Emergency Shelter Research Articles

A Comparative Study on Temporary Shelters for Emergency Disasters of Thailand: Case Study of Emergency Shelter of Japan

Since there were some spatial physical problems of temporary shelters in Thailand regarding the use of temples as temporary shelters for supporting victims of emergency disasters that failed to meet with international standards, the researcher conducted this study to decrypt spatial physical condition of temporary shelter of Japan that was the case study of this research. The objective of this research was to conduct comparative study on temporary shelters for emergency disasters of Thailand: case study of emergency shelter of Japan. Research process used in this research was qualitative research and research tools were divided into 2 parts including: document research for studying on documents related to temporary shelters of Japan and Thailand; and field survey. The samples were obtained from considering on 5 temples. The results Japan’s temporary shelter that was the case study of this research the residential place of victims was a gymnasium located in primary school with utility spaces for supporting behaviors and daily life activities of victims. When comparing to Thailand, the building used as temporary shelter of victims was multipurpose building the major utility space of multipurpose building was the hall. Conclusions on environmental improvement or arrangement of temples for supporting temporary shelters to meet with international standards were divided into 3 alternatives. The researcher divided suggestions in to 2 dimensions including: 1) Operations of Government Sector; and 2) Participation in Establishment of Temporary Shelters in Temple Areas, in Thai context in order to obtain temporary shelters with international standards.

Problemas ligados ao álcool em centros de emergência (PLACE)-People experiencing homelessness with alcohol-related problems in Lisbon's emergency shelters during the COVID-19 pandemic: a description and analysis of a harm reduction intervention.

Alcohol-related problems disproportionally affect people experiencing homelessness. As the first wave of the COVID-2019 pandemic spread in 2020, a number of emergency shelters were opened in Lisbon. Increased difficulties in obtaining alcohol could have led to an increased incidence of alcohol withdrawal. Therefore, a low-threshold harm reduction intervention was introduced to these emergency shelters. This consisted of a fixed medication treatment, made available immediately for those with specific conditions, without the need for a medical evaluation or abstinence from alcohol, together with an offer of subsequent access to specialized addiction centers. The Problemas Ligados ao Álcool em Centros de Emergência (PLACE) study (alcohol-related problems in emergency shelters) is a retrospective mixed-methods observational study. It describes the demographic, health, and social characteristics of shelter users participating in the program and aims to evaluate the intervention as well as the experience of the patients, professionals, and decision-makers involved. A total of 69 people using shelters self-reported alcohol-related problems. Among them, 36.2% of the people accepted a pharmacological intervention, and 23.2% selected an addiction appointment. The take-up of the intervention was associated with better housing outcomes. A description of an individual's trajectory after leaving the shelter is provided. This study suggests that non-abstinence-focused interventions can be useful and well-tolerated in treating addiction in this population.

Homelessness and housing assistance among persons with HIV, and associations with HIV care and viral suppression, New York City 2018.

To measure housing assistance and homelessness among persons living with HIV (PLWH) and their association with health. Exposure categories were: experiencing homelessness (per emergency shelter use or self-report), receiving housing assistance (per housing subsidy) without homelessness, or neither homelessness nor receiving housing assistance. Outcomes were: engagement (≥1 visit) and retention (≥2 visits ≥90 days apart) in HIV-related medical care and one-time (latest viral load) and durable (≥1 viral load test, all suppressed) HIV viral suppression (<200 copies/mL). Among PLWH in New York City (NYC), we calculated and conducted modified Poisson regressions of the four outcomes according to exposure category. During 2018, 45% of NYC's 84,053 PLWH received housing assistance, and 8% experienced homelessness. Relative to homelessness, receipt of assistance without homelessness was associated with 3-7% higher adjusted relative risk (ARR) of engagement and retention in care and 31-64% higher ARR of one-time and durable viral suppression. Relative to not receiving assistance, receipt of assistance without homelessness was associated with 6-18% higher ARR of care and 2-5% lower ARR of viral suppression. Programs promoting housing stability may support HIV care and viral suppression, particularly if preventing homelessness. These may help improve HIV care and suppression rates.

