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Objective: To identify organizational service features associated with positive patient ratings of primary care within primary care clinics tailored to accommodate persons with ongoing and recent experiences of homelessness (PEH). Data Sources and Study Setting: PEH receiving primary care in 29 United States Veterans Health Administration homeless‐tailored clinics were surveyed about their primary care experience using the validated Primary Care Quality‐Homeless (PCQ‐H) survey. Characteristics of the clinics were assessed through surveys of clinic staff using a new organizational survey developed through literature review, site visits, statistical analysis, and consensus deliberation. Study Design: Cross‐sectional examination of patients' ratings of care based on surveys of patients, and of clinic characteristics, analyzed with Classification and Regression Tree (CART) analysis, a form of machine learning. Data Collection Methods: Patient surveys (n = 3394) were obtained from a random sample of enrolled patients by both mail and telephone by an external survey contractor. Staff (n = 52 from 29 clinics) were interviewed by telephone. Principal Findings: This analysis identified service features that impact patient experience favorably, including aspects of patient‐centeredness, team identity, strong external leadership support, and service that reach beyond traditional primary care clinic confines. Results varied according to the patient experience scale analyzed. Individual characteristics of PEH, such as degree of social support, general health, and unsheltered status, were also correlated with how they rate care. Conclusions: Organizational characteristics correlate with ratings of primary care from patients with recent and ongoing homelessness. Primary care programs serving homeless individuals can assure better care based on who they hire, how they foster team identity, what services they provide, and the strength of leadership support to protect a homeless‐focused mission. [ABSTRACT FROM AUTHOR]

This paper considers interactions between police and individuals experiencing homelessness, a fundamental aspect of contemporary urban dynamics. The challenges and vulnerabilities faced by the 'street population' intersect with policing priorities in ways that prompt re-evaluation of conventional policing methods. Beginning with an exploration of existing research, Section 1 analyses police interactions with the street population, illuminating the complexities, challenges, and outcomes of these encounters. Section 2 takes an ethics-based approach to scrutinise the implicit assumptions and values underpinning traditional policing. By dissecting the moral implications of these encounters, the paper underscores the necessity for an alternative framework grounded in compassion, empathy, and social welfare. Section 3 considers the potential for a paradigm shift in policing methods concerning the street population towards community-based strategies, restorative justice practices, and collaborative partnerships between police and social service providers. By combining research findings, ethical considerations, and potential strategies, the paper contributes to a deeper understanding of these interactions, ultimately seeking to enhance the well-being of people experiencing homelessness and promote community harmony. By challenging existing paradigms and advocating for a more empathetic and socially conscious approach, the paper strives to ignite meaningful transformations that address the complex dynamics between police and the street population. [ABSTRACT FROM AUTHOR]

Background: Alcohol misuse is higher among adults experiencing homelessness (AEH) compared to housed adults. Greater expectancy that alcohol will improve mood, negative affect, and lower self-efficacy have been linked to alcohol misuse in AEH. However, little is known about the momentary relationships between affect, alcohol expectancies, and self-efficacy to avoid alcohol in AEH. To our knowledge, this is the first study to examine these constructs in a sample of AEH. Methods: AEH (n = 72; Mage= 47, 85% Male, 68% Nonwhite) completed smartphone-based ecological momentary assessments 5x/day for four weeks. Generalized multilevel modeling examined the association between concurrent momentary ratings of (1) expectancy that alcohol would improve mood and negative and positive affect and (2) self-efficacy to do something other than drink to improve mood and negative and positive affect. Results: Momentary reports of increased negative affect were associated with greater expectancy that alcohol would improve mood (b = 0.25, p < 0.01), whereas momentary reports of increased positive affect were associated with less expectancy that alcohol would improve mood (b = −0.11, p < 0.01). Increased momentary negative affect was associated with less self-efficacy to improve mood without alcohol (b = −0.09, p = 0.03), but momentary reports of increased positive affect were associated with greater self-efficacy to do something other than drink to improve mood (b = 0.18, p < 0.01). Conclusion: It may be important to deliver real-time treatment messages suggesting alternatives to drinking and/or ways to boost self-efficacy during moments when negative affect is high. [ABSTRACT FROM AUTHOR]

The article discusses the global issue of homelessness, particularly its impact on vulnerable groups like women, Indigenous Australians, and those with mental health challenges. Topics include homelessness as a complex social issue, the lived experiences of homelessness, and the role of mental health nurses in providing trauma-informed care and advocating for affordable housing.

Introduction: Medical students, residents and faculty are all capable of holding biases towards stigmatised groups like people experiencing homelessness. This study sought to investigate how the level of training may influence perceptions of homelessness among medical students, residents and faculty. Additionally, we sought to understand how different specialities perceive people experiencing homelessness and whether this changes at various points in a career. Methods: The Health Professionals' Attitudes Towards the Homeless Inventory (HPATHI) was administered to medical students, residents and faculty at one institution in the United States. Basic demographics as well as length of time spent in practice were collected in addition to HPATHI responses. Results: A total of 1,141 individuals were invited to complete the survey, including 736 medical students, 214 residents and 191 faculty. Two hundred and ninety individuals participated in the survey and 238 recorded complete responses were analysed for a sample response rate of 238/1141 (20.9%.) Overall perceptions of homelessness across the entire sample were positive and not greatly influenced by the level of training during a medical career. Medical students across classes were largely in agreement and there was a noticeable increase in positive perceptions for students engaged in clinical rotations. However, clinical specialties demonstrated wide variation in perceptions, with the most prominent differences amongst individuals from surgical subspecialties of General Surgery and Obstetrics & Gynaecology. Conclusion: Our study demonstrates the largely favourable attitudes physicians, residents and students have towards people experiencing homelessness with implications for future work to support greater exposure to underserved populations during training. Specialty choice appears to play a larger role in the formation of attitudes towards underserved populations rather than the length of time spent in a particular specialty. [ABSTRACT FROM AUTHOR]

