Psychological distress among homeless adults.

PubMed

Gelberg, L; Linn, L S

1989-05-01

Recent studies have reported a high prevalence of mental illness among the homeless. As part of a community-based survey of 529 homeless adults, we developed and tested a model to increase our understanding of the factors related to their psychological distress. Using a previously validated and reliable scale of perceived psychological distress, we found that homeless adults were more likely to report psychological distress than the general population (80% vs. 49%). Distress levels were not associated with most demographic or homeless characteristics or general appearance. However, distress was related to unemployment, greater cigarette and alcohol use, worse physical health, fewer social supports, and perceived barriers to obtaining needed medical care. Since mental, physical, and social health are strongly related among homeless adults, alleviating distress among them may be most effectively done by implementing a broad-based health services package coupled with employment programs provided in an accessible service delivery setting.

Characteristics and Use of Services Among Literally Homeless and Unstably Housed U.S. Veterans With Custody of Minor Children.

PubMed

Tsai, Jack; Rosenheck, Robert A; Kasprow, Wesley J; Kane, Vincent

2015-10-01

The study examined the number of homeless veterans with minor children in their custody ("children in custody"), compared sociodemographic and clinical characteristics among homeless veterans with and without children in custody, and observed differences in referral and admission patterns among veterans with and without children in custody for a variety of U.S. Department of Veterans Affairs (VA) programs for homeless veterans. Data were obtained from the VA Homeless Operations Management and Evaluation System for 89,142 literally homeless and unstably housed veterans. Sociodemographic, housing, health, and psychosocial characteristics of veterans were analyzed. Among literally homeless veterans, 9% of men and 30% of women had children in custody; among unstably housed veterans, 18% of men and 45% of women had children in custody. Both male and female veterans with children in custody were younger and less likely to have chronic general medical conditions and psychiatric disorders compared with other veterans, but, notably, 11% of homeless veterans with children in custody had psychotic disorders. Veterans with children in custody were more likely than other veterans to be referred and admitted to the VA's permanent supported housing program, and women were more likely than men to be admitted to the program. A substantial proportion of homeless veterans served by the VA have severe mental illness and children in custody, which raises concerns about the parenting environment for their children. Particular focus should be directed at VA's supported-housing program, and the practical and ethical implications of serving homeless parents and their children need to be considered.

The relationship between victimization and mental health functioning in homeless youth and adults.

PubMed

Rattelade, Stephanie; Farrell, Susan; Aubry, Tim; Klodawsky, Fran

2014-06-01

This study examined the relationship between victimization and mental health functioning in homeless individuals. Homeless populations experience higher levels of victimization than the general population, which in turn have a detrimental effect on their mental health. A sample of 304 homeless adults and youth completed one-on-one interviews, answering questions on mental health, past victimization, and recent victimization experiences. A hierarchical linear regression showed that experiences of childhood sexual abuse predicted lower mental health functioning after controlling for the sex and age of individuals. The study findings are applicable to current support programs for victims in the homeless population and are relevant to future research on homelessness and victimization.

Promoting oral health among the inner city homeless: a community-academic partnership.

PubMed

Lashley, Mary

2008-09-01

Oral health care resources for the homeless are scarce, underfunded, and generally inadequate to meet the oral health needs of this population. The purpose of this program was to improve oral health among the urban homeless in a faith-based inner city mission through education, screening, and improved access to oral health care. The program provided for expanded delivery of oral health care services to the homeless while preparing students in the health professions for community-based practice with at-risk and vulnerable populations. By proactively addressing oral health needs through prevention and earlier diagnosis and treatment, morbidity, quality of life, and cost can be positively affected. Innovative, cross-disciplinary, community delivery models that involve key stakeholders at all levels are needed to address the oral health needs of the homeless and underserved adequately.

Use of outpatient mental health services by homeless veterans after hurricanes.

PubMed

Brown, Lisa M; Barnett, Scott; Hickling, Edward; Frahm, Kathryn; Campbell, Robert R; Olney, Ronald; Schinka, John A; Casey, Roger

2013-05-01

Little is known about the impact of hurricanes on people who are homeless at the time a disaster occurs. Although researchers have extensively studied the psychosocial consequences of disaster produced homelessness on the general population, efforts focused on understanding how homeless people fare have been limited to a few media reports and the gray literature. In the event of a hurricane, homeless veterans may be at increased risk for negative outcomes because of their cumulative vulnerabilities. Health care statistics consistently document that homeless veterans experience higher rates of medical, emotional, substance abuse, legal, and financial problems compared with the general population. This study used the 2004 to 2006 Veterans Health Administration (VHA) Outpatient Medical Dataset to examine the effects of hurricanes on use of outpatient mental health services by homeless veterans. Homeless veterans residing in hurricane-affected counties were significantly more likely to participate in group psychotherapy (32.4% vs. 13.4%, p < .002), but less likely to participate in individual 30-40-min sessions with medical evaluations (3.5% vs. 17.3%, p < .001). The study findings have implications for homeless programs and the provision of VHA mental health services to homeless veterans postdisaster. PsycINFO Database Record (c) 2013 APA, all rights reserved.

34 CFR 491.5 - What definitions apply?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Regulations of the Offices of the Department of Education (Continued) OFFICE OF VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General § 491.5 What definitions apply? (a... literacy training mean adult education for homeless adults whose inability to speak, read, or write the...

34 CFR 491.5 - What definitions apply?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Regulations of the Offices of the Department of Education (Continued) OFFICE OF VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General § 491.5 What definitions apply? (a... literacy training mean adult education for homeless adults whose inability to speak, read, or write the...

34 CFR 491.5 - What definitions apply?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Regulations of the Offices of the Department of Education (Continued) OFFICE OF VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General § 491.5 What definitions apply? (a... literacy training mean adult education for homeless adults whose inability to speak, read, or write the...

Does Race Matter in Addressing Homelessness? A Review of the Literature

PubMed Central

Jones, Marian Moser

2017-01-01

Since the 1980s, black persons have been overrepresented in the United States homeless population. Given that morbidity and mortality is elevated among both the black population and the homeless population in comparison to the general U.S. population, this overrepresentation has important implications for health policy. However, the racial demographics of homelessness have received little attention from policymakers. This article reviews published social and behavioral science literature that addresses the relationship between race and contemporary homelessness in the United States. This literature points to substantial differences between racial subgroups of the U.S. homeless population in vulnerabilities, health risks, behaviors, and service outcomes. Such observed differences suggest that policies and programs to prevent and end homelessness must explicitly consider race as a factor in order to be of maximum effectiveness. The limited scope of these findings also suggests that more research is needed to better understand these differences and their implications. PMID:29576910

Project Re-Start. A Program for Homeless Adults.

ERIC Educational Resources Information Center

Pelzer, Dagmar F.; And Others

Project Re-Start, of the Dade County Public Schools in Florida, was funded under the Adult Education Act and the Stewart B. McKinney Homeless Assistance Act. Classes in literacy skills, General Educational Development (GED) preparation, English for speakers of other languages, employability skills, and life coping skills were conducted at most of…

Health-Seeking Challenges Among Homeless Youth

PubMed Central

Hudson, Angela L.; Nyamathi, Adeline; Greengold, Barbara; Slagle, Alexandra; Koniak-Griffin, Deborah; Khalilifard, Farinaz; Getzoff, Daniel

2010-01-01

Background Approximately 1.5 to 2 million homeless young persons live on the streets in the United States. With the current economic situation, research is needed on quality of services geared toward homeless young adults. Objectives The objective of this study was to explore homeless young adults' perspectives on barriers and facilitators of health-care-seeking behavior and their perspectives on improving existing programs for homeless persons. Methods This article is a descriptive qualitative study using focus groups, with a purposeful sample of 24 homeless drug-using young adults. Results Identified themes were failing access to care based on perceived structural barriers (limited clinic sites, limited hours of operation, priority health conditions, and long wait times) and social barriers (perception of discrimination by uncaring professionals, law enforcement, and society in general). Discussion Results provide insight into programmatic and agency resources that facilitate health-seeking behaviors among homeless young adults and include implications for more research with providers of homeless health and social services. PMID:20404776

Homeless Status, Postdischarge Health Care Utilization, and Readmission After Surgery.

PubMed

Titan, Ashley; Graham, Laura; Rosen, Amy; Itani, Kamal; Copeland, Laurel A; Mull, Hillary J; Burns, Edith; Richman, Joshua; Kertesz, Stefan; Wahl, Tyler; Morris, Melanie; Whittle, Jeffery; Telford, Gordon; Wilson, Mark; Hawn, Mary

2018-06-01

Homeless Veterans are vulnerable to poor care transitions, yet little research has examined their risk of readmission following inpatient surgery. This study investigates the predictors of surgical readmission among homeless relative to housed Veteran patients. Inpatient general, vascular, and orthopedic surgeries occurring in the Veterans Health Administration from 2008 to 2014 were identified. Administrative International Classification of Diseases, Ninth Revision, Clinical Modification codes and Veterans Health Administration clinic stops were used to identify homeless patients. Bivariate analyses examined characteristics and predictors of readmission among homeless patients. Multivariate logistic models were used to estimate the association between homeless experience and housed patients with readmission following surgery. Our study included 232,373 surgeries: 43% orthopedic, 39% general, and 18% vascular with 5068 performed on homeless patients. Homeless individuals were younger (56 vs. 64 y, P<0.01), more likely to have a psychiatric comorbidities (51.3% vs. 19.4%, P<0.01) and less likely to have other medical comorbidities such as hypertension (57.1% vs. 70.8%, P<0.01). Homeless individuals were more likely to be readmitted [odds ratio (OR), 1.43; confidence interval (CI), 1.30-1.56; P<0.001]. Discharge destination other than community (OR, 0.57; CI, 0.44-0.74; P<0.001), recent alcohol abuse (OR, 1.45; CI, 1.15-1.84; P<0.01), and elevated American Society Anesthesiologists classification (OR, 1.86; CI, 1.30-2.68; P<0.01) were significant risk factors associated with readmissions within the homeless cohort. Readmissions are higher in homeless individuals discharged to the community after surgery. Judicious use of postoperative nursing or residential rehabilitation programs may be effective in reducing readmission and improving care transitions among these vulnerable Veterans. Relative costs and benefits of alternatives to community discharge merit investigation.

Academic Achievement Trajectories of Homeless and Highly Mobile Students: Resilience in the Context of Chronic and Acute Risk

ERIC Educational Resources Information Center

Cutuli, J. J.; Desjardins, Christopher David; Herbers, Janette E.; Long, Jeffrey D.; Heistad, David; Chan, Chi-Keung; Hinz, Elizabeth; Masten, Ann S.

2013-01-01

Analyses examined academic achievement data across third through eighth grades ("N" = 26,474), comparing students identified as homeless or highly mobile (HHM) with other students in the federal free meal program (FM), reduced price meals (RM), or neither (General). Achievement was lower as a function of rising risk status (General…

Housing First for Homeless Persons with Active Addiction: Are We Overreaching?

PubMed Central

Kertesz, Stefan G; Crouch, Kimberly; Milby, Jesse B; Cusimano, Robert E; Schumacher, Joseph E

2009-01-01

Context More than 350 communities in the United States have committed to ending chronic homelessness. One nationally prominent approach, Housing First, offers early access to permanent housing without requiring completion of treatment or, for clients with addiction, proof of sobriety. Methods This article reviews studies of Housing First and more traditional rehabilitative (e.g., “linear”) recovery interventions, focusing on the outcomes obtained by both approaches for homeless individuals with addictive disorders. Findings According to reviews of comparative trials and case series reports, Housing First reports document excellent housing retention, despite the limited amount of data pertaining to homeless clients with active and severe addiction. Several linear programs cite reductions in addiction severity but have shortcomings in long-term housing success and retention. Conclusions This article suggests that the current research data are not sufficient to identify an optimal housing and rehabilitation approach for an important homeless subgroup. The research regarding Housing First and linear approaches can be strengthened in several ways, and policymakers should be cautious about generalizing the results of available Housing First studies to persons with active addiction when they enter housing programs. PMID:19523126

Housing first for homeless persons with active addiction: are we overreaching?

PubMed

Kertesz, Stefan G; Crouch, Kimberly; Milby, Jesse B; Cusimano, Robert E; Schumacher, Joseph E

2009-06-01

More than 350 communities in the United States have committed to ending chronic homelessness. One nationally prominent approach, Housing First, offers early access to permanent housing without requiring completion of treatment or, for clients with addiction, proof of sobriety. This article reviews studies of Housing First and more traditional rehabilitative (e.g., "linear") recovery interventions, focusing on the outcomes obtained by both approaches for homeless individuals with addictive disorders. According to reviews of comparative trials and case series reports, Housing First reports document excellent housing retention, despite the limited amount of data pertaining to homeless clients with active and severe addiction. Several linear programs cite reductions in addiction severity but have shortcomings in long-term housing success and retention. This article suggests that the current research data are not sufficient to identify an optimal housing and rehabilitation approach for an important homeless subgroup. The research regarding Housing First and linear approaches can be strengthened in several ways, and policymakers should be cautious about generalizing the results of available Housing First studies to persons with active addiction when they enter housing programs.

Challenges of Providing End-of-Life Care for Homeless Veterans.

PubMed

Hutt, Evelyn; Whitfield, Emily; Min, Sung-Joon; Jones, Jacqueline; Weber, Mary; Albright, Karen; Levy, Cari; O'Toole, Thomas

2016-05-01

To describe challenges of caring for homeless veterans at end of life (EOL) as perceived by Veterans Affairs Medical Center (VAMC) homeless and EOL care staff. E-mail survey. Homelessness and EOL programs at VAMCs. Programs and their ratings of personal, structural, and clinical care challenges were described statistically. Homelessness and EOL program responses were compared in unadjusted analyses and using multivariable models. Of 152 VAMCs, 50 (33%) completed the survey. The VAMCs treated an average of 6.5 homeless veterans at EOL annually. Lack of appropriate housing was the most critical challenge. The EOL programs expressed somewhat more concern about lack of appropriate care site and care coordination than did homelessness programs. Personal, clinical, and structural challenges face care providers for veterans who are homeless at EOL. Deeper understanding of these challenges will require qualitative study of homeless veterans and care providers. © The Author(s) 2015.

75 FR 29366 - ``Homeless Veterans' Reintegration Program (HVRP) National Technical Assistance Center...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-25

... ``Homeless Veterans' Reintegration Program (HVRP) National Technical Assistance Center Cooperative Agreement...). Section 2021 authorizes programs to expedite the reintegration of homeless Veterans into the labor force... Technical Assistance Center (NTAC) for the Homeless Veterans' Reintegration Program (HVRP) to include the...

Changing Social Networks Among Homeless Individuals: A Prospective Evaluation of a Job- and Life-Skills Training Program.

PubMed

Gray, Heather M; Shaffer, Paige M; Nelson, Sarah E; Shaffer, Howard J

2016-10-01

Social networks play important roles in mental and physical health among the general population. Building healthier social networks might contribute to the development of self-sufficiency among people struggling to overcome homelessness and substance use disorders. In this study of homeless adults completing a job- and life-skills program (i.e., the Moving Ahead Program at St. Francis House, Boston), we prospectively examined changes in social network quality, size, and composition. Among the sample of participants (n = 150), we observed positive changes in social network quality over time. However, social network size and composition did not change among the full sample. The subset of participants who reported abstaining from alcohol during the months before starting the program reported healthy changes in their social networks; specifically, while completing the program, they re-structured their social networks such that fewer members of their network used alcohol to intoxication. We discuss practical implications of these findings.

Risk Factors for Homelessness Among US Veterans

PubMed Central

Tsai, Jack; Rosenheck, Robert A.

2015-01-01

Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. PMID:25595171

45 CFR 1351.10 - What is the purpose of the Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false What is the purpose of the Runaway and Homeless... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.10 What is the purpose of the Runaway and Homeless Youth...

45 CFR 1351.17 - How is application made for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false How is application made for a Runaway and Homeless... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.17 How is application made for a Runaway and Homeless...

45 CFR 1351.10 - What is the purpose of the Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.10 What is the purpose of the Runaway and Homeless Youth... 45 Public Welfare 4 2014-10-01 2014-10-01 false What is the purpose of the Runaway and Homeless...

45 CFR 1351.10 - What is the purpose of the Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.10 What is the purpose of the Runaway and Homeless Youth... 45 Public Welfare 4 2011-10-01 2011-10-01 false What is the purpose of the Runaway and Homeless...

45 CFR 1351.10 - What is the purpose of the Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2012 CFR

2012-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.10 What is the purpose of the Runaway and Homeless Youth... 45 Public Welfare 4 2012-10-01 2012-10-01 false What is the purpose of the Runaway and Homeless...

45 CFR 1351.17 - How is application made for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.17 How is application made for a Runaway and Homeless... 45 Public Welfare 4 2011-10-01 2011-10-01 false How is application made for a Runaway and Homeless...

45 CFR 1351.17 - How is application made for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.17 How is application made for a Runaway and Homeless... 45 Public Welfare 4 2014-10-01 2014-10-01 false How is application made for a Runaway and Homeless...

45 CFR 1351.17 - How is application made for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2012 CFR

2012-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.17 How is application made for a Runaway and Homeless... 45 Public Welfare 4 2012-10-01 2012-10-01 false How is application made for a Runaway and Homeless...

45 CFR 1351.10 - What is the purpose of the Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2013 CFR

2013-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.10 What is the purpose of the Runaway and Homeless Youth... 45 Public Welfare 4 2013-10-01 2013-10-01 false What is the purpose of the Runaway and Homeless...

45 CFR 1351.17 - How is application made for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2013 CFR

2013-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.17 How is application made for a Runaway and Homeless... 45 Public Welfare 4 2013-10-01 2013-10-01 false How is application made for a Runaway and Homeless...

The health of homeless immigrants

PubMed Central

Chiu, Shirley; Redelmeier, Donald A.; Tolomiczenko, George; Kiss, Alex; Hwang, Stephen W.

2009-01-01

Background This study examined the association between immigrant status and current health in a representative sample of 1,189 homeless people in Toronto, Canada. Methods Multivariate regression analyses were performed to examine the relationship between immigrant status and current health status (assessed using the SF-12) among homeless recent immigrants (≤10 years since immigration), non-recent immigrants (>10 years since immigration), and Canadian-born individuals recruited at shelters and meal programs (response rate 73%). Results After adjusting for demographic characteristics and lifetime duration of homelessness, recent immigrants were significantly less likely to have chronic conditions (RR 0.7, 95% CI 0.5 to 0.9), mental health problems (OR 0.4, 95% CI 0.2 to 0.7), alcohol problems (OR 0.2, 95% CI 0.1 to 0.5), and drug problems (OR 0.2, 95% CI 0.1 to 0.4) compared to non-recent immigrants and Canadian-born individuals. Recent immigrants were also more likely to have better mental health status (+3.4 points, SE ±1.6) and physical health status (+2.2 points, SE ±1.3) on scales with a mean of 50 and a standard deviation of 10 in the general population. Conclusion Homeless recent immigrants are a distinct group who are generally healthier and may have very different service needs compared to other homeless people. PMID:19654122

Universal health insurance and health care access for homeless persons.

PubMed

Hwang, Stephen W; Ueng, Joanna J M; Chiu, Shirley; Kiss, Alex; Tolomiczenko, George; Cowan, Laura; Levinson, Wendy; Redelmeier, Donald A

2010-08-01

We examined the extent of unmet needs and barriers to accessing health care among homeless people within a universal health insurance system. We randomly selected a representative sample of 1169 homeless individuals at shelters and meal programs in Toronto, Ontario. We determined the prevalence of self-reported unmet needs for health care in the past 12 months and used regression analyses to identify factors associated with unmet needs. Unmet health care needs were reported by 17% of participants. Compared with Toronto's general population, unmet needs were significantly more common among homeless individuals, particularly among homeless women with dependent children. Factors independently associated with a greater likelihood of unmet needs were younger age, having been a victim of physical assault in the past 12 months, and lower mental and physical health scores on the 12-Item Short Form Health Survey. Within a system of universal health insurance, homeless people still encounter barriers to obtaining health care. Strategies to reduce nonfinancial barriers faced by homeless women with children, younger adults, and recent victims of physical assault should be explored.

Universal Health Insurance and Health Care Access for Homeless Persons

PubMed Central

Ueng, Joanna J. M.; Chiu, Shirley; Kiss, Alex; Tolomiczenko, George; Cowan, Laura; Levinson, Wendy; Redelmeier, Donald A.

2010-01-01

Objectives. We examined the extent of unmet needs and barriers to accessing health care among homeless people within a universal health insurance system. Methods. We randomly selected a representative sample of 1169 homeless individuals at shelters and meal programs in Toronto, Ontario. We determined the prevalence of self-reported unmet needs for health care in the past 12 months and used regression analyses to identify factors associated with unmet needs. Results. Unmet health care needs were reported by 17% of participants. Compared with Toronto's general population, unmet needs were significantly more common among homeless individuals, particularly among homeless women with dependent children. Factors independently associated with a greater likelihood of unmet needs were younger age, having been a victim of physical assault in the past 12 months, and lower mental and physical health scores on the 12-Item Short Form Health Survey. Conclusions. Within a system of universal health insurance, homeless people still encounter barriers to obtaining health care. Strategies to reduce nonfinancial barriers faced by homeless women with children, younger adults, and recent victims of physical assault should be explored. PMID:20558789

77 FR 45421 - Homeless Emergency Assistance and Rapid Transition to Housing: Continuum of Care Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-31

... Re-Housing for Families Demonstration program and the Homelessness Prevention and Rapid Re-Housing... to quickly rehouse homeless individuals and families while minimizing the trauma and dislocation caused to homeless individuals, families, and communities by homelessness; promote access to and...

Barriers to care and service needs among chronically homeless persons in a housing first program.

PubMed

Parker, R David; Albrecht, Helmut A

2012-01-01

In 2010, more than 600,000 people in the United States experienced homelessness. Efficient and cost-effective housing methods that reduce homelessness need to be implemented. Housing Ready programs are the standard method that often has set requirements including earned income and sobriety, among others. These programs enable a subset of the homeless to become housed. However, chronically homeless persons, who use the most resources, are often not successful at enrollment or maintaining enrollment. Housing First (H1) is a method focusing on chronically homeless persons. Housing First places a client in housing and provides services after stabilization. This article assessed differences between chronically homeless persons in a H1 program and chronically homeless persons who are not in H1. A case-control study imbedded within a homeless service program collected sociodemographic and service variables, including access and barriers to care. Although the sample was 100% native English speaking, 22% of homeless persons reported that their providers do not speak their same language. All (100%) of participants had a disabling condition under HUD guidelines, but only 17.78% of homeless controls reported having a disabling condition. There were no differences on housing status based on income, gender, race, or age. The lack of differences between these groups indicates that a H1 program can be a clear derivation from the more common Housing Ready programs that have specific requirements for participation. Provider communication may negatively impact an individual's ability to transition from homelessness. Furthermore, chronically homeless persons not in intensive case management are less likely to understand the eligibility requirements for housing and, therefore, self-disqualify because of this lack of knowledge. Intentional communication and education for chronically homeless persons are 2 examples where case managers could improve the ability of the chronically homeless to obtain housing.

45 CFR 1351.18 - What criteria has HHS established for deciding which Runaway and Homeless Youth Program grant...

Code of Federal Regulations, 2014 CFR

2014-10-01

... which Runaway and Homeless Youth Program grant applications to fund? 1351.18 Section 1351.18 Public..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.18 What...

45 CFR 1351.18 - What criteria has HHS established for deciding which Runaway and Homeless Youth Program grant...

Code of Federal Regulations, 2013 CFR

2013-10-01

... which Runaway and Homeless Youth Program grant applications to fund? 1351.18 Section 1351.18 Public..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.18 What...

45 CFR 1351.18 - What criteria has HHS established for deciding which Runaway and Homeless Youth Program grant...

Code of Federal Regulations, 2012 CFR

2012-10-01

... which Runaway and Homeless Youth Program grant applications to fund? 1351.18 Section 1351.18 Public..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.18 What...

45 CFR 1351.18 - What criteria has HHS established for deciding which Runaway and Homeless Youth Program grant...

Code of Federal Regulations, 2011 CFR

2011-10-01

... which Runaway and Homeless Youth Program grant applications to fund? 1351.18 Section 1351.18 Public..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.18 What...

Educating Homeless Children and Youth: A Sample of Programs, Policies and Procedures.

ERIC Educational Resources Information Center

McCall, Kathleen P.

This report reviews a variety of approaches for working with homeless students. Information was gathered from state Coordinators of Education for Homeless Children and Youth, regional coordinators of homeless programs, and national and local organizations. The programs described are organized into five categories. The first concerns educating…

Understanding pregnancy-related attitudes and behaviors: a mixed-methods study of homeless youth.

PubMed

Tucker, Joan S; Sussell, Jesse; Golinelli, Daniela; Zhou, Annie; Kennedy, David P; Wenzel, Suzanne L

2012-12-01

Pregnancy rates are substantially higher among homeless youth than in the general population of youth, yet little is known about homeless adolescents' and young adults' pregnancy-related attitudes and behaviors. Pregnancy-related attitudes and behaviors were examined among two samples of sexually active homeless 13-24-year-olds in Los Angeles County. Data from 37 semistructured interviews conducted in March-April 2011 were analyzed using standard qualitative methods. Data from a structured survey with 277 respondents, conducted between October 2008 and August 2009, were analyzed primarily using regression modeling. More than half of interview respondents held ambivalent attitudes toward pregnancy, and ambivalent youth reported less contraceptive use than others. The interviews identified several potential influences on pregnancy attitudes: barriers associated with homelessness, readiness to settle down, desire to achieve goals, belief that a child would create something positive in life, and family and partners. In the survey, having positive attitudes toward pregnancy was positively associated with duration of homelessness (odds ratio, 1.6), contact with relatives (1.1) and relationship commitment (1.8); it was negatively associated with frequency of drinking (0.9). Relationship commitment was positively associated with nonuse of an effective contraceptive method at last sex (1.5). Effective and accessible pregnancy prevention and family planning programs for homeless youth are needed. Youths' ambivalence toward pregnancy and feelings of relationship commitment warrant attention as possible areas for programs to address. Copyright © 2012 by the Guttmacher Institute.

Understanding Pregnancy-Related Attitudes and Behaviors: A Mixed-Methods Study of Homeless Youth

PubMed Central

Tucker, Joan S.; Sussell, Jesse; Golinelli, Daniela; Zhou, Annie; Kennedy, David P.; Wenzel, Suzanne L.

2012-01-01

CONTEXT Pregnancy rates are substantially higher among homeless youth than in the general population of youth, yet little is known about homeless adolescents’ and young adults’ pregnancy-related attitudes and behaviors. METHODS Pregnancy-related attitudes and behaviors were examined among two samples of sexually active homeless 13–24-year-olds in Los Angeles County. Data from 37 semistructured interviews conducted in March–April 2011 were analyzed using standard qualitative methods. Data from a structured survey with 277 respondents, conducted between October 2008 and August 2009, were analyzed primarily using regression modeling. RESULTS More than half of interview respondents held ambivalent attitudes toward pregnancy, and ambivalent youth reported less contraceptive use than others. The interviews identified several potential influences on pregnancy attitudes: barriers associated with homelessness, readiness to settle down, desire to achieve goals, belief that a child would create something positive in life, and family and partners. In the survey, having positive attitudes toward pregnancy was positively associated with duration of homelessness (odds ratio, 1.6), contact with relatives (1.1) and relationship commitment (1.8); it was negatively associated with frequency of drinking (0.9). Relationship commitment was positively associated with nonuse of an effective contraceptive method at last sex (1.5). CONCLUSIONS Effective and accessible pregnancy prevention and family planning programs for homeless youth are needed. Youths’ ambivalence toward pregnancy and feelings of relationship commitment warrant attention as possible areas for programs to address. PMID:23231333

Health status of homeless persons: a pilot study in the Padua municipal dorm.

PubMed

Levorato, S; Bocci, G; Troiano, G; Messina, G; Nante, N

2017-01-01

Homeless persons can be considered a vulnerable group and several studies showed in this group an higher prevalence of chronic and infectious diseases, a lower mental health status, and a higher abuse of alcohol. The aim of our study was to investigate the health status of homeless in Padua, Italy, administering a questionnaire composed by SF-36 and EQ-5D. We conducted a cross-sectional study from 15 December 2015 to 15 February 2016. We enrolled in our study 73 homeless persons welcomed in the municipal dorm of Padua. 5 persons refused to participate in the study; 9 had a mental status incompatible with the participation to the study. We administered to the participants a questionnaire composed by three parts: in the first part we asked sociodemographic information (gender, age, nationality, qualification, height and weight) to calculate BMI, time spent at the dorm, period of homelessness, alcohol intake, smoking habit, availability of a general practitioner, emergency room visits in the last year, admissions in the last year, pre-existing conditions and in act, participation in screening programs. The second part was represented by the Short Form 36 questionnaire. The third part by the EQ-5D questionnaire. Our sample was composed by 79% men and 21% women. 54.7% were Italian. The mean age was 48 years. 72.8% were smoker and 60,3% drunk alcohol. In this latter group 28.8% drunk more than 1 liter of wine per day. Non Italian homeless smoke less than the Italian: this difference is statistically significant (OR = 3.7 p = 0.032 ). Only 9 foreigners had a general practitioner compared to 30 Italian homeless: this difference is statistically significant (OR = 60 P < 0.01). 43 of the 59 respondents (72.8 % ) said to suffer from some disease. No one reported a history of tuberculosis. The most represented diseases were pneumonia (30%), myocardial infarction (17%), hepatitis C (13.5%). Participation in screening programs was very low. From the analysis of the SF-36 results, homeless persons obtained lower scores than Italian population. In our study, 40 persons reported a level 2 or 3 in the EQ-5D dimension called "anxiety/ depression". In the EQ visual-analogue scale, the homeless population showed a lower perception of its health status. Compared to the general population, the homeless reported a worse mental health, and this showed that they represent a particularly vulnerable group. Moreover they had a higher percentage of incorrect habits for their health (alcoholism and tobacco addiction), they suffered from chronic conditions, and tended to have a higher frequency of accesses to the emergency rooms. It would be better to improve the state of health of the homeless, through initiatives that could reduce the causes of homelessness, and that could prevent the onset of diseases in this group.

45 CFR 1351.20 - What are the additional requirements under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2013 CFR

2013-10-01

... THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND... Runaway and Homeless Youth Program grant? 1351.20 Section 1351.20 Public Welfare Regulations Relating to... Runaway and Homeless Youth Program grant? (a) To improve the administration of the Runaway and Homeless...

Latent homeless risk profiles of a national sample of homeless veterans and their relation to program referral and admission patterns.

PubMed

Tsai, Jack; Kasprow, Wesley J; Rosenheck, Robert A

2013-12-01

We identified risk and need profiles of homeless veterans and examined the relation between profiles and referrals and admissions to Department of Veterans Affairs (VA) homeless service programs. We examined data from the VA's new Homeless Operations Management and Evaluation System on 120,852 veterans from 142 sites nationally in 2011 and 2012 using latent class analyses based on 9 homeless risk factors. The final 4-class solution compared both referral and admission to VA homeless services. We identified 4 latent classes: relatively few problems, dual diagnosis, poverty-substance abuse-incarceration, and disabling medical problems. Homeless veterans in the first group were more likely to be admitted to the VA's permanent supportive housing program, whereas those in the second group were more likely to be admitted to more restrictive VA residential treatment. Homeless veterans in the third group were more likely to be admitted to the VA's prisoner re-entry program, and those in the fourth group were more likely to be directed to VA medical services. The heterogeneous risk and need profiles of homeless veterans supported the diversity of VA homeless services and encouraged the development of specialized services to meet their diverse needs.

45 CFR 1351.19 - What additional information should an applicant or grantee have about a Runaway and Homeless...

Code of Federal Regulations, 2013 CFR

2013-10-01

... grantee have about a Runaway and Homeless Youth Program grant? 1351.19 Section 1351.19 Public Welfare... AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.19 What...

45 CFR 1351.19 - What additional information should an applicant or grantee have about a Runaway and Homeless...

Code of Federal Regulations, 2012 CFR

2012-10-01

... grantee have about a Runaway and Homeless Youth Program grant? 1351.19 Section 1351.19 Public Welfare... AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.19 What...

45 CFR 1351.19 - What additional information should an applicant or grantee have about a Runaway and Homeless...

Code of Federal Regulations, 2014 CFR

2014-10-01

... grantee have about a Runaway and Homeless Youth Program grant? 1351.19 Section 1351.19 Public Welfare... AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.19 What...

45 CFR 1351.19 - What additional information should an applicant or grantee have about a Runaway and Homeless...

Code of Federal Regulations, 2011 CFR

2011-10-01

... grantee have about a Runaway and Homeless Youth Program grant? 1351.19 Section 1351.19 Public Welfare... AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.19 What...

Homeless Housing: HUD's Shelter Programs. Updated.

ERIC Educational Resources Information Center

Vanhorenbeck, Susan M.

This paper briefly discusses new housing programs for the homeless sponsored by the Department of Housing and Urban Development (HUD), the funding provided by the 100th Congress, and two additional HUD programs to aid the homeless. The following four programs are discussed: (1) the Emergency Shelter Program; (2) the Transitional Housing Program,…

Latent Homeless Risk Profiles of a National Sample of Homeless Veterans and Their Relation to Program Referral and Admission Patterns

PubMed Central

Kasprow, Wesley J.; Rosenheck, Robert A.

2013-01-01

Objectives. We identified risk and need profiles of homeless veterans and examined the relation between profiles and referrals and admissions to Department of Veterans Affairs (VA) homeless service programs. Methods. We examined data from the VA’s new Homeless Operations Management and Evaluation System on 120 852 veterans from 142 sites nationally in 2011 and 2012 using latent class analyses based on 9 homeless risk factors. The final 4-class solution compared both referral and admission to VA homeless services. Results. We identified 4 latent classes: relatively few problems, dual diagnosis, poverty–substance abuse–incarceration, and disabling medical problems. Homeless veterans in the first group were more likely to be admitted to the VA’s permanent supportive housing program, whereas those in the second group were more likely to be admitted to more restrictive VA residential treatment. Homeless veterans in the third group were more likely to be admitted to the VA’s prisoner re-entry program, and those in the fourth group were more likely to be directed to VA medical services. Conclusions. The heterogeneous risk and need profiles of homeless veterans supported the diversity of VA homeless services and encouraged the development of specialized services to meet their diverse needs. PMID:24148048

45 CFR 1351.15 - What costs are supportable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false What costs are supportable under a Runaway and... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.15 What costs are supportable under a Runaway and Homeless...

45 CFR 1351.11 - Who is eligible to apply for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Who is eligible to apply for a Runaway and... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.11 Who is eligible to apply for a Runaway and Homeless...

45 CFR 1351.11 - Who is eligible to apply for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2012 CFR

2012-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.11 Who is eligible to apply for a Runaway and Homeless... 45 Public Welfare 4 2012-10-01 2012-10-01 false Who is eligible to apply for a Runaway and...

45 CFR 1351.11 - Who is eligible to apply for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.11 Who is eligible to apply for a Runaway and Homeless... 45 Public Welfare 4 2014-10-01 2014-10-01 false Who is eligible to apply for a Runaway and...

45 CFR 1351.15 - What costs are supportable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.15 What costs are supportable under a Runaway and Homeless... 45 Public Welfare 4 2011-10-01 2011-10-01 false What costs are supportable under a Runaway and...

45 CFR 1351.15 - What costs are supportable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.15 What costs are supportable under a Runaway and Homeless... 45 Public Welfare 4 2014-10-01 2014-10-01 false What costs are supportable under a Runaway and...

45 CFR 1351.15 - What costs are supportable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2013 CFR

2013-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.15 What costs are supportable under a Runaway and Homeless... 45 Public Welfare 4 2013-10-01 2013-10-01 false What costs are supportable under a Runaway and...

45 CFR 1351.11 - Who is eligible to apply for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.11 Who is eligible to apply for a Runaway and Homeless... 45 Public Welfare 4 2011-10-01 2011-10-01 false Who is eligible to apply for a Runaway and...

45 CFR 1351.15 - What costs are supportable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2012 CFR

2012-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.15 What costs are supportable under a Runaway and Homeless... 45 Public Welfare 4 2012-10-01 2012-10-01 false What costs are supportable under a Runaway and...

45 CFR 1351.11 - Who is eligible to apply for a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2013 CFR

2013-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.11 Who is eligible to apply for a Runaway and Homeless... 45 Public Welfare 4 2013-10-01 2013-10-01 false Who is eligible to apply for a Runaway and...

Chronic kidney disease in homeless persons in Mexico.

PubMed

Garcia-Garcia, Guillermo; Gutiérrez-Padilla, Alfonso J; Renoirte-Lopez, Karina; Mendoza-Garcia, Martha; Oseguera-Vizcaino, Ma C; Perez-Gomez, Hector R; Marquez-Amezcua, J Mario; Tonelli, Marcello

2013-05-01

Little is known about the prevalence of chronic kidney disease (CKD) among the homeless in Mexico. The role of substance abuse, alcoholism, and homelessness in CKD has not been properly evaluated. We screened 260 homeless individuals in the state of Jalisco, Mexico, for the presence of CKD and its risk factors, and compared their characteristics with those from a separate cohort of poor Jalisco residents and with a survey of the general Mexican population. CKD was more prevalent among the homeless than among the poor Jalisco population (22% vs. 15.8%, P =0.0001); 16.5% had stage 3, 4.3% stage 4, and 1.2% stage 5. All were unaware of having CKD. Only 5.8% knew they had diabetes, but 19% had fasting blood sugar >126 mg/dl; 3.5% knew they were hypertensive but 31% had systolic blood pressure ⩾140 mm Hg or diastolic blood pressure ⩾90 mm Hg. Alcoholism was less common than in the poor Jalisco population (23.5% vs. 32.3%, P =0.002), but tobacco smoking (34.6% vs. 21.5%, P =0.0001) and substance abuse (18% vs. 1.1%, P =0.0001) were more prevalent among the homeless. Likewise, chronic viral infections such as HIV (4.5% vs. 0.3%, P =0.0001) and HCV (7.7% vs. 1.4%, P =0.0001) were also significantly higher among the homeless than in the general population. In conclusion, CKD and its risk factors are highly prevalent among the homeless individuals in Jalisco, Mexico. Lack of awareness of having diabetes and hypertension is highly common, as is substance abuse. Programs aiming to prevent CKD and its risk factors in Mexico should specifically target this high-risk population.

The individual and beyond: a socio-rational choice model of service participation among homeless adults with substance abuse problems.

PubMed

Sosin, Michael R; Grossman, Susan F

2003-01-01

While substance user service programs can help homeless adults solve their substance use and housing problems, relatively few needy individuals use and complete these programs. The lack of participation is poorly explained by typical empirical studies, most of which consider the role in service participation of various personal traits and client problems. The current article instead seeks to explain service participation through the application of an alternative, "socio-rational choice" model. This model has three premises: Clients weigh the costs and benefits of participating in services against alternative uses of their time and resources. The clients' weighing procedures reflect their personal situations and perceptions of the treatment environment. The perceptions of their personal situations and perceptions of the treatment environment are affected by the manner in which clients react to representatives of service systems, members of their social network including both housed and homeless persons, and other individuals. Secondary evidence supports many of the model's hypotheses and generally suggests that homeless clients may be heavily affected by their experiences with individuals and systems with which they come into contact.

Risk factors for homelessness among US veterans.

PubMed

Tsai, Jack; Rosenheck, Robert A

2015-01-01

Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Residential Instability and the McKinney-Vento Homeless Children and Education Program: What We Know, Plus Gaps in Research

ERIC Educational Resources Information Center

Cunningham, Mary; Harwood, Robin; Hall, Sam

2010-01-01

As homelessness increased among families and children during the 1980s and 1990s, policymakers created, and strengthened, the McKinney-Vento Education for Homeless Children and Youth (EHCY) program. The McKinney-Vento EHCY program aims to mitigate the effects of residential instability through the identification of homeless children in schools and…

Case Management Models in Permanent Supported Housing Programs for People With Complex Behavioral Issues Who Are Homeless.

PubMed

Clark, Colleen; Guenther, Christina C; Mitchell, Jessica N

2016-01-01

The purpose of this article is to examine two evidence-based models of case management for people with co-occurring disorders and histories of chronic homelessness and to better understand their roles in permanent supported housing. Critical Time Intervention and Assertive Community Treatment are examined in terms of key elements, how they assist in ending homelessness, as well as the role they play in an individual's recovery from co-occurring disorders. Participants in two supported housing programs were interviewed at baseline and 6 months. One program used Critical Time Intervention (n = 144) and the other used Assertive Community Treatment (n = 90). Staff in both programs were interviewed about their experiences and fidelity assessments were conducted for each program. Both programs operated at high levels of fidelity. Despite similar criteria for participation, there were significant differences between groups. Critical Time Intervention participants were older, were more likely to be male, were more likely to be homeless, and reported greater psychiatric symptoms and higher levels of substance use (all p's < .001). Separate outcome analyses suggested that each program was successful in supporting people to transition from homelessness to stable housing; 88.6% of Assertive Community Treatment participants were homeless at baseline, while at 6 months 30% were homeless (p < .001), and 91.3% of those in the Critical Time Intervention were homeless at baseline, while 44.3% were homeless at 6 months (p < .001). Participants in the Critical Time Intervention program also showed significant decreases in alcohol use, drug use, and psychiatric symptoms (all p's < .01). The preliminary results suggest that each case management model is helpful in assisting people with complex behavioral health needs and chronic homelessness to move to stable housing. Permanent supported housing seems to be an effective way to end homelessness among people with co-occurring disorders. Further research is needed to determine which case management models work most effectively with supported housing to help policy makers and program directors make informed decisions in developing these programs.

34 CFR 491.3 - What activities may the Secretary fund?

Code of Federal Regulations, 2014 CFR

2014-07-01

... existing resources such as community-based organizations, VISTA recipients, the adult basic education... VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General... for projects that implement a program of literacy training and basic skills remediation for adult...

34 CFR 491.3 - What activities may the Secretary fund?

Code of Federal Regulations, 2013 CFR

2013-07-01

... existing resources such as community-based organizations, VISTA recipients, the adult basic education... VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General... for projects that implement a program of literacy training and basic skills remediation for adult...

34 CFR 491.3 - What activities may the Secretary fund?

Code of Federal Regulations, 2012 CFR

2012-07-01

... existing resources such as community-based organizations, VISTA recipients, the adult basic education... VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General... for projects that implement a program of literacy training and basic skills remediation for adult...

34 CFR 491.3 - What activities may the Secretary fund?

Code of Federal Regulations, 2011 CFR

2011-07-01

... existing resources such as community-based organizations, VISTA recipients, the adult basic education... VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General... for projects that implement a program of literacy training and basic skills remediation for adult...

Recognizing the Needs of the Homeless.

ERIC Educational Resources Information Center

France, Joseph B.

This paper summarizes reports and research on the homeless in the United States, presents findings of a survey of Red Cross chapters on services to the homeless, and describes programs for the homeless of selected Red Cross chapters. Section 1 discusses definitions of homelessness and methodologies used to count homeless people. The homeless are…

Adult Education for the Homeless: A Program in Jeopardy.

ERIC Educational Resources Information Center

Office of Vocational and Adult Education (ED), Washington, DC. Div. of Adult Education and Literacy.

During its 8-year history, the federal Adult Education for the Homeless Program (AEH) pioneered new methods of service to adults in need and benefited over 320,000 homeless adults and families. Despite an evaluation that documented program success, funding was rescinded from the 1995 federal budget and never reinstated. AEH programs developed the…

32 CFR 226.4 - Responsibilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (Installations) shall: (1) Administer the Homeless Assistance Program and issue such supplemental guidance as is... answering all inquiries. (b) The Assistance Secretary of Defense (Comptroller) shall provide guidance on the... Homeless program. (2) Appoint a senior manager to monitor the Shelter for the Homeless program within that...

Inner resources for survival: integrating interpersonal psychotherapy with spiritual visualization with homeless youth.

PubMed

Mastropieri, Biagio; Schussel, Lorne; Forbes, David; Miller, Lisa

2015-06-01

Homeless youth have particular need to develop inner resources to confront the stress, abusive environment of street life, and the paucity of external resources. Research suggests that treatment supporting spiritual awareness and growth may create a foundation for coping, relationships, and negotiating styles to mitigate distress. The current pilot study tests the feasibility, acceptability, and helpfulness of an interpersonal spiritual group psychotherapy, interpersonal psychotherapy (IPT) integrated with spiritual visualization (SV), offered through a homeless shelter, toward improving interpersonal coping and ameliorating symptoms of depression, distress, and anxiety in homeless youth. An exploratory pilot of integrative group psychotherapy (IPT + SV) for homeless young adults was conducted in a New York City on the residential floor of a shelter-based transitional living program. Thirteen young adult men (mean age 20.3 years, SD = 1.06) participated in a weekly evening psychotherapy group (55 % African-American, 18 % biracial, 18 % Hispanic, 9 % Caucasian). Measures of psychological functioning were assessed at pre-intervention and post-intervention using the General Health Questionnaire (GHQ-12), Patient Health Questionnaire (PHQ-9, GAD-7), and the Inventory of Interpersonal Problems (IIP-32). A semi-structured exit interview and a treatment satisfaction questionnaire were also employed to assess acceptability following treatment. Among homeless young adults to participate in the group treatment, significant decreases in symptoms of general distress and depression were found between baseline and termination of treatment, and at the level of a trend, improvement in overall interpersonal functioning and levels of general anxiety. High utilization and treatment satisfaction showed the intervention to be both feasible and acceptable. Offered as an adjunct to the services-as-usual model at homeless shelters serving young adults, interpersonal psychotherapy with spiritual visualization (IPT + SV) in group appears to be a feasible and potentially useful treatment option for promoting improved mental health.

Results of Innovative and Supportive Learning Programs for Homeless Children and Adults

ERIC Educational Resources Information Center

Sinatra, Richard; Eschenauer, Robert

2012-01-01

Four-week summer academy programs served homeless children and adults in two contiguous innovative learning programs. The programs may be the first of their kind in the homeless literature in which both adults and children were exposed to career, academic, and leadership opportunities in the supportive learning environment of a university campus,…

Caring for homeless persons with serious mental illness in general hospitals.

PubMed

Bauer, Leah K; Baggett, Travis P; Stern, Theodore A; O'Connell, Jim J; Shtasel, Derri

2013-01-01

The care of homeless persons with serious mental illness remains a common and challenging problem in general hospital settings. This article aims to review data on homelessness and its psychiatric comorbidities, and to expand the skills of providers who encounter homeless individuals in general hospital settings. Literature review reveals patient, provider, and systems factors that contribute to suboptimal health outcomes in homeless individuals. Diagnostic rigor, integrated medical and psychiatric care, trauma-informed interventions, special considerations in capacity evaluations, and health care reform initiatives can improve the treatment of homeless persons with serious mental illness. Copyright © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Personality disorders and psychosocial problems in a group of participants to therapeutic processes for people with severe social disabilities.

PubMed

Salavera, Carlos; Tricás, José M; Lucha, Orosia

2011-12-11

Homeless people have high dropout rates when they participate in therapeutic processes. The causes of this failure are not always known. This study investigates whether dropping-out is mediated by personality disorders or whether psychosocial problems are more important. Eighty-nine homeless people in a socio-laboral integration process were assessed. An initial interview was used, and the MCMI II questionnaire was applied to investigate the presence of psychosocial disorders (DSM-IV-TR axis IV). This was designed as an ex post-facto prospective study. Personality disorders were very frequent among the homeless people examined. Moreover, the high index of psychosocial problems (axis IV) in this population supported the proposal that axis IV disorders are influential in failure to complete therapy. The outcomes of the study show that the homeless people examined presented with more psychopathological symptoms, in both axis II and axis IV, than the general population. This supports the need to take into account the comorbidity between these two types of disorder among homeless people, in treatment and in the development of specific intervention programs. In conclusion, the need for more psychosocial treatments addressing the individual problems of homeless people is supported.

Supportive Housing for Homeless Families: Foster Care Outcomes and Best Practices. Summary

ERIC Educational Resources Information Center

Lenz-Rashid, Sonja

2013-01-01

The "Supportive Housing for Homeless Families: Foster Care Outcomes and Best Practices" report describes the outcome evaluation of Cottage Housing Incorporated's Serna Village program in Sacramento, California. Serna Village is a supportive housing program serving homeless families. Outcomes from the program illustrate that it is…

Perceptions of homelessness in older homeless veterans, VA homeless program staff liaisons, and housing intervention providers.

PubMed

Molinari, Victor A; Brown, Lisa M; Frahm, Kathryn A; Schinka, John A; Casey, Roger

2013-05-01

To understand the needs and challenges encountered by older homeless veterans. We conducted six focus groups of older veterans, two focus groups, and one semi-structured interview of VA staff liaisons, and two focus groups and one semi-structured interview of housing intervention providers. Major themes for older veterans: 1) negative homelessness experience; 2) benefits of the structured transitional housing program; 3) importance of peer outreach; and 4) need for age-tailored job placement programs. Major themes for VA staff liaison/housing intervention providers: 1) belief that the transitional housing program has made a positive change; 2) need for individualized criteria to address the unique needs of veterans; 3) distinct differences between older and younger homeless veterans; 4) outreach services; 5) permanent housing issues; and 6) coordination of services. Compared with younger veterans, older veterans have less social support, greater employment and health challenges, and, perhaps greater motivation to change.

45 CFR 1351.13 - What are the Federal and non-Federal match requirements under a Runaway and Homeless Youth grant?

Code of Federal Regulations, 2010 CFR

2010-10-01

... requirements under a Runaway and Homeless Youth grant? 1351.13 Section 1351.13 Public Welfare Regulations... SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.13 What are the Federal and non...

The Community College and the Homeless: A Model for the Nation. Job Training for the Homeless Demonstration Program Final Evaluation Report.

