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This research explores the incidence of child maltreatment among homeless families. The maltreatment explored in the study includes physical, emotional and sexual abuse. The data reported a high incidence of child maltreatment in the lives of the homeless. The policy implications for these findings are discussed.

BACKGROUND: Social integration (i.e., reciprocal interactions with peers and community members) is a notable challenge for many homeless-experienced adults with serious mental illness (SMI). In this study, we examine a range of housing services offered to homeless-experienced adults with SMI and identify the impacts of supportive services on participants social integration outcomes, with the goal of improving services in transitional and permanent housing settings for homeless-experienced adults with SMI. METHODS: Through semi-structured interviews with homeless-experienced adults with SMI (n = 30), we examine the impacts of housing and service settings on participants social integration. Participants received services in a variety of housing settings, including transitional housing with congregate/shared living (n = 10), transitional housing with individual quarters (n = 10), and permanent supportive housing (n = 10). RESULTS: Participants expressed caution in developing social relationships, as these could pose barriers to recovery goals (e.g., substance use recovery). For many, social integration was secondary to mental and physical health and/or housing stability goals. Individual quarters gave individuals a place of respite and a sense of control regarding when and with whom they socialized. Meeting recovery goals was strongly related to connecting to and receiving a range of supportive services; interviews suggest that proximity to services was critical for engagement in these resources. CONCLUSIONS: Programs serving homeless experienced adults with SMI should seek to understand how individuals conceptualize social integration, and how social relationships can either support or hinder participants recovery journey.

There are two dominant approaches to implementing permanent supportive housing (PSH), namely place-based (PB) and scattered-site (SS). Formal guidance does not distinguish between these two models and only specifies that PSH should be reserved for those who are most vulnerable with complex health needs. To consider both system- and self-selection factors that may affect housing assignment, this study applied the Gelberg-Anderson behavioral model for vulnerable populations to compare predisposing, enabling, and need factors among people experiencing homelessness (PE) by whether they were assigned to PB-PSH (n = 272) or SS-PSH (n = 185) in Los Angeles County during the COVID-19 pandemic. This exploratory, observational study also included those who were approved but did not receive PSH (n = 94). Results show that there are notable differences between (a) those who received PSH versus those who did not, and (b) those in PB-PSH versus SS-PSH. Specifically, PEH who received PSH were more likely to be white, US-born, have any physical health condition, and have lower health activation scores. PEH who received PB- versus SS-PSH were more likely to be older, Black, have any alcohol use disorder, and have higher health activation scores. These findings suggest that homeless service systems may consider PB-PSH more appropriate for PEH with higher needs but also raises important questions about how race may be a factor in the type of PSH that PEH receive and whether PSH is received at all.

More than 500,000 people experience homelessness in the United States, and many turn to transit vehicles, stops, and stations for shelter. We present findings from a survey of 115 U.S. and Canadian transit operators that inquired about homelessness on transit systems. We find that homelessness is broadly present, though more concentrated on central hotspots, and worsened during the pandemic. In response, transit agencies often initiate a combination of punitive and outreach strategies. Based on our findings, we argue for better data collection, establishment of policies and protocols, engagement in outreach strategies, and partnering with service providers.

Although widely acknowledged as an important social determinant of health, until recently researchers and policymakers have primarily approached housing insecurity as an urban issue, obscuring the visibility of its impacts in rural contexts, including the ways in which housing insecurity intersects with other health and structural inequities facing rural populations. Working to address this gap in the existing literature, this paper explores the experiences of housing insecurity in a rural context by reporting on an analysis of 210 in-depth interviews with 153 adults between the ages of 18-35, living in California's rural North State, a relatively overlooked far northern region of the state comprised of 12 north central and north eastern counties. Using in-depth qualitative interview data, we conducted an exploratory pattern-level analysis of participants' narratives structured by four dimensions of housing insecurity defined in the literature (housing affordability, housing stability, housing conditions, and neighborhood context). Drawing attention to the pervasiveness of rural housing insecurity within our sample, this analysis highlights the unique ways in which rurality creates distinct experiences not currently captured in the existing literature. Further research is needed across different types of rural communities to better understand the various ways that housing insecurity affects the everyday lives and health of rural residents. By grounding research within the experiences of rural residents, we are better able to respond to the crisis of rural housing insecurity and develop solutions that are tailored to rural residents' unique needs.

Homelessness is a public health concern in California and throughout the United States. Intimate partner violence (IPV) is a risk factor for experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Qualitative methods can provide a greater understanding of the lived experience of IPV and homelessness to identify potential solutions. We purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. We administered semi-structured interviews focusing on IPV and six other topic areas pertaining to homelessness from October 2021 to May 2022. We created and applied a codebook with a multidisciplinary team using a hybrid of deductive and inductive logic. Our analysis included all participants who discussed IPV and homelessness across the seven studies. We conducted a thematic analysis using an interpretivist approach and informed by grounded theory. We found that violence within a partnership was multidimensional (physical, sexual, emotional, and financial) and bidirectional. We identified six themes: (1) IPV precipitated and prolonged homelessness; (2) Need for housing, financial stability, and material resources influenced staying in abusive relationships; (3) Alcohol and illicit substance use exacerbated violence between partners; (4) Participants struggled to find resources in domestic violence (DV) shelters; (5) The healthcare system did not provide substantial support; and (6) discrimination and stigma influenced equitable access to housing and DV resources. Experiencing IPV contributed to homelessness and impeded returns to housing. Limitations in current IPV resources impede care. We propose equitable expansion of survivor-centered services that improve access to long-term subsidized housing, prevent IPV and homelessness with flexible funding options, and facilitate rapid exits from homelessness through trauma-informed, non-congregate shelter that transitions to permanent housing.