This article investigates the ways in which base maps are a fundamental, but under-recognised, starting point for planners, architects, cartographers and geographic information scientists in urban spatial planning and decision-making contexts. Focusing on the case study of a collaborative mapping project with the Wood Street Commons, an unhoused community in West Oakland, it contends that base maps create a cartographic terra infirma, fundamentally shaping the process of negotiations over urban space in ways that reinforce possessive logics and normalize property as central to the function of the city. Base maps do so by paradoxically absenting all people – with the effect of absenting the occupation of land by unhoused people, while shielding property owners from view while enacting their possession through infrastructure, parcel boundaries and land features. We argue this privileging inherent in the urban base map ultimately fuels a process of "unbecoming" (Fraser, 2018) – a simultaneous invisibilizing and reproduction of spatial inequality – and in response, call for attention towards the politics of base maps from urban cartographers, planners, architects and spatial scientists alike. [ABSTRACT FROM AUTHOR]

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The article from the British Journal of General Practice discusses the effectiveness of different primary healthcare models for people experiencing homelessness in England. The study, known as HEARTH, compared four models: Dedicated Centres, Mobile Teams, Specialist GPs, and Usual Care GPs. The Dedicated Centre model performed best overall, offering flexible, holistic care with a focus on people who are homeless. Specialist GPs also showed positive outcomes, while Mobile Teams faced challenges in coordination. Usual Care GPs, serving a settled population, struggled to provide care to those with complex needs. The study highlights the importance of tailored and integrated services for homeless populations and the need for effective monitoring and evaluation in primary healthcare services. [Extracted from the article]

Objectives Methods Results Conclusion The purpose of the present study was to use telephone follow‐up (TFU) to investigate the actions taken by patients after they took their own leave (TOL) from an ED, with a focus on priority groups who are at risk of experiencing health inequity. These included people experiencing homelessness (EH), people with a low socioeconomic status by index of relative socioeconomic disadvantage (IRSD) and First Nations people. The primary outcome was being seen by a general practitioner (GP) within 2 days of the TOL event. The utility of the TFU was also examined.This was an observational study of data collected during a quality improvement intervention at an inner‐city, tertiary, teaching hospital in Melbourne from January to December 2022. Descriptive results were obtained from a TFU survey that was administered 24–48 h after the TOL event.During the study period, 4209 patients TOL from the ED. Eight hundred forty‐one of these were contacted and consented to the TFU survey. 97.7% of patients expressed gratitude at being followed up. Patients EH, compared to patients not EH, were less likely to have seen their GP within 2 days of TOL event (0.295 [0.132–0.661], P < 0.001). Both First Nations patients and those from low IRSD areas were as likely to have seen their GP within 2 days as other groups.Patients EH were less likely to receive GP care within 2 days of TOL. Improving the access and acceptability of health care in these priority groups is important for achieving health equity. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Impact Reporting Methods To explore specialist homeless health professionals' perceptions of gaps in homeless health care and understand whether these might be addressed through existing nursing scopes of practice.Qualitative descriptive study.Semi‐structured interviews and focus groups with a purposive sample of 22 staff in nursing (11) and non‐nursing (11) roles, engaged with a Homeless Health Service. Data were collected via videoconferencing and recordings transcribed verbatim. An exploratory framework guided deductive and inductive thematic analysis.Service gap themes included the need for integration with mainstream health services, more specialised health professionals, and adaptations to the existing models of care. Addressing these gaps involved enhancements to the broad scope of nursing practice, workforce development by establishing homeless health as a nursing specialty and optimising organisational governance to minimise risk.The most pressing homeless health service delivery gap was lack of health service integration, and it was unclear how this could be resolved through nursing scopes of practice. Other service gaps could be addressed through skilling nurses to practice preventative health care, as well as crisis management. Enhancing nurses' capability in physical and mental health assessment skills including alcohol and other drugs and procedural skills would support wraparound care for people experiencing homelessness. We conclude that a homeless health nursing specialty could be established that formalises the scope of practice of nurses in this field to ensure future post‐graduate training aligns with service gaps.This study identifies opportunities to optimise nursing scopes of practice to address Homeless Health Service gaps through reviewing models of care and nursing practice. For example, enhancing nurses' capability to provide preventative and wraparound care. This research may inform a development pathway to enhance education and training for nurses working with vulnerable populations.COREQ 32‐item checklist.No patient or public contribution. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAimMethodsResultsConclusionService providers are experiencing mental health decline as they work to meet the needs of persons experiencing homelessness in a system that constrains their ability to help. Although moral distress is widely recognized in health care, the experience of moral distress in service providers working with people experiencing homelessness has not been explored in a scoping review.To identify the range and nature of literature on moral distress among service providers working with persons experiencing homelessness.We conducted a scoping review using Arksey and O’Malley five-stage framework.From the 2219 records yielded from our search, 40 studies were included in this review. Our narrative synthesis generated three distinct themes: 1) helping is part of our identity, it’s who we are, 2) we are doing the best we can, but there are so many barriers, 3) it’s more than we can take, we’re not okay.Service providers across studies were described as experiencing a high degree of moral distress in relation to constraints that impeded their ability to fulfil their moral value of helping. [ABSTRACT FROM AUTHOR]

Background: The opioid overdose epidemic disproportionately impacts people experiencing homelessness. Outpatient-based opioid treatment (OBOT) programs have been established in homeless health care settings across the USA, but little is known about the success of these programs in engaging and retaining this highly marginalized patient population in addiction care. Objective: To evaluate predictors of initial engagement and subsequent attendance in a homeless-tailored OBOT program. Design: Prospective cohort study with 4 months of follow-up. Participants: A total of 148 homeless-experienced adults (≥18 years) who newly enrolled in the Boston Healthcare for the Homeless Program (BHCHP) OBOT program over a 1-year period (1/6/2022–1/5/2023). Main Measures: The primary outcomes were (1) initial OBOT program engagement, defined as having ≥2 additional OBOT visits within 1 month of OBOT enrollment, and (2) subsequent OBOT program attendance, measured monthly from months 2 to 4 of follow-up. Key Results: The average age was 41.7 years (SD 10.2); 23.6% were female, 35.8% were Hispanic, 12.8% were non-Hispanic Black, and 43.9% were non-Hispanic White. Over one-half (57.4%) were initially engaged. OBOT program attendances during months 2, 3, and 4 were 60.8%, 50.0%, and 41.2%, respectively. One-quarter (24.3%) were initially engaged and then attended the OBOT program every month during the follow-up period. Participants in housing or residential treatment programs (vs. unhoused; adjusted odds ratios (aORs) = 2.52; 95% CI = 1.17–5.44) and those who were already on or initiated a medication for opioid use disorder (OUD) (aOR = 6.53; 95% CI = 1.62–26.25) at the time of OBOT enrollment had higher odds of engagement. Older age (aOR = 1.74 per 10-year increment; 95% CI = 1.28–2.38) and initial engagement (aOR = 3.50; 95% CI = 1.86–6.59) conferred higher odds of attendance. Conclusions: In this study, over half initially engaged with the OBOT program, with initial engagement emerging as a strong predictor of subsequent OBOT program attendance. Interventions aimed at enhancing initial OBOT program engagement, including those focused on housing and buprenorphine initiation, may improve longer-term outcomes in this marginalized population. [ABSTRACT FROM AUTHOR]

