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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.

Homelessness, particularly unsheltered homelessness is a public health emergency in the U.S. Street outreach programs have demonstrated efficacy in connecting people to housing, initiating or retaining people in primary care, improving access to mental health services, and increasing treatment for substance use disorder. Effective outreach is generally characterized by trained, multidisciplinary teams that visit clients where they are, forming trusting relationships over time. Public health nurses working on outreach teams have opportunities to exercise their full scope and standards of practice and advance street outreach to the benefit of a distinctly marginalized group. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this integrative review was to explore the beliefs and practices used to promote physical and mental health among youth ages 18–25 years, identifying as LGBTIQ+ experiencing housing insecurity. Method: The approach used strategies described by Whittemore and Knafl. Peer‐reviewed, published research articles in English were identified using eight electronic databases. Eighteen research reports using qualitative, quantitative, and mixed methods were identified. Articles were evaluated for quality using the American Association of Critical Care Nurses Evidenced‐Level Hierarchy evaluation tool. Data were analyzed and synthesized using Braun and Clarke's method. Findings: Four themes related to the purpose were extracted: pervasive experiences of stigma and discrimination, constantly attuned to navigating risks, inconsistent engagement in health information and care, and inner strength developed through personal and community experiences. Discussion: There are strong implications for future research, public health nursing practice, and health policy. Public health nurses should incorporate social determinants of health (addressing harmful social processes such as homophobia and racism) as well as a strength‐based upstream approach in research, education, and health care practices. More research must also be done to assess engagement in physical and mental health information and care. [ABSTRACT FROM AUTHOR]

Sexual and gender minorities (SGM; i.e. lesbian, gay, bisexual, transgender, queer, intersex, asexual and other identities aka LGBTQIA+) experience homelessness at disproportionately higher rates than their cisgender and heterosexual peers. Adverse childhood experiences (ACE)—experiences of abuse, neglect, or challenges in the family setting—have been identified as a key risk factor for experiencing homelessness. The present study assessed the relationship between ACE and first-time homelessness in a community sample of SGM adults in South Texas. Participants (n = 910) completed a cross-sectional survey and logistic regression models were used to estimate associations with first-time homelessness childhood and adulthood. Adjusting for covariates, the odds of first-time homelessness increased by 1.58 times in childhood (95% CI = 1.36–1.84) and 1.33 times in adulthood (95% CI = 1.21–1.46) for every additional ACE reported. Specific ACE categories were also associated with homelessness experiences. Research is needed to understand the breadth of causes and consequences of homelessness among SGM individuals. [ABSTRACT FROM AUTHOR]

People identifying as homeless in high income countries are becoming older and more medically complex. Previous studies have demonstrated the health and social benefits of various housing interventions for people who are homeless after hospital discharge. In this pre-/post-intervention cohort study, we recruited 57 participants from two transitional housing programs on the grounds of a single inner-city tertiary care center. In comparison to the 12 months prior to attending the transitional housing program, the number of hospital admissions decreased by 45% in the 12 months thereafter from an average of 2.0 to 1.1 admissions (p = 0.01). The number of inpatient days decreased by 64% from an average of 23.2 to 8.3 days (p < 0.01). Housing status at 12 months after baseline interviews had improved for 42% of our participants. Through our qualitative interviews with participants, key strengths of the programs included the trauma-informed approach and social service navigation provided by staff members, as well as the stable physical environment with proximity to comprehensive healthcare and social resources. Among hospitalized individuals facing homelessness, our study demonstrates that participation in a hospital-based transitional housing program can be associated with reductions in hospitalizations and hospital length of stay, and improved housing status. [ABSTRACT FROM AUTHOR]

Homelessness and rough sleeping are currently on the rise in England. Literature evidences an empirical relationship between substance use disorders and offending behavior within homelessness. This qualitative study explores this relationship from the perspective of those currently experiencing homelessness and substance use disorders, with an offending history. Thematic analysis identified substance use disorders as the dominant factor in the continuous relationship between three. Furthermore, when discussing their experiences of prison, participants did not identify prison as a deterrent from committing offenses. Feelings of stigmatization and marginalization from mainstream society were also identified, but participants expressed feelings of social inclusion within their marginalized groups. These findings, and their implications for support services in the community, are discussed in this paper. [ABSTRACT FROM AUTHOR]

