with fewer emergency shelter stays in this retrospective cohort study. We can observe when an individual accessed free dental care and how emergency shelter use changed over four years of follow-up, matching participants to comparable controls. We estimate difference-in-differences effects for each year since receipt of dental care. We estimate models for the typical user (M-estimation) and the average user (OLS regression). We found that in years 2, 3, and 4 after care, the typical user experienced a net result of fewer shelter stays than controls. The estimated average user stayed more nights in shelter than controls over the four years after dental care, likely driven by outliers that used substantially more shelter stays than the typical user. These results are consistent with the idea that participants benefit in the long-term from dental care received while at an emergency shelter after an initial stabilization period. That is likely due to both the permanent nature of the intervention and the lack of access to publicly-funded dental care in Canada. [ABSTRACT FROM AUTHOR]

A sample of 202 Portuguese homeless male adults aged 22–64 was presented with 50 questions referring to reasons that could deter them from entering or re-entering the labor market. Through factor analysis, four factors were found: Unattractive Working Conditions (e.g. Companies offer jobs that are not interesting), Adhesion to Homelessness Culture (e.g. I have no reason to try to please anybody), Lack of Self-Confidence (e.g. I don't believe in myself), and Habituation to Shelter (e.g. I can have everything I need from this institution). For 39%, mainly those participants who have experienced substance abuse problems, bad health, and conflict with the family in the past, working conditions were perceived as a strong barrier. For 27%, mainly people with a lower educational level, homeless culture was viewed as a strong barrier. Finally, for 21% and 6% respectively, perceived personal weaknesses, and habituation to current life in shelter home were additional barriers. [ABSTRACT FROM AUTHOR]

Homelessness is a major threat to overall wellbeing. Individuals and families experiencing homelessness have higher rates of chronic and infectious diseases than the general population, including most mental illnesses. They also tend to have much lower levels of hope than the general population. While working to obtain stable housing, people experiencing homelessness can benefit from psychosocial support strategies. Strategies to leverage positive psychological factors, such as hope, satisfaction with life, and perceived standing in society, are associated with improved health status and other wellbeing indicators in vulnerable populations. The primary objective of this exploratory study was to determine if a brief, open, small-group intervention at a homeless daytime drop-in center could increase levels of hope, satisfaction with life, and perceived standing in society. This intervention did not produce significant changes in dispositional hope, satisfaction with life, or perceived standing in society. The principal findings of this exploratory study signal a possible need for more thorough and long-term efforts in populations experiencing homelessness. [ABSTRACT FROM AUTHOR]

Many homeless persons experience poverty, social marginalization, poor physical and mental health, and substance abuse disorders, which were all brought into sharp focus during the COVID-19 pandemic. Hence, the study explored the experiences of homeless persons at homeless shelters in Tshwane, South Africa during the period from 20 March to 25 April 2020 when the country was in hard lockdown. Guided by a qualitative case study research design, face-to-face interviews were conducted with nine homeless people. In terms of results, the main reasons for becoming homeless were drug problems and stealing; and domestic challenges and conflicts. Benefits from temporary accommodation at one or more shelters during the pandemic included the themes of safety, comfort and provision of basic needs; the opportunity to come off drugs and learn new skills; and assistance with family re-unifications. Challenges included difficulty complying with COVID-19 regulations under overcrowded conditions and living under stringent rules; violence; resentment at being treated like children; and issues around dietary needs, late delivery of food and leaking tents. Findings highlight the need for a review of the Tshwane homeless policy, integration of services and contingency plans for future national crises. [ABSTRACT FROM AUTHOR]

Studies in Europe and North America have shown that the mental health of individuals experiencing homelessness (IEHs) is worse than that of the general population. The objective of this study was to analyze the mental health of IEHs in Spain. A retrospective cohort study (observational study) of the health of 3,854 IEHs was conducted, according to age and gender, using diagnoses registered in the health service, over the 15 years between 2006 and 2020. Of this population, 31.6% were diagnosed with some sort of substance use disorder (SUD), mainly alcohol-related (18.1%), 20.1% had a mental disorder not related to drugs, and 11.5% had a dual disorder. Younger people had more mental health problems. This study—the first large study of IEHs in Spain—highlights significant differences in mental health and addictions according to gender and age. In general, Spanish IEHs have better mental health for all of the analyzed diagnostics than other populations internationally. [ABSTRACT FROM AUTHOR]