Introduction: Contraceptive methods are techniques used to prevent pregnancy during sexual intercourse. The primary goal of contraception is to inhibit the fertilization of an egg by sperm or to prevent the implantation of a fertilized egg in the uterus. Unwanted pregnancy is a major challenge for street beggar women. Due to limited use of modern contraception, unwanted pregnancy and STDs are key issues faced by this population. This study aims to assess modern contraceptive utilization and explore factors influencing contraceptive choices among street beggar women in the Sidama region, Ethiopia by using Bayesian logistic approaches. Methods: A cross-sectional quantitative study was conducted on reproductive-aged (15–49) street beggar women in the Sidama Region. Data was collected using a pre-tested, structured interview questionnaire in the local language from each town in the Sidama region. Descriptive and inferential statistics were used to analyze the data using STATA version 17. A Bayesian logistic approach, with Markov Chain Monte Carlo methods, was used to model the association between modern contraceptive utilization and independent variables, allowing for estimation of model parameters and credible intervals. Result: The study found that 38.9% of street women in the Sidama region used modern contraceptives, primarily implants and injections. Bayesian logistic regression identified key factors influencing contraceptive use including, women aged 25–34 (AOR: 2.69 (95% CI: 1.57, 4.26)), married women (AOR: 4.91 (95% CI: 2.67, 8.51)), Widowed women (AOR: 2.81 (95% CI: 1.49)) and educated women (AOR: 2.16 (95% CI: 1.48, 3.01)) were more likely to use contraceptives. In contrast, those living on the street (AOR: 0.12 (95% CI: 0.05, 0.27)), with no history of pregnancy (AOR: 0.07 (95% CI: 0.02, 0.16)), and no sexual activity in the last six months (AOR: 0.11 (95% CI: 0.01, 0.03)), had lower usage rates. Additionally, women whose only job was begging (AOR: 0.43 (95% CI: 0.13, 0.92)) and those lacking health advice (AOR: 0.25 (95% CI: 0.07, 0.59)) also showed reduced utilization. Lack of discussion about contraceptives with partners (AOR: 0.18 (95% CI: 0.08, 0.33)) and no women's approval (AOR: 0.18 (95% CI: 0.08, 0.33)) further contributed to lower usage. Conversely, good knowledge of modern contraceptives was positively associated with utilization (AOR: 2.33 (95% CI: 1.44, 3.64)). Conclusion: The findings of this study identified several factors significantly associated with modern contraceptive use among street beggar women in the Sidama region, including age, marital status, Education level, disability, Job in addition to begging, Current living situation, history of sexual assault/rape, History of pregnancy after street life, discussion of modern contraception with a sexual partner, Advice from a health professional, Sexual activity in the last six months, time taken to arrive at a health facility on foot, approval of modern contraception, and knowledge. The main barriers reported were fear of side effects and lack of knowledge about contraceptive methods. The study suggests that concerned stakeholders should intervene to address these factors and improve modern contraceptive uptake in this vulnerable population. [ABSTRACT FROM AUTHOR]

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

Background: The delivery of rehabilitation services for hard-to-reach populations (e.g., refugees) is highly complex. There is a need for evidence-based approaches to deliver physiotherapy (PT) or occupational therapy (OT) services to this underserved group. Objectives: The purpose of this scoping review was to identify PT and OT service delivery models that have been implemented, for populations typically identified as hard-to-reach and their associated health outcomes. Eligibility criteria: Articles were eligible if they described PT and/or OT services for hard-to-reach populations. There were no restrictions on study design. Study selection: Six electronic databases (AMED, CINAHL, MEDLINE, EMBASE, Healthstar, and PsycINFO) were searched from January 2000 to June 2023. Articles were screened in duplicate by two independent reviewers, and conflicts were resolved by consensus. Results: Twenty-one articles with variable sample sizes (min, max n = 3 to 237) were included and detailed PT and/or OT services for immigrants/migrants, refugees, hard-to-reach veterans, people experiencing homelessness, lower incomes, trauma/torture, and those living in rehabilitation-deficient areas. Common rehabilitation needs (e.g., clinician to client connectivity), barriers (e.g., high transportation costs) and facilitators (e.g., encouragement) were identified among the various populations, mainly due to intersecting identities such as those who are both traumatized and refugees. Unique factors pertaining to the PT and OT services were also identified in some groups, including access to child and family services for people experiencing homelessness. Conclusions: Despite common and individual needs, barriers, and facilitators in hard-to-reach groups in the literature, there is a need for studies with larger sample sizes, rigorous methodology and a conscious effort to publish the results of interventions to generate stronger recommendations for practice. [ABSTRACT FROM AUTHOR]