ERIC Educational Resources Information Center

Moehrlin, Cynthia D.

Established in 1981, the Alternatives Program at Elgin Community College (ECC) has provided services for displaced homemakers, single parents, welfare recipients, and homeless women, laying the groundwork for the 1988 formation of the Fox Valley Consortium for Job Training and Placement of the Homeless. Using federal funding, the Consortium offers…

45 CFR 1351.13 - What are the Federal and non-Federal match requirements under a Runaway and Homeless Youth grant?

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.13 What are the Federal and non... requirements under a Runaway and Homeless Youth grant? 1351.13 Section 1351.13 Public Welfare Regulations...

45 CFR 1351.13 - What are the Federal and non-Federal match requirements under a Runaway and Homeless Youth grant?

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.13 What are the Federal and non... requirements under a Runaway and Homeless Youth grant? 1351.13 Section 1351.13 Public Welfare Regulations...

45 CFR 1351.13 - What are the Federal and non-Federal match requirements under a Runaway and Homeless Youth grant?

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.13 What are the Federal and non... requirements under a Runaway and Homeless Youth grant? 1351.13 Section 1351.13 Public Welfare Regulations...

45 CFR 1351.13 - What are the Federal and non-Federal match requirements under a Runaway and Homeless Youth grant?

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.13 What are the Federal and non... requirements under a Runaway and Homeless Youth grant? 1351.13 Section 1351.13 Public Welfare Regulations...

Homelessness and the Homeless: Responses and Innovations. A Canadian Contribution to IYSH 1987.

ERIC Educational Resources Information Center

Oberlander, H. Peter; Fallick, Arthur L.

This report presents descriptions of successful Canadian public and private programs to aid the homeless and alleviate homelessness as part of participation in the International Year of Shelter for the Homeless (IYSH). Part 1, "The International Year of Shelter for the Homeless," includes the following: (1) objectives; (2) global…

78 FR 26559 - Homeless Emergency Assistance and Rapid Transition to Housing: Rural Housing Stability Assistance...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-07

...). SUPPLEMENTARY INFORMATION: The Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009 (HEARTH... Homelessness Grant program. The HEARTH Act also directs HUD to promulgate regulations for these new programs...

An Analysis of Homeless Veterans Participating in the Homeless Veteran Reintegration Program

ERIC Educational Resources Information Center

Campbell, Katrina Lanelle

2010-01-01

The purpose of this study was to conduct an analysis on ex post facto data of the federal grant supported Homeless Veterans Reintegration Program (HVRP) administered at Goodwill Industries of Lower South Carolina. Pre-existing data on variables such as performance goals, training activities, support services, and demographics from program years…

Creating a Science of Homelessness During the Reagan Era

PubMed Central

JONES, MARIAN MOSER

2015-01-01

Policy Points: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net. Context A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences’ role in the policy response to homelessness and how politics has shaped the federal research agenda. Methods Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. Findings Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding “social research,” together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services. Conclusions The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists’ long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways. PMID:25752353

Creating a science of homelessness during the Reagan era.

PubMed

Jones, Marian Moser

2015-03-01

POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net. A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda. Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services. The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways. © 2015 Milbank Memorial Fund.

Addressing Homelessness: Recent Happenings--Iowa, 2004

ERIC Educational Resources Information Center

Iowa Department of Education, 2004

2004-01-01

This guide provides information on the following resources available to the homeless in Iowa: (1) Funding Sources for School District Programs Serving Homeless Students; (2) Local Educational Liaison for Homeless Children and Youth; (3) Homeless Advisory Committee; (4) Identification, Counting, and Maintaining Data at the Local School District…

Post-hospital medical respite care and hospital readmission of homeless persons.

PubMed

Kertesz, Stefan G; Posner, Michael A; O'Connell, James J; Swain, Stacy; Mullins, Ashley N; Shwartz, Michael; Ash, Arlene S

2009-01-01

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital.

Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

PubMed Central

Kertesz, Stefan G.; Posner, Michael A.; O’Connell, James J.; Swain, Stacy; Mullins, Ashley N.; Michael, Shwartz; Ash, Arlene S.

2009-01-01

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This paper examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, Respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital. PMID:19363773

Hospital Readmissions in a Community-based Sample of Homeless Adults: a Matched-cohort Study.

PubMed

Saab, Dima; Nisenbaum, Rosane; Dhalla, Irfan; Hwang, Stephen W

2016-09-01

Hospital readmission rates are a widely used quality indicator that may be elevated in disadvantaged populations. The objective of this study was to compare the hospital readmission rate among individuals experiencing homelessness with that of a low-income matched control group, and to identify risk factors associated with readmission within the group experiencing homelessness. We conducted a 1:1 matched cohort study comparing 30-day hospital readmission rates between homeless patients and low-income controls matched on age, sex and primary reason for admission. Multivariate analyses using generalized estimating equations were used to assess risk factors associated with 30-day readmission in the homeless cohort. This study examined a cohort of 1,165 homeless adults recruited at homeless shelters and meal programs in Toronto, Ontario, between 6 December 2004 and 20 December 2005. The primary outcome was the occurrence of an unplanned medical or surgical readmission within 30 days of discharge from hospital. Between 6 December 2004 and 31 March 2009, homeless participants (N = 203) had 478 hospitalizations and a 30-day readmission rate of 22.2 %, compared to 300 hospitalizations and a readmission rate of 7.0 % among matched controls (OR = 3.79, 95 % CI 1.93-7.39). In the homeless cohort, having a primary care physician (OR = 2.65, 95 % CI 1.05-6.73) and leaving against medical advice (OR = 1.96, 95 % CI 0.99-3.86) were associated with an increased risk of 30-day readmission. Homeless patients had nearly four times the odds of being readmitted within 30-days as compared to low-income controls matched on age, sex and primary reason for admission to hospital. Further research is needed to evaluate interventions to reduce readmissions among this patient population.

Alcoholism, Drug Abuse, and the Homeless.

ERIC Educational Resources Information Center

McCarty, Dennis; And Others

1991-01-01

Reviews policies that address substance abuse among the homeless. Recommends that the changing needs of the homeless require an integration of alcoholism and drug abuse recovery services with programs for various groups, substance-free housing, and psychological knowledge incorporated into programs for those struggling with addiction and…

Predictors of homeless services re-entry within a sample of adults receiving Homelessness Prevention and Rapid Re-Housing Program (HPRP) assistance.

PubMed

Brown, Molly; Vaclavik, Danielle; Watson, Dennis P; Wilka, Eric

2017-05-01

Local and national evaluations of the federal Homelessness Prevention and Rapid Re-Housing Program (HPRP) have demonstrated a high rate of placement of program participants in permanent housing. However, there is a paucity of research on the long-term outcomes of HPRP, and research on rehousing and prevention interventions for single adults experiencing homelessness is particularly limited. Using Homeless Management Information System data from 2009 to 2015, this study examined risk of return to homeless services among 370 permanently housed and 71 nonpermanently housed single adult HPRP participants in Indianapolis, Indiana. Kaplan-Meier survival curves were conducted to analyze time-to-service re-entry for the full sample, and the homelessness prevention and rapid rehousing participants separately. With an average follow-up of 4.5 years after HPRP exit, 9.5% of the permanently housed HPRP participants and 16.9% of those nonpermanently housed returned to homeless services. By assistance type, 5.4% of permanently housed and 15.8% of nonpermanently housed homelessness prevention recipients re-entered services, and 12.8% of permanently housed and 18.2% of nonpermanently housed rapid rehousing recipients re-entered during the follow-up period. Overall, veterans, individuals receiving rapid rehousing services, and those whose income did not increase during HPRP had significantly greater risk of returning to homeless services. Veterans were at significantly greater risk of re-entry when prevention and rehousing were examined separately. Findings suggest a need for future controlled studies of prevention and rehousing interventions for single adults, aiming to identify unique service needs among veterans and those currently experiencing homelessness in need of rehousing to inform program refinement. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Programmatic Impact of 5 Years of Mortality Surveillance of New York City Homeless Populations

PubMed Central

Marder, Dova; Begier, Elizabeth; Gutkovich, Alexander; Mos, Robert; Griffin, Angela; Zimmerman, Regina; Madsen, Ann

2013-01-01

A homeless mortality surveillance system identifies emerging trends in the health of the homeless population and provides this information to key stakeholders in a timely and ongoing manner to effect evidence-based, programmatic change. We describe the first 5 years of the New York City homeless mortality surveillance system and, for the first time in peer-reviewed literature, illustrate the impact of key elements of sustained surveillance (i.e., timely dissemination of aggregate mortality data and real-time sharing of information on individual homeless decedents) on the programs of New York City’s Department of Homeless Services. These key elements had a positive impact on the department’s programs that target sleep-related infant deaths and hypothermia, drug overdose, and alcohol-related deaths among homeless persons. PMID:24148068

45 CFR 1351.16 - What costs are not allowable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false What costs are not allowable under a Runaway and... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.16 What costs are not allowable under a Runaway and...

45 CFR 1351.16 - What costs are not allowable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.16 What costs are not allowable under a Runaway and... 45 Public Welfare 4 2011-10-01 2011-10-01 false What costs are not allowable under a Runaway and...

45 CFR 1351.16 - What costs are not allowable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2013 CFR

2013-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.16 What costs are not allowable under a Runaway and... 45 Public Welfare 4 2013-10-01 2013-10-01 false What costs are not allowable under a Runaway and...

45 CFR 1351.16 - What costs are not allowable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2012 CFR

2012-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.16 What costs are not allowable under a Runaway and... 45 Public Welfare 4 2012-10-01 2012-10-01 false What costs are not allowable under a Runaway and...

45 CFR 1351.16 - What costs are not allowable under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.16 What costs are not allowable under a Runaway and... 45 Public Welfare 4 2014-10-01 2014-10-01 false What costs are not allowable under a Runaway and...

YogaHome: teaching and research challenges in a yoga program with homeless adults.

PubMed

Davis-Berman, Jennifer; Farkas, Jean

2012-01-01

YogaHome is a therapeutic yoga program for homeless women. Developing and refining YogaHome provided a unique opportunity to explore the process of teaching yoga to women faced with the physical and emotional stress of living in a homeless shelter. Unique teaching and research challenges are presented and recommendations for future programs are discussed.

24 CFR 582.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... DEVELOPMENT COMMUNITY FACILITIES SHELTER PLUS CARE General § 582.1 Purpose and scope. (a) General. The Shelter Plus Care program (S+C) is authorized by title IV, subtitle F, of the Stewart B. McKinney Homeless... § 582.100. Applicants may apply for assistance under any one of the four components, or a combination...

Personality disorders and psychosocial problems in a group of participants to therapeutic processes for people with severe social disabilities

PubMed Central

2011-01-01

Background Homeless people have high dropout rates when they participate in therapeutic processes. The causes of this failure are not always known. This study investigates whether dropping-out is mediated by personality disorders or whether psychosocial problems are more important. Method Eighty-nine homeless people in a socio-laboral integration process were assessed. An initial interview was used, and the MCMI II questionnaire was applied to investigate the presence of psychosocial disorders (DSM-IV-TR axis IV). This was designed as an ex post-facto prospective study. Results Personality disorders were very frequent among the homeless people examined. Moreover, the high index of psychosocial problems (axis IV) in this population supported the proposal that axis IV disorders are influential in failure to complete therapy. Conclusion The outcomes of the study show that the homeless people examined presented with more psychopathological symptoms, in both axis II and axis IV, than the general population. This supports the need to take into account the comorbidity between these two types of disorder among homeless people, in treatment and in the development of specific intervention programs. In conclusion, the need for more psychosocial treatments addressing the individual problems of homeless people is supported. PMID:22151623

Lessons Learned: A "Homeless Shelter Intervention" by a Medical Student

ERIC Educational Resources Information Center

Owusu, Yasmin; Kunik, Mark; Coverdale, John; Shah, Asim; Primm, Annelle; Harris, Toi

2012-01-01

Objective: The authors explored the process of implementing a medical student-initiated program designed to provide computerized mental health screening, referral, and education in a homeless shelter. Method: An educational program was designed to teach homeless shelter staff about psychiatric disorders and culturally-informed treatment…

Serving Homeless Children and Families in Head Start.

ERIC Educational Resources Information Center

Koblinsky, Sally A.; Anderson, Elaine A.

1993-01-01

Describes the plight of homeless families in the United States, examining the special role that Head Start programs can play in homeless families' lives. Suggests that Head Start programs need to address staff training, family recruitment, health services, transportation, flexible scheduling, home-based options, attendance, parent education,…

45 CFR 1351.12 - Who gets priority for the award of a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Who gets priority for the award of a Runaway and... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.12 Who gets priority for the award of a Runaway and...

45 CFR 1351.12 - Who gets priority for the award of a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.12 Who gets priority for the award of a Runaway and... 45 Public Welfare 4 2011-10-01 2011-10-01 false Who gets priority for the award of a Runaway and...

45 CFR 1351.12 - Who gets priority for the award of a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.12 Who gets priority for the award of a Runaway and... 45 Public Welfare 4 2014-10-01 2014-10-01 false Who gets priority for the award of a Runaway and...

45 CFR 1351.12 - Who gets priority for the award of a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2013 CFR

2013-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.12 Who gets priority for the award of a Runaway and... 45 Public Welfare 4 2013-10-01 2013-10-01 false Who gets priority for the award of a Runaway and...

45 CFR 1351.12 - Who gets priority for the award of a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2012 CFR

2012-10-01

... FOR CHILDREN, YOUTH AND FAMILIES, FAMILY AND YOUTH SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Runaway and Homeless Youth Program Grant § 1351.12 Who gets priority for the award of a Runaway and... 45 Public Welfare 4 2012-10-01 2012-10-01 false Who gets priority for the award of a Runaway and...

A Case Study of a Post-Secondary Pilot Program That Provides Education to Qualified Homeless Students at a Private University

ERIC Educational Resources Information Center

Blanchard, Weedens E.

2017-01-01

The purpose of this research case study was to examine a post-secondary pilot program that provides education to select New York City homeless adults at a private university. In this study, the researcher examined how the Academy program assists homeless and disadvantaged adults to obtain post-graduate employment opportunities through academic…

Posttraumatic Stress Disorder and Interpersonal Process in Homeless Veterans Participating in a Peer Mentoring Intervention: Associations With Program Benefit.

PubMed

Van Voorhees, Elizabeth E; Resnik, Linda; Johnson, Erin; O'Toole, Thomas

2018-01-25

Homelessness among veterans has dropped dramatically since the expansion of services for homeless veterans in 2009, and now engaging homeless veterans in existing programs will be important to continuing to make progress. While one promising approach for engaging homeless veterans in care is involving peer mentors in integrated services, posttraumatic stress disorder (PTSD) may diminish the effects of peer mentorship. This mixed methods study examined how interpersonal and emotional processes in homeless veterans with and without PTSD impacted their capacity to engage in relationships with peer mentors. Four focus groups of 5-8 homeless male veterans (N = 22) were drawn from a larger multisite randomized trial. Qualitative analysis identified five primary themes: disconnectedness; anger, hostility, or resentment; connecting with others; positive view of self; and feeling like an outsider. Thematic comparisons between participants with and without a self-reported PTSD diagnosis, and between those who did and did not benefit from the peer mentor program, were validated by using quantitative methods. Disconnectedness was associated with self-reported PTSD diagnosis and with lack of program benefit; feeling like an outsider was associated with program benefit. Results suggest that disruption to the capacity to develop and maintain social bonds in PTSD may interfere with the capacity to benefit from peer mentorship. Social rules and basic strategies for navigating interpersonal relationships may differ somewhat within the homeless community and outside of it; for veterans who feel disconnected from the domiciled community, a formerly homeless veteran peer may serve as a critical "bridge" between the two social worlds. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Education for Homeless Children and Youths Program. Title VII-B of the McKinney-Vento Homeless Assistance Act, as Amended by the Every Student Succeeds Act. Non-Regulatory Guidance. Updated

ERIC Educational Resources Information Center

US Department of Education, 2017

2017-01-01

The McKinney-Vento Act was originally authorized in 1987 and originally sponsored programs to provide services to the homeless. The McKinney-Vento Act is designed to address the challenges that homeless children and youths have faced in enrolling, attending, and succeeding in school. Under the McKinney-Vento Act, State educational agencies (SEAs)…

Rapid HIV testing experience at Veterans Affairs North Texas Health Care System's Homeless Stand Downs.

PubMed

Hooshyar, Dina; Surís, Alina M; Czarnogorski, Maggie; Lepage, James P; Bedimo, Roger; North, Carol S

2014-01-01

In the USA, 21% of the estimated 1.1 million people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) are unaware they are HIV-infected. In 2011, Veterans Health Administration (VHA)'s Office of Public Health in conjunction with VHA's Health Care for Homeless Veterans Program funded grants to support rapid HIV testing at homeless outreach events because homeless populations are more likely to obtain emergent rather than preventive care and have a higher HIV seroprevalence as compared to the general population. Because of a Veterans Affairs North Texas Health Care System (VANTHCS)'s laboratory testing requirement, VANTHCS partnered with community agencies to offer rapid HIV testing for the first time at VANTHCS' 2011 Homeless Stand Downs in Dallas, Fort Worth, and Texoma, Texas. Homeless Stand Downs are outreach events that connect Veterans with services. Veterans who declined testing were asked their reasons for declining. Comparisons by Homeless Stand Down site used Pearson χ², substituting Fisher's Exact tests for expected cell sizes <5. Of the 910 Veterans attending the Homeless Stand Downs, 261 Veterans reported reasons for declining HIV testing, and 133 Veterans were tested, where 92% of the tested Veterans obtained their test results at the events - all tested negative. Veterans' reported reasons for declining HIV testing included previous negative result (n=168), no time to test (n=49), no risk factors (n=36), testing is not a priority (n=11), uninterested in knowing serostatus (n=6), and HIV-infected (n=3). Only "no time to test" differed significantly by Homeless Stand Down site. Nonresponse rate was 54%. Offering rapid HIV testing at Homeless Stand Downs is a promising testing venue since 15% of Veterans attending VANTHCS' Homeless Stand Downs were tested for HIV, and majority obtained their HIV test results at point-of-care while further research is needed to determine how to improve these rates.

Prescription drug misuse among homeless youth.

PubMed

Rhoades, Harmony; Winetrobe, Hailey; Rice, Eric

2014-05-01

Prescription drug misuse (PDM) is highly prevalent among youth in the U.S., and can have serious health consequences. Homeless youth are a particularly vulnerable population with high rates of substance use. However, PDM has not been studied in a sample comprised exclusively of homeless youth. A sample of 451 homeless youth recruited from drop-in centers in Los Angeles, CA, provided information on substance use, mental health, service utilization, trauma, and sexual risk behavior. Multivariable logistic regression assessed correlates of past month PDM. Nearly 50% reported lifetime PDM and 21.6% reported PDM in the past month. The most frequently used prescriptions in the past month were: opioids only (24.5%), sedatives only (23.4%), and stimulants only (10.6%); 14.9% used some combination of these three types of prescription medications. Homeless youth reported that prescriptions were most commonly obtained for free from friends or relatives (24.5%). Foster care involvement was associated with decreased PDM, while hard drug use, suicidal ideation, and unprotected sex were associated with increased PDM. Homeless youth report high rates of PDM, and access these medications most frequently from friends and family. PDM among homeless youth clusters with other risk factors, including hard drug use, unprotected sex, and suicidal ideation. Surprisingly, foster care history was associated with decreased PDM. Programs aimed at preventing PDM among homeless youth should recognize the clustering of risk behaviors, assess prescription use/access when providing mental health services, and educate the general public about proper disposal of prescriptions. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Mental, neurologic, and substance use (MNS) disorders among street homeless people in Ethiopia.

PubMed

Ayano, Getinet; Assefa, Dawit; Haile, Kibrom; Chaka, Asrat; Solomon, Haddish; Hagos, Petros; Yohannis, Zegeye; Haile, Kelemua; Bekana, Lulu; Agidew, Melkamu; Demise, Seife; Tsegaye, Belachew; Solomon, Melat

2017-01-01

About 25-60% of the homeless population is reported to have some form of mental disorder. To our knowledge, there are no studies aimed at the screening, diagnosis, treatment, care, rehabilitation, and support of homeless people with mental, neurologic, and substance use (MNS) disorders in general in Ethiopia. This is the first study of its kind in Africa which was aimed at screening, diagnosis, care, treatment, rehabilitation, and support of homeless individuals with possible MNS disorder. Community-based survey was conducted from January to March 2015. Homeless people who had overt and observable psychopathology and positive for screening instruments (SRQ20, ASSIST, and PSQ) were involved in the survey and further assessed for possible diagnosis by structured clinical interview for DSM-IV diagnoses and international diagnostic criteria for seizure disorders for possible involvement in care, treatment, rehabilitation services, support, and training. The Statistical Program for Social Science (SPSS version 20) was used for data entry, clearance, and analyses. A total of 456 homeless people were involved in the survey. Majority of the participants were male ( n   =  402; 88.16%). Most of the homeless participants had migrated into Addis Ababa from elsewhere in Ethiopia and Eritrea (62.50%). Mental, neurologic, and substance use disorders resulted to be common problems in the study participants (92.11%; n   =  420). Most of the participants with mental, neurologic, and substance use disorders (85.29%; n   =  354) had psychotic disorders. Most of those with psychosis had schizophrenia (77.40%; n   =  274). Almost all of the participants had a history of substance use (93.20%; n   =  425) and about one in ten individuals had substance use disorders (10.54%; n   =  48). Most of the participants with substance use disorder had comorbid other mental and neurologic disorders (83.33%; n   =  40). Mental, neurologic, and substance use disorders are common (92.11%) among street homeless people in Ethiopia. The development of centers for care, treatment, rehabilitation, and support of homeless people with mental, neurologic, and substance use disorders is warranted. In addition, it is necessary to improve the accessibility of mental health services and promote better integration between mental and primary health care services, as a means to offer a better general care and to possibly prevent homelessness among mentally ill.

34 CFR 303.17 - Homeless children.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true Homeless children. 303.17 Section 303.17 Education... DISABILITIES General Definitions Used in This Part § 303.17 Homeless children. Homeless children means children who meet the definition given the term homeless children and youths in section 725 (42 U.S.C. 11434a...

34 CFR 303.17 - Homeless children.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false Homeless children. 303.17 Section 303.17 Education... DISABILITIES General Definitions Used in This Part § 303.17 Homeless children. Homeless children means children who meet the definition given the term homeless children and youths in section 725 (42 U.S.C. 11434a...

34 CFR 303.17 - Homeless children.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false Homeless children. 303.17 Section 303.17 Education... DISABILITIES General Definitions Used in This Part § 303.17 Homeless children. Homeless children means children who meet the definition given the term homeless children and youths in section 725 (42 U.S.C. 11434a...

Mission Impossible? Physical Activity Programming for Individuals Experiencing Homelessness

ERIC Educational Resources Information Center

Gregg, Melanie J.; Bedard, Andrea

2016-01-01

Purpose: A pilot study was conducted to describe the physical activity experiences and perceived benefits of and barriers to physical activity participation for patrons of a homeless shelter. The resulting pilot data may be used to inform the creation of and support for physical activity and sport programs for those experiencing homelessness.…

Homelessness and Work Experience: Two Years in Saint Paul. Final Report.

ERIC Educational Resources Information Center

Davis, Dennis R.

A study explored the role of work experience in addressing problems of homeless people in Saint Paul (Minnesota) during the 1989-91 grant cycles of the McKinney Job Training for the Homeless Demonstration Program. The program included a number of elements: outreach, intake, assessment and enrollment, orientation, work experience, basic…

Impact of Nursing Intervention on Decreasing Substances among Homeless Youth

PubMed Central

Nyamathi, Adeline; Branson, Catherine; Kennedy, Barbara; Salem, Benissa; Khalilifard, Farinaz; Marfisee, Mary; Getzoff, Daniel; Leake, Barbara

2013-01-01

Background Alcohol use, and in particular, binge drinking, and methamphetamine use is pervasive among homeless youth and remains a social pressure among this vulnerable population. However, there is no compelling evidence that specific interventions for reducing drug and alcohol use are effective for homeless youth. Objectives This community-based participatory action pilot study assessed the impact of an intervention study focused on decreasing use of drugs and alcohol among a sample of homeless young adults (N=154) visiting a drop-in site in Santa Monica, California. The two programs consisted of a HIV/AIDS and Hepatitis Health Promotion (HHP) program led by nurses and an Art Messaging (AM) program led by artists. Six-month follow-up data were obtained from 100 of these individuals. Results Findings revealed significant reductions in alcohol and marijuana use and binge drinking in both the HHP and AM programs. However, homeless youth in the HHP program reported additional reductions in methamphetamine, cocaine and hallucinogen use at six-month follow-up. Conclusions Reductions in drugs and alcohol are important as these substances are linked to HIV/AIDS, hepatitis and other health risks in homeless youth. Scientific Significance The successful outcomes of the study intervention validate the utility of nurse-led and artistic health promotion strategies to decrease drug and alcohol use and other risky behaviors in homeless youth populations. PMID:23082836

Impact of nursing intervention on decreasing substances among homeless youth.

PubMed

Nyamathi, Adeline; Branson, Catherine; Kennedy, Barbara; Salem, Benissa; Khalilifard, Farinaz; Marfisee, Mary; Getzoff, Daniel; Leake, Barbara

2012-01-01

Alcohol use, and in particular, binge drinking, and methamphetamine use is pervasive among homeless youth and remains a social pressure among this vulnerable population. However, there is no compelling evidence that specific interventions for reducing drug and alcohol use are effective for homeless youth. This community-based participatory action pilot study assessed the impact of an intervention study focused on decreasing use of drugs and alcohol among a sample of homeless young adults (N= 154) visiting a drop-in site in Santa Monica, California. The two programs consisted of an HIV/AIDS and Hepatitis Health Promotion (HHP) program led by nurses and an Art Messaging (AM) program led by artists. Six-month follow-up data were obtained from 100 of these individuals. Findings revealed significant reductions in alcohol and marijuana use and binge drinking in both the HHP and AM programs. However, homeless youth in the HHP program reported additional reductions in methamphetamine, cocaine, and hallucinogen use at 6-month follow-up. Reductions in drugs and alcohol are important as these substances are linked to HIV/AIDS, hepatitis, and other health risks in homeless youth. The successful outcomes of the study intervention validate the utility of nurse-led and artistic health promotion strategies to decrease drug and alcohol use and other risky behaviors in homeless youth populations. Copyright © American Academy of Addiction Psychiatry.

Predictors of Retention in a Homeless Veteran Intervention Program

DTIC Science & Technology

2012-12-01

Educational Development /High School GPD Grant and Per Diem HCHV Health Care for Homeless Veterans HEARTH Homeless Emergency Assistance and...Planning and Public Affairs, University of Illinois at Chicago. The Homeless Emergency Assistance and Rapid Transition to Housing ( HEARTH ) Act (P.L. 111

Assessing the need for a medical respite: perceptions of service providers and homeless persons.

PubMed

Biederman, Donna J; Gamble, Julia; Manson, Marigny; Taylor, Destry

2014-01-01

For homeless persons, posthospitalization care is increasingly provided in formal medical respite programs, and their success is now reported in the literature. However, there is a dearth of literature on posthospitalization transitional care for homeless persons in the absence of a respite program. Through this formative study, we sought to understand the process of securing posthospitalization care in the absence of a formal homeless medical respite. Results demonstrated a de facto patchwork respite process that has emerged. We describe both human and monetary costs associated with patchwork respite and demonstrate opportunities for improvement in homeless health care transitions.

Evaluating the Impact of Dental Care on Housing Intervention Program Outcomes Among Homeless Veterans

PubMed Central

Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A.; Schinka, John A.

2013-01-01

Objectives. In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Methods. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Results. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Conclusions. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation. PMID:23678921

Characteristics of a random sample of emergency food program users in New York: II. Soup kitchens.

PubMed Central

Bowering, J; Clancy, K L; Poppendieck, J

1991-01-01

A random sample of soup kitchen clients in New York City was studied and specific comparisons made on various parameters including homelessness. Compared with the general population of low income persons, soup kitchen users were overwhelmingly male, disproportionately African-American, and more likely to live alone. The homeless (41 percent of the sample) were less likely to receive food stamps or free food, or to use food pantries. Fewer of them received Medicaid or had health insurance. Forty-seven percent had no income in contrast to 29 percent of the total sample. PMID:2053673

Mental health, concurrent disorders, and health care utilization in homeless women.

PubMed

Strehlau, Verena; Torchalla, Iris; Kathy, Li; Schuetz, Christian; Krausz, Michael

2012-09-01

This study assessed lifetime and current prevalence rates of mental disorders and concurrent mental and substance use disorders in a sample of homeless women. Current suicide risk and recent health service utilization were also examined in order to understand the complex mental health issues of this population and to inform the development of new treatment strategies that better meet their specific needs. A cross-sectional survey of 196 adult homeless women in three different Canadian cities was done. Participants were assessed using DSM-IV-based structured clinical interviews. Current diagnoses were compared to available mental health prevalence rates in the Canadian female general population. Current prevalence rates were 63% for any mental disorder, excluding substance use disorders; 17% for depressive episode; 10% for manic episode; 7% for psychotic disorder; 39% for anxiety disorders, 28% for posttraumatic stress disorder; and 19% for obsessive-compulsive disorder; 58% had concurrent substance dependence and mental disorders. Lifetime prevalence rates were notably higher. Current moderate or high suicide risk was found in 22% of the women. Participants used a variety of health services, especially emergency rooms, general practitioners, and walk-in clinics. Prevalence rates of mental disorders among homeless participants were substantially higher than among women from the general Canadian population. The percentage of participants with moderate or high suicide risk and concurrent disorders indicates a high severity of mental health symptomatology. Treatment and housing programs need to be accompanied by multidisciplinary, specialized interventions that account for high rates of complex mental health conditions.

38 CFR 61.66 - Financial management.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Financial management. 61...) VA HOMELESS PROVIDERS GRANT AND PER DIEM PROGRAM § 61.66 Financial management. (a) All recipients... management system that follows generally accepted accounting principals and provides accounting records...

38 CFR 61.66 - Financial management.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Financial management. 61...) VA HOMELESS PROVIDERS GRANT AND PER DIEM PROGRAM § 61.66 Financial management. (a) All recipients... management system that follows generally accepted accounting principals and provides accounting records...

A web-based personal health information system for homeless youth and young adults.

PubMed

Dang, Michelle T; Whitney, Kimberley D; Virata, Maria Catrina D; Binger, Melissa M; Miller, Elizabeth

2012-01-01

Runaway and homeless youth face multiple challenges to their health and experience inadequate access to health care services. This article describes a web-based personal health information system (PHIS) called Healthshack that was specifically designed to improve health care access and health outcomes for runaway and homeless youth at a community-based agency that served homeless youth and young adults up to age 24. The program was developed in partnership with homeless youth and piloted by public health nurses. Preliminary findings from the program indicate that a PHIS is acceptable to runaway and homeless youth and feasible to incorporate into the flow of a youth agency. Thus, a PHIS may be an innovative model of service delivery for other marginalized populations. © 2011 Wiley Periodicals, Inc.

Strategies for Implementing New HUD Homeless Assistance Requirements to Collaborate with Schools

ERIC Educational Resources Information Center

National Association for the Education of Homeless Children and Youth, 2013

2013-01-01

The U.S. Department of Housing and Urban Development (HUD) recently announced the release of its 2010 Notice of Funding Availability for the Homeless Assistance Programs that it administers. As a result of the passage of the HEARTH Act, there are four new requirements for HUD-funded homeless service programs related to education. These…

Public Library Services and Outreach for the Homeless Population in Ohio.

ERIC Educational Resources Information Center

Lichtenberg, Evelyn

This investigative study, through a questionnaire survey, was conducted to determine if public libraries in Ohio saw a need for library programs/outreach to the homeless, and if, indeed, any libraries had a structured program to serve the special needs of the homeless population. One library from each Ohio county was selected through systematic…

Applying the Chronic Care Model to Homeless Veterans: Effect of a Population Approach to Primary Care on Utilization and Clinical Outcomes

PubMed Central

Buckel, Lauren; Bourgault, Claire; Blumen, Jonathan; Redihan, Stephen G.; Jiang, Lan; Friedmann, Peter

2010-01-01

Objectives. We compared a population-tailored approach to primary care for homeless veterans with a usual care approach. Methods. We conducted a retrospective prolective cohort study of homeless veterans enrolled in a population-tailored primary care clinic matched to a historical sample in general internal medicine clinics. Overall, 177 patients were enrolled: 79 in the Homeless-Oriented Primary Care Clinic and 98 in general internal medicine primary care. Results. Homeless-oriented primary care–enrolled patients had greater improvements in hypertension, diabetes, and lipid control, and primary care use was higher during the first 6 months (5.96 visits per person vs 1.63 for general internal medicine) but stabilized to comparable rates during the second 6 months (2.01 vs 1.31, respectively). Emergency department (ED) use was also higher (2.59 vs 1.89 visits), although with 40% lower odds for nonacute ED visits than for the general internal medicine group (95% confidence interval = 0.2, 0.8). Excluding substance abuse and mental health admissions, hospitalizations were reduced among the homeless veterans between the 2 periods (28.6% vs 10.8%; P < .01) compared with the general internal medicine group (48.2% vs 44.4%; P = .6; difference of differences, P < .01). Conclusions. Tailoring primary care to homeless veterans can decrease unnecessary ED use and medical admissions and improve chronic disease management. PMID:20966377

Homelessness in the state and federal prison population.

PubMed

Greenberg, Greg A; Rosenheck, Robert A

2008-01-01

This study sought to investigate the rates and correlates of homelessness (i.e. living on the street or in a homeless shelter), including mental illness, among US adult state and federal prison inmates (ASFPIs). Data from a national survey of ASFPIs based on a random sampling survey (N = 17,565) were used to compare the homelessness rate among AFSPIs with that in the general population. Logistic regression was then used to examine the association of homelessness among ASFPIs with factors including symptoms, treatment of mental illness, previous criminal justice involvement, specific crimes, and demographic characteristics. Nine percent of ASFPIs reported an episode of homelessness in the year prior to arrest, 4-6 times the estimated rate in the general US adult population after allowing for age, race/ethnicity, and gender. In comparison to other inmates, these homeless inmates were more likely to be currently incarcerated for a property crime, but also to have had previous criminal justice system involvement for both property and violent crimes, to suffer from mental health and/or substance abuse problems, and to be more likely to have been unemployed and with a low income. Recent homelessness is far more common among ASFPIs than the general population. Prior incarceration, mental illness, substance abuse and disadvantageous socio-demographic characteristics were all found to be associated with homelessness among prison inmates, suggesting that there are several important factors in addition to efforts to survive with limited resources through criminal acts that influence the rates of homelessness among incarcerated individuals.

34 CFR 300.19 - Homeless children.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Homeless children. 300.19 Section 300.19 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.19 Homeless children. Homeless children has the...

34 CFR 300.19 - Homeless children.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Homeless children. 300.19 Section 300.19 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.19 Homeless children. Homeless children has the...

34 CFR 300.19 - Homeless children.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false Homeless children. 300.19 Section 300.19 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.19 Homeless children. Homeless children has the...

34 CFR 300.19 - Homeless children.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true Homeless children. 300.19 Section 300.19 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.19 Homeless children. Homeless children has the...

34 CFR 300.19 - Homeless children.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false Homeless children. 300.19 Section 300.19 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.19 Homeless children. Homeless children has the...

24 CFR 91.15 - Submission date.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS General § 91.15 Submission date. (a... process, the action plan, and the certifications must be submitted on an annual basis. (2) The housing, and homeless needs assessment, market analysis, and strategic plan must be submitted at least once...

Factors associated with substance use in older homeless adults: Results from the HOPE HOME study.

PubMed

Spinelli, Matthew A; Ponath, Claudia; Tieu, Lina; Hurstak, Emily E; Guzman, David; Kushel, Margot

2017-01-01

The median age of the single adult homeless population is 50 and rising. Although the prevalence of substance use decreases as individuals age, older adults now have a higher prevalence of substance use than older adults did 10 years ago. Homeless individuals have a higher prevalence of substance use disorders than the general population. However, little is known about substance use in older homeless adults. The objective of the study was to examine prevalence of and factors associated with substance use in a population-based sample (N = 350) of homeless individuals aged 50 and older in Oakland, California. Dependent variables included moderate or greater severity illicit drug symptoms (Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) score >3) and moderate or greater alcohol symptoms (Alcohol Use Disorders Identification Test (AUDIT) score >7). Independent variables included demographics, mental health problems, and negative life course events such as physical and sexual abuse, school expulsion, and onset of homelessness. Almost two thirds of participants, 64.6%, had moderate or greater severity symptoms for at least 1 illicit drug; 25.8% had moderate or greater severity alcohol symptoms. History of psychiatric hospitalization was associated with moderate or greater illicit drug symptoms (adjusted odds ratio [AOR] = 1.9, 1.0-3.6). The presence of major depressive symptoms was associated with moderate or greater severity alcohol symptoms (AOR = 1.8, 1.1-3.0). In this sample of older homeless adults, substance use is common. There is a need for substance use treatment programs, integrated with mental health services, which are targeted towards the needs of older homeless adults.

Comparing homeless persons' care experiences in tailored versus nontailored primary care programs.

PubMed

Kertesz, Stefan G; Holt, Cheryl L; Steward, Jocelyn L; Jones, Richard N; Roth, David L; Stringfellow, Erin; Gordon, Adam J; Kim, Theresa W; Austin, Erika L; Henry, Stephen Randal; Kay Johnson, N; Shanette Granstaff, U; O'Connell, James J; Golden, Joya F; Young, Alexander S; Davis, Lori L; Pollio, David E

2013-12-01

We compared homeless patients' experiences of care in health care organizations that differed in their degree of primary care design service tailoring. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the "Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient-clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient-clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results. Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness.

Crossing the Threshhold: Successful Learning Provision for Homeless People.

ERIC Educational Resources Information Center

Cameron, Helen; McKaig, Wendy; Taylor, Sue

This guide tells the story of a successful collaboration between The City Literary Institute and homelessness agencies to create an arts-based learning program for homeless people in central London. It identifies guidelines and good practice to stimulate similar work in other locations with problems of homelessness and rough sleeping. The guide is…

Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: a multi-site focus group study.

PubMed

Palepu, Anita; Hubley, Anita M; Russell, Lara B; Gadermann, Anne M; Chinni, Mary

2012-08-15

The aim of this study was to identify what is most important to the quality of life (QoL) of those who experience homelessness by directly soliciting the views of homeless and hard-to-house Canadians themselves. These individuals live within a unique social context that differs considerably from that of the general population. To understand the life areas that are most important to them, it is critical to have direct input from target populations of homeless and hard-to-house persons. Focus groups were conducted with 140 individuals aged 15 to 73 years who were homeless or hard-to-house to explore the circumstances in which they were living and to capture what they find to be important and relevant domains of QoL. Participants were recruited in Toronto, Ottawa, Montreal, and Vancouver. Content analysis was used to analyze the data. Six major content themes emerged: Health/health care; Living conditions; Financial situation; Employment situation; Relationships; and Recreational and leisure activities. These themes were linked to broader concepts that included having choices, stability, respect, and the same rights as other members of society. These findings not only aid our understanding of QoL in this group, but may be used to develop measures that capture QoL in this population and help programs and policies become more effective in improving the life situation for persons who are homeless and hard-to-house. Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study.

Tobacco-, Alcohol-, and Drug-Attributable Deaths and Their Contribution to Mortality Disparities in a Cohort of Homeless Adults in Boston

PubMed Central

Chang, Yuchiao; Singer, Daniel E.; Porneala, Bianca C.; Gaeta, Jessie M.; O’Connell, James J.; Rigotti, Nancy A.

2015-01-01

Objectives. We quantified tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities among homeless adults. Methods. We ascertained causes of death among 28 033 adults seen at the Boston Health Care for the Homeless Program in 2003 to 2008. We calculated population-attributable fractions to estimate the proportion of deaths attributable to tobacco, alcohol, or drug use. We compared attributable mortality rates with those for Massachusetts adults using rate ratios and differences. Results. Of 1302 deaths, 236 were tobacco-attributable, 215 were alcohol-attributable, and 286 were drug-attributable. Fifty-two percent of deaths were attributable to any of these substances. In comparison with Massachusetts adults, tobacco-attributable mortality rates were 3 to 5 times higher, alcohol-attributable mortality rates were 6 to 10 times higher, and drug-attributable mortality rates were 8 to 17 times higher. Disparities in substance-attributable deaths accounted for 57% of the all-cause mortality gap between the homeless cohort and Massachusetts adults. Conclusions. In this clinic-based cohort of homeless adults, over half of all deaths were substance-attributable, but this did not fully explain the mortality disparity with the general population. Interventions should address both addiction and non-addiction sources of excess mortality. PMID:25521869

National dissemination of supported housing in the VA: model adherence versus model modification.

PubMed

O'Connell, Maria; Kasprow, Wesley; Rosenheck, Robert A

2010-01-01

The continuing development and dissemination of emerging evidence-based practices may be facilitated by the availability of descriptive information on the actual delivery of the service, and its variability, across sites. This paper presents data on the participation of 2,925 homeless veterans in the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program at 36 sites across the country, for up to five years. While most conceptual models emphasize rapid placement, sustained intensive case management, rehabilitation services, and "permanent" housing, no program has yet presented empirical data on the actual delivery of such services over an extended period of time. Using extensive longitudinal data from the VA's national homeless outreach program, the Health Care for Homeless Veterans (HCHV) program, a quantitative portrait presents what happens in supported housing in a large real-world dissemination effort. Program entry to HUD-VASH was generally slow with 108 days (sd = 92 days) on average passing between program entry and housing placement. Total program participation lasted 2.6 years on average (sd = 1.6 years)-just half of the possible 5 years. Service delivery became substantially less intensive over time by several measures, and three-fourths of the veterans terminated within five years, although the vast majority (82%) were housed at the time. Few veterans received rehabilitation services (6%) or employment assistance (17%) and most service delivery focused on obtaining housing. These data suggest that real-world supported housing programs may not adhere to the prevalent model descriptions either because of implementation failure or because veteran needs and preferences differ from those suggested by that model.

7 CFR 245.6a - Verification requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS DETERMINING ELIGIBILITY FOR FREE AND REDUCED PRICE MEALS AND FREE MILK IN... agencies serving foster, homeless, migrant, or runaway children, as defined in § 245.2. Agency records may...) General. The local educational agency must verify eligibility of children in a sample of household...

Using Evidence-Based Programs to Support Children and Families Experiencing Homelessness

ERIC Educational Resources Information Center

Siebel, Nancy L.; Bassuk, Ellen; Medeiros, Debra

2012-01-01

This article was originally published (November 2011) as a brief created on behalf of the Strengthening At Risk and Homeless Young Mothers and Children Coordinating Center, which is a partnership of The National Center on Family Homelessness, National Alliance to End Family Homelessness, and ZERO TO THREE. The article offers a definition of…

Coping and resilience among ethnoracial individuals experiencing homelessness and mental illness.

PubMed

Paul, Sayani; Corneau, Simon; Boozary, Tanya; Stergiopoulos, Vicky

2018-03-01

The multiple challenges that ethnoracial homeless individuals experiencing mental illness face are well documented. However, little is known about how this homeless subpopulation copes with the compounding stressors of racial discrimination, homelessness and mental illness. This study is an in-depth investigation of the personal perceived strengths, attitudes and coping behaviors of homeless adults of diverse ethnoracial backgrounds experiencing homelessness and mental illness in Toronto, Canada. Using qualitative methods, 36 in-depth semi-structured interviews were conducted to capture the perspectives of ethnoracial homeless participants with mental illness on coping and resilience. Transcripts were analyzed using thematic analysis. Similar to prior findings in the general homeless population, study participants recognized personal strengths and attitudes as great sources of coping and resilience, describing hope and optimism, self-esteem and confidence, insight into their challenges and spirituality as instrumental to overcoming current challenges. In addition, participants described several coping strategies, including seeking support from family, friends and professionals; socializing with peers; engaging in meaningful activities; distancing from overwhelming challenges; and finding an anchor. Findings suggest that homeless adults with mental illness from ethnoracial groups use similar coping strategies and sources of resilience with the general homeless population and highlight the need for existing services to foster hope, recognize and support individual coping strategies and sources of resilience of homeless individuals experiencing complex challenges.

24 CFR 576.1 - Applicability and purpose.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SHELTER GRANTS PROGRAM: STEWART B. McKINNEY HOMELESS... program contained in subtitle B of title IV of the Stewart B. McKinney Homeless Assistance Act (42 U.S.C...

The Boston Health Care for the Homeless Program: a public health framework.

PubMed

O'Connell, James J; Oppenheimer, Sarah C; Judge, Christine M; Taube, Robert L; Blanchfield, Bonnie B; Swain, Stacy E; Koh, Howard K

2010-08-01

During the past 25 years, the Boston Health Care for the Homeless Program has evolved into a service model embodying the core functions and essential services of public health. Each year the program provides integrated medical, behavioral, and oral health care, as well as preventive services, to more than 11 000 homeless people. Services are delivered in clinics located in 2 teaching hospitals, 80 shelters and soup kitchens, and an innovative 104-bed medical respite unit. We explain the program's principles of care, describe the public health framework that undergirds the program, and offer lessons for the elimination of health disparities suffered by this vulnerable population.

Happiness on the street: Overall happiness among homeless people in Madrid (Spain).

PubMed

Panadero, Sonia; Guillén, Ana Isabel; Vázquez, José Juan

2015-07-01

This article tests a hypothesized model of overall happiness among homeless people in Spain. The research was conducted based on a representative sample of homeless people in Madrid (n = 235), all adults, who had spent the night before the interview in a shelter for homeless people, on the street or in other places not initially designed for sleeping, or who were in supervised accommodation for homeless people at the time of the interview. Information was gathered using a structured interview. The results obtained show that around half of the homeless people in Madrid said that they were happy. A positive meta-stereotype and a better perceived general health were associated with a higher overall happiness, while feelings of loneliness were associated with a lower overall happiness. Happiness also showed a significant effect on future expectations. Disabilities and handicaps had a significant effect on perceived general health, which was in turn associated with overall happiness among homeless people. (c) 2015 APA, all rights reserved).

Runaway and Homeless Youth Grants: Improvements Needed in the Grant Award Process. Report to Congressional Committees. GAO-10-335

ERIC Educational Resources Information Center

Brown, Kay E.

2010-01-01

The Department of Health and Human Services (HHS) awards grants to provide shelter and services to runaway and homeless youth through the Basic Center, Transitional Living and Street Outreach Programs. In response to a mandate for a review of the grant award process for these programs in the Reconnecting Homeless Youth Act of 2008 (Pub. L. No.…

Comparing Homeless Persons’ Care Experiences in Tailored Versus Nontailored Primary Care Programs

PubMed Central

Holt, Cheryl L.; Steward, Jocelyn L.; Jones, Richard N.; Roth, David L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa W.; Austin, Erika L.; Henry, Stephen Randal; Kay Johnson, N.; Shanette Granstaff, U.; O’Connell, James J.; Golden, Joya F.; Young, Alexander S.; Davis, Lori L.; Pollio, David E.

2013-01-01

Objectives. We compared homeless patients’ experiences of care in health care organizations that differed in their degree of primary care design service tailoring. Methods. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the “Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Results. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient–clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient–clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results. Conclusions. Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness. PMID:24148052

Alcohol and drug use disorders among homeless veterans: prevalence and association with supported housing outcomes.

PubMed

Tsai, Jack; Kasprow, Wesley J; Rosenheck, Robert A

2014-02-01

This study examines the prevalence of alcohol and drug disorders among homeless veterans entering the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program and its association with both housing and clinical outcomes. A total of 29,143 homeless veterans were categorized as either having: no substance use disorder, only an alcohol use disorder, only a drug use disorder, or both alcohol and drug use disorders. Veterans were compared on housing and clinical status prior to admission to HUD-VASH and a smaller sample of 14,086 HUD-VASH clients were compared on their outcomes 6 months after program entry. Prior to HUD-VASH, 60% of program entrants had a substance use disorder and 54% of those with a substance use disorder had both alcohol and drug use disorders. Homeless veterans with both alcohol and drug use disorders had more extensive homeless histories than others, and those with any substance use disorder stayed more nights in transitional housing or residential treatment in the previous month. After six months in HUD-VASH, clients with substance use disorders continued to report more problems with substance use, even after adjusting for baseline differences, but there were no differences in housing outcomes. These findings suggest that despite strong associations between substance use disorders and homelessness, the HUD-VASH program is able to successfully house homeless veterans with substance use disorders although additional services may be needed to address their substance abuse after they become housed. Published by Elsevier Ltd.

7 CFR 245.6a - Verification requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS DETERMINING ELIGIBILITY FOR FREE AND REDUCED PRICE MEALS AND FREE MILK IN... established under the Runaway and Homeless Youth Act (42 U.S.C. 5701); or serving migratory children, as they...) General. The local educational agency must verify eligibility of children in a sample of household...

7 CFR 245.6a - Verification requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS DETERMINING ELIGIBILITY FOR FREE AND REDUCED PRICE MEALS AND FREE MILK IN... established under the Runaway and Homeless Youth Act (42 U.S.C. 5701); or serving migratory children, as they...) General. The local educational agency must verify eligibility of children in a sample of household...

34 CFR 491.4 - What regulations apply?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false What regulations apply? 491.4 Section 491.4 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General § 491.4 What regulations apply? The...

38 CFR 1.780-1.783 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false [Reserved] 1.780-1.783 Section 1.780-1.783 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Homeless Claimants §§ 1.780-1.783 [Reserved] Part-Time Career Employment Program Source: 44 FR...

How to Program to the Homeless.

ERIC Educational Resources Information Center

Polzer, Christopher M.

1995-01-01

Recreation leaders recommend reaching out to homeless individuals and providing programs that may help improve their health, bring them some fun and happiness, and boost their quality of life. The paper describes how one North Carolina county addressed the issue through recreation programs and other activities. (SM)

Learning To Hope: A Study of the Adult Education for the Homeless Program.