Individuals experiencing homelessness have a range of unmet needs during homelessness. Less is known about how these daily living needs evolve in the transition to housing and how existing services are supporting individuals to meet these needs. Using the capabilities approach, we conducted a cross-sectional qualitative study with two participant groups (unhoused; housed between 1 and 24 months). Using thematic analysis, we generated five meta-themes to describe the experiences and compare these two groups: (1) Managing mental health and substance use; (2) Creating connection and community; (3) Involvement in something meaningful; (4) Emotional adaptation to impoverished living conditions; and (5) The helping relationship as foundation. Our findings indicate that for individuals to thrive following homelessness, researchers, service providers, and policymakers need to design and implement strategies that target outcomes beyond tenancy sustainment. These key strategies include: (1) facilitating access to resources that enable thriving following homelessness; (2) developing measures that orient programs and policies to target thriving rather than sustaining a tenancy; and (3) including persons with lived experiences of homelessness in the design and delivery of services and in the evaluation of new and existing programs. [ABSTRACT FROM AUTHOR]

Data on COVID-19 among people experiencing homelessness has been extremely limited, despite known unique risks faced by this population. Gaps in data collection, monitoring, and reporting across multiple systems and government levels create challenges to understanding how COVID-19 is impacting people experiencing homelessness. This article examines these challenges and gaps in public health data on homelessness, presents examples of best practices, and offers policy recommendations for data collection, sharing, and dissemination of pandemic-related health metrics by homelessness status. [ABSTRACT FROM AUTHOR]

Protracted homelessness creates a biopsychosocial circumstance for poor health outcomes, including a worsening cognitive profile with an increased risk for dementia. Dementia is a global public health concern, and it is reported that up to 40% of all dementia may be attributed to potentially modifiable lifestyle risk factors. Whilst Alzheimer's disease, vascular dementia, and frontotemporal dementia remain the most common types of dementia overall, the experience of homelessness may directly influence other dementias, including alcohol dementia and HIV-associated dementia to be more frequently seen. We searched five databases (CINAHL, PsycINFO, Informit, Web of Science, and PubMed) and followed scoping review methodology to identify studies exploring potentially modifiable risk factors for dementia in people experiencing homelessness. After excluding prevalence studies, reviews and articles that were not original research, we identified a total of seven studies. We included studies reporting on risk factors for cognitive impairment, itself being a risk factor for dementia. Our results show a paucity of literature examining how the experience of homelessness influences the risk for developing dementia. This contributes to a lack of understanding how potentially modifiable risk factors for dementia may, or may not, differ between people experiencing homelessness and the stably domiciled populations. [ABSTRACT FROM AUTHOR]

Copyright of Wirtschafts- und Sozialwissenschaftliches Institut Mitteilungen is the property of Nomos Verlagsgesellschaft mbH & Co. KG 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.)

Background: This paper describes the protocols for a randomized controlled trial using a parallel-group trial design that includes an intervention designed to address social isolation and loneliness among people experiencing homelessness known as Miracle Friends and an intervention that combines Miracles Friends with an economic poverty-reduction intervention known as Miracle Money. Miracle Friends pairs an unhoused person with a volunteer "phone buddy." Miracle Money provides guaranteed basic income of $750 per month for 1 year to Miracle Friends participants. The study will examine whether either intervention reduces social isolation or homelessness compared to a waitlist control group. Methods: Unhoused individuals who expressed interest in the Miracle Friends program were randomized to either receive the intervention or be placed on a waitlist for Miracle Friends. Among those randomized to receive the Miracle Friends intervention, randomization also determined whether they would be offered Miracle Money. The possibility of receiving basic income was only disclosed to study participants if they were randomly selected and participated in the Miracle Friends program. All study participants, regardless of assignment, were surveyed every 3 months for 15 months. Results: Of 760 unhoused individuals enrolled in the study, 256 were randomized to receive Miracle Friends, 267 were randomized to receive Miracle Money, and 237 were randomized to the waitlist control group. In the two intervention groups, 360 of 523 unhoused individuals were initially matched to a phone buddy. Of the 191 study participants in the Miracle Money group who had been initially matched to a volunteer phone buddy, 103 were deemed to be participating in the program and began receiving monthly income. Discussion: This randomized controlled trial will determine whether innovative interventions involving volunteer phone support and basic income reduce social isolation and improve housing outcomes for people experiencing homelessness. Although we enrolled unhoused individuals who initially expressed interest in the Miracle Friends program, the study team could not reach approximately 30% of individuals referred to the study. This may reflect the general lack of stability in the lives of people who are unhoused or limitations in the appeal of such a program to some portion of the unhoused population. Trial registration: ClinicalTrials.gov NCT05408884 (first submitted on May 26, 2022). [ABSTRACT FROM AUTHOR]

Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1. Who needs to do what differently? 2. What are the barriers and enablers that need to be addressed? 3. Which intervention components could overcome the modifiable barriers and enhance the enablers? 4. How can the changes be measured? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1st June 2019 and 31st December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness are at increased risk of violence and abuse, however, there is insufficient knowledge about rates of inquiry or readiness of healthcare professionals to address violence and abuse among this population. This study aimed to explore healthcare professionals' experiences and perceptions of asking about violence and abuse among patients experiencing homelessness. Methods: This study used a qualitative, interpretive, and exploratory design. We performed focus group discussions with healthcare professionals (n = 22) working at an integrative healthcare unit for people experiencing homelessness. Data were analysed using reflexive thematic analysis, following Braun and Clarke's six-phase approach. Findings are reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: The overarching theme of the analysis is that addressing violence and abuse is at risk of "falling through the cracks". The theme is supported by three sub-themes: Hesitance to address violence and abuse, The complex dynamics of violence and abuse in homelessness, and Challenges in addressing violence and abuse amidst competing priorities and collaborative efforts. The normalisation of violence and abuse within the context of homelessness perpetuates a "cycle" where the severity and urgency of addressing violence and abuse are overlooked or minimised, hindering effective interventions. Moreover, healthcare professionals themselves may inadvertently contribute to this normalisation. The hesitance expressed by healthcare professionals in addressing the issue further reinforces the prevailing belief that violence and abuse are inherent aspects of homelessness. This normalisation within the healthcare system adds another layer of complexity to addressing these issues effectively. Conclusions: The findings underscore the need for targeted interventions and coordinated efforts that not only address the immediate physical needs of people experiencing homelessness but also challenge and reshape the normalised perceptions surrounding violence and abuse. By prioritising awareness, education, and supportive interventions, we can begin to "break the cycle" and provide a safer environment where violence and abuse are not accepted or overlooked. [ABSTRACT FROM AUTHOR]

Background: Homelessness is associated with significant health disparities. Conventional health services often fail to address the unique needs and lived experience of homeless individuals and fail to include participatory design when planning health services. This scoping review aimed to examine areas of patient experience that are most frequently reported by people experiencing homelessness when seeking and receiving healthcare, and to identify existing surveys used to measure patient experience for this cohort. Methods: A scoping review was undertaken reported according to the PRISMA-ScR 2020 Statement. Databases were searched on 1 December 2022: MEDLINE, EMBASE, APA PsychINFO and CINAHL. Included studies focused on people experiencing homelessness, healthcare services and patient experience, primary research, published in English from 2010. Qualitative papers and findings were extracted and synthesized against a modified framework based on the National Institute for Health and Care Excellence guidelines for care for people experiencing homelessness, the Institute of Medicine Framework and Lachman's multidimensional quality model. People with lived experience of homelessness were employed as part of the research team. Results: Thirty-two studies were included. Of these, 22 were qualitative, seven quantitative and three mixed methods, from the United States of America (n = 17), United Kingdom (n = 5), Australia (n = 5) and Canada (n = 4). Health services ranged from primary healthcare to outpatient management, acute care, emergency care and hospital based healthcare. In qualitative papers, the domains of 'accessible and timely', 'person-centred', and values of 'dignity and respect' and 'kindness with compassion' were most prevalent. Among the three patient experience surveys identified, 'accessible and timely' and 'person-centred' were the most frequent domains. The least frequently highlighted domains and values were 'equitable' and 'holistic'. No questions addressed the 'safety' domain. Conclusions: The Primary Care Quality-Homeless questionnaire best reflected the priorities for healthcare provision that were highlighted in the qualitative studies of people experiencing homelessness. The most frequently cited domains and values that people experiencing homelessness expressed as important when seeking healthcare were reflected in each of the three survey tools to varying degrees. Findings suggest that the principles of 'Kindness and compassion' require further emphasis when seeking feedback on healthcare experiences and the domains of 'safety', 'equitable', and 'efficiency' are not adequately represented in existing patient experience surveys. [ABSTRACT FROM AUTHOR]