The travel experiences of unhoused women in Los Angeles present a critical yet underexplored aspect of urban mobility and homelessness. This report aims to fill the gap in literature addressing the unique travel patterns and challenges this group faces, emphasizing the need for solutions tailored to their mobility needs. Interviews with unhoused women in Los Angeles were conducted to gauge their travel patterns and primary safety concerns. Interviews took place in Van Nuys and Little Tokyo to reflect the differences in travel experiences between the suburbs and the inner city. Homelessness resources are more concentrated in Central City Los Angeles, where Little Tokyo is located, providing a model for what could be possible in terms of mobility, safety, and access to public transportation. Conversely, in Van Nuys, resources are sparse and spread out, compelling unhoused women to travel greater distances and optimize their travel time by multitasking.Key takeaways include reliance on community networks, increasing preference for biking as an affordable and eco-friendly travel mode, and the use of bikes and fare-free transit for feelings of autonomy and independence. Additionally, despite concerns about safety when alone, unhoused women are still wary of law enforcement, and anti-homeless measures like 41.18 lead to continuous displacements, disrupting daily routines.Findings suggest addressing the fundamental issue of housing, implementing robust data collection, partnering with homelessness advocacy groups, securing funding for essential amenities, and making infrastructural improvements to support the autonomy, mobility, and safety of unhoused women. All in all, a comprehensive approach is necessary to provide effective relief.

California faces a severe housing crisis, characterized by soaring rents, limited affordability, and increasing homelessness. Latinos, in particular, suffer disproportionately from housing insecurity, which is defined as a spectrum of housing precarity – ranging from homelessness to substandard living conditions. This report employs a mixed-methods approach to analyze housing insecurity in California. Its quantitative analysis introduces novel housing insecurity estimates, using data from the California Department of Education and the American Community Survey. Qualitative data from literature reviews and semi-structured interviews provide deeper insights into the factors driving housing insecurity and potential policy solutions.The findings reveal a high prevalence of housing insecurity, especially among Latinos. In 2022, approximately 1.3 million Californians were housing insecure, significantly higher than the 820,961 in doubled-up housing in 2021 and nearly eight times the 171,521 counted as homeless in 2022. Latinos, comprising 39.5% of the state's population, represent 68% of the housing insecure. The majority of housing insecure individuals reside in Southern California, with over 55% concentrated in Los Angeles, Orange, San Bernardino, San Diego, and San Bernardino counties, and Latinos account for 71.8% of this housing insecure population.Ultimately, this analysis underscores the imperative of broadening the conceptualization of homelessness support to encompass a spectrum of services for those experiencing housing insecurity. By adopting the inclusive framework of housing insecurity, policymakers and stakeholders can develop tailored interventions to address some identified causes of housing insecurity, including housing affordability, access to transportation, culturally competent services, and immigration support.

OBJECTIVES: To evaluate the impact of homelessness on surgical outcomes following ankle fracture surgery. DESIGN: Retrospective cohort study. SETTING: Mariner claims database. PATIENTS/PARTICIPANTS: Patients older than 18 years who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2010 and 2021. A total of 345,759 patients were included in the study. INTERVENTION: Study patients were divided into two cohorts (homeless and nonhomeless) based on whether their patient record contained International Classification of Disease (ICD)-9 or ICD-10 codes for homelessness/inadequate housing. MAIN OUTCOME MEASURES: One-year rates of reoperation for amputation, irrigation and debridement, repeat ORIF, repair of nonunion/malunion, and implant removal in isolation. RESULTS: Homeless patients had significantly higher odds of undergoing amputation (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.08-2.27, P = 0.014), irrigation and debridement (aOR 1.22, 95% CI 1.08-1.37, P < 0.001), and repeat ORIF (aOR 1.16, 95% CI 1.00-1.35, P = 0.045). Implant removal was less common in homeless patients (aOR 0.65, 95% CI 0.59-0.72, P < 0.001). There was no significant difference between homeless and nonhomeless patients in the rate of nonunion/malunion repair (aOR 0.87, 95% CI 0.63-1.18, P = 0.41). CONCLUSIONS: Homelessness is a significant risk factor for worse surgical outcomes following ankle fracture surgery. The findings of this study warrant future research to identify gaps in surgical fracture care for patients with housing insecurity and underscore the importance of developing interventions to advance health equity for this vulnerable patient population. LEVEL OF EVIDENCE: Prognostic Level III.

BackgroundLong-acting (LA) antiretrovirals may provide meaningful benefit to people who use drugs and people experiencing homelessness (PEH) who face disproportionate structural and psychosocial barriers in adhering to daily oral HIV antiretroviral therapy or pre-exposure prophylaxis (PrEP), but their use in these populations has not been studied.SettingThe Maria X. Martinez Health Resource Center is a low-barrier (eg, no appointment) community-based clinic serving San Francisco PEH.MethodsA multidisciplinary care model with robust monitoring and outreach support was developed to provide LA antiretroviral therapy (ART) and LA-PrEP to eligible patients experiencing difficulties adhering to oral antiretrovirals. Feasibility was assessed by evaluating the rates of HIV viremia and on-time injections among patients receiving LA antiretrovirals over the first 24 months of program implementation.ResultsBetween November 2021 and November 2023, 33 patients initiated LA-ART or LA-PrEP (median age, 37 years; 27% transgender/nonbinary; 73% non-White; 27% street homeless; 52% sheltered homeless; 30% with opioid use disorder; 82% with methamphetamine use disorder). Among 18 patients with HIV, 14 initiated LA-ART injections with detectable viremia (median CD4 count, 340 cells/mm 3 ; mean log 10 viral load, 3.53; SD, 1.62), 8 had never previously been virally suppressed, and all but 1 achieved or maintained virologic suppression (mean, 9.67 months; SD, 8.30). Among 15 LA-PrEP patients, all remained HIV negative (mean, 4.73 months; SD, 2.89). Of 224 total injections administered, 8% were delayed >7 days.DiscussionThe implementation of LA antiretrovirals is feasible in low-barrier, highly supportive clinical settings serving vulnerable PEH. Expansion of such programs will be critical in ending the HIV epidemic.