Housing is an important social determinant of health and wellbeing. Aotearoa New Zealand is an outlier in the Organisation for Economic Co-operation and Development both in terms of its notably poor housing standards and the fact that it is one of the few countries where public housing has a better indoor environment and tenure security than private rentals. Our paper analyses the transition from emergency housing to public housing among individuals experiencing homelessness in Aotearoa New Zealand. Using linked de-identified microdata, we identified 31,761 individuals, who moved from emergency housing to public housing between 2016 and 2023. We found about four-fifths of those who transited from emergency housing to public housing required more than one application, and it took more than two months to settle them into public housing. We found a decrease in annual hospitalisation rates (0.50 to 0.29) and the annual rates of mental health outpatient use (5.8 to 3.7) after entering public housing, confirming the importance of stable and secure housing for health and wellbeing. Considering the health and wellbeing benefits observed, increasing affordable and accessible public housing stock in Aotearoa New Zealand is recommended. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease pandemic has worsened psychological distress in people experiencing homelessness (PEH). This study evaluates the impact of learning the Bhagavad Gita versus engaging in Kuchipudi dance on reducing psychological distress in PEH in Chennai and Dhanbad, India. Methods and analysis: Participants will be allocated into Bhagavad Gita, Kuchipudi dance, Both interventions, or Control groups. The Kessler scale (K10) score, representing the primary outcome, will be measured at four time points: one day before intervention, one day after intervention completion, 40 days post-intervention, and 1 year post-intervention. The K10 scores will be analyzed using the Generalized Estimating Equation framework. Additionally, subgroup analysis based on participant demographics (e.g., age, education, religion, employment) will be conducted to explore potential differential effects using analysis of covariance. Statistical significance will be determined at p < 0.05 (two-tailed). Dissemination: After study completion, findings will be shared at conferences, in peer-reviewed journals, and with stakeholders and community groups. Authorship will be granted to contributing researchers, with acknowledgment for others. The dataset will be publicly available upon publication. Efforts will be made to communicate results through infographics, plain language summaries, and tailored strategies, including community meetings and digital platforms, to engage and empower PEH in decision-making. Trial registration: The trial has been registered with the Clinical Trials Registry of India (registration number: CTRI/2022/12/048416). [ABSTRACT FROM AUTHOR]

Background: Homelessness is a visible manifestation of large-scale societal challenges, such as lack of affordable housing, poverty, and health inequities. Governments may miss opportunities to address these structural problems by removing people experiencing homelessness from public spaces. On 29 November 2022, after a press conference by Mayor Eric Adams, the city of New York issued a directive entitled Mental Health Involuntary Removals. The program authorized mental health providers and NYPD officers to take any person into custody who appears mentally ill and displays inability to meet basic living needs, even when no dangerous act has been observed. Methods: We reviewed the existing literature from 1973 to 2023 for studies, enacted legislation, state and federal policies, and interventions related to homelessness, mental health, and admission of people experiencing homelessness into psychiatric hospitals in the United States. We used academic databases, including PubMed, PsycInfo, and JSTOR for peer-reviewed articles, government reports, and policy analyses. Our search strategy included keyword combinations such as "homelessness and mental health," "policy interventions for homeless populations," and "health care services costs." We applied inclusion criteria focusing on reports and articles that directly address the intersectionality of homelessness, mental health policy, and psychiatric care. Results: Homelessness and mental illness frequently intersect, creating complex challenges that require nuanced solutions. Forced hospitalization of people experiencing homelessness in New York City, while intended to address critical social and health care issues, carries a risk for significant long-term harm. This approach places strain on the mental health care system and may ultimately exacerbate the problems it purports to resolve. [ABSTRACT FROM AUTHOR]

Certified peer support specialists (CPSS) are used as a paraprofessional workforce to engage hard-to-reach populations, including people experiencing homelessness. Thematic analysis was used to explore with CPSS (N = 7) what contributed to their effectiveness when working with this population. Participants were recruited at a HUD lead organization in the southeastern United States. Open-ended semi-structured questions were used in online, synchronous interviews. Themes related to three areas, experience, competence, and the organization, contributed to participants being effective. Specifically, interviewees observed that their lived experiences and abilities to speak a common language with clients contributed to their effectiveness. They identified how personal qualities and unique skillsets suited them for the work. Participants also valued the training they received; certification helped them to develop competencies and to balance vulnerability, empathy, and connection. Finally, participants attributed their effectiveness to clarity about their roles within the organization, supervision, attention to self-care, and co-worker support. Findings from this study may have implications for the value of lived and learned knowledge coexisting in organizations serving those who experience homelessness. [ABSTRACT FROM AUTHOR]

Homeless seniors confront distinct challenges regarding their mental health needs and service access. This study aims to illuminate the mental health landscape of homeless seniors by examining the prevalence of mental illness, utilization of mental health services, and perceived need for mental health care. The study comprises 177 homeless seniors in New York, NY. Findings indicate 10.2% experiencing depression, 10.2% schizophrenia, and 5.7% bipolar disorder. Despite high prevalence, there is a significant gap between diagnosed mental health conditions and service utilization, with only 50% of those with depression seeking care. Perceived need for mental health services emerges as a critical aspect of the study, with over half of those suffering from depression (61.1%; n = 11), PTSD (75%; n = 3), schizophrenia (77.8%; n = 14), and other mental illnesses (100%; n = 1) expressing a need for mental health care. Also, mental health conditions, loneliness, and levels of social support play significant roles in a need for mental health services. [ABSTRACT FROM AUTHOR]

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

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]

The article discusses the importance of qualitative research methods as liberatory tools, emphasizing the need to center marginalized voices, challenge existing power structures, and expand the definition of legitimate knowledge in the field. It highlights various qualitative approaches, such as autoethnography, participatory action research, and Afrofuturism, showcasing their potential to disrupt traditional power dynamics and create inclusive knowledge. The authors stress the emotional labor involved in conducting qualitative research, acknowledging the heavy topics and sensitive situations researchers may encounter. Overall, the article encourages scholars to embrace methodological and epistemological pluralism, appreciate diverse forms of knowledge, and engage in research practices that prioritize liberation and community engagement. [Extracted from the article]

Background: Mental health disparities persistently cause inequity and social exclusion. Extensive research underpins the need to embrace the social determinants of health and facilitate network learning at various ecosystem levels. Despite valuable quality frameworks and ratified conventions, local practices which counter health inequity are scarce. Methods: The Dutch HOP-TR study collected health and needs of Homeless Service Users (HSU) in a rights-based, transdiagnostic, recovery framework. We assessed the survival modes and conducted a socio-ecological analysis, exploring what happened in care pathways at three ecosystem levels: individual HSU, caregiver networks, society. While documenting vital conditions for growth and citizenship, we explore major opportunities to develop 'fair space for life'. Results: Under low distress levels, prosocial behavior is prominent (32.9%). High distress levels are found with an avoidant (42.0%) or aggressive mode (24.9%). Rising distress levels give more frictions in relations, psychiatric admissions, and police-justice contacts. The distress-induced descent in the social hierarchy causes social withdrawal, alienation, and marginalization. At society level, fair conditions for growth and citizenship are challenged by the cumulative impact of distress over the HSU' lives. Discussion: This care monitor uncovers the impact of distress on caregiver interactions. The care pathways reveal that the survival strategies reflect a systematic, pervasive neglect. Unfair representations hold HSU personally responsible of their situation, disregarding the cumulative impact of environmental conditions over their lives. The diverse sources of unfairness are intrinsic to the health care system and culture. Therefore, the survival modes ask for profound culture transformations in a whole-system-whole-society approach. Conclusion: Given the need for action on health equity and the social determinants of health, this paper provides an example of a dynamic care monitor. The actionable data elicit dialogs and stimulate to enrich opportunities for inclusion and growth in communities and societies. [ABSTRACT FROM AUTHOR]