Many people who are homeless own a companion animal (a "pet"). For people who are homeless, pet ownership has a range of benefits. However, it may also limit a person's access to services and interventions, and so complicate or even prolong their homelessness. "Pet-friendly" services/interventions – which preserve the relationship between people who are homeless and their pets, whilst also meeting their unique needs – are important. Currently, however, there is limited knowledge about what services/interventions exist for people who are homeless with pets, the impact of these, and how they can be implemented in practice. This systematic review was undertaken to address these gaps. It was conducted according to the PRISMA guidelines. Eleven academic journal articles were selected for inclusion. The review identified four key services/interventions which may benefit people who are homeless with pets – pet-friendly accommodation, free veterinary care, free pet food, and foster care/ boarding – in addition to a number of "other" related services/interventions. It identified multiple challenges associated with delivering these services/interventions in practice. None of the studies offered rigorous evaluations – and, therefore, evidence – about "what works." Further research is essential to identify the most effective and cost-effective approaches. [ABSTRACT FROM AUTHOR]

Service delivery and care of street-involved pregnant women is recognized as a complex issue, and as such comorbidities, addictions, and risky behaviors can result in significantly higher risks of contracting HIV. We inquired into the experiences of service providers who work in community-based supportive intervention programs for vulnerable street-involved, pregnant, and early parenting women in precarious housing situations who are living with HIV or are at risk of contracting HIV, across the continuum of care. We used a qualitative descriptive design and interviewed 22 service providers from local government and non-governmental community agencies about their experiences delivering services to this population. Four key themes emerged from the data: focus on outcomes and success, understanding tensions in service delivery, challenges in accessing appropriate services and resources, and attention to moving forward. We highlight the complex tensions experienced by service providers in a health and social care system that centers on measurable and quantifiable outcomes while overlooking larger issues that shape equitable care. Our study highlights the need for alternative approaches to service delivery that are focused on the lives of women. [ABSTRACT FROM AUTHOR]

AbstractBuilt for Zero (BFZ) is a data-driven methodology that some US homeless systems are using to allocate housing assistance. The ‘by-name data’ that BFZ needs is produced by actors within a ‘data assemblage’: a socio-technical system that people re/create to produce, analyse, and use data. Although BFZ is diffusing across the Global North, little research has examined the barriers that local administrators face whilst upgrading their systems’ data assemblage with this methodology. This paper advances housing scholarship by using interview data from 28 US homeless systems to answer the question: what barriers do administrators face whilst upgrading their data assemblage with BFZ? I delineate four barriers that fray the network ties that local administrators need to produce by-name data: disinterest, fragmentation, noncompliance, and incapacity. My analysis shows how data assemblage theory can be used to understand homeless governance, delineates several factors that prevent or complicate data sharing within homeless systems, and identifies new directions for research on homeless datafication. [ABSTRACT FROM AUTHOR]

Objective: To evaluate universal suicide risk screening and evaluation processes among newly homeless Veterans. Study Setting: Not applicable. Study Design: Examination of Veterans Health Administration (VHA) using newly homeless patients' health record data in Calendar Year 2021. Data Collection: Not applicable. Data Source: Health record data. Principal Findings: Most patients received suicide risk screening and/or evaluation in the year prior to and/or following homeless identification (n = 49,505; 87.4%). Smaller percentages of patients were screened and/or evaluated in close proximity to identification (n = 7358; 16.0%), 1–30 days prior to identification (n = 12,840; 39.6%), or 1–30 days following identification (n = 14,263; 34.3%). Common settings for screening included primary care, emergency and urgent care, and mental health services. Of positive screens (i.e., potentially elevated risk for suicide), 72.6% had a Comprehensive Suicide Risk Evaluation (CSRE) completed in a timely manner (i.e., same day or within 24 h). Age, race, and sex were largely unrelated to screening and/or evaluation. Conclusions: Although many newly identified homeless patients were screened and/or evaluated for suicide risk, approximately 13% were not screened; and 27% of positive screens did not receive a timely CSRE. Continued efforts are warranted to facilitate suicide risk identification to ensure homeless patients have access to evidence‐based interventions. [ABSTRACT FROM AUTHOR]

The purpose of this clinical epidemiological investigation was to examine the oral health conditions of homeless people in the city of Rome, Italy. A total of 157 homeless subjects were subjected to a first dental visit, during which anamnestic information was recorded in a digital medical record. A diagnosis of dental disorders was performed by assessing oral hygiene conditions, periodontal health, the presence of caries and/or root residues, and the presence of partial and/or total edentulousness. Caries and missing teeth were evaluated by the DMFT index. The first major criticality was represented by poor or absent oral hygiene. The examined sample showed a major percentage of high DMFT (63.0%); the most common clinical condition was the presence of numerous root residues. Regarding periodontal health, 73.2% of patients had gingivitis, 21.6% periodontitis, while 11 patients had periodontal pathologies with tooth mobility (7%). Finally, 8.9% of patients had one or two missing elements, 22.9% had partial edentulousness, and 8.9% of the sample had total edentulism. This analysis provides an important basis for strengthening health promotion and the importance of accessible and effective care for this population. It will therefore be necessary to continue to adopt a patient-centered approach geared towards addressing the demands that this population faces in maintaining their oral health. [ABSTRACT FROM AUTHOR]