BACKGROUND: Approximately 70-80% of people experiencing homelessness in the United States use tobacco. Smoking cessation programs specifically for this population have been found to be less effective for African American participants. The purpose of this study was to explore discrimination experiences and their impact on smoking habits and readiness to quit cigarette smoking while experiencing homelessness. METHODS: In the qualitative phase of this mixed methods study, five focus groups were conducted for African Americans residing in a homeless shelter in Skid Row, Los Angeles, CA. Using a semi-structured interview guide, we asked participants about discrimination experiences, how smoking habits were impacted by these experiences, and tools needed to successfully abstain from cigarette smoking. Qualitative descriptive content analysis was used to explore discrimination experiences and its association with readiness to quit cigarette smoking. RESULTS: Of the 17 participants, 14 (82.4%) were male, and the average age was 46.8 years. Using a qualitative In Vivo coding method, three themes were revealed: Experiencing Discrimination while Black, The Psychosocial Fabric-Why Quitting Cigarette Smoking is a Challenge, and The Lesser of Two Evils-Choosing to Smoke over More Harmful Options. Participants discussed working in the blue-collar workforce while Black, identifying as a double minority, smoking to cope with stress, early exposure to cigarettes, smoking being a central part of ones belonging to a group, and the legality of cigarette smoking. DISCUSSION: Our findings show that African Americans experiencing homelessness (1) may experience discrimination in multiple settings, regardless of housing status, (2) could have grown up around cigarette smoking and remain surrounded by it while experiencing homelessness, and (3) may experience a calming effect with smoking, which slows some from reacting negatively to adverse situations. CONCLUSION: Barriers to successfully abstaining from smoking are multifactorial among African Americans experiencing homelessness and should be addressed individually. Future research should explore the cultural tailoring of interventions that support cessation efforts unique to minoritized populations to improve smoking cessation programs offered to this population.

Rates of homelessness among adults aged 50 and over are rising. Common strategies for exiting homelessness rely on social and family support. However, intergenerational trauma may disrupt these social support networks and contribute to homelessness. Understanding the impact of intergenerational trauma on living with family or friends may give insight into addressing homelessness among older adults. We purposefully sampled 46 adults who reported living with family or friends from the HOPE HOME study cohort (350 community-recruited adults, ≥ 50 years and experiencing homelessness in Oakland, California) and 19 family/friends who had hosted the participants in their living spaces. We conducted independent, semi-structured interviews and used grounded theory methodologies to analyze data. We identified four major themes from the interviews: (1) Intergenerational trauma was common and made it difficult to stay with family or friends; (2) Participants and hosts sought to protect future generations from intergenerational trauma; (3) Relationships endured despite intergenerational trauma; and (4) social structures exacerbated the impact of intergenerational trauma and played a significant role in perpetuating homelessness. Trauma-informed policies that confront the structures that propagate or exacerbate intergenerational trauma may mitigate their impact and facilitate housing for older adults.

BACKGROUND: Homeless-experienced adults smoke at rates 5 times that of the general adult population, and often have limited access to cessation treatments while homeless. Permanent Supportive Housing (PSH) can be a catalyst for cessation treatment utilization, yet little is known about use of these treatments following PSH entry, or how to tailor and implement cessation care that meets homeless-experienced adults vulnerabilities. METHODS: Using Department of Veterans Affairs (VA) administrative data, we assessed smoking status (ie, current, former, non/never) among a cohort of homeless-experienced Veterans (HEVs) housed in Los Angeles-based PSH. We compared cessation treatment use rates (ie, nicotine replacement therapies, cessation medications, psychosocial counseling) pre- and post-housing using Chi-square tests. Predisposing (ie, demographics), enabling (eg, primary care, benefits), and need characteristics (ie, health, mental health, substance use diagnoses) were examined as correlates of cessation treatment utilization pre- and post-housing in univariable and multivariable logistic regression models. RESULTS: Across HEVs (N = 2933), 48.6% were identified as currently-smoking, 17.7% as formerly-smoking, and 14.0% as non/never smoking. Among currently- and formerly-smoking HEVs (n = 1944), rates of cessation treatment use post-housing were significantly lower, compared to pre-housing, across all treatment types. Health, mental health, and substance use was more prevalent among currently- and formerly-smoking HEVs compared to non/never-smoking HEVs, and most diagnoses were positively associated with utilization univariably. However, in multivariable models, cessation clinic referrals and primary care engagement were the only significant (P

Over the past few decades, scholars and educators have challenged the traditional focus of architectural history on styles and formal features, placing more emphasis on user experience. This experience, however, is not common to all. Each sector of society understands, inhabits, and utilizes architecture differently, leading to divergent ways of performing one’s identity within the city. For example, unhoused people are often excluded from full participation in public life. This commentary shares an experiment that complements an architectural history course with a set of assignments where students engage with sociopolitical aspects of the built environment through mapping and analyzing anti-homeless, hostile design in Eugene, Oregon.

BackgroundWater, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area.MethodsIn this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates.ResultsOf 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing.ConclusionWASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.

BackgroundLoneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging in the United States; now, 48% of single homeless adults are 50 and older. We know little about loneliness among older adults who have experienced homelessness. We aimed to describe the loneliness experience among homeless-experienced older adults with cognitive and functional impairments and the individual, social, and structural conditions that shaped these loneliness experiences.MethodsWe purposively sampled 22 older adults from the HOPE HOME study, a longitudinal cohort study among adults aged 50 years or older experiencing homelessness in Oakland, California. We conducted in-depth interviews about participants perceived social support and social isolation. We conducted qualitative content analysis.ResultsTwenty participants discussed loneliness experience, who had a median age of 57 and were mostly Black (80%) and men (65%). We developed a typology of participants' loneliness experience and explored the individual, social, and structural conditions under which each loneliness experience occurred. We categorized the loneliness experience into four groups: (1) "lonely- distressed", characterized by physical impairment and severe isolation; (2) "lonely- rather be isolated", reflecting deliberate social isolation as a result of trauma, marginalization and aging-related resignation; (3) "lonely- transient", as a result of aging, acceptance and grieving; and (4) "not lonely"- characterized by stability and connection despite having experienced homelessness.ConclusionsLoneliness is a complex and heterogenous social phenomenon, with homeless-experienced older adults with cognitive or functional impairments exhibiting diverse loneliness experiences based on their individual life circumstances and needs. While the most distressing loneliness experience occurred among those with physical impairment and mobility challenges, social and structural factors such as interpersonal and structural violence during homelessness shaped these experiences.

BackgroundWater, sanitation, and hygiene (WaSH) insecurity increases the risk of water-related diseases. However, limited research has been conducted on psychosocial distress as it relates to WaSH insecurity, especially among people who inject drugs (PWID). We examined the relationship between WaSH insecurity and related anxiety among PWID living in different housing conditions along the US-Mexico border region.MethodsFrom 2020-2021, a cross-sectional study was conducted among 585 people who injected drugs within the last month in Tijuana (N = 202), San Diego (N = 182), and in both Tijuana and San Diego (N = 201). Participants underwent interviewer-administered surveys related to WaSH access, substance use, and generalized anxiety disorder (GAD-7). Quasi-Poisson regressions were used to assess associations between WaSH insecurity and anxiety in the prior 6-months.ResultsParticipants were 75% male, 42% were unhoused and 91% experienced WaSH insecurity in the prior 6-months. After adjusting for housing status, gender, and age, lack of access to basic drinking water (Adj RR: 1.28; 95% CI: 1.02-1.58), sanitation (Adj RR:1.28; 95% CI: 1.07-1.55), and a daily bath/shower (Adj RR: 1.38; 95% CI: 1.15-1.66) were associated with mild-severe anxiety. The number of WaSH insecurities was independently associated with a 20% increased risk of experiencing anxiety per every additional insecurity experienced (Adj RR: 1.20; CI: 1.12-1.27). We also found a significant interaction between gender and housing status (p = 0.003), indicating that among people experiencing sheltered/unsheltered homelessness, women had a higher risk of mild-severe anxiety compared to men (Adj RR: 1.55; 95% CI: 1.27-1.89). At the same time, among women, those who are unhoused have 37% increased risk of anxiety than those who live in stable housing conditions (Adj RR: 1.37; 95% CI: 1.01-1.89).ConclusionThe lack of specific WaSH services, particularly lack of drinking water, toilets, and daily showers were associated with higher levels of anxiety among PWID in the Tijuana-San Diego border region. Women experiencing homelessness were especially vulnerable. WaSH interventions that provide safe, 24-h access may help to reduce anxiety and health risks associated with WaSH insecurity.

Women experiencing homelessness may face heightened vulnerabilities and encounter barriers to accessing social services, which could perpetuate their situation and exacerbate the impact on their physical and mental health. This research aims to identify barriers and opportunities for women experiencing homelessness to access social care services based on a systematic integrative literature review. The inclusion criteria encompassed scientific articles and gray literature, focusing on studies of the access to social care services for women experiencing homelessness. English and Spanish documents from the past 20 years were considered, excluding publications lacking full‐text access. The search was conducted until April 30, 2024, across 6 databases including Web of Science, Scopus, PsycINFO, Social Services Abstracts, Sociology, and Cochrane. Article quality was assessed before inclusion to mitigate bias. Data analysis employed a narrative approach using categories and subcategories. Thirty‐eight publications were included, consisting of 36 articles and 2 theses. These publications predominantly relied on qualitative methods. Two main areas and eight categories emerged, covering structural, institutional, social, and personal barriers and opportunities, with 36 subcategories identified. Study limitations include a predominance of women in the study sample who had access to social care services, making it hard to include those experiencing hidden homelessness. Nonetheless, the research underscores the significance of gender‐specific barriers and opportunities in access to social care. The need for gender‐sensitive and intersectional policies is emphasized, as well as professional practices and training, to enhance the well‐being of women experiencing homelessness and improve their access to services. [ABSTRACT FROM AUTHOR]

People with disabilities are more likely to be homeless than the general population and experience additional barriers to accessing housing. Despite this, there is limited research exploring the intersection of homelessness and disability, or the impact of responses such as permanent supportive housing (PSH) from the perspective of people with disabilities. This paper reports on research that explored the experiences of tenants with disabilities in a single site mixed tenancy PSH setting and the extent to which the housing and supports they received addressed psychosocial, welfare and health needs. The research also explored experiences of accessing Australia's National Disability Insurance Scheme (NDIS) as well as other community supports designed to promote inclusion. We found benefits included a sense of stability and ‘home’ whilst challenges related to the limits of congregate housing for this tenant cohort and workforce capacity to manage significant complexity and competing needs. The findings highlight the need for trauma‐informed practices and design, and commitment to workforce development and capacity consistent with tenant needs. We also identified significant challenges and barriers at the interface with the NDIS and other funded services with implications for more assertive in reach education, support and planning to promote community participation. [ABSTRACT FROM AUTHOR]