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

People experiencing homelessness (PEH) are highly vulnerable to discrimination and violence, which impact physical and mental health. The study examines past-month discrimination and violence against PEH in Los Angeles County (LAC). A total of 332 PEH in LAC were surveyed about their past-month experiences with discrimination, physical violence, and sexual violence from April–July 2023. Analyses were conducted in 2023. 31.8% of respondents reported experiencing discrimination daily and 53.9% reported it weekly, whereas rates of lifetime discrimination in studies of general populations of minoritized groups range between 13-60%. Nearly half of respondents who reported experiencing discrimination (49.6%) believed that their housing situation was the reason they were targeted. Victimization was also common, with 16.0% of participants experiencing physical violence and 7.5% experiencing sexual violence in the past 30 days. These rates of past- month victimization are high when compared to past- year physical violence (3.0%) and sexual violence (0.24%) among general populations in major U.S. cities. In multivariate regression analyses, discrimination was associated with being unsheltered in a vehicle (p <0.05) or outdoors (p <0.001), weekly illicit drug use (p <0.01), and psychological distress (p <0.001); violent victimization was associated with being sheltered (p <0.05) or unsheltered outdoors (p <0.001), physical health conditions (p <0.05), and psychological distress (p <0.01); and sexual victimization was associated with non-male gender (p <0.05) and being unsheltered outdoors (p <0.05). Discrimination and victimization outcomes were not associated with any race/ethnicity, sexual orientation, or time homeless characteristics. Study findings highlight the dangers of homelessness in the U.S., particularly for those who are unsheltered outdoors. [ABSTRACT FROM AUTHOR]

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

Bridging gaps in care coordination for homeless populations is a complex task that requires addressing attitudinal and behavioral changes, as patients hold more control over chronic and preventive care. Despite these challenges, organizations like the Patient Care Intervention Center (PCIC) have made significant strides in improving health equity for vulnerable populations in Houston. PCIC integrates data, fosters collaboration between social services and medical providers, and provides comprehensive and targeted services, positively impacting the health and social outcomes of 98,838 individuals. By addressing diverse needs and integrating medical and social care, PCIC offers a model for developing comprehensive solutions to prevent and reduce homelessness while improving health equity for socially and medically vulnerable populations. PCIC's approach involves data sharing partnerships and care coordination initiatives with various agencies in Harris County and Houston. This cross-sector collaboration, integrating data from multiple sources such as hospital systems, managed care organizations, and government agencies, enables the development of more effective interventions. PCIC demonstrates the limits of fragmented interventions and the importance of integrating medical and social care. PCIC's model serves as an example of how collaboration, targeted services, and data integration can improve health equity and contribute to the prevention and reduction of homelessness. [ABSTRACT FROM AUTHOR]

Despite significant efforts to address the homelessness in the United States, on any given night more than 500,000 individuals lack shelter/place to call home. This persistent and high rate of homelessness can be attributed to the shortage of affordable housing options, the eviction crisis, and unmet need for rental assistance. Administrative burdens tied to homeless services may also create barriers to housing for individuals experiencing homelessness, and to date have been under-explored in the literature. Our study explores administrative burden by examining 28 individuals' experiences navigating homeless services in New Haven, Connecticut. Our analysis describes the learning, compliance and psychological costs individuals face. Our findings suggest that administrative burdens may lead to underutilization of services and prolonged homelessness. Further, they may promote new forms of inequities. We conclude with recommendations to reduce administrative burden and increase investments in homeless services and housing resources nationwide. [ABSTRACT FROM AUTHOR]

Community-based service providers working with people experiencing homelessness encounter many occupational challenges and high turnover rates are a challenge in the sector. This qualitative study examined the perceived causes and decision paths of turnover among service providers working with people experiencing homelessness in Canada. In-depth interviews were completed with 40 service providers working in homeless service, supportive housing, and harm reduction programs. Thematic analysis and a deductive-based matrix analysis were used to identify causes and decision paths of turnover, respectively. Primary causes of employee turnover included: (1) career advancement and growth; (2) incongruence between providers' needs, values, and work position; (3) mental health deteriorations; (4) organizational stability and support issues; and (5) staff dismissal. Further, two contextual factors – low sectoral wages and a transitory work culture – shaped service providers' occupational experiences and had indirect effects on turnover. Push and pull decisions were the primary paths to voluntary turnover among participants. Overall, the findings highlight that employee turnover often occurs voluntarily when service providers experience unmet occupational or work-interacting personal needs, or want to pursue new career-related opportunities. Practice and policy recommendations, including use of realistic job previews and establishment of workforce development strategies, are made to prevent turnover. [ABSTRACT FROM AUTHOR]

Prior research finds that individuals with greater exposure to homelessness express more favorable attitudes toward people experiencing homelessness. However, it is unclear whether exposure to more broader forms of housing insecurity (e.g. lack of affordability, poor housing quality, being doubled-up) is linked to perceptions of and attitudes toward homelessness. We thus examined the association between both exposure to homelessness and several broader measures of housing insecurity and perceptions and attitudes toward homelessness. We also assessed whether rurality modified these associations. We used Qualtrics Panels to conduct an online survey of 1270 low- and moderate-income adults, equally split between urban and rural areas nationwide in 2018. The survey included questions assessing experiences and opinions about homelessness and housing insecurity. In multiple regression models, we found that exposure to both homelessness and other forms of housing insecurity were associated with an increased degree of perception of homelessness as beyond individual control and an increased propensity for sympathetic interactions with people experiencing homelessness. Rurality did not modify these relationships. As both homelessness and other forms of housing insecurity are on the rise, these findings may portend a shift toward more favorable attitudes and perceptions of homelessness. [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]