Transportation needs and mobility patterns of persons experiencing homelessness following shelter decentralization

The provision and siting of homeless emergency shelters have community-wide implications for addressing the needs of people experiencing homelessness (PEH). In Utah, Salt Lake County’s transition from a large, centralized emergency shelter sited in a free transit zone to a decentralized scattered-site model outside of a no-cost transit zone provided the context to evaluate how transportation access and mobility patterns of PEH were affected as they were displaced from a centralized service network in a downtown core. We conducted 19 in-depth, semi-structured interviews with PEH aged 18 + who were staying in one of three distributed resource centers who had also previously stayed at the former centralized shelter. Thematic analysis of the interviews resulted in three categories, each with distinct sub-categories: 1) Pre-decentralization transportation and mobility, 2) Post-decentralization transportation and mobility, and 3) Recommendations to improve transportation access for PEH, including lowering or eliminating financial barriers to transportation and expanding transit and shuttle van frequency and route radius. Study findings demonstrate that there is a significant need for community planners to collaborate on the siting of homeless shelters to provide more affordable, flexible, and equitable access to transportation networks.

Evaluation of Emergency Shelter Service Functions and Optimisation Suggestions—Case Study in the Songyuan City Central Area

Reasonable planning and construction of emergency shelters is of great significance in improving the ability of cities to prevent and mitigate disasters and ensuring urban public safety. From the perspective of the needs of the evacuees, this paper constructs an evaluation index system for the service function of emergency evacuation places in four aspects: effectiveness, accessibility, safety and rescue responsiveness. This paper takes the central city of Songyuan as the case study area. We apply the entropy weight–TOPSIS–grey correlation method to evaluate the service functions of emergency shelters in the central city of Songyuan and determine their service function levels. An interactive analysis using the bivariate Moran index is used to determine the current state of supply and demand for places of refuge, in terms of their service functions and population distribution. It also makes recommendations for optimisation, based on the extent to which the service function of the emergency shelter is coordinated with the distribution of the population. The results show that of the 54 emergency shelters in the central city of Songyuan, the low and medium service function levels are divided into 33 and 15, with problems such as unreasonable spatial layout and inadequate emergency supplies and medical resources. The future construction of emergency shelters should focus not only on increasing the number and improving the scale, but also on considering the characteristics of population distribution, optimising the spatial distribution pattern and making full use of existing resources such as parks, squares and schools. The establishment of composite spatial resources for disaster preparedness and the promotion of a government-led model of interconnected shelter and emergency infrastructure can effectively enhance the spatial resilience of cities in response to natural hazards.

Homelessness, COVID-19, and discourses of contagion

In March 2020, when the COVID-19 pandemic began in Canada, public health and medical authorities quickly identified emergency shelters and people experiencing homelessness as particularly at risk of contracting and spreading COVID-19 (Knight et al., 2021). Drawing on interviews with 28 service providers in organizations that primarily serve people experiencing homelessness in Ottawa, Ontario, Canada and a media scan, we explored how people who worked in and accessed these organizations negotiated discourses of contagion and infection throughout the COVID-19 pandemic. This paper is informed by Goffman's (1963) theory of stigma, complemented by Crawford's (1994) idea of the Self and unhealthy Other. We argue that people experiencing homelessness, the spaces that they occupy, and the people they engage with, have been discursively marked as dangerous vectors of infection who present a risk to the health of the whole population, rather than as vulnerable to the health consequences and social disruption of COVID-19. Consequently, people experiencing homelessness have experienced further stigmatization throughout the pandemic as they have been separated from their communities, friends, and families, left without support or shelter, internalized blame for the spread of COVID-19, and faced dehumanization, grief, and trauma resulting from uneven COVID-19 interventions. We highlight these findings to support the application of trauma- and violence-informed care in service settings to prevent the further traumatization of people experiencing homelessness in services intended to support them.