Background: Holistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting social cohesion). In a deprived neighbourhood in Utrecht, the Netherlands, this paper examined residents' and professionals' experiences, ideas, and perceptions regarding holistic housing renovation, its health effects, and underlying mechanisms explaining those effects. Methods: Semi-structured in-depth interviews were conducted with 21 social housing residents exposed to holistic housing renovation, and 12 professionals involved in either the physical renovation or social interventions implemented. Residents were interviewed in various renovation stages (before, during, after renovation). Transcripts were deductively and inductively coded using qualitative software. Results: Residents experienced and professionals acknowledged renovation stress caused by nuisance from construction work (noise, dust), having to move stuff around, and temporary moving; lack of information and control; and perceived violation of privacy. Involvement in design choices was appreciated, and mental health improvement was expected on the long term due to improved housing quality and visual amenity benefits. Social contact between residents increased as the renovation became topic for small talk. Few comments were made regarding physical health effects. The interviews revealed a certain amount of distrust in and dissatisfaction with the housing corporation, construction company, and other authorities. Conclusions: Renovation stress, aggravated by lack of information and poor accessibility of housing corporation and construction company, negatively affects mental health and sense of control. Potential stress relievers are practical help with packing and moving furniture, and increased predictability by good and targeted communication. Social interventions can best be offered after renovation, when residents live in their renovated apartment and the nuisance and stress from the renovation is behind them. Social partners can use the period leading up to the renovation to show their faces, offer practical help to reduce renovation stress, and increase residents' trust in their organization and authorities in general. This might also contribute to residents' willingness to accept help with problems in the social domain after renovation. [ABSTRACT FROM AUTHOR]

People who are homeless are at increased risk of COVID-19 infection, and of poorer associated outcomes. Delivering vaccinations to, and ensuring uptake of multiple doses in, people who are homeless is complex. Financial incentives may improve vaccination uptake, particularly in people who have not received routine vaccinations previously, though evidence about the effect of incentives is limited and variable. This randomized controlled trial (ANZCTR 383156) assessed the effect of a financial incentive (an A$10 grocery voucher) on uptake of the second COVID-19 vaccination in Australian adults who were homeless, and who had received their first dose. Participants were recruited through a vaccination program for people experiencing homelessness between September 2021 and January 2022. They were followed-up for a minimum of 6.5 months. Uptake was measured 'on-time' at 6 weeks, and at any time during the trial period. Vaccination status was checked on the Australian Immunisation Register. Demographic and vaccination program characteristics associated with uptake were also investigated. Eighty-six people consented to participate, and 43 were randomly allocated to each of the 'incentive' and 'no incentive' groups. The incentive slightly increased the likelihood of a participant receiving a second vaccination on-time (risk difference (RD), 11.6 % [95 %CI, −9.0, 32.2 %]; p = 0.27), and at any time during the trial (RD, 14.0 % [95 %CI, –2.2, 30.1 %], p = 0.09). The incentive had a significant positive effect on uptake in people with no previous vaccination history, increasing their likelihood of receiving a second vaccination on-time (RD, 42.3 % [95 %CI, 15.7, 68.8 %]; p = 0.002) and at any time during the trial (RD, 38.7 % [95 %CI, 16.1, 61.3 %], p < 0.001). Financial incentives may increase COVID-19 vaccination uptake in people who are homeless, and particularly those who have no previous vaccination history. Future research should consider alternative incentive values, types, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to utilize the data generated by the City of Toronto, Street Needs Assessment conducted in 2021 to explore the prevalence, causes, experiences, and characteristics of 2-spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) individuals experiencing homelessness in Toronto, Ontario, Canada. Methods: Data was collected by the City of Toronto during its Street Needs Assessment in April 2021. The Street Needs Assessment is a needs assessment survey and Point-in-Time count of people experiencing homelessness across the city of Toronto. Homelessness included any individual who was sleeping outdoors or staying in City-administered emergency/transitional shelters and shelter motels/hotels on the night of data collection. The Street Needs Assessment survey was administered to clients by trained shelter and outreach staff using a computer or mobile device. To ensure that survey questions were 2SLGBTQ+ inclusive, questions on sexual orientation, gender identity, and 2SLGBTQ+ identity were included in the survey. Results: Two hundred and eighty-eight 2SLGBTQ+ individuals completed the survey. Compared to non-2SLGBTQ+ individuals experiencing homelessness, 2SLGBTQ+ respondents were younger at the time of survey completion and when they first experienced homelessness, were more likely to have been in foster care or a group home, reported higher rates of conflict with and/or abuse by a parent/guardian as their main pathway into homelessness, and were more likely to experience chronic homelessness. Conclusion: Our study results demonstrate that Street Needs Assessments and Point-in-Time counts can be used to examine homelessness in marginalized populations, including 2SLGBTQ+ individuals and that sexual orientation and gender identity questions need to be included on future government surveys. The consistency of findings from this study and previous research suggests that 2SLGBTQ+ individuals experience a significant need for population-based housing and social support services aimed at meeting the needs of 2SLGBTQ+ populations. [ABSTRACT FROM AUTHOR]