People experiencing homelessness (PEH) frequently have multiple and complex needs that may contribute to interpersonal difficulties that affect their relationships with services. As a result, professionals working in frontline homelessness services are frequently exposed to primary trauma (e.g. workplace aggression, crisis situations) and secondary trauma (e.g. hearing about service users' traumatic experiences). This cross-sectional study explored organizational and individual factors in relation to three related but distinct facets of work-related distress: posttraumatic stress disorder (PTSD), secondary traumatic stress (STS), and burnout. A sample of 139 frontline workers in UK homelessness services completed an inventory of 15 possible distressing workplace experiences and four psychometric questionnaires. Results clearly evidence that frontline workers are exposed to high levels of potentially traumatic incidents at work and that this is associated with significant distress, with 23% of the sample meeting the threshold for PTSD diagnosis. Hierarchical multiple regression analyses identified trauma exposure and the use of "maladaptive" cognitive coping strategies as strong predictors of PTSD and STS, while organizational culture and compassion satisfaction were protective against burnout. These findings have important service implications, and recommendations are made regarding trauma- and psychologically informed approaches that organizations can implement to effectively support their employees. [ABSTRACT FROM AUTHOR]

The experience of homelessness goes beyond being houseless and requires a whole-person-in-context approach. Although scant and varied, research with people experiencing homelessness suggests positive benefits from music therapy. Narrative reviews are helpful to synthesize literature with varied levels of evidence and research perspectives. The purpose of this narrative literature review is to provide a critical overview of the extant music therapy literature related to people experiencing homelessness and to inform recommendations for future research and practice. The 22 studies that meet inclusion criteria focused on three main areas of knowledge: (a) the impact of music therapy on people experiencing homelessness, (b) considerations for using music therapy with people experiencing homelessness, and (c) both a and b. Studies about the impact of music therapy indicate benefits including experiencing, regulating, and expressing emotions; engaging in meaningful connection and support; and developing and expressing identities that resist oppression. Other studies offer considerations related to musical preferences, aspects of the therapeutic process, and the therapists' position in terms of culture and power. Ongoing research about the role of music therapy in approaching and understanding homelessness is recommended. [ABSTRACT FROM AUTHOR]

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Background: Peer workers are individuals who draw on their personal experiences in a professional capacity to support clients. Existing research on the role of peer workers in mental health, homelessness, and substance use services has primarily focused on their impact on client outcomes. This paper describes the development of peer workers as they transition into, through, and beyond this role. Utilising data from the Supporting Harm Reduction through Peer Support (SHARPS) study, where Peer Navigators supported people experiencing homelessness and substance use challenges, this paper explores the sense-making involved in an intensive peer support worker role, adaptation to organisational culture, and engagement with opportunities for professional advancement. Methods: Semi-structured interviews with three Peer Navigators were conducted by two SHARPS study researchers at four time points in 2018 and 2019 corresponding with the beginning, middle, and end of the intervention. These data were analysed along with entries from the three Peer Navigators' reflective diaries. Analysis followed a multi-stage approach to thematic analysis utilising both inductive and deductive processes. The Peer Navigators' personal reflections have also been incorporated into the recommendations. Results: The foundational training provided to the Peer Navigators before taking up their role helped to ensure readiness and build confidence. This training illuminated the dynamics of supporting individuals with complex health and social challenges. Integrating into diverse organisational environments, the Peer Navigators adapted to new professional expectations and consistently advocated for harm reduction and psychologically informed approaches, sometimes encountering resistance from other professionals. Establishing effective relationships with participants and professionals was essential and involved dealing with challenges such as overcoming personal biases and navigating systemic obstacles. the Peer Navigators benefitted from the specially designed training to support career progress with personal and professional development opportunities which enabled successful transitions beyond the SHARPS study. Conclusions: Pre-work training, coupled with support and adherence to key principles, enabled the Peer Navigators to integrate effectively into diverse organisations. Quality relationships were vital in achieving client outcomes and supporting the professional growth of the Peer Navigators. These findings are important for services employing peer workers and underscore the importance of a commitment to training and continuing professional development. [ABSTRACT FROM AUTHOR]

Background: Homelessness represents a widespread social issue globally, yet the risk of neurodegenerative diseases (NDDs) associated with people experiencing homelessness (PEH) has not received sufficient attention. Therefore, this study aimed to explore the risk of NDDs among PEH and its variation across countries and regions through meta-analysis and systematic review. Methods: Searching from databases such as PubMed and Web of Science, relevant research articles on PEH and NDDs were identified. After multiple screening, eight articles were selected for meta-analysis. Statistical methods and models were used to evaluate the association between PEH and NDDs, stratified by disease type and country. Results: We found that PEH had a 51% higher risk of NDDs (OR = 1.51 (95% CI: 1.21, 1.89)) compared with those with stable housing. Specifically, PEH had a significantly higher risk of developing multiple sclerosis (OR = 4.64 (95% CI: 1.96, 10.98)). Alzheimer's disease and related dementias (ADRD) (OR = 1.93 (95% CI: 1.34, 2.77)), dementia (OR = 1.69 (95% CI: 1.26, 2.27)), and cognitive impairment (OR = 1.07 (95% CI: 0.98, 1.16)) were all at higher risk. Furthermore, country and regional differences were observed, with countries such as Iran (OR = 4.64 (95% CI: 1.96, 10.98)), the Netherlands (OR = 2.14 (95% CI: 1.23, 3.73)), the United States (OR = 1.66 (95% CI: 1.25, 2.22)), and Canada (OR = 1.06 (95% CI: 1.01, 1.10)) showing a higher risk of NDDs among the PEH. Conclusions: The study emphasizes the significant NDD risks among PEH, providing novel perspectives on this issue and shedding light on national disparities influenced by variations in healthcare systems and social environments. This will be beneficial for academia and government to prioritize the health of PEH with NDDs, aiming to mitigate disease incidence and economic burdens while preserving social stability and upholding basic human rights. [ABSTRACT FROM AUTHOR]