Location-allocation of fixed shelters for the elderly from the perspective of needs for refuge: A case of Hefei, China

Disasters, occurring more frequently and severely, have had significant effects on the elderly, who are particularly vulnerable. In response to this risk, there has been increased focus on the emergency shelter planning. This study investigates the location-allocation of fixed shelters for the elderly, considering their needs for evacuation and refuge. A multi-objective model for the location-allocation of fixed shelters is developed, and is solved using genetic algorithms and simulated annealing algorithms. Then, the model is used to compare the location-allocation of fixed shelters in two scenarios: when there are no differences in the needs of the elderly and non-elderly refugees for evacuation and refuge, and when there are differences in their needs. This study also analyzes the current situation of the elderly population and fixed shelters in four urban districts of Hefei, and selects Luyang district, where there is a high demand of the elderly for refuge compared to the supply of fixed shelters, as a case study. Results show that when considering the needs of the elderly, the success rate of evacuation and refuge in Luyang district is decreased by 1.88%, with the elderly refugees who can evacuate independently having the lowest success rate, 87.36%, among all refugees. Empirical tests also reveal that the optimization of fixed shelters for the elderly can be achieved by utilizing public buildings to increase the number of fixed shelters, and by building indoor refuge rooms for the elderly refugees in outdoor fixed shelters to improve the type structure of the fixed shelters.

Beyond Housing: Supporting the Health and Well-Being of Individuals Residing in Toronto's Temporary Shelter Hotels.

In response to the COVID-19 pandemic, the City of Toronto opened temporary shelter hotels with on-site supports for people previously living on the street, in encampments or in emergency shelters. The Beyond Housing program was created to enhance service offerings in the shelter hotel system and to support people not engaging with services. Using a Housing First approach, Beyond Housing offers three main interventions: (1) case management, (2) care coordination and (3) on-site and community-based mental health and social supports. This commentary explores the strengths and challenges of implementing Beyond Housing within temporary shelter hotels, and then discusses the lessons learned.

A Comprehensive Review of Geospatial Technology Applications in Earthquake Preparedness, Emergency Management, and Damage Assessment

The level of destruction caused by an earthquake depends on a variety of factors, such as magnitude, duration, intensity, time of occurrence, and underlying geological features, which may be mitigated and reduced by the level of preparedness of risk management measures. Geospatial technologies offer a means by which earthquake occurrence can be predicted or foreshadowed; managed in terms of levels of preparation related to land use planning; availability of emergency shelters, medical resources, and food supplies; and assessment of damage and remedial priorities. This literature review paper surveys the geospatial technologies employed in earthquake research and disaster management. The objectives of this review paper are to assess: (1) the role of the range of geospatial data types; (2) the application of geospatial technologies to the stages of an earthquake; (3) the geospatial techniques used in earthquake hazard, vulnerability, and risk analysis; and (4) to discuss the role of geospatial techniques in earthquakes and related disasters. The review covers past, current, and potential earthquake-related applications of geospatial technology, together with the challenges that limit the extent of usefulness and effectiveness. While the focus is mainly on geospatial technology applied to earthquake research and management in practice, it also has validity as a framework for natural disaster risk assessments, emergency management, mitigation, and remediation, in general.

An Emerging Health Crisis in Turkey and Syria after the Earthquake Disaster on 6 February 2023: Risk Factors, Prevention and Management of Infectious Diseases

On 6 February 2023, Turkey and Syria were hit by two major earthquakes that caused extremely heavy structural damage to buildings and infrastructure in one of the most densely populated areas of Anatolia. The authors visited the devastated area shortly after the earthquakes in the frame of search and rescue and scientific missions in order to check whether the newly formed conditions have the potential to further affect public health. Based on the collected disaster-related field data, it is revealed that risk factors associated with and favoring emergence of infectious diseases are present in the affected residential areas from the first hours of the emergency state. The coexistence and synergy of many collapsed health facilities, cold winter conditions, destruction of lifeline infrastructures, overcrowding in emergency shelters, poor sanitation and adverse socio-economic conditions along with evolving crises and disasters (conflicts, pandemic and epidemics) may further aggravate the already fragile public health situation and cause considerable delays in the recovery process. Efficient disease surveillance at local and regional levels is a crucial requirement for early warning and protection against emerging infectious diseases in the earthquake-affected areas among other proposed measures for prevention and management of infectious diseases.

