Experiencing Homelessness Research Articles

Lifetime Experiences of Housing Insecurity among Gay Men Living with HIV at Midlife: An Exploratory Study Utilizing a Social Determinants of Health Perspective

Understanding the socioecological contexts of gay men living with HIV is critical to addressing the environmental conditions that influence their lifetime experiences of housing insecurity and homelessness. In line with the strategies of the US Center for Disease Control and Prevention to end the HIV epidemic, it is of utmost importance to recognize how the allocation of available resources impacts health inequities affecting gay men living with HIV who experience housing insecurity and homelessness. Drawing from the World Health Organization’s social determinants of health (SDoH) framework, we used an exploratory, community-based research (CBR) approach to examine the lifetime experiences and important sources of support of gay men living with HIV at midlife who have experienced housing insecurity in Southern Nevada. Thematic analysis of our semi-structured interviews with 12 gay men living with HIV at midlife revealed three overarching themes: (1) challenges to obtaining housing and related support, (2) informal support from friends, and (3) formal support from community-based sources employing diverse support strategies. In this article, we discuss the different sub-themes we identified under these overarching themes and the implications of our findings from an SDoH perspective. We conclude with a discussion on the dire need to (1) highlight the considerable value of both informal and formal sources of support for the housing insecure, and (2) generate recommendations for interventions to address housing insecurity and homelessness with greater consideration for the impacts of SDoH in the work dedicated to helping gay men living with HIV at midlife overcome housing insecurity as they age.

Organizational and patient factors associated with positive primary care experiences for veterans with current or recent homelessness.

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

Norms of Fairness and Generosity Among People Experiencing Homelessness: A Dictator Game Field Experiment

Society often ascribes negative stereotypes to people experiencing homelessness. However, people experiencing homelessness have been found to display highly nuanced social behaviors. We employ a field dictator game to examine prosocial behavior among 173 unhoused individuals in Nashville, TN. We test whether an unhoused population displays ingroup bias, wherein they are more generous toward other people experiencing homelessness (the hypothesized ingroup) than people not experiencing homelessness (the hypothesized out-group). Additionally, we explore relationships between sociodemographic and personal characteristics (social support, perceptions of deservedness/generosity) and dictator game behavior. We did not observe ingroup bias. However, on average, participants allocated 29% of their game endowment to recipients, consistent with cross-cultural dictator game studies. We found that the duration of homelessness, social support, and gender were associated with dictator game allocations. Additionally, people experiencing homelessness were more generous when they perceived other unhoused individuals would be more generous and deserving.

Continued Homelessness and Depressive Symptoms in Older Adults

Depression is common in adults experiencing homelessness. It is unclear whether continued homelessness is associated with more depressive symptoms. To examine the association between residential status and depressive symptoms in adults aged 50 years or older experiencing homelessness at study entry. This cohort study analyzed results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age (HOPE HOME) project, which in 2013 began enrolling adults aged 50 years or older experiencing homelessness in Oakland, California, and conducted structured interviews every 6 months for a mean duration of 5.5 years through 2023 (for this cohort study). Eligible participants included those aged 50 years or older, able to speak English, and experiencing homelessness at enrollment. We analyzed data collected from 2013 to 2023. The exposure of interest was residential status. At follow-up visits, residential status was categorized as (1) homelessness (meeting the HEARTH [Homeless Emergency Assistance and Rapid Transition to Housing] Act definition) or (2) housed (living in a noninstitutional environment and not meeting the HEARTH Act definition). The primary outcome was moderate to severe depressive symptoms (with Center for Epidemiologic Studies-Depression [CES-D] scale score ≥22). The augmented inverse probability of treatment weighting (AIPTW) approach was used to examine the association between continued homelessness and depressive symptoms. The AIPTW adjusted for the following variables: number of chronic health conditions, age, sex, visiting a health care practitioner, receiving outpatient mental health treatment, receiving mental health medication, exposure to abuse, substance use disorder, and binge drinking. The cohort was composed of 450 participants, of whom 343 (76.2%) were males, and the mean (SD) age was 58.5 (5.2) years. Participants completed a median (IQR) of 8.9 (8-11) follow-up visits. With 1640 person-years of observation time, participants continued homelessness for 880 person-years (57.1%) and experienced being housed for 715 person-years (44.3%). Many participants (304 [78.0%]) were housed during at least 1 follow-up visit. The odds of a CES-D scale score of 22 or higher was significantly higher among participants who continued experiencing homelessness than among housed participants (marginal causal odds ratio, 1.08; 95% CI, 1.04-1.11; P < .001). This cohort study found that continued homelessness was associated independently with increased odds of depressive symptoms. Obtaining housing may have a favorable role in depression and overall well-being of older adults experiencing homelessness and may be considered as a mental health intervention.