The divide between the rich and poor in the European housing market is fast rising. Latest research indicates that Europe is dealing with an increasing number of homeless people. Every city in Europe has them—homeless people compelled to live on street corners, frequently hiding themselves with cardboard. Rain, snow, and temperatures below zero pose a threat to their lives on a daily basis. There are many varied kinds of services that have been discovered, but it is difficult to keep track of everyone and guarantee that they have a warm night's sleep in the winter. The current article suggests accommodation as a workaround until they can receive high-intensity support, a way to keep a single person warm and safe during the winter. The focus is on devising a strategy that not only ensures the warmth and safety of individuals during the harsh winter months but also seeks to industrialize the construction of shelters, ensuring affordability below the cost of winter hospitalization for a homeless person. Crucially, the article introduces an additional layer to this initiative by highlighting the dual purpose of these individual shelters. Beyond being a means to provide respite for the homeless during severe weather, these shelters are envisioned as immediate response units in the event of emergencies such as earthquakes in urban areas. The article explores the potential impact of this multi-layered approach on transforming urban landscapes and fostering resilient communities. [ABSTRACT FROM AUTHOR]

Background The government of Korea implemented a strategy of prevention and early diagnosis in high-risk groups to reduce the tuberculosis (TB) burden. This study aims to investigate the TB epidemiology and gap in understanding of TB prevalence among homeless individuals by analyzing active TB chest X-ray (CXR) screening results in Korea. Methods The Korean National Tuberculosis Association conducted active TB screening with CXR for homeless groups from January 1 to December 31, 2021. Sputum acid-fast bacilli smear and culture were performed for the subjects suggestive of TB on CXR. We performed a cross-sectional analysis of the data in comparison with the national health screening results from the general population. Results Among 17,713 homeless persons, 40 (0.23%), 3,077 (17.37%), and 79 (0.45%) were categorized as suggested TB, inactive TB, and observation required, respectively. Prevalence of suggested TB in the homeless was significantly higher (3–5 fold) than in Univerthe national general health screening based on age category (p

Abstract The divide between the rich and poor in the European housing market is fast rising. Latest research indicates that Europe is dealing with an increasing number of homeless people. Every city in Europe has them—homeless people compelled to live on street corners, frequently hiding themselves with cardboard. Rain, snow, and temperatures below zero pose a threat to their lives on a daily basis. There are many varied kinds of services that have been discovered, but it is difficult to keep track of everyone and guarantee that they have a warm night's sleep in the winter. The current article suggests accommodation as a workaround until they can receive high-intensity support, a way to keep a single person warm and safe during the winter. The focus is on devising a strategy that not only ensures the warmth and safety of individuals during the harsh winter months but also seeks to industrialize the construction of shelters, ensuring affordability below the cost of winter hospitalization for a homeless person. Crucially, the article introduces an additional layer to this initiative by highlighting the dual purpose of these individual shelters. Beyond being a means to provide respite for the homeless during severe weather, these shelters are envisioned as immediate response units in the event of emergencies such as earthquakes in urban areas. The article explores the potential impact of this multi-layered approach on transforming urban landscapes and fostering resilient communities.

PurposeInfectious keratitis is a vision-threatening condition requiring close follow-up and disciplined eye drop administration to achieve resolution. Although patients presenting to county hospitals often have more severe presentations, there is a paucity of risk and outcomes data in this setting. This study investigates risk factors predicting loss to follow-up (LTFU), medication noncompliance, and poor outcomes for infectious keratitis in the county hospital setting.MethodsThis was a retrospective case-control study at Zuckerberg San Francisco General Hospital and Trauma Center. Inclusion criteria were patients who had corneal cultures for suspected infectious bacterial or fungal keratitis between 2010 and 2021. Exclusion criteria were patients with viral keratitis only. Multivariable logistic regression was used to analyze the relationship of social and medical risk factors with LTFU, medication noncompliance, worsened visual acuity (VA), and delayed resolution time.ResultsOf 174 patients with infectious keratitis in this analysis, 69 (40.0%) had LTFU. Unemployment was associated with increased risk of LTFU (odds ratio 2.58, P = 0.049) and worse final VA ( P = 0.001). Noncompliance trended toward an association with homelessness (odds ratio 3.48, P = 0.095). Increasing age correlated with longer resolution time, with each 1-year increase associated with delayed resolution by 0.549 days ( P = 0.042).ConclusionsPatients experiencing unemployment, homelessness, or increased age demonstrate higher risk for treatment barriers including loss to follow-up and medication noncompliance, resulting in worse VA and delayed time to resolution. These risk factors should be considered when determining the need for more deliberate follow-up measures in patients with infectious keratitis.