5616412 SOCIAL DETERMINANTS OF HEALTH AND THEIR IMPACT ON FAMILIES OF CHILDREN WITH SICKLE CELL DISEASE DURING COVID-19 PANDEMIC

Background: According to national prevalence data, SCD has an estimated economic burden of $2.98 billion per year in the United States and caring for a child with sickle cell disease (SCD) carries its own financial burden, resulting in higher healthcare costs and unintended days lost from employment. Social experiences are known to impact health outcomes in the general pediatric population. These experiences can be examined through the construct of social determinants of health (SDOH), the “condition in which people are born, grow, work, live and age” that impact their health. Since the WHO has designated COVID-19 a pandemic in January 2020, many families in the US have suffered financially, and during the shutdowns, there was a record number of jobs lost. The objective of this study was to determine the impact of the COVID-19 pandemic on financial and employment status of SCD Families Methods: This study was part of the larger CNH Sickle Cell Disease Social Determinants of Health study that was IRB approved. Caregivers of children with SCD completed a 30-question survey reporting their experiences with SDOH that included Demographics, USDA Food Security Scale, the We Care housing screening tool, and the validated COVID-19 Employment Status/COVID-19 related household finances survey in RedCap during clinic visits and hospitalizations Results: 99 caregivers of SCD patients responded to our survey (82.5% Female, 17.5% Male) (N=97). 93.9% identified as African-American, 3% identified as Hispanic or Latinx, 1% identified as “other”. Of respondents, 66% were insured through on Medicaid and 33% had private insurance. Twenty-six percent endorsed food insecurity and 2724% relied on low-cost food. Thirty-one percent lived in an apartment, 67.768% lived in a home, 1% lived in shelter or transitional housing. Sixteen percent lived in subsidized or public housing. Thirty-seven (36.8%) percent reported at least once they were being unable to pay the mortgage or rent on time at least once, 9% (8.5%) reported living with other people because of financial difficulties, 55.2% reported their home not being heated, 7.2% reported being evicted from their home and 3.1% lived in an emergency shelter or transitional housing. 6.1% had an educational level of high school graduation or less, 42.2% were college graduates or completed additional post-graduate education (N=98). Two weeks prior to the pandemic, 61.5% worked full time, 13.5% worked part time, 6.3% were unemployed with only 2.1% working from home of the 96 caregivers who responded to this question. 15.5% (N=12 of 77) reported losing their job or were furloughed during the pandemic; 34.4% (N=33 of 96) reporting at least one household member losing a job or a significant amount of income. Twenty-five percent (N=21 of 83) reported it was difficult to get work/school done because of the home environment. 36.4 % (N=35 of 96) reported household income was significantly less since February 2020. 53% (N=52 of 97) worried their household income has been or will be negatively impacted by the COVID-19 pandemic. Additionally, 48.9% (N=47 of 96) worried the value of their assets (housing, savings, other financial assets) has been or will be negatively impacted by COVID-19 and its effects. Since February 2020, 9.8% (N= 9 of 97) received unemployment insurance, 30.9% (N=29 of 94) received SNAP or food stamps, 16.5% (N= 15 of 91) received from the food pantry, 6.6% (N=6 of 90) applied for temp ass

Evaluation of the Warehouse Location Alternatives for Possible Great Istanbul Earthquake