The article discusses innovative housing models for older women, emphasizing affordability and community connections to combat poverty and loneliness. It highlights resident-coordinated housing options like co-living and enhanced Naturally Occurring Retirement Communities (NORCs) as effective solutions. These models, rooted in traditional concepts, offer older women opportunities to age comfortably while fostering social connections and empowerment. The commentary calls for further research and community support to develop and sustain these housing models effectively. [Extracted from the article]

Although awareness and understanding of LGBTIQ+ people's experiences of homelessness are rising, their broader housing experiences remain under‐researched. This paper uses qualitative interview data to explore takatāpui and LGBTIQ+ people's experiences of housing instability in Aotearoa New Zealand. In expanding the focus to housing instability, this paper explores how LGBTIQ+ people experience and navigate the housing system, which sheds light on the upstream factors that contribute to the disproportionately high rates of homelessness amongst LGBTIQ+ communities worldwide. A reflexive thematic analysis of the data generated four themes to takatāpui and LGBTIQ+ people's experiences of housing instability; personal experiences are political, survival within inequitable systems is nuanced, instability is relational, and selfhood is mediated through instability. These results highlight the impact of policy and structural failures on LGBTIQ+ communities. [ABSTRACT FROM AUTHOR]

This article shares the micro‐ethical lessons from those researching alongside Aboriginal people experiencing homelessness and Aboriginal Elders in Perth, Western Australia. The article is written from the perspective of the first and second author who are two non‐Aboriginal researchers being mentored in Aboriginal culture. From this positioning, it offers reflections and practical insights into researching “in the right spirit” with Aboriginal communities. More specifically, it shares lessons in negotiating community roles within community‐driven research, the importance in forming relationship with Aboriginal culture as antidote to research fatigue, practical ways to work with Aboriginal communities when they have a history of being exploited in research, navigating fair and ethical payment for involvement, and ways to clearly communicate research with them. It also shares the cultural importance and benefits of working closely with Aboriginal Elders when engaging in research with Aboriginal communities, including their ability to better negotiate project scope with community, and the value in making sense of the research findings alongside them. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic and subsequent implementation of public health policies exacerbated multiple intersecting systemic inequities, including homelessness. Housing is a key social determinant of health that played a significant part in the front-line defence against COVID-19, posing challenges for service providers working with people experiencing homelessness (PEH). Public health practitioners and not-for-profit organizations (NFPs) had to adapt existing COVID-19 policies and implement novel measures to prevent the spread of disease within congregate settings, including shelters. It is essential to share the perspectives of service providers working with PEH and their experiences implementing policies to prepare for future public health emergencies and prevent service disruptions. Methods: In this qualitative case study, we explored how service providers in the non-profit sector interpreted, conceptualized, and implemented COVID-19 public health outbreak control policies in Nova Scotia. We interviewed 11 service providers between September and December 2020. Using thematic analysis, we identified patterns and generated themes. Local, provincial, and national policy documents were useful to situate our findings within the first year of the COVID-19 pandemic and contextualize participants' experiences. Results: Implementing policies in the context of homelessness was difficult for service providers, leading to creative temporary solutions, including pop-up shelters, a dedicated housing isolation phone line, comfort stations, and harm reduction initiatives, among others. There were distinct rural challenges to navigating the pandemic, which stemmed from technology limitations, lack of public transportation, and service closures. This case study illustrates the importance of flexible and context-specific policies required to support PEH and mitigate the personal and professional impact on service providers amid a public health emergency. Innovative services and public health collaboration also exemplified the ability to enhance housing services beyond the pandemic. Conclusions: The results of this project may inform context-specific emergency preparedness and response plans for COVID-19, future public health emergencies, and ongoing housing crises. [ABSTRACT FROM AUTHOR]

Background: The concurrence of homelessness and alcohol use disorder (AUD) has negative consequences in affected individuals. Managed alcohol programs (MAPs), a harm reduction strategy based on providing regular doses of alcohol to individuals with AUD, have emerged as a potential solution to reduce alcohol-related harms.Objectives: This study examined the impact of a MAP implemented in Barcelona on patterns of alcohol and other psychoactive substance use, health, and quality of life among people who use drugs and were experiencing homelessness. The research also incorporated a gender perspective and focused on individuals who had accessed a residential center.Methods: A descriptive qualitative design was used, employing semi-structured interviews with eight participants who were enrolled in the MAP (three women, five men) and four program professionals. Thematic analysis was used to analyze the resulting data.Results: The domains guiding the study appeared as outcome themes: patterns of use of alcohol and other substances, health, quality of life and impact on female-identified participants. Participants reported improved health due to reduced consumption of alcohol and other substances, better anxiety management, and reconnection to health services. The participants reported enhanced quality of life, including feeling safer, and better use of time, which had been spent on meeting their basic needs. Women reported that a key benefit of the program was living in a sexism-free environment.Conclusion: These results appear to demonstrate that harm reduction strategies prioritizing basic needs and adopting a gender-sensitive perspective can positively impact the health and quality of life of people experiencing homelessness with AUD. [ABSTRACT FROM AUTHOR]

Background: Homeless-experienced adults smoke at rates 5 times that of the general adult population, and often have limited access to cessation treatments while homeless. Permanent Supportive Housing (PSH) can be a catalyst for cessation treatment utilization, yet little is known about use of these treatments following PSH entry, or how to tailor and implement cessation care that meets homeless-experienced adults' vulnerabilities. Methods: Using Department of Veterans Affairs (VA) administrative data, we assessed smoking status (ie, current, former, non/never) among a cohort of homeless-experienced Veterans (HEVs) housed in Los Angeles-based PSH. We compared cessation treatment use rates (ie, nicotine replacement therapies, cessation medications, psychosocial counseling) pre- and post-housing using Chi-square tests. Predisposing (ie, demographics), enabling (eg, primary care, benefits), and need characteristics (ie, health, mental health, substance use diagnoses) were examined as correlates of cessation treatment utilization pre- and post-housing in univariable and multivariable logistic regression models. Results: Across HEVs (N = 2933), 48.6% were identified as currently-smoking, 17.7% as formerly-smoking, and 14.0% as non/never smoking. Among currently- and formerly-smoking HEVs (n = 1944), rates of cessation treatment use post-housing were significantly lower, compared to pre-housing, across all treatment types. Health, mental health, and substance use was more prevalent among currently- and formerly-smoking HEVs compared to non/never-smoking HEVs, and most diagnoses were positively associated with utilization univariably. However, in multivariable models, cessation clinic referrals and primary care engagement were the only significant (P <.001) predictors of pre-housing and post-housing cessation treatment utilization. Conclusion: Among HEVs, we found high smoking rates and low cessation treatment utilization pre- and post-PSH entry. Efforts to educate providers about this population's desire to quit smoking, support primary care engagement, and increase cessation clinic referrals may bolster their utilization. For homeless-experienced adults, optimizing cessation treatment accessibility by embedding cessation services within PSH and homeless service settings may reduce utilization impediments. [ABSTRACT FROM AUTHOR]