The importance of accounting for gender in relation to homelessness is exemplified by experiences of pregnancy and early motherhood. Drawing on qualitative research conducted with 14 women who were pregnant while homeless in Victoria, Australia, this article applies the conceptual framework of ‘affective injustice’ to three case studies to explore these gendered experiences. Affective injustice refers to the deprivation of nurturing capital, including safe, secure relationships, love and support and occurs when individuals are exposed to neglect or inequality, including unequal access to health and social services. Moreover, individuals may feel undeserving of support and that being homeless is their burden to resolve. This study found that a lack of safe housing, economic deprivation and experiences of violence and neglect characterized the women’s experiences before and during their pregnancies. Consequently, their capacity to build nurturing capital was severely jeopardized. The provision of suitable accommodation and engagement with supportive relationships with professional and state services enabled the women to harness caring relations and foster maternal identity formation. [ABSTRACT FROM AUTHOR]

People living in situations of homelessness and drug use experience significant barriers when seeking to access services in the Danish welfare state. Yet rarely are journeys to services examined in depth with attention to the factors that may either support or prevent their completion. Towards this aim, the article employs a ‘service journey’ approach by unfolding an ethnographic case study of a service journey pieced together at the street-level. This is achieved through the collective efforts of outreach workers and a man encountered at a drug consumption room in urgent need of medication. The article highlights the role of serendipity in the construction of such ‘street-level’ service journeys. It thus shows how possibilities for initiating or pushing a particular service journey forward occur through serendipitous outreach encounters. Further, it is shown how service journeys of unstably housed people who use drugs are both conditioned by and come up against other shifting everyday ‘itineraries’ of clients as they seek to piece together a living at the urban margins. [ABSTRACT FROM AUTHOR]

ABSTRACT A “Housing First” approach to homelessness, showing promise for single adults, might also be effective for families whose homelessness combined with other challenges bring them to the attention of the child welfare system. This paper reports impact findings from the evaluation of a randomized, controlled trial in San Francisco that tested the effectiveness of an intervention designed to provide permanent housing and supportive services to such families, with the goal of safely reducing the use of foster care. Compared with families in the control group (33 families with 60 children), we found no significant impact on the likelihood of out‐of‐home placement up to 2 years after randomization. For families whose children were already in foster care, children in the treatment group (43 families with 63 children) reunified faster than those in the control group (42 families with 68 children), although nearly always before being housed. There was no difference between groups in time to case closure or likelihood of subsequent child welfare involvement. We discuss these findings in the context of important implementation challenges that have implications for further testing this intervention in tight housing markets. [ABSTRACT FROM AUTHOR]

Objective: To date, systematic reviews of frostbite injuries predominantly focus on the treatment of frostbite, which narrows the scope of prevention and disregards the impact of frostbite-related predisposing factors. Comprehensively synthesizing relevant evidence to understand the psychosocial and personal predisposing factors to frostbite injury and related amputation would provide new insight into frostbite injury prevention. This review investigated the psychosocial and personal predisposing factors of frostbite injury and associated amputation. Methods: Databases, including Embase, PubMed, and PsycINFO, were systematically searched for relevant studies. Two independent reviewers performed the screening, data extraction, and quality assessment. Inclusion criteria were studies that reported cold injury, predisposing factors for frostbite injury or related amputations, and assessed the relationship between a predisposing factor and the frostbite injury or amputation outcome based on a descriptive or inferential test. Results: Thirty-six (36) studies met the inclusion criteria; 29 reported on both frostbite injury and amputations, and seven reported on only frostbite injury. Six psychosocial predisposing factors were observed in 28 out of the 36 studies reviewed, which included people experiencing homelessness, low socioeconomic status, alcohol intoxication/abuse, smoking, psychiatric disorders, and substance use. Personal predisposing factors identified included inadequate/improper winter clothing, delay in seeking medical care, and lack of knowledge of how to deal with the cold. Conclusions: While it is crucial to allocate additional resources and research toward improving the treatment of individuals affected by frostbite injuries and associated limb loss, it is equally important to direct efforts toward addressing the psychosocial and personal predisposing factors that predispose individuals to these injuries and amputations. [ABSTRACT FROM AUTHOR]

Background: Under a housing affordability crisis, Montreal, Canada, is host to a growing homeless population. While people who use drugs or alcohol make up a large part of this group, homeless resources in the city continue to exclude them through sobriety rules or by not adapting programming to their specific needs. This systematic exclusion, and the conditions of these resources, can often be retraumatizing for individuals seeking help. Applying a trauma‐informed spaces of care framework, this research asks what are the needs of homeless individuals who use substances to exit homelessness? What are the current limits within homeless resources in Montreal to actualize these needs? How can they change to meet these needs? Methods: In 2023, 30 semistructured interviews were conducted, with follow‐up at 3 months, with individuals who use drugs or alcohol currently experiencing homelessness. Transcribed interviews were analyzed in Nvivo. Results: Findings called for serious reforms to homeless service provision, with an emphasis on more forms of harm reduction‐based programming, integrated occupational activities, improved psychosocial accompaniment, better division of service users, and alternative and adapted housing interventions for substance users. Most participants disclosed potentially traumatic life experiences, highlighting the need for trauma‐informed programming. Conclusion: Allowing individuals to articulate their needs and desires for programming demonstrates that this group recognizes the inadequacy of services and identifies the homeless resource as a site of potential traumatization. While the recommendations of people with living experience of homelessness and substance use articulate promising practices in substance use recovery, as well as homelessness service provision, homeless service providers are slow to adapt their programming accordingly. [ABSTRACT FROM AUTHOR]

This study explored the manifestations of intersectional structural stigma and stigma-reducing strategies in the context of health among a diverse group of persons experiencing homelessness in the southwest United States. Purposive sampling was used to recruit youth (ages 12–17), young adults (ages 18–24), adults (ages 25 years old or older), women with children, veterans, and males over 60 years old who self-identified as homeless. Grounded theory was applied, and thematic analysis was conducted using data collected from seven focus groups (n = 76 participants). A model of intersectional stigma was adapted from the Health Stigma and Discrimination Framework. This adaptation depicts pathways for addressing intersectional stigmatization experienced by individuals with multiple intersecting identities across the interpersonal, organization, and community levels not explicitly addressed in the Health Stigma and Discrimination Framework. At the interpersonal level, participants indicated they experienced stigmatizing behaviors and practices by service providers due primarily to their identities related to economic or unhoused statuses, gender, age, and mental health. Facilitators of intersectional stigma were identified through organization practices and processes. Multiple stigmatized identities due to social beliefs also facilitated stigmatization at the community level. Health outcomes influenced by stigmatization were also identified. Despite the stigmatization they experienced, participants discussed stigma-reducing strategies related to community assets, medical care, and destigmatizing practices by service providers. [ABSTRACT FROM AUTHOR]