Evaluation of Functional Cognition in People Experiencing Homelessness: Findings from A Scoping Review and Implications for OT Practice

Abstract Date Presented 03/22/24 Cognition may be assessed as a predictor of ability to maintain housing in people experiencing homelessness. A scoping review was completed to identify current methods for evaluating functional cognition in PEH, including implications for OT practice Primary Author and Speaker: Caitlin E. Synovec Additional Authors and Speakers: Lee Westover, Leonie Boland

Navigating and negotiating “outness” among 2S/LGBTQ+ youth experiencing homelessness

There are important implications associated with coming and being out for Two-Spirit, lesbian, gay, bisexual, transgender, and queer, and other sexual and gender minority (2S/LGBTQ+) people. “Outness” is indeed imbued with risks, particularly in contexts of visibility and structural precarity. This community-based study used photovoice methods, including data from 61 semi-structured interviews with 32 2S/LGBTQ+ youth (ages 17-29), to examine how they navigate and negotiate outness in connection with homelessness. Our reflexive thematic analysis was guided by theoretical perspectives related to gender and queer performativity, hegemonic masculinities, and strategic outness. We developed four themes: (i) being out in/of harm’s way, (ii) norming outness, (iii) concealing outness, and (iv) masc-ing up. Across these thematic findings, we characterize the stakes of coming out and being outed with respect to trajectories and experiences of homelessness for 2S/LGBTQ+ youth. Moreover, we examine youths’ dynamics of managing outness to broker access to services and housing and mitigate anti-2S/LGBTQ+ and gender-based discrimination and violence risks. Findings detail how youth negotiate the tensions between what they perceive and experience as possible with respect to outness in the context of homelessness and pursuing belonging, safety, material security, and housing. Recognizing these efforts while addressing long-standing inequities in homelessness for 2S/LGBTQ+ youth is a necessary pursuit.

“Especially Being Homeless, They Just Think You’re Infected with COVID or Something”: A Qualitative Exploration of the COVID-19 Pandemic’s Impact on People Experiencing Homelessness With a History of Injection Drug Use in Baltimore, Maryland

People experiencing homelessness with a substance use disorder are a highly structurally vulnerable population, facing a unique burden of compounding stigma, discrimination, and adverse health outcomes. Evidence remains mixed on best practices for housing interventions designed to meet the needs of this population. Ten people with a history of injection drug use experiencing homelessness during the COVID-19 pandemic were interviewed between July 2021 and February 2022 in Baltimore, Maryland. Thematic analysis was used to characterize the pandemic’s impact on their resource access, housing, and substance use. Participants highlighted substantial challenges resulting from structural changes during the pandemic, including limits on income-generating opportunities and resource access, and increases in experiences of stigma and discrimination. However, several individuals reported decreased substance use in response to changes to their housing status, with those placed in secure housing attributing their decreased use to this change. These accounts can help guide housing and social support interventions best suited to meet the unique needs of people experiencing homelessness with substance use disorders.

Predictors of recurrent stroke and subsequent mortality among patients experiencing housing instability

BackgroundThe experience of homelessness has been linked with developing poor health outcomes. Little is known about the risk of recurrent stroke among these individuals. This study investigated the correlates of developing recurrent stroke and subsequent mortality among Veterans with housing instability. MethodsUsing a national sample of Veterans from the U.S. Department of Veterans Affairs who had an indicator of housing instability between 2014–2018 (n=659,987), we identified 15,566 Veterans who experienced incident stroke. We compared characteristics of Veterans who experienced incident stroke and did and did not experience recurrent stroke and conducted logistic regressions using a discrete-time survival framework to assess two outcomes: recurrent stroke and all-cause mortality. ResultsAmong our cohort, 91.3% did not experience recurrent stroke while 8.7% did during the observation period. The receipt of any level of primary care outpatient visits was associated with a reduction in the odds of recurrent stroke. Several medical diagnoses were also associated with increased odds of recurrent stroke, including hypertension (aOR 1.35, 95% CI 1.15-1.59), diabetes (aOR 1.21, 95% CI 1.07-1.36), and renal disease (aOR 1.17, 95% CI 1.02, 1.35). Veterans who used any level of VA Homeless Programs had reduced odds of all-cause mortality (high level: aOR 0.65, 95% CI 0.60-0.71; low level: aOR 0.66, 95% CI 0.60-0.73). ConclusionOur study found several predictors of developing recurrent stroke and subsequent death in a population of Veterans experiencing housing instability. Implications include the need to monitor closely high-risk patients who have experienced incident stroke and have other co-occurring needs.

Factors associated with homeless experiences amid the COVID-19 pandemic in the Nipissing District, Ontario, Canada.