In the last decades, there have been significant changes in the understanding of homelessness. The "new orthodoxy" in the late 20th century led to a reformulation of the concept of homelessness with changes in approaches for addressing the problem, emphasizing unconditional intervention in regular housing. Thirty years later, the limits of the new orthodoxy seem to be marked by a lack of recognition of the individual agency and the potential identification of internally homogeneous subgroups within homelessness. Focusing on the individual agency, this study presents the results of 120 surveys and 5 semi-structured interviews conducted with individuals experiencing homelessness regarding their residential preferences in homeless response services. The study aims to understand the preferences and expectations in residential modalities (shelters, individual housing, and shared housing) used by support services for homeless people, as well as the identification of population characteristics that may influence preferences for one type of resource over another. It is concluded that, although individual housing is the most valued resource, certain personal characteristics and circumstances seem to constrain the choice of shelters and shared housing in some cases. This opens the possibility for specialized responses to homelessness tailored to internally homogeneous groups. [ABSTRACT FROM AUTHOR]

In the United States and worldwide, food insecurity continues to plague underserved communities. At-risk populations experiencing other barriers to health, such as homelessness and poverty, will further suffer from food insecurity to a greater degree. Locally, public housing facilities can be improved by implementing community gardens. This will not only address food insecurity but also provide health benefits that can uniquely benefit the older adult and disabled population. Benefits include improvements in physical mobility, decreasing fall risk, and preventing vitamin D deficiency. Cruciferous vegetables grown in gardens can support the gastrointestinal system's microbiome, improving cardiovascular function. Because food insecurity is linked to depression, improving mental health through gardening can notably benefit vulnerable populations. Growing food together as a community will also reduce stress levels, increase social connectedness, and improve individual-level psychosocial outcomes. By directing efforts against food insecurity, community members can receive the vital aid needed to protect their right to health. [ABSTRACT FROM AUTHOR]

Purpose: Housing First (HF) is an evidence-based practice effective in reducing homelessness among those who experience chronic homelessness. However, a strong synthesis evaluating the effectiveness of this intervention is lacking for people who use drugs. The purpose of this study is to explore international literature databases to identify the effectiveness of the HF programme among people who use drugs. Design/methodology/approach: A modified framework from Arksey and O'Malley (2005) was used, namely: identifying the research question; developing inclusion and exclusion criteria; identifying relevant studies for study selection; charting the data; and collating, summarising and reporting the results. Findings: Three main themes were identified: substance use related outcomes, housing-related outcomes and social outcomes. There is strong evidence that HF increases housing retention and reduces homelessness among chronically homeless people who use drugs. However, literature relating to substance use and social outcomes for this population report mixed and inconclusive findings. Research limitations/implications: This scoping review concludes that additional research is required to conclusively determine whether HF is an effective intervention for homeless substance users. Future researchers must use formal assessments of substance use and ensure clear reporting of the HF intervention is accomplished. It is recommended for researchers and policymakers to consider the specific needs of the people who use drugs before implementation of HF for this population. Practical implications: Differential effectiveness of HF through diagnostic subgroups such as alcohol use and drug use is varied with alcohol use being found to decrease due to the HF programme, but findings relating to other drug use outcomes are varied. As most previous studies used the Addiction Severity Index (ASI) to measure substance use among participants, however, the ASI, a self-reporting measure has unstable criterion validity and can cause under or over reporting of substance use. Structured toxicology or diagnostic assessments of substance use must be used for research instead to assist researchers in making firm conclusions about the reported rates. Social implications: The slightly poorer housing outcomes among people who use substances indicate that this group may need more intensive approaches to finding and maintaining housing. Additional services for the group that address comorbid problems and consequences relating to substance use are required. It is suggested that housing should be provided within an integrated model that offers additional support services such as case management as when well matched to clients, case management appears to be an effective intervention among homeless sub-populations, as it reduces substance use, improves quality of life and health outcomes, improves social connectedness and increases housing tenure and satisfaction. Originality/value: This scoping review concludes that additional research is required to conclusively determine whether HF is an effective intervention for homeless substance users. Future researchers must use formal assessments of substance use and ensure clear reporting of the HF intervention is accomplished. It is recommended for researchers and policymakers to consider the specific needs of the people who use drugs before HF implementation for this population. [ABSTRACT FROM AUTHOR]