Background: Homelessness is a rising crisis that affects hundreds of thousands of individuals in America; but affects women differently than men. The experiences women face while homeless can translate into traumatic experiences and profoundly shape an individual's story of homelessness. These experiences prompt a need to change the systems that contribute to homelessness. Purpose: This study aims to highlight trauma across women's experiences of homelessness. Methods: Data collection for this research was conducted through qualitative interviews with eight women experiencing homelessness in Modesto, California. NVivo, a qualitative data analysis software, was used to format the interviews, identifying common code words that developed into overlapping themes. Results: The eight interviews of women experiencing homelessness identified core emerging themes of causes of homelessness, fear of loneliness, quality, and type of available services, perception of homelessness, and an understanding of the societal constructs of homelessness and gender. This research confirmed that some women experiencing homelessness are less likely to report traumatic experiences and seek support from their local social service community providers. The limitations of the smaller sample size only captured a small scale of the problem being analyzed to a potentially larger issue. Conclusion: Services should begin focusing on asking more trauma-informed questions, not only to improve care but to allow more women experiencing homelessness the chance to seek help; this is the only way to begin understanding how their traumatic experiences have impacted their livelihood.

Background - The new increasing homeless lately consist of women, children, youth, the elderly and marginalized ethnic or migrant groups. Some of them are working and earn salaries, however, the income is not sufficient to live modestly. Purpose – The purpose of this research is to establish a desired support system to eradicate urban homelessness in the country. Design/methodology/approach – This is an exploratory descriptive method study which employed quantitative techniques. The study employed a social ecological model to investigate behavior of homeless via multiple levels of influences including intrapersonal, interpersonal, organizational, community and public policy. Surveys have been conducted on sixty-five homeless individuals. Findings – It was found that support systems and structures should be derived from the whole streams from families, communities, organizations and government. Employment opportunities, long-term shelters within the community places and highly demanded skills are needed to improve their living condition. Research limitations – This study is only focused on the socio-economic structures of the homeless in a capital city. Originality/value – This is an empirical research using a social ecological model for the homeless in the Kuala Lumpur area. Research on homeless study has received little attention and has yet to be fully explored.

Existing literature suggests many victims of housing loss due to disaster need emergency shelter, and low-income individuals are at risk of becoming chronically homeless without assistance in the transition to conventional housing. In response, FEMA provides Transitional Sheltering Assistance (TSA) to victims of housing loss. However, the extent to which sheltering needs are met by TSA has not been investigated, especially among low-income households. Analyzing FEMA's administrative data including all damaged housing units in Harris and Galveston counties (N = 283,085), we found that low-income victims of housing loss not only had greater sheltering needs but also were less likely to access TSA than their counterparts not of low-income status. When both groups were in need of shelter, the chance of obtaining TSA for low-income victims of housing loss was much lower than that for their counterparts. Our study highlights the critical sheltering needs of low-income households in a natural disaster, and advocates for a broader and more equitable distribution of TSA. [ABSTRACT FROM AUTHOR]

Background: The post-release period is associated with an increased risk of morbidity and mortality. Previous studies have identified deficits in pre-release planning for mentally ill people in prison, particularly in remand settings. Objectives: We aimed to determine the proportion of mentally ill people in Ireland's main remand prison who were referred for mental health follow up in community and prison settings, who achieved face to face contact with the receiving service. Method: This retrospective observational cohort study was based in Ireland's main male remand prison, Cloverhill. Participants included all those individuals on the caseload of the prison inreach mental health team who were referred for mental health follow up in community and prison settings at the time of discharge, prison transfer or release from custody over a three-year period, 2015 - 2017. Successful transfer of care (TOC) was defined as face-to-face contact with the receiving service, confirmed by written correspondence or by follow up telephone call. Clinical, demographic and offence related variables were recorded for all participants. Results: There were 911 discharges from the prison inreach mental health team within the three-year study period. Of these, 121 were admitted to hospital, 166 were transferred to other prison inreach mental health services and 237 were discharged to community based mental health follow up in psychiatric outpatient or primary care settings. One third (304/911) had an ICD-10 diagnosis of schizophreniform or bipolar disorder (F20--31) and 37.5% (161/911) were homeless. Over 90% (152/166) of those referred to mental health teams in other prisons achieved successful TOC, with a median of six days to first faceto face assessment. Overall, 59% (140/237) of those referred to community psychiatric outpatient or primary care services achieved TOC following referral on release from custody, with a median of nine days from release to assessment. Clinical and demographic variables did not differ between those achieving and not achieving successful TOC, other than having had input from the PICLS Housing Support Service. Conclusion: Successful transfer of care can be achieved in remand settings using a systematic approach with an emphasis on early and sustained interagency liaison and clear mapping of patient pathways. For incarcerated individuals experiencing homelessness and mental health disorders, provision of a housing support service was associated with increased likelihood of successful transfer of care to community mental health supports. [ABSTRACT FROM AUTHOR]