The "Great Istanbul Earthquake" is expected to occur in Istanbul within the next 10 years. Preparations have long been made for the great Istanbul earthquake, which is expected to cause heavy loss of life and property. One of the important parts of earthquake preparedness is the disaster logistics warehouses, where emergency supplies and shelter equipment are stored to be dispatched to earthquake victims. The aim of this study is determining the optimal locations of the warehouses in order to deliver the aid materials to the points of need as soon as possible and to meet the needs in the event of a possible large earthquake in Istanbul. The model was set up in two steps to determine the number of warehouses to be opened with the set covering problem in the first step, and to minimize the weighted distance with p-median in the second step. The established model was solved using The General Algebraic Modeling System (GAMS), and the optimum scenario was decided according to the results and the scenarios were mapped.

Quantitative evaluation of emergency shelters in mountainous areas among multiple scenarios: Evidence from Biancheng, China

Accurate evaluation of urban emergency shelters is key to improving disaster response capacity and government emergency management ability, especially in mountainous areas where disasters are common. Most existing studies focus on evaluating material aspects, such as the capacity and accessibility of emergency shelters, ignoring the impact of different scenarios in the same area such as topographic, demographic, and population spatial–temporal distribution differences. Considering the multiple scenarios factors influencing emergency shelter practice, this study constructed a validity, efficiency, and security evaluation framework which was tested in Biancheng, Hunan, China. A combination of qualitative multiple scenario analysis and quantitative Network Analysis method were used to portray existing emergency shelters during emergency evacuations. The important conclusions are as follows: (1) there are significant differences in the evaluation of emergency shelters in the different scenarios. Scenario I (considering terrain) and Scenario II (considering demographics) decreased the evaluation results, while Scenario III (considering time–space) increased the evaluation results. (2) All three scenarios could cause variation in the validity indicators (A) and efficiency indicators (B), but A1 were unchanged in Scenario II and B2 remained constant in Scenario III, while none of the security indicators (C) were affected except in Scenario I. (3) While different emergency shelters performed differently in different scenarios, overall ID2 performed best and ID5 performed worst. Consideration of all scenarios was clearly necessary for us to scientifically evaluate the real use of emergency shelters, which can effectively guide emergency shelter planning and thus improve the abilities of urban disaster relief.

Reprint of: Homelessness and child protection involvement: Temporal links and risks to student attendance and school mobility

BackgroundThe experience of homelessness and child protection involvement pose risks to children's school success. Elucidating processes by which these interrelated systems affect child well-being is important for guiding policy and practice. ObjectiveThis study examines the temporal relation between emergency shelter or transitional housing use and child protection involvement among school-aged children. We evaluated effects of both risk indicators on school attendance and school mobility. Participant and settingUsing integrated administrative data, we identified 3278 children (ages 4 to 15) whose families used emergency or transitional housing in Hennepin and Ramsey County of Minnesota during the 2014 and 2015 academic years. A propensity-score-matched comparison group of 2613 children who did not use emergency or transitional housing. MethodThrough a series of logistic regressions and generalized estimating equations, we tested the temporal associations of emergency/transitional housing and child protection involvement as well as how both experiences affected school attendance and mobility. ResultsExperiences of emergency or transitional housing often proceeded or occurred concurrently with child protection involvement and increased the likelihood of child protection services. Emergency or transitional housing and child protection involvement posed risks for lower school attendance and greater school mobility. ConclusionsA multisystem approach to assist families across social services may be important for stabilizing children's housing and bolstering their success at school. A two-generation approach focused on residential and school stability and enhancing family resources could boost adaptive success of family members across contexts.

Knowledge, Perceived Competence, and Behaviors Relative to Traumatic Brain Injury Among a Sample of Domestic Violence Emergency Shelter Advocates in a New England State.