Homelessness is both a significant determinant and consequence of health and social inequalities. To better meet healthcare needs, dedicated mental health and general nurses were implemented to deliver outreach healthcare to people experiencing homelessness in one United Kingdom (UK) county. During COVID-19, the UK Government also instructed local authorities to accommodate individuals sleeping rough and have a national target to end rough sleeping. This qualitative study explored experiences of this nurse-let outreach service and housing journeys during and beyond COVID-19 among people experiencing homelessness. Face-to-face, narrative storytelling interviews were conducted via opportunistic sampling in community settings. Individuals with recent or current experiences of homelessness were eligible. Participants were informed about the study via known professionals and introduced to the researcher. Eighteen narrative interviews were conducted, transcribed, and analysed using reflective thematic analysis. Individuals described complex journeys in becoming and being homeless. The nurse-led outreach service provided integral support, with reported benefits to person-centred and accessible care and improved outcomes in health and well-being. After being housed, individuals valued housing necessities and described new responsibilities. However, some participants did not accept or stay in housing provisions where they perceived risks. Interviewed participants perceived that the dedicated nurse-led outreach service improved their access to care and health outcomes. In the absence of dedicated provisions, mainstream healthcare should ensure flexible processes and collaborative professional working. Local authorities must also be afforded increased resources for housing, as well as integrated support, to reduce social and health inequalities. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic disproportionately impacted marginalized populations including Black Americans, people with serious mental illness, and individuals experiencing homelessness. Although the double disadvantage hypothesis would suggest that individuals with multiple minoritized statuses would experience worse psychosocial impacts from the pandemic, this may not be the case for vulnerable Black Veterans. The present study investigated the sustained mental health and functional responses to the pandemic in Black and White Veterans with psychosis or recent homelessness and in a control group of Veterans enrolled in the Department of Veterans Affairs healthcare services. Clinical interviews and questionnaires were administered remotely by telephone at five time points from May 2020 through July 2021, including a retrospective time point for March 2020 (i.e., before the pandemic started). Overall, there was a striking absence of systematic differences by race in the trajectories of psychiatric symptoms and functioning among Veterans during the study period. These findings are consistent with a report on initial responses to the pandemic that revealed only a few select differences by race among Veteran groups. The lack of racial disparities is inconsistent with the double disadvantage hypothesis. Although further investigation is needed, one possible interpretation is that the wrap-around services offered by the Veterans Health Administration may have mitigated expected differences by race among Veterans with psychosis or homelessness. Future research should continue to examine whether VA services mitigate disparities in mental health and psychosocial outcomes. [ABSTRACT FROM AUTHOR]

Despite the prevalence of animal companions in the lives of homeless individuals and the established benefits and complications offered by animals during serious illness and end-of-life (EOL), little is known about the experiences of homeless people who have animal companions and chronic illness. Two subsamples from a larger study – longitudinal medical documentation of homeless palliative-care patients who discussed animal companionship during their care (n = 11) and interviews with cross-sector service providers (n = 3) who spoke to the role of animals in care – were analyzed using an interpretive description approach. Results showcased three major themes: (1) healing benefits to animal companionship during concurrent homelessness and serious illness; (2) choosing animal companionship over formal housing and health services; (3) when animal companionship's consequences outweigh the benefits. These findings provide practical implications for clinical assessment, programing, and service expansion for persons with animal companions and future translational science to benefit animal companion owners experiencing serious illnesses while homeless. [ABSTRACT FROM AUTHOR]