This document is an editorial that explores the mental health challenges faced by individuals experiencing homelessness. It provides a historical overview of the study of homelessness and the terminology used to describe this population. The editorial highlights the efforts of researchers and organizations dedicated to understanding and addressing the mental health needs of homeless individuals. It also mentions a research topic on mental illness and neuropsychiatry of the homeless, which includes articles from different journals covering topics such as medication adherence, executive dysfunction, readmissions, personality disorders, and harm reduction interventions. The document is a brief research report published in Frontiers in Public Health by Catthoor et al. from Belgium, discussing the housing problems faced by psychiatric patients admitted to hospitals. The authors express their hope that their research will stimulate further discussions on the experiences of individuals with psychiatric disorders and neurological diseases who are also homeless. The report includes information about author contributions, funding, acknowledgments, conflicts of interest, and a publisher's note, as well as a references section listing various sources related to homelessness and mental health. [Extracted from the article]

Homelessness is a priority public health issue in the United States (U.S.) given its strong associations with multiple adverse health outcomes. While overall rates of homelessness have decreased over the last decade, some populations—such as sexual and gender minorities—have not seen equitable decreases. The present study explores the relationship between experiences of first-time homelessness with substance misuse (assessed via the DAST-10) and depression and anxiety (assessed via the PHQ-4) in an adult sample of SGM individuals in South Central Texas. The analytic sample (n = 907) was majority gay/lesbian or same-gender loving (55.8%) followed by bisexual or pansexual (34.7%) or another sexual identity (9.5%) and 12.5% were transgender. First-time homelessness was more common in childhood than adulthood. Multivariate logistic regression models were used to evaluate relationships between first-time homelessness and outcomes of interest. The odds of substance misuse (DAST > 3) were marginally higher for those experiencing first-time homelessness in childhood and significantly higher for those reporting first-time homelessness in adulthood. The odds of experiencing past 2-week depression were significantly greater for those reporting homelessness in childhood or adulthood. However, only first-time homelessness in adulthood was significantly associated with past two-week anxiety. These findings underscore the need to consider intersectionality when exploring solutions to existing health disparities, as this work suggests that both sexual and gender identity and homelessness are important factors in shaping mental and behavioral health outcomes. [ABSTRACT FROM AUTHOR]

This study explored the experiences of mothers experiencing homelessness amidst the COVID-19 pandemic. Semi-structured interviews were completed with nine mothers and analyzed using thematic analysis. Themes uncovered during the interviews highlighted sources of motivation and perseverance, additional and ongoing impacts of COVID-19, sources of further mental anguish, and unmet needs challenging roles and routines. Notably, the identity of being a mother and the value placed on that role significantly influenced their daily routines and engagement in meaningful occupations. Occupational therapy practitioners can utilize these findings to deliver contextually sensitive care tailored to the unique circumstances and immediate requirements of this population. [ABSTRACT FROM AUTHOR]

The homeless population remains understudied, and their victimisation is unreported, especially homeless victims of homicide. With the number of people faced with homelessness increasing, the heightened rates of victimisation for violent crimes throughout this population becomes even more concerning. A review of the literature revealed an absence of meaningful research beyond basic descriptive statistics of rates of homeless homicide in the UK. The current study explores the behavioural variation and risk factors associated with the victims and perpetrators of 19 cases of homeless homicide in the UK. A content analysis was first conducted to derive 22 case variables. Smallest Space Analysis was then employed to analyse the cases according to the variables selected. The themes produced in the SSA output were comparable to that of Canter's Victim Role Model: Victim as Object, Victim as Person and Victim as Vehicle. The current study lays a foundation for developing an understanding of the variation in behaviour across cases of homeless homicide and may serve to inform preventative measures. [ABSTRACT FROM AUTHOR]

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

In the United States, in 2013, 610,042 people were estimated homeless in one night. Improving the effectiveness of homeless assistance programs, particularly aligning programs' practices with their goals, is critical to serving this population. Using a theory that predicts homeless exits, this study presents an innovative, low-cost evaluation tool that can be used by a wide range of human service providers to conduct more frequent "in-house" process evaluations. The Gap Assessment of Policy and Practice (GAPP) tool streamlines process evaluations thus improving social programs. To test this tool's effectiveness, we compared the results of a traditional process evaluation and a GAPP tool evaluation of a homeless assistance program. Both evaluations revealed a consistent disparity between program activities and expressed goals. The GAPP tool is less time intensive and provides a useful road map for structuring a process evaluation for program providers, thus increasing program impact by encouraging more frequent and efficient self-assessments. [ABSTRACT FROM AUTHOR]

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

Background - The new increasing homeless lately consist of women, children, youth, the elderly and marginalized ethnic or migrant groups. Some of them are working and earn salaries, however, the income is not sufficient to live modestly. Purpose – The purpose of this research is to establish a desired support system to eradicate urban homelessness in the country. Design/methodology/approach – This is an exploratory descriptive method study which employed quantitative techniques. The study employed a social ecological model to investigate behavior of homeless via multiple levels of influences including intrapersonal, interpersonal, organizational, community and public policy. Surveys have been conducted on sixty-five homeless individuals. Findings – It was found that support systems and structures should be derived from the whole streams from families, communities, organizations and government. Employment opportunities, long-term shelters within the community places and highly demanded skills are needed to improve their living condition. Research limitations – This study is only focused on the socio-economic structures of the homeless in a capital city. Originality/value – This is an empirical research using a social ecological model for the homeless in the Kuala Lumpur area. Research on homeless study has received little attention and has yet to be fully explored.

BackgroundHomeless people are continuously facing adverse living conditions as poor access to basic nutrition, hygiene conditions and healthcare services, being at increased risk of severe infectious diseases as HIV and hepatitis as well as cardiovascular diseases and mental disorders. The characterization of homeless people’s health is fundamental to identify their health care needs. Considering that the aforementioned diseases are associated with chronic inflammatory processes, the main goal of this study was to characterize the inflammatory profile of a homeless population through quantification in saliva of a panel of inflammatory cytokines.MethodsThe inflammatory profile was assessed in 114 individuals residing in two temporary shelters located in Lisbon and that accepted to participated in the study. Inflammatory proteins were quantified using a Multiplex Immunoassay approach. Data analysis was performed using the GraphPad Prism software and statistical significance among the groups was assessed using the nonparametric Mann–Whitney test.ResultsEven though some protein levels might be masked by drug treatment, data analysis showed high levels of INF-ϒ, IL-10 and TNF-α in the infectious disease group, critical cytokines for the immune response against viruses and bacteria. Also, cytokines like IL-1β and IL-6 were detected at statistically significant levels in the cardiovascular disease group and all cytokines included in this study were quantified in the mental disorders group.ConclusionThese findings may help the healthcare services in the evaluation of treatment efficacy and disease monitoring, and in the development of effective public healthcare strategies and policy interventions to improve quality of life of the homeless population.

This study aimed to analyze the temporary settlements set up for Venezuelan refugees in the city of Boa Vista-RR, Brazil, to propose guidelines for these facilities. The methodology uses multiple exploratory case studies with a qualitative approach. The research is based on a comparative analysis between data collected during field research, conducted in 2018, and the main guidelines for temporary settlements from national and international literature. It examines the physical-spatial and functional characteristics of settlements, such as layout, facilities, services and infrastructure. The results show the structure of the settlements and its organization, as well as routine activities, such as security actions, food distribution, healthcare, provision of household items and other services. Universal accessibility, psychosocial care, privacy, cultural adequacy and awareness actions are essential to enhance quality of life in settlements. Improvements need to be made over time to promote urbanization, spatial appropriation, and encourage community empowerment. The findings help to consolidate a reference framework of guidelines for decision-making regarding temporary settlements for disaster scenarios.