ERIC Educational Resources Information Center

Drury, Darrel; Koloski, Judy

A comprehensive study of the Adult Education for the Homeless Program (AEH) was conducted using data from the following sources: program files; focus groups conducted with state project administrators; site visits to 9 local programs in 3 states; surveys of 32 state projects, 230 local programs, 588 service delivery sites, and 2,943 program…

Social Capital and Homeless Youth: Influence of Residential Instability on College Access

ERIC Educational Resources Information Center

Tierney, William G.; Hallett, Ronald E.

2012-01-01

This article examines the experiences homeless youth face and the influence of social networks on their education. Using a social capital framework, we analyze the experiences that are different for poor youth in general and those homeless. Data used include interviews with 123 homeless youth and more than 40 policymakers, school counselors, and…

Service Content as a Determinant of Homeless Adults' Perceptions of Program Efficacy

ERIC Educational Resources Information Center

Sosin, Michael; George, Christine; Grossman, Susan

2012-01-01

This work analyzes the relationship between the services clients receive in treatment programs and client ratings of program efficacy. It relies on data from a random sample of clients served by Chicago's homelessness system (N = 554). Regressions utilizing that data suggest that ratings of program efficacy are positively predicted by program…

Diabetes and Hypertension Prevalence in Homeless Adults in the United States: A Systematic Review and Meta-Analysis

PubMed Central

Meurer, Linda N.; Plumb, Ellen J.; Jackson, Jeffrey L.

2015-01-01

We estimated hypertension and diabetes prevalence among US homeless adults compared with the general population, and investigated prevalence trends. We systematically searched 5 databases for published studies (1980–2014) that included hypertension or diabetes prevalence for US homeless adults, pooled disease prevalence, and explored heterogeneity sources. We used the National Health Interview Survey for comparison. We included data from 97 366 homeless adults. The pooled prevalence of self-reported hypertension was 27.0% (95% confidence interval = 23.8%, 29.9%; n = 43 studies) and of diabetes was 8.0% (95% confidence interval = 6.8%, 9.2%; n = 39 studies). We found no difference in hypertension or diabetes prevalence between the homeless and general population. Additional health care and housing resources are needed to meet the significant, growing burden of chronic disease in the homeless population. PMID:25521899

Disparities in Cancer Incidence, Stage, and Mortality at Boston Health Care for the Homeless Program

PubMed Central

Baggett, Travis P.; Chang, Yuchiao; Porneala, Bianca C.; Bharel, Monica; Singer, Daniel E.; Rigotti, Nancy A.

2015-01-01

Introduction Homeless people have a high burden of cancer risk factors and suboptimal rates of cancer screening, but the epidemiology of cancer has not been well described in this population. We assessed cancer incidence, stage, and mortality in homeless adults relative to general population standards. Methods We cross-linked a cohort of 28,033 adults seen at Boston Health Care for the Homeless Program in 2003–2008 to Massachusetts cancer registry and vital registry records. We calculated age-standardized cancer incidence and mortality ratios (SIRs and SMRs). We examined tobacco use among incident cases and estimated smoking-attributable fractions. Trend tests were used to compare cancer stage distributions with those in Massachusetts adults. Analyses were conducted in 2012–2015. Results During 90,450 person-years of observation, there were 361 incident cancers (SIR=1.13, 95% CI=1.02, 1.25) and 168 cancer deaths (SMR=1.88, 95% CI=1.61, 2.19) among men, and 98 incident cancers (SIR=0.93, 95% CI=0.76, 1.14) and 38 cancer deaths (SMR=1.61, 95% CI=1.14, 2.20) among women. For both sexes, bronchus and lung cancer was the leading type of incident cancer and cancer death, exceeding Massachusetts estimates more than twofold. Oropharyngeal and liver cancer cases and deaths occurred in excess among men, whereas cervical cancer cases and deaths occurred in excess among women. About one third of incident cancers were smoking-attributable. Colorectal, female breast, and oropharyngeal cancers were diagnosed at more-advanced stages than in Massachusetts adults. Conclusions Efforts to reduce cancer disparities in homeless people should include addressing tobacco use and enhancing participation in evidence-based screening. PMID:26143955

Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration's "Homeless Patient Aligned Care Team" Program.

PubMed

O'Toole, Thomas P; Johnson, Erin E; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

2016-03-31

Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a "homeless medical home" initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Integrating social determinants of health into clinical care can be effective for high-risk homeless veterans.

Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program

PubMed Central

Johnson, Erin E.; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

2016-01-01

Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a “homeless medical home” initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. Methods We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. Results More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Conclusion Integrating social determinants of health into clinical care can be effective for high-risk homeless veterans. PMID:27032987

Effects of a nurse-managed program on hepatitis A and B vaccine completion among homeless adults.

PubMed

Nyamathi, Adeline; Liu, Yihang; Marfisee, Mary; Shoptaw, Steven; Gregerson, Paul; Saab, Sammy; Leake, Barbara; Tyler, Darlene; Gelberg, Lillian

2009-01-01

Hepatitis B virus (HBV) infection constitutes a major health problem for homeless persons. Ability to complete an HBV vaccination series is complicated by the need to prioritize competing needs, such as addiction issues, safe places to sleep, and food, over health concerns. The objectives of this study were to evaluate the effectiveness of a nurse-case-managed intervention compared with that of two standard programs on completion of the combined hepatitis A virus (HAV) and HBV vaccine series among homeless adults and to assess sociodemographic factors and risk behaviors related to the vaccine completion. A randomized, three-group, prospective, quasi-experimental design was conducted with 865 homeless adults residing in homeless shelters, drug rehabilitation sites, and outdoor areas in the Skid Row area of Los Angeles. The programs included (a) nurse-case-managed sessions plus targeted hepatitis education, incentives, and tracking (NCMIT); (b) standard targeted hepatitis education plus incentives and tracking (SIT); and (c) standard targeted hepatitis education and incentives only (SI). Sixty-eight percent of the NCMIT participants completed the three-series vaccine at 6 months, compared with 61% of SIT participants and 54% of SI participants. NCMIT participants had almost 2 times greater odds of completing vaccination than those of participants in the SI program. Completers were more likely to be older, to be female, to report fair or poor health, and not to have participated in a self-help drug treatment program. Newly homeless White adults were significantly less likely than were African Americans to complete the vaccine series. The use of vaccination programs incorporating nurse case management and tracking is critical in supporting adherence to completion of a 6-month HAV/HBV vaccine. The finding that White homeless persons were the least likely to complete the vaccine series suggests that programs tailored to address their unique cultural issues are needed.

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless.

PubMed

Poremski, Daniel; Woodhall-Melnik, Julia; Lemieux, Ashley J; Stergiopoulos, Vicky

2016-02-01

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

Homeless Health Concerns

MedlinePlus

... make it worse. That's why the health of homeless people in the United States is worse than that of the general population. Common health problems include Mental health problems Substance abuse ... and skin infections Many homeless women are victims of domestic or sexual abuse. ...

Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study

PubMed Central

2012-01-01

Background The aim of this study was to identify what is most important to the quality of life (QoL) of those who experience homelessness by directly soliciting the views of homeless and hard-to-house Canadians themselves. These individuals live within a unique social context that differs considerably from that of the general population. To understand the life areas that are most important to them, it is critical to have direct input from target populations of homeless and hard-to-house persons. Methods Focus groups were conducted with 140 individuals aged 15 to 73 years who were homeless or hard-to-house to explore the circumstances in which they were living and to capture what they find to be important and relevant domains of QoL. Participants were recruited in Toronto, Ottawa, Montreal, and Vancouver. Content analysis was used to analyze the data. Results Six major content themes emerged: Health/health care; Living conditions; Financial situation; Employment situation; Relationships; and Recreational and leisure activities. These themes were linked to broader concepts that included having choices, stability, respect, and the same rights as other members of society. Conclusions These findings not only aid our understanding of QoL in this group, but may be used to develop measures that capture QoL in this population and help programs and policies become more effective in improving the life situation for persons who are homeless and hard-to-house. Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study. PMID:22894551

CHOICES. A Resource for Literacy Providers and Homeless Families.

ERIC Educational Resources Information Center

Koehler, Gwen; And Others

CHOICES, a literacy program for homeless families, piloted a program at the Women's Emergency Shelter in Champaign, Illinois and later expanded its services to A Woman's Place, a domestic violence shelter, in Urbana, Illinois. The CHOICES program offered weekly language activities for the children and gave mothers information about developing…

Homeless Children and Their Families' Perspectives of Agency Services.

PubMed

Lorelle, Sonya; Grothaus, Tim

2015-10-01

While numerous programs aim to mediate the risks for children experiencing homelessness, there is a lack of research representing the children's and parents' perspectives in supportive housing programs. With this phenomenological qualitative study, the authors share the voices of 22 participants, including children and their families, regarding their experiences while receiving services from a homeless agency. Participating parents perceived that the program provided resources to the children that they could not provide themselves, opportunities for exposure to positive new experiences, and improved psychosocial outcomes for their children. Participants also discussed desired program changes and the responsiveness of agency staff regarding unmet needs of the children. Implications for policies and programs are discussed.

The Boston Health Care for the Homeless Program: A Public Health Framework

PubMed Central

Oppenheimer, Sarah C.; Judge, Christine M.; Taube, Robert L.; Blanchfield, Bonnie B.; Swain, Stacy E.; Koh, Howard K.

2010-01-01

During the past 25 years, the Boston Health Care for the Homeless Program has evolved into a service model embodying the core functions and essential services of public health. Each year the program provides integrated medical, behavioral, and oral health care, as well as preventive services, to more than 11 000 homeless people. Services are delivered in clinics located in 2 teaching hospitals, 80 shelters and soup kitchens, and an innovative 104-bed medical respite unit. We explain the program's principles of care, describe the public health framework that undergirds the program, and offer lessons for the elimination of health disparities suffered by this vulnerable population. PMID:20558804

A Review of the Literature on LGBTQ Adults Who Experience Homelessness.

PubMed

Ecker, John; Aubry, Tim; Sylvestre, John

2017-12-05

Little is known about lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults who experience homelessness. The current review critically analyzes the scant literature on LGBTQ adults who experience homelessness, with a particular focus on: (1) pathways into homelessness; (2) support needs; (3) targeted programming; and (4) exits out of homelessness. A total of 143 articles were identified, and 16 articles met the criteria of appropriate age range, article quality, and relevance of topic. Results from this review demonstrate that homeless LGBTQ adults have unique physical and mental health challenges, largely concerning HIV and substance use. Transgender and gender non-conforming adults who experience homelessness encounter several challenges in the homelessness system, particularly in regard to safety and gender-affirming supports. Recommendations focus on practical implications for support and suggestions for future research.

Comparisons of Prevention Programs for Homeless Youth

PubMed Central

Rotheram-Borus, Mary Jane

2014-01-01

There are six HIV prevention programs for homeless youth whose efficacy has been or is currently being evaluated: STRIVE, the Community Reinforcement Approach, Strengths-Based Case Management, Ecologically-Based Family Therapy, Street Smart, and AESOP (street outreach access to resources). Programs vary in their underlying framework and theoretical models for understanding homelessness. All programs presume that the youths’ families lack the ability to support their adolescent child. Some programs deemphasize family involvement while others focus on rebuilding connections among family members. The programs either normalize current family conflicts or, alternatively, provide education about the importance of parental monitoring. All programs aim to reduce HIV-related sexual and drug use acts. A coping skills approach is common across programs: Problem-solving skills are specifically addressed in four of the six programs; alternatively, parents in other programs are encouraged to contingently reward their children. Each program also engineers ongoing social support for the families and the youth, either by providing access to needed resources or by substituting a new, supportive relationship for the existing family caretaker. All of the interventions provide access to health and mental health services as basic program resources. A comparison of HIV prevention programs for homeless youth identifies the robust components of each and suggests which programs providers may choose to replicate. PMID:19067164

Comparisons of prevention programs for homeless youth.

PubMed

Arnold, Elizabeth Mayfield; Rotheram-Borus, Mary Jane

2009-03-01

There are six HIV prevention programs for homeless youth whose efficacy has been or is currently being evaluated: STRIVE, the Community Reinforcement Approach, Strengths-Based Case Management, Ecologically-Based Family Therapy, Street Smart, and AESOP (street outreach access to resources). Programs vary in their underlying framework and theoretical models for understanding homelessness. All programs presume that the youths' families lack the ability to support their adolescent child. Some programs deemphasize family involvement while others focus on rebuilding connections among family members. The programs either normalize current family conflicts or, alternatively, provide education about the importance of parental monitoring. All programs aim to reduce HIV-related sexual and drug use acts. A coping skills approach is common across programs: Problem-solving skills are specifically addressed in four of the six programs; alternatively, parents in other programs are encouraged to contingently reward their children. Each program also engineers ongoing social support for the families and the youth, either by providing access to needed resources or by substituting a new, supportive relationship for the existing family caretaker. All of the interventions provide access to health and mental health services as basic program resources. A comparison of HIV prevention programs for homeless youth identifies the robust components of each and suggests which programs providers may choose to replicate.

Fidelity to the housing first model and effectiveness of permanent supported housing programs in California.

PubMed

Gilmer, Todd P; Stefancic, Ana; Katz, Marian L; Sklar, Marisa; Tsemberis, Sam; Palinkas, Lawrence A

2014-11-01

Permanent supported housing programs are being implemented throughout the United States. This study examined the relationship between fidelity to the Housing First model and residential outcomes among clients of full service partnerships (FSPs) in California. This study had a mixed-methods design. Quantitative administrative and survey data were used to describe FSP practices and to examine the association between fidelity to Housing First and residential outcomes in the year before and after enrollment of 6,584 FSP clients in 86 programs. Focus groups at 20 FSPs provided qualitative data to enhance the understanding of these findings with actual accounts of housing-related experiences in high- and low-fidelity programs. Prior to enrollment, the mean days of homelessness were greater at high- versus low-fidelity (101 versus 46 days) FSPs. After adjustment for individual characteristics, the analysis found that days spent homeless after enrollment declined by 87 at high-fidelity programs and by 34 at low-fidelity programs. After adjustment for days spent homeless before enrollment, days spent homeless after enrollment declined by 63 at high-fidelity programs and by 53 at low-fidelity programs. After enrollment, clients at high-fidelity programs spent more than 60 additional days in apartments than clients at low-facility programs. Differences were found between high- and low-fidelity FSPs in client choice in housing and how much clients' goals were considered in housing placement. Programs with greater fidelity to the Housing First model enrolled clients with longer histories of homelessness and placed most of them in apartments.

Making the Grade: Challenges and Successes in Providing Educational Opportunities for Children and Youth in Homeless Situations. Bridging the Gap between Home and School. A Position Document.

ERIC Educational Resources Information Center

National Association of State Coordinators for the Education of Homeless Children and Youth.

Profiles of the 1995-96 implementation of the Stewart B. McKinney Act's Education for Homeless Children and Youth (EHCY) Programs in 37 states are presented in this document. In these 37 states, at least 173,082 homeless children and youth were served through programs funded by the McKinney Act, and at least 465 local education agencies received…

34 CFR 491.2 - Who may apply for an award?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 3 2012-07-01 2012-07-01 false Who may apply for an award? 491.2 Section 491.2 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General § 491.2 Who...

34 CFR 491.2 - Who may apply for an award?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 3 2013-07-01 2013-07-01 false Who may apply for an award? 491.2 Section 491.2 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General § 491.2 Who...

34 CFR 491.2 - Who may apply for an award?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false Who may apply for an award? 491.2 Section 491.2 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General § 491.2 Who...

34 CFR 491.2 - Who may apply for an award?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 3 2014-07-01 2014-07-01 false Who may apply for an award? 491.2 Section 491.2 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General § 491.2 Who...

34 CFR 491.2 - Who may apply for an award?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 3 2011-07-01 2011-07-01 false Who may apply for an award? 491.2 Section 491.2 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION FOR THE HOMELESS PROGRAM General § 491.2 Who...

Homelessness and the Public's Health: Legal Responses.

PubMed

Hodge, James G; DiPietro, Barbara; Horton-Newell, Amy E

2017-03-01

This commentary addresses public health issues underlying homelessness and related law, policy, and advocacy options. After framing public health issues for affected individuals and the community, legal and policy approaches and related barriers are assessed. Major topics include deficits in housing availability, the role of state-based Medicaid programs, criminalization of homelessness, and the use of emergency declarations seeking to address particular issues related to homelessness in select states and localities.

Social networking technology, social network composition, and reductions in substance use among homeless adolescents.

PubMed

Rice, Eric; Milburn, Norweeta G; Monro, William

2011-03-01

Peer-based prevention programs for homeless youth are complicated by the potential for reinforcing high-risk behaviors among participants. The goal of this study is to understand how homeless youth could be linked to positive peers in prevention programming by understanding where in social and physical space positive peers for homeless youth are located, how these ties are associated with substance use, and the role of social networking technologies (e.g., internet and cell phones) in this process. Personal social network data were collected from 136 homeless adolescents in Los Angeles, CA. Respondents reported on composition of their social networks with respect to: home-based peers and parents (accessed via social networking technology; e.g., the internet, cell phone, texting), homeless peers and agency staff (accessed face-to-face) and whether or not network members were substance-using or non-substance-using. Associations between respondent's lifetime cocaine, heroin, and methamphetamine use and recent (previous 30 days) alcohol and marijuana use were assessed by the number of non-substance-using versus substance-using ties in multivariate linear regression models. 43% of adolescents reported a non-substance-using home-based tie. More of these ties were associated with less recent alcohol use. 62% of adolescents reported a substance-using homeless tie. More of these ties were associated with more recent marijuana use as well as more lifetime heroin and methamphetamine use. For homeless youth, who are physically disconnected from positive peers, social networking technologies can be used to facilitate the sorts of positive social ties that effective peer-based prevention programs require.

Providing smoking cessation programs to homeless youth: the perspective of service providers.

PubMed

Shadel, William G; Tucker, Joan S; Mullins, Leslie; Staplefoote, Lynette

2014-10-01

There is almost no information available on cigarette smoking among homeless youth, whether they are currently receiving services for smoking cessation, and how to best help them quit. This paper presents data collected from a series of semi-structured telephone interviews with service providers from 23 shelters and drop-in centers serving homeless youth in Los Angeles County about their current smoking cessation programming, interest in providing smoking cessation services to their clients, potential barriers to providing this service, and ways to overcome these barriers. Results indicated that 84% of facilities did not offer smoking cessation services, although nearly all (91%) were interested in doing so. Barriers to implementing formal smoking cessation programs on site included lack of resources (e.g., money, personnel) to support the programs, staff training, and concern that smoking cessation may not be a high priority for homeless youth themselves. Overall, service providers seemed to prefer a less intensive smoking cessation program that could be delivered at their site by existing staff. Data from this formative needs assessment will be useful for developing and evaluating a smoking cessation treatment that could be integrated into the busy, complex environment that characterizes agencies that serve homeless youth. Copyright © 2014 Elsevier Inc. All rights reserved.

Lessons learned: a "homeless shelter intervention" by a medical student.

PubMed

Owusu, Yasmin; Kunik, Mark; Coverdale, John; Shah, Asim; Primm, Annelle; Harris, Toi

2012-05-01

The authors explored the process of implementing a medical student-initiated program designed to provide computerized mental health screening, referral, and education in a homeless shelter. An educational program was designed to teach homeless shelter staff about psychiatric disorders and culturally-informed treatment strategies. Pre- and post-questionnaires were obtained in conjunction with the educational program involving seven volunteer shelter staff. A computerized mental health screening tool, Quick Psycho-Diagnostics Panel (QPD), was utilized to screen for the presence of nine psychiatric disorders in 19 volunteer homeless shelter residents. Shelter staffs' overall fund of knowledge improved by an average of 23% on the basis of pre-/post-questionnaires (p=0.005). Of the individuals who participated in the mental health screening, 68% screened positive for at least one psychiatric disorder and were referred for further mental health care. At the 3-month follow-up of these individuals, 46% of those referred had accessed their referral services as recommended. Medical student-initiated psychiatric outreach programs to the homeless community have the potential to reduce mental health disparities by both increasing access to mental health services and by providing education. The authors discuss educational challenges and benefits for the medical students involved in this project.

Providing Homeless Adults with Advantage: A Sustainable University Degree Program

ERIC Educational Resources Information Center

Sinatra, Richard; Lanctot, Melissa Kim

2016-01-01

A university partnered with the New York City Department of Homeless Services (NYC DHS) to provide cohorts of adults a 60-credit Associate Degree Program in Business Administration over a 2-year period. Results of two cohorts of 30 Advantage Academy Program graduates revealed significant improvement in College Board AccuPlacer (ACPL) Arithmetic…

Previous Homelessness as a Risk Factor for Recovery from Serious Mental Illnesses.

PubMed

Castellow, Jennifer; Kloos, Bret; Townley, Greg

2015-08-01

This paper argues that the experience of homelessness is inherently traumatic and thus has the potential to affect the manifestation of mental illness. The experiences related to being homeless might act as specific and unique sources of vulnerability. This study included 424 people diagnosed with serious mental illnesses living in supported housing programs in South Carolina. Three hierarchical regression analyses measuring the impact of homelessness on three types of outcomes revealed the following: (1) ever experiencing homelessness as well as the amount of time spent homeless were related to higher levels of psychiatric distress, (2) ever experiencing homelessness was related to higher levels of reported alcohol use, and (3) total amount of time spent homeless was related to lower perceived recovery from mental illness. These findings suggest that experiencing homelessness might contribute to psychosocial vulnerability to negative mental health outcomes. Future investigations examining this concept of risk and vulnerability as a result of homelessness are in order.

The Homeless in Contemporary Society.

ERIC Educational Resources Information Center

Bingham, Richard D.; And Others

This book consists of 15 chapters on understanding and helping the homeless. The first seven chapters present the "new" homeless in historical context and describe this population and its situation. The remaining eight chapters discuss policy and program options of the government and other organizations in attempting to alleviate the problems of…

Young Children and Families Experiencing Homelessness

ERIC Educational Resources Information Center

Wilson, Allison B.; Squires, Jane

2014-01-01

The increasing prevalence of homelessness among young children and families in the United States is described, as is the developmental impact on young children and cost to society. Although services are mandated for this population under the McKinney­-Vento Act, Education of Homeless Children and Youth Program, and the Individuals With…

77 FR 56712 - Agency Information Collection (Homeless Providers Grant and Per Diem Program) Activities Under...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-13

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0554] Agency Information Collection (Homeless...-7316. Please refer to ``OMB Control No. 2900-0554'' in any correspondence. FOR FURTHER INFORMATION... . Please refer to ``OMB Control No. 2900-0554.'' SUPPLEMENTARY INFORMATION: Titles: a. Homeless Providers...

Homeless Students' Lived Experiences in Postsecondary Institutions and Academie: A Hermeneutic-Phenomenological Study

ERIC Educational Resources Information Center

Bongoy, Batombo M.

2016-01-01

This was a hermeneutic-phenomenological study on homeless students' life-world in urban, postsecondary public educational institutions. The sample population comprised 10 male and female Hispanic, Black, and Caucasian homeless student participants enrolled in professional and academic programs in postsecondary public vocational institutions…

Educating Homeless Children: Issues and Answers. Fastback 313.

ERIC Educational Resources Information Center

Stronge, James H.; Tenhouse, Cheri

This publication summarizes issues relating to the education of homeless children and youth and reviews programs that are effective in the delivery of educational services to this population. The report is comprised of five sections. The first section, "Introduction," surveys factors contributing to homelessness and indicates the special…

Program Evaluation of Services for the Homeless: Challenges and Strategies.

ERIC Educational Resources Information Center

Mercier, Celine; And Others

1992-01-01

Research strategies, including types of evaluations, designs, and indicators, developed to assess programs for chronic alcoholics and mentally ill homeless people in Canada are reviewed. Findings from previous evaluations are summarized, and the implications for evaluation practice are considered. (SLD)

[Mediating effect of self-efficacy in the relationship between anger and functional health of homeless men].

PubMed

Park, Su In; Kim, Sunah

2014-08-01

The purpose of this study was to examine the mediation of self-efficacy in the relationship between anger and the functional health of homeless men in order to provide a basis for planning nursing interventions to improve the functional health of homeless persons. The participants were 137 homeless men who lived in homeless shelters or visited one center serving free meals for homeless persons in Seoul. Data were collected using self-report questionnaires and analyzed with the SPSS-WIN 20.0 program. The instruments were the Functional Health Pattern Screening Assessment Tool (FHPAST), Self-efficacy Scale (SES), and State-trait Anger Expression Inventory-Korean version (STAXI-K). The mean score for functional health was 2.41. Overall self-efficacy was 70.82. state anger was 16.53, trait anger was 19.54, and anger expression was 25.31. There were signigicant correlations among the 3 variables, functional health, self-efficacy, and anger. Also, self-efficacy had a complete mediating effect in the relationship between anger and functional health. Based on the findings of this study, health management programs focusing on anger management and self-efficacy improvement are highly recommended to promote functional health in homeless persons.

Evaluation of an integrated housing and recovery model for people with severe and persistent mental illnesses: the Doorway program.

PubMed

Dunt, David R; Benoy, Andrew W; Phillipou, Andrea; Collister, Laura L; Crowther, Elizabeth M; Freidin, Julian; Castle, David J

2017-10-01

Objective The Doorway program is a 3-year pilot integrated housing and recovery support program aimed at people with a severe and persistent mental illness who are 'at risk' or actually homeless. Participants source and choose properties through the open rental market, with appropriate rental subsidy and brokerage support. This arrangement is highly innovative, differing from widely favoured arrangements internationally involving congregate and scattered-site housing owned or managed by the support program. The aim of the present study was to determine the effects of the Doorway program on participants' health, housing, service utilisation and costs. Methods A pre-post study design was used with outcome measures consisting of a number of question inventories and their costs (where relevant). The principal inventories were the Behaviour and Symptom Identification Scale 32 (BASIS-32), a consumer-oriented, self-report measure of behavioural symptoms and distress, the Health of the Nation Outcome Scale (HoNOS), an interviewer-administered measurement tool designed to assess general health and social functioning of mentally ill people and the Outcomes Star (Homelessness) system which measures various aspects of the homelessness experience. Baseline measurements were performed routinely by staff at entry to the program and then at 6-monthly intervals across the evaluation period. Results For 55 of 59 participants, total mean BASIS-32 scores (including as well three of five subscale scores) improved significantly and with moderate effect size. Four of the 10 domain scores on the Outcome Star (Homelessness) inventory also improved significantly, with effect sizes ranging from small-medium (three domains) to large (one domain). Mean usage of bed-based mental health clinical services and general hospital admissions both significantly decreased (with overall net savings of A$3096 per participant per annum). Overall cost savings (including housing) to government ranged from A$1149 to A$19837 depending on the housing type comparator. Conclusion The Doorway program secured housing for this vulnerable group with additional benefits in client outcomes, including reduced use and cost of health services. These findings, if confirmed in larger studies, should have widespread applicability internationally. What is known about the topic? Beneficial effects of housing and recovery programs (Housing First) on people with severe and persistent mental illness and who are 'at risk', or actually homeless, are being demonstrated in Northern America. These effects include housing security, well being, health service utilisation and cost effects on government. However, these beneficial effects can only be regarded as settled for housing security. The highly innovative Doorway care model in which participants source and choose properties through the open rental market, with appropriate rental subsidy and brokerage support, has not been investigated previously. What does this paper add? This paper adds new data on the Doorway care models, it's effects and costs, particularly with regard to participant behavioural distress and social functioning. What are the implications for practitioners? The beneficial effects of this innovative model, if confirmed in larger studies, should have widespread applicability internationally.

Risk factors for homelessness among women with schizophrenia.

PubMed Central

Caton, C L; Shrout, P E; Dominguez, B; Eagle, P F; Opler, L A; Cournos, F

1995-01-01

A study of risk factors for homelessness among the severely mentally ill was extended to include women, and a case-control study of 100 indigent women with schizophrenia meeting criteria for literal homelessness and 100 such women with no history of homelessness was conducted. Subjects were recruited from shelters, clinics, and inpatient psychiatric programs in New York City. Clinical interviewers used standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. Findings adjusted for ethnicity revealed that homeless women had higher rates of a concurrent diagnosis of alcohol abuse, drug abuse, and antisocial personality disorder. Homeless women also had less adequate family support. PMID:7625518

Tuberculosis among the homeless, United States, 1994-2010.

PubMed

Bamrah, S; Yelk Woodruff, R S; Powell, K; Ghosh, S; Kammerer, J S; Haddad, M B

2013-11-01

1) To describe homeless persons diagnosed with tuberculosis (TB) during the period 1994-2010, and 2) to estimate a TB incidence rate among homeless persons in the United States. TB cases reported to the National Tuberculosis Surveillance System were analyzed by origin of birth. Incidence rates were calculated using the US Department of Housing and Urban Development homeless population estimates. Analysis of genotyping results identified clustering as a marker for transmission among homeless TB patients. Of 270,948 reported TB cases, 16,527 (6%) were homeless. The TB incidence rate among homeless persons ranged from 36 to 47 cases per 100,000 population in 2006-2010. Homeless TB patients had over twice the odds of not completing treatment and of belonging to a genotype cluster. US- and foreign-born homeless TB patients had respectively 8 and 12 times the odds of substance abuse. Compared to the general population, homeless persons had an approximately 10-fold increase in TB incidence, were less likely to complete treatment and more likely to abuse substances. Public health outreach should target homeless populations to reduce the excess burden of TB in this population.

From homeless to housed: caring for people in transition.

PubMed

Drury, Lin J

2008-01-01

This ethnographic study was conducted to determine what homeless people experience during the transition from street life into community housing. Data were gathered through participant observation at a program designed to secure housing and support services for homeless people upon discharge from a psychiatric hospital. Sixty homeless, mentally ill adults were followed from hospital discharge through their first 2 years in community housing. Homeless people interact with health care providers across a cultural divide produced by vast differences in their lived experiences. This cultural distance limits access to the services that these individuals require to achieve residential stability.

Mental Disorder Among Homeless Persons in the United States: An Overview of Recent Empirical Literature.

ERIC Educational Resources Information Center

Robertson, Marjorie J.

1986-01-01

Reviews literature on the homeless reporting higher rates of psychiatric disorder, psychological distress, and previous psychiatric hospitalization compared to the general population. However, understandardized methodology and lack of consistent findings across studies prohibit reliable prevalence estimates of mental disorder among the homeless.…

Strengthening At-Risk and Homeless Young Mothers and Children

ERIC Educational Resources Information Center

Medeiros, Debra; Vaulton, Wendy

2010-01-01

The Strengthening At Risk and Homeless Young Mothers and Children Initiative, funded by the Conrad N. Hilton Foundation, aims to improve the housing, health, and development of homeless and at-risk young families. This article describes the services provided in four program sites (Pomona, CA; Antelope Valley, CA; Minneapolis, MN; and Chicago, IL)…

Health Services Utilization between Older and Younger Homeless Adults.(author Abstract)

ERIC Educational Resources Information Center

Nakonezny, Paul A.; Ojeda, Michael

2005-01-01

Purpose: Our purpose in the current study was to examine the relationship between health services utilization delivered by means of the Homeless Outreach Medical Services (HOMES) program and health services utilization delivered by means of the Parkland emergency room and inpatient units among a sample of older and younger homeless adults being…

Characterizing Stressors and Modifiable Health Risk Factors among Homeless Smokers: An Exploratory Pilot Study

ERIC Educational Resources Information Center

Kendzor, Darla E.; Reitzel, Lorraine R.; Businelle, Michael S.

2015-01-01

This pilot study was conducted to explore the associations between stressors related to homelessness and modifiable health risk factors (poor diet, insufficient physical activity, and overweight/obesity) and to provide direction for future research. Participants (N = 57) were homeless adults enrolled in a smoking cessation program. Analyses were…

Recruitment and Retention of Homeless Youth in a Substance Use and HIV-Risk Reduction Program

ERIC Educational Resources Information Center

Garvey, Rick; Pedersen, Eric R.; D'Amico, Elizabeth J.; Ewing, Brett A.; Tucker, Joan S.

2018-01-01

Conducting intervention studies with homeless populations can be difficult, particularly in terms of retaining participants across multiple sessions and locating them for subsequent follow-up assessments. Homeless youth are even more challenging to engage due to substance use, mental health problems, wariness of authority figures, and frequent…

77 FR 33223 - Announcement of the Publication of Funding Opportunity Announcements Under the Runaway and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

... the Publication of Funding Opportunity Announcements Under the Runaway and Homeless Youth Act AGENCY... Statutory Authority: Runaway and Homeless Youth Act, 42 U.S.C. sections 5701-5752, as amended by the.... Porter, Director, Runaway and Homeless Youth Program, Family and Youth Services Bureau, 1250 Maryland Ave...

Heart to Heart Art: Empowering Homeless Children and Youth

ERIC Educational Resources Information Center

Shepard, Jerri; Booth, Deborah

2009-01-01

This article describes Heart to Heart Art, an after-school program developed for homeless children and youth at the YWCA in Spokane, Washington. Pre-service teacher candidates from a local university create meaningful activities that engage homeless students in visual art, music, drama, cooking, and community service. Heart to Heart Art was…

Housing Retention in Single-Site Housing First for Chronically Homeless Individuals With Severe Alcohol Problems

PubMed Central

Malone, Daniel K.; Clifasefi, Seema L.

2013-01-01

Objectives. We studied housing retention and its predictors in the single-site Housing First model. Methods. Participants (n = 111) were chronically homeless people with severe alcohol problems who lived in a single-site Housing First program and participated in a larger nonrandomized controlled trial (2005–2008) conducted in Seattle, Washington. At baseline, participants responded to self-report questionnaires assessing demographic, illness burden, alcohol and other drug use, and psychiatric variables. Housing status was recorded over 2 years. Results. Participants were interested in housing, although a sizable minority did not believe they would be able to maintain abstinence-based housing. Only 23% of participants returned to homelessness during the 2-year follow-up. Commonly cited risk factors—alcohol and other drug use, illness burden, psychiatric symptoms, and homelessness history—did not predict resumed homelessness. Active drinkers were more likely to stay in this housing project than nondrinkers. Conclusions. We found that single-site Housing First programming fills a gap in housing options for chronically homeless people with severe alcohol problems. PMID:24148063

Effect of Our Nation's Housing Policy on Homelessness. Hearing before the Ad Hoc Task Force on the Homeless and Housing of the Committee on the Budget, House of Representatives. One Hundredth Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on the Budget.

According to Congressman Charles E. Schumer in his opening statement, the deqrease in Federal housing funds is inextricably linked to the increase in homelessness. Since 1981 the Reagan Administration has been systematically dismantling the nation's housing programs, leaving tens of thousands of low-income people homeless. In 1982 there were 1,088…

76 FR 22785 - Direct Certification and Certification of Homeless, Migrant and Runaway Children for Free School...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-25

... 1309 of the Elementary and Secondary Education Act of 1965 (ESEA). In general, a migrant child is one... Children for Free School Meals AGENCY: Food and Nutrition Service, USDA. ACTION: Interim rule with request... children's eligibility for free meals under the National School Lunch Program and the School Breakfast...

The Psychosocial Context of Homeless Mothers with Young Children: Program and Policy Implications.

ERIC Educational Resources Information Center

Dail, Paula W.

1990-01-01

Study explores the psychosocial difficulties facing homeless mothers with young children. Variables include impulse control, emotional tonality, social relationships, morality, goal orientation, coping, psychopathology, social adjustment, and sense of fatalism or control. Addresses value of results for designing social intervention programs for…

Factors associated with receipt of pension and compensation benefits for homeless veterans in the VBA/VHA Homeless Outreach Initiative.

PubMed

Chen, Joyce H; Rosenheck, Robert A; Greenberg, Greg A; Seibyl, Catherine

2007-03-01

Public support payments may facilitate exit from homelessness for persons with mental illness. We examined data from 10,641 homeless veterans contacted from October 1, 1995 to September 30, 2002 in a collaborative outreach program designed to facilitate access to Department of Veterans Affairs (VA) disability benefits. Those who were awarded benefits (22% of contacted veterans) were more likely to report disability, poor to fair self-rated health, and were more likely to have used VA services in the past. Thus, this program achieved only modest success and was most successful with veterans who were already receiving VA services and who might have received benefits even without the outreach effort.

Analysis of the Dynamics among Tutors in an After-School Tutoring Program in a Homeless Shelter for Families

ERIC Educational Resources Information Center

MacGillivray, Laurie; Goode, Gretchen S.

2016-01-01

Researchers of after-school tutoring primarily focus on educational outcomes with little attention to the social dynamics of such programs. In our qualitative case study, we examined the nature of interactions among tutors in a tutoring program at a homeless shelter for families. Employing Bourdieu's concepts of "social capital" and…

Monetary Incentives to Reinforce Engagement and Achievement in a Job-Skills Training Program for Homeless, Unemployed Adults

ERIC Educational Resources Information Center

Koffarnus, Mikhail N.; Wong, Conrad J.; Fingerhood, Michael; Svikis, Dace S.; Bigelow, George E.; Silverman, Kenneth

2013-01-01

The current study examined whether monetary incentives could increase engagement and achievement in a job-skills training program for unemployed, homeless, alcohol-dependent adults. Participants (n?=?124) were randomized to a no-reinforcement group (n?=?39), during which access to the training program was provided but no incentives were given; a…

Mortality among the homeless: Causes and meteorological relationships.

PubMed

Romaszko, Jerzy; Cymes, Iwona; Dragańska, Ewa; Kuchta, Robert; Glińska-Lewczuk, Katarzyna

2017-01-01

The homeless constitute a subpopulation particularly exposed to atmospheric conditions, which, in the temperate climate zone, can result in both cold and heat stress leading to the increased mortality hazard. Environmental conditions have become a significant independent risk factor for mortality from specific causes, including circulatory or respiratory diseases. It is known that this group is particularly prone to some addictions, has a shorter life span, its members often die of different causes than those of the general population and may be especially vulnerable to the influence of weather conditions. The retrospective analysis is based on data concerning 615 homeless people, out of which 176 died in the analyzed period (2010-2016). Data for the study was collected in the city of Olsztyn, located in north-east Poland, temperate climatic zone of transitional type. To characterize weather conditions, meteorological data including daily minimum and maximum temperatures and the Universal Thermal Climate Index (UTCI) were used. The average life span of a homeless person was shorter by about 17.5 years than that recorded for the general population. The average age at death of a homeless male was 56.27 years old (SD 10.38), and 52.00 years old (SD 9.85) of a homeless female. The most frequent causes of death were circulatory system diseases (33.80%). A large number of deaths were attributable to smoking (47.18%), whereas a small number was caused by infectious diseases, while a relatively large proportion of deaths were due to tuberculosis (2.15%). Most deaths occurred in the conditions of cold stress (of different intensity). Deaths caused by hypothermia were thirteen-fold more frequently recorded among the homeless than for the general population. A relative risk of death for a homeless person even in moderate cold stress conditions is higher (RR = 1.84) than in thermoneutral conditions. Our results indicate excessive mortality among the homeless as well as the weak and rather typical influence of atmospheric conditions on mortality rates in this subpopulation, except for a greater risk of cold related deaths than in the general population. UTCI may serve as a useful tool to predict death risk in this group of people.

Serving the Homeless through Recreation Programs. Research Update.

ERIC Educational Resources Information Center

Kunstler, Robin

1993-01-01

Literature review examines problems faced by homeless adults and children and discusses how recreation programs can serve them. The recreation and leisure profession can offer to the healthy child development through play and recreation, physical fitness, stress management, socialization, opportunities to learn goal-setting, self-esteem building,…

Prevalence of Homelessness in the Emergency Department Setting.

PubMed

Feldman, Brett J; Calogero, Cristina G; Elsayed, Kareem S; Abbasi, Osman Z; Enyart, Joshua; Friel, Timothy J; Abunamous, Yasir H; Dusza, Stephen W; Greenberg, Marna Rayl

2017-04-01

According to the National Alliance to End Homelessness, the national rate of homelessness has been cited as 17.7 homeless people/10,000 people in the general population, and 24.8 homeless veterans/10,000 veterans in the general population. However, it is unknown what the prevalence of homelessness is in the emergency department (ED) setting. We set out to determine the prevalence of homelessness or at risk for homelessness in the ED setting. Using a five-question screening tool derived from the U.S. Department of Housing and Urban Development, Health and Human Services and the Veterans Administration definition for homelessness, we surveyed all patients meeting inclusion/exclusion criteria on scheduled shifts in one of three EDs in Northeastern Pennsylvania. To participate, subjects had to be a registered patient in the ED, be 18 years or older, speak English, have the capacity to answer survey questions, not be critically ill, be willing to participate, and not have taken the survey before. We selected two survey periods to represent seasonal variations. We included 4,395 subjects in the analysis. The mean age of those who screened positive for homelessness or at risk for homelessness was 43.1 (SD 16.6). Overall, 136 (3.1%) participants screened positive for at risk for homelessness and 309 (7.0%) screened positive for homelessness. A total of 103 subjects (9.8%) screened positive for homelessness or at risk for homelessness on weekends and 312 (10.3%) on weekdays (p=0.64). The proportion of those screening positive for homelessness or at risk for homelessness varied by site: 145 (7.5%) at the trauma center, 151(9.1%) at the suburban site, and 149 (18.7%) at the center city site, p<0.001.There was no statistical significance to the difference between the trauma center and the suburban site (p=.088), but there was statistical significance between both the suburban and the trauma center when compared to the center city site (both p<0.0001). The proportion of those screening positive for homelessness in the summer months (156, 7.5%) was similar to those in the winter months (153, 6.6%), p=0.23. In our study, the overall prevalence of homelessness or at risk for homelessness was 10.1 percent. This prevalence did not seem to vary between weekdays and weekends. Additionally, summer months had a prevalence that was as concerning as winter months. The prevalence does, however, seem to vary by institutional characteristics even in the same geographic region. Understanding the patterns of prevalence of homelessness is a step toward considering possible interventions to assist this vulnerable population.

Teaching health-care trainees empathy and homelessness IQ through service learning, reflective practice, and altruistic attribution.

PubMed

Chrisman-Khawam, Leanne; Abdullah, Neelab; Dhoopar, Arjun

2017-05-01

This article describes a novel inter-professional curriculum designed to address the needs of homeless patients in a Midwestern region of the United States which has high rates of poverty. The curriculum is intended for healthcare trainees coming from undergraduate pre-medical programs, nursing, pharmacy, social work, clinical psychology, medical school and post-graduate medical training in family medicine, medicine-pediatrics, and psychiatry. The clinical component is specifically designed to reach destitute patients and the curriculum is structured to reverse commonly held myths about homelessness among the trainees, thereby improving their Homelessness Information Quotient, the ability to more fully understand homelessness. Participants across all disciplines and specialties have shown greater empathy and helper behavior as determined by qualitative measures. Learners have also developed a greater understanding of health-care systems allowing them to more consistently address social determinants of health identified by the authors as their Disparity Information Quotient. This article outlines the process of initiating a homeless service program, a curriculum for addressing common myths about homelessness and the effective use of narrative methods, relational connections, and reflective practice to enable trainees to process their experience and decrease burnout by focusing on the value of altruism and finding meaning in their work.

Racial Differences in Cigarette Smoking Among Homeless Youth.

PubMed

Golinelli, Daniela; Tucker, Joan S; Shadel, William G

2016-12-01

Several studies have reported pronounced racial/ethnic differences in smoking behavior among homeless youth. Better understanding the factors underlying racial/ethnic differences in daily smoking among homeless youth may help inform programs to reduce smoking in this population. Data come from a probability sample of homeless youth in Los Angeles County collected between 2008 and 2009. The sample includes 116 African American, 99 Hispanic, and 119 White youth with ages ranging from 13 to 24 years. Chi-square tests were used to test the differences in daily smoking among African American, Hispanic, and White youth. Propensity score and doubly robust methods were used to produce a less biased estimate of the association between daily smoking and race/ethnicity after having removed the effect of potential confounders. The daily smoking rate for White youth was 70.1%, more than 31 percentage points than the rates for either African American or Hispanic youth. Propensity score analysis revealed that the majority of the racial/ethnic differences in smoking rates could be explained by differences in homelessness severity, although background characteristics and comorbidity were relevant as well. As programs are developed to reduce smoking among homeless youth, results suggest that additional outreach may be needed to engage White youth in services. Also, smoking prevention programs may benefit from incorporating a social network-based approach that assists youth in fostering relationships with lower-risk peers, as well as addressing other forms of substance use. Incorporating these elements may help reduce the large racial/ethnic disparities in daily smoking among homeless youth. This report extends the small existing literature on racial/ethnic differences in smoking among homeless youth in two important respects. First, it confirms differences in daily smoking, an important indicator of dependence, across racial/ethnic groups. Second, it seeks to understand the extent to which differences in smoking can be explained by demographic characteristics (other than race/ethnicity), background factors, homelessness severity, and comorbidity characteristics known to be associated with substance use among homeless youth. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada.

PubMed

Zhang, Linda; Norena, Monica; Gadermann, Anne; Hubley, Anita; Russell, Lara; Aubry, Tim; To, Matthew J; Farrell, Susan; Hwang, Stephen; Palepu, Anita

2018-01-01

Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorders, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having concurrent disorders on health care utilization among homeless or vulnerably housed individuals, using longitudinal data from the Health and Housing in Transition Study. In 2009, 1190 homeless or vulnerably housed adults were recruited in Ottawa, Toronto, and Vancouver, Canada. Participants completed baseline interviews and four annual follow-up interviews, providing data on sociodemographics, housing history, mental health diagnoses, problematic drug use with the Drug Abuse Screening Test (DAST-10), problematic alcohol use with the Alcohol Use Disorders Identification Test (AUDIT), chronic health conditions, and utilization of the following health care services: emergency department (ED), hospitalization, and primary care. Concurrent disorders were defined as the participant having ever received a mental health diagnosis at baseline and having problematic substance use (i.e., DAST-10 ≥ 6 and/or AUDIT ≥ 20) at any time during the study period. Three generalized mixed effects logistic regression models were used to examine the independent association of having concurrent disorders and reporting ED use, hospitalization, or primary care visits in the past 12 months. Among our sample of adults who were homeless or vulnerably housed, 22.6% (n = 261) reported having concurrent disorders at baseline. Individuals with concurrent disorders had significantly higher odds of ED use (adjusted odds ratio [AOR] = 1.71; 95% confidence interval [CI], 1.4-2.11), hospitalization (AOR = 1.45; 95% CI, 1.16-1.81), and primary care visits (AOR = 1.34; 95% CI, 1.05-1.71) in the past 12 months over the four-year follow-up period, after adjusting for potential confounders. Concurrent disorders were associated with higher rates of health care utilization when compared to those without concurrent disorders among homeless and vulnerably housed individuals. Comprehensive programs that integrate mental health and addiction services with primary care as well as community-based outreach may better address the unmet health care needs of individuals living with concurrent disorders who are vulnerable to poor health outcomes.

Homeless and Housed Inpatients with Schizophrenia: Disparities in Service Access upon Discharge from Hospital

ERIC Educational Resources Information Center

Burra, Tara A.; Hwang, Stephen W.; Rourke, Sean B.; Stergiopoulos, Vicky

2012-01-01

This study examines differences in services available at the time of discharge for homeless and housed psychiatric inpatients. Participants diagnosed with schizophrenia or schizoaffective disorder were recruited from a general hospital psychiatric inpatient unit. Thirty homeless individuals and 21 housed controls (matched for diagnosis, gender,…

Understanding the Need for Obesity Prevention Counseling among Homeless Patients

ERIC Educational Resources Information Center

Peart, Tasha; de Leon Siantz, MaryLou

2017-01-01

Though many studies have examined the level of physician obesity prevention counseling among the general population, little is known about how homeless patients are advised about healthy eating and physical activity by their health care provider. The homeless are an at-risk population with whom physicians and other health professionals can play a…

A Critical Analysis of the Research on Student Homelessness

ERIC Educational Resources Information Center

Miller, Peter M.

2011-01-01

Since the onset of the economic recession, rates of student homelessness have increased rapidly in urban, suburban, and rural school districts throughout the United States. Despite the widespread urgency of the issue, there is a lack of general coherence in the research about how diverse conditions of homelessness affect students and how schools…

Summer Literacy Intervention for Homeless Children Living in Transitional Housing

ERIC Educational Resources Information Center

Willard, Adrienne Lisa; Kulinna, Pamela Hodges

2012-01-01

This study reports the findings of a six-week summer literacy program conducted at a transitional housing facility for homeless families in the Southwestern region of the U.S. This study is grounded on the body of knowledge on students' literacy and homelessness. The intervention included one-on-one instruction by tutors. This study examined…

Job Training for the Homeless Demonstration Program: U.S. Department of Labor--Employment and Training Administration. Final Evaluation Report.

ERIC Educational Resources Information Center

Elgin Community Coll., IL.

This report evaluates the Fox Valley Consortium for Job Training and Placement of the Homeless which involves five educational, social service, and community organizations in activities to facilitate the educational development and financial independence of homeless participants. The consortium consists of: the Community Crisis Center (area…

Nowhere to Run: HIV Prevention for Runaway and Homeless Youth.

ERIC Educational Resources Information Center

Posner, Marc

This volume is a guide to providing effective Human Immunodeficiency Virus (HIV) and substance abuse prevention services to runaway and homeless youth. The guide is based on current research and the best programs in this field. Chapters 1 and 2 summarize what is known about runaway and homeless youth, the services these youth require if they are…

A Status Report on Hunger and Homelessness in America's Cities, 2002: A 25-City Survey.

ERIC Educational Resources Information Center

Lowe, Eugene T.

To assess the status of hunger and homelessness in U.S. cities during 2002, 25 major cities completed surveys regarding demand for emergency food assistance and emergency shelter and capacity of local agencies to meet the demand; causes of hunger and homelessness and demographics of populations experiencing these problems; exemplary programs or…

Homeless in Michigan: Voices of the Children. A Report from KIDS COUNT in Michigan.

ERIC Educational Resources Information Center

Dohoney, Jo M.; Reiling, Denise

Because homeless children are often a hidden group, staying with friends or relatives for brief or long periods, and occasionally spilling into the roughly 150 private emergency shelters and domestic violence programs in Michigan, their numbers are difficult to define. This Kids Count! study interviewed 25 children of 25 homeless families residing…

[Characteristics and health status of homeless women born in France and abroad: Results of Insee-Ined 2012 survey].

PubMed

Gomes do Espirito Santo, M-E; Perrine, A-L; Bonaldi, C; Guseva-Canu, I

2018-03-01

French national surveys among the homeless population in 2001 and 2012 provided a general description of the homeless beneficiaries of medical and social aids. However, given the increasing number of women in this population, mostly born abroad and accompanied by their children, a descriptive study of homeless women according to the fact of being born in France or abroad was conducted. A probability sample of 1470 French-speaking homeless women was recruited for the Insee-Ined 2012 survey. Socio-demographic characteristics, life trajectories, work and employment over the last 12 months, perceived health, reported morbidity, use of care and medical coverage have been described, comparing homeless women born abroad with those born in France. Homeless women are young (median age=34 y.), often single (55%), without a partner (71%) and often accompanied by children (52%). The vast majority (60%) reported no salary during the previous 12 months. Housing conditions were less precarious in women born in France, but these women had a more difficult life history, a more unfavorable perception of their health status, and a higher frequency of chronic health problems. Homeless women born abroad seemed to have more precarious conditions of life and more difficulties to access aids and medical coverage. Overall, despite a relatively good availability of medical insurance, homeless women, regardless of the place of birth, often reported health problems, which were not treated. This study suggests that homeless women often have to deal with chronic health problems that are not treated. Homeless women born abroad are characterized by more precarious living conditions that women born in France. Although younger, with an overall favorable perception of their health and declaring less often an addiction, their general state of health appears to be as fragile as for women born in France. Actions towards homeless women should be implemented to promote their access to care. Copyright © 2017. Published by Elsevier Masson SAS.

Tuberculosis among the homeless, United States, 1994–2010

PubMed Central

Bamrah, S.; Yelk Woodruff, R. S.; Powell, K.; Ghosh, S.; Kammerer, J. S.; Haddad, M. B.

2016-01-01

SUMMARY OBJECTIVES 1) To describe homeless persons diagnosed with tuberculosis (TB) during the period 1994–2010, and 2) to estimate a TB incidence rate among homeless persons in the United States. METHODS TB cases reported to the National Tuberculosis Surveillance System were analyzed by origin of birth. Incidence rates were calculated using the US Department of Housing and Urban Development homeless population estimates. Analysis of genotyping results identified clustering as a marker for transmission among homeless TB patients. RESULTS Of 270 948 reported TB cases, 16 527 (6%) were homeless. The TB incidence rate among homeless persons ranged from 36 to 47 cases per 100 000 population in 2006–2010. Homeless TB patients had over twice the odds of not completing treatment and of belonging to a genotype cluster. US- and foreign-born homeless TB patients had respectively 8 and 12 times the odds of substance abuse. CONCLUSIONS Compared to the general population, homeless persons had an approximately 10-fold increase in TB incidence, were less likely to complete treatment and more likely to abuse substances. Public health outreach should target homeless populations to reduce the excess burden of TB in this population. PMID:24125444

Costs of services for homeless people with mental illness in 5 Canadian cities: a large prospective follow-up study

PubMed Central

Latimer, Eric A.; Rabouin, Daniel; Cao, Zhirong; Ly, Angela; Powell, Guido; Aubry, Tim; Distasio, Jino; Hwang, Stephen W.; Somers, Julian M.; Stergiopoulos, Vicky; Veldhuizen, Scott; Moodie, Erica E.M.; Lesage, Alain; Goering, Paula N.

2017-01-01

Background: Limited evidence on the costs of homelessness in Canada is available. We estimated the average annual costs, in total and by cost category, that homeless people with mental illness engender from the perspective of society. We also identified individual characteristics associated with higher costs. Methods: As part of the At Home/Chez Soi trial of Housing First for homeless people with mental illness, 990 participants were assigned to the usual-treatment (control) group in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montréal and Moncton) between October 2009 and June 2011. They were followed for up to 2 years. Questionnaires ascertained service use and income, and city-specific unit costs were estimated. We adjusted costs for site differences in sample characteristics. We used generalized linear models to identify individual-level characteristics associated with higher costs. Results: Usable data were available for 937 participants (94.6%). Average annual costs (excluding medications) per person in Vancouver, Winnipeg, Toronto, Montréal and Moncton were $53 144 (95% confidence interval [CI] $46 297-$60 095), $45 565 (95% CI $41 039-$50 412), $58 972 (95% CI $52 237-$66 085), $56 406 (95% CI $50 654-$62 456) and $29 610 (95% CI $24 995-$34 480), respectively. Net costs ranged from $15 530 to $341 535. Distributions of costs across categories varied significantly across cities. Lower functioning and a history of psychiatric hospital stays were the most important predictors of higher costs. Interpretation: Homeless people with mental illness generate very high costs for society. Programs are needed to reorient this spending toward more effectively preventing homelessness and toward meeting the health, housing and social service needs of homeless people. PMID:28724726

Drug use and barriers to and facilitators of drug treatment for homeless youth

PubMed Central

Nyamathi, Adeline; Hudson, Angela; Mutere, Malaika; Christiani, Ashley; Sweat, Jeff; Nyamathi, Kamala; Broms, Theresa

2007-01-01

In the United States, homeless youth are becoming increasingly entrenched in problem substance use, including high prevalence of alcohol abuse and injection use. A total of 54 substance-using homeless youth (18–25 years) participated in focus groups in order to provide their perspectives on barriers to and facilitators of seeking treatment. Participants were recruited from shelters in Hollywood, CA, and from a street-based, drop-in site in Santa Monica, CA. Participants identified personal barriers to treatment, but reported that facilitators of treatment tended to be more systematic. Homeless youth used and abused substances to dim the psychological effects of living on the streets. They appreciated programs that facilitated treatment and rehabilitation such as mentoring, support groups, and alternative choices to substance use. Implications point to the need for further development and research on culturally-appropriate, age-sensitive programs for homeless youth. The experiences of these youth underscore the need for strategic interventions. PMID:19956442

Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review

PubMed Central

Brody, Jennifer K.; León, Casey; Baggett, Travis P.

2016-01-01

Drug overdose is a major cause of death among homeless people, but little is known about the characteristics of homeless overdose decedents. We conducted a retrospective record review of 219 adult patients of Boston Health Care for the Homeless Program (BHCHP) who died of drug overdose in 2003–2008. We assessed the substances implicated in overdose and the health and service use characteristics of decedents prior to death. Eighty-one percent of overdose deaths involved opioids and 40% involved multiple drugs. Problem substance use (85%), psychiatric illness (61%), and chronic pain (45%) were common, and 32% had documentation of all three. Half were well-connected to BHCHP, and 35% had a clinic visit within 90 days of death. The complex health histories and frequent health care contacts of homeless drug overdose decedents suggest that clinical facilities may be an important frontline venue for overdose education, naloxone distribution, and integrated substance use treatment programming. PMID:27180712

'Growing Old' in Shelters and 'On the Street': Experiences of Older Homeless People.

PubMed

Grenier, Amanda; Sussman, Tamara; Barken, Rachel; Bourgeois-Guérin, Valerie; Rothwell, David

2016-01-01

Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.

Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective.

PubMed

Van Leeuwen, James M; Boyle, Susan; Salomonsen-Sautel, Stacy; Baker, D Nico; Garcia, J T; Hoffman, Allison; Hopfer, Christian J

2006-01-01

This article reports on results of a one-day public health survey conducted in six states by homeless youth providers to measure and compare risk factors between lesbian, gay, and bisexual (LGB) homeless youth and non-LGB homeless youth. This article intends to inform the child welfare field on existing gaps in services and areas where more training and technical support is necessary in providing services to homeless LGB youth. The findings point to substantial differences within the homeless youth sample and demonstrate that in addition to the public health risks young people face merely by being homeless, the risks are exacerbated for those who self-identify as lesbian, gay, or bisexual. The article informs child welfare providers and policymakers about the substantial vulnerability of LGB youth beyond that of non-LGB homeless youth and the need to fund programming, training, technical assistance and further research to specifically respond to the complex needs of this population.

Psychosis, Lack of Job Skills, and Criminal History: Associations With Employment in Two Samples of Homeless Men.

PubMed

Tsai, Jack; Rosenheck, Robert A

2016-06-01

This study examined factors associated with employment among homeless men with mental illness, particularly history of criminal justice involvement. Data from 569 homeless men in the 11-site Collaborative Initiative to Help End Chronic Homelessness (2004-2009) and 1,101 homeless male veterans in the U.S. Department of Housing and Urban Development-Veterans Affairs Supportive Housing program at 19 sites (1992-2003) were analyzed. In neither sample was criminal or incarceration history significantly associated with job attainment or earnings for either black or white participants. In contrast, psychotic disorders and public-support income were negatively associated with job attainment and earnings. The majority of homeless veterans reported lifetime occupations as skilled or unskilled manual workers. These findings highlight the high rate of nonemployment among homeless men and suggest that employment among homeless men is not significantly impeded by a criminal record but by psychiatric problems and reliance on public-support income.

Emergency Department Use for Dental Problems among Homeless Individuals: A Population-Based Cohort Study.

PubMed

Figueiredo, Rafael; Dempster, Laura; Quiñonez, Carlos; Hwang, Stephen W

2016-01-01

To evaluate emergency department (ED) visits for dental problems among Toronto's homeless population (Ontario, Canada). A random sample of 1,189 homeless was recruited from shelters and meal programs. Emergency department visits for non-traumatic dental problems (ICD-10-CA codes K00-K14) were identified using participants' health insurance number, during 2005-2009. Age- and sex-matched controls were selected from low-income neighborhoods. Homeless and matched controls had 182 and 10 ED visits for dental problems, respectively. Homeless people were more significantly more likely (OR=2.27, p=.007) to make ED visit for dental problems compared with controls. Over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit. The high rate of ED visits for dental problems by people who are homeless suggests that access to dental care is inadequate. The large number of repeat visits indicates that ED settings are ineffective for treatment of dental problems.

The lived experiences of homeless men.

PubMed

Lafuente, C R; Lane, P L

1995-01-01

To investigate the phenomenon of social disaffiliation in homeless men, a qualitative study was conducted that used a framework of Bahr's (1973) social disaffiliation theory. Ten homeless men were interviewed to determine their reasons for becoming homeless, their feelings about being homeless, and the specific resources they used for maintaining life on the streets. Using a semistructured interview, audiotapes were made of the responses of the 10 men, 20 to 61 years old, who were using a shelter for the homeless in a U.S. southern city. For data analysis, Giorgi's phenomenological approach (cited in Omery, 1983) was used. Activities and resources that the men used to meet their social, economic, and other needs were described. The following three major themes were identified: rejection, uncertainty, and social isolation. Recommendations include changing nursing curricula and conducting staff development programs, testing interventions to alleviate social isolation, and assisting the homeless to return to the societal mainstream.

Alcohol, poverty and social exclusion: Alcohol consumption among the homeless and those at risk of social exclusion in Madrid.

PubMed

Panadero, Sonia; Vázquez, José Juan; Martín, Rosa María

2016-06-14

The work analyzes different aspects related to alcohol consumption among homeless people and people at risk of social exclusion. The data was gathered from a representative sample of homeless people in Madrid (n = 188) and a sample of people at risk of social exclusion (n = 164) matched in sex, age, and origin (Spaniards vs. foreigners). The results showed that homeless people present a greater consumption of alcohol and have experienced more problems derived from its consumption than people at risk of social exclusion. Most of the homeless people who had alcohol-related problems had had them prior to their homelessness, and they stated they had poorer health and had experienced a greater number of homelessness episodes. Despite the relevance of problems related to alcohol among our sample, only a small percentage of the sample had participated in treatment programs for alcohol consumption.

The worlds of homeless white and African American youth in San Francisco, California: a cultural epidemiological comparison.

PubMed

Hickler, Benjamin; Auerswald, Colette L

2009-03-01

Research to date has given little attention to differences in the experience of youth homelessness by ethnicity. This article provides a comparative descriptive analysis of the effect of differences and similarities in paths to homelessness, self-perception, and survival strategies on health behaviors and consequent health outcomes of African American and white homeless youth in San Francisco, USA. We conducted participant observation and ethnographic interviews with 54 youth primarily recruited from street venues. Hypotheses generated from the ethnographic data were validated in between-group analyses using concurrent epidemiological data collected from a sample of 205 youth. Our samples of unstably housed African American and white youth, though sharing common histories of family dysfunction, differed in both the ethnographic accounts and epidemiological analyses in their experiences of family, access to housing, street survival strategies, self-presentation, health behaviors and service utilization. Our sample of white youth generally identified with the term "homeless," engaged in survival activities associated with such a label, and accessed the services intended to address the needs of homeless youth. In contrast, our sample of African American youth generally did not perceive themselves as "homeless," a stigmatized term, and were thus less likely to utilize, or be accessed by, relevant services.

Responding to the Needs of the Homeless and Hungry.

ERIC Educational Resources Information Center

American National Red Cross, Washington, DC.

This report describes the Hotels-Motels in Partnership Program, a human services resource sponsored by the Red Cross and other organizations to respond to housing needs of the homeless, disaster victims, and others in need of emergency assistance. The partnership program involves several hundred businesses in more than 240 communities. Since its…

7 CFR 278.6 - Disqualification of retail food stores and wholesale food concerns, and imposition of civil money...

Code of Federal Regulations, 2011 CFR

2011-01-01

... providers, and shelters for battered women and children which the wholesale food concern was authorized to... addict and alcoholic treatment program, homeless meal providers, or shelters for battered women and... program, group living arrangement, homeless meal provider, meal delivery service, or shelter for battered...

7 CFR 278.6 - Disqualification of retail food stores and wholesale food concerns, and imposition of civil money...

Code of Federal Regulations, 2010 CFR

2010-01-01

... providers, and shelters for battered women and children which the wholesale food concern was authorized to... addict and alcoholic treatment program, homeless meal providers, or shelters for battered women and... program, group living arrangement, homeless meal provider, meal delivery service, or shelter for battered...

Can You Trust Self-Report Data Provided by Homeless Mentally Ill Individuals?

ERIC Educational Resources Information Center

Calsyn, Robert J.; And Others

1993-01-01

Reliability and validity of self-report data provided by 178 mentally ill homeless persons were generally favorable. Self-reports of service use also generally agreed with treatment staff estimates, providing further validity evidence. Researchers and administrators can be relatively confident in using such data. (SLD)

The Effect of Selected Intervention Tactics on Self-Sufficient Behaviors of the Homeless: An Application of the Theory of Planned Behavior.

ERIC Educational Resources Information Center

Moroz, Pauline

A sample of 24 voluntary participants in a federally funded vocational training and placement program for homeless people in El Paso, Texas, was studied to identify specific interventions that increase self-sufficient behaviors of homeless individuals. Case study data were collected from orientation discussions, career counseling sessions, and…

Serving homeless Veterans in the VA Desert Pacific Healthcare Network: A needs assessment to inform quality improvement endeavors

PubMed Central

Gabrielian, Sonya; Yuan, Anita; Rubenstein, Lisa; Andersen, Ronald M.; Gelberg, Lillian

2016-01-01

This report describes a needs assessment of VA programs for homeless Veterans in Southern California and Nevada, the geographic region with the most homeless Veterans in the nation. The assessment was formulated through key informant interviews. Current service provisions are discussed, along with salient unmet needs for this vulnerable population. PMID:23974403

Serving homeless veterans in the VA Desert Pacific Healthcare Network: a needs assessment to inform quality improvement endeavors.

PubMed

Gabrielian, Sonya; Yuan, Anita; Rubenstein, Lisa; Andersen, Ronald M; Gelberg, Lillian

2013-08-01

This report describes a needs assessment of VA programs for homeless Veterans in Southern California and Nevada, the geographic region with the most homeless Veterans in the nation. The assessment was formulated through key informant interviews. Current service provisions are discussed, along with salient unmet needs for this vulnerable population.

Homelessness in America: What Should We Do? Public Talk Series.

ERIC Educational Resources Information Center

Niedergang, Mark; McCoy, Martha, Ed.

This program guide provides a forum for discussing the different beliefs that influence public policy about homelessness as well as policy goals. The central question is addressed in two parts: (1) what society ought to do for homeless people; and (2) laying out a range of possible answers for part 1. Four possible answers are discussed: help only…

Adult Education for the Homeless. FY 89 Project Abstracts. Twenty-Eight Programs that Can Help the Homeless.

ERIC Educational Resources Information Center

Office of Vocational and Adult Education (ED), Washington, DC. Clearinghouse on Adult Education and Literacy.

In the first portion of this document, abstracts are given for 30 projects that were designed to provide basic skills and literacy training to homeless adults in fiscal year 1989. The following information is provided for each project: state; grant award number; grantee; project title; project director, telephone number, and address; and…

Hepatitis A/B vaccine completion among homeless adults with history of incarceration.

PubMed

Nyamathi, Adeline M; Marlow, Elizabeth; Branson, Catherine; Marfisee, Mary; Nandy, Karabi

2012-03-01

Hepatitis B virus (HBV) vaccination rates for incarcerated adults remain low despite their high risk for infection. This study determined predictors of vaccine completion in homeless adults (N= 297) who reported histories of incarceration and who participated in one of three nurse-led hepatitis programs of different intensity. Moreover time since release from incarceration was also considered. Just over half of the former prisoners completed the vaccine series. Older age (≥40), having a partner, and chronic homelessness were associated with vaccine completion. Recent research has documented the difficulty in providing vaccine services to younger homeless persons and homeless males at risk for HBV. Additional strategies are needed to achieve HBV vaccination completion rates greater than 50% for formerly incarcerated homeless men. © 2012 International Association of Forensic Nurses.

Attributions about homelessness in homeless and domiciled people in Madrid, Spain: "Why are they homeless people?".

PubMed

Vázquez, José Juan; Panadero, Sonia; Zúñiga, Claudia

2018-01-01

Causal attributions of homelessness may affect both the design and acceptance of public policies aimed at improving the situation of homeless people and the strategies that homeless people themselves decide to adopt in order to cope with their situation. This article analyzes the differences in causal attributions of homelessness based on gender, age, nationality, educational background, perceived social class, evolution of personal economic situation, and future expectations between the members of 2 groups: (a) "homeless group", consisting of a representative sample of homeless people in Madrid, Spain (n = 188); and (b) "domiciled group", consisting of a sample of people in Madrid at no risk of homelessness (n = 180), matched for sex, age and nationality. Results show that among domiciled population, women, older people, those without university education, those considering themselves to belong to lower income social classes, those who considered their economic situation to have worsened, and those who expressed negative expectations for the future attributed homelessness to individualistic courses to a greater extent. Meanwhile, among homeless group, younger people, those without university education, those considering themselves to belong to higher social classes, those who perceived their economic situation as having improved in recent years, and those who expressed positive expectations for the future generally attributed homelessness to individualistic courses to a greater extent. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

"I'M OPENING MY ARMS RATHER THAN PUSHING AWAY:" PERCEIVED BENEFITS OF A MINDFULNESS-BASED INTERVENTION AMONG HOMELESS WOMEN AND YOUNG CHILDREN.

PubMed

Alhusen, Jeanne L; Norris-Shortle, Carole; Cosgrove, Kim; Marks, Lauren

2017-05-01

Family homelessness is associated with adverse outcomes in mothers and their young children. Evidence-based programs are needed to support the socioemotional needs of these families. The purpose of this qualitative study was to explore the perceived benefits of participating in a mindfulness program in mother-child dyads receiving services at a therapeutic nursery serving homeless children under the age of 3 years. A convenience sample of 17 predominantly African American mothers participated in in-depth qualitative interviews. Four themes were derived from the data regarding the perceived benefits of the mindfulness program: "me" time, maternal self-regulation, dyadic connectedness, and child well-being. Results demonstrate the perceived benefits of mindfulness on the parent-child relationship and have important implications for families at an increased risk of adverse outcomes. Because homelessness and residential instability confer considerable risk for young children, interventions to support effective parenting are critical. © 2017 Michigan Association for Infant Mental Health.

Homelessness: Recent Statistics, Targeted Federal Programs, and Recent Legislation

DTIC Science & Technology

2005-05-31

submit semiannual financial and program reports, as well as a final report 90 days after the end of the project period. Transitional Living Program. (42...costs. To prevent homelessness, financial assistance may be given to families who have received eviction or termination of utility service notices if...assistance. Centers must also be equipped to provide job training, counseling and placement services (including job readiness and literacy and skills

45 CFR 1351.20 - What are the additional requirements under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false What are the additional requirements under a Runaway and Homeless Youth Program grant? 1351.20 Section 1351.20 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

45 CFR 1351.20 - What are the additional requirements under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false What are the additional requirements under a Runaway and Homeless Youth Program grant? 1351.20 Section 1351.20 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

45 CFR 1351.20 - What are the additional requirements under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 4 2014-10-01 2014-10-01 false What are the additional requirements under a Runaway and Homeless Youth Program grant? 1351.20 Section 1351.20 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

Young Children and Their Families Who Are Homeless. A University Affiliated Program's Response.

ERIC Educational Resources Information Center

Taylor, Tawara D.; Brown, Marisa C.

This monograph describes a University Affiliated Program's (UAP) initiative that targets the development needs of children from birth to 5 years of age who are homeless and the services and supports provided to their families. The Georgetown University Child Development Center, the UAP for the District of Columbia, has implemented a homelessness…

The Most Frequently Asked Questions on the Education Rights of Children and Youth in Homeless Situations. Revised

ERIC Educational Resources Information Center

National Association for the Education of Homeless Children and Youth, 2009

2009-01-01

This document provides answers to frequently asked questions on the McKinney-Vento Homeless Assistance Act and the education rights of children and youth in homeless situations. The answers are general responses based on federal statutes, regulations, and guidance; relevant case law; and best practices from across the country. While the National…

HIV Risk Behavior and Access to Services: What Predicts HIV Testing among Heterosexually Active Homeless Men?

ERIC Educational Resources Information Center

Wenzel, Suzanne L.; Rhoades, Harmony; Tucker, Joan S.; Golinelli, Daniela; Kennedy, David P.; Zhou, Annie; Ewing, Brett

2012-01-01

HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV…

A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System of Universal Health Insurance

PubMed Central

Chambers, Catharine; Chiu, Shirley; Katic, Marko; Kiss, Alex; Redelmeier, Donald A.; Levinson, Wendy

2013-01-01

Objectives. We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. Methods. We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs). Results. Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical–surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical–surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations. Conclusions. In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services. PMID:24148051

Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups.

PubMed

Stergiopoulos, Vicky; O'Campo, Patricia; Gozdzik, Agnes; Jeyaratnam, Jeyagobi; Corneau, Simon; Sarang, Aseefa; Hwang, Stephen W

2012-10-02

The literature on interventions addressing the intersection of homelessness, mental illness and race is scant. The At Home/Chez Soi research demonstration project is a pragmatic field trial investigating a Housing First intervention for homeless individuals with mental illness in five cities across Canada. A unique focus at the Toronto site has been the development and implementation of a Housing First Ethno-Racial Intensive Case Management (HF ER-ICM) arm of the trial serving 100 homeless individuals with mental illness from ethno-racial groups. The HF ER-ICM program combines the Housing First approach with an anti-racism/anti-oppression framework of practice. This paper presents the findings of an early implementation and fidelity evaluation of the HF ER-ICM program, supplemented by participant narrative interviews to inform our understanding of the HF ER-ICM program theory. Descriptive statistics are used to describe HF ER-ICM participant characteristics. Focus group interviews, key informant interviews and fidelity assessments were conducted between November 2010 and January 2011, as part of the program implementation evaluation. In-depth qualitative interviews with HF ER-ICM participants and control group members were conducted between March 2010 and June 2011. All qualitative data were analysed using grounded theory methodology. The target population had complex health and social service needs. The HF ER-ICM program enjoyed a high degree of fidelity to principles of both anti-racism/anti-oppression practice and Housing First and comprehensively addressed the housing, health and sociocultural needs of participants. Program providers reported congruence of these philosophies of practice, and program participants valued the program and its components. Adapting Housing First with anti-racism/anti-oppression principles offers a promising approach to serving the diverse needs of homeless people from ethno-racial groups and strengthening the service systems developed to support them. The use of fidelity and implementation evaluations can be helpful in supporting successful adaptations of programs and services.

Voices from the street: exploring the realities of family homelessness.

PubMed

Gültekin, Laura; Brush, Barbara L; Baiardi, Janet M; Kirk, Keri; VanMaldeghem, Kelley

2014-11-01

Homelessness threatens the health and well-being of thousands of families in the United States, yet little is known about their specific needs and how current services address them. To fill this knowledge gap, we explored the experiences of homelessness families in Detroit, Michigan. We targeted homeless mothers and their caseworkers for study to see if the perceptions of needs and services were in alignment. Using focus groups and content analysis, we identified four overarching themes that illustrate homeless mothers' experience with homelessness. We then analyzed data from caseworkers to look specifically for similarities and differences in their perceptions. Key findings included reports of family histories of violence, poverty, social isolation, and a lack of informal support as contributing to homelessness. The differing perspectives of mothers and their caseworkers regarding how best to move forward highlight how current programs and services may not be meeting the needs of this growing and vulnerable cohort. © The Author(s) 2014.

Are the mentally ill homeless a distinct homeless subgroup?

PubMed

North, C S; Smith, E M; Pollio, D E; Spitznagel, E L

1996-09-01

The question has been raised whether it is useful or meaningful to dichotomize the homeless population by mental illness - i.e., to consider the mentally ill homeless as distinct from other homeless people. The current article presents evidence from a single data set to address this question empirically. Data from a randomly sampled population of 900 homeless men and women systemically interviewed using the Diagnostic Interview Schedule were examined to determine associations of mental illness with the problems of homelessness, controlling for the presence of substance abuse in the analyses. Although a few clinically meaningful associations with mental illness were found that might suggest directions for appropriate interventions, mental illness did not differentiate individuals in many important demographic and biographic respects. Individual diagnoses did not perform much better in differentiating the homeless by mental illness. Schizophrenia and bipolar mania showed a few significant associations not identified by the "major mental illness" construct. Major depression, constituting the majority of nonsubstance Axis I disorder in the homeless, provided no association beyond that obtained with the "major mental illness" category. The data provide little support for conceptualizing homeless subgroups or homelessness in general on the basis of mental illness alone. To do so also risks neglecting the emotional distress of the majority without major mental illness and the other problems that homeless persons share regardless of psychiatric illness. While serious mental illness is overrepresented among the homeless, it represents just one of many important vulnerability factors for homelessness. Substance abuse is far more prevalent than other Axis I disorders. Media images equating homelessness with major mental illness unnecessarily stigmatize homeless people and encourage oversimplified and narrowly conceived psychiatric interventions. While continuing attention is needed on improving identification and management of serious mental illness among the homeless, this must be accomplished within the broader context of social and economic aspects of homelessness.

A Guide to Enhancing the Cultural Competence of Runaway and Homeless Youth Programs.

ERIC Educational Resources Information Center

Johnson, Bassin, and Shaw, Inc., Silver Spring, MD.

In June 1993, the Family and Youth Services Bureau brought together a working group to help local programs for runaway and homeless youth better meet the needs of an increasingly diverse population of young people. Strategies developed by this working group are shared in this guide. The introductory chapter provides a framework within which local…

Perceived racial, sexual identity, and homeless status-related discrimination among Black adolescents and young adults experiencing homelessness: Relations with depressive symptoms and suicidality.

PubMed

Gattis, Maurice N; Larson, Andrea

2016-01-01

There is a dearth of empirical evidence that addresses how racial minority, sexual minority, and homeless statuses, with their accompanying experiences of stigma and discrimination, are related to mental health in adolescent and young adult populations. The current study addresses this gap by examining the associations between multiple forms of discrimination, depressive symptoms, and suicidality in a sample of 89 Black adolescents and young adults (52% female; 47% nonheterosexual, ages 16-24) experiencing homelessness. Results from a series of ordinary least squares and logistic regressions suggested that perceived homelessness stigma and racial discrimination were associated with higher levels of depressive symptoms, controlling for gender, age, and other types of discrimination, while perceived sexual identity discrimination showed no association. Having ever spent a homeless night on the street, an indicator of homelessness severity, accounted for a substantial amount of the association between homelessness stigma and depressive symptoms. In contrast, suicidality was not significantly associated with any measure of discrimination, homelessness severity, or personal characteristics. We also found no indication that the associations between perceived discrimination targeted at racial and homelessness statuses and mental health differed by sexual minority status. Our results suggest that depressive symptoms and suicidality are prevalent among Black homeless youth, and that depressive symptoms are particularly associated with racial discrimination and indicators of homelessness. The roles of discrimination and a lack of safe housing may be taken into account when designing programs and policies that address the mental health of Black adolescents and young adults experiencing homelessness. (c) 2016 APA, all rights reserved).

[Rational motivation of drug injection and prostitution].

PubMed

Beauchamp, Sylvie

2003-01-01

Homeless drug users and prostitutes constitute a population at risk for contracting and propagating AIDS. This study aims at understanding the paradox related to drug injection and prostitution among 21 homeless from Montreal. These behaviors are studied following the picoeconomic paradox of an apprehended desire. The results show that these homeless see drug injection as a self-reward motivated by imaginary emotional object, in spite of the known and dreaded consequences. Prostitution is described as a self-investment accessory to drug injection. This study concludes with reflections on AIDS prevention programs in relation with the needs of the homeless.

Military sexual trauma among homeless veterans.

PubMed

Pavao, Joanne; Turchik, Jessica A; Hyun, Jenny K; Karpenko, Julie; Saweikis, Meghan; McCutcheon, Susan; Kane, Vincent; Kimerling, Rachel

2013-07-01

Military sexual trauma (MST) is the Veteran Health Administration's (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans. To estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men. National, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010. All variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization. Of homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST. A substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless programs in providing mental health care to homeless Veterans.

Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams.

PubMed

Jones, Audrey L; Hausmann, Leslie R M; Kertesz, Stefan; Suo, Ying; Cashy, John P; Mor, Maria K; Schaefer, James H; Gundlapalli, Adi V; Gordon, Adam J

2018-05-12

Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.

Chronically homeless women report high rates of substance use problems equivalent to chronically homeless men.

PubMed

Edens, Ellen Lockard; Mares, Alvin S; Rosenheck, Robert A

2011-01-01

The U.S. federal government recently committed itself to ending chronic homelessness within 5 years. Women constitute one out of four chronically homeless adults and represent a particularly vulnerable group, but have been little studied. To identify potentially unique needs in this group, we report characteristics and 2-year outcomes in a large sample of male and female chronically homeless adults participating in a multisite, supportive housing program. Men and women participating in the outcome evaluation of the 11-site Collaborative Initiative on Chronic Homelessness (n = 714) supportive housing program and who received at least one follow-up assessment were compared on baseline characteristics and up to 2-year follow-up outcomes. Mixed model multivariate regression adjusted outcome findings for baseline group differences. Few significant baseline differences existed between males and females, with both sexes self-reporting very high rates of lifetime mental health (83% women, 74% men) and substance use (68% women, 73% men) problems. Throughout the 2-year follow-up, both men and women dramatically increased the number of days housed, showed minimal changes in substance use patterns, and had modest improvements in mental health outcomes, without significant differences between genders. Unlike other U.S. populations, chronically homeless adults do not demonstrate substantial gender differences on mental health or addiction problems. Policy and service delivery must address these remarkably high rates of substance use and mental illness. Published by Elsevier Inc.

Where There Is No Hope: A Teacher's Experience with Homelessness

ERIC Educational Resources Information Center

Nath, Veena; Hallett, Ronald E.

2015-01-01

Stereotypical notions of who experiences homelessness frame how educational institutions approach policy and program development. This life history of a teacher challenges assumptions by providing an in-depth look at a mother's struggle to find stability.

76 FR 33788 - Homeless Veterans' Reintegration Into Employment

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-09

... contract, such programs as the Secretary determines appropriate to provide job training, counseling, and placement services (including job readiness and literacy and skills training) to expedite the reintegration... DEPARTMENT OF LABOR Veterans' Employment and Training Service Homeless Veterans' Reintegration...

Causes of homelessness prevalence: Relationship between homelessness and disability.

PubMed

Nishio, Akihiro; Horita, Ryo; Sado, Tadahiro; Mizutani, Seiko; Watanabe, Takahiro; Uehara, Ryosuke; Yamamoto, Mayumi

2017-03-01

Many studies have reported that the prevalence of mental illness and cognitive disability is higher among homeless individuals compared to the general population, and the rates of mental illness among the homeless population have recently increased. This study: (i) compares causes of homelessness or barriers to escaping homelessness for people with/without mental illness/cognitive disability; (ii) reveals problems with the Japanese homeless policy; and (iii) proposes an effective and necessary support system. The participants were 114 homeless individuals. A psychiatric diagnostic interview and the Wechsler Adult Intelligence Scale, version III were used to measure participants' mental health and cognitive abilities. A questionnaire was administered comprising 17 items related to the causes of their homelessness and barriers to escaping from it. Participants were divided into four groups - with/without mental illness or cognitive disability - and Fisher's exact test was used to compare the questionnaire results. Individuals with cognitive disabilities considered bad relationships with their family members to be the cause of their homelessness. Conversely, normal individuals considered their homelessness to be the result of debt more so than did individuals with mental problems. Individuals with mental illness had more difficulties escaping homelessness than did either normal individuals or individuals with cognitive disability. This tendency was observed most strongly among individuals with both mental illness and cognitive disability. Most homeless individuals considered economic problems to be the cause of their homelessness; however, difficulties with human relationships were also important factors and were more difficult for participants to acknowledge. Furthermore, these difficulties were exacerbated among those individuals with mental problems. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

The Most Frequently Asked Questions on the Education Rights of Children and Youth in Homeless Situations. Updated September 2016

ERIC Educational Resources Information Center

Duffield, Barbara; Julianelle, Patricia; Santos, Michael

2016-01-01

This document provides answers to frequently asked questions on the McKinney-Vento Homeless Assistance Act and the education rights of children and youth in homeless situations, based on the amendments made by the Every Student Succeeds Act of 2015, which took effect on October 1, 2016. The answers are general responses based on federal statutes,…

Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review.

PubMed

Fitzpatrick-Lewis, Donna; Ganann, Rebecca; Krishnaratne, Shari; Ciliska, Donna; Kouyoumdjian, Fiona; Hwang, Stephen W

2011-08-10

Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations. These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless populations with HIV.

Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review

PubMed Central

2011-01-01

Background Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. Methods A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. Results Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations. Conclusions These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless populations with HIV. PMID:21831318

Exploring Protective factors among homeless youth: the role of natural mentors.

PubMed

Dang, Michelle T; Conger, Katherine J; Breslau, Joshua; Miller, Elizabeth

2014-08-01

This study explored the presence and characteristics of natural mentors among 197 homeless youth and the association between natural mentoring relationships and youth functioning. Few studies have explored protective factors in the lives of homeless youth and how these may buffer against poor health outcomes. Relationships with natural mentors have been shown to have protective effects on adolescent functioning among the general adolescent population, and, thus, warrant further investigation with homeless youth. Results from this study revealed that 73.6% of homeless youth have natural mentoring relationships, split between kin and non-kin relationships. Having a natural mentor was associated with higher satisfaction with social support and fewer risky sexual behaviors. Findings suggest that natural mentors may play a protective role in the lives of homeless youth and should be considered an important source of social support that may enhance youth resilience.

Perceptions of masculinity and fatherhood among men experiencing homelessness.

PubMed

Rice, Alexander; Kim, Ji Youn Cindy; Nguyen, Christopher; Liu, William Ming; Fall, Kevin; Galligan, Patrick

2017-05-01

This study explored the perceptions of fatherhood held by 11 men living in a homeless shelter. Using consensual qualitative research methodology (CQR; Hill, 2012), we investigated perceptions of masculinity and fatherhood among fathers experiencing homelessness. Participants described (a) their perceptions of masculinity and fatherhood and changes resulting from homelessness, (b) physical and psychological challenges of being a father experiencing homelessness, and (c) expectations of homeless fathers. The fathers generally expressed feelings of low self-esteem related to their perceived difficulty fulfilling the role of providers for their family; however, they also adapted their view of fatherhood to include roles suited to their situation, such as that of guide, teacher, and role model. Suggestions are made for clinicians in helping fathers navigate and develop these roles, and limitations and directions for future research are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Homeless youth: Barriers and facilitators for service referrals.

PubMed

Black, Emma B; Fedyszyn, Izabela E; Mildred, Helen; Perkin, Rhianna; Lough, Richard; Brann, Peter; Ritter, Cheryl

2018-06-01

Young people who are homeless and experiencing mental health issues are reluctant to use relevant services for numerous reasons. Youth are also at risk of disengaging from services at times of referral to additional or alternative services. This study aimed to identify barriers and facilitators for inter-service referrals for homeless youth with mental health issues who have already engaged with a service. Qualitative, semi-structured interviews were conducted with homeless youth (n = 10), homelessness support workers (n = 10), and mental health clinicians (n = 10). Barriers included: resource shortages; programs or services having inflexible entry criteria; complexity of service systems; homeless youth feeling devalued; and a lack of communication between services, for example, abrupt referrals with no follow up. Referral facilitators included: services providers offering friendly and client-centred support; supported referrals; awareness of other services; and collaboration between services. Relationships with service providers and inter-service collaboration appeared essential for successful referrals for homeless youth. These facilitating factors may be undermined by sector separation and siloing, as well as resource shortages in both the homelessness and mental health sectors. Service transitions may be conceptualised as a genuine service outcome for homeless youth, and as a basis for successful future service provision. Copyright © 2018 Elsevier Ltd. All rights reserved.

Predictors of Frequent Emergency Room Visits among a Homeless Population

PubMed Central

Thakarar, Kinna; Morgan, Jake R.; Gaeta, Jessie M.; Hohl, Carole; Drainoni, Mari-Lynn

2015-01-01

Background Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER) visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use. Methods A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH). This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits. Results In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, p<0.01). HIV seropositivity was not predictive of frequent ER visits. In patients with history of illicit drug use, mental health (OR 2.53, 95% CI 1.07–5.95) and hepatitis C (OR 2.85, 95% CI 1.37–5.93) were predictors of frequent ER use. HIV seropositivity did not predict ER use (OR 0.45, 95% CI 0.21 – 0.97). Conclusions In a HCH population, hepatitis C predicted frequent ER visits in homeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population. PMID:25906394

Using cost and health impacts to prioritize the targeted testing of tuberculosis in the United States.

PubMed

Miller, Thaddeus L; Hilsenrath, Peter; Lykens, Kristine; McNabb, Scott J N; Moonan, Patrick K; Weis, Stephen E

2006-04-01

Evaluation improves efficiency and effectiveness. Current U.S. tuberculosis (TB) control policies emphasize the treatment of latent TB infection (LTBI). However, this policy, if not targeted, may be inefficient. We determined the efficiency of a state-law mandated TB screening program and a non state-law mandated one in terms of cost, morbidity, treatment, and disease averted. We evaluated two publicly funded metropolitan TB prevention and control programs through retrospective analyses and modeling. Main outcomes measured were TB incidence and prevalence, TB cases averted, and cost. A non state-law mandated TB program for homeless persons in Tarrant County screened 4.5 persons to identify one with LTBI and 82 persons to identify one with TB. A state-law mandated TB program for jail inmates screened 109 persons to identify one with LTBI and 3274 persons to identify one with TB. The number of patients with LTBI treated to prevent one TB case was 12.1 and 15.3 for the homeless and jail inmate TB programs, respectively. Treatment of LTBI by the homeless and jail inmate TB screening programs will avert 11.9 and 7.9 TB cases at a cost of 14,350 US dollars and 34,761 US dollars per TB case, respectively. Mandated TB screening programs should be risk-based, not population-based. Non mandated targeted testing for TB in congregate settings for the homeless was more efficient than state-law mandated targeted testing for TB among jailed inmates.

Feasibility of shelter-based mental health screening for homeless children.

PubMed

Lynch, Sean; Wood, Julia; Livingood, William; Smotherman, Carmen; Goldhagen, Jeffrey; Wood, David

2015-01-01

Homeless children are known to be at risk for mental health and behavioral disorders due to housing instability and family and environmental risk factors, such as domestic violence. However, homeless children seldom receive screening for mental health and behavioral disorders with validated instruments. Moreover, few examples exist of programs that integrate outreach, screening, referral to appropriate diagnostic and therapeutic services, and care coordination. We describe early results of the Medical Home for Homeless Children Project, whose nurse care coordinators work with homeless families to conduct standardized nursing assessments that include evidence-based screening for child mental health and behavioral disorders with referral and case management for mental and behavioral health services. Screening identified a group of children with mental health issues that warranted referral, and many of those referrals were successfully completed.

Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study.

PubMed

Janssens, Jean-Paul; Wuillemin, Timothee; Adler, Dan; Jackson, Yves

2017-05-16

Whereas high risk groups such as asylum seekers are systematically screened for active tuberculosis (TB) upon entry in Switzerland, this strategy does not apply to homeless persons despite a reported high risk. Geneva health and social authorities implemented an intersectoral project to screen for active TB in homeless persons. We aimed to assess acceptability of this program and prevalence of active TB in this group. This prospective study targeted all homeless adults registering for shelter accommodation in Geneva during winter 2015. Applicants were proposed a questionnaire-based screening ( www.tb-screen.ch ) exploring epidemiological and clinical risk factors for active TB. Participants with a positive score underwent diagnostic procedures at Geneva University Hospital. Enhanced TB surveillance targeting homeless persons in the community was continued 3 months after the study termination. Overall, 726/832 (87.3%) homeless persons accepted the screening procedure. Most were young male migrants without access to care in Switzerland. Male gender (adjusted OR: 2.14; 95% confidence interval: 1.27-3.62), age below 25 years (aOR: 4.16; 95% CI: 1.27-13.64) and short duration of homelessness (aOR: 1.75; 95% CI: 1.06-2.87) were predictors of acceptance. Thirty (4.1%) had positive screening scores but none of the 24 who underwent further testing had active TB. Post-study surveillance did not identify any incident case in Geneva. Active TB screening targeting highly mobile homeless persons in shelters was well accepted and feasible. The participants' sociodemographic profile highlighted the heterogeneity of homeless groups in Europe and the null TB prevalence the variability of their active TB risks. These findings underline the feasibility of health programs targeting this hard to reach group and the need for close monitoring of this social group considering the rapid changes in international mobility patterns to tailor preventive and screening strategies to the local context.

Health Care for the Homeless: What We Have Learned in the Past 30 Years and What’s Next

PubMed Central

Zerger, Suzanne; Wolfe, Phyllis B.

2013-01-01

In the 1980s, the combined effects of deinstitutionalization from state mental hospitals and the economic recession increased the number and transformed the demographic profile of people experiencing homelessness in the United States. Specialized health care for the homeless (HCH) services were developed when it became clear that the mainstream health care system could not sufficiently address their health needs. The HCH program has grown consistently during that period; currently, 208 HCH sites are operating, and the program has become embedded in the federal health care system. We reflect on lessons learned from the HCH model and its applicability to the changing landscape of US health care. PMID:24148056

Posttraumatic Stress Symptoms and Their Association With Smoking Outcome Expectancies Among Homeless Smokers in Boston

PubMed Central

Campbell, Eric G.; Chang, Yuchiao; Magid, Leah M.; Rigotti, Nancy A.

2016-01-01

Introduction: Cigarette smoking and traumatic life experiences are each common among homeless adults, but the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms among homeless smokers are not known. We assessed symptoms of PTSD and their association with smoking outcome expectancies in a sample of homeless smokers in Boston. Methods: We used time-location sampling to conduct an in-person survey of homeless adult smokers using Boston Health Care for the Homeless Program clinical services. We assessed symptoms of PTSD with the PTSD Checklist—Civilian version and considered scores at least 14 as positive. We used the Smoking Effects Questionnaire to assess positive and negative smoking outcome expectancies. We modeled the associations between PTSD screening status and smoking expectancies using design-adjusted linear regression. Results: Eighty-six percent of eligible individuals participated (N = 306). Sixty-eight percent of participants screened positive for PTSD. Screen-positive respondents were younger (P = .001), more likely to report fair/poor health (P = .01), chronic obstructive pulmonary disease (P = .02), and past-month hallucinations (P = .004), and had greater drug (P < .001) and alcohol (P < .001) use severity and cigarette dependence (P = .002). In analyses controlling for these confounders, PTSD screen-positive participants more strongly endorsed smoking to reduce negative affect (P = .01), smoking for social benefits (P = .002), and smoking for weight control (P = .03). Exploratory analyses suggested that these associations were driven by avoidance/numbing and re-experiencing symptoms. Conclusions: Symptoms of posttraumatic stress are common among homeless smokers and strongly associated with positive smoking outcome expectancies. Tobacco cessation programs for this population should consider screening for PTSD and fostering a trauma-sensitive treatment environment. Implications: In this study of homeless cigarette smokers in Boston, over two-thirds of participants screened positive for PTSD. PTSD screen-positive respondents more strongly endorsed multiple positive smoking outcome expectancies than screen-negative individuals. These findings suggest that the psychological sequelae of trauma may be a pervasive but under-recognized factor impacting the persistence of smoking among homeless people. Tobacco cessation programs for this population should consider screening for PTSD, fostering a trauma-sensitive treatment environment, and incorporating strategies that have shown promise in smokers with PTSD. PMID:26508393

Posttraumatic Stress Symptoms and Their Association With Smoking Outcome Expectancies Among Homeless Smokers in Boston.

PubMed

Baggett, Travis P; Campbell, Eric G; Chang, Yuchiao; Magid, Leah M; Rigotti, Nancy A

2016-06-01

Cigarette smoking and traumatic life experiences are each common among homeless adults, but the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms among homeless smokers are not known. We assessed symptoms of PTSD and their association with smoking outcome expectancies in a sample of homeless smokers in Boston. We used time-location sampling to conduct an in-person survey of homeless adult smokers using Boston Health Care for the Homeless Program clinical services. We assessed symptoms of PTSD with the PTSD Checklist-Civilian version and considered scores at least 14 as positive. We used the Smoking Effects Questionnaire to assess positive and negative smoking outcome expectancies. We modeled the associations between PTSD screening status and smoking expectancies using design-adjusted linear regression. Eighty-six percent of eligible individuals participated (N = 306). Sixty-eight percent of participants screened positive for PTSD. Screen-positive respondents were younger (P = .001), more likely to report fair/poor health (P = .01), chronic obstructive pulmonary disease (P = .02), and past-month hallucinations (P = .004), and had greater drug (P < .001) and alcohol (P < .001) use severity and cigarette dependence (P = .002). In analyses controlling for these confounders, PTSD screen-positive participants more strongly endorsed smoking to reduce negative affect (P = .01), smoking for social benefits (P = .002), and smoking for weight control (P = .03). Exploratory analyses suggested that these associations were driven by avoidance/numbing and re-experiencing symptoms. Symptoms of posttraumatic stress are common among homeless smokers and strongly associated with positive smoking outcome expectancies. Tobacco cessation programs for this population should consider screening for PTSD and fostering a trauma-sensitive treatment environment. In this study of homeless cigarette smokers in Boston, over two-thirds of participants screened positive for PTSD. PTSD screen-positive respondents more strongly endorsed multiple positive smoking outcome expectancies than screen-negative individuals. These findings suggest that the psychological sequelae of trauma may be a pervasive but under-recognized factor impacting the persistence of smoking among homeless people. Tobacco cessation programs for this population should consider screening for PTSD, fostering a trauma-sensitive treatment environment, and incorporating strategies that have shown promise in smokers with PTSD. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Mobile Phone and Social Media Use of Homeless Youth in Denver, Colorado.

PubMed

Harpin, Scott; Davis, Jillian; Low, Hana; Gilroy, Christine

2016-01-01

The purpose of this study was to investigate homeless youth mobile phone and social media use, to plan health promotion efforts. Nearly half (46.7%) of runaway/homeless youth in this sample (n = 181) owned a mobile phone and a majority of those devices were smart phones. Ownership did not vary significantly by shelter location, though regular use of Facebook was more prevalent among those in housing programs or camping, than those living on the streets. Over 90% of youth in the sample reported using Facebook. Such media use might facilitate parent, family, and health provider communications with homeless youth.

Childhood risk factors for criminal justice involvement in a sample of homeless people with serious mental illness.

PubMed

Desai, R A; Lam, J; Rosenheck, R A

2000-06-01

It has been suggested that criminal justice involvement among the homeless, particularly those with mental illness, is largely situational. The objective of this study was to assess, in a sample of homeless seriously mentally ill people, the prevalence of childhood conduct disorder behaviors as a risk factor for adult criminal activity as well as the extent and types of adult criminal justice contact. Data were taken from the national ACCESS program, which conducted extensive baseline interviews with 7,222 homeless seriously mentally ill adults. The interview assessed demographics, childhood risk factors for criminal activity such as conduct disorder behaviors, foster care, and parental abuse, as well as current illness severity and recent criminal justice contact. The 2-month arrest rate in this sample was much higher than national rates (11% compared with 1% annually in the general population). Although most arrests were for minor crimes (10.8%), there were also substantial rates of arrest for major (2.7%) and substance-related charges (2.0%). The prevalence of a history of conduct disorder behavior was also substantial (55% in male subjects, 40% in female subjects), and conduct disorder was a strong predictor of recent criminal justice involvement, even after controlling for other predictors of arrest (odds ratio = 1.76 for major crimes, 1.49 for minor crimes, and 1.98 for substance-related crimes). Recent literature has criticized a trend to criminalize homeless mentally ill persons for attempting to get needed food, shelter, or medical attention. However, these data indicate that at least some proportion of arrests in this population are of people who have been exhibiting antisocial behavior since early adolescence, and that early antisocial behavior is a strong predictor of all types of recent arrests in this population.

Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study.

PubMed

Hurstak, Emily; Johnson, Julene K; Tieu, Lina; Guzman, David; Ponath, Claudia; Lee, Christopher T; Jamora, Christina Weyer; Kushel, Margot

2017-09-01

We evaluated cognitive function and factors associated with cognitive impairment in a cohort of older homeless adults. We hypothesized that substance use and a history of traumatic brain injury would be associated with cognitive impairment. We recruited 350 homeless individuals aged ≥50 years using population-based sampling and conducted structured interviews and neuropsychological testing. We evaluated alcohol use with the Alcohol Use Disorder Identification Test, defining high-severity alcohol use as a total score ≥16 or ≥4 on the alcohol dependency sub-scale. We assessed global cognition with the Modified Mini-Mental State Test (3MS) and processing speed and executive function with the Trail Making Test (TMTB), defining impairment as performing 1.5 standard deviations below the standardized mean. We used multivariable logistic regression to examine the association between alcohol use and cognition. Participants had a median age of 58 years [IQR 54-61], 76.7% were men, and 79.9% were African American. A quarter (25.1%) of participants met criteria for impairment on the 3MS; 32.9% met criteria for impairment on TMTB. In models adjusted for sociodemographic variables and health conditions, high-severity alcohol use was associated with global cognitive impairment (AOR 2.39, CI 1.19-4.79) and executive dysfunction (AOR 3.09, CI 1.61-5.92). Older homeless adults displayed a prevalence of cognitive impairment 3-4 times higher than has been observed in general population adults aged 70 and older. Impaired cognition in older homeless adults could impact access to housing programs and the treatment of health conditions, including the treatment of alcohol use disorders. Copyright © 2017 Elsevier B.V. All rights reserved.

The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care.

PubMed

Rae, Bernadette Emma; Rees, Sharon

2015-09-01

To understand the perspective of the homeless about their healthcare encounters and how their experiences of receiving healthcare influence their health-seeking behaviour. A phenomenological study was undertaken because of the increasing levels of homelessness in the United Kingdom. Most of the current literature is American or Canadian. An interpretive phenomenological inquiry. An opportunistic sample of fourteen single homeless adults was recruited from one male hostel and one non-residential day centre. Data collection was done in 2013. Semi-structured audio-recorded interviews were conducted one-to-one. Colaizzi's method for data analysis was used. Three major themes were identified. Expressed Health Need, Healthcare Experiences and Attitudes to health care. Health problems are recognized by the homeless but the need for intervention is not always prioritised. Obstacles in access to health care in the UK are both perceived (attitudes towards the homeless; previous bad experience) and actual (difficulty in registering with a general practitioner, difficulty travelling to services, being forced to move to new area). Some homeless people feel that they are treated with prejudice and receive substandard care. Positive healthcare experiences were also reported. Positive and negative healthcare encounters can profoundly affect the homeless. Address apparent inconsistency of care; promote greater interdisciplinary communication and referrals to homeless services from prisons and hospitals; increase the availability of intermediate services; reduce obligation of homeless to move area; research experiences of homeless families. © 2015 John Wiley & Sons Ltd.

Mobilizing Homeless Youth for HIV Prevention: A Social Network Analysis of the Acceptability of a Face-to-Face and Online Social Networking Intervention

ERIC Educational Resources Information Center

Rice, Eric; Tulbert, Eve; Cederbaum, Julie; Adhikari, Anamika Barman; Milburn, Norweeta G.

2012-01-01

The objective of the study is to use social network analysis to examine the acceptability of a youth-led, hybrid face-to-face and online social networking HIV prevention program for homeless youth. Seven peer leaders (PLs) engaged face-to-face homeless youth (F2F) in the creation of digital media projects (e.g. You Tube videos). PL and F2F…

Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: a systematic literature review.

PubMed

Heerde, Jessica A; Scholes-Balog, Kirsty E; Hemphill, Sheryl A

2015-01-01

Homeless youth commonly report engaging in sexual risk behaviors. These vulnerable young people also frequently report being sexually victimized. This systematic review collates, summarizes, and appraises published studies of youth investigating relationships between homelessness, perpetration of sexual offenses, experience of sexual victimization, and engagement in sexual risk behavior. A systematic search of seventeen psychology, health, and social science electronic databases was conducted. Search terms included "homeless*," "youth," "offend*," "victimization," "crime," "rape," "victim*," and "sex crimes." Thirty-eight studies were identified that met the inclusion criteria. Findings showed homeless youth commonly report being raped and sexually assaulted, fear being sexually victimized, and engage in street prostitution and survival sex. Rates of victimization and sexual risk behavior were generally higher for females. Given the paucity of longitudinal studies and limitations of current studies, it is unclear whether homelessness is prospectively associated with sexual victimization or engagement in sexual risk behavior, and whether such associations vary cross nationally and as a function of time and place. Future prospective research examining the influence of the situational context of homelessness is necessary to develop a better understanding of how homelessness influences the perpetration of sexual offenses, experience of sexual victimization, and engagement in sexual risk behavior among homeless youth.

Education in a homeless shelter to improve the nutrition of young children.

PubMed

Yousey, Yvonne; Leake, Jacquelyn; Wdowik, Melissa; Janken, Janice K

2007-01-01

To improve the nutritional status of homeless children by implementing an educational program for their mothers and the cafeteria staff at a homeless shelter. Program evaluation including before and after measures of mothers' nutritional knowledge and nutritional quality of foods served in the cafeteria. Fifty-six mothers with children aged 18 months to 6 years and 3 cafeteria staff. Four nutrition classes developed by a registered nutritionist were taught to mothers by clinic nurses; 3 nutrition classes were taught to the cafeteria staff by the nutritionist. Mothers scored higher on posttests than on pretests, indicating improved nutritional knowledge. Minimal differences in the nutritional quality of foods served to residents were observed after staff education. This project demonstrates the challenges of altering the nutritional status of children in a homeless shelter. Despite mothers showing better knowledge of nutritional requirements for children, the types of food served in the cafeteria were an obstacle to them in practicing what they had learned. The cafeteria staff's ability to demonstrate their learning was impeded by the constraints of food donations. Educational strategies may need to be augmented by policies to improve the nutritional status of children in homeless shelters.

The Social Networks of Homeless Youth Experiencing Intimate Partner Violence

PubMed Central

Petering, Robin; Rice, Eric; Rhoades, Harmony; Winetrobe, Hailey

2015-01-01

While there is a growing body of research on intimate partner violence (IPV) experienced by the housed youth population, a limited amount is known about IPV experienced by homeless youth. To our knowledge, no previous studies have examined how homeless youths’ experience of IPV is related to their social network, even though the social networks of homeless youth have been shown to be significant indicators of health and mental health. The purpose of this study is to understand the relationship between IPV, gender, and social networks among a sample of 386 homeless youth in Los Angeles, California. Results revealed that one fifth of the sample experienced IPV in the past year. Stratified regression models revealed that IPV was not significantly related to any measure of male social networks; however, females who experienced IPV had more male friends (β = 2.03, SE = 0.89, p < .05) than females who did not experience IPV. Female homeless youth who witnessed family violence during childhood had more male friends (β = 2.75, SE = 1.08, p < .05), but those who experienced sexual abuse during childhood had fewer male friends (β = −2.04, SE = 0.93, p < .05). Although there was no significant difference in the rate of IPV victimization across genders, the context of this abuse appears to be drastically different. The results suggest that females with more male friendships are at greater risk for exposure to IPV. To date, there are few effective youth-targeted IPV prevention programs and none have been shown to be effective with homeless youth. These results provide insight into future program development. PMID:24421071

The Social Networks of Homeless Youth Experiencing Intimate Partner Violence.

PubMed

Petering, Robin; Rice, Eric; Rhoades, Harmony; Winetrobe, Hailey

2014-08-01

While there is a growing body of research on intimate partner violence (IPV) experienced by the housed youth population, a limited amount is known about IPV experienced by homeless youth. To our knowledge, no previous studies have examined how homeless youths' experience of IPV is related to their social network, even though the social networks of homeless youth have been shown to be significant indicators of health and mental health. The purpose of this study is to understand the relationship between IPV, gender, and social networks among a sample of 386 homeless youth in Los Angeles, California. Results revealed that one fifth of the sample experienced IPV in the past year. Stratified regression models revealed that IPV was not significantly related to any measure of male social networks; however, females who experienced IPV had more male friends (β = 2.03, SE = 0.89, p < .05) than females who did not experience IPV. Female homeless youth who witnessed family violence during childhood had more male friends (β = 2.75, SE = 1.08, p < .05), but those who experienced sexual abuse during childhood had fewer male friends (β = -2.04, SE = 0.93, p < .05). Although there was no significant difference in the rate of IPV victimization across genders, the context of this abuse appears to be drastically different. The results suggest that females with more male friendships are at greater risk for exposure to IPV. To date, there are few effective youth-targeted IPV prevention programs and none have been shown to be effective with homeless youth. These results provide insight into future program development. © The Author(s) 2014.

The Yellow School Bus Project: Helping Homeless Students Get Ready for School.

ERIC Educational Resources Information Center

Vissing, Yvonne

2003-01-01

Describes the Yellow School Bus Project, a community program jointly sponsored by religious, civic, fraternal, business, and nonprofit organizations in Durham, New Hampshire, to provide homeless children with supplies and clothes to help them succeed in school. (PKP)

77 FR 20849 - Homeless Veterans' Reintegration Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-06

... determines appropriate to provide job training, counseling, and placement services (including job readiness and literacy and skills training) to expedite the reintegration of homeless veterans into the labor... Training Service (VETS), Department of Labor. Announcement Type: New Notice of Availability of Funds and...

Association of housing first implementation and key outcomes among homeless persons with problematic substance use.

PubMed

Davidson, Clare; Neighbors, Charles; Hall, Gerod; Hogue, Aaron; Cho, Richard; Kutner, Bryan; Morgenstern, Jon

2014-11-01

Housing First is a supportive housing model for persons with histories of chronic homelessness that emphasizes client-centered services, provides immediate housing, and does not require treatment for mental illness or substance abuse as a condition of participation. Previous studies of Housing First have found reduced governmental costs and improved personal well-being among participants. However, variations in real-world program implementation require better understanding of the relationship between implementation and outcomes. This study investigated the effects of Housing First implementation on housing and substance use outcomes. Study participants were 358 individuals with histories of chronic homelessness and problematic substance use. Clients were housed in nine scatter-site Housing First programs in New York City. Program fidelity was judged across a set of core Housing First components. Client interviews at baseline and 12 months were used to assess substance use. Clients in programs with greater fidelity to consumer participation components of Housing First were more likely to be retained in housing and were less likely to report using stimulants or opiates at follow-up. Consistently implemented Housing First principles related to consumer participation were associated with superior housing and substance use outcomes among chronically homeless individuals with a history of substance use problems. The study findings suggest that program implementation is central to understanding the potential of Housing First to help clients achieve positive housing and substance use outcomes.

Justice involvement among homeless individuals with mental illnesses: Are self-report and administrative measures comparable?

PubMed

Lemieux, Ashley J; Roy, Laurence; Martin, Michael S; Latimer, Eric A; Crocker, Anne G

2017-04-01

Individuals with mental illnesses who experience homelessness have frequent interactions with the criminal justice system. Correctly measuring this involvement is essential to develop and evaluate the efficacy of intervention programs. Criminal justice involvement is typically assessed through administrative records or self-reported accounts. The aims of this study are to: 1) assess agreement between self-report and administrative data related to court appearances, and 2) identify individual characteristics that affect discrepancies between sources. Participants were 468 homeless persons with mental illness from the Montreal site of the At Home/Chez Soi randomized controlled trial, in Canada. Self-reported data was collected through an interviewer-administered questionnaire. Administrative data was collected through provincial and municipal court databases. Overall, agreement was good. Discrepancies were more common among those with a diagnosis of mood disorder with psychotic features, and those with a criminal history. Increased age and interviewer's perception of sincerity and interest increased likelihood of concordance. Generally, high agreement between self-report and administrative data suggests that either source can provide reliable information. Further work to understand predictors of discrepancies could further enhance the quality of data collected through these different sources. Copyright © 2016 Elsevier Ltd. All rights reserved.

Six-year mortality in a street-recruited cohort of homeless youth in San Francisco, California.

PubMed

Auerswald, Colette L; Lin, Jessica S; Parriott, Andrea

2016-01-01

Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004. Methods. Using data collected from a longitudinal, venue-based sample of street youth 15-24 years of age, we calculated age, race, and gender-adjusted mortality rates. Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3-18.9]). Gender specific SMRs were 16.1 (95% CI [3.3-47.1]) for females and 9.4 (95% CI [4.0-18.4]) for males. Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the state's general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population.

The diversity of case management needs for the care of homeless persons.

PubMed Central

Stephens, D; Dennis, E; Toomer, M; Holloway, J

1991-01-01

Health care providers have been attempting to meet the special needs of homeless people on a national level since 1984. The need to implement strategies specific to serving the diversity of services required by homeless people has been apparent. To devise appropriate strategies, clinical information was drawn from the Health Resources and Services Administration-Health Care for the Homeless (HRSA-HCH) projects, which were created in 1987 primarily to fill such a need. In addition, data gathered by the HCH projects (1984-87) funded by the Robert Wood Johnson and Pew Memorial Trust were used. It is suggested that the past mode of providing health care for the homeless has been found to be inadequate when confronting the complex problems of the homeless person of today. In general, health care providers need to focus more on case management activities, which may include activities not necessarily associated with the provision of health care services (for example, finding and providing food, clothing, shelter, and assessing entitlement eligibility) to achieve the ultimate goal--stabilization--and when possible, reintegration of the homeless person back into society. PMID:1899934

Clinical and cognitive correlates of unsheltered status in homeless persons with psychotic disorders.

PubMed

Llerena, Katiah; Gabrielian, Sonya; Green, Michael F

2018-02-24

Homeless persons with psychosis are particularly susceptible to unsheltered homelessness, which includes living on the streets, in cars, and other places not meant for human habitation. Homeless persons with psychosis have distinct barriers to accessing care and comprise a high-need and hard-to-serve homeless subpopulation. Therefore, this study sought to understand unsheltered homelessness in persons with psychosis and its relationship to cognitive impairment, clinical symptoms, and community functioning, examined both categorically and dimensionally. This study included 76 homeless participants with a history of a psychotic diagnosis who were enrolled in a supported housing program but had not yet received housing. This study used two different housing stability thresholds (literally homeless at any point vs. literally homeless >20% of days) for comparing homeless Veterans with psychosis living in sheltered versus unsheltered situations on cognition, clinical symptoms, and community integration. Dimensional analyses also examined the relationship between percentage of days spent in unsheltered locations and cognition, clinical symptoms, and community integration. Sheltered and unsheltered Veterans with psychosis did not differ on clinical symptoms or community integration, but there was an inconsistent group difference on cognition depending on the threshold used for determining housing stability. In the unsheltered group, cognitive deficits in overall cognition, visual learning, and social cognition were related to more days spent in unsheltered locations. Rehabilitation efforts targeting specific cognitive deficits may be useful to facilitate greater access to care and successful interventions in this population. Copyright © 2018 Elsevier B.V. All rights reserved.

Opportunities for engaging low-income, vulnerable populations in health care: a systematic review of homeless persons' access to and use of information technologies.

PubMed

McInnes, D Keith; Li, Alice E; Hogan, Timothy P

2013-12-01

We systematically reviewed the health and social science literature on access to and use of information technologies by homeless persons by searching 5 bibliographic databases. Articles were included if they were in English, represented original research, appeared in peer-reviewed publications, and addressed our research questions. Sixteen articles met our inclusion criteria. We found that mobile phone ownership ranged from 44% to 62%; computer ownership, from 24% to 40%; computer access and use, from 47% to 55%; and Internet use, from 19% to 84%. Homeless persons used technologies for a range of purposes, some of which were health related. Many homeless persons had access to information technologies, suggesting possible health benefits to developing programs that link homeless persons to health care through mobile phones and the Internet.

Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups

PubMed Central

2012-01-01

Background The literature on interventions addressing the intersection of homelessness, mental illness and race is scant. The At Home/Chez Soi research demonstration project is a pragmatic field trial investigating a Housing First intervention for homeless individuals with mental illness in five cities across Canada. A unique focus at the Toronto site has been the development and implementation of a Housing First Ethno-Racial Intensive Case Management (HF ER-ICM) arm of the trial serving 100 homeless individuals with mental illness from ethno-racial groups. The HF ER-ICM program combines the Housing First approach with an anti-racism/anti-oppression framework of practice. This paper presents the findings of an early implementation and fidelity evaluation of the HF ER-ICM program, supplemented by participant narrative interviews to inform our understanding of the HF ER-ICM program theory. Methods Descriptive statistics are used to describe HF ER-ICM participant characteristics. Focus group interviews, key informant interviews and fidelity assessments were conducted between November 2010 and January 2011, as part of the program implementation evaluation. In-depth qualitative interviews with HF ER-ICM participants and control group members were conducted between March 2010 and June 2011. All qualitative data were analysed using grounded theory methodology. Results The target population had complex health and social service needs. The HF ER-ICM program enjoyed a high degree of fidelity to principles of both anti-racism/anti-oppression practice and Housing First and comprehensively addressed the housing, health and sociocultural needs of participants. Program providers reported congruence of these philosophies of practice, and program participants valued the program and its components. Conclusions Adapting Housing First with anti-racism/anti-oppression principles offers a promising approach to serving the diverse needs of homeless people from ethno-racial groups and strengthening the service systems developed to support them. The use of fidelity and implementation evaluations can be helpful in supporting successful adaptations of programs and services. Trial registration Current Controlled Trials ISRCTN42520374 PMID:23031406

A systematic review of cognitive functioning among young people who have experienced homelessness, foster care, or poverty.

PubMed

Fry, Charlotte E; Langley, Kate; Shelton, Katherine H

2017-11-01

Young people who have experienced homelessness, foster care, or poverty are among the most disadvantaged in society. This review examines whether young people who have these experiences differ from their non-disadvantaged peers with respect to their cognitive skills and abilities, and whether cognitive profiles differ between these three groups. Three electronic databases were systematically searched for articles published between 1 January 1995 and 1 February 2015 on cognitive functioning among young people aged 15 to 24 years who have experienced homelessness, foster care, or poverty. Articles were screened using pre-determined inclusion criteria, then the data were extracted, and its quality assessed. A total of 31 studies were included. Compared to non-disadvantaged youth or published norms, cognitive performance was generally found to be impaired in young people who had experienced homelessness, foster care, or poverty. A common area of difficulty across all groups is working memory. General cognitive functioning, attention, and executive function deficits are shared by the homeless and poverty groups. Creativity emerges as a potential strength for homeless young people. The cognitive functioning of young people with experiences of impermanent housing and poverty has been relatively neglected and more research is needed to further establish cognitive profiles and replicate the findings reviewed here. As some aspects of cognitive functioning may show improvement with training, these could represent a target for intervention.

Position-Specific HIV Risk in a Large Network of Homeless Youths

PubMed Central

Barman-Adhikari, Anamika; Milburn, Norweeta G.; Monro, William

2012-01-01

Objectives. We examined interconnections among runaway and homeless youths (RHYs) and how aggregated network structure position was associated with HIV risk in this population. Methods. We collected individual and social network data from 136 RHYs. On the basis of these data, we generated a sociomatrix, accomplished network visualization with a “spring embedder,” and examined k-cores. We used multivariate logistic regression models to assess associations between peripheral and nonperipheral network position and recent unprotected sexual intercourse. Results. Small numbers of nominations at the individual level aggregated into a large social network with a visible core, periphery, and small clusters. Female youths were more likely to be in the core, as were youths who had been homeless for 2 years or more. Youths at the periphery were less likely to report unprotected intercourse and had been homeless for a shorter duration. Conclusions. HIV risk was a function of risk-taking youths' connections with one another and was associated with position in the overall network structure. Social network–based prevention programs, young women's housing and health programs, and housing-first programs for peripheral youths could be effective strategies for preventing HIV among this population. PMID:22095350

Families Experiencing Housing Instability: The Effects of Housing Programs on Family Routines and Rituals

PubMed Central

Mayberry, Lindsay S.; Shinn, Marybeth; Benton, Jessica Gibbons; Wise, Jasmine

2013-01-01

Maintenance of family processes can protect parents, children, and families from the detrimental effects of extreme stressors, such as homelessness. When families cannot maintain routines and rituals, the stressors of poverty and homelessness can be compounded for both caregivers and children. However, characteristics of living situations common among families experiencing homelessness present barriers to the maintenance of family routines and rituals. We analyzed 80 in-depth interviews with parents who were experiencing or had recently experienced an instance of homelessness. We compared their assessments of challenges to family schedules, routines, and rituals across various living situations, including shelter, transitional housing programs, doubled up (i.e. living temporarily with family/friend), and independent housing. Rules common across shelters and transitional housing programs impeded family processes, and parents felt surveilled and threatened with child protective service involvement in these settings. In doubled up living situations, parents reported adapting their routines to those of the household and having parenting interrupted by opinions of friends and family members. Families used several strategies to maintain family rituals and routines in these living situations and ensure consistency and stability for their children during an otherwise unstable time. PMID:24826832

Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention.

PubMed

Rice, Eric; Tulbert, Eve; Cederbaum, Julie; Barman Adhikari, Anamika; Milburn, Norweeta G

2012-04-01

The objective of the study is to use social network analysis to examine the acceptability of a youth-led, hybrid face-to-face and online social networking HIV prevention program for homeless youth.Seven peer leaders (PLs) engaged face-to-face homeless youth (F2F) in the creation of digital media projects (e.g. You Tube videos). PL and F2F recruited online youth (OY) to participate in MySpace and Facebook communities where digital media was disseminated and discussed. The resulting social networks were assessed with respect to size, growth, density, relative centrality of positions and homophily of ties. Seven PL, 53 F2F and 103 OY created two large networks. After the first 50 F2F youth participated, online networks entered a rapid growth phase. OY were among the most central youth in these networks. Younger aged persons and females were disproportionately connected to like youth. The program appears highly acceptable to homeless youth. Social network analysis revealed which PL were the most critical to the program and which types of participants (younger youth and females) may require additional outreach efforts in the future.

Families experiencing housing instability: the effects of housing programs on family routines and rituals.

PubMed

Mayberry, Lindsay Satterwhite; Shinn, Marybeth; Benton, Jessica Gibbons; Wise, Jasmine

2014-01-01

Maintenance of family processes can protect parents, children, and families from the detrimental effects of extreme stressors, such as homelessness. When families cannot maintain routines and rituals, the stressors of poverty and homelessness can be compounded for both caregivers and children. However, characteristics of living situations common among families experiencing homelessness present barriers to the maintenance of family routines and rituals. We analyzed 80 in-depth interviews with parents who were experiencing or had recently experienced an instance of homelessness. We compared their assessments of challenges to family schedules, routines, and rituals across various living situations, including shelter, transitional housing programs, doubled-up (i.e., living temporarily with family or friends), and independent housing. Rules common across shelters and transitional housing programs impeded family processes, and parents felt surveilled and threatened with child protective service involvement in these settings. In doubled-up living situations, parents reported adapting their routines to those of the household and having parenting interrupted by opinions of friends and family members. Families used several strategies to maintain family routines and rituals in these living situations and ensure consistency and stability for their children during an otherwise unstable time. (c) 2014 APA, all rights reserved.

Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention

PubMed Central

Rice, Eric; Tulbert, Eve; Cederbaum, Julie; Barman Adhikari, Anamika; Milburn, Norweeta G.

2012-01-01

The objective of the study is to use social network analysis to examine the acceptability of a youth-led, hybrid face-to-face and online social networking HIV prevention program for homeless youth.Seven peer leaders (PLs) engaged face-to-face homeless youth (F2F) in the creation of digital media projects (e.g. You Tube videos). PL and F2F recruited online youth (OY) to participate in MySpace and Facebook communities where digital media was disseminated and discussed. The resulting social networks were assessed with respect to size, growth, density, relative centrality of positions and homophily of ties. Seven PL, 53 F2F and 103 OY created two large networks. After the first 50 F2F youth participated, online networks entered a rapid growth phase. OY were among the most central youth in these networks. Younger aged persons and females were disproportionately connected to like youth. The program appears highly acceptable to homeless youth. Social network analysis revealed which PL were the most critical to the program and which types of participants (younger youth and females) may require additional outreach efforts in the future. PMID:22247453

Neurobehavioural and cognitive function is linked to childhood trauma in homeless adults.

PubMed

Pluck, Graham; Lee, Kwang-Hyuk; David, Rajan; Macleod, Diana C; Spence, Sean A; Parks, Randolph W

2011-03-01

To describe levels of traumatic childhood events in a sample of homeless individuals and to assess the contribution of traumatic events to neurobehavioural traits (measured with the Frontal Systems Behaviour Scale, FrSBe) and general cognitive function (IQ). A sample of 55 homeless adults was recruited from homeless services in the city of Sheffield, UK. All were interviewed to acquire substance misuse information, record experiences of childhood trauma, and assess cognitive and neurobehavioural traits. Experiences of abuse and neglect were assessed with the Childhood Trauma Questionnaire. Participants also completed the Wechsler Abbreviated Scale of Intelligence and the FrSBe, which was completed with respect to current behaviour and conduct prior to homelessness. Around three-quarters of the sample scored in the clinically significant range for current neurobehavioural impairment. They also reported high levels of impairment when rating retrospectively for the period before they were homeless. The mean group IQ was below average at 88. Abuse or neglect during their upbringing was reported by 89% of the sample. Emotional abuse, emotional neglect, and physical neglect were all positively correlated with total FrSBe scores. Sexual abuse, emotional neglect, and physical neglect were all negatively correlated with IQ. The associations between trauma and IQ and neurobehavioural traits appear generally unrelated to the presence of substance misuse in the sample. Our homeless sample displayed relatively low IQ with high levels of neurobehavioural impairment. Our evidence suggests that these neuropsychological factors may, in part, constitute a long-term consequence of childhood trauma. ©2010 The British Psychological Society.

Leadership Advocacy: Bringing Nursing to the Homeless and Underserved.

PubMed

Porter-OʼGrady, Tim

Nurses have historically played a key role in advocacy and service for all members of the community, including those who are traditionally underserved by other providers or the health system. Nurses from a local Atlanta community health system, both clinical and administrative, have continued this tradition by developing an advocacy and service program for the downtown homeless of Atlanta. From its beginnings as a highly informal volunteer program to its current structure as a strongly integrated community health center for the underserved and homeless of Atlanta, local nurses have demonstrated their strong value of service advocacy. Their leadership, insight, discipline, and strategic development have facilitated the growth of a focused, viable health service network for marginalized people of the city of Atlanta.

Exploring family environment characteristics and multiple abuse experiences among homeless youth.

PubMed

Ferguson, Kristin M

2009-11-01

This qualitative study used data from the Social Enterprise Intervention (SEI) pilot study, a comprehensive vocational training program with integrated clinical services for homeless youth. In-depth interviews were conducted with 28 homeless youth participating in the SEI study to explore their perceptions of family environment characteristics and abuse experiences. The constant comparative method was used to analyze transcripts from in-depth interviews with the youth participants. Emergent themes related to family characteristics include home instability, abandonment, and caregiver substance abuse. Abuse-related subthemes include intrafamilial abuse, caregiver abuse, rejection, and deprecation by caregivers. Grounded theory is used to interpret findings and develop working hypotheses to guide future studies of multitype maltreatment among homeless youth.

Childhood Risk Factors in Dually Diagnosed Homeless Adults.

ERIC Educational Resources Information Center

Blankertz, Laura E.; And Others

1993-01-01

Examined prevalence of five childhood risk factors (sexual abuse, physical abuse, parental mental illness, substance abuse, out-of-home placement) among dually diagnosed (mentally ill and substance abusing) homeless adults (n=156) in rehabilitation programs. Findings suggest that childhood risk factors, whether single or multiple, are very…

76 FR 58822 - Announcement of Funding Awards for Fiscal Year 2010 Transformation Initiative: Homeless Families...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-22

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5415-FA-23] Announcement of Funding Awards for Fiscal Year 2010 Transformation Initiative: Homeless Families Demonstration Small Grant Research Program AGENCY: Office of the Assistant Secretary for Policy Development, HUD. ACTION...

The Potential Explanatory Role of Perceived Stress in Associations Between Subjective Social Status and Health-Related Quality of Life Among Homeless Smokers.

PubMed

Garey, Lorra; Reitzel, Lorraine R; Kendzor, Darla E; Businelle, Michael S

2016-01-01

Homeless individuals smoke at high rates relative to the general population and are at heightened risk of tobacco-related illnesses and poor health-related quality of life (HRQoL). Homeless smokers also report low subjective social status (SSS) or perceived social standing relative to others. SSS may contribute to poor HRQoL, potentially through perceived stress. The current study examined the role of perceived stress in the association of SSS and HRQoL among 227 (70.9% male, Mage = 43.2) homeless smokers. Participants completed self-report measures of SSS, perceived stress, and HRQoL. Perceived stress partially explained the relation between SSS (United States and Community) and HRQoL in covariate-adjusted analyses. Results suggested that perceived stress is a pathway through which SSS contributes to HRQoL among homeless smokers. Findings broaden current understanding of the impact of social disadvantage and perceived stress on HRQoL among homeless smokers. © The Author(s) 2015.

Prevalence, Characteristics, and Associated Health and Health Care of Family Homelessness Among Fifth-Grade Students

PubMed Central

Elliott, Marc N.; Kanouse, David E.; Grunbaum, Jo Anne; Gilliland, M. Janice; Tortolero, Susan R.; Cuccaro, Paula; Schuster, Mark A.

2009-01-01

Objectives. We describe the lifetime prevalence and associated health-related concerns of family homelessness among fifth-grade students. Methods. We used a population-based, cross-sectional survey of 5147 fifth-grade students in 3 US cities to analyze parent-reported measures of family homelessness, child health status, health care access and use, and emotional, developmental, and behavioral health and child-reported measures of health-related quality of life and exposure to violence. Results. Seven percent of parents reported that they and their child had experienced homelessness (i.e., staying in shelters, cars, or on the street). Black children and children in the poorest families had the highest prevalence of homelessness (11%). In adjusted analyses, most general health measures were similar for children who had and had not been homeless. Children who had ever experienced homelessness were more likely to have an emotional, behavioral, or developmental problem (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.1, 2.6; P = .01), to have received mental health care (OR = 2.2; 95% CI = 1.6, 3.2; P < .001), and to have witnessed serious violence with a knife (OR = 1.6; 95% CI = 1.1, 2.3; P = .007) than were children who were never homeless. Conclusions. Family homelessness affects a substantial minority of fifth-grade children and may have an impact on their emotional, developmental, and behavioral health. PMID:19542035

VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles.

PubMed

Gabrielian, Sonya; Yuan, Anita H; Andersen, Ronald M; Rubenstein, Lisa V; Gelberg, Lillian

2014-05-01

The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program-the VA's Housing First effort-is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. We performed a secondary database analysis of Veterans (n=62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care.

Upstream Disaster Management to Support People Experiencing Homelessness.

PubMed

Sundareswaran, Madura; Ghazzawi, Andrea; O'Sullivan, Tracey L

2015-08-18

The unique context of day-to-day living for people who are chronically homeless or living with housing insecurity puts them at high risk during community disasters. The impacts of extreme events, such as flooding, storms, riots, and other sources of community disruption, underscore the importance of preparedness efforts and fostering community resilience. This study is part of larger initiative focused on enhancing resilience and preparedness among high risk populations. The purpose of this study was to explore critical issues and strategies to promote resilience and disaster preparedness among people who are homeless in Canada. A sample of interviews (n=21) from key informants across Canada was analyzed to explore existing programs and supports for homeless populations. The data was selected from a larger sample of (n=43) interviews focused on programs and supports for people who are at heightened risk for negative impacts during disasters. Qualitative content analysis was used to extract emergent themes and develop a model of multi-level collaboration to support disaster resilience among people who are homeless. The results indicate there is a need for more upstream continuity planning, collaboration and communication between the emergency management sector and community service organizations that support people who are homeless. Prioritization and investment in the social determinants of health and community supports is necessary to promote resilience among this high-risk population. The findings from this study highlight the importance of acknowledging community support organizations as assets in disaster preparedness. Day-to-day resilience is an ongoing theme for people who are chronically homeless or living with housing insecurity. Upstream investment to build adaptive capacity and collaborate with community organizations is an important strategy to enhance community resilience.

Diagnostic patterns in hospital use by an urban homeless population.

PubMed Central

Morris, W; Crystal, S

1989-01-01

Because patterns of disease and health care system usage by the homeless constitute a neglected area of research in the medical literature, we undertook a retrospective analysis of inpatient records on medically indigent adults, controlling for housing status, to add to the growing body of research in the area of homeless health care. Data on all 4,243 indigent patients admitted over 2 fiscal years (1985 and 1986) under the county medical services program of San Diego County, California, revealed 5.3% (226) to be homeless. The commonest major diagnostic category among the homeless discharges was "diseases and disorders of the skin, subcutaneous tissue, and breast," constituting 21.2% as compared with only 8.7% of the discharge diagnoses for housed indigent persons. Within this major diagnostic category, the predominant diagnosis-related group was cellulitis, accounting for 12.8% of diagnoses in the homeless and only 4.0% of discharge diagnoses in other medically indigent persons. A homeless housing status was also correlated with a higher percentage of discharges with the major diagnostic category of "substance use and substance-induced organic mental disorders" but was negatively correlated with that of "diseases and disorders of the circulatory system." PMID:2588589

Opportunities for Engaging Low-Income, Vulnerable Populations in Health Care: A Systematic Review of Homeless Persons’ Access to and Use of Information Technologies

PubMed Central

Li, Alice E.; Hogan, Timothy P.

2013-01-01

We systematically reviewed the health and social science literature on access to and use of information technologies by homeless persons by searching 5 bibliographic databases. Articles were included if they were in English, represented original research, appeared in peer-reviewed publications, and addressed our research questions. Sixteen articles met our inclusion criteria. We found that mobile phone ownership ranged from 44% to 62%; computer ownership, from 24% to 40%; computer access and use, from 47% to 55%; and Internet use, from 19% to 84%. Homeless persons used technologies for a range of purposes, some of which were health related. Many homeless persons had access to information technologies, suggesting possible health benefits to developing programs that link homeless persons to health care through mobile phones and the Internet. PMID:24148036

20 CFR 672.310 - What eligible activities may be funded under the YouthBuild program?

Code of Federal Regulations, 2012 CFR

2012-04-01

... shadowing; and (4) Job search assistance. (c) Other eligible activities include: (1) Supervision and... for homeless individuals and families or low-income families, or transitional housing for homeless individuals and families; (2) Supervision and training for participants in the rehabilitation or construction...

20 CFR 672.310 - What eligible activities may be funded under the YouthBuild program?

Code of Federal Regulations, 2014 CFR

2014-04-01

... shadowing; and (4) Job search assistance. (c) Other eligible activities include: (1) Supervision and... for homeless individuals and families or low-income families, or transitional housing for homeless individuals and families; (2) Supervision and training for participants in the rehabilitation or construction...

20 CFR 672.310 - What eligible activities may be funded under the YouthBuild program?

Code of Federal Regulations, 2013 CFR

2013-04-01

... shadowing; and (4) Job search assistance. (c) Other eligible activities include: (1) Supervision and... for homeless individuals and families or low-income families, or transitional housing for homeless individuals and families; (2) Supervision and training for participants in the rehabilitation or construction...

45 CFR 1351.1 - Significant terms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Definition of Terms § 1351.1 Significant terms. For the purposes of this part: (a) Aftercare services means the provision of services to runaway or otherwise... homeless. (b) Area means a specific neighborhood or section of the locality in which the runaway and...

The School as a Tool for Survival for Homeless Children.

ERIC Educational Resources Information Center

Lively, K. L.; Kleine, Paul F.

This study used an ecological perspective to examine the development and implementation of Hopeful Horizons, a program designed to serve the educational needs of homeless children in Morgan County, Oklahoma. Information was collected through journals, observations, key informant interviews, surveys of administrators and staff, and psychological…

38 CFR 61.33 - Payment of per diem.

Code of Federal Regulations, 2010 CFR

2010-07-01

... United States, from departments of State and local governments, from private entities or organizations...) VA HOMELESS PROVIDERS GRANT AND PER DIEM PROGRAM § 61.33 Payment of per diem. (a) A capital grant... non-grant recipient for those homeless veterans— (1) Who VA referred to the grant recipient or non...

Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review

PubMed Central

Dombrowski, Kirk; Sittner, Kelley; Crawford, Devan; Welch-Lazoritz, Melissa; Habecker, Patrick; Khan, Bilal

2016-01-01

During the United States economic recession of 2008–2011, the number of homeless and unstably housed people in the United States increased considerably. Homeless adult women and unaccompanied homeless youth make up the most marginal segments of this population. Because homeless individuals are a hard to reach population, research into these marginal groups has traditionally been a challenge for researchers interested in substance abuse and mental health. Network analysis techniques and research strategies offer means for dealing with traditional challenges such as missing sampling frames, variation in definitions of homelessness and study inclusion criteria, and enumeration/population estimation procedures. This review focuses on the need for, and recent steps toward, solutions to these problems that involve network science strategies for data collection and analysis. Research from a range of fields is reviewed and organized according to a new stress process framework aimed at understanding how homeless status interacts with issues related to substance abuse and mental health. Three types of network innovation are discussed: network scale-up methods, a network ecology approach to social resources, and the integration of network variables into the proposed stress process model of homeless substance abuse and mental health. By employing network methods and integrating these methods into existing models, research on homeless and unstably housed women and unaccompanied young people can address existing research challenges and promote more effective intervention and care programs. PMID:28042394

Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review.

PubMed

Dombrowski, Kirk; Sittner, Kelley; Crawford, Devan; Welch-Lazoritz, Melissa; Habecker, Patrick; Khan, Bilal

2016-09-01

During the United States economic recession of 2008-2011, the number of homeless and unstably housed people in the United States increased considerably. Homeless adult women and unaccompanied homeless youth make up the most marginal segments of this population. Because homeless individuals are a hard to reach population, research into these marginal groups has traditionally been a challenge for researchers interested in substance abuse and mental health. Network analysis techniques and research strategies offer means for dealing with traditional challenges such as missing sampling frames, variation in definitions of homelessness and study inclusion criteria, and enumeration/population estimation procedures. This review focuses on the need for, and recent steps toward, solutions to these problems that involve network science strategies for data collection and analysis. Research from a range of fields is reviewed and organized according to a new stress process framework aimed at understanding how homeless status interacts with issues related to substance abuse and mental health. Three types of network innovation are discussed: network scale-up methods, a network ecology approach to social resources, and the integration of network variables into the proposed stress process model of homeless substance abuse and mental health. By employing network methods and integrating these methods into existing models, research on homeless and unstably housed women and unaccompanied young people can address existing research challenges and promote more effective intervention and care programs.

Job Coaching and Success in Gaining and Sustaining Employment Among Homeless People

PubMed Central

Ford, Rebecca; Willmot, Anne; Hagan, Stephanie; Siegrist, Johannes

2014-01-01

Objective: People who are homeless experience many barriers that affect their ability to gain and sustain work. In this study, we investigate whether personal job coaching support contributes toward employment success. Methods: The short- and long-term employment outcomes of 2,480 clients participating in a labor market program were analyzed. Results: Clients being supported by a job coach have significantly higher chances of gaining employment than those not being supported. This holds particularly true for the youngest age-group. Furthermore, results also indicate that job coaching improves clients’ chances of successfully sustaining employment. Conclusions: Personal approaches and individual coaching seem to be promising strategies in social work practice and specifically in return to work programs for people who have experienced homelessness. PMID:27630516

Correlates of Serious Violent Crime for Recently Released Parolees With a History of Homelessness

PubMed Central

Nyamathi, Adeline; Marfisee, Mary; Khalilifard, Farinaz; Leake, Barbara; Marlow, Elizabeth; Zhang, Sheldon; Hall, Elizabeth; Farabee, David; Faucette, Mark

2013-01-01

This study used baseline data on recently-released homeless paroled men who are homeless (N = 157), residing in a residential drug treatment program, and enrolled in a longitudinal study to examine personal, developmental, and social correlates of parolees who are homeless and parolees who have committed serious violent offenses. Having experienced childhood sexual abuse, poor parental relationships, and early-onset incarceration (prior to 21 years of age) were important correlates of serious violent crimes. These findings highlight the need for interventions that address offenders’ prior adult and childhood victimization, and suggest that policies for reentering violent offenders should encompass an understanding of the broader family contexts in which these patterns of maltreatment often occur. PMID:23155727

Correlates of service utilization among homeless youth.

PubMed

Tyler, Kimberly A; Akinyemi, Sarah L; Kort-Butler, Lisa A

2012-07-01

Though few studies exist on service utilization among homeless youth in the U.S., services are important because without them, many of these young people may resort to delinquent strategies in order to meet their daily survival needs. The current study examines frequency and correlates of service utilization (i.e., shelters, food programs, street outreach, counseling, STI and HIV testing) among a sample of 249 homeless youth ages 14 to 21. Multivariate analysis revealed significant differences in service usage by sex, age, and sexual orientation. Experiencing family physical and/or sexual abuse, being kicked out of the family home, spending more nights per week sleeping on the street, and having ever stayed in a group home facility were significant correlates of homeless youths' service usage.

Defensive functioning of homeless youth in relation to experiences of child maltreatment and cumulative victimization.

PubMed

Mounier, Carrie; Andujo, Estela

2003-10-01

To determine the relationship between use of defense mechanisms and experiences of child maltreatment and cumulative victimization among homeless youth. Twenty-five homeless youth were individually interviewed regarding their victimization experiences and coping strategies. Use of defense mechanisms was assessed using the Defense Mechanism Rating Scale. Relationships were demonstrated between use of defenses and specific as well as cumulative victimization experiences. All levels of defenses became more pervasive in response to victimization, but this was not a predictor of overall immature defensive functioning. Clinical and program interventions to engage homeless youth need to incorporate an understanding of the relationship between defenses and victimization in order to be effective in maximizing upon the strengths of this population.

Discrimination and mental health problems among homeless minority young people.

PubMed

Milburn, Norweeta G; Batterham, Philip; Ayala, George; Rice, Eric; Solorio, Rosa; Desmond, Kate; Lord, Lynwood; Iribarren, Javier; Rotheram-Borus, Mary Jane

2010-01-01

We examined the associations among perceived discrimination, racial/ethnic identification, and emotional distress in newly homeless adolescents. We assessed a sample of newly homeless adolescents (n=254) in Los Angeles, California, with measures of perceived discrimination and racial/ethnic identification. We assessed emotional distress using the Brief Symptom Inventory and used multivariate linear regression modeling to gauge the impact of discrimination and racial identity on emotional distress. Controlling for race and immigration status, gender, and age, young people with a greater sense of ethnic identification experienced less emotional distress. Young people with a history of racial/ethnic discrimination experienced more emotional distress. Intervention programs that contextualize discrimination and enhance racial/ethnic identification and pride among homeless young people are needed.

Down and Out in London: Addictive Behaviors in Homelessness

PubMed Central

Sharman, Steve; Dreyer, Jenny; Clark, Luke; Bowden-Jones, Henrietta

2016-01-01

Backgrounds and aims Problem gambling occurs at higher levels in the homeless than the general population. Past work has not established the extent to which problem gambling is a cause or consequence of homelessness. This study sought to replicate recent observations of elevated rates of problem gambling in a British homeless sample, and extend that finding by characterizing (a) the temporal sequencing of the effect, (b) relationships with drug and alcohol misuse, and (c) awareness and access of treatment services for gambling by the homeless. Methods We recruited 72 participants from homeless centers in Westminster, London, and used the Problem Gambling Severity Index to assess gambling involvement, as well as DSM-IV criteria for substance and alcohol use disorders. A life-events scale was administered to establish the temporal ordering of problem gambling and homelessness. Results Problem gambling was evident in 23.6% of the sample. In participants who endorsed any gambling symptomatology, the majority were categorized as problem gamblers. Within those problem gamblers, 82.4% indicated that gambling preceded their homelessness. Participants displayed high rates of substance (31.9%) and alcohol dependence (23.6%); these were not correlated with PGSI scores. Awareness of treatment for gambling was significantly lower than for substance and alcohol use disorders, and actual access of gambling support was minimal. Discussion and conclusions Problem gambling is an under-recognized health issue in the homeless. Our observation that gambling typically precedes homelessness strengthens its role as a causal factor. Despite the elevated prevalence rates, awareness and utilization of gambling support opportunities were low compared with services for substance use disorders. PMID:27348556

Future employment among homeless single mothers: the effects of full-time work experience and depressive symptomatology.

PubMed

Bogard, C J; Trillo, A; Schwartz, A; Gerstel, N

2001-01-01

This study examines the relationship between work and depressive symptomatology for extremely destitute single mothers-mothers who have experienced an episode of homelessness. Using longitudinal data collected from 294 respondents who became homeless in 1992 and were followed for approximately two years, we find that a history of full-time work is the best predictor of whether a woman will find full-time employment in the aftermath of an episode of homelessness. Even an extensive history of part-time or informal work was not predictive of finding employment after leaving a homeless shelter. A woman's level of depressive symptomatology at the onset of homelessness predicted her strategy in dealing with the shelter bureaucracy. Women with full-time work histories who experienced high levels of depressive moods at the onset of a shelter episode were likely to leave the shelter quickly. Those with lower levels of depressive symptomatology stayed and were more likely than others to complete an education or job training program. Both types of women with full-time work histories were more likely than others to find full-time employment after a homeless episode. These findings suggest that policy makers must focus on providing full-time, and not part-time, work for impoverished mothers and take depressive symptomatology into account when offering assistance to homeless mothers.

Prevalence of Human Immunodeficiency Virus, Hepatitis C Virus, and Hepatitis B Virus Among Homeless and Nonhomeless United States Veterans.

PubMed

Noska, Amanda J; Belperio, Pamela S; Loomis, Timothy P; O'Toole, Thomas P; Backus, Lisa I

2017-07-15

Veterans are disproportionately affected by human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Homeless veterans are at particularly high risk for HIV, HCV, and HBV due to a variety of overlapping risk factors, including high rates of mental health disorders and substance use disorders. The prevalence of HIV, HCV, and HBV among homeless veterans nationally is currently unknown. This study describes national testing rates and prevalence of HIV, HCV, and HBV among homeless veterans. Using data from the Department of Veterans Affairs (VA) Corporate Warehouse Data from 2015, we evaluated HIV, HCV, and HBV laboratory testing and infection confirmation rates and diagnoses on the Problem List for nonhomeless veterans and for veterans utilizing homeless services in 2015. Among 242740 homeless veterans in VA care in 2015, HIV, HCV, and HBV testing occurred in 63.8% (n = 154812), 78.1% (n = 189508), and 52.8% (n = 128262), respectively. The HIV population prevalence was 1.52% (3684/242740) among homeless veterans, compared with 0.44% (23797/5424685) among nonhomeless veterans. The HCV population prevalence among homeless veterans was 12.1% (29311/242740), compared with 2.7% (148079/5424685) among nonhomeless veterans, while the HBV population prevalence was 0.99% (2395/242740) for homeless veterans and 0.40% (21611/5424685) among nonhomeless veterans. To our knowledge this work represents the most comprehensive tested prevalence and population prevalence estimates of HIV, HCV, and HBV among homeless veterans nationally. The data demonstrate high prevalence of HIV, HCV, and HBV among homeless veterans, and reinforce the need for integrated healthcare services along with homeless programming. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Student Access and Completion: A Regional Strategic Enrollment Partnership

ERIC Educational Resources Information Center

Peterson, Angela

2014-01-01

"Albert" told his story to special visitor Dr. Jill Biden in order to bring notice to a very unique tuition assistance program provided to Valencia College's homeless students. Not only was Albert homeless, his background was indicative of failure and through education he turned his life around and helped others with similar backgrounds.…

The Jailing of America's Homeless: Evaluating the Rabble Management Thesis

ERIC Educational Resources Information Center

Fitzpatrick, Kevin M.; Myrstol, Brad

2011-01-01

The authors of this article test hypotheses derived from Irwin's rabble management thesis. The analysis uses data from 47,592 interviews conducted with jailed adults in 30 U.S. cities as part of the Arrestee Drug Abuse Monitoring program. Clearly, homeless persons are overrepresented among those arrested and booked into local jails. Bivariate…

76 FR 48204 - Fund Availability Under VA's Homeless Providers Grant and Per Diem Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-08

... homeless veteran populations: Women, including women who have care of minor dependents; Frail elderly; Terminally ill; or Chronically mentally ill. Definitions of women and women who have care of minor dependents... service, operation, or personnel to facilitate the following with regard to the targeted group: Women...

Materials for Serving Homeless Adult Learners. A Resource Guide.

ERIC Educational Resources Information Center

Office of Vocational and Adult Education (ED), Washington, DC. Div. of Adult Education and Literacy.

This guide is intended to assist in linking service providers to existing resources and models and to build awareness of the body of innovative work that has been developed to respond to needs of homeless adult learners. It describes materials for instruction, outreach, and program management that were primarily developed in projects funded under…

78 FR 43221 - Federal Property Suitable as Facilities To Assist the Homeless

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-19

... speech-impaired (202) 708-2565 (these telephone numbers are not toll-free), or call the toll-free Title V... the Homeless v. Veterans Administration, No. 88-2503-OG (D.D.C.). Properties reviewed are listed in... Assistant Secretary for Special Needs. TITLE V, FEDERAL SURPLUS PROPERTY PROGRAM FEDERAL REGISTER REPORT FOR...

Evaluation of a Peer-Led Drug Abuse Risk Reduction Project for Runaway/Homeless Youths.

ERIC Educational Resources Information Center

Fors, Stuart W.; Jarvis, Sara

1995-01-01

Evaluates the Drug Prevention in Youth risk reduction program that was implemented in shelters for runaway/homeless youths in the southeastern United States. An evaluation strategy was developed allowing for comparisons between peer-led, adult-led and nonintervention groups. Well-trained and motivated peer/near-peer leaders made particularly…

Health Care for the Homeless in a National Health Program.

ERIC Educational Resources Information Center

Reuler, James B.

1989-01-01

An evaluation of free health care for the homeless in Britain showed that it lacks government directive, has biases and overlaps, is disproportionately delivered in emergency rooms, and relies on advocacy from the nonprofit sector. Systems of care in the U. S. must better address the needs of disenfranchised groups. (Author/VM)

76 FR 75953 - Homeless Emergency Assistance and Rapid Transition to Housing: Emergency Solutions Grants Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-05

... medium-term rental assistance and services to rapidly re- house homeless people. In addition the new... and stabilization services and short- and medium-term rental assistance to help people avoid becoming... sufficient resources or support networks, e.g., family, friends, faith-based or other social networks...

Reductions in Hard Drug Use Among Homeless Youth Receiving a Strength-Based Outreach Intervention: Comparing the Long-Term Effects of Shelter Linkage Versus Drop-in Center Linkage.

PubMed

Guo, Xiamei; Slesnick, Natasha

2017-06-07

The current study sought to test hard drug use outcomes for youth receiving a strengths-based outreach and advocacy intervention that linked youth to either a shelter or a drop-in center. Homeless youth (14-24 years old) were engaged by research assistants (RAs) at soup kitchens, parks, libraries, and other locations that homeless youth were known to frequent. Youth were randomly assigned to receive six months of advocacy that focused on linking youth to a drop-in center (n = 40) or to a crisis shelter (n = 39). Follow-up assessments were conducted at 3, 6, and 9 months post-baseline. Hard drug use over time was the main outcome. Intervention condition and service connection were used as predictors for the baseline level and the slope of change in hard drug use over time. Data analysis was conducted with Bernoulli Hierarchical Generalized Linear Modeling in HLM7. The current study found that those who were in the drop-in linkage condition exhibited a greater reduction in their odds of using hard drugs during the follow-up points than their counterparts in the shelter linkage condition. And finally, those who utilized services more often during the follow-ups were those who exhibited less hard drug use at baseline and less reduction in their odds of using hard drugs. This study suggests that drop-in centers, which are often characterized by low-demand programming and few behavioral restrictions, are effective for addressing hard drug use among homeless youth.

Experience of Primary Care among Homeless Individuals with Mental Health Conditions

PubMed Central

Chrystal, Joya G.; Glover, Dawn L.; Young, Alexander S.; Whelan, Fiona; Austin, Erika L.; Johnson, Nancy K.; Pollio, David E.; Holt, Cheryl L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa A.; Daigle, Shanette G.; Steward, Jocelyn L.; Kertesz, Stefan G

2015-01-01

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons’ needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers. PMID:25659142

Experience of primary care among homeless individuals with mental health conditions.

PubMed

Chrystal, Joya G; Glover, Dawn L; Young, Alexander S; Whelan, Fiona; Austin, Erika L; Johnson, Nancy K; Pollio, David E; Holt, Cheryl L; Stringfellow, Erin; Gordon, Adam J; Kim, Theresa A; Daigle, Shanette G; Steward, Jocelyn L; Kertesz, Stefan G

2015-01-01

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.

Development of the Primary Care Quality-Homeless (PCQ-H) Instrument: A Practical Survey of Patients' Experiences in Primary Care

PubMed Central

Kertesz, Stefan. G.; Pollio, David E.; Jones, Richard N.; Steward, Jocelyn; Stringfellow, Erin J.; Gordon, Adam J.; Johnson, Nancy K.; Kim, Theresa A.; Granstaff, Unita; Austin, Erika L.; Young, Alexander S.; Golden, Joya; Davis, Lori L.; Roth, David L.; Holt, Cheryl L.

2015-01-01

Background Homeless patients face unique challenges in obtaining primary care responsive to their needs and context. Patient experience questionnaires could permit assessment of patient-centered medical homes for this population, but standard instruments may not reflect homeless patients' priorities and concerns. Objectives This report describes (a) the content and psychometric properties of a new primary care questionnaire for homeless patients and (b) the methods utilized in its development. Methods Starting with quality-related constructs from the Institute of Medicine, we identified relevant themes by interviewing homeless patients and experts in their care. A multidisciplinary team drafted a preliminary set of 78 items. This was administered to homeless-experienced clients (n=563) across 3 VA facilities and 1 non-VA Health Care for the Homeless Program. Using Item Response Theory, we examined Test Information Function curves to eliminate less informative items and devise plausibly distinct subscales. Results The resulting 33-item instrument (Primary Care Quality-Homeless, PCQ-H) has four subscales: Patient-Clinician Relationship (15 items), Cooperation among Clinicians (3 items), Access/Coordination (11 items) and Homeless-Specific Needs (4 items). Evidence for divergent and convergent validity is provided. Test Information Function (TIF) graphs showed adequate informational value to permit inferences about groups for 3 subscales (Relationship, Cooperation and Access/Coordination). The 3-item Cooperation subscale had lower informational value (TIF<5) but had good internal consistency (alpha=0.75) and patients frequently reported problems in this aspect of care. Conclusions Systematic application of qualitative and quantitative methods supported the development of a brief patient-reported questionnaire focused on the primary care of homeless patients and offers guidance for future population-specific instrument development. PMID:25023918

Personality disorders and treatment drop out in the homeless

PubMed Central

Salavera, Carlos; Tricás, José M; Lucha, Orosia

2013-01-01

The homeless drop out of treatment relatively frequently. Also, prevalence rates of personality disorders are much higher in the homeless group than in the general population. We hypothesize that when both variables coexist — homelessness and personality disorders — the possibility of treatment drop out grows. The aim of this study was to analyze the hypotheses, that is, to study how the existence of personality disorders affects the evolution of and permanence in treatment. One sample of homeless people in a therapeutic community (N = 89) was studied. The structured clinical interview for the diagnostic and statistical manual of mental disorders (DSM-IV-TR) was administered and participants were asked to complete the Millon Clinical Multiaxial Inventory-II (MCMI-II). Cluster B personality disorders (antisocial, borderline, and narcissistic) avoided permanence in the treatment process while cluster C disorders, as dependent, favored adhesion to the treatment and improved the prognosis. Knowledge of these personality characteristics should be used to advocate for better services to support homeless people and prevent their dropping out before completing treatment. PMID:23569378

Ethical issues in research with homeless youths.

PubMed

Ensign, Josephine; Ammerman, Seth

2008-05-01

This paper is a report of a study to document researcher, healthcare provider and programme administrators' experiences with ethical issues in research with homeless youths in North America. While there are legal and ethical guidelines for research with adolescents and with vulnerable populations in general, there are no specific guidelines for the ethical conduct of research with homeless youths. Using a web-based questionnaire, healthcare and social service providers, programme administrators and researchers working with homeless young people throughout the United States of America and Canada were surveyed in 2005. The survey group consisted of 120 individuals; a total of 72 individuals completed the survey. Survey questions included experiences with using incentives in research with homeless youths, consent and experiences with ethics review boards. Numerical data were analysed using frequencies and cross-tabulations. Text data were analysed qualitatively. Researchers doing mental health and/or substance use research tended to use money as a research incentive, whereas healthcare providers and programme administrators tended to use non-monetary incentives. The majority of respondents reported using written consent for research from homeless youths, including minors. Respondents reporting difficulties with ethics review boards were mainly involved with intervention research. Consensus is needed from a variety of stakeholders, including homeless youths and service providers, on use of various types of research incentives for different types of research, as well as use of consent for homeless youths who are minors.

Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: a qualitative analysis.

PubMed

McNeil, Ryan; Guirguis-Younger, Manal; Dilley, Laura B; Aubry, Tim D; Turnbull, Jeffrey; Hwang, Stephen W

2012-05-17

Homeless and marginally housed persons who use alcohol and/or illicit drugs often have end-of-life care needs that go unmet due to barriers that they face to accessing end-of-life care services. Many homeless and marginally housed persons who use these substances must therefore rely upon alternate sources of end-of-life care and support. This article explores the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons who use alcohol and/or illicit drugs. A qualitative case study design was used to explore end-of-life care services delivery to homeless and marginally housed persons in six Canadian cities. A key objective was to explore the role of harm reduction services. 54 health and social services professionals participated in semi-structured qualitative interviews. All participants reported that they provided care and support to this population at end-of-life. Harm reduction services (e.g., syringe exchange programs, managed alcohol programs, etc.) were identified as a critical point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs. Where possible, harm reduction services facilitated referrals to end-of-life care services for this population. Harm reduction services also provided end-of-life care and support when members of this population were unable or unwilling to access end-of-life care services, thereby improving quality-of-life and increasing self-determination regarding place-of-death. While partnerships between harm reduction programs and end-of-life care services are identified as one way to improve access, it is noted that more comprehensive harm reduction services might be needed in end-of-life care settings if they are to engage this underserved population.

Internet and Social Media Access Among Youth Experiencing Homelessness: Mixed-Methods Study.

PubMed

VonHoltz, Lauren A Houdek; Frasso, Rosemary; Golinkoff, Jesse M; Lozano, Alicia J; Hanlon, Alexandra; Dowshen, Nadia

2018-05-22

Youth experiencing homelessness are at a risk for a variety of adverse outcomes. Given the widespread use of the internet and social media, these new technologies may be used to address their needs and for outreach purposes. However, little is known about how this group uses these resources. This study investigated how homeless adolescents use these technologies for general and health-related purposes, whether the scope of their use changes with housing status, and their interest in a website dedicated to youth experiencing homelessness. A convenience sample of youth aged 18 to 21 years was recruited from a youth-specific homeless shelter. All participants completed a 47-item survey, with 10 individuals completing a semistructured interview. Descriptive statistics, exact testing, logistic regression, and generalized estimating equation modeling was performed for quantitative data analysis. Interviews were transcribed verbatim, and NVivo 10 (QSR International) was employed to facilitate double coding and thematic analysis. A total of 87 participants completed the survey with a mean age of 19.4 (SD 1.1) years. While experiencing homelessness, 56% (49/87) accessed the internet at least once a day, with 86% (75/87) accessing once a week. Access to a smartphone was associated with a 3.03 greater odds of accessing the internet and was the most frequently used device (66% of participants, 57/87). While experiencing homelessness, subjects reported a 68% decreased odds in internet access frequency (odds ratio [OR] 0.32, P<.001), 75% decreased odds in spending greater amounts of time on the internet (OR 0.25, P<.001), and an 87% decreased odds of social media use (OR 0.13, P=.01). Ten participants completed the semistructured interview. Several themes were identified, including (1) changes in internet behaviors while experiencing homelessness, (2) health status as a major concern and reason for Internet use, and (3) interest in a website dedicated to youth experiencing homelessness. While experiencing homelessness, participants indicated their behaviors were more goal-oriented and less focused on leisure or entertainment activities. While homeless youth experience changes in the frequency, amount of time, and specific uses of the internet and social media, study participants were able to access the internet regularly. The internet was used to search health-related topics. Given the importance of smartphones in accessing the internet, mobile-optimized websites may be an effective method for reaching this group. ©Lauren A Houdek VonHoltz, Rosemary Frasso, Jesse M Golinkoff, Alicia J Lozano, Alexandra Hanlon, Nadia Dowshen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.05.2018.

History of co-occurring disorders and current mental health status among homeless veterans.

PubMed

Ding, Kele; Slate, Matthew; Yang, Jingzhen

2018-06-18

Homeless veterans are at high risk for co-occurring disorders (COD), defined as mental illnesses that include at least one alcohol or other drug use disorder and at least one non-drug related mental disorder. However, epidemiological studies examining the prevalence of COD and associated mental health status in this population are limited. The objectives of the study were: (1) to describe a history of diagnosed mental disorders among homeless veterans admitted to a transitional housing program, and (2) to examine the associations of the prior diagnosed COD and other mental disorders with current mental health status. Study participants were male homeless veterans admitted to a transitional housing program from July 2015 to September 2017 in a large municipal area in Northeast Ohio, the United States. Cross-sectional, self-reported data from the admission assessment were included and analyzed. History of mental disorder diagnoses were aggregated into five categories for the purpose of this study: no mental disorders, only alcohol or other drug use disorder(s), one non-drug related mental disorder, two or more non-drug related mental disorders, and COD. Current mental status were measured as empowerment, mental component summary score (MCS) and physical component summary score (PCS) of health related quality of life (VR-12), and perceived overall well-being. Sample distribution of the five categories and their associations with current mental status were examined using Generalized Linear Model test. Of all participants, 76.7% had at least one prior diagnosed mental disorder, including 47.4% with any drug-related disorders. Over one-third (37.2%) reported having COD. Compared to those with no mental disorder history, those with COD scored significantly lower on MCS and empowerment scores; those with any prior diagnosed non-drug related mental disorders also scored significantly lower on MCS. No significant differences, however, were found in current mental health status between those with COD and those with mental disorders but not COD. COD prevalence among homeless veterans was within the parameter of other literature reports. Veterans with COD compared to veterans with no history of mental disorders tended to have lower MCS and empowerment scores. Veterans with COD had the same mental health status as those with other mental disorders.

Concurrent Mental Health and Substance Use Problems among Street-Involved Youth

ERIC Educational Resources Information Center

Kirst, Maritt; Frederick, Tyler; Erickson, Patricia G.

2011-01-01

Among marginalized populations, homeless adults are known to have elevated rates of mental health and substance use problems compared to the general population, but less is known about their youthful homeless counterparts. While few studies currently exist, what research has been conducted among street-involved youth has confirmed high rates of…

77 FR 49823 - Federal Property Suitable as Facilities To Assist the Homeless

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-17

... suitability for use to assist the homeless. HUD generally publishes this weekly report each Friday. Today's notice announces that due to the size of HUD's next report, the Office of the Federal Register has informed HUD that it cannot accommodate HUD's request to schedule publication of the report on Friday...

Predictors of Adherence to Nicotine Replacement Therapy (Nicotine Patch) Among Homeless Persons Enrolled in a Randomized Controlled Trial Targeting Smoking Cessation.

PubMed

Ojo-Fati, O; Thomas, J L; Vogel, R I; Ogedegbe, O; Jean-Louis, G; Okuyemi, K S

2016-01-01

Adherence to smoking cessation treatment is generally low, especially among socio-economically disadvantaged groups including individuals experiencing homelessness and those with mental illnesses. Despite the high smoking rates in homeless populations (~70%) no study to date has systematically examined predictors of adherence to nicotine replacement therapy (NRT) in this population. The aim of this secondary analysis was to identify predictors of adherence to NRT in a smoking cessation trial conducted among homeless smokers. Secondary analysis of data from a randomized controlled trial enrolling 430 persons who were homeless and current cigarette smokers. Participants were assigned to one of the two study conditions to enhance smoking cessation: Motivational Interviewing (MI; 6 sessions of MI + 8 weeks of NRT) or Standard Care (Brief advice to quit+ 8 weeks of NRT). The primary outcome for the current analysis was adherence to NRT at end of treatment (8 weeks following randomization). Adherence was defined as a total score of zero on a modified Morisky adherence scale). Demographic and baseline psychosocial, tobacco-related, and substance abuse measures were compared between those who did and did not adhere to NRT. After adjusting for confounders, smokers who were depressed at baseline (OR=0.58, 95% CI, 0.38-0.87, p=0.01), had lower confidence to quit (OR=1.10, 95% CI, 1.01-1.19, p=0.04), were less motivated to adhere (OR=1.04, 95% CI, 1.00-1.07, p=0.04), and were less likely to be adherent to NRT. Further, age of initial smoking was positively associated with adherence status (OR= 0.83, 95% CI, 0.69-0.99, p=0.04). These results suggest that smoking cessation programs conducted in this population may target increased adherence to NRT by addressing both depression and motivation to quit. clinicaltrials.gov: NCT00786149.

Protective factors associated with fewer multiple problem behaviors among homeless/runaway youth.

PubMed

Lightfoot, Marguerita; Stein, Judith A; Tevendale, Heather; Preston, Kathleen

2011-01-01

Although homeless youth exhibit numerous problem behaviors, protective factors that can be targeted and modified by prevention programs to decrease the likelihood of involvement in risky behaviors are less apparent. The current study tested a model of protective factors for multiple problem behavior in a sample of 474 homeless youth (42% girls; 83% minority) ages 12 to 24 years. Higher levels of problem solving and planning skills were strongly related to lower levels of multiple problem behaviors in homeless youth, suggesting both the positive impact of preexisting personal assets of these youth and important programmatic targets for further building their resilience and decreasing problem behaviors. Indirect relationships between the background factors of self-esteem and social support and multiple problem behaviors were significantly mediated through protective skills. The model suggests that helping youth enhance their skills in goal setting, decision making, and self-reliant coping could lessen a variety of problem behaviors commonly found among homeless youth.

Protective Factors Associated with Fewer Multiple Problem Behaviors Among Homeless/Runaway Youth

PubMed Central

Lightfoot, Marguerita; Stein, Judith A.; Tevendale, Heather; Preston, Kathleen

2015-01-01

Although homeless youth exhibit numerous problem behaviors, protective factors that can be targeted and modified by prevention programs to decrease the likelihood of involvement in risky behaviors are less apparent. The current study tested a model of protective factors for multiple problem behavior in a sample of 474 homeless youth (42% girls; 83% minority) ages 12 to 24 years. Higher levels of problem solving and planning skills were strongly related to lower levels of multiple problem behaviors in homeless youth, suggesting both the positive impact of preexisting personal assets of these youth and important programmatic targets for further building their resilience and decreasing problem behaviors. Indirect relationships between the background factors of self-esteem and social support and multiple problem behaviors were significantly mediated through protective skills. The model suggests that helping youth enhance their skills in goal setting, decision making, and self-reliant coping could lessen a variety of problem behaviors commonly found among homeless youth. PMID:22023279

Job Training for the Homeless: Report on Demonstration's First Year. Research and Evaluation Report Series 91-F.

ERIC Educational Resources Information Center

Bailis, Lawrence N.; And Others

An interim evaluation analyzed the first year of operation of the Job Training for the Homeless Demonstration Program (JTHDP). Data were collected from quarterly progress reports and evaluation reports submitted by 32 local JTHDP projects. The projects exceeded planned levels of clients served and achieved other positive outcomes, including…

78 FR 28947 - Fund Availability Under VA's Homeless Providers Grant and Per Diem Program (VANS)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... Certified Public Accountant (CPA) or letter from the United Way stating they are a member in good standing... cash and in-kind resources from other public (including Federal and State) and private sources that are... public transportation available to homeless veterans in your project. (b) Project location (e.g., is the...

Implementing a Social Enterprise Intervention with Homeless, Street-Living Youths in Los Angeles

ERIC Educational Resources Information Center

Ferguson, Kristin M.

2007-01-01

Homeless, street-dwelling youths are an at-risk population who often use survival behaviors to meet their basic needs. The traditional outreach approach brings services into the streets, yet does not adequately replace the youths' high-risk behaviors. Similarly, job training programs often fail to address the mental health issues that constitute…

77 FR 59627 - Federal Property Suitable as Facilities To Assist the Homeless

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-28

... (202) 708-2565 (these telephone numbers are not toll- free), or call the toll-free Title V information... published in order to comply with the December 12, 1988 Court Order in National Coalition for the Homeless v... (Acting) for Special Needs. TITLE V, FEDERAL SURPLUS PROPERTY PROGRAM FEDERAL REGISTER REPORT FOR 09/28...

The Child Care Council of Westchester's "Hope for the Homeless."

ERIC Educational Resources Information Center

McBride, Kathleen

The problem of homelessness in Westchester County, New York has escalated sharply in the past few years. Estimates suggest that 5,000 people live in motels throughout the county. The largest segment of this population consists of families--women with young children. Mothers are often unable to participate in training programs due to a lack of…

Children and Young People at Risk of Social Exclusion: Links between Homelessness, Child Protection and Juvenile Justice. Data Linkage Series. Number 13

ERIC Educational Resources Information Center

Aalders, Rachel

2012-01-01

Current research demonstrates relationships between child abuse and neglect, homelessness and criminal activity. This report presents key findings from analysis of a data set linking three community-sector data collections: Supported Accommodation Assistance Program (SAAP), juvenile justice supervision, and child protection notifications and…

Job Coaching and Success in Gaining and Sustaining Employment among Homeless People

ERIC Educational Resources Information Center

Hoven, Hanno; Ford, Rebecca; Willmot, Anne; Hagan, Stephanie; Siegrist, Johannes

2016-01-01

Objective: People who are homeless experience many barriers that affect their ability to gain and sustain work. In this study, we investigate whether personal job coaching support contributes toward employment success. Methods: The short- and long-term employment outcomes of 2,480 clients participating in a labor market program were analyzed.…

Patterns, Predictors, and Situational Contexts of HIV Risk Behaviors among Homeless Men and Women.

ERIC Educational Resources Information Center

Somlai, Anton M.; Kelly, Jeffrey A.; Wagstaff, David A.; Whitson, Donna P.

1998-01-01

Investigates psychosocial, relationship, and situational factors associated with HIV risk in a sample of 152 inner-city homeless men and women. Results show gender differences in risk patterns. Concludes that HIV prevention efforts tailored to the different risk circumstances of men and women are needed in social services programs for homeless…

"Let's Spend More Time Together Like This!": Fussy Baby Network® Infusion in a Baltimore Homeless Nursery Program

ERIC Educational Resources Information Center

Cosgrove, Kim; Norris-Shortle, Carole

2015-01-01

The development of babies whose families are homeless can easily be affected by their uncertain living arrangements. The PACT Therapeutic Nursery's attachment-based, trauma-informed, mindfully focused family interventions help these children and families move beyond the trauma of shelter living. In the past year, Nursery clinicians have infused…

The Impact of Criminal Justice Involvement and Housing Outcomes Among Homeless Persons with Co-occurring Disorders.

PubMed

Mitchell, Jessica N; Clark, Colleen; Guenther, Christina C

2017-11-01

The relationship between criminal justice involvement and housing among homeless persons with co-occurring disorders was examined. Program participants assisted in moving to stable housing were interviewed at baseline, six months, and discharge. Those who remained homeless at follow-up and discharge had significantly more time in jail in the past month than those who were housed. However, criminal justice involvement was not significantly related to housing status at the six month follow-up or discharge. Findings suggest that housing people with complex behavioral health issues reduces the likelihood of further criminal justice involvement.

[Tuberculosis control in Shinjuku Ward, Tokyo--promoting the DOTS program and its outcome].

PubMed

Kaguraoka, Sumi; Ohmori, Masako; Takao, Yoshiko; Yamada, Mari; Muroi, Masako; Nagamine, Michiko; Fukazawa, Keiji; Nagai, Megumi; Wada, Masako; Hoshino, Hitoshi; Yoshiyama, Takashi; Maeda, Hideo; Ishikawa, Nobukatsu

2008-09-01

The objectives were to report how to promote tuberculosis (TB) control including DOTS (Directly Observed Treatment, Short-course) programs, and to evaluate the results of TB control programs in Shinjuku Ward (Shinjuku-ku). SETTING AND CHARACTERISTICS: Inhabitants and TB patients in Shinjuku Ward. Shinjuku Ward is located in the center of metropolitan Tokyo and has typical urban TB problems, such as high incidence rate and TB among foreigners and the homeless. The TB incidence rates in Shinjuku Ward decreased from 83.9 per 100,000 population in 1999 to 42.5 per 100,000 population in 2006, however, the rates were still two times higher than the national average. Therefore, one of the important TB programs in Shinjuku has been to actively detect cases among high-risk groups such as foreigners and the homeless. We observed the trend of case detection rates by health examination with chest X-ray among different high-risk groups, and compared the treatment outcomes before and after DOTS program execution. We also reviewed the changes of re-treatment rates and drug resistance rates. The case detection rates of TB by health examinations of foreign students at Japanese language schools decreased from 0.49% in 1996 to 0.13% in 2006 (p = 0.021). Although the case detection rates decreased, they were still about 26 times higher than those of Japanese students. While, the case detection rates among the homeless remained high with 4.7%, 3.3%, 4.5% and 3.6% in 1999-2002, respectively, since 2003, however, they had decreased and no TB cases were detected in 2005-2006. The DOTS program for homeless TB patients has been carried out since 2000 and that for the foreigners since 2003. The rates of defaulting during treatment before DOTS were very high among both homeless patients (21.4%) and foreigners (29.8%) in 1998-1999. However, after the introduction of DOTS program, those rates declined to 10.4% (p = 0.014) among the homeless and 7.8% (p = 0.002) among foreigners in 2002-2004. The proportion of newly notified patients with previous TB treatment and those with multi-drug resistant TB (MDR-TB) have also decreased after the introduction of DOTS programs. From 2000-2002 to 2003-2006, the re-treatment rates decreased from 19.4% to 10.0% (p < 0.001) and MDR-TB rates decreased from 1.6% to 0.2% (p = 0.042), respectively. The key points of TB control in Shinjuku Ward are to detect TB cases early especially among the high-risk groups, and to assist all TB patients to complete their treatment. In order to expand this strategy, besides promoting active case findings among high-risk groups, we have developed many types of DOTS programs, considering each patient's lifestyle and cooperating with school teachers at schools, pharmacists at pharmacies, home-care specialists at homes or facilities for the elderly, and so on. Among others, a major premise for the homeless and some other socially disadvantaged patients was to guarantee the provision of medicine and living by introducing social welfare services, before starting DOTS programs. This approach might have helped to reduce the defaulting rate, relapse rate and MDR-TB rate.

Gender Differences in Factors Associated with Unsheltered Status and Increased Risk of Premature Mortality among Individuals Experiencing Homelessness.

PubMed

Montgomery, Ann Elizabeth; Szymkowiak, Dorota; Culhane, Dennis

Among individuals experiencing homelessness, unsheltered status is associated with poor health and access to care and an increased risk for premature death. Insufficient research has explored gender differences in these outcomes; the objective of this study was to address this gap in the research. This study used survey data collected during the 100,000 Homes Campaign. Chi-square tests identified differences in the characteristics of women, men, and transgender individuals. Generalized linear mixed models fit with demographic, homelessness, mental/behavioral health, institutional, and income characteristics were run separately for women and men to assess correlates of unsheltered status and increased risk of premature mortality. Men reported more frequently experiencing unsheltered homelessness while women and transgender participants more frequently met the criteria for risk of premature mortality. Women reported less frequently than men a history of or current substance use, but it significantly increased their likelihood of unsheltered homelessness; reports of mental health issues were rarer among men but significantly increased their odds of unsheltered homelessness. The experience of a violent attack while homeless was most strongly related to increased risk of premature mortality for both women and men. Interventions to reduce unsheltered homelessness among men should be particularly sensitive to mental health issues while for women there may need to be increased attention to substance use. A focus on experience of trauma and the provision of trauma-informed care is essential to address the increased risk of premature mortality among both men and women experiencing homelessness. Published by Elsevier Inc.

Impact of a New York City Supportive Housing Program on Housing Stability and Preventable Health Care among Homeless Families.

PubMed

Lim, Sungwoo; Singh, Tejinder P; Hall, Gerod; Walters, Sarah; Gould, L Hannah

2018-03-12

To assess the impact of a New York City supportive housing program on housing stability and preventable emergency department (ED) visits/hospitalizations among heads of homeless families with mental and physical health conditions or substance use disorders. Multiple administrative data from New York City and New York State for 966 heads of families eligible for the program during 2007-12. We captured housing events and health care service utilization during 2 years prior to the first program eligibility date (baseline) and 2 years postbaseline. We performed sequence analysis to measure housing stability and compared housing stability and preventable ED visits and hospitalizations between program participants (treatment group) and eligible applicants not placed in the program (comparison group) via marginal structural modeling. We matched electronically collected data. Eighty-seven percent of supportive housing tenants experienced housing stability in 2 years postbaseline. Compared with unstably housed heads of families in the comparison group, those in the treatment group were 0.60 times as likely to make preventable ED visits postbaseline (95% CI = 0.38, 0.96). Supportive housing placement was associated with improved housing stability and reduced preventable health care visits among homeless families. © Health Research and Educational Trust.

Cognitive Skills Training for Homeless Transition-Age Youth: Feasibility and Pilot Efficacy of a Community Based Randomized Controlled Trial.

PubMed

Medalia, Alice; Saperstein, Alice M; Huang, Yanlan; Lee, Seonjoo; Ronan, Elizabeth J

2017-11-01

Cognitive impairments are common in homeless youth and negatively impact academic and vocational outcomes. We examined the feasibility and efficacy of cognitive interventions provided to 18- to 22-year-old homeless youth living in urban supportive housing. Ninety-one homeless youth were randomized to receive either targeted cognitive training (cognitive remediation) or general cognitive activation (computer skills training). Cognitive and psychological outcomes were assessed at baseline, after 13 and 26 sessions, and 1 month postintervention. A high dropout rate highlighted the feasibility challenges of treating this population. Intent-to-treat analysis found significant improvements across groups in specific and global measures of cognition and psychological distress, with no significant group differences. Transition-age homeless youth show improvements in cognitive and psychological functioning when engaged in interventions that address their cognitive development. This speaks to the malleability of cognitive skills in this cohort and lays the groundwork for future research to address their cognitive health.

Depression Symptoms Among Homeless Smokers: Effect of Motivational Interviewing.

PubMed

Robinson, Cendrine D; Rogers, Charles R; Okuyemi, Kolawole S

2016-08-23

Tobacco use is higher among homeless individuals than the general population. Homeless individuals are also more likely to have symptoms of depression. Depression symptoms may add to the burden of homelessness by increasing psychological distress and serve as a barrier to quitting smoking. The primary goal of this study is to assess the impact of depression symptoms on psychological distress in homeless smokers. The effect of depression symptoms on abstinence and the effect of Motivational Interviewing (MI) on cessation among smokers is also explored. Homeless smokers (N = 430) enrolled in a smoking cessation study were randomized to Motivational Interviewing (MI) or standard care (SC). Participants received nicotine replacement therapy and were followed for 26 weeks. Participants were categorized into a depression symptoms (DS) group or control group using the Patient Health Questionnaire-9. Between group differences of perceived stress, hopelessness, confidence, craving and abstinence were assessed at weeks 8 and 26. The interaction between depression symptoms (levels: DS and control) and the intervention (levels: MI and SC) was also assessed. Homeless smokers in the DS group reported higher levels of hopelessness, perceived stress, and craving. There was no effect of DS status on abstinence at week 8 or week 26. There was no significant interaction between depression symptoms (DS vs. Control) and the intervention (MI vs. SC). Despite reporting greater psychological distress, homeless smokers with depression symptoms in this sample had abstinence levels similar to the control group. Future research should explore protective factors among depressed smokers.

A place to call home: study protocol for a longitudinal, mixed methods evaluation of two housing first adaptations in Sydney, Australia.

PubMed

Whittaker, Elizabeth; Swift, Wendy; Flatau, Paul; Dobbins, Timothy; Schollar-Root, Olivia; Burns, Lucinda

2015-04-09

This protocol describes a study evaluating two 'Housing First' programs, Platform 70 and Common Ground, presently being implemented in the inner-city region of Sydney, Australia. The Housing First approach prioritises housing individuals who are homeless in standard lease agreement tenancies as rapidly as possible to lock in the benefits from long-term accommodation, even where the person may not be seen as 'housing ready'. The longitudinal, mixed methods evaluation utilises both quantitative and qualitative data collected at baseline and 12-month follow-up time points. For the quantitative component, clients of each program were invited to complete client surveys that reported on several factors associated with chronic homelessness and were hypothesised to improve under stable housing, including physical and mental health status and treatment rates, quality of life, substance use patterns, and contact with the health and criminal justice systems. Semi-structured interviews with clients and stakeholders comprised the qualitative component and focused on individual experiences with, and perceptions of, the two programs. In addition, program data on housing stability, rental subsidies and support levels provided to clients by agencies was collected and will be used in conjunction with the client survey data to undertake an economic evaluation of the two programs. This study will systematically evaluate the efficacy of a scatter site model (Platform 70) and a congregated model (Common Ground) of the Housing First approach; an examination that has not yet been made either in Australia or internationally. A clear strength of the study is its timing. It was designed and implemented as the programs in question themselves were introduced. Moreover, the programs were introduced when the Australian Government, with State and Territory support, began a more focused, coordinated response to homelessness and funded rapid expansion of innovative homelessness programs across the country, including Common Ground supportive housing developments.

The Voices behind the Numbers: Understanding the Experiences of Homeless Students

ERIC Educational Resources Information Center

Mohan, Erica; Shields, Carolyn M.

2014-01-01

In a given year, approximately 1.6 million children in the United States experience homelessness, and research shows that their living conditions generally place these children at risk for educational underperformance and failure at school (Hall, 2007; Love, 2009). Although lack of education or low levels of education on the part of a head of…

Psychache and Suicide Ideation among Men Who Are Homeless: A Test of Shneidman's Model

ERIC Educational Resources Information Center

Patterson, Allisha A.; Holden, Ronald R.

2012-01-01

Suicide ideation among the homeless is 10 times more common than in the general population. Cognitive theories of depression and hopelessness propose to explain suicidality; however, as yet, none of these fully account for the phenomenon. Shneidman has suggested a theory of psychache or unbearable psychological pain to explain suicidality. This…

Comparisons of substance abuse, high-risk sexual behavior and depressive symptoms among homeless youth with and without a history of foster care placement.

PubMed

Hudson, Angela L; Nandy, Karabi

2012-10-01

The purpose of this study was to compare prevalence of substance use, high-risk sexual behaviors, and depression symptoms between homeless youth with and without a history of foster care placement. Approximately 26,000 young persons exit foster care annually in the United States. Once they 'age out' of foster care, however, many young persons do not have access to comprehensive health care. They also are at risk for substance abuse, homelessness, or mental illness. Because persons with a history of foster care are at risk for negative psycho-social outcomes, it is unclear if these young people might be different than homeless youth without this history. The design is descriptive and cross-sectional. A total of 156 homeless young persons, of whom 44 had a history of foster care placement, were recruited from a drop-in center that caters to homeless youth and young adults. The sample was majority male and white; ages were 16-25. Significantly higher proportion of homeless former foster youth used methamphetamine within the last six months compared to non-fostered homeless youth p = 0.03). Homeless former foster youth were significantly older (p = 0.02) and less educated (p = 0.02) than their homeless counterparts without a history of foster care placement. Prevalence of using tobacco, marijuana, alcohol, crack cocaine, and powder cocaine were similar for both groups. Although not significant, a higher proportion of homeless former foster youth reported trading sex for money or drugs compared to non-fostered, homeless youth (19% versus 12% [trading sex for money], and 26% versus 14% [trading sex for drugs], respectively. Findings from this study show that, in general, homelessness is a negative outcome, irrespective of having a foster care history. However, those with that history need continued support when transitioning to independent living, such as access to health care, and encouragement to further their education. It is important that nurses, who serve homeless youth populations, conduct a risk assessment profile, in order to ascertain a history of foster care placement, link former foster youth to social service agencies that provide risk reduction/health promotion education, and advocate for stable housing.

Does experiencing homelessness affect women's motivation to change alcohol or drug use?

PubMed

Upshur, Carole C; Weinreb, Linda; Cheng, Debbie M; Kim, Theresa W; Samet, Jeffrey H; Saitz, Richard

2014-01-01

Homeless women are at high risk of drug and alcohol dependence and may receive less opportunity for treatment. Our objective was to examine the association between experiencing homelessness and motivation to change drug or alcohol use. Women (n = 154) participants in a study of substance dependence at an urban medical center (69 with some homeless days in the last 90 days; 85 continuously housed at baseline) completed six items rating motivation to change alcohol or drug use (ie, importance, readiness, and confidence) at baseline and in 3-, 6-, and 12-month follow-up interviews. Unadjusted and longitudinal analyses controlling for covariates (eg, demographics, insurance status, substance use consequences, mental health status, and participation in treatment) were conducted. There were no significant differences between women experiencing homeless days versus continuously housed women in the odds of reporting high motivation to change alcohol or drug use, either in unadjusted baseline analyses or longitudinal analyses adjusted for covariates. Covariates that were significantly associated with high importance, readiness or confidence to change behavior were higher life time consequences of substance use, and participation in 12-step programs. The findings suggest that clinicians should not make assumptions that homeless women have low motivation to change their substance use. The same opportunities for addiction treatment should be offered to homeless as to housed women. © American Academy of Addiction Psychiatry.

In-vivo job development training among peer providers of homeless veterans supported employment programs.

PubMed

Gao, Ni; Dolce, Joni; Rio, John; Heitzmann, Carma; Loving, Samantha

2016-06-01

This column describes a goal-oriented, time-limited in vivo coaching/training approach for skills building among peer veterans vocational rehabilitation specialists of the Homeless Veteran Supported Employment Program (HVSEP). Planning, implementing, and evaluating the training approach for peer providers was intended, ultimately, to support veterans in their goal of returning to community competitive employment. The description draws from the training experience that aimed to improve the ability of peer providers to increase both rates of employment and wages of the homeless veterans using their services. Training peers using an in vivo training approach provided a unique opportunity for the veterans to improve their job development skills with a focus to support employment outcomes for the service users. Peers who received training also expressed that learning skills through an in vivo training approach was more engaging than typical classroom trainings. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

At a crossroads: reentry challenges and healthcare needs among homeless female ex-offenders.

PubMed

Salem, Benissa E; Nyamathi, Adeline; Idemundia, Faith; Slaughter, Regina; Ames, Masha

2013-01-01

The exponential increase in the number of women parolees and probationers in the last decade has made women the most rapidly growing group of offenders in the United States. The purpose of this descriptive, qualitative study is to understand the unique gendered experiences of homeless female ex-offenders, in the context of healthcare needs, types of health services sought, and gaps in order to help them achieve a smooth transition post prison release. Focus group qualitative methodology was utilized to engage 14 female ex-offenders enrolled in a residential drug treatment program in Southern California. The findings suggested that for homeless female ex-offenders, there are a myriad of healthcare challenges, knowledge deficits, and barriers to moving forward in life, which necessitates strategies to prevent relapse. These findings support the development of gender-sensitive programs for preventing or reducing drug and alcohol use, recidivism, and sexually transmitted infections among this hard-to-reach population.

Gender Differences in Predictors of Suicidal Thoughts and Attempts Among Homeless Veterans that Abuse Substances

ERIC Educational Resources Information Center

Benda, Brent B.

2005-01-01

This study of 315 male and 310 female homeless military veterans in a V.A. inpatient program designed to treat substance abusers, many of whom also suffer psychiatric disorders, was designed to examine gender differences in factors associated with the odds of having suicidal thoughts, and of attempting suicide, in comparison to being nonsuicidal.…

To Whom Do They Belong? "A Profile of America's Runaway and Homeless Youth and the Programs That Help Them."

ERIC Educational Resources Information Center

National Network of Runaway and Youth Services, Inc., Washington, DC.

A profile and needs assessment of runaway and homeless children was produced using survey data gathered from 210 youth services agencies throughout the United States. The National Network of Runaway and Youth Services conducted this survey to provide policymakers and the media with information about successful, cost-effective crisis intervention…

Homeless Families with Children: Programmatic Responses of Five Communities. Volume I: Cross-Site Comparisons and Findings.

ERIC Educational Resources Information Center

Macro Systems, Inc., Silver Spring, MD.

An exploratory study was conducted to examine the ways in which existing programs or service delivery systems have adapted to meet the needs of homeless families with children. Key issues and model and innovative approaches were identified prior to study site visits in five cities: (1) Atlanta (Georgia); (2) Baltimore (Maryland); (3) Boston…

Practical Lessons: The 1998 National Symposium on Homelessness Research (Arlington, Virginia, October 29-30, 1998).

ERIC Educational Resources Information Center

Fosburg, Linda B., Ed.; Dennis, Deborah L., Ed.

In 1998, one decade after the Stewart B. McKinney Homeless Assistance Act was implemented and research results on the impacts of funding were becoming available, an evaluation of the effectiveness of fifteen programs, which included services such as emergency shelter, primary health care, and education, was needed This report presents 13 papers…

[Winter surveillance of cold exposure effects on health among the homeless population in the Paris area: data from the Coordinated Health Surveillance of Emergency Department network (Organisation de la surveillance coordonnée des urgences [Oscour(®)])].

PubMed

Rouquette, A; Mandereau-Bruno, L; Baffert, E; Laaidi, K; Josseran, L; Isnard, H

2011-12-01

A program for helping homeless individuals in winter is implemented from November 1(st) to March 31(st) each year in France. Its aim is to prevent morbidity and mortality in this population during cold spells and periods of severe cold. A health surveillance system of the homeless population in the Paris area has been proposed to evaluate the effectiveness of the program and to alert decision-makers if an unusual increase in cold-weather effects is observed. The goal of this study was the creation of an indicator for the proposed surveillance system based on emergency department activity in the Paris area (Oscour(®) Network - Organisation de la surveillance coordonnée des urgences). The winter 2007-2008 computer medical files of 11 emergency departments in the Paris area were examined to confirm diagnosis and ascertain patient-homelessness for each patient visit which was selected from the Oscour(®) database by the patient chief-complaint or diagnosis code referring to hypothermia or frostbites. The proposed indicator is based on the maximization of three criteria: the positive predictive value, the proportion of people identified as being homeless and the number of emergency department visits. A Shewhart control chart was applied to the indicator for the four winters between 2005 and 2009 in the Paris area. Values beyond the statistical threshold would indicate a need for an adjustment to the program strategy. Two hundred and sixteen medical files were analyzed. An indicator was created, "number of emergency department visits of 15 to 69-years-old persons with chief-complaint or diagnosis code referring to hypothermia". It had a positive predictive value estimated near 85 % and identified 61.7 % people as being homeless. In the winter of 2008-2009, the statistical threshold was reached in December during the first cold spell, and again at the beginning of January during a period of severe cold. Our results support the use of this health indicator, alongside social indicators, for optimizing the strategy for helping the homeless population during winter. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Tuberculosis Containment among the Homeless in Metropolitan Jackson, Mississippi.

PubMed

Azevedo, Mario J; Conwill, David E; Lawrence, Shonda; Jackson, Ann; Bhuiyan, Azad R; Hall, Dianne; Anderson, Brian; Franklin, Donald; Brown, David; Wilkerson, Patricia; Beckett, Gloria

2015-08-01

Preventing tuberculosis among the homeless has emerged as an especially difficult challenge. We assessed a 2008-2009 tuberculosis (TB) outbreak ad subsequent prevention strategies among homeless persons in metropolitan Jackson, Hinds County, Mississippi. We compared data about cases and subclinical TB infections (LTBI) among homeless persons during the outbreak and post-outbreak years, interviewed involved homeless persons, compiled observations from visits to Jackson homeless shelters and conducted literature reviews on homelessness and infectious diseases. We reviewed homeless shelter TB prevention methods adopted by other municipalities, guidelines developed by the Centers for Disease Control and Prevention (CDC), and recommendations from other official and ad hoc groups and considered their applicability to metropolitan Jackson. The Mississippi State Department of Health TB Program assisted by the CDC and other agencies, contained the Jackson-area outbreak by the end of 2009 as reflected by progressively lower TB rates among homeless persons thereafter. However, some follow-up activities and enforcement of shelter preventive measures have not been consistently maintained. Resources to prevent further outbreaks continue to be inadequate, and over-reliance on private organizations has continued. In the process, appreciation of the dynamic interaction enhancing TB risk among the homeless and incarcerated persons has emerged. Major outbreak contributors were lack of periodic TB screening among homeless shelter clients, preventive treatment compliance and follow-up difficulties among those with subclinical tuberculosis infections, interrupted preventive measures among infected persons incarcerated in local correctional facilities who disproportionately re-join Jackson's homeless community when released, inadequate attention to shelter environmental preventive strategies such as ultraviolet light germicidal irradiators and proper air-exchange/ventilation, costs of isolation housing for homeless people with full-blown tuberculosis (especially those co-infected with HIV and other infections and those with alcohol and/or other chemical dependencies), lack of adequate transportation which impacts access to evaluation and care, lack of mandated ongoing training among shelter and correctional facility staff, and inadequate attention to the societal problem of homelessness itself. Sustained adherence to local shelter and correctional facility TB prevention measures based on standards and policies proved effective in other settings is most crucial. These include requirements for periodic tuberculosis prevention and awareness training for shelter and correctional facility staff, ongoing tuberculosis screening and follow-up among homeless shelter clients and inmates of local correctional facilities, and attention to shelter and correctional facility environmental sanitation, proper ventilation, ultraviolet light fixtures and capacity/bed alignment standards.

Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study

PubMed Central

Cullivan, Sarah; Sears, Jess; Lawlee, Ann Marie; Browne, Joe; Kieran, Jennifer; Segurado, Ricardo; O’Carroll, Austin; O’Reilly, Fiona; Creagh, Donnacha; Bergin, Colm; Kenny, Rose Anne; Byrne, Declan

2017-01-01

Objectives Homeless people lack a secure, stable place to live and experience higher rates of serious illness than the housed population. Studies, mainly from the USA, have reported increased use of unscheduled healthcare by homeless individuals. We sought to compare the use of unscheduled emergency department (ED) and inpatient care between housed and homeless hospital patients in a high-income European setting in Dublin, Ireland. Setting A large university teaching hospital serving the south inner city in Dublin, Ireland. Patient data are collected on an electronic patient record within the hospital. Participants We carried out an observational cross-sectional study using data on all ED visits (n=47 174) and all unscheduled admissions under the general medical take (n=7031) in 2015. Primary and secondary outcome measures The address field of the hospital’s electronic patient record was used to identify patients living in emergency accommodation or rough sleeping (hereafter referred to as homeless). Data on demographic details, length of stay and diagnoses were extracted. Results In comparison with housed individuals in the hospital catchment area, homeless individuals had higher rates of ED attendance (0.16 attendances per person/annum vs 3.0 attendances per person/annum, respectively) and inpatient bed days (0.3 vs 4.4 bed days/person/annum). The rate of leaving ED before assessment was higher in homeless individuals (40% of ED attendances vs 15% of ED attendances in housed individuals). The mean age of homeless medical inpatients was 44.19 years (95% CI 42.98 to 45.40), whereas that of housed patients was 61.20 years (95% CI 60.72 to 61.68). Homeless patients were more likely to terminate an inpatient admission against medical advice (15% of admissions vs 2% of admissions in homeless individuals). Conclusion Homeless patients represent a significant proportion of ED attendees and medical inpatients. In contrast to housed patients, the bulk of usage of unscheduled care by homeless people occurs in individuals aged 25–65 years. PMID:29196477

Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study.

PubMed

Ní Cheallaigh, Clíona; Cullivan, Sarah; Sears, Jess; Lawlee, Ann Marie; Browne, Joe; Kieran, Jennifer; Segurado, Ricardo; O'Carroll, Austin; O'Reilly, Fiona; Creagh, Donnacha; Bergin, Colm; Kenny, Rose Anne; Byrne, Declan

2017-12-01

Homeless people lack a secure, stable place to live and experience higher rates of serious illness than the housed population. Studies, mainly from the USA, have reported increased use of unscheduled healthcare by homeless individuals.We sought to compare the use of unscheduled emergency department (ED) and inpatient care between housed and homeless hospital patients in a high-income European setting in Dublin, Ireland. A large university teaching hospital serving the south inner city in Dublin, Ireland. Patient data are collected on an electronic patient record within the hospital. We carried out an observational cross-sectional study using data on all ED visits (n=47 174) and all unscheduled admissions under the general medical take (n=7031) in 2015. The address field of the hospital's electronic patient record was used to identify patients living in emergency accommodation or rough sleeping (hereafter referred to as homeless). Data on demographic details, length of stay and diagnoses were extracted. In comparison with housed individuals in the hospital catchment area, homeless individuals had higher rates of ED attendance (0.16 attendances per person/annum vs 3.0 attendances per person/annum, respectively) and inpatient bed days (0.3 vs 4.4 bed days/person/annum). The rate of leaving ED before assessment was higher in homeless individuals (40% of ED attendances vs 15% of ED attendances in housed individuals). The mean age of homeless medical inpatients was 44.19 years (95% CI 42.98 to 45.40), whereas that of housed patients was 61.20 years (95% CI 60.72 to 61.68). Homeless patients were more likely to terminate an inpatient admission against medical advice (15% of admissions vs 2% of admissions in homeless individuals). Homeless patients represent a significant proportion of ED attendees and medical inpatients. In contrast to housed patients, the bulk of usage of unscheduled care by homeless people occurs in individuals aged 25-65 years. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

An innovative approach to address homelessness in regional Australia: Participant evaluation of a co-payment model.

PubMed

Jacups, S; Rogerson, B; Kinchin, I

2018-03-01

Homelessness is not only about lack of secure housing, it is sometimes caused by simple reasons such as lack of money to travel home. The purpose of this study was to investigate whether the participant co-funded assistance program ('Return to Country' [R2C]), when offered to low socio-economic individuals experiencing homelessness, represented an effective use of scarce resources. In northern Australia, a remote and sparsely populated area, Indigenous persons who travel to regional centres cannot always afford airfares home; they therefore become stranded away from their 'country' leading to rapidly deteriorating health, isolation and separation from family and kin. The R2C program was designed to facilitate travel for persons who were temporarily stranded and were voluntarily seeking to return home. The program provided operational support and funding (participants co-funded AU$99) to participants to return home. Using a descriptive, case series research design, university researchers independently evaluated the R2C program using semi-structured interviews with 37 participants. An investment of AU$970 per participant in the program with partial co-payment was associated with high participant acceptability and satisfaction in-line with harms reduction around substance and criminal abuse, which is suggestive of long-term success for the model. Findings from this study can contribute to the development of best practice guidelines and policies that specifically address the needs of this unique population of stranded persons, who are seeking to return home. The acceptance of the co-payment model can be adopted by policy makers involved in homelessness prevention in other locations in Australia or internationally as an add-on service provision to mainstream housing support. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Longer duration of homelessness is associated with a lower likelihood of non-detectable plasma HIV-1 RNA viral load among people who use illicit drugs in a Canadian setting.