Access to safe and stable housing has both a direct and indirect effect on health. Homeless persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfil one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of homeless populations. Access to safe and stable housing has both a direct and indirect effect on health. Experiencing homelessness and housing instability can induce stress and trauma, worsening behavioral health and substance use. The absence of safe and stable living conditions can make it challenging to rest, recuperate, and recover from health ailments and can pose barriers to treatment adherence. Homelessness and housing instability is associated with high rates of numerous diseases and chronic conditions. Its cyclical relationship with other social drivers of health can exacerbate health disparities. As a result, unhoused persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. Physicians and other health professionals have a role in educating themselves about the needs of unhoused patients as well as making themselves aware of community and government resources available to these populations. Policymakers must support health professionals in these efforts by supporting the data infrastructure needed to facilitate these referrals to resources, supporting research into best practices for caring for these populations, and investing in community-based organization capacity. Policy action is needed to address the underlying drivers of homelessness, including a dearth of affordable housing, while also addressing the short-term need for safe shelter now. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfill one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of unhoused populations. [ABSTRACT FROM AUTHOR]

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IX: people and places--diverse populations and locations of care', authors address the following themes: 'LGBTQIA+health in family medicine', 'A family medicine approach to substance use disorders', 'Shameless medicine for people experiencing homelessness', "'Difficult" encounters--finding the person behind the patient', 'Attending to patients with medically unexplained symptoms', 'Making house calls and home visits', 'Family physicians in the procedure room', 'Robust rural family medicine' and 'Full-spectrum family medicine'. May readers appreciate the breadth of family medicine in these essays. [ABSTRACT FROM AUTHOR]

Understanding of how time is experienced is essential when conducting qualitative research. This article explores how time seemingly stands still, speeds up, slows down, rewinds and fast-forwards for the participants in our qualitative investigations. Drawing upon interview data with street homeless people in Moscow, Russia, this article examines the ways in which time is contextualized and used by research participants to make sense of their everyday experiences and important events in their lives. There is a tendency to understand time by measuring it, rather than seeing it as something within which lived experience happens and qualitative research is carried out. Drawing on Bergson's conception of time as duration, this article examines the ways in which time can be distinctively used and understood within qualitative research. [ABSTRACT FROM AUTHOR]

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Health care for the homeless population is a complex challenge and represents a significant gap in care, particularly for those at the end of life. Hospice care may be desired but is rarely an option for people without residences, social support, and payment sources. Social model hospice is a unique paradigm of care delivery that offers a viable solution to make hospice and palliative care possible for this population. In this historical report from interviews with early organizers, prior and current leadership (n = 6), the evolution of The INN Between in Salt Lake City, Utah, is described. In 2010, The INN Between was conceptualized as a nonprofit community effort addressing this need to provide an alternative to people dying unsheltered. After 5 years of planning, it opened in 2015 and has grown to become a comprehensive community resource for homeless medically frail and terminally ill individuals. Recommendations for establishing social model hospices are made: key strategies include identifying stakeholders dedicated to alleviating end-of-life homelessness needs, doing a formal needs assessment to identify community resource deficits, and forming mentoring relationships with established programs. Social model hospice is a viable way of meeting the end-of-life needs of many communities' most vulnerable residents. [ABSTRACT FROM AUTHOR]

Background and objective Although digital health promises improved healthcare efficiency and equity, access and uptake might be low in disadvantaged populations. We measured access to digital health technology, the uptake of digital health, digital health literacy and COVID-19 vaccination intentions in an inner-city Australian population experiencing homelessness. Methods An existing Australian survey, including a validated digital health literacy measure (eHealth Literacy Scale [eHEALS]), was modified and distributed in three general practices specifically targeting the homeless population. Data analysis used appropriate descriptive statistics and correlation coefficients. Results Eighty-three respondents completed the survey in 2021. Digital health uptake was much lower than in the general Australian population in 2019-20, despite good access to working smart phones and connectivity. Digital health literacy was positively associated with uptake. Internet-sourced information was trusted less than information from a general practitioner. Discussion Further work is needed to understand the perceived usefulness and sociocultural compatibility of digital health in different subpopulations experiencing homelessness, including susceptibility to misinformation. [ABSTRACT FROM AUTHOR]

The article discusses the intersection of homelessness and criminalization, exploring the systemic failures perpetuated by carceral systems rooted in colonialism, capitalism, and white supremacy. Topics discussed include the disproportionate punishment and surveillance experienced by marginalized individuals, the inadequacy of existing social services, and the importance of community support in dismantling oppressive systems and envisioning more just futures.