This cross-sectional study describes knowledge, perceived competence, and behaviors relative to intimate partner violence (IPV)-related brain injury (BI) among staff in residential domestic violence shelter programs across a New England state. A 23-item questionnaire was administered to registrants of an online IPV-related BI training series. Within this sample, knowledge about IPV-related BI was high, but relative to providing screening, accommodations, and specialized referrals to survivors with BI, perceived competence was low, and behaviors were infrequent. IPV shelter agencies should facilitate IPV-related BI training programs for staff and prioritize developing and implementing BI screening, accommodation, and referral policies and procedures.

Investing in Saving Lives: Designing Second-Stage Women’s Shelters on First Nation Reserves

Most Indigenous women in Canada (61%) experience intimate partner violence (IPV), which is significantly worse than the high rate of 44 percent for other women in Canada. Despite the great risk for IPV, only three unfunded second-stage shelters for more than 600 First Nation reserves exist in Canada to provide First Nation women and their children a safe home. Second-stage housing offers IPV survivors transitional homes for an extended period that provide safety and renewal after their initial emergency shelter stays. This article documents the need for safe, nurturing, and culturally appropriate second-stage shelters for Indigenous women and their families to heal and rebuild. The authors provide two second-stage prototype designs based on domestic environmental analysis and concepts of houselessness, home, and co-housing. We discuss how these designs are one step in an action plan to protect Indigenous women and stop the genocide of Indigenous Peoples by supporting cultural, economic, health, and social development. The literature review and design concepts form an agenda to have design goals for housing IPV survivors that answers the “Calls to Justice for Murdered and Missing Women” and expands this needed service to every reserve.

Sexual exploitation of children: Barriers for boys in accessing social supports for victimization

BackgroundThe global evidence regarding sexual exploitation of children (SEC) is expanding, however, the majority of research continues to focus on girls. ECPAT International's Global Boys Initiative is a major contribution to broadening knowledge by exploring how sexual exploitation impacts boys specifically. ObjectiveThis discussion paper explores data from the initiative to better understand how boys and children of all genders may be impacted by sexual exploitation. Participants and settingDuring 2019–21, research was undertaken by ECPAT member organizations into the sexual exploitation of boys in 10 primarily low-and-middle income countries globally. The initiative also supported a global systematic scoping review of published and gray literature published in this issue (Moss et al., in press). MethodsGender norms analysis of Initiative data identifies critical thematic issues impairing access to support services for victimized boys. ResultsMost disconcerting is gender-based stigmatization from services that can compound children's trauma. Justice-based, rather than trauma-informed models of support predominate in responses for boys. Legal frameworks create barriers when binary gendered terminology defines sexual violence, thereby excluding anyone other than women and girls from protection. ConclusionsThree solutions emerged to improve access to support for more children affected by sexual exploitation: (1) challenge problematic gender norms and consequent practices, such as gendered terminology in legislation, that create barriers for boys and gender-diverse children; (2) create psychologically, emotionally, and physically safe circumstances (i.e. trauma-informed care) for all children to know help-seeking is possible; and (3) undertake proactive support that specifically connects boys and gender-diverse children to therapeutic services like drop-in centers, night-time counseling, and emergency shelter.

Addressing health disparities of individuals experiencing homelessness in the U.S. with community institutional partnerships: An integrative review.

To examine existing community-institutional partnerships providing health care services to people experiencing homelessness by addressing social determinants of health (SDOH) at multiple socioecological levels. Integrative review. PubMed (Public/Publisher MEDLINE), CINAHL (The Cumulative Index of Nursing and Allied Health Literature database), and EMBASE (Excerpta Medica database) were searched to identify articles on health care services, partnerships, and transitional housing. Database search used the following keywords: Public-private sector partnerships, community-institutional relation, community-academic, academic community, community university, university community, housing, emergency shelter, homeless persons, shelter, and transitional housing. Articles published until November 2021 were eligible for inclusion. The Johns Hopkins Nursing Evidence-Based Practice Quality Guide was used to appraise the quality of articles included in the review by two researchers. Seventeen total articles were included in the review. The types of partnerships discussed in the articles included academic-community partnerships (n= 12) and hospital-community partnerships (n= 5). Health services were also provided by different kinds of health care providers, including nursing and medical students, nurses, physicians, social workers, psychiatrists, nutritionists, and pharmacists. Health care services spanning from preventative care services to acute and specialized care services and health education were also made possible through community-institutional partnerships. There is a need for more studies on partnerships that aim to improve the health of homeless populations by addressing social determinants of health at multiple socioecological levels of individuals who experience homelessness. Existing studies do not utilize elaborate evaluation methods to determine partnership efficacy. Findings from this review highlight gaps in the current understanding of partnerships that seek to increase access to care services for people who experience homelessness. The results of the systematic review were solely from the articles reviewed and do not include information from patients, service users, caregivers, or members of the public.