Sleep problems are common among United States (U.S.) veterans and are associated with poor health, mental health, and functioning. Yet, little is known about insufficient sleep and factors contributing to sleep disparities among veterans experiencing homelessness. We conducted semi-structured interviews to better understand the clinical, environmental, and structural factors contributing to insufficient sleep among veterans and to improve care for this population. Interviews were conducted with 13 providers caring for veterans experiencing homelessness, including physicians, psychologists, nurses, social workers, and peer support specialists. Providers worked at a West Coast VA institution serving a large population of veterans experiencing homelessness. Interviews were analyzed for themes pertaining to sleep using the social-ecological model as a framework. On an individual level, factors influencing sleep included psychiatric disorders and use of substances. On an interpersonal level, factors included safety concerns while sleeping. On an environmental level, factors included noise and proximity to others as barriers to sleep. On the organizational level, logistical issues scheduling sleep clinic appointments and lack of transportation to attend sleep clinic appointments were identified as treatment barriers. These findings can inform future research studying the impact of sleep on health and housing outcomes and interventions addressing sleep among veterans experiencing homelessness.

ObjectivesThe COVID-19 pandemic caused dramatic upsurges in stress and anxiety across the United States, as well as increased substance use to cope with pandemic-related stress. Few studies have focused exclusively on extremely disadvantaged individuals who are already at risk for substance use. We sought to understand factors associated with increased alcohol and cannabis use during the first 10 months of the COVID-19 pandemic among unsheltered and unstably housed women.MethodsBetween July and December 2020, we conducted phone surveys with San Francisco unhoused and unstably housed women regarding substance use, health, and health services use since the beginning of the pandemic (March 2020).ResultsAmong 128 participants, increased use of alcohol and cannabis were reported by 15% and 23%, respectively. The odds of increased use of both substances were 4 times higher in participants who also had increased difficulties managing symptoms of a chronic medical condition during the pandemic.ConclusionsAn intentional and comprehensive approach to managing the health of particularly vulnerable individuals during the COVID pandemic could help alleviate its exacerbating influences. Such an approach should include resources, tools and interventions for managing substance use, as well as chronic, non-COVID medical conditions, which are common and strongly tied to substance use in unhoused and unstably housed women.

This review presents and explores "Homelessness: A Critical Introduction" by Cameron Parsell.

Abstract 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 Harmful use of illicit drugs and/or alcohol is linked to life-limiting illness and complex health and social care needs, but people who use substances and have complex needs do not receive timely palliative care and fail to achieve quality standards for a good death. They and their families often require support from multiple health and social care services which are shown to be poorly integrated and fail to deliver interdisciplinary care. This study aimed to identify the existing barriers and facilitators within and between services in providing this population with a good death. Using a mixed methods approach of survey, focus groups and semi-structured interviews, we explored the perspectives of practitioner and management staff across a range of health and social disciplines and organisations in one combined authority in a large city in the north west of England. Our findings indicate that practitioners want to provide better care for this client group, but face structural, organisational and professional boundary barriers to delivering integrated and shared care. Differences in philosophy of care, piecemeal commissioning and funding of services, and regulatory frameworks for different services, lead to poor and inequitable access to health and social care services. Ways forward for improving care are suggested as bespoke hostel-based accommodation for palliative care for this client group, and specialist link workers who can transcend professional and organisational boundaries to support co-ordination of services and support. We conclude that it is no longer adequate to call for more training, better communication and improved joint working. Complex care at the end of life requires creative and cohesive systemic responses that enable multi-disciplinary practitioners to provide the care they wish to give and enables individuals using substances to get the respect and quality service they deserve.

Little is known about how older adults with a current or recent experience of homelessness navigated the switch to telehealth during the COVID-19 pandemic. We examined the perceptions and use of telehealth in a purposive sample of 37 homeless-experienced older adults in mid-late 2020 through semi-structured qualitative interviews. We purposively recruited participants from a larger longitudinal study on homeless-experienced older adults in Oakland, CA. We subjected the data to content analysis. We found that most participants who used telehealth used audio-only phone calls for care. We found that (1) participants experienced challenges accessing the necessary technologies for telehealth, (2) perceptions of telehealth for physical health differed based on the modality (video vs. audio-only), and (3) participants had generally positive perceptions of telehealth for mental healthcare. Our findings suggest that clinicians interacting with homeless-experienced older adults should address the potential skepticism of audio-only telehealth patients, and assess their access to, and knowledge of, video conferencing technology.