Background and Objectives Comprehensive definitions of social issues and populations can set the stage for the development of responsive policies and practices. Yet despite the rise of late-life homelessness, the phenomenon remains narrowly understood and ill-defined. Research Design and Methods This article and the definition that ensued are based on the reconceptualization of interview data derived from a critical ethnography conducted in Montreal, Canada, with older homeless persons (N = 40) and service providers (N = 20). Results Our analysis suggests that definitions of late-life homelessness must include 4 intersecting components: (1) age, eligibility, and access to services; (2) disadvantage over the life course and across time; (3) social and spatial processes of exclusion that necessitate aging in "undesirable" places; and (4) unmet needs that result from policy inaction and nonresponse. Discussion and Implications The new definition derived from these structural and relational components captures how the service gaps and complex needs identified in earlier works are shaped by delivery systems and practices whose effect is compounded over time. It provides an empirically grounded and conceptually solid foundation for the development of better responses to address homelessness in late life. [ABSTRACT FROM AUTHOR]

High and low daily ambient temperatures are associated with higher mortality in the general population. People experiencing homelessness (PEH) are thought to be particularly vulnerable, but there is almost no direct evidence available. We examined the temperature-mortality association among PEH in 2 populous, urban counties in hot-climate regions of the United States, focusing on heat effects. Study setting was Los Angeles County, CA, and Clark County, NV, which encompass the cities of Los Angeles and Las Vegas, respectively. Outcomes were 2015-2022 deaths among decedents categorized as homeless in county administrative records. We used quasi-Poisson distributed lag nonlinear models to estimate the association of mortality with daily temperatures and with 7-day lagged temperatures, adjusting for day of week, seasonality, and long-term trends. We estimated the minimum mortality temperature and fraction of mortality attributable to temperatures above and below minimum mortality temperature. The association between daily temperature and PEH mortality was skewed towards greater risk at higher temperatures, especially in Clark County. Temperature-attributable mortality equaled 50.1% of deaths in Clark County (95% CI, 29.0-62.8) and 7.0% in Los Angeles County (95% CI, 1.4-12.1). In both counties, most temperature-attributable deaths were attributable to heat rather than cold. In these hot-climate urban counties, our estimates of heat-attributable mortality among PEH were orders of magnitude greater than those reported in prior research on the general population. These results indicate that temperature vulnerability, particularly heat vulnerability, requires stronger public health and policy responses. This article is part of a Special Collection on Environmental Epidemiology. [ABSTRACT FROM AUTHOR]

In this article, I challenge the tendency towards underreported engagement with one's own positionality vis-à-vis the state and note that qualitative manuscripts offer a unique opportunity to engage in liberatory practices by articulating this specific aspect of positionality on the page. To provide empirical evidence of the value of identifying and reckoning with the scholar's relationship with the state, I use an autoethnographic approach to articulate the explanatory power of considering of my own state relationship within the research analysis and writing processes. I show that early findings from a qualitative research endeavor led me to view citizen coproduction practices that targeted homeless individuals as overly deterministic rather than distinctively malicious and tied to systems of state violence. In writing the manuscript that was relevant to this research endeavor, I engaged with my positionality vis-à-vis the state directly within the document which enhanced the validity of my final findings. As the qualitative research process is particularly suited for this liberatory practice, I conclude with some loose guidance for other researchers seeking out ways to identify their own relationship with the state and place it within the manuscript. [ABSTRACT FROM AUTHOR]

Reflexivity, which requires the conscious appraisal of how researchers' social positions and subjectivities interact with the research process, has become increasingly popular in qualitative research with participants at heightened risk of marginalization and trauma histories. Despite the documented traumas associated with marginalization, little has been written about the process of integrating a reflexive approach into research with marginalized communities. This methodological paper seeks to redress this gap by illuminating how our research team used the lens of space as a reflexive framework to attend to positionality, transformation, and power in a qualitative study with older persons with experiences of homelessness. These reflections emerged from our work conducting research in one of three sites associated with a pan-Canadian study, on housing, aging, place/space, and homelessness. More specifically, they emerged from our team's observations and de-briefings during and following data collection with 11 participants (aged 50+ years) of a long-term transitional housing site in Montreal, Canada. These reflections illuminate how integrating concepts of space may provide an avenue for attending to reflexivity when conducting research that informs policy and public service initiatives for marginalized communities, and support research processes that disrupt tendencies to overlook trauma. [ABSTRACT FROM AUTHOR]

Objectives: Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors. Methods: We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015–2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income. Results: Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder. Conclusion: We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations. [ABSTRACT FROM AUTHOR]

This article traces the origins and goals of the abolition movement in the United States that began during the era of chattel slavery to demonstrate that the true aspirations of this movement—a racially just society free of racism and oppression—remain aspirations that are not yet realized. Realizing these aspirations is the real work of abolition and this is the work that social work must embrace today. Yet for social work to truly work toward an anti-racist future, we must also be anti-capitalist. This requires that we work toward both the abolition of harmful, racist systems and abolition of the racial capitalism that maintains these systems. The article concludes with recommendations for scholars and leaders in human service organizations to engage in and advance this work. [ABSTRACT FROM AUTHOR]