Canadian homelessness is an ongoing issue, especially in the Nipissing District, Ontario, where agencies work to support those in need. However, these efforts were challenged with the sudden onset of the COVID-19 pandemic. Drawing on the Cycle of Homelessness model, this study examines sociodemographic factors associated with homeless experiences during the pandemic. Using data from the 2021 (n = 207) Nipissing District homeless enumeration survey and employing bivariate and multivariate binary logistic analyses, this study examined sociodemographic factors associated with reasons of homelessness, barriers to housing loss and experiences of chronic and episodic homelessness during the pandemic. The results showed a significant sociodemographic variation in the experiences of the homeless population during the COVID-19 pandemic. Those over the age of 35 versus their younger counterparts were more likely (43.7%) found in emergency shelters. Multivariate findings indicated that females experienced housing/financial loss and interpersonal/family issues, directly causing homelessness, 2.2 and 2.5 times more than males, respectively. Welfare recipients were more likely to experience health-related reasons for housing loss (Odds Ratio (OR): 2.8), chronic homelessness (OR: 3.3), addiction (OR: 2.9), and mental health-related barriers to housing (OR: 4.1). Those aged 25-34, 25-44, and 45+ were 7.9, 4.9, and 5.1 times more likely to face chronic homelessness. Conclusions: Welfare recipients are more at-risk of health-related housing loss, addiction, and mental health barriers to housing, and chronic homelessness. This could be attributed to poor public planning and policies that put people in marginal economic and housing circumstances, especially during the pandemic. Therefore, policy reform is required to address the main barriers in eliminating homelessness.

Predicting Intimate Partner Violence Perpetration Among Young Adults Experiencing Homelessness in Seven U.S. Cities Using Interpretable Machine Learning.

Young adults experiencing homelessness (YAEH) are at higher risk for intimate partner violence (IPV) victimization than their housed peers. This is often due to their increased vulnerability to abuse and victimization before and during homelessness, which can result in a cycle of violence in which YAEH also perpetrates IPV. Identifying and addressing factors contributing to IPV perpetration at an early stage can reduce the risk of IPV. Yet to date, research examining YAEH's IPV perpetration is scarce and has largely employed conventional statistical approaches that are limited in modeling this complex phenomenon. To address these gaps, this study used an interpretable machine learning approach to answer the research question: What are the most salient predictors of IPV perpetration among a large sample of YAEH in seven U.S. cities? Participants (N = 1,426) on average were 21 years old (SD = 2.09) and were largely cisgender males (59%) and racially/ethnically diverse (81% were from historically excluded racial/ethnic groups; i.e., African American, Latino/a, American Indian, Asian or Pacific Islander, and mixed race/ethnicity). Over one-quarter (26%) reported IPV victimization, and 20% reported IPV perpetration while homeless. Experiencing IPV victimization while homeless was the most important factor in predicting IPV perpetration. An additional 11 predictors (e.g., faced frequent discrimination) were positively associated with IPV perpetration, whereas 8 predictors (e.g., reported higher scores of mindfulness) were negatively associated. These findings underscore the importance of developing and implementing effective interventions with YAEH that can prevent IPV, particularly those that recognize the positive association between victimization and perpetration experiences.

Clinical Sociology and Community Interventions

At least 235,000 people experience homelessness in Canada each year, with over 35,000 experiencing homelessness on any given night (Gaetz et al. 2013a). For many, maintaining housing is challenging due to the absence of essential life skills. This paper departs from a community-identified problem with conventional life skills programming and uses sociological tools to address it. Community partners have expressed a need for a life skills curriculum that is inclusive, representing the intersecting needs and experiences of a diversity of clients, and that will address budgetary constraints of not-for-profit (NFP) organizations in the region. The Community-Ideas Factory: The Life Skills Project consists of an interdisciplinary research team and 16 NFPs collaborating to build a comprehensive, inclusive, relevant, and effective online life skills intervention. Adopting a clinical sociological and community-engaged research approach, our findings emphasize the importance of recognizing that essential life skills are diverse and shaped by the larger social, political, and economic context, such as social inequities. Notably, social justice is identified as a crucial life skill, uncovering the intersectionalities that shape individuals' lives and that must be integrated into life skills programming. This ground-breaking finding is facilitated by our methodology, deviating from the positivist research approaches prevalent in life skills studies. Significantly, the entire life skills curriculum is Equity, Diversity, and Inclusion (EDI)-informed. The intervention addresses immediate financial strains for partner organizations. We anticipate that the intervention will interrupt current cycles of homelessness while holding promise as a preventative measure.

What We (Don't) Know about the Infectious Disease Burden Among Youth Experiencing Homelessness in the United States and Canada.

Youth experiencing homelessness (YEH) and sexual and gender minority (SGM) YEH may be at increased risk for infectious diseases due to living arrangements, risk behaviors, and barriers to healthcare access that are dissimilar to those of housed youth and older adults experiencing homelessness. To better understand infectious diseases among YEