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Students of child health nursing conducted weekly preschool health promotion activities for children in homeless shelters. They also organized a health fair and interviewed family members to learn about their coping strategies and help they develop healthy strategies. (SK)

Nursing faculty initiated a partnership with a homeless shelter through which nursing students experienced community nursing and health promotion. Lessons learned from partnership development included the importance of ongoing dialogue and negotiation and clarification of expectations and responsibilities. (SK)

While many design projects assume they empower participants, studies that evaluate the effectiveness of empowerment in Participatory Design (PD) are rare. This paper investigates which elements architectural design projects need to consider if they want to effectively empower the individuals and communities involved. To address this, we use the Theory of Action (ToA) part of the Direct Design Empowerment Framework, to analyse the end user empowerment process and outcomes in the Solidary Mobile Housing (SMH) project and draw lessons from this case. SMH is a Living Laboratory on the co-creation of an alternative, temporary, or transitional housing solution for the Brussels-Capital Region. Our detailed unravelling of the inputs, strategies, activities, factors, outcomes, and outputs of this PD project reveals how consideration of all participants’ needs and wishes, collaboration with experienced social organisations, the use of boundary objects, and extensive and open communication not only contributed to empowering the homeless people involved but also led to mutual learning for all the other parties involved. In general, this paper demonstrates how participation in the design process can enable signposting/prefiguration directly with end users and allow for Networked Critical Spatial Practices and how this, in turn, can contribute to architectural design empowerment. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionIn this article, we describe an institutional ethnographic investigation of the housing and homelessness response in one municipality in Ontario, Canada.Drawing on 42 interviews with social service professionals and municipal government employees and 49 interviews with people who are or have been using municipal housing and homeless services (e.g. emergency shelters, mobile healthcare, outreach services, transitional housing), we bring into view some of the inter-institutional and organizational processes that shape housing precarity among people who use drugs.Our research pinpoints specific institutionally-organized processes – i.e. structural vulnerabilities – that expose people who use drugs to housing loss, unsheltered homelessness, and difficulties in re-housing (or homeless chronicity). In many cases, the processes also make people more vulnerable to harms associated with substance use.The specificity of our analysis points toward policy, legislative and institutional reforms that could improve access to justice, health, and housing for people who use drugs. [ABSTRACT FROM AUTHOR]

Drawing on field interviews, this study examines hurricane plans among men experiencing homelessness in Central Florida. Specifically, we demonstrate how shelter policies contribute to homeless shelter aversion leading some participants' to assert that they are better off riding out hurricanes alone in tents or makeshift shelters. Secondly, we examine how past experiences contribute to a sense of self-efficacy among participants, which may lead them to perceive tents and improvised shelters as providing adequate shelter. This article builds on Kusenbach's research on hurricane plans among mobile home residents, arguing that socially marginalized populations assess risk and vulnerability based on experience and socio-cultural context. [ABSTRACT FROM AUTHOR]

Background: The City of Boston has faced unprecedented challenges with substance use amidst changes to the illicit drug supply and increased visibility of homelessness. Among its responses, Boston developed six low threshold harm reduction housing (HRH) sites geared towards supporting the housing needs of people who use drugs (PWUD) and addressing health and safety concerns around geographically concentrated tent encampments. HRH sites are transitional supportive housing that adhere to a "housing first" approach where abstinence is not required and harm reduction services and supports are co-located. Despite the importance of HRH, the specific characteristics and operations of these sites are not well understood. This study sought to address this gap by cataloging the common features of Boston's HRH sites to generate a comprehensive inventory tool for evaluating implementation of harm reduction strategies at transitional housing locations. Methods: We collected data between June and September 2023 and included semi-structured qualitative interviews with HRH staff (n = 19), ethnographic observations and photos at six HRH sites. Candidate inventory components were derived through triangulation of the data. Two expert medical staff unaffiliated with data collection reviewed a draft inventory measuring awareness and utility of HRH inventory components. We then pilot tested the inventory with three HRH residents across two sites for readability and reliability. Awareness, frequency of use, and perceived helpfulness of key inventory items were further tested in a survey to 106 residents. Results: HRH staff identified best practices, resources, and policies in HRH sites that were further contextualized with ethnographic field notes. Common to all were overdose prevention protocols, behavioral policies, security measures, and distribution of harm reduction supplies. The initial 44-item inventory of services, policies and site best practices was further refined with expert and participant feedback and application, then finalized to generate a 32-item inventory. Residents identified and valued harm reduction services; medical supports were highly valued but less utilized. Conclusion: The HRH inventory comprehensively assesses harm reduction provision and residents' awareness and perceived helpfulness of HRH operational components in staying safe from drug-related harms. Characterizing the critical components of HRH through this tool will aid in standardizing the concept and practice of HRH for PWUD and may assist other cities in planning and implementing HRH. [ABSTRACT FROM AUTHOR]

• 34% of parents in shelters reported at least one weekly nonparental care arrangement. • Over 46% of parents reported being the sole provider of care for their child. • Children of Black/African American ethnicity were less likely use child care. • Child care usage was predicted by older child age and parent employment. Families living in homeless shelters with young children (birth-36 months) face a variety of complex challenges which make it difficult to locate and maintain child care enrollment. Although the inequitable access to child care for families in shelter has been documented, little is known about the factors that predict child care usage among families experiencing homelessness. This investigation utilized interviews of 150 parents with children ages birth-36 months residing in nine different homeless shelters to identify: how many families used center-based care, how many families relied only on parental care, and what other types of nonparental child care arrangements families utilized. Next, we investigated whether usage of center-based child care was associated with child and family characteristics of race/ethnicity, unemployment, time spent in shelter, reasons for seeking shelter, and parent depression symptoms. Data for this study came from three data collection efforts considering risk and resilience factors among families with infants and toddlers experiencing homelessness. Parents in this study reported using nonparental child care at lower rates than the general population. Employed parents were more likely to use center-based child care, and families who reported their child's race/ethnicity as Black or African American were less likely to report using center-based child care. Findings have implications for policy considerations necessary to support the use of center-based child care among families living in homeless shelters. [ABSTRACT FROM AUTHOR]

This study aimed to examine the factors that either mitigate or impede exiting from the roofless situation among single homeless adults who stayed in a homeless shelter. The study is focused on factors like mental disorder pathology, sociodemographic characteristics, as well as the itineraries taken by each resident. The methodology was based on pre-test post-test data, which was analysed by statistical tests. The study sample was composed by N=241 homeless adults who exit the housing program between 2019 and 2020. Data was collected from the entity's database, where both baseline and exit questionnaires were digitally recorded for every participant in the program. The obtained results show that, on average, residents with mental health pathologies (MHP), that are treated through a comprehensive approach, seem to show similar results in terms of housing outputs (not roofless, ETHOS=B or higher) in comparison with residents without mental health pathologies. Among residents with MHP, staying for more than 3 months in the program has a higher percentage of exits out of the roofless situation than those cases that have a shorter duration (less than 3 months), or those who do not have any MHP. People with addictions show lower percentages of exiting the roofless situation compared to people without addictions. The study concludes that, for homeless people with MHP, stays longer than 3 months in a service for homeless people are beneficial for the success of the program, in terms of housing situation. Within this period, they have more chances to be attended by the mental health service, allowing them to adhere to the prescribed treatments. This period may allow them to access to public aids associated to their health condition, which improves their economic situation, their access to housing or access to permanent residential resources. [ABSTRACT FROM AUTHOR]

Violence is a critical issue in homeless shelters that affects service users and staff, yet there is limited evidence on how shelter-based violence occurs. The objective of this qualitative study was to investigate the antecedents and consequences of shelter-based violence from the perspectives of service users and staff. Purposive sampling was used to recruit individuals experiencing homelessness and shelter staff in a large metropolitan city in Ontario, Canada. Data from in-depth interviews with 56 individuals experiencing homelessness and 30 shelter staff were analyzed. Findings showed that shelter-based violence toward service users and staff was perceived to manifest in response to three interacting factors: (a) burden of homelessness and shelter living, (b) individual histories and marginalization, and (c) interpersonal conflict. These antecedents had a hierarchical structure in that each subsequent factor exacerbated the risk of previous ones and culminated with the most proximal factor for violence. There were three primary outcomes of shelter-based violence reported by service users and staff: (a) health and environmental harms, (b), procedural enforcement, and (c) avoidant behaviors. Avoidance was often a subsequent impact following health harms, as was procedural enforcement to a lesser extent. Overall, the study findings demonstrate that shelter-based violence is a complex and dynamic problem that is perceived to be the result of interacting structural, environmental, programmatic, interpersonal, and individual factors, with similar consequences for service users and staff. Implications for preventing violence through shelter design and service delivery are discussed. [ABSTRACT FROM AUTHOR]

Background: To compare the effectiveness of four surveillance strategies for detecting SARS-CoV-2 within the homeless shelter population in Hamilton, ON and assess participant adherence over time for each surveillance method. Methods: This was an open-label, cluster-randomized controlled trial conducted in eleven homeless shelters in Hamilton, Ontario, from April 2020 to January 2021. All participants who consented to the study and participated in the surveillance were eligible for testing by self-swabbing. SARS-CoV-2 detection rate as the primary outcome, number of outbreaks, adherence, and overall acceptability were assessed. All participants, which included staff and residents, underwent daily symptom surveillance conducted by shelter staff and shelters were allocated to one of three asymptomatic surveillance arms (once weekly, self-collected oral swabs (OS); once-weekly self-collected oral-nasal swab (ONS); or once-weekly nurse collected nasopharyngeal swab (NPS) or a symptomatic only SARS-CoV-2 testing arm. Results: A total of 9747 SARS-CoV-2 tests were performed on 1570 participants. There were 4527 participants allocated to oral swab collection and 4935 participants allocated to oral-nasal swab collection. For nasopharyngeal swab collection, 285 participants were assigned before this arm was discontinued. The OS group identified 5 new cases (1.1 per 1000; 95% CI 0.4–2.3), while the ONS group identified 15 new cases (3.0 per 1000; 95% CI 1.9–4.7), resulting in a Risk Ratio (RR) of 2.76 (95% CI 1.00-7.58; p = 0.040). However, the mixed-effect model did not show a significantly higher positivity rate in the ONS compared to OS (OR 1.64; 95% CI 0.76–9.14; p = 0.129). Both ONS and OS were preferred over NPS, which did not detect any cases due to low adherence. Three outbreaks were identified during the study period within the shelters, two of the outbreaks had 2 positive cases each and the third outbreak had 3 positive cases. Conclusions: The two self-collection strategies were superior and showed the best adherence, with the ONS strategy shown to be superior or non-inferior in all measures. We are now studying the operationalization of a large-scale self-collected ONS surveillance strategy in a prospective cohort study of multiple homeless shelters. Funding was provided by the Hamilton Academic Hospital Organization (HAHSO) and Research St. Joseph's - Hamilton. Trial Registration: The trial was retrospectively registered with ClinicalTrials.gov on June 18, 2020, with the identifier NCT04438070. [ABSTRACT FROM AUTHOR]

ObjectiveMethodResultsConclusionsTo examine differences in parenting factors among caregivers with children with and without externalizing behavior problems (EBP) in a community homeless shelter sample versus a stable housing sample.Nine hundred and fourteen children (ages = 2.01-7.49 years, SD = 1.45 years, 40.8% female, 54.3% Black, 46.7% Hispanic) were recruited from a service-driven research project in a shelter setting (n = 638) and a longitudinal/clinical study (n = 276). Primary caregivers (97% mothers) completed a parenting stress questionnaire and an observational measure of parent-child interactions.Logistic regression indicated that children who were Black and/or of Hispanic background were less likely to be identified as having elevated EBP but only in the homeless shelter sample. Multivariate analyses indicated that the homeless shelter-EBP group reported the highest levels of overall stress compared to the homeless shelter-typically developing (TD), stable housing-EBP and stable housing-TD groups. Mothers from the homeless shelter-EBP group exhibited a higher proportion of negative verbalizations relative to caregivers from all other groups while mothers from the homeless shelter-TD group exhibited a higher proportion of positive verbalizations relative to the caregivers from the homeless shelter-EBP group and the stable housing TD group. Both homeless shelter groups engaged in less total verbalizations relative to both stable housing samples, with the stable housing-EBP group exhibiting the most verbalizations.High levels of parenting stress and negative parent-child interactions within a homeless shelter sample are exacerbated by having a child with EBP. Embedding universal parenting programs in a homeless shelter setting to reduce parenting stress would be valuable to address health disparities in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: A new transitional housing program was established in Sudbury, Ontario, Canada, in response to the escalating global prevalence of substance use and homelessness, and the specific challenges faced in Northern Ontario. This protocol outlines a comprehensive program evaluation to assess its impact on patient outcomes, healthcare utilization, and client perspectives. Methods: We will conduct a parallel mixed-method study that includes the analysis of single-center-level administrative health data and primary data collection. This includes a longitudinal observational study (target n = 1,200), pre- and post-admission quantitative interviews (target n = 40), and qualitative interviews (target n = 40). We will implement a participatory approach to this evaluation collaborating with people who use substances, frontline staff, and decision-makers. Data analysis methods include a range of statistical techniques, including logistic regression models, Cox proportional hazards models, Kaplan-Meier curves, Generalized Estimating Equations, and thematic qualitative analysis, ensuring a robust evaluation of patient outcomes and healthcare utilization. Discussion: This protocol underpins a comprehensive assessment aimed at providing insights into the program's effectiveness in addressing substance use-related challenges, reducing healthcare disparities, and improving patient outcomes, such as stable housing and increased social capital. All study procedures adhere to the ethical principles outlined in the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Findings will be disseminated progressively through established committees and working groups and subsequently published in peer-reviewed journals. Anticipated outcomes include informing evidence-based healthcare decision-making and driving improvements in addiction treatment practices within healthcare settings. [ABSTRACT FROM AUTHOR]

Iran is one of the earthquake-prone countries in the world. The problem is that despite the studies and researches made, it seems that no significant progress has been achieved in the field of post-earthquake temporary shelter design, using climatic approach. The use of Conex and prevalent methods of providing temporary shelter for the homeless after the recent disasters in Iran has not been effective due to the lack of adaptation to the climate, context, and characteristics of the affected area. On the one hand, they have caused long-term problems in the area, and on the other hand, they have wasted financial resources. Therefore, the purpose of this article is to design alternatives for post-earthquake temporary shelter in the city of Isfahan, Iran, located in hot-arid climate. In this regard, to find the best result, alternatives are designed and the final alternative is presented, by recognizing and analyzing the indicators and criteria of the temporary shelter, as well as framework development based on the context and conditions of the climate. The findings of this study display that in addition to criteria of 'upgradable', 'reusable', 'relocatable', 'recyclable', and 'resaleable', it is recommended to consider other criteria including 'climatic', 'modular', 'community-based', 'multi-functional', and 'context-based' in the design of post-earthquake temporary shelter. The practical implication of the article is that the developed criteria are generalizable, and the alternatives proposed can be used in similar climates and answer the challenges related to thermal comfort, transportation, recycling, assembling, upgradability, flexibility, and modularity of temporary shelter units. [ABSTRACT FROM AUTHOR]

This research paper examines threshold spaces in traditional housing within historic Indian cities, emphasizing how these transitional areas are shaped by cultural, social, and environmental influences. It underscores that thresholds function beyond mere physical divisions between interior and exterior; they are intricate spatial elements that engage the senses and perception. Key findings include the following: (a) Historical evolution: traditional dwellings display layers of history, shaped by cultural, economic, and climatic factors. (b) Character and morphology: this paper explores the qualities and structures of threshold spaces, analyzing features such as transparency, material choice, hierarchy, and enclosure. (c) Social significance: thresholds play essential roles, supporting a variety of activities, providing shelter, defining boundaries, enhancing community interaction and security, and contributing to residents' identities. (d) Design implications: insights from this study suggest that a deeper understanding of these spaces can enhance design strategies for transitional areas in housing, highlighting their functional and socio-cultural value. The study adopts a structured comparative analysis of six case studies, evaluated at four scales—township, neighborhood, dwelling, and threshold—focusing on spatial parameters including design, function, definition, structure, and sequence. Overall, this paper highlights the critical role of threshold spaces in architecture and urban design, demonstrating their potential to enhance social interaction, define spatial relationships, and reflect cultural significance in contemporary design practices. [ABSTRACT FROM AUTHOR]

The politics of participatory design implicates empowerment as the core value of the approach. This study centres on empowerment as its primary focus and seeks to address the gap in literature by exploring the implications of the phenomenon in architectural design. Direct Design Empowerment Framework (dDEF) is briefly introduced and applied to analyse the end user empowerment in the Solidary Mobile Housing (SMH) case – a Living Laboratory on the co-creation of an alternative, temporary, or transitional housing solution for the Brussels-Capital Region. Besides revealing that the SMH proposal can be considered promising in terms of end user empowerment, the critical discussion of the findings also reveals a lack of clarity in defining empowerment in architectural design. It is argued that an explicit and systematic evaluation is needed for identification and more radical envisioning of empowerment facilitating power sharing and mutual learning between all actors. Finally, as a secondary outcome, the study presents observations on the efficacy of dDEF in evaluating empowerment. The study concludes by revisiting the research questions, discussing its limitations, and suggesting for future research directions. [ABSTRACT FROM AUTHOR]

In this article, we argue for the relevance of studying the association between objects and people as co‐constituting legality in everyday life rather than solely focusing either on people or on 'icons'. Indeed, we go further and argue that scholarship is in danger of producing an impoverished version of legal consciousness if it fails to look beyond the human actors, the people in society. Studying objects and associations, and their role in the making of legalities, is enriched by engaging with the insights of legal consciousness, and its close attention to the way in which everyday forms of engagement with legal orders are co‐constitutive of legality. We illustrate through two different case studies how associations between objects and people (in a homeless shelter for young people and among herbalists) mediate and shape legal consciousness. [ABSTRACT FROM AUTHOR]

Background Despite many studies evaluating lung ultrasound (LUS) for coronavirus disease 2019 (COVID-19) prognostication, the generalizability and utility across clinical settings are uncertain. Methods Adults (≥18 years of age) with COVID-19 were enrolled at 2 military hospitals, an emergency department, home visits, and a homeless shelter in the United States, and in a referral hospital in Uganda. Participants had a 12-zone LUS scan performed at time of enrollment and clips were read off-site. The primary outcome was progression to higher level of care after the ultrasound scan. We calculated the cross-validated area under the curve for the validation cohort for individual LUS features. Results We enrolled 191 participants with COVID-19 (57.9% female; median age, 45.0 years [interquartile range, 31.5–58.0 years]). Nine participants clinically deteriorated. The top predictors of worsening disease in the validation cohort measured by cross-validated area under the curve were B-lines (0.88 [95% confidence interval {CI},.87–.90]), discrete B-lines (0.87 [95% CI,.85–.88]), oxygen saturation (0.82 [95%, CI,.81–.84]), and A-lines (0.80 [95% CI,.78–.81]). Conclusions In an international multisite point-of-care ultrasound cohort, LUS parameters had high discriminative accuracy. Ultrasound can be applied toward triage across a wide breadth of care settings during a pandemic. [ABSTRACT FROM AUTHOR]

This study presents an innovative enhancement to retrieval-augmented generation (RAG) systems by seamlessly integrating fine-tuned large language models (LLMs) with vector databases. This integration capitalizes on the combined strengths of structured data retrieval and the nuanced comprehension provided by advanced LLMs. Central to our approach are the LoRA and QLoRA methodologies, which stand at the forefront of model refinement through parameter-efficient fine-tuning and memory optimization. A novel feature of our research is the incorporation of user feedback directly into the training process, ensuring the model's continuous adaptation to user expectations and thus, improving its performance and applicability. Additionally, we introduce a Quantized Influence Measure (QIM) as an innovative "AI Judge" mechanism to enhance the precision of result selection, further refining the system's accuracy. Accompanied by an executive diagram and a detailed algorithm for fine-tuning QLoRA, our work provides a comprehensive framework for implementing these advancements within chatbot technologies. This research contributes significant insights into LLM optimization for specific uses and heralds new directions for further development in retrieval-augmented models. Through extensive experimentation and analysis, our findings lay a robust foundation for future advancements in chatbot technology and retrieval systems, marking a significant step forward in the creation of more sophisticated, precise, and user-centric conversational AI systems. We make the dataset, the data processing package huggify-data, the model, and the app publicly available for the community. [ABSTRACT FROM AUTHOR]

Congregate homeless shelters are disproportionately affected by infectious disease outbreaks. We describe enterovirus epidemiology across 23 adult and family shelters in King County, Washington, USA, during October 2019-May 2021, by using repeated cross-sectional respiratory illness and environmental surveillance and viral genome sequencing. Among 3,281 participants >3 months of age, we identified coxsackievirus A21 (CVA21) in 39 adult residents (3.0% [95% CI 1.9%-4.8%] detection) across 7 shelters during October 2019-February 2020. We identified enterovirus D68 (EV-D68) in 5 adult residents in 2 shelters during October-November 2019. Of 812 environmental samples, 1 was EV-D68-positive and 5 were CVA21-positive. Other enteroviruses detected among residents, but not in environmental samples, included coxsackievirus A6/A4 in 3 children. No enteroviruses were detected during April 2020-May 2021. Phylogenetically clustered CVA21 and EV-D68 cases occurred in some shelters. Some shelters also hosted multiple CVA21 lineages. [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]

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]

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]

Medical respite programs (MRPs) constitute a potential strategy to improve the continuum of care for persons who have lived experiences of homeless (PWLEH). A MRP was developed in Alberta, Canada, through a partnership between the provincial health authority (Alberta Health Services) and the province's largest homeless shelter (Calgary Drop-In Centre). We conducted a qualitative study of 25 stakeholders who held an operational, administrative and/or healthcare provider role in the MRP's design and implementation to evaluate the barriers and facilitators to its implementation using Proctor's implementation framework. While stakeholders had a common motivation of addressing health inequity, the program's acceptability and fidelity were hampered by a lack of clear common objectives and expectations. Program adoption was difficult due to differences in organizational policies and priorities. Program staff and leadership were dedicated to the patient population, enhancing feasibility, but the limited training and experience of frontline providers specifically in addictions and mental health resulted in important needs not being met (affecting intervention appropriateness). The lack of integration with community resources, despite being intended as a program to transition patients from hospital to community, affected program penetration. Our findings are relevant for other jurisdictions and organizations aiming to develop and implement similar interventions. [ABSTRACT FROM AUTHOR]

Distress Tolerance (DT) is a transdiagnostic factor that may help better understand vulnerability to mental health problems. This study explores DT among recently incarcerated adults experiencing homelessness (RIHAs). Participants (n = 298) were recruited from an ongoing clinical trial at a homeless shelter in Texas. Cross-sectional linear regression analyses were conducted to examine the relations between DT subconstructs (tolerance, appraisal, regulation, and absorption) and psychosocial factors (depression, aggression, hostility, anxiety, and stress) in a sample of RIHAs. Lower DT absorption was associated with greater depression, aggression, hostility, anxiety, and stress. Lower DT appraisal was associated with greater hostility, anxiety, and stress. Greater DT regulation was associated with lower hostility and stress (ps<.05). DT tolerance was unrelated to any psychosocial factors. DT subscales are associated with psychosocial factors among RIHAs. Future research should assess the feasibility of interventions that enhance DT absorption and appraisal coping among RIHAs. [ABSTRACT FROM AUTHOR]

COVID-19 vaccines mitigate severe disease, yet uptake remains low among people experiencing homelessness (PEH) despite the risk of transmission in congregate settings like homeless shelters. This study evaluated retrospective COVID-19 vaccination intent and decision-making between March 2020-October 2021 to identify modifiable factors to improve vaccine acceptance among PEH. We conducted 31 semi-structured interviews and eight focus group discussions across six homeless shelters in Seattle-King County, Washington. Residents and staff aged ≥18 years were recruited through purposive sampling for interviews and convenience sampling for focus groups. Thematic analysis was conducted. Participants reported that too much contradictory and changing information about COVID-19 vaccines led to confusion. Information deemed trustworthy contributed to individual's knowledge and in some cases changed their vaccination intent. While many intended to get vaccinated without external motivators, others were motivated by incentives and requirements. Despite intention to vaccinate, participants reported barriers to COVID-19 vaccine access including availability of vaccine doses, timely eligibility for vaccination, and availability of appointments. Participants presented recommendations to improve COVID-19 information content and dissemination, access, and use of incentives in shelter settings. Future research should test recommended vaccination strategies rooted in the voices and experiences of PEH to determine feasibility and effectiveness in shelter settings. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Describe patterns of substance use and comorbid conditions among clinic attenders in homeless shelters in Sydney. Method: Retrospective cohort study of 2498 people who attended a psychiatric clinic at one of three homeless hostels between February 2008 and May 2020. Multivariable logistic regression was used to identify factors associated with self-reported substance use, psychiatric diagnosis and measures of social function. Results: A total of 2041 of the 2498 (81.7%) reported the harmful use of at least one substance, with alcohol (61.8%), cannabis (50.9%) and stimulant drugs (34.9%) the three most common. Those reporting the regular use of two or more substances (1466, 58.7%) were more likely to have a history of early life and adult trauma, a diagnosis of personality disorder, a criminal conviction, receive the Disability Support Pension, be chronically homeless and sleep in the open. Conclusions: The study found a high rate of polysubstance use among homeless clinic attenders in Sydney, and an increase in the prevalence of substance use compared to previous studies. Substance use is both a cause and a consequence of homelessness, and services to address substance use have to be part of any program to reduce homelessness and sleeping in the open. [ABSTRACT FROM AUTHOR]

While corporate social responsibility by firms aims at improving welfare for different social groups, whether it achieves this is often difficult to measure. After Apr. 2018 protests, Starbucks enacted policies that anybody could sit in their stores and use the bathroom without making a purchase. Using anonymized cellphone location data, we estimate this led to a 7.0% decline in attendance relative to other nearby coffee shops. The effect is 84% larger near homeless shelters and larger for Starbucks' wealthier customers. The average time spent per visit declined by 4.1%. Public urination citations decreased near Starbucks locations, but other minor crimes were unchanged. [ABSTRACT FROM AUTHOR]

This ethnographic exploration of death in the Peruvian context draws on fieldwork among abandoned–both by their families and the state–older adults in a shelter for the homeless in Lima, Peru. I examine the conditions and local forces that shape the ways people at this institution socially and physically die. My argument is that people in this long-term care facility who have lived entire lives on the margins, usually, end up having irrelevant deaths to their families, other residents of the institution, and the Peruvian state. At this shelter, dying in an irrelevant way means dying without companionship from family members and receiving poor and flawed care from the institution that shelters them. [ABSTRACT FROM AUTHOR]

Background and Aims: Louse‐borne Bartonella quintana infection and flea‐borne murine typhus are two potentially serious vector‐borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse‐ and flea‐borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases. Methods and Results: Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared. Conclusions: Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse‐ and flea‐borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing. [ABSTRACT FROM AUTHOR]

This paper is based on an ethnographic study of how domesticity is enacted and adapted at homeless shelters for determining which clients are “service worthy .” The study draws on nineteen placement meetings with homeless men and focuses on institutional mechanisms for encouraging homemaking skills or domesticity among clients. Adapting Robert K. Merton's typology of adaptations to social norms, as well as Jaber Gubrium's “task‐designated identity,” we showcase male clients' self‐presentation strategies for adapting to the institutional mandates of domesticity. Specifically, our qualitative analysis reveals four modes of task adaption: (1) task conformity by professing the desired norms in their service encounters, (2) task evasion to avoid conversations and related tasks, (3) task transformation by linking the task at hand with something other than originally intended, particularly by reframing biographies to meet the local goals of domesticity, and (4) task protestation, which involves questioning the rationale and necessity of assigned tasks. [ABSTRACT FROM AUTHOR]

The impact of housing and individual residential mobility on recidivism is nuanced. Individuals may move from prosocial environments to criminogenic environments, or from neighborhoods that are more, or less, socioeconomically disadvantaged. We explore these phenomena using data on individuals on parole in the District of Columbia with community-level Census data. We hypothesize that residential mobility will affect recidivism through changes in both housing types and neighborhood characteristics. Findings suggest that people immediately placed into treatment-oriented or transitional housing had lower rates of rearrest than those in other housing situations. Results of the community-level measures of social disorganization were mixed. [ABSTRACT FROM AUTHOR]