Tenancy support services (TSS) allow homeless or institutionalized people with disabilities to obtain and maintain housing in community settings. In the United States, Medicaid is expanding to include coverage for these services. We conducted a comparison case study of two high performing North Carolina (NC) TSS provider agencies, augmented with the voices of key stakeholders in NC and experienced leaders in Louisiana, to explore promising practices for providing effective TSS. Through employing a Housing First philosophy, client centered service delivery, teams with specialized positions, a supportive environment for staff, and staff training TSS outcomes of increased housing, housing retention, improved health, social connection, and enhanced quality of life for residents were achieved. Study findings are intended to inform TSS agencies, state officials, and other stakeholders interested in effective TSS provision. [ABSTRACT FROM AUTHOR]

Many women experiencing homelessness and intimate partner violence (IPV) often do not use formal support services due to barriers such as finances, inaccessibility, controlling partners, and stigma. The current literature lacks studies that examine the formal service experiences of women who have undergone both homelessness and IPV. Therefore, the current study used a qualitative-dominant design and explored the formal service needs of these women, barriers and facilitating factors associated with accessing services, and how the women's identities affected their experiences with formal services. Interviews with 10 women were conducted, and a reflexive thematic analysis was conducted using a critical feminist and intersectionality lens. The most common factors that led to homelessness were conflict and precarious circumstances leading to housing instability. Common barriers were systemic, psychological, dismissal, minimization, and financial barriers. The most common needs were health, finances, and basic necessities. The most common facilitating factors were support networks and resilience, growth, and proactivity. The social positionings most commonly affecting their experiences were class and race/ethnicity. These findings highlighted the voices of marginalized women and can be used to implement positive change in formal services that cater to this subgroup of women. [ABSTRACT FROM AUTHOR]

The status of single women in the eighteenth century was precarious; homelessness and economic dependence plagued the lives of those who chose not to marry. This was the case, at least, for Mary and Charlotte Winn, the unmarried sisters of the 5th Baronet of Nostell Priory. Like many single women, the Winn sisters' archive is sparse. But such a sparseness can be utilised and, in this instance, provides the opportunity for creative methods of recovering women's voices. By exploring the materiality of Mary's and Charlotte's letters, this article demonstrates how these sisters negotiated their distance from the family home through the space they occupied on the page. Paradoxically, moreover, it is this distance that has ensured the survival of their papers. As such, the article concludes by considering the epistolary afterlives of the Winn sisters' letters and addresses how their manuscript legacy has posthumously afforded them a place in the family's history. In effect, paper ties to landed estates, though fragile, remain exactly that – ties. [ABSTRACT FROM AUTHOR]

Aims: Research has associated lack of parental care, physical abuse, and parental substance abuse to homelessness, with the presence of two or more such factors dramatically increasing one's chances of becoming homeless as an adult. Less clear is which (cumulation of) factors may mediate the difference between transitional and recurrent homelessness. Methods: Quantitative analysis of four risk factors—addiction, weak social network, criminal activity, psychopathology—among 69 transitionally and recurrently homeless (RH) adults, followed by in‐depth qualitative analysis of adverse childhood experiences (ACEs) among 30 selected participants. Results: RH participants had higher cumulative risk and a higher prevalence and broader range of ACEs than transitionally homeless participants, with the prevalence of childhood physical abuse marking the greatest difference between the two groups. Recurrent homelessness was also correlated with addiction to hard drugs, criminal activity, and weak social networks. Conclusion: Longitudinal and intervention studies in larger groups are needed to assess causality. [ABSTRACT FROM AUTHOR]

Child labour is a complex social problem worldwide, affecting the physical, moral and educational development of children. A cross sectional quantitative survey research design was used to assess child labour in quarrying activities of the Ga West Municipality, Ghana. The municipality was selected due to evidence in literature of children engaging in quarrying activities. The study examined child labour occurrence and intensity, the working condition of child labourers in the stone quarries; factors influencing child labour in quarrying activities; and the impact of quarrying activities on children. Data which were analysed using probit model and descriptive statistics indicated a negative effect of stone quarry activity on the development, growth and education of the child. Significant influencers were poverty, attitude and poor perception of parents, broken homes, traditional belief systems and migration. The study recommends offering educational support, grants and essential resources to vulnerable households in order to ensure that children remain in school. [ABSTRACT FROM AUTHOR]

Persons experiencing homelessness (PEH) are vulnerable emergency department (ED) patients due to high rates of multi-comorbidity and mortality, as well as a lack of follow up care. Communication of test results pending at discharge (TPAD) is an important area of post-ED follow up care. We examined phone access, successful contact, and change in treatment among PEH and non-PEH with TPAD from the ED. We performed a retrospective cohort study and included all abnormal TPAD and patient telephone notes regarding TPAD over 7 months extracted from the electronic health record of a single, high-volume, urban, safety-net hospital in Denver, Colorado. Two investigators reviewed all data to determine phone access, successful contact, and recommended treatment change. Descriptive statistics were calculated for all variables and compared between PEH and non-PEH. We assessed associations between homelessness and successful contact and phone access while adjusting for age and sex using multivariable logistic regression. A total of 940 patient encounters with TPAD were included. 142 telephone notes regarding abnormal TPAD were included, of which 33 (23 %) were to PEH. Compared to PEH, housed patients were significantly more likely to have access to a phone (+31 %, 95 % CI: 14–48 %), have an active phone (+46 %, 95 % CI: 29–64 %), and be successfully contacted (+42 %, 95 % CI: 24–60 %), but were less likely to have a recommended change in treatment (−14 %, 95 % CI: −24 to −5 %). Homelessness was significantly associated with decreased successful contact (odds ratio [OR] 0.16, 95 % CI: 0.07–0.38) and decreased phone access (OR 0.11, 95 % CI: 0.04–0.33) after adjusting for age and sex. In the subgroup of patients with phone access (n = 124), homelessness was significantly associated with decreased successful contact (OR 0.26, 95 % CI: 0.10–0.70) after adjusting for age and sex. PEH are less likely to have phone access and be successfully contacted regarding TPAD, resulting in untreated or improperly treated infectious disease. Thus, EDs and hospital systems should explore innovative communication solutions, such as shared responsibility models and partnerships with shelters and healthcare for the homeless clinics to improve successful contact with PEH regarding TPAD. • Communication of test results pending at discharge is an important area of post-emergency department follow up care. • Persons experiencing homelessness are less likely to be successfully contacted regarding tests pending at discharge. • EDs should explore innovative solutions to improve successful contact regarding tests pending at discharge. [ABSTRACT FROM AUTHOR]