PubMed

Loh, Jane; Kennedy, Mary Clare; Wood, Evan; Kerr, Thomas; Marshall, Brandon; Parashar, Surita; Montaner, Julio; Milloy, M-J

2016-11-01

Homelessness is common among people who use drugs (PWUD) and, for those living with HIV/AIDS, an important contributor to sub-optimal HIV treatment outcomes. This study aims to investigate the relationship between the duration of homelessness and the likelihood of plasma HIV-1 RNA viral load (VL) non-detectability among a cohort of HIV-positive PWUD. We used data from the ACCESS study, a long-running prospective cohort study of HIV-positive PWUD linked to comprehensive HIV clinical records including systematic plasma HIV-1 RNA VL monitoring. We estimated the longitudinal relationship between the duration of homelessness and the likelihood of exhibiting a non-detectable VL (i.e., <500 copies/mL plasma) using generalized linear mixed-effects modelling. Between May 1996 and June 2014, 922 highly active antiretroviral therapy-exposed participants were recruited and contributed 8188 observations. Of these, 4800 (59%) were characterized by non-detectable VL. Participants reported they were homeless in 910 (11%) interviews (median: six months, interquartile range: 6-12 months). A longer duration of homelessness was associated with lower odds of VL non-detectability (adjusted odds ratio = 0.71 per six-month period of homelessness, 95% confidence interval: 0.60-0.83) after adjustment for age, ancestry, drug use patterns, engagement in addiction treatment, and other potential confounders. Longer durations of episodes of homelessness in this cohort of HIV-positive illicit drug users were associated with a lower likelihood of plasma VL non-detectability. Our findings suggest that interventions that seek to promptly house homeless individuals, such as Housing First approaches, might assist in maximizing the clinical and public health benefits of antiretroviral therapy among people living with HIV/AIDS.

Experiences and attitudes of residents and students influence voluntary service with homeless populations.

PubMed

O'toole, T P; Hanusa, B H; Gibbon, J L; Boyles, S H

1999-04-01

To assess the impact of two programs at the University of Pittsburgh, one that requires and one that encourages volunteer activity. In the program that requires primary care interns to spend 15 hours in a homeless clinic, we measured volunteer service after the requirement was fulfilled. In the program that encourages and provides the structure for first- and second-year medical students to volunteer, we assessed correlates of volunteering. When primary care interns were required to spend time at homeless clinics, all (13/13) volunteered to work at the same clinic in subsequent years. Categorical interns without this requirement were less likely to volunteer (24/51; chi2 = 12.7, p >. 001). Medical students who volunteered were more likely to be first-year students, have previously volunteered in a similar setting, have positive attitudes toward caring for indigent patients, and have fewer factors that discouraged them from volunteering (p <. 01 for all) than students who did not volunteer. Volunteering with underserved communities during medical school and residency is influenced by previous experiences and, among medical students, year in school. Medical schools and residency programs have the opportunity to promote volunteerism and social responsibility through mentoring and curricular initiatives.

Exploring the Potential of Technology-Based Mental Health Services for Homeless Youth: A Qualitative Study

PubMed Central

Adkins, Elizabeth C.; Zalta, Alyson K.; Boley, Randy A.; Glover, Angela; Karnik, Niranjan S.; Schueller, Stephen

2017-01-01

Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths’ use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18 to 20 years old with current periods of homelessness ranging from six days to four years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings towards technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. PMID:28481610

Sexual Risk Behaviors, Sexual Offenses, and Sexual Victimization Among Homeless Youth: A Systematic Review of Associations With Substance Use.

PubMed

Heerde, Jessica A; Hemphill, Sheryl A

2016-12-01

The use of substances among youth experiencing homelessness is an important issue in the context of addressing the developing burden of morbidities arising due to illness, injury, physical and mental health concerns, and low rates of health care utilization among this population group. Youth experiencing homelessness report engaging in and being victimized by various forms of sexual behavior. Of interest in this systematic review were published studies investigating substance use in its association with perpetration of sexual offenses, engagement in sexual risk behavior, or experience of sexual victimization among homeless youth. A systematic search of 12 psychology, health, and social science electronic databases was conducted. Search terms included "homeless*," "youth," "sex crimes," "sexual victimization," "survival sex," "rape," "drugs," and "substance abuse." Twenty-three studies were identified that met the inclusion criteria. No studies statistically examining substance use in its association with perpetrating sexual offenses were located. Findings showed substance use was generally associated with sexual risk behavior or sexual victimization; however, it remains unclear whether substance use precedes or follows these behaviors and experiences. It is possible substances are used by homeless youth as a means of coping with sexual risk behavior and victimization. Implications of the review findings in relation to prevention and intervention approaches aimed to decrease the incidence and severity of health concerns among homeless youth are discussed. © The Author(s) 2015.

A Population-Based Assessment of the Health of Homeless Families in New York City, 2001–2003

PubMed Central

Bainbridge, Jay; Kennedy, Joseph; Bennani, Yussef; Agerton, Tracy; Marder, Dova; Forgione, Lisa; Faciano, Andrew; Thorpe, Lorna E.

2011-01-01

Objectives. We compared estimated population-based health outcomes for New York City (NYC) homeless families with NYC residents overall and in low-income neighborhoods. Methods. We matched a NYC family shelter user registry to mortality, tuberculosis, HIV/AIDS, and blood lead test registries maintained by the NYC Department of Health and Mental Hygiene (2001–2003). Results. Overall adult age-adjusted death rates were similar among the 3 populations. HIV/AIDS and substance-use deaths were 3 and 5 times higher for homeless adults than for the general population; only substance-use deaths were higher than for low-income adults. Children who experienced homelessness appeared to be at an elevated risk of mortality (41.3 vs 22.5 per 100 000; P < .05). Seven in 10 adult and child deaths occurred outside shelter. Adult HIV/AIDS diagnosis rates were more than twice citywide rates but comparable with low-income rates, whereas tuberculosis rates were 3 times higher than in both populations. Homeless children had lower blood lead testing rates and a higher proportion of lead levels over 10 micrograms per deciliter than did both comparison populations. Conclusions. Morbidity and mortality levels were comparable between homeless and low-income adults; homeless children's slightly higher risk on some measures possibly reflects the impact of poverty and poor-quality, unstable housing. PMID:21233439

The role of charity care and primary care physician assignment on ED use in homeless patients.

PubMed

Wang, Hao; Nejtek, Vicki A; Zieger, Dawn; Robinson, Richard D; Schrader, Chet D; Phariss, Chase; Ku, Jocelyn; Zenarosa, Nestor R

2015-08-01

Homeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting. A retrospective medical records review of homeless patients presenting to the ED and receiving treatment between July 2013 and June 2014 was completed. Appropriate vs inappropriate use of the ED was determined using the New York University ED Algorithm. The association between patients with charity care coverage, PCP assignment status, and appropriate vs inappropriate ED use was analyzed and compared. Following New York University ED Algorithm standards, 76% of all ED visits were deemed inappropriate with approximately 77% of homeless patients receiving charity care and 74% of patients with no insurance seeking noncrisis health care in the ED (P=.112). About 50% of inappropriate ED visits and 43.84% of appropriate ED visits occurred in patients with a PCP assignment (P=.019). Both charity care homeless patients and those without insurance coverage tend to use the ED for noncrisis care resulting in high rates of inappropriate ED use. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED use in homeless patients. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

The co-occurrence of AIDS and homelessness: results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia.

PubMed

Culhane, D P; Gollub, E; Kuhn, R; Shpaner, M

2001-07-01

Administrative databases from the City of Philadelphia that track public shelter utilisation (n=44 337) and AIDS case reporting (n=7749) were merged to identify rates and risk factors for co-occurring homelessness and AIDS. Multiple decrement life tables analyses were conducted, and logistic regression analyses used to identify risk factors associated with AIDS among the homeless, and homelessness among people with AIDS. City of Philadelphia, Pennsylvania, USA. People admitted to public shelters had a three year rate of subsequent AIDS diagnosis of 1.8 per 100 person years; nine times the rate for the general population of Philadelphia. Logistic regression results show that substance abuse history (OR = 3.14), male gender (OR = 2.05), and a history of serious mental disorder (OR = 1.62) were significantly related to the risk for AIDS diagnosis among shelter users. Among people with AIDS, results show a three year rate of subsequent shelter admission of 6.9 per 100 person years, and a three year rate of prior shelter admission of 9%, three times the three year rate of shelter admission for the general population. Logistic regression results show that intravenous drug user history (OR = 3.14); no private insurance (OR = 2.93); black race (OR = 2.82); pulmonary or extra-pulmonary TB (OR = 1.43); and pneumocystis pneumonia (OR = 0.56) were all related to the risk for shelter admission. Homelessness prevention programmes should target people with HIV risk factors, and HIV prevention programmes should be targeted to homeless persons, as these populations have significant intersection. Reasons and implications for this intersection are discussed.

Predictors of frequent withdrawal management unit use among chronically homeless, homeless, and housed men: a retrospective cohort study.

PubMed

Svoboda, Tomislav

2013-01-01

Reports suggest that repeat users of detoxification services are less likely to get rehabilitated. The goal of this study is to determine rates and predictors of detoxification unit visits among individuals who are chronically homeless with severe drinking problems compared to those who are housed and in the general homeless population. Visit records (n = 1027) from all inner city Toronto detoxification units (n = 5) by men (n = 169) over a 6 year period were analyzed and linked to structured interview data for three populations: chronically homeless individuals with severe drinking problems (CHDP, n = 50); members of the general homeless population (GH, n = 61); and low-income housed individuals (LIH, n = 58). The CHDP group had 4.13 (3.86, 4.39) detoxification unit admissions per year, 18.1 (95% CI 12.5-23.7) and 33 (95% CI 21-46) times higher than the GH and LIH groups respectively. Admission rates were 43.8 % (95% CI 32.7-54.9%) higher in the winter than summer months for the CHDP group. The proportions of stays that involved police, leaving without discharge, and staying two days or less were 74%, 75%, and 89% among CHDP, GH, and LIH subjects. Rather than being a resource for achieving abstinence, frequent short visits, treatment non-compliance, higher winter visit rates suggest that detoxification units are more likely used by individuals as shelter; high rates of admission related police involvement suggest that they continue to be used as an alternative to judicial intervention into public inebriation. Copyright © American Academy of Addiction Psychiatry.

It takes a village: a community partnership model in caring for the homeless.

PubMed

Zazworsky, Donna; Johnson, Nancy

2014-01-01

Population health management calls for hospitals and health care entities to better align their strategies in order to deliver quality care more efficiently. Although these efforts tend to be addressed with insured populations, the homeless demand a very intentional focus. The issue of homelessness has adverse effects on the health care system, resulting in the inefficient use of resources. Community-wide efforts must be mobilized to address this inefficiency and need for preventative care and self-management education for this population. Carondelet Health Network, in partnership with El Rio Community Health Center, a federally qualified health center, along with other health care and social service providers, has established the Southern Arizona Health Village for the Homeless, providing a health care delivery system to ensure the best functional and clinical outcomes. This system includes a van (the Van of Hope), licensed as a health center, and staffed with an El Rio Community Health Center nurse practitioner and a medical assistant partnering with a Carondelet Health Network behavioral health specialist and a community outreach worker. Clinical patient information is managed via an electronic health record inclusive of clinical data, number of visits, referrals, self-management education, hospitalizations, and follow-up care. A post-hospital program with shelters and an Emergency Room Navigation Program are additional components of the village that provide a comprehensive pre-acute and post-acute effort to support the homeless. Financial impact is measured by reductions in hospitalizations and average length of stay.

Individual and Social Network Sexual Behavior Norms of Homeless Youth at High Risk for HIV Infection

PubMed Central

Tyler, Kimberly A.; Melander, Lisa A.

2012-01-01

Although previous research shows that homeless youth engage in numerous risky sexual behaviors, little is known about whether or not specific rules govern this conduct within their social networks and how group norms influence subsequent sexual actions. The current study utilizes 19 in-depth interviews with homeless youth to investigate different elements of their sexual behavior. Findings reveal that their decision to have sex generally depends on chemistry and physical appearance whereas a potential partner’s risky sexual history and heavy substance use discourages youth from engaging in sex. Both males and females discuss condom usage as it relates to unknown sexual history, availability, pregnancy, and the prevention of sexually transmitted infections (STIs). Sixteen homeless youth indicate that they do not discuss safe sex practices with their partners or social network members. PMID:23162182

Individual and Social Network Sexual Behavior Norms of Homeless Youth at High Risk for HIV Infection.

PubMed

Tyler, Kimberly A; Melander, Lisa A

2012-12-01

Although previous research shows that homeless youth engage in numerous risky sexual behaviors, little is known about whether or not specific rules govern this conduct within their social networks and how group norms influence subsequent sexual actions. The current study utilizes 19 in-depth interviews with homeless youth to investigate different elements of their sexual behavior. Findings reveal that their decision to have sex generally depends on chemistry and physical appearance whereas a potential partner's risky sexual history and heavy substance use discourages youth from engaging in sex. Both males and females discuss condom usage as it relates to unknown sexual history, availability, pregnancy, and the prevention of sexually transmitted infections (STIs). Sixteen homeless youth indicate that they do not discuss safe sex practices with their partners or social network members.

75 FR 24514 - Supportive Services for Veteran Families Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

...This proposed rule would establish regulations concerning the Supportive Services for Veteran Families Program (SSVF Program) of the Department of Veterans Affairs (VA). This proposed rule is necessary to implement the provisions of section 604 of the Veterans' Mental Health and Other Care Improvements Act of 2008. The purpose of the SSVF Program is to provide supportive services grants to private non-profit organizations and consumer cooperatives who would coordinate or provide supportive services to very low-income veteran families who are residing in permanent housing, are homeless and scheduled to become residents of permanent housing within a specified time period, or after exiting permanent housing, are seeking other housing that is responsive to such very low-income veteran family's needs and preferences. The new SSVF Program is within the continuum of VA's homeless services programs.

Factors Associated with Community Participation among Individuals Who Have Experienced Homelessness.

PubMed

Chang, Feng-Hang; Helfrich, Christine A; Coster, Wendy J; Rogers, E Sally

2015-09-10

Community participation is an important goal for people who have experienced homelessness. The aim of this study was to use the International Classification of Functioning, Disability and Health (ICF) as a framework to examine factors associated with community participation among people who are homeless or recently housed through housing programs. Participants (n = 120) recruited from six housing placement and search programs completed measures of community participation (including productivity, social and leisure, and community-services-use domains), psychiatric and physical symptoms, functional limitations, and a demographic form. Multiple regression analyses were used to identify predictors of overall community participation and subdomain scores. Results suggested that cognitive and mobility limitations, relationship status, and housing status significantly predicted both overall participation and participation in productivity and social and leisure subdomains. Participants who were housed through housing programs, who had cognitive and mobility limitations, and who were single showed less community participation. The findings suggest that activity limitations and environmental and personal factors may need to be addressed in efforts to enhance community participation in this population.

Viral hepatitis in a homeless shelter in Hawai'i.

PubMed

Boyce, Daniel E C; Tice, Alan D; Ona, Fernando V; Akinaka, Kenneth T; Lusk, Heather

2009-06-01

It is estimated that as many as 21,000 people in the state of Hawai'i may be infected with HCV Most of those infected with viral hepatitis are unaware they are infected. Complications from viral hepatitis include liver cirrhosis and hepatocellular carcinoma. Hawai'i has the highest incidence of hepatocellular carcinoma in the United States. In 2003 there were over 6000 homeless and over 155,000 people at-risk of becoming homeless living in the state of Hawai'i. Risk factors for hepatitis, such as drug use, tattoos, sexual contact, and sharing of personal hygiene equipment are more prevalent in the homeless population. To determine the incidence of hepatitis B and C among a population of homeless individuals, a health fair was held at a Honolulu area homeless shelter with approximately 200 residents. The incidence of hepatitis B and C was determined by anti-HCV and HBsAg blood tests. A survey was also conducted regarding risk factors and basic demographics. Fifty-nine homeless adults volunteered for testing and took the survey. Thirty-one (52%) volunteers were born in Micronesia, twenty-four (41%) were born in the United States, two (3%) were born in Samoa, one (2%) was born in the Philippines, and one (2%) was born in the Marshall Islands. Forty adults were tested for Hepatitis C antibody, three of which tested positive. The primary risk factor among this group was jail time (100%), followed by illegal drug injection (67%), tattoos (67%), ear/body piercing (67%), snorting drugs (33%), blood transfusions (33%), and a sex partner with hepatitis (33%). Forty adults were also tested for HBsAg, One of which tested positive. This was a recent immigrant from Micronesia. Homeless people in Hawai'i are more likely to have hepatitis B or C because risk factors are common among this population. Additionally a large proportion of Hawai'i's homeless people come from the Pacific Islands, where the prevalence of hepatitis B is one of the highest in the world. In addition there are significant risks of hepatitis spread among the homeless and into the general population as many homeless do not realize they are infected. The health fair approach was an effective means for screening homeless people for hepatitis B and C. Our preliminary information suggests homeless shelters may be a good place for education, screening, and possibly interventions as well.

Self-harm among the homeless population in Ireland: A national registry-based study of incidence and associated factors.

PubMed

Barrett, Peter; Griffin, Eve; Corcoran, Paul; O'Mahony, Mary T; Arensman, Ella

2018-03-15

Self-harm is a strong predictor of future suicide, but little is known about self-harm among the homeless population. The study aim was to estimate the incidence of self-harm among the homeless population and to assess factors associated with self-harm. Data on self-harm presentations to 34 hospital emergency departments in Ireland were collected by the National Self-Harm Registry Ireland (NSHRI). Index presentations between 2010 and 2014 were included for the homeless and fixed residence populations. Incidence rates of self-harm were calculated using NSHRI data and census estimates. Factors associated with self-harm and repeated self-harm were analysed by multivariable-adjusted logistic regression. The age-standardised incidence rate of self-harm was 30 times higher among the homeless (5572 presentations per 100,000) compared with those with a fixed residence (187 presentations per 100,000). Homeless people had significantly higher odds of being male (OR 1.86, 95%CI 1.56-2.23), presenting with self-cutting (vs. overdose, OR 2.15, 95%CI 1.74-2.66) and having psychiatric admission (vs. general admission, OR 2.43, 95%CI 1.66-3.57). Homeless people had higher odds of self-harm repetition within 12 months (vs. fixed residence, OR 1.46, 95%CI 1.21-1.77). The odds of repetition were significantly increased among homeless who engaged in self-cutting (vs. overdose, OR 1.76, 95%CI 1.17-2.65) and did not receive psychiatric review at index presentation (vs. reviewed, OR 1.54, 95%CI 1.05-2.26). The study only reflects self-harm presenting to hospital, and assumes no change in homelessness status after index presentation. Residual confounding may affect the results. There is a disproportionate burden of self-harm among the homeless. Targeted preventive actions are warranted. Copyright © 2017 Elsevier B.V. All rights reserved.

U.S. Minority Homeless Youth's Access to and Use of Mobile Phones: Implications for mHealth Intervention Design.

PubMed

Jennings, Larissa; Lee, Nicole; Shore, Deborah; Strohminger, Nancy; Allison, Burgundi; Conserve, Donaldson F; Cheskin, Lawrence J

2016-07-01

Few interventions for homeless youth have leveraged the potential of mHealth technologies, in part because of the limited data on phone behaviors, perceptions, and intervention preferences among youth experiencing homelessness. We conducted 9 focus groups (n = 52 homeless youth) and 41 individual structured interviews also with homeless youth in underserved communities in Baltimore and Washington, DC, to ascertain how youth perceived their mobile phone, acquired and maintained mobile services over time, and thought mHealth programs for this population should be designed. We also measured phone use, functionality, source, duration of ownership, and reasons for changing phones or numbers. Results showed that mobile coverage was high, as most youth self-purchased phones or received gift payments from others. Maintaining mobile connectivity was often challenging because of financial constraints and interpersonal conflict. Youth valued phones to access social support but used several tactics to avoid perceived negative consequences of phone ownership, such as harassment, theft, or relational disputes. Youth most preferred mHealth content relating to sexual, reproductive, and mental health provided that mobile communication was confidential, empowering, and integrated with other digital media. Integrating hidden phones, financial support, and safety management may improve homeless youth's access to and engagement with mHealth strategies over time.

Challenges to immunization: the experiences of homeless youth.

PubMed

Doroshenko, Alexander; Hatchette, Jill; Halperin, Scott A; MacDonald, Noni E; Graham, Janice E

2012-07-04

Homelessness is a critical social issue, both a product of, and contributing to, poor mental and physical health. Over 150,000 young Canadians live on the streets. Homeless youth experience a high incidence of infectious diseases, many of which are vaccine preventable. Early departure from school and limited access to public health services makes them a particularly vulnerable high-risk group. This study explores challenges to obtaining essential vaccines experienced by homeless youth. A qualitative research study to explore knowledge, attitudes, beliefs, and experiences surrounding immunization of hard-to-reach homeless youth was designed. Participants were recruited for focus groups from Phoenix House and Shelter, a non-profit, community-based organization assisting homeless youth in Halifax, Nova Scotia, Canada. An experienced facilitator guided the recorded discussions. Transcripts of audiotapes were analyzed using a constant comparative method until data revealed a set of exemplars and themes that best captured participants' knowledge, attitudes, beliefs and experiences surrounding immunization and infectious diseases. Important themes emerged from our analysis. Considerable variability in knowledge about immunization and vaccine preventable diseases was found. The homeless youth in the study had limited awareness of meningitis in contrast to a greater knowledge about sexually transmitted infections and influenza, gained during the H1N1/09 public health campaign. They recognized their poverty as a risk for contracting infectious diseases, along with their inability to always employ known strategies to prevent infectious diseases, due to circumstances. They showed considerable insight into the detrimental effects of poor hygiene, sleeping locations and risk behaviour. Interviewed homeless youth regarded themselves as good compliers of health professional advice and offered valuable suggestions to improve immunization in their population. To provide effective public health interventions, it is necessary to consider the knowledge, attitudes, beliefs, and experiences of hard to reach, high risk groups. Our study shows that homeless youth are interested and capable in discussing immunization. Active targeting of homeless youth for public health immunization programs is needed. Working collaboratively with non-profit organizations that assist homeless youth provides an opportunity to increase their knowledge of infectious risks and to improve immunization strategies in this vulnerable group.

Challenges to immunization: the experiences of homeless youth

PubMed Central

2012-01-01

Background Homelessness is a critical social issue, both a product of, and contributing to, poor mental and physical health. Over 150,000 young Canadians live on the streets. Homeless youth experience a high incidence of infectious diseases, many of which are vaccine preventable. Early departure from school and limited access to public health services makes them a particularly vulnerable high-risk group. This study explores challenges to obtaining essential vaccines experienced by homeless youth. Methods A qualitative research study to explore knowledge, attitudes, beliefs, and experiences surrounding immunization of hard-to-reach homeless youth was designed. Participants were recruited for focus groups from Phoenix House and Shelter, a non-profit, community-based organization assisting homeless youth in Halifax, Nova Scotia, Canada. An experienced facilitator guided the recorded discussions. Transcripts of audiotapes were analyzed using a constant comparative method until data revealed a set of exemplars and themes that best captured participants’ knowledge, attitudes, beliefs and experiences surrounding immunization and infectious diseases. Results Important themes emerged from our analysis. Considerable variability in knowledge about immunization and vaccine preventable diseases was found. The homeless youth in the study had limited awareness of meningitis in contrast to a greater knowledge about sexually transmitted infections and influenza, gained during the H1N1/09 public health campaign. They recognized their poverty as a risk for contracting infectious diseases, along with their inability to always employ known strategies to prevent infectious diseases, due to circumstances. They showed considerable insight into the detrimental effects of poor hygiene, sleeping locations and risk behaviour. Interviewed homeless youth regarded themselves as good compliers of health professional advice and offered valuable suggestions to improve immunization in their population. Conclusions To provide effective public health interventions, it is necessary to consider the knowledge, attitudes, beliefs, and experiences of hard to reach, high risk groups. Our study shows that homeless youth are interested and capable in discussing immunization. Active targeting of homeless youth for public health immunization programs is needed. Working collaboratively with non-profit organizations that assist homeless youth provides an opportunity to increase their knowledge of infectious risks and to improve immunization strategies in this vulnerable group. PMID:22568937

Problems of Runaway Youth. Hearing before the Subcommittee on Juvenile Justice of the Committee on the Judiciary. United States Senate, Ninety-Seventh Congress, Second Session on Problems of and Services Provided for Runaway and Homeless Youth, Focusing on Support to State and Local Governments and Nonprofit Agencies for the Development of Community-Based Programs.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on the Judiciary.

These hearings, focusing on financial support for community-based programs dealing with problems of runaway and homeless youths, explore the scope of the problem, types of activities which are being undertaken, and paths for future action. Testimony and prepared statements are presented by several witnesses including a commissioner of the…

Characteristics of Violent Deaths Among Homeless People in Maryland, 2003-2011.

PubMed

Stanley, Jennifer L; Jansson, Alexandra V; Akinyemi, Adebola A; Mitchell, Clifford S

2016-11-01

People experiencing homelessness are susceptible to many adverse health events, including violence. The purpose of this study was to provide a descriptive analysis of homeless individuals who suffered a violent death in Maryland. Characterizing these deaths will provide a basis for additional analyses that can inform violence prevention activities. This study used data from the Maryland Violent Death Reporting System to examine violent deaths of homeless people occurring from 2003 through 2011. This surveillance system collects information on all violent deaths occurring in Maryland. Victim demographics, injury and death information, precipitating circumstances contributing to deaths, and toxicology information were examined. All analyses were conducted in 2014 and 2015. Among all violent death victims from 2003 through 2011 (N=14,327), a total of 279 (2.0%) were identified as homeless victims. More than half (65.2%) of deaths were of undetermined intent, 21.2% were homicides, and 13.6% were suicides. The most common method of injury was poisoning (59.0%). Substance abuse and having a current mental health problem were among the most commonly reported circumstances relating to death. This study found substance abuse and mental health problems to be major circumstances precipitating violent death among people experiencing homelessness. This study will serve as a starting point for more in-depth analyses on experiences of violent death among homeless people that can inform violence prevention policy and programming. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Runaway and pregnant: risk factors associated with pregnancy in a national sample of runaway/homeless female adolescents.

PubMed

Thompson, Sanna J; Bender, Kimberly A; Lewis, Carol M; Watkins, Rita

2008-08-01

Homeless youth are at particularly high risk for teen pregnancy; research indicates as many as 20% of homeless young women become pregnant. These pregnant and homeless teens lack financial resources and adequate health care, resulting in increased risk for low-birth-weight babies and high infant mortality. This study investigated individual and family-level predictors of teen pregnancy among a national sample of runaway/homeless youth in order to better understand the needs of this vulnerable population. Data from the Runaway/Homeless Youth Management Information System (RHY MIS) provided a national sample of youth seeking services at crisis shelters. A sub-sample of pregnant females and a random sub-sample (matched by age) of nonpregnant females comprised the study sample (N = 951). Chi-square and t tests identified differences between pregnant and nonpregnant runaway females; maximum likelihood logistic regression identified individual and family-level predictors of teen pregnancy. Teen pregnancy was associated with being an ethnic minority, dropping out of school, being away from home for longer periods of time, having a sexually transmitted disease, and feeling abandoned by one's family. Family factors, such as living in a single parent household and experiencing emotional abuse by one's mother, increased the odds of a teen being pregnant. The complex problems associated with pregnant runaway/homeless teens create challenges for short-term shelter services. Suggestions are made for extending shelter services to include referrals and coordination with teen parenting programs and other systems of care.

Persistent Super-Utilization of Acute Care Services Among Subgroups of Veterans Experiencing Homelessness.

PubMed

Szymkowiak, Dorota; Montgomery, Ann Elizabeth; Johnson, Erin E; Manning, Todd; O'Toole, Thomas P

2017-10-01

Acute health care utilization often occurs among persons experiencing homelessness. However, knowing which individuals will be persistent super-utilizers of acute care is less well understood. The objective of the study was to identify those more likely to be persistent super-utilizers of acute care services. We conducted a latent class analysis of secondary data from the Veterans Health Administration Corporate Data Warehouse, and Homeless Operations Management and Evaluation System. The study sample included 16,912 veterans who experienced homelessness and met super-utilizer criteria in any quarter between July 1, 2014 and December 31, 2015. The latent class analysis included veterans' diagnoses and acute care utilization. Medical, mental health, and substance use morbidity rates were high. More than half of the sample utilized Veterans Health Administration Homeless Programs concurrently with their super-utilization of acute care. There were 7 subgroups of super-utilizers, which varied considerably on the degree to which their super-utilization persisted over time. Approximately a third of the sample met super-utilizer criteria for ≥3 quarters; this group was older and disproportionately male, non-Hispanic white, and unmarried, with lower rates of post-9/11 service and higher rates of rural residence and service-connected disability. They were much more likely to be currently homeless with more medical, mental health, and substance use morbidity. Only a subset of homeless veterans were persistent super-utilizers, suggesting the need for more targeted interventions.

Cost of health care utilization among homeless frequent emergency department users.

PubMed

Mitchell, Matthew S; León, Casey L K; Byrne, Thomas H; Lin, Wen-Chieh; Bharel, Monica

2017-05-01

Research demonstrates that homelessness is associated with frequent use of emergency department (ED) services, yet prior studies have not adequately examined the relationship between frequent ED use and utilization of non-ED health care services among those experiencing homelessness. There has also been little effort to assess heterogeneity among homeless individuals who make frequent use of ED services. To address these gaps, the present study used Medicaid claims data from 2010 to estimate the association between the number of ED visits and non-ED health care costs for a cohort of 6,338 Boston Health Care for the Homeless Program patients, and to identify distinct subgroups of persons in this cohort who made frequent use of ED services based on their clinical and demographic characteristics. A series of gamma regression models found more frequent ED use to be associated with higher non-ED costs, even after adjusting for demographic and clinical characteristics. Latent class analysis was used to examine heterogeneity among frequent ED users, and the results identified 6 characteristically distinct subgroups among these persons. The subgroup of persons with trimorbid illness had non-ED costs that far exceeded members of all 5 other subgroups. Study findings reinforce the connection between frequent ED use and high health care costs among homeless individuals and suggest that different groups of homeless frequent ED users may benefit from interventions that vary in terms of their composition and intensity. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Does experiencing homelessness affect women’s motivation to change alcohol or drug use??

PubMed Central

Upshur, Carole C.; Weinreb, Linda; Cheng, Debbie M.; Kim, Theresa W.; Samet, Jeffrey H.; Saitz, Richard

2013-01-01

Background and Objectives Homeless women are at high risk of drug and alcohol dependence and may receive less opportunity for treatment. Our objective was to examine the association between experiencing homelessness and motivation to change drug or alcohol use. Methods Women (n=154) participants in a study of substance dependence at an urban medical center (69 with some homeless days in the last 90 days; 85 continuously housed at baseline) completed 6 items rating motivation to change alcohol or drug use (i.e., importance, readiness, and confidence) at baseline and in 3, 6, and 12-month follow up interviews. Unadjusted, and longitudinal analyses controlling for covariates (e.g., demographics, insurance status, substance use consequences, mental health status, and participation in treatment), were conducted. Results There were no significant differences between women experiencing homeless days versus continuously housed women in the odds of reporting high motivation to change alcohol or drug use, either in unadjusted baseline analyses or longitudinal analyses adjusted for covariates. Covariates that were significantly associated with high importance, readiness or confidence to change behavior were higher life time consequences of substance use, and participation in 12-step programs. Discussion and Conclusions The findings suggest that clinicians should not make assumptions that homeless women have low motivation to change their substance use. Scientific Significance and Future Directions The same opportunities for addiction treatment should be offered to homeless as to housed women. PMID:24313245

Effects of social support and conflict on parenting among homeless mothers.

PubMed

Marra, Jaime V; McCarthy, Elissa; Lin, Hsiu-Ju; Ford, Julian; Rodis, Eleni; Frisman, Linda K

2009-07-01

Research has shown that having a supportive social network is generally beneficial for individuals, particularly those who are homeless or at risk of homelessness. However, conflict within these networks may diminish the positive effects of social support on well-being, and these effects may be felt acutely within a vulnerable population with multiple needs. This study examined the impact of conflict and social support on parenting behaviors in a sample of mothers who are homeless and were involved in a study of case management interventions of varying intensity. We found that women who reported high emotional and instrumental social support self-reported greater improvements in parenting consistency over time than those who reported lower levels of support. However, three-way interactions showed that conflict in support networks was a risk factor for harsh parenting practices among participants who reported lower levels of instrumental social support. Results suggest that social support may enhance homeless mothers' ability to provide consistent parenting, but that these benefits may be undermined if conflict occurs in combination with limited levels of instrumental social support.

77 FR 23491 - Notice of Submission of Proposed Information Collection to OMB; Continuum of Care Homeless...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... Program, and changed to match the new inclusive program name created through the HEARTH Act. DATES... Occupancy Program, and changed to match the new inclusive program name created through the HEARTH Act...

"Rewarding and challenging at the same time": emergency medicine residents' experiences caring for patients who are homeless.

PubMed

Doran, Kelly M; Curry, Leslie A; Vashi, Anita A; Platis, Stephanie; Rowe, Michael; Gang, Maureen; Vaca, Federico E

2014-06-01

The objectives were to examine how emergency medicine (EM) residents learn to care for patients in the emergency department (ED) who are homeless and how providing care for patients who are homeless influences residents' education and professional development as emergency physicians. We conducted in-depth, one-on-one interviews with EM residents from two programs. A random sample of residents stratified by training year was selected from each site. Interviews were digitally recorded and professionally transcribed. A team of researchers with diverse content-relevant expertise reviewed transcripts independently and applied codes to text segments using a grounded theory approach. The team met regularly to reconcile differences in code interpretations. Data collection and analysis occurred iteratively, and interviews continued until theoretical saturation was achieved. Three recurring themes emerged from 23 resident interviews. First, residents learn unique aspects of EM by caring for patients who are homeless. This learning encompasses both specific knowledge and skills (e.g., disease processes infrequently seen in other populations) and professional development as an emergency physician (e.g., the core value of service in EM). Second, residents learn how to care for patients who are homeless through experience and informal teaching rather than through a formal curriculum. Residents noted little formal curricular time dedicated to homelessness and instead learned during clinical shifts through personal experience and by observing more senior physicians. One unique method of learning was through stories of "misses," in which patients who were homeless had bad outcomes. Third, caring for patients who are homeless affects residents emotionally in complex, multifaceted ways. Emotions were dominated by feelings of frustration. This frustration was often related to feelings of futility in truly helping homeless patients, particularly for patients who were frequent visitors to the ED and who had concomitant alcohol dependence. Caring for ED patients who are homeless is an important part of EM residency training. Our findings suggest the need for increased formal curricular time dedicated to the unique medical and social challenges inherent in treating patients who are homeless, as well as enhanced support and resources to improve the ability of residents to care for this vulnerable population. Future research is needed to determine if such interventions improve EM resident education and, ultimately, result in improved care for ED patients who are homeless. © 2014 by the Society for Academic Emergency Medicine.

Photography and Oral History as a Means of Chronicling the Homeless in Miami: The "StreetWays" Project

ERIC Educational Resources Information Center

Provenzo, Eugene F.; Ameen, Edward; Bengochea, Alain; Doorn, Kristen; Pontier, Ryan; Sembiante, Sabrina

2011-01-01

This article describes the use of Photography and Oral History research methods as part of a collaborative research project on homelessness in Miami. Issues involving the use of documentary photography and oral history as a means of creating greater social awareness in the general public are explored, as well as broader issues of Social Justice.…

Effective interventions for homeless youth: a systematic review.

PubMed

Altena, Astrid M; Brilleslijper-Kater, Sonja N; Wolf, Judith L M

2010-06-01

To date, there has not been clear evidence regarding interventions that are effective in addressing the specific needs of homeless youth. A systematic and comprehensive international review on effective interventions for homeless youth is presented. This study seeks to provide an accurate and complete picture of effective interventions for homeless youth by collecting, summarizing, categorizing, and evaluating quantitative studies (i.e., those that have assessed treatment outcomes). EVIDENCE ACQUISTION: The following databases were searched in 2008: PsycINFO, ERIC, MEDLINE, and Cochrane were searched from 1985 through 2008 using specific key words: interventions and programs, with homeless youth (s), homeless adolescents, street youth (s), runaways and throwaways. In addition, references of key articles were searched by hand. Eleven studies met pre-established inclusion criteria. To determine study quality, a set of operational parameters was formulated to rate each study as either good, fair, or poor. There is no compelling evidence that specific interventions are effective for homeless youth, owing to moderate study quality and the small number of intervention studies. Conclusions that can be drawn from the studies are limited by the heterogeneity of interventions, participants, methods, and outcome measures. Many interventions focused on reduction of substance abuse, whereas other important outcomes, such as quality of life, have received little attention. No study received a quality rating of good, and four studies were rated as fair. Most convincing, but still marginal, were results of interventions based on cognitive-behavioral approaches, which revealed some positive results on psychological measures. More methodologically sound research is needed to determine what specific interventions are beneficial for subgroups of homeless youth. Implications for future research are discussed. 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Substance use among persons with homeless experience in primary care.

PubMed

Stringfellow, Erin J; Kim, Theresa W; Gordon, Adam J; Pollio, David E; Grucza, Richard A; Austin, Erika L; Johnson, N Kay; Kertesz, Stefan G

2016-01-01

Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.

Substance Use Among Persons with Homeless Experience in Primary Care

PubMed Central

Stringfellow, Erin J.; Kim, Theresa W.; Gordon, Adam J.; Pollio, David E.; Grucza, Richard A.; Austin, Erika L.; Johnson, N. Kay; Kertesz, Stefan G.

2016-01-01

Background Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There is less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. Methods We surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at 5 federally-funded programs in the U.S., administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). We used the ASSIST definitions of lower, moderate, and high risk to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Results Almost one-half of the sample (n = 601) had recently (within the past 3 months) used alcohol, and one-third had recently used an illicit drug. The most commonly used illicit drugs in the past 3 months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one-half (59%) of respondents had ASSIST-defined moderate or high risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Conclusions Less severe (moderate risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high risk use in this primary care, homeless-experienced sample. Our findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons. PMID:26914448

Reliability and Validity of the World Health Organization Quality of Life: Brief Version (WHOQOL-BREF) in a Homeless Substance Dependent Veteran Population

ERIC Educational Resources Information Center

Garcia-Rea, Elizabeth A.; LePage, James P.

2010-01-01

With the high number of homeless, there is a critical need for rapid and accurate assessment of quality of life to assess program outcomes. The World Health Organization's WHOQOL-100 has demonstrated promise in accurately assessing quality-of-life in this population. However, its length may make large scale use impractical for working with a…

Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care.

PubMed

Basu, Anirban; Kee, Romina; Buchanan, David; Sadowski, Laura S

2012-02-01

To assess the costs of a housing and case management program in a novel sample-homeless adults with chronic medical illnesses. The study used data from multiple sources: (1) electronic medical records for hospital, emergency room, and ambulatory medical and mental health visits; (2) institutional and regional databases for days in respite centers, jails, or prisons; and (3) interviews for days in nursing homes, shelters, substance abuse treatment centers, and case manager visits. Total costs were estimated using unit costs for each service. Randomized controlled trial of 407 homeless adults with chronic medical illnesses enrolled at two hospitals in Chicago, Illinois, and followed for 18 months. Compared to usual care, the intervention group generated an average annual cost savings of (-)$6,307 per person (95 percent CI: -16,616, 4,002; p = .23). Subgroup analyses of chronically homeless and those with HIV showed higher per person, annual cost savings of (-)$9,809 and (-)$6,622, respectively. Results were robust to sensitivity analysis using unit costs. The findings of this comprehensive, comparative cost analyses demonstrated an important average annual savings, though in this underpowered study these savings did not achieve statistical significance. © Health Research and Educational Trust.

Exploring the potential of technology-based mental health services for homeless youth: A qualitative study.

PubMed

Adkins, Elizabeth C; Zalta, Alyson K; Boley, Randy A; Glover, Angela; Karnik, Niranjan S; Schueller, Stephen M

2017-05-01

Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths' use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18- to 20-years-old with current periods of homelessness ranging from 6 days to 4 years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings toward technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A Group-Based Motivational Interviewing Brief Intervention to Reduce Substance Use and Sexual Risk Behavior among Homeless Young Adults

PubMed Central

Tucker, Joan S.; D’Amico, Elizabeth J.; Ewing, Brett A.; Miles, Jeremy N. V.; Pedersen, Eric R.

2017-01-01

Homeless young adults ages 18–25 exhibit high rates of alcohol and other drug (AOD) use, and sexual risk behaviors such as unprotected sex. Yet few programs exist for this population that are both effective and can be easily incorporated into settings serving this population. This pilot cluster cross-over randomized controlled trial evaluates AWARE, a voluntary four session group-based motivational interviewing (MI) intervention to reduce AOD use and sexual risk behavior. We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County (mean age=21.8 years; 73% male; 79% heterosexual; 31% non-Hispanic White, 25% African American, 24% Hispanic, 21% multiracial/other). Surveys were completed at baseline and three months after program completion. Retention in the AWARE program was excellent (79% attended multiple sessions) and participants reported high levels of satisfaction with the program. AWARE participants self-reported positive change in their past 3 month and past 30 day alcohol use (ps ≤ .05), motivation to change drug use (ps < .05), and condom use self-efficacy (p = .05) compared to the control group. Among those with multiple sex partners, AWARE participants showed a decrease in unprotected sexual events (p < .05), whereas the control group did not. Results from this pilot evaluation are promising, suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use. Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes. PMID:28340904

Taking family planning services to hard-to-reach populations.

PubMed

Donovan, P

1996-01-01

Interviews were conducted in 1995 among 100 US family planning program personnel who serve hard-to-reach populations, such as drug abusers, prisoners, the disabled, homeless persons, and non-English speaking minorities. Findings indicate that a range of services is available for hard-to-reach groups. Most family planning agencies focus on drug abusers because of the severity of HIV infections and the availability of funding. This article describes the activities of various agencies in Michigan, Pennsylvania, and Massachusetts that serve substance abuse centers with family planning services. One recommendation for a service provider is to present services in an environment where it is safe to talk about a person's needs. One other program offered personal greetings upon arrival and the continuity of having a familiar face to oversee all reproductive and health needs. Programs for prisoners ranged from basic sex education classes to comprehensive reproductive health care. Some prisons offered individual counseling. Some programs were presented in juvenile offender facilities. Outreach to the homeless involved services at homeless shelters, outreach workers who recruited women into traditional family planning clinics, and establishment of nontraditional sites for the homeless and other hard-to-reach persons. One provider's suggestion was to offer services where high-risk women already go for other services. Most services to the disabled target the developmentally disabled rather than the physically disabled. Experience has shown that many professionals working with the disabled do not recognize their clients' sexual needs. Other hard-to-reach groups include women in housing projects and shelters for battered women, welfare applicants, and sex workers. Key to service provision is creating trust, overcoming language and cultural differences, and subsidizing the cost of care.

Unmet healthcare needs in homeless women with children in the Greater Paris area in France.

PubMed

Vuillermoz, Cécile; Vandentorren, Stéphanie; Brondeel, Ruben; Chauvin, Pierre

2017-01-01

Despite their poor health status, homeless women encounter many barriers to care. The objectives of our study were to estimate the prevalence of unmet healthcare needs in homeless women and to analyse associated relationships with the following factors: financial and spatial access to care, housing history, migration status, healthcare utilisation, victimization history, caring for children, social network and self-perceived health status. We used data from 656 homeless women interviewed during the ENFAMS representative survey of sheltered homeless families, conducted in the Paris region in 2013. Structural equation models (SEM) were used to estimate the impact of various factors on homeless women's unmet healthcare needs. Among those interviewed, 25.1% (95%CI[21.3-29.0]) had at least one unmet healthcare need over the previous year. Most had given up on visiting general practitioners and medical specialists. No association with factors related to financial access or to health insurance status was found. However, food insecurity, poor spatial health access and poor self-perceived health were associated with unmet healthcare needs. Self-perceived health appeared to be affected by victimization and depression. The lower prevalence of unmet healthcare needs in homeless women compared with women in stable housing situations suggests that homeless women have lower needs perceptions and/or lower expectations of the healthcare system. This hypothesis is supported by the results from SEM. Strategies to provide better access to care for this population should not only focus on financial interventions but also more broadly on spatial healthcare access, cultural norms, and perceptions of health. Reducing their unmet needs and improving their access to healthcare and prevention must include an improvement in their living, financial and housing conditions.

Unmet healthcare needs in homeless women with children in the Greater Paris area in France

PubMed Central

Vandentorren, Stéphanie; Brondeel, Ruben; Chauvin, Pierre

2017-01-01

Background Despite their poor health status, homeless women encounter many barriers to care. The objectives of our study were to estimate the prevalence of unmet healthcare needs in homeless women and to analyse associated relationships with the following factors: financial and spatial access to care, housing history, migration status, healthcare utilisation, victimization history, caring for children, social network and self-perceived health status. Methods We used data from 656 homeless women interviewed during the ENFAMS representative survey of sheltered homeless families, conducted in the Paris region in 2013. Structural equation models (SEM) were used to estimate the impact of various factors on homeless women’s unmet healthcare needs. Results Among those interviewed, 25.1% (95%CI[21.3–29.0]) had at least one unmet healthcare need over the previous year. Most had given up on visiting general practitioners and medical specialists. No association with factors related to financial access or to health insurance status was found. However, food insecurity, poor spatial health access and poor self-perceived health were associated with unmet healthcare needs. Self-perceived health appeared to be affected by victimization and depression. Discussion The lower prevalence of unmet healthcare needs in homeless women compared with women in stable housing situations suggests that homeless women have lower needs perceptions and/or lower expectations of the healthcare system. This hypothesis is supported by the results from SEM. Strategies to provide better access to care for this population should not only focus on financial interventions but also more broadly on spatial healthcare access, cultural norms, and perceptions of health. Reducing their unmet needs and improving their access to healthcare and prevention must include an improvement in their living, financial and housing conditions. PMID:28877209

The syringe gap: an assessment of sterile syringe need and acquisition among syringe exchange program participants in New York City

PubMed Central

Heller, Daliah I; Paone, Denise; Siegler, Anne; Karpati, Adam

2009-01-01

Background Programmatic data from New York City syringe exchange programs suggest that many clients visit the programs infrequently and take few syringes per transaction, while separate survey data from individuals using these programs indicate that frequent injecting – at least daily – is common. Together, these data suggest a possible "syringe gap" between the number of injections performed by users and the number of syringes they are receiving from programs for those injections. Methods We surveyed a convenience sample of 478 injecting drug users in New York City at syringe exchange programs to determine whether program syringe coverage was adequate to support safer injecting practices in this group. Results Respondents reported injecting a median of 60 times per month, visiting the syringe exchange program a median of 4 times per month, and obtaining a median of 10 syringes per transaction; more than one in four reported reusing syringes. Fifty-four percent of participants reported receiving fewer syringes than their number of injections per month. Receiving an inadequate number of syringes was more frequently reported by younger and homeless injectors, and by those who reported public injecting in the past month. Conclusion To improve syringe coverage and reduce syringe sharing, programs should target younger and homeless drug users, adopt non-restrictive syringe uptake policies, and establish better relationships with law enforcement and homeless services. The potential for safe injecting facilities should be explored, to address the prevalence of public injecting and resolve the 'syringe gap' for injecting drug users. PMID:19138414

A primary care-public health partnership addressing homelessness, serious mental illness, and health disparities.

PubMed

Weinstein, Lara Carson; Lanoue, Marianna D; Plumb, James D; King, Hannah; Stein, Brianna; Tsemberis, Sam

2013-01-01

People with histories of homelessness and serious mental illness experience profound health disparities. Housing First is an evidenced-based practice that is working to end homelessness for these individuals through a combination of permanent housing and community-based supports. The Jefferson Department of Family and Community Medicine and a Housing First agency, Pathways to Housing-PA, has formed a partnership to address multiple levels of health care needs for this group. We present a preliminary program evaluation of this partnership using the framework of the patient-centered medical home and the "10 Essential Public Health Services." Preliminary program evaluation results suggest that this partnership is evolving to function as an integrated person-centered health home and an effective local public health monitoring system. The Pathways to Housing-PA/Jefferson Department of Family and Community Medicine partnership represents a community of solution, and multiple measures provide preliminary evidence that this model is feasible and can address the "grand challenges" of integrated community health services.

An Exploratory Analysis of Unhealthy and Abusive Relationships for Adults with Serious Mental Illnesses Living in Supportive Housing.

PubMed

Forenza, Brad; Bermea, Autumn M

2017-08-01

Individuals living with serious mental illness are at high risk of chronic homelessness, victimization, and intimate partner violence. In recent years, supportive housing programs have emerged as one way to prevent homelessness and victimization for this population, while also expanding social interactions and social networks. In concert with a focal supportive housing program, this research conducted two focus groups with 18 individuals who have a serious mental illness diagnosis. The authors sought to answer the research question, "What are perceptions of healthy and unhealthy relationships among formerly homeless people with serious mental illness?" To this end, the eight-item questionnaire was created around dimensions of power and control, as well as relationship equality. Findings from an inductive thematic analysis reveal three broad families of themes (relationship ideals, lived experiences, and risk/resources in supportive housing), around which smaller themes and subthemes are organized. Implications for policy, practice, and future research are also discussed.

Leaving Homelessness Behind: Housing Decisions among Families Exiting Shelter1

PubMed Central

Fisher, Benjamin W.; Mayberry, Lindsay; Shinn, Marybeth; Khadduri, Jill

2014-01-01

Because homelessness assistance programs are designed to help families, it is important for policymakers and practitioners to understand how families experiencing homelessness make housing decisions, particularly when they decide not to use available services. This study explores those decisions using in-depth qualitative interviews with 80 families recruited in shelters across four sites approximately six months after they were assigned to one of four conditions (permanent housing subsidies, project-based transitional housing, community-based rapid re-housing, and usual care). Familiar neighborhoods near children’s schools, transportation, family and friends, and stability were important to families across conditions. Program restrictions on eligibility constrained family choices. Subsidized housing was the most desired intervention and families leased up at higher rates than in other studies of poor families. Respondents were least comfortable in and most likely to leave transitional housing. Uncertainty associated with community-based rapid re-housing generated considerable anxiety. Across interventions, many families had to make unhappy compromises, often leading to further moves. Policy recommendations are offered. PMID:25258503

Home for now: A mixed-methods evaluation of a short-term housing support program for homeless families.

PubMed

Meschede, Tatjana; Chaganti, Sara

2015-10-01

The use of short-term rental subsidy vouchers offers a new approach to addressing the housing needs of families facing homelessness. In Massachusetts, the Family Home pilot program placed homeless families in housing instead of shelter, providing two years of rental subsidy plus support services with the goal of enabling families to maintain market rate housing. This mixed-method case study complements staff and participant interview data with participant survey and administrative data to evaluate the implementation and short-term outcomes of Family Home in one region. Data point to improved family well-being in housing but also persistent barriers to achieving longer-term housing and economic stability. Of the families who had exited the program at the end of the study, one quarter were able to retain their housing at market rate, only 9% returned to shelter, and one in five moved in with families/friends. Lack of affordable housing in a high rental cost region and jobs that pay living wages were among the major reasons that families struggled to maintain housing. This research points to the need for integrating supportive services from the program's start, including targeted workforce development, to plan for the end of the short-term rental subsidy. Copyright © 2015 Elsevier Ltd. All rights reserved.

77 FR 27243 - Notice of Propose Information Collection for Public Comment; Continuum of Care Homeless...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-09

.... This Notice also lists the following information: Title of Proposal: HEARTH Continuum of Care Program... Occupancy Program, and changed to match the new inclusive program name created through the HEARTH Act. To...

Care Cascade for targeted tuberculosis testing and linkage to Care in Homeless Populations in the United States: a meta-analysis.

PubMed

Parriott, Andrea; Malekinejad, Mohsen; Miller, Amanda P; Marks, Suzanne M; Horvath, Hacsi; Kahn, James G

2018-04-12

Homelessness increases the risk of tuberculosis (TB) disease and latent TB infection (LTBI), but persons experiencing homelessness often lack access to testing and treatment. We assessed the yield of TB testing and linkage to care for programs targeting homeless populations in the United States. We conducted a comprehensive search of peer-reviewed and grey literature, adapting Cochrane systematic review methods. Two reviewers independently assessed study eligibility and abstracted key data on the testing to care cascade: number of persons reached, recruited for testing, tested for LTBI, with valid test results, referred to follow-up care, and initiating care. We used random effects to calculate pooled proportions and 95% confidence intervals (CI) of persons retained in each step via inverse-variance weighted meta-analysis, and cumulative proportions as products of adjacent step proportions. We identified 23 studies published between 1986 and 2014, conducted in 12 states and 15 cities. Among studies using tuberculin skin tests (TST) we found that 93.7% (CI 72.4-100%) of persons reached were recruited, 97.9% (89.3-100%) of those recruited had tests placed, 85.5% (78.6-91.3%) of those with tests placed returned for reading, 99.9% (99.6-100%) of those with tests read had valid results, and 24.7% (21.0-28.5%) with valid results tested positive. All persons testing positive were referred to follow-up care, and 99.8% attended at least one session of follow-up care. Heterogeneity was high for most pooled proportions. For a hypothetical cohort of 1000 persons experiencing homelessness reached by a targeted testing program using TST, an estimated 917 were tested, 194 were positive, and all of these initiated follow-up care. Targeted TB testing of persons experiencing homelessness appears effective in detecting LTBI and connecting persons to care and potential treatment. Future evaluations should assess diagnostic use of interferon gamma release assays and completion of treatment, and costs of testing and treatment.

Palliative care for homeless people: a systematic review of the concerns, care needs and preferences, and the barriers and facilitators for providing palliative care.

PubMed

Klop, Hanna T; de Veer, Anke J E; van Dongen, Sophie I; Francke, Anneke L; Rietjens, Judith A C; Onwuteaka-Philipsen, Bregje D

2018-04-24

Homeless people often suffer from complex and chronic comorbidities, have high rates of morbidity and die at much younger ages than the general population. Due to a complex combination of physical, psychosocial and addiction problems at the end of life, they often have limited access to palliative care. Both the homeless and healthcare providers experience a lot of barriers. Therefore, providing palliative care that fits the needs and concerns of the homeless is a challenge to healthcare providers. This systematic review aims to summarize evidence about the concerns, palliative care needs and preferences of homeless people, as well as barriers and facilitators for delivering high quality palliative care. PubMed, Embase, PsycINFO, CINAHL and Web of Science were searched up to 10 May 2016. Included were studies about homeless people with a short life expectancy, their palliative care needs and the palliative care provided, that were conducted in Western countries. Data were independently extracted by two researchers using a predefined extraction form. Quality was assessed using a Critical Appraisal instrument. The systematic literature review was based on the PRISMA statement. Twenty-seven publications from 23 different studies met the inclusion criteria; 15 studies were qualitative and eight were quantitative. Concerns of the homeless often related to end-of-life care not being a priority, drug dependence hindering adequate care, limited insight into their condition and little support from family and relatives. Barriers and facilitators often concerned the attitude of healthcare professionals towards homeless people. A respectful approach and respect for dignity proved to be important in good quality palliative care. A patient-centred, flexible and low-threshold approach embodying awareness of the concerns of homeless people is needed so that appropriate palliative care can be provided timely. Training, education and experience of professionals can help to accomplish this.

Dietary inadequacies observed in homeless men visiting an emergency night shelter in Paris.

PubMed

Darmon, N; Coupel, J; Deheeger, M; Briend, A

2001-04-01

To assess the dietary intake and the nutritional status of homeless men. A night emergency shelter in Paris, France. Dietary survey (48-h) including alcohol intake and a questionnaire on age, duration of homelessness, smoking habits. Subjects were also weighed and measured. Ninety-seven men aged 18-72 years (mean 43.3), of whom 54% were homeless for more than 18 months, 82% were smokers and 53% were regular and/or excessive drinkers. The BMI distribution was shifted towards low values, the percentage of wasted persons being four times higher than in the reference population. The mean total energy intake was 2376 kcal and included a high and highly variable percentage of energy derived from alcohol (12.0% Among drinkers, the mean ethanol intake was 90 g and there was a significant negative correlation between ethanol and non-alcoholic energy intakes. The median intakes of potassium, calcium, zinc, vitamins B1, B2, and niacin were lower than European Population Reference Intakes but only the mean intake of vitamin B1 was significantly lower. Eighty percent of non-alcoholic energy was provided by charitable organisations. For most nutrients, the nutritional density of the shelter ration was not significantly different from the density of the foods purchased by the homeless. These data suggest that the content of some nutrients should be increased in existing food assistance programs for homeless people in France.

Homeless Mentally Ill: Problems and Options in Estimating Numbers and Trends. Report to the Chairman, Committee on Labor and Human Resources, U.S. Senate.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Program Evaluation and Methodology Div.

In response to a request by the United States Senate Committee on Labor and Human Resources, the General Accounting Office (GAO) examined the methodological soundness of current population estimates of the number of homeless chronically mentally ill persons, and proposed several options for estimating the size of this population. The GAO reviewed…

Preliminary needs assessment of mobile technology use for healthcare among homeless veterans.

PubMed

McInnes, D Keith; Fix, Gemmae M; Solomon, Jeffrey L; Petrakis, Beth Ann; Sawh, Leon; Smelson, David A

2015-01-01

Background. Homeless veterans have complex healthcare needs, but experience many barriers to treatment engagement. While information technologies (IT), especially mobile phones, are used to engage patients in care, little is known about homeless veterans' IT use. This study examines homeless veterans' access to and use of IT, attitudes toward health-related IT use, and barriers to IT in the context of homelessness. Methods. Qualitative interviews were conducted with 30 homeless veterans in different housing programs in Boston, MA, ranging from emergency shelters to supportive transitional housing that allow stays of up to 2 years. Interviews were conducted in person, audio recorded and then transcribed. Three researchers coded transcripts. Inductive thematic analysis was used. Results. Most participants (90%) had a mobile phone and were receptive to IT use for health-related communications. A common difficulty communicating with providers was the lack of a stable mailing address. Some participants were using mobile phones to stay in touch with providers. Participants felt mobile-phone calls or text messages could be used to remind patients of appointments, prescription refills, medication taking, and returning for laboratory results. Mobile phone text messaging was seen as convenient, and helped participants stay organized because necessary information was saved in text messages. Some reported concerns about the costs associated with mobile phone use (calls and texting), the potential to be annoyed by too many text messages, and not knowing how to use text messaging. Conclusion. Homeless veterans use IT and welcome its use for health-related purposes. Technology-assisted outreach among this population may lead to improved engagement in care.

Preliminary needs assessment of mobile technology use for healthcare among homeless veterans

PubMed Central

Fix, Gemmae M.; Solomon, Jeffrey L.; Petrakis, Beth Ann; Sawh, Leon; Smelson, David A.

2015-01-01

Background. Homeless veterans have complex healthcare needs, but experience many barriers to treatment engagement. While information technologies (IT), especially mobile phones, are used to engage patients in care, little is known about homeless veterans’ IT use. This study examines homeless veterans’ access to and use of IT, attitudes toward health-related IT use, and barriers to IT in the context of homelessness. Methods. Qualitative interviews were conducted with 30 homeless veterans in different housing programs in Boston, MA, ranging from emergency shelters to supportive transitional housing that allow stays of up to 2 years. Interviews were conducted in person, audio recorded and then transcribed. Three researchers coded transcripts. Inductive thematic analysis was used. Results. Most participants (90%) had a mobile phone and were receptive to IT use for health-related communications. A common difficulty communicating with providers was the lack of a stable mailing address. Some participants were using mobile phones to stay in touch with providers. Participants felt mobile-phone calls or text messages could be used to remind patients of appointments, prescription refills, medication taking, and returning for laboratory results. Mobile phone text messaging was seen as convenient, and helped participants stay organized because necessary information was saved in text messages. Some reported concerns about the costs associated with mobile phone use (calls and texting), the potential to be annoyed by too many text messages, and not knowing how to use text messaging. Conclusion. Homeless veterans use IT and welcome its use for health-related purposes. Technology-assisted outreach among this population may lead to improved engagement in care. PMID:26246964

Runaway and Pregnant: Risk Factors Associated with Pregnancy in a National Sample of Runaway/Homeless Female Adolescents

PubMed Central

Thompson, Sanna J.; Bender, Kimberly A.; Lewis, Carol M.; Watkins, Rita

2009-01-01

Purpose Homeless youth are at particularly high risk for teen pregnancy; research indicates as many as 20% of homeless young women become pregnant. These pregnant and homeless teens lack financial resources and adequate health care, resulting in increased risk for low– birth-weight babies and high infant mortality. This study investigated individual and family-level predictors of teen pregnancy among a national sample of runaway/homeless youth in order to better understand the needs of this vulnerable population. Methods Data from the Runaway/Homeless Youth Management Information System (RHY MIS) provided a national sample of youth seeking services at crisis shelters. A sub-sample of pregnant females and a random sub-sample (matched by age) of nonpregnant females comprised the study sample (N= 951). Chi-square and t tests identified differences between pregnant and nonpregnant runaway females; maximum likelihood logistic regression identified individual and family-level predictors of teen pregnancy. Results Teen pregnancy was associated with being an ethnic minority, dropping out of school, being away from home for longer periods of time, having a sexually transmitted disease, and feeling abandoned by one's family. Family factors, such as living in a single parent household and experiencing emotional abuse by one's mother, increased the odds of a teen being pregnant. Conclusions The complex problems associated with pregnant runaway/homeless teens create challenges for short-term shelter services. Suggestions are made for extending shelter services to include referrals and coordination with teen parenting programs and other systems of care. PMID:18639785

Stewart B. McKinney Homeless Health Care, Education, Training, and Community Services Amendments of 1990. Report (to Accompany S. 2863. Senate, 101st Congress, 2d Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

This report is submitted to accompany a bill reauthorizing the Stewart B. McKinney Homeless Assistance Act programs within the jurisdiction of the Committee. In the report, the Committee recommends that the bill be passed with a suggested amendment in the nature of a substitute The report is divided into six parts. Part I,…

Social Network Decay as Potential Recovery from Homelessness: A Mixed Methods Study in Housing First Programming

PubMed Central

Golembiewski, Elizabeth; Watson, Dennis P.; Robison, Lisa; Coberg, John W.

2017-01-01

The positive relationship between social support and mental health has been well documented, but individuals experiencing chronic homelessness face serious disruptions to their social networks. Housing First (HF) programming has been shown to improve health and stability of formerly chronically homeless individuals. However, researchers are only just starting to understand the impact HF has on residents’ individual social integration. The purpose of the current study was to describe and understand changes in social networks of residents living in a HF program. Researchers employed a longitudinal, convergent parallel mixed method design, collecting quantitative social network data through structured interviews (n = 13) and qualitative data through semi-structured interviews (n = 20). Quantitative results demonstrated a reduction in network size over the course of one year. However, increases in both network density and frequency of contact with network members increased. Qualitative interviews demonstrated a strengthening in the quality of relationships with family and housing providers and a shedding of burdensome and abusive relationships. These results suggest network decay is a possible indicator of participants’ recovery process as they discontinued negative relationships and strengthened positive ones. PMID:28890807

Monetary incentives to reinforce engagement and achievement in a job-skills training program for homeless, unemployed adults.

PubMed

Koffarnus, Mikhail N; Wong, Conrad J; Fingerhood, Michael; Svikis, Dace S; Bigelow, George E; Silverman, Kenneth

2013-01-01

The current study examined whether monetary incentives could increase engagement and achievement in a job-skills training program for unemployed, homeless, alcohol-dependent adults. Participants (n=124) were randomized to a no-reinforcement group (n=39), during which access to the training program was provided but no incentives were given; a training reinforcement group (n=42), during which incentives were contingent on attendance and performance; or an abstinence and training reinforcement group (n=43), during which incentives were contingent on attendance and performance, but access was granted only if participants demonstrated abstinence from alcohol. abstinence and training reinforcement and training reinforcement participants advanced further in training and attended more hours than no-reinforcement participants. Monetary incentives were effective in promoting engagement and achievement in a job-skills training program for individuals who often do not take advantage of training programs. © Society for the Experimental Analysis of Behavior.

Exposure to hepatitis C virus in homeless men in Central Brazil: a cross-sectional study.

PubMed

Ferreira, Priscilla Martins; Guimarães, Rafael Alves; Souza, Christiane Moreira; Guimarães, Lara Cristina da Cunha; Barros, Cleiciane Vieira de Lima; Caetano, Karlla Antonieta Amorim; Rezza, Giovanni; Spadoni, Lila; Brunini, Sandra Maria

2017-01-18

Homeless men are highly vulnerable to acquisition of the hepatitis C virus (HCV) compared to the general population. In Brazil, a country of continental dimensions, the extent of HCV infection in this population remains unknown. The objective of this study is to investigate the epidemiological profile of exposure to HCV in homeless men in Central Brazil. A Cross-sectional study was conducted in 481 men aged over 18 years attending therapeutic communities specialized in the recovery and reintegration of homeless people. Participants were tested for anti-HCV markers using rapid tests. Poisson regression analysis was used to verify the risk factors associated with exposure to HCV. The prevalence of HCV exposure was 2.5% (95.0% CI: 1.4 to 4.3%) and was associated with age, absence of family life, injection drug use, number of sexual partners, and history of sexually transmitted infections (STI). Participants reported multiple risk behaviors, such as alcohol (78.9%), cocaine (37.1%) and/or crack use (53.1%), and inconsistent condom use (82.6%). Injection drug use was reported by 8.7% of participants. The prevalence of HCV infection among homeless men was relatively high. Several risk behaviors were commonly reported, which shows the high vulnerability of this population. These findings emphasize the need for the development of specific strategies to reduce the risk of HCV among homeless men.

The health diagnoses of homeless adolescents: a systematic review of the literature.

PubMed

Medlow, Sharon; Klineberg, Emily; Steinbeck, Kate

2014-07-01

Homelessness during adolescence impacts negatively upon young people's physical and mental wellbeing. To be effective, programs aimed at addressing the health needs of this population must include knowledge of both the presenting and underlying acute and chronic conditions that characterise this high risk group of youth. We undertook a systematic review of the international literature for studies that used validated instruments and techniques to diagnose prevalence rates of physical and mental health disorders in homeless adolescents. Twenty-one studies fulfilled the selection criteria. Of these, nine studies examined mental health diagnoses including depression, post-traumatic stress disorder, anxiety and substance abuse disorders. With one exception, the remaining twelve studies all related to sexually transmitted infections. Homeless adolescents are diagnosed with widely varying rates of mental health disorders and high rates of sexually transmitted infection. Other likely chronic and acute physical conditions appear to be neglected in the published research. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

A cluster analysis of service utilization and incarceration among homeless youth

PubMed Central

Kort-Butler, Lisa A.; Tyler, Kimberly A.

2012-01-01

Our paper examines service usage (e.g., shelter) as well as a typology of individuals who are most likely to use groupings of services among 249 homeless youth. Our results revealed that the majority of homeless young people have used food programs (66%) and street outreach (65%) on at least one occasion within the past year. Cluster analysis of services revealed four distinct groups: (1) basic survival service use, characterized by above average shelter, food, and outreach service use, but below average on counseling, substance abuse/ mental health services, and incarceration; (2) multiple service use, which included above average use of all six services; (3) incarceration experience, characterized by above average incarceration experience, but below average use of all other five services; and (4) minimal service use, which included slightly above average use of counseling, but below average use of all other services. These findings have the potential to provide important information that may assist with targeting services to homeless youth. PMID:23017796

Characterizing Stressors and Modifiable Health Risk Factors Among Homeless Smokers: An Exploratory Pilot Study.

PubMed

Kendzor, Darla E; Reitzel, Lorraine R; Businelle, Michael S

2015-10-01

This pilot study was conducted to explore the associations between stressors related to homelessness and modifiable health risk factors (poor diet, insufficient physical activity, and overweight/obesity) and to provide direction for future research. Participants (N = 57) were homeless adults enrolled in a smoking cessation program. Analyses were conducted to characterize the sample as well as the relations between relevant stressors (discrimination, chronic stress, and fear and mistrust) and health risk factors. Inadequate daily consumption of fruits, vegetables, and fiber was common. High-fat diet and insufficient physical activity were also prevalent, and the majority of participants were overweight/obese. Participants commonly endorsed discrimination, fear of victimization, mistrust of others, and several other stressors. Greater endorsement of stressors was associated with a high-fat diet. Results suggest that lifestyle interventions and policy changes may be warranted in homeless shelters to attenuate the potential effects of stressors on high-fat dietary consumption among smokers. © 2015 Society for Public Health Education.

Trichomonas vaginalis infection among homeless and unstably housed adult women living in a resource-rich urban environment.

PubMed

Riley, Elise D; Cohen, Jennifer; Dilworth, Samantha E; Grimes, Barbara; Marquez, Carina; Chin-Hong, Peter; Philip, Susan S

2016-06-01

The social context of poverty is consistently linked to Trichomonas vaginalis infection, yet few studies regarding T. vaginalis have been conducted exclusively among low-income individuals. We identified social determinants of health associated with prevalent T. vaginalis infection among homeless and unstably housed adult women. Between April and October of 2010, we conducted cross-sectional T. vaginalis screening and behavioural interviews in an existing cohort of San Francisco homeless and unstably housed women. Data were analysed using multivariable logistical regression. Among 245 study participants, the median age was 47 years and 72% were of non-Caucasian race/ethnicity. T. vaginalis prevalence was 12%, compared to 3% in the general population, and 33% of infected individuals reported no gynaecological symptoms. In adjusted analysis, the odds of T. vaginalis infection were lower among persons older than 47 years, the population median (OR=0.14, 95% CI 0.04 to 0.38), and higher among those reporting recent short-term homeless shelter stays (OR=5.36, 95% CI 1.57 to 18.26). Race and income did not reach levels of significance. Sensitivity analyses indicated that testing all women who report recent unprotected sex would identify more infections than testing those who report gynaecological symptoms (20/30 vs 10/30; p=0.01). The prevalence of T. vaginalis is high among homeless and unstably housed adult women, over one-third of infected individuals have no gynaecological symptoms, and correlates of infection differ from those reported in the general population. Targeted screening and treatment among impoverished women reporting recent unprotected sex, particularly young impoverished women and all women experiencing short-term homelessness, may reduce complications related to this treatable infection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Characteristics and treatment outcomes of tuberculosis cases by risk groups, Japan, 2007-2010.

PubMed

Uchimura, Kazuhiro; Ngamvithayapong-Yanai, Jintana; Kawatsu, Lisa; Ohkado, Akihiro; Yoshiyama, Takashi; Shimouchi, Akira; Ito, Kunihiko; Ishikawa, Nobukatsu

2013-01-01

We studied the characteristics and treatment outcomes of the following risk groups for tuberculosis (TB): those with HIV and diabetes mellitus (DM), contact cases, the homeless, foreigners, health care workers (HCW) and the elderly. A descriptive cross-sectional study was conducted by analysing the Japanese tuberculosis surveillance data of all cases registered between 2007 and 2010 (n = 96 689). The annual proportion of TB cases by risk group was stable over the study period, although there was a slight but significant increase observed for foreigners and elderly cases. Homeless and elderly TB cases had the highest DM co-morbidity (16.6% and 15.3%). HIV co-infection was low in all TB cases (0.2%) yet highest in foreigners (1.3%). HIV status of 45% of TB cases was unknown. The proportion of multi drug resistant (MDR) TB was similar among all risk groups (0.0-0.9%) except foreigners, at 3.4%. Males in most risk groups had higher mortality than females; the mortality of all TB cases in all age groups for both males and females were 3.6-24 times higher than the general population. Reasons for the high proportion of "HIV status unknown" should be investigated and improved. Contact tracing among foreign cases with MDR-TB should be a priority. Homeless persons should be screened for DM together with TB. Programs to enhance health and nutrition status may benefit tuberculosis prevention among the elderly. Tuberculosis screening and TB education are important for HCW.

Drug use patterns and predictors among homeless youth: results of an ecological momentary assessment.

PubMed

Santa Maria, Diane; Padhye, Nikhil; Yang, Yijiong; Gallardo, Kathryn; Santos, Glenn-Milo; Jung, Julie; Businelle, Michael

2017-12-29

Alcohol and drug use is associated with significant morbidity and mortality and is highly prevalent among homeless youth. Ecological Momentary Assessments (EMA) have been used to examine the effect of urges on drug use, though not among homeless youth. We assessed the patterns of drug use and the correlation between real-time contextual factors and drug use using EMA collected daily. We identified predictors of drug use among a sample of homeless youth 18-25 years old in Houston, Texas. Homeless youth (n = 66, 62% male) were recruited from a drop-in center between September 2015 and May 2016. We used generalized linear mixed models and cross-validation methods to determine the best predictive model of drug use. The overall drug use was high: 61% and 32% of participants reported using drugs or alcohol at least one day, respectively. Marijuana and synthetic marijuana use (i.e., Kush, K2, incense packs) were reported most frequently; 86% and 13% of the total drug use EMAs, respectfully. Drug use urge was reported on 26% of days and was the highest on drug use days. Drug use was predicted by discrimination, pornography use, alcohol use, and urges for drugs, alcohol, and to steal. EMA can be used to predict drug use among homeless youth. Drug use treatment among homeless youth should address the role of experiencing discrimination, pornography and alcohol use, and urge management strategies on drug use. Research is needed to determine if EMA informed just-in-time interventions targeting these predictors can reduce use.

Homeless Shelters' Policies on Sex Offenders: Is This Another Collateral Consequence?

PubMed

Rolfe, Shawn M; Tewksbury, Richard; Schroeder, Ryan D

2017-12-01

The primary focus of sex offender research has been on the efficacy and collateral consequences of sex offender registration and notification (SORN) and residence restrictions. Past scholarship has found these laws to cause numerous re-entry barriers for sex offenders. Such barriers have affected sex offenders' ability to find and maintain housing, employment, and social support. Moreover, registered sex offenders (RSOs) have become homeless due to such laws. Although previous scholarship has highlighted the collateral consequences of SORN, there is a lack of scholarship addressing homeless sex offenders. Specifically, the current study assesses policies regarding RSO access to homeless shelters in a four-state region, focusing on the effect of structural, procedural, and geographic factors, as well as a shelter's proximity to children. Drawing on the loose coupling organizational framework, the findings suggest that a small maximum occupancy, unwritten policies for RSOs, being in Kentucky or Tennessee, being located near a school, and being near a higher proportion of homes with children all decrease the odds that a homeless shelter allows RSOs. Furthermore, although unwilling to make exceptions to the policies regarding RSOs, shelters were generally willing to make exceptions to other policies governing shelter accessibility.

A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs.

PubMed

Simmons, Molly M; Gabrielian, Sonya; Byrne, Thomas; McCullough, Megan B; Smith, Jeffery L; Taylor, Thom J; O'Toole, Tom P; Kane, Vincent; Yakovchenko, Vera; McInnes, D Keith; Smelson, David A

2017-04-04

Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, "one-stop program" to address housing and health care needs of homeless veterans. However, while 70% of HPACT's veteran enrollees have co-occurring mental health and substance use disorders, HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One wraparound intervention designed to address the needs of homeless veterans with co-occurring mental health and substance use disorders which is suitable to be integrated into HPACT clinic sites is the evidence-based practice called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT clinics, implementation of an evidence-based intervention within a busy program like HPACT can be difficult. The current study is being undertaken to identify an appropriate implementation strategy for MISSION-Vet within HPACT. The study will test the implementation platform called Facilitation and compared to implementation as usual (IU). The aims of this study are as follows: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3) Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and describe key stakeholders' (patients, providers, staff) experiences with, and perspectives on, the barriers to, and facilitators of implementing MISSION. Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation across seven HPACT teams in three sites in the greater Los Angeles VA system. This is a cluster randomized trial. Integrating MISSION-Vet within HPACT has the potential to improve the health of thousands of veterans, but it is crucial to implement the intervention appropriately in order for it to succeed. The lessons learned in this protocol could assist with a larger roll-out of MISSION within HPACT. This protocol is registered with clinicaltrials.gov and was assigned the number NCT 02942979.

Relevance of a subjective quality of life questionnaire for long-term homeless persons with schizophrenia.

PubMed

Girard, V; Tinland, A; Bonin, J P; Olive, F; Poule, J; Lancon, C; Apostolidis, T; Rowe, M; Greacen, T; Simeoni, M C

2017-02-17

Increasing numbers of programs are addressing the specific needs of homeless people with schizophrenia in terms of access to housing, healthcare, basic human rights and other domains. Although quality of life scales are being used to evaluate such programs, few instruments have been validated for people with schizophrenia and none for people with schizophrenia who experience major social problems such as homelessness. The aim of the present study was to validate the French version of the S-QoL a self-administered, subjective quality of life questionnaire specific to schizophrenia for people with schizophrenia who are homeless. In a two-step process, the S-QoL was first administered to two independent convenience samples of long-term homeless people with schizophrenia in Marseille, France. The objective of the first step was to analyse the psychometric properties of the S-QoL. The objective of the second step was to examine, through qualitative interviews with members of the population in question, the relevance and acceptability of the principle quality of life indicators used in the S-QoL instrument. Although the psychometric characteristics of the S-QoL were found to be globally satisfactory, from the point of view of the people being interviewed, acceptability was poor. Respondents frequently interrupted participation complaining that questionnaire items did not take into account the specific context of life on the streets. Less intrusive questions, more readily understandable vocabulary and greater relevance to subjects' living conditions are needed to improve the S-QoL questionnaire for this population. A modular questionnaire with context specific sections or specific quality of life instruments for socially excluded populations may well be the way forward.

Oversight Hearing on Runaway and Homeless Youth Program. Hearing before the Subcommittee on Human Resources of the Committee on Education and Labor. House of Representatives, Ninety-Seventh Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Education and Labor.

These hearings present a performance review of and information about the Federal administration of the Runaway and Homeless Youth Act, which assists 169 centers for runaways throughout the country. The centers provide emergency shelter and family mediation for many of the youngsters who run away or who are directed to leave home by their parents.…

Attitudes Toward Smoking Cessation Among Sheltered Homeless Parents.

PubMed

Stewart, Holly C; Stevenson, Terrell N; Bruce, Janine S; Greenberg, Brian; Chamberlain, Lisa J

2015-12-01

The prevalence of smoking among homeless adults is approximately 70 %. Cessation programs designed for family shelters should be a high priority given the dangers cigarette smoke poses to children. However, the unique nature of smoking in the family shelter setting remains unstudied. We aimed to assess attitudes toward smoking cessation, and unique barriers and motivators among homeless parents living in family shelters in Northern California. Six focus groups and one interview were conducted (N = 33, ages 23-54). The focus groups and interviews were audiorecorded, transcribed verbatim, and a representative team performed qualitative theme analysis. Eight males and 25 females participated. The following major themes emerged: (1) Most participants intended to quit eventually, citing concern for their children as their primary motivation. (2) Significant barriers to quitting included the ubiquity of cigarette smoking, its central role in social interactions in the family shelter setting, and its importance as a coping mechanism. (3) Participants expressed interest in quitting "cold turkey" and in e-cigarettes, but were skeptical of the patch and pharmacotherapy. (4) Feelings were mixed regarding whether individual, group or family counseling would be most effective. Homeless parents may be uniquely motivated to quit because of their children, but still face significant shelter-based social and environmental barriers to quitting. Successful cessation programs in family shelters must be designed with the unique motivations and barriers of this population in mind.

Achieving Drug and Alcohol Abstinence Among Recently Incarcerated Homeless Women: A Randomized Controlled Trial Comparing Dialectical Behavioral Therapy-Case Management With a Health Promotion Program.

PubMed

Nyamathi, Adeline M; Shin, Sanghyuk S; Smeltzer, Jolene; Salem, Benissa E; Yadav, Kartik; Ekstrand, Maria L; Turner, Susan F; Faucette, Mark

Homeless female ex-offenders (homeless female offenders) exiting jail and prison are at a critical juncture during reentry and transitioning into the community setting. The purpose of the study was to compare the effect of a dialectical behavioral therapy-case management (DBT-CM) program with a health promotion (HP) program on achieving drug and alcohol abstinence among female parolees/probationers residing in the community. We conducted a multicenter parallel randomized controlled trial with 130 female parolees/probationers (aged 19-64 years) residing in the community randomly assigned to either DBT-CM (n = 65) or HP (n = 65). The trial was conducted in four community-based partner sites in Los Angeles and Pomona, California, from February 2015 to November 2016. Treatment assignment was carried out using a computer-based urn randomization program. The primary outcome was drug and alcohol use abstinence at 6-month follow up. Analysis was based on data from 116 participants with complete outcome data. Multivariable logistic regression revealed that the DBT-CM program remained an independent positive predictor of decrease in drug use among the DBT-CM participants at 6 months (p = .01) as compared with the HP program participants. Being non-White (p < .05) and having higher depressive symptom scores (p < .05) were associated with lower odds of drug use abstinence (i.e., increased the odds of drug use) at 6 months. DBT-CM increased drug and alcohol abstinence at 6-month follow-up, compared to an HP program.

Coming of age on the streets: survival sex among homeless young women in Hollywood.

PubMed

Warf, Curren W; Clark, Leslie F; Desai, Mona; Rabinovitz, Susan J; Agahi, Golnaz; Calvo, Richard; Hoffmann, Jenny

2013-12-01

This study examined childhood physical or sexual abuse, involvement in dependency or delinquency systems, psychiatric hospitalization, and suicide as possible risk factors for survival sex among homeless young women. Homeless young women were found to have similarly high rates of childhood sexual abuse, dependency and delinquency systems involvement, and psychiatric hospitalization. Homeless young women involved in survival sex disclosed higher rates of attempted suicide and reported marginally higher rates of childhood physical abuse. Analysis of qualitative data showed that those engaged in survival sex were motivated primarily by desperation to meet basic needs including a place to stay, food and money, and one third mentioned that peers commonly were influential in decisions to engage in survival sex. Others were influenced by coercion (10%) or pursuit of drugs (10%). Young women engaged in survival sex generally experienced regret and shame about their experience. Copyright © 2013 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Impact of an intervention for recently released homeless offenders on self-reported re-arrest at 6 and 12 months.

PubMed

Nyamathi, Adeline; Salem, Benissa E; Farabee, David; Hall, Elizabeth; Zhang, Sheldon; Faucette, Mark; Bond, Doug; Yadav, Kartik

2017-01-01

A randomized controlled trial was conducted with 600 paroled men, homeless prior to incarceration, to assess varying levels of peer-coach and nurse-partnered interventions on re-arrest at 6 and 12 months. Findings revealed that positive predictors of re-arrest at 12 months included having received social support from drug users and non-drug users, as well as having used marijuana at least once a week prior to their most recent incarceration. In terms of protective factors, those who participated in a substance abuse program contract within a residential drug treatment program or spent 90 days or greater in a residential drug treatment program were less likely to have been re-arrested within 12 months.

75 FR 20541 - Homeless Emergency Assistance and Rapid Transition to Housing: Defining “Homeless”

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-20

... Housing Stability Program. The HEARTH Act also codifies in statutory law the Continuum of Care planning... activities and to add rapid re-housing activities. The new Rural Housing Stability program replaces the Rural... Care program, and the Rural Housing Stability program. Each of these programs will include the...

"Walking in a maze": community providers' difficulties coordinating health care for homeless patients.

PubMed

LaCoursiere Zucchero, Terri; McDannold, Sarah; McInnes, D Keith

2016-09-07

While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population. Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used. HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received. Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons.

24 CFR 576.400 - Area-wide systems coordination requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

...): (8) Head Start (45 CFR chapter XIII, subchapter B); (9) Mental Health and Substance Abuse Block..., if any, on the homelessness prevention or rapid re-housing assistance that each program participant... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SOLUTIONS GRANTS PROGRAM Program Requirements...

24 CFR 576.400 - Area-wide systems coordination requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

...): (8) Head Start (45 CFR chapter XIII, subchapter B); (9) Mental Health and Substance Abuse Block..., if any, on the homelessness prevention or rapid re-housing assistance that each program participant... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SOLUTIONS GRANTS PROGRAM Program Requirements...

24 CFR 576.400 - Area-wide systems coordination requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

...): (8) Head Start (45 CFR chapter XIII, subchapter B); (9) Mental Health and Substance Abuse Block..., if any, on the homelessness prevention or rapid re-housing assistance that each program participant... HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SOLUTIONS GRANTS PROGRAM Program Requirements...

[Requirements for the provision of healthcare to socially disadvantaged population groups: evaluation of 10 years of medical care provided to the homeless in Hanover].

PubMed

Meidl, Jana; Wenzlaff, Paul; Sens, Brigitte; Goesmann, Cornelia

2012-01-01

In 2007, the German Federal Government introduced a general health insurance obligation, but there are still vulnerable groups such as poor and homeless people without access to medical care. Especially for social fringe groups, a visit to the doctor involves many obstacles. Ten years ago the project "Outreach medical care for homeless people and people threatened by homelessness in Hanover" was established in order to reduce those gaps in healthcare provision. A continuously conducted evaluation of the project shows that low-threshold consulting hours are accepted and the transition to medical specialists is becoming increasingly easy. So the evaluation plays an important part in the development of the project. Since the healthcare reform in 2004, however, the number of cases has increased by 30 % while the actual homeless target group has remained the same. In order to guarantee access to the healthcare system for patients who cannot afford additional payments, the abolition of the quarterly practice fee and other additional payments for people on a low income is an important step. The growing requirements, resulting from a changing clientele and changes in the general conditions, are raising questions as to the nature of such projects and its future funding. In the long run it isn't the aim of this non-profit project to take on central tasks of a mutually supportive community. Therefore the data and results collected on the evaluation not only serve to improve the projects management, but also provide important information to other initiatives outside Hanover whether and how to support the respective groups of patients. Copyright © 2012. Published by Elsevier GmbH.

Bridging the Gap Between Micro and Macro Practice to Address Homelessness in the U.S.-Mexico Border Region: Implications for Practitioners and Community Stakeholders

PubMed Central

Moya, Eva M.; Chavez-Baray, Silvia Maria; Martinez, Omar; Mattera, Brian; Adcox, Courtney

2018-01-01

Research and scholarship efforts continue to promote the integration of micro and macro practice in social work practice and education. Despite this, scholarship has documented persistent challenges in the fluid integration between the domains of micro-level service provision and macro-level social change efforts in practice and academic programs. This paper outlines a successful bridge between the micro-macro divide in the form of community-engaged practice to address homelessness and social work education in the U.S.-Mexico border region. MSW students enrolled in a macro-level course at the University of Texas at El Paso’s College of Health Sciences successfully partnered with the Opportunity Center for the Homeless, a grassroots community-based organization serving individuals experiencing homelessness. The narrative describes how students were effectively able to apply both micro- and macro-level skills learned in the classroom to an experiential learning environment while providing much-needed assistance to an underfunded community-based organization. A set of challenges and recommendations are also discussed. Research initiatives are needed to evaluate and test clinical and community work initiatives, including the use of photovoice methodology to address homelessness, while being responsive to community needs and challenges. PMID:29809204

Bridging the Gap Between Micro and Macro Practice to Address Homelessness in the U.S.-Mexico Border Region: Implications for Practitioners and Community Stakeholders.

PubMed

Moya, Eva M; Chavez-Baray, Silvia Maria; Martinez, Omar; Mattera, Brian; Adcox, Courtney

2018-01-01

Research and scholarship efforts continue to promote the integration of micro and macro practice in social work practice and education. Despite this, scholarship has documented persistent challenges in the fluid integration between the domains of micro-level service provision and macro-level social change efforts in practice and academic programs. This paper outlines a successful bridge between the micro-macro divide in the form of community-engaged practice to address homelessness and social work education in the U.S.-Mexico border region. MSW students enrolled in a macro-level course at the University of Texas at El Paso's College of Health Sciences successfully partnered with the Opportunity Center for the Homeless, a grassroots community-based organization serving individuals experiencing homelessness. The narrative describes how students were effectively able to apply both micro- and macro-level skills learned in the classroom to an experiential learning environment while providing much-needed assistance to an underfunded community-based organization. A set of challenges and recommendations are also discussed. Research initiatives are needed to evaluate and test clinical and community work initiatives, including the use of photovoice methodology to address homelessness, while being responsive to community needs and challenges.

Taming Big Data: An Information Extraction Strategy for Large Clinical Text Corpora.

PubMed

Gundlapalli, Adi V; Divita, Guy; Carter, Marjorie E; Redd, Andrew; Samore, Matthew H; Gupta, Kalpana; Trautner, Barbara

2015-01-01

Concepts of interest for clinical and research purposes are not uniformly distributed in clinical text available in electronic medical records. The purpose of our study was to identify filtering techniques to select 'high yield' documents for increased efficacy and throughput. Using two large corpora of clinical text, we demonstrate the identification of 'high yield' document sets in two unrelated domains: homelessness and indwelling urinary catheters. For homelessness, the high yield set includes homeless program and social work notes. For urinary catheters, concepts were more prevalent in notes from hospitalized patients; nursing notes accounted for a majority of the high yield set. This filtering will enable customization and refining of information extraction pipelines to facilitate extraction of relevant concepts for clinical decision support and other uses.

Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review.

PubMed

Sumalinog, Rafael; Harrington, Katy; Dosani, Naheed; Hwang, Stephen W

2017-02-01

Homeless individuals have a high prevalence of multiple chronic comorbidities and early mortality compared to the general population. They also experience significant barriers to access and stigmatization in the healthcare system. Providing advance care planning, palliative care, and end-of-life care for this underserved population is an important health issue. To summarize and evaluate the evidence surrounding advance care planning, palliative care, and end-of-life care interventions for homeless persons. A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Articles from MEDLINE, EMBASE, CINAHL, PsycINFO, Social Work Abstracts, Cochrane Library, Web of Science, and PubMed databases were searched through 13 June 2015. Peer-reviewed studies that implemented advance care planning, palliative care, and end-of-life care interventions for homeless populations were included. Data from studies were independently extracted by two investigators using pre-specified criteria, and quality was assessed using modified Cochrane and Critical Appraisal Skills Programme tools. Six articles met inclusion criteria. Two studies were randomized controlled trials involving advance directive completion. Two cohort studies investigated the costs of a shelter-based palliative care intervention and predictors for completing advance directives. These studies were rated low to fair quality. Two qualitative studies explored the interface between harm-reduction services and end-of-life care and the conditions for providing palliative care for homeless persons in a support home. The effectiveness of advance care planning, palliative care, and end-of-life care interventions for homeless individuals is uncertain. High-quality studies of interventions that reflect the unique and complex circumstances of homeless populations and investigate patient-related outcomes, caregiver burden, and cost-effectiveness are needed.

Foot Conditions among Homeless Persons: A Systematic Review

PubMed Central

To, Matthew J.; Brothers, Thomas D.; Van Zoost, Colin

2016-01-01

Introduction Foot problems are common among homeless persons, but are often overlooked. The objectives of this systematic review are to summarize what is known about foot conditions and associated interventions among homeless persons. Methods A literature search was conducted on MEDLINE (1966–2016), EMBASE (1947–2016), and CINAHL (1982–2016) and complemented by manual searches of reference lists. Articles that described foot conditions in homeless persons or associated interventions were included. Data were independently extracted on: general study characteristics; participants; foot assessment methods; foot conditions and associated interventions; study findings; quality score assessed using the Downs and Black checklist. Results Of 333 articles screened, 17 articles met criteria and were included in the study. Prevalence of any foot problem ranged from 9% to 65% across study populations. Common foot-related concerns were corns and calluses, nail pathologies, and infections. Foot pathologies related to chronic diseases such as diabetes were identified. Compared to housed individuals across studies, homeless individuals were more likely to have foot problems including tinea pedis, foot pain, functional limitations with walking, and improperly-fitting shoes. Discussion Foot conditions were highly prevalent among homeless individuals with up to two thirds reporting a foot health concern, approximately one quarter of individuals visiting a health professional, and one fifth of individuals requiring further follow-up due to the severity of their condition. Homeless individuals often had inadequate foot hygiene practices and improperly-fitting shoes. These findings have service provision and public health implications, highlighting the need for evidence-based interventions to improve foot health in this population. An effective interventional approach could include optimization of foot hygiene and footwear, provision of comprehensive medical treatment, and addressing social factors that lead to increased risk of foot problems. Targeted efforts to screen for and treat foot problems could result in improved health and social outcomes for homeless individuals. PMID:27936071

Homeless people's access to primary care physiotherapy services: an exploratory, mixed-method investigation using a follow-up qualitative extension to core quantitative research.

PubMed

Dawes, Jo; Deaton, Stuart; Greenwood, Nan

2017-06-30

The purpose of this study was to appraise referrals of homeless patients to physiotherapy services and explore perceptions of barriers to access. This exploratory mixed-method study used a follow-up qualitative extension to core quantitative research design. Over 9 months, quantitative data were gathered from the healthcare records of homeless patients referred to physiotherapy by a general practitioner (GP) practice, including the number of referrals and demographic data of all homeless patients referred. Corresponding physiotherapy records of those people referred to physiotherapy were searched for the outcome of their care. Qualitative semi-structured telephone interviews, based on the quantitative findings, were carried out with staff involved with patient care from the referring GP practice and were used to expand insight into the quantitative findings. Two primary care sites provided data for this study: a GP practice dedicated exclusively to homeless people and the physiotherapy department receiving their referrals. Quantitative data from the healthcare records of 34 homeless patient referrals to physiotherapy were collected and analysed. In addition, five staff involved in patient care were interviewed. 34 referrals of homeless people were made to physiotherapy in a 9-month period. It was possible to match 25 of these to records from the physiotherapy department. Nine (36%) patients did not attend their first appointment; seven (28%) attended an initial appointment, but did not attend a subsequent appointment and were discharged from the service; five (20%) completed treatment and four patients (16%) had ongoing treatment. Semi-structured interviews revealed potential barriers preventing homeless people from accessing physiotherapy services, the complex factors being faced by those making referrals and possible ways to improve physiotherapy access. Homeless people with musculoskeletal problems may fail to access physiotherapy treatment, but opportunities exist to make access to physiotherapy easier. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

38 CFR 61.62 - Program changes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Program changes. 61.62... HOMELESS PROVIDERS GRANT AND PER DIEM PROGRAM § 61.62 Program changes. (a) Except as provided in paragraphs (b) through (d) of this section, a recipient may not make any significant changes to a project for...

45 CFR 1351.20 - What are the additional requirements under a Runaway and Homeless Youth Program grant?

Code of Federal Regulations, 2010 CFR

2010-10-01

..., such areas as: • Program Management, • Fiscal Management, • Development of coordinated networks of... and Family counseling, and • Crisis intervention techniques. (b) Grantees will be required to...

Homelessness among a cohort of women in street-based sex work: the need for safer environment interventions.

PubMed

Duff, Putu; Deering, Kathleen; Gibson, Kate; Tyndall, Mark; Shannon, Kate

2011-08-12

Drawing on data from a community-based prospective cohort study in Vancouver, Canada, we examined the prevalence and individual, interpersonal and work environment correlates of homelessness among 252 women in street-based sex work. Bivariate and multivariate logistic regression using generalized estimating equations (GEE) was used to examine the individual, interpersonal and work environment factors that were associated with homelessness among street-based sex workers. Among 252 women, 43.3% reported homelessness over an 18-month follow-up period. In the multivariable GEE logistic regression analysis, younger age (adjusted odds ratio [aOR] = 0.93; 95%confidence interval [95%CI] 0.93-0.98), sexual violence by non-commercial partners (aOR = 2.14; 95%CI 1.06-4.34), servicing a higher number of clients (10+ per week vs < 10) (aOR = 1.68; 95%CI 1.05-2.69), intensive, daily crack use (aOR = 1.65; 95%CI 1.11-2.45), and servicing clients in public spaces (aOR = 1.52; CI 1.00-2.31) were independently associated with sleeping on the street. These findings indicate a critical need for safer environment interventions that mitigate the social and physical risks faced by homeless FSWs and increase access to safe, secure housing for women.

For Homeless Veterans

MedlinePlus

... Adaptive Sports Program Creative Arts Festival Golden Age Games Summer Sports Clinic Training - Exposure - Experience (TEE) Tournament Wheelchair Games Winter Sports Clinic Locations Hospitals & Clinics Vet Centers ...

Bed Bug Infestations in an Urban Environment

PubMed Central

Svoboda, Tomislav J.; De Jong, Iain J.; Kabasele, Karl J.; Gogosis, Evie

2005-01-01

Until recently, bed bugs have been considered uncommon in the industrialized world. This study determined the extent of reemerging bed bug infestations in homeless shelters and other locations in Toronto, Canada. Toronto Public Health documented complaints of bed bug infestations from 46 locations in 2003, most commonly apartments (63%), shelters (15%), and rooming houses (11%). Pest control operators in Toronto (N = 34) reported treating bed bug infestations at 847 locations in 2003, most commonly single-family dwellings (70%), apartments (18%), and shelters (8%). Bed bug infestations were reported at 20 (31%) of 65 homeless shelters. At 1 affected shelter, 4% of residents reported having bed bug bites. Bed bug infestations can have an adverse effect on health and quality of life in the general population, particularly among homeless persons living in shelters. PMID:15829190

Childhood antecedents of incarceration and criminal justice involvement among homeless veterans.

PubMed

Tsai, Jack; Rosenheck, Robert A

2013-10-01

Although criminal justice involvement and incarceration are common problems for homeless veterans, few studies have examined childhood risk factors for criminal justice involvement among veterans. This study examined the association between three types of childhood problems, family instability, conduct disorder behaviors, and childhood abuse, and criminal justice involvement and incarceration in adulthood. Data from 1,161 homeless veterans across 19 sites participating in the Housing and Urban Development-Veterans Affairs Supportive Housing program were examined. After controlling for sociodemographics and mental health diagnoses, veterans who reported more conduct disorder behaviors during childhood tended to report more criminal charges of all types, more convictions, and longer periods of incarceration during adulthood. However, the variance explained in criminal behavior by childhood was not large, suggesting that there are other factors that affect the trajectory by which homeless veterans become involved in the criminal justice system. Further research is needed to intervene in the pathway to the criminal justice system and guide efforts to prevent incarceration among veterans. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

But Everyone is Doing It (Sort of)! Perceived Sexual Risks in the Social Environment and the Impact on Homeless Youth Engagement in Concurrent Sexual Relationships.

PubMed

Hsu, Hsun-Ta; Fulginiti, Anthony; Rice, Eric; Rhoades, Harmony; Winetrobe, Hailey; Danforth, Laura

2018-05-03

Although homeless youth are likely to engage in concurrent sexual relationships and doing so can accelerate HIV transmission, the issue of sexual concurrency (i.e., having sexual partnerships that overlap in time) has received scarce attention in this vulnerable population. The literature that exists tends to focus on individuals' characteristics that may be associated with concurrency and overlooks the influence of their social environment. Informed by the risk amplification and abatement model (RAAM), this study explored the association between pro-social and problematic social network connections, and sexual concurrency among homeless youth using drop-in center services (N = 841). Nearly 37% of youth engaged in concurrency. Partially consistent with the RAAM, regression analyses showed that affiliation with more problematic ties (i.e., having more network members who practice concurrency and unprotected sex) was associated with greater sexual concurrency. Programs addressing HIV risk among homeless youth in drop-in centers should consider the role youths' network composition may play in concurrency.