The author partnered with the Harrison County Library System (HCLS) to create a multilevel program plan for expanding library services to the growing number of homeless people who seek refuge in the library’s facilities. The research for this program plan involved evaluating existing library resources such as collections, programming, and available staff resources; identifying the best practices for providing services to people experiencing homelessness; identifying staff perceptions of working with the homeless; and identifying potential partners for expanded service offerings. The author used document analysis to research data on the library system (IMLS 2021 and reviewed library policy to identify barriers to providing service for the homeless. The author applied qualitative and humanistic research methods involving personal narratives (scenarios) provided through two separate one-on-one interviews with the library director to discuss the library system in general, and one one-on-one interview with six library staff working in the three libraries with the highest use by people experiencing homelessness. This paper discusses the findings from this mixed methods research project and their application to expanding services for chronically homeless patrons who use the HCLS. [ABSTRACT FROM AUTHOR]

Background: There is a significant gap in scientific understanding about suicide among people experiencing homelessness (PEHs). Method: This seven-year longitudinal study examined a cohort of 154 PEHs. In 2015, clinical assessments were conducted, including an evaluation of suicide risk, with data on causes of death collected from public health service records in 2022. Results: Over the course of seven years, 14.3% of the sample passed away at an average age of 52.6 years. The leading causes of death were cancer, suicide, and accidental overdose. Participants who experienced violence had a higher number of suicide attempts and scored higher on the suicidal ideation scale. The most significant factors associated with mortality were prior suicide attempts and suicidal ideation. Conclusions: This study underscores the importance of suicide risk scale scores as the primary predictor of mortality. It emphasizes the need for further longitudinal research on suicide among PEHs and the development of specific programs to prevent suicide within this population. An approach combining structural and individual perspectives is suggested, considering appropriate housing policies and mental health care. [ABSTRACT FROM AUTHOR]

Introduction: Despite increased awareness of the detrimental relationship between homelessness and health, people experiencing homelessness remain an underserved population in health and social care research. Due to barriers affecting the accessibility of medicine and healthcare services, as well as reported competing priorities such as food and shelter, evidence has demonstrated that people experiencing homelessness are less likely to undergo routine examinations, receive diagnoses and adhere to prescribed medical treatments. To enhance service design and access for those experiencing homelessness, it is critical to better recognise, understand and address the barriers these individuals face. This meta‐ethnography aims to identify barriers, enablers and interventions to begin addressing this inequality gap. Methods: A systematic literature search was undertaken in October and re‐ran in December 2023 across four databases: MEDLINE, Embase, CINAHL and Scopus. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines and health service inequalities among populations experiencing homelessness. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta‐ethnographic approach, as outlined by Noblit and Hare. The review was registered on PROSPERO (CRD42024511502) and performed according to PRISMA guidelines. Results: This meta‐ethnographic systematic review synthesised data from eight studies across multiple countries. Three overarching third‐order constructs (termed 'themes') were developed through reciprocal translation and centred around: recognising and acknowledging the discrimination, stigma and barriers experienced when using current services; exploring safe and practical use of medicines and the promotion of general health education and appreciating strategies to tackle inequalities, namely community outreach programmes designed for homeless communities. Conclusion: This work highlighted the barriers, enablers and interventions that sought to address the inequalities affecting people experiencing homelessness in accessing medication and healthcare services. Future research should utilise lived‐experience narratives and co‐design to further explore ways to tackle wider healthcare accessibility inequalities for this minoritised population. Trial Registration: Not applicable, as this is a systematic review. Patient or Public Contribution: Public contributors (minority research champions and one public health research champion, H.K.G. and T.G.) informed and shaped this project during study design and conceptualisation. They helped to ensure that the study was conducted, and the findings were reported with sensitivity. [ABSTRACT FROM AUTHOR]

Young adults who have endured chronic housing instability have often been failed by settings which have inadequately supported them – such as home and school settings. As such, young people experiencing homelessness and housing instability are seeking supportive settings. Permanent supportive housing (PSH) is a burgeoning supportive intervention in the youth homelessness services landscape. Our study used the geographic interview methodology, a novel qualitative geographic information systems methodology, to understand how young adult residents (N = 15) in PSH experience the physical setting. Residents experienced the common spaces in PSH as contested spaces; meanwhile, they sought choice-centered spaces – where there are choices of what to do, who to spend time with, and how to spend time. PSH settings for young adults may embrace choice-centered principles and practices when building trauma-informed PSH for young adults. Future research should explore these findings across demographic and geographic differences. [ABSTRACT FROM AUTHOR]

This paper is grounded in the context of a severe housing, shelter shortage, and of an increasing number of homeless people in France. It will focus on LGBTQ homelessness in Paris as revealing moments of conflation, overlap and distinction in terms of gender and sexuality. In light of the binary gender framework underpinning the shelter space, there is very little consideration for non-normative gender identities and sexual orientations in the social support shelters provide. This paper will analyse issues of hypervisibility and invisibility amongst homeless LGBTQ people within a French universalist framework. Using interview material from fieldwork focused on the narratives of homeless LGBTQ respondents and drawing from the professional experience of the authors, this paper will highlight how precarious LGBTQ identities and subjectivities are produced by compulsory cisheteronormativity, as well as its consequences on LGBTQ bodies and survival strategies. As LGBTQ homelessness has not been explored much in the French context, these insights will call for the importance of assessing social difference in order to find adequate solutions to ending homelessness. [ABSTRACT FROM AUTHOR]