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

• Homeless pregnant women are at higher risk of preterm birth compared to those with stable living arrangements. • Homeless women are more likely be affected by other adverse social determinants of health. • We report a ten fold increase in pregnant women reporting homelessness over the study period. To evaluate the association, if any, of homelessness or refuge accommodation on delivery and short term perinatal outcomes in an Irish tertiary maternity hospital. A retrospective cohort study of 133 singleton pregnancies in women reporting to be homeless or living in refuge at their booking antenatal appointment between 2013 and 2022. Analysis compared sociodemographic characteristics and perinatal outcomes in this cohort to a reference population of 76,858 women with stable living arrangements. Women in the homeless/refuge population were statistically more likely to be single (75.2 % vs 39.5 %, p < 0.001), have an unplanned pregnancy (73.7 % vs 27.2 %, p < 0.001), report a history of psychiatric illness (42.9 % vs 22.4 %, p < 0.001), domestic violence (18.8 % vs 0.9 %, p < 0.001) alcohol consumption in pregnancy (3.0 % vs 0.8 %, p < 0.001) or smoking in pregnancy (41.3 % vs 9.7 %, p < 0.001). They were significantly more likely to have a preterm birth (adjusted OR 1.71 (1.01–2.87) p = 0.04). They also had a significantly lower median birth weight compared to the reference population (birthweight 3270 g vs 3420 g, p < 0.001). Women in the homeless and refuge population are more likely to experience poorer perinatal outcomes compared to women with stable living arrangements. [ABSTRACT FROM AUTHOR]

This article considers the ways in which we as a society see victims of crime, particularly those who fall into Miers' category of 'delinquent victims'. Focusing on homelessness in the United Kingdom, the article is critical of the 'victim' label, which is arguably at odds with real crime victims, yet produces the victims we do see as well as those we do not. While those experiencing homelessness suffer from heightened levels of victimisation, they are also less likely to attain victim status. The following discussion seeks to rationalise this paradox by suggesting that being seen as homeless is somehow incompatible with being seen as a victim. Given the importance of the visual, drawing is employed as a research method to understand public perceptions of homelessness and crime. The resulting visual representations are unanticipated, yet significant, and often omit the crime component entirely, instead focusing on stereotypical representations of homelessness. The article concludes by emphasising the importance of seeing and suggests directions for future research. [ABSTRACT FROM AUTHOR]

Skid Row is an impoverished neighborhood in Los Angeles, also known as the homeless capital of America. Those experiencing homelessness have compounding needs that are largely unmet by existing safety-net systems. The goal of this study is to evaluate the needs of homeless individuals in the Skid Row community, to better tailor services for the homeless population residing in the area. For the study, the International Collegiate Health Initiative (ICHI), a 501(c)-3 nonprofit, conducted a community needs assessment and a comprehensive review of the literature regarding community-based solutions to addressing unmet needs of this population. A cross-sectional survey approach was utilized to conduct a community needs assessment of adults residing in Skid Row. The subsequent descriptive analysis of the data collected reveal unmet needs of individual's health, social, and employment situations among unhoused individuals in Skid Row. Potential exists for the needs of the unhoused population to be met through various community efforts and public health interventions. The identified service priorities for mental health care, medical care, and employment services, are verified by prior literature which identifies high frequency of mental health issues, substance use, and underemployment in the population. [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]

Medicaid is expanding funding for tenancy support services (TSS) that help people who have experienced homelessness or lived in institutional settings obtain and maintain housing. To identify critical considerations for Medicaid TSS regulations, we compared two successful TSS provider agencies in North Carolina, and conducted additional stakeholder interviews in North Carolina and Louisiana, which is ahead of North Carolina in expanding Medicaid-funded TSS. Stakeholder concerns focused on the impact of regulation on goals of access, quality, and flexibility, and noted tensions among these goals. Specific regulatory approaches may mitigate the tension among these goals, such as outcome- and client feedback-based accountability, and an emphasis on job-specific training. Moreover, meeting the goals of access, quality, and flexibility and mitigating their trade-offs is supported by state infrastructure that includes braided funding; horizontal and vertical coordination across agencies; and the capacity for multimodal, multilevel quality assurance and multilevel training and technical assistance. [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]

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]

This study examines facilitators and barriers to attain housing among adults who identify as 2SLGBTQ+ (Two-Spirit, lesbian, gay, bisexual, transgender, queer) and who have experiences of homelessness. Twenty 2SLGBTQ+adults who were currently or formerly homeless participated in one qualitative interview. The interview protocol included questions on the participants' experiences with exiting homelessness and searching for housing. Data was analyzed using an iterative coding process. The results show that participants engaged in various paths to access housing, including goal setting related to one's gender identity and health, and accessing formal and informal supports. Barriers largely focused on discrimination from landlords, a lack of safety in one's housing or neighborhood, a lack of awareness of services, and challenges with accepting one's 2SLGBTQ+identity and related fear of unequal treatment from service providers. The results are discussed in terms of policy and programming strategies to support 2SLGBTQ+adults to attain permanent housing in the community. [ABSTRACT FROM AUTHOR]