Resilience to hazards overlapping a pandemic: A shelter resource stabilization model

COVID-19 and the resulting financial impacts had budget and workforce implications for organizations involved in emergency shelter provision. To address distancing and sanitation protocols as well as virus transmission and vaccination rates, shelter supplies, facility modifications, and staffing adjustments were needed. As funding and authorizations to implement public health guidance and stabilize the workforce expired, emergency managers had to determine whether to continue pandemic protocols. In order to understand these relationships, we conducted a workshop in September 2021 with 137 emergency managers, public health leaders, and other government and nonprofit practitioners from 20 states, the U.S. Virgin Islands, and Canada to identify resource reallocation strategies utilized for sheltering from post-lockdown to post-vaccine periods of the COVID-19 pandemic. We applied a fiscal recovery framework to explore how these operational changes were influenced by and have implications for fiscal and policy support as well as operational adaptability. Results show that as fiscal and policy support waned, some pandemic protocols were suspended, thereby shifting and reducing human and facility resource needs. Distancing protocols benefited from improvements in masking, vaccine, and testing availability without consistent mandates, but non-congregate shelter provision was reduced as authorizations and funding expired. Modified service contracts and increased utilization of special needs registries can realign resources with health and safety needs. Based on participant responses, we developed a Retractable Stabilization Model to indicate how shelter resources can be reallocated and supported by future policy interventions to provide a range of emergency sheltering options during pandemics and overlapping hazards.

A socioecological perspective to contraceptive access for women experiencing homelessness in the United States

ObjectiveAlthough persons who are pregnancy-capable and experiencing homelessness may have a strong desire to avoid pregnancy, they face unique barriers to contraception. This multimethod qualitative study aimed to identify preferences for, barriers to, and facilitators of contraceptive access and use among women experiencing homelessness in the United States using a systems perspective. Study designWe conducted semistructured interviews with women experiencing homelessness (n = 19), healthcare providers (n = 6), and social service providers (n = 6). We recruited participants from community-based, housing, and medical organizations in North Texas in the United States. Two coders conducted thematic analysis and reached consensus for codes. ResultsWomen participants were in emergency shelter, unsheltered, or transitional/rapid rehousing. We stratified themes using the Socioecological Framework to illustrate factors affecting contraception access at individual, interpersonal, organizational and community, and societal levels. Notable results include women’s preferences for long-acting reversible contraception, difficulties healthcare providers face in initiating contraceptive counseling, and the underutilized role of social service providers in reproductive healthcare. Insurance policies, connections between health clinics and community organizations, and organizational priorities both facilitated and hindered women experiencing homelessness’s access to women’s healthcare services. ConclusionThis study identified opportunities throughout the healthcare and social service systems to support contraceptive access for women experiencing homelessness. Future interventions should strengthen and leverage these connections to promote access among this vulnerable population with the goal of supporting reproductive autonomy. ImplicationsThis study explored the reproductive health needs of women experiencing homelessness. Multilevel interventions, such as interdisciplinary care, patient-centered approaches, and an emphasis on health literacy, are needed to adequately provide the preferred methods of contraception for women experiencing homelessness, thus enabling reproductive autonomy for this population.