An introduction is presented in which the editor discusses articles in the issue on topics including the intersection of homelessness and incarceration, criminalization tactics, and carceral violence.

The COVID-19 pandemic's impact on older adults (55+) living at the mid-point of the shelter-care continuum, in seniors housing (SH) and assisted living (AL), remains largely unexplored. This study compares survey responses of SH and AL residents with those of age peers living in private conventional community-based dwellings (CD) in British Columbia, Canada. Despite more SH/AL residents reporting feelings of isolation and changes to social support access, the pandemic appears to have had a greater negative impact on the routines of CD older adults. AL residents were more likely to engage in advance care planning discussions before and since the COVID-19 outbreak. These data are important for improving response to current and future disasters across the shelter-care continuum, particularly in ways to reduce the psychosocial effects of isolation or routine disruption, and strategies to increase advance care planning engagement. [ABSTRACT FROM AUTHOR]

Preventing people from experiencing homelessness is a complex task requiring the coordination of multiple actors. There are various frameworks for homelessness prevention; however, there is no published example of an Indigenous-led model. We present the Giiwe model for systems homelessness prevention led by M’Wikwedong Indigenous Friendship Centre in Owen Sound, Canada. Giiwe hosted regular in-person meetings that use ceremony, Indigenous Knowledges, discussion, and follow-up actions to increase service access among a network of over 20 organizations. Building on Giiwe’s experience, we discuss how Western and Indigenous worldviews impact inter-organizational collaboration. Giiwe’s success suggests funding and policy contexts mandating partnerships between Indigenous and non- Indigenous organizations could benefit from ceding space for initiatives affirming Indigenous collaboration approaches. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: to understand nurse perspectives regarding homeless pregnant women’s accessibility to prenatal care. Methods: a qualitative study, with analysis based on the concept of accessibility. Semi-structured interviews were carried out with 11 nurses who work at the Street Outreach Office in northern Brazil. Results: nurses are faced with geographic barriers and dangerous situations in border regions, recognizing that there is a context of physical, sexual and psychological violence that involves homeless pregnant women who seek care at the Street Outreach Office. Street Outreach Office nurses’ work occurs in conjunction with other services in the Health Care Network. The implementation of educational measures is a powerful strategy, as is establishing links with women. Final Considerations: the Street Outreach Office’s work provides meetings with pregnant women on site in the territory, which can provide geographic and socio-organizational accessibility to prenatal care.

BackgroundHomeless street sweeps are frequent operations in many cities in the USA in which government agencies move unhoused people living in public outdoor areas. Little research exists on the health impact of street sweeps operations.ObjectiveThis study was created at the request of community advocacy groups to investigate and document the health impacts of street sweeps from the perspective of healthcare providers.DesignThis is a qualitative study using data gathered from open-ended questions.ParticipantsWe recruited 39 healthcare providers who provided health and wellness services in San Francisco for people experiencing homelessness (PEH) between January 2018 and January 2020.InterventionsWe administered a qualitative, open-ended questionnaire to healthcare providers using Qualtrics surveying their perspectives on the health impact of street sweeps.ApproachWe conducted qualitative thematic analysis on questionnaire results.Key resultsStreet sweeps may negatively impact health through two outcomes. The first outcome is material loss, including belongings and medical items. The second outcome is instability, including geographic displacement, community fragmentation, and loss to follow-up. These outcomes may contribute to less effective management of chronic health conditions, infectious diseases, and substance use disorders, and may increase physical injuries and worsen mental health. Providers also reported that sweeps may negatively impact the healthcare system by promoting increased usage of emergency departments and inpatient hospital care.ConclusionsSweeps may have several negative consequences for the physical and mental health of the PEH community and for the healthcare system.