Pet ownership is an important leisure activity for unhoused people, yet housed people at leisure often disapprove. Reviewing literature from leisure studies and beyond, I consider the tension surrounding this practice through the lenses of critical leisure, multi-species perspectives, and the capabilities approach. I examine (1) how people at leisure react to unhoused pet owners, (2) how pet ownership impacts wellbeing and leisure activities while unhoused, (3) whether the human leisure benefits produced also serve the animals involved, and (4) what actions and attitudes are necessary to alleviate the conflicting leisure interests produced by unhoused pet ownership. Housed people at leisure assume the unhoused cannot care for a pet when they "cannot even take care of themselves." However, these pets generally receive good care, and unhoused pet owners also perceive practical and emotional benefits, though empirical evidence for these benefits is still lacking. While the everyday challenges faced by unhoused pet owners are apparent, more research is needed to assess the physical, psychological, and social benefits they experience by participating in leisure through pet ownership. To address this leisure conflict, animal-accommodating shelter services must be provided, and the public must better understand the relationship between unhoused people and their pets. [ABSTRACT FROM AUTHOR]

In response to Diaspora criticism's recommendations for listening to underground voices, often eclipsed by the leading diaspora figures, the present paper brings attention to the blossoming literary work of the contemporary Moroccan-American writer Laila Lalami. Her fiction, four full-length novels and short prose so far, is argued to intertwine creatively with the major scholarly turns that have marked diasporic literary criticism since its inception in the early 1990s. It registers certain mobility and shifts of concerns from the tropes of homesickness, through homelessness to the rhetoric of transnationalism to grapple with white hegemonic spatiality and politics. However, the focus here is laid on her latest novel The Other Americans (2019) which features minorities from different ethnic backgrounds, yet converging in the enmeshment of their personal lives with the political forces, which intensifies the unsettled issues of identity in the US. Though no material principles of assimilation are proposed, Lalami's implied protagonist's eventual urges for complete integration into mainstream society draw on the power of love and forgetting rather than violence and revenge. In so doing, Lalami's materialist perspective is believed to debunk the Trumpist right political paranoia with reference to the assimilating capability of immigrants. [ABSTRACT FROM AUTHOR]

This article presents the conceptual framework of political and physical homelessness as embodiments of precarious homelessness, emanating from the palpable characteristics of housing. This physical housing doesn't just provide shelter, it also gives people a sense of political identity and belonging to a home or country. The uphill Tamil community, coerced into migratory movements from India to Sri Lanka for plantation labor, confronted a formidable existence marked by precarious homelessness. This community nurtured a perception that the absence of their personal dwelling impeded a sense of belonging to the Sri Lankan nation. Even subsequent to acquiring Indian citizenship and repatriating, their precarious homelessness endured during their post-repatriation phase due to transient or inadequate housing conditions in India. This state of precarious homelessness begets housing insecurity and prolonged psychological adversities, encompassing apprehension, strain, and anguish among the Hill Country Tamils. By propounding this framework, the study not only enhances understanding of homelessness dynamics, but also provides scholars and policymakers with a holistic view to address homelessness among stateless and displaced populations. [ABSTRACT FROM AUTHOR]

Belonging is a human need and an essential component of community integration following homelessness. Little is known about the range of studies exploring experiences of belonging following homelessness. We conducted this systematic review and meta-aggregation to address this gap using Joanna Briggs Institute (JBI) methodology following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA). We searched seven databases (EMBASE; PsychINFO; CINAHL; Medline; AMED; Nursing and Allied Health Database; and Sociological Abstracts), combining three main concepts: 1) homelessness; 2) belonging; and 3) transition. The search identified 2504 titles and abstracts. Of these, we included 33 studies in our review and meta-aggregation. Our meta-aggregation generated four themes describing experiences of belonging following homelessness: 1) developing a sense of belonging is a challenging process in the transition to housing; 2) shifting connections and finding new belonging; 3) belonging through engaging in meaningful activities; and 4) housing as a foundation for connection. These findings indicate that housing stability creates opportunities to belong but developing a sense of belonging is a difficult process involving changes in social networks facilitated by engaging with others in meaningful activities. [ABSTRACT FROM AUTHOR]

Introduction: Per capita rates of homelessness are higher in many rural communities than Canada's largest cities, yet little attention has focused on strategies to address rural homelessness. This study compared experiences and lessons learned from three models of homeless shelters in a small town in rural Ontario: a church, motel, and warming center. Methods: Qualitative interviews were conducted with 17 individuals who stayed in or administered any of three emergency shelters that ran between 2019 and 2022. Results: Participants described challenges resulting from insufficient structure, policies, partnerships, funding, and training that led the church and motel shelters to be unsustainable. The warming center had more sustainable funding but lacked supports and had short operating hours. Several aspects of participants' experiences were unique to the rural context, including the lack of infrastructure, precarity of services, and feelings of being surveilled and pushed out of their community. Informal supports and a sense of connection to their hometown meant most had no intention of leaving. Conclusion: The strengths of each model and lessons learned offer opportunities to improve and adapt emergency shelters to the rural context. [ABSTRACT FROM AUTHOR]