Trauma-informed care (TIC) benefits to service users and providers are increasingly acknowledged across various health and social care settings. TIC can potentially increase service user engagement, prolong shelter placements, and lessen staff vicarious trauma and burnout. However, studies documenting staff experiences and/or the implementation of TIC are scarce. This limitation has prompted calls for more grounded and applied research into trauma-informed practice, tracking implementation in practice, staff perceptions, barriers, and organisational change. This study aims to address this gap and is an ecological, mixed-methods evaluation of the efficacy of TIC training in a female-only homeless shelter. Quantitative data included 132 incident reports during the first yearly quarters pre- and post-training, hypothesising post-training reductions in incident numbers and severity. Using expansive thematic analysis, semi-structured interviews with six shelter staff (n = 6) explored employee views of TIC relative to trauma understanding, incident management, and integration in practice. Findings revealed a marginal increase in incident numbers and a statistically significant reduction in incident severity post-TIC with a 50% reduction in calls to emergency medical services (EMS). Participant accounts of working practice pre- and post-TIC uncovered increased trauma understanding, increased confidence and competence, healing relationships, and enhanced selfcare. Findings are discussed with reference to Substance Abuse and Mental Health Services Administration (SAMHSA)'s (2014) traumainformed framework and Yatchmenoff et al's. (2017) core questions in evaluating TIC. While these results are significant as one of the first evaluations of TIC training in Ireland, limitations and implications for future research and practice are considered. [ABSTRACT FROM AUTHOR]

Why do some cities provide many emergency shelter beds while others do not? We interpret differences with respect to the supply of shelter beds as originating from alternative choices concerning a series of policy trade-offs. These trade-offs arise because of climate effects, prejudice, levels of poverty, and housing and labour market conditions affecting the rates of homelessness. Governments have policy levers they can adjust to respond to changes in most, if not all these conditions. One of these policy levers is the number of emergency shelter beds that are made available. But other policy responses are also possible. These include efforts to reduce poverty, policies designed to increase the stock of affordable housing, and policies to increase income support payments. Choosing to supply shelter beds over other policy responses reveals a preference for one set of societal outcomes over another. Using data describing conditions in 52 Canadian cities, we test six hypotheses describing why some communities choose to provide more homeless shelter beds than others. [ABSTRACT FROM AUTHOR]

Background: A structure of everyday life creates routines and a sense of familiarity, which provides a recognizable basis for being and acting in the world. A structure of everyday life reduces stress, and daily stress has consistently been associated with higher levels of psychiatric symptoms. Little is known about how patients with schizophrenia and severe social impairment structure their lives. Thus, we aimed to explore the everyday lives of this group of patients, looking for structuring elements. Methods: In this qualitative study, we included patients diagnosed with schizophrenia who were either homeless or had difficulties reporting for treatment and, thus, needed treatment from an outreach team. Results: 17 participants were included in the study. We found only few structuring elements across all participants in the qualitative analyses. We identified five themes in our sample that serve as structuring elements in the everyday life: social interactions, volunteering to assist with basic tasks, self-initiated routines such as going for a walk daily, exoskeleton (structure provided by others), and having pets. None of the participants reported much activity during the day, and for most of them, social interactions were minimal. Discussion: All the participants had very little structure and routines in their everyday life. The shelters provided the homeless participants with some structuring elements, whereas the domiciled participants had no external structuring elements. The findings have important implications for psychosocial treatment of severe social impairment in schizophrenia. The lack of structure in these patients' everyday lives highlights the need for targeted interventions that could facilitate such structures and guide social involvement and personal recovery. [ABSTRACT FROM AUTHOR]

People experiencing homelessness are more likely to utilize emergency departments than their non-homeless counterparts. However, obtaining a bed in a homeless shelter for patients can be complex. To better understand the challenges of finding a safe discharge plan for homeless patients in the emergency department, our team conducted interviews with emergency department social workers and homeless shelter case managers in the Boston area. We identified and mapped the stages in the processes performed by both parties, identifying challenges with successful placement into a shelter. Furthermore, we assembled a data dictionary of key factors considered when assessing a patient's fit for a homeless shelter. By identifying bottlenecks and areas of opportunity, this study serves as a first step in enabling homeless individuals to receive the post-discharge assistance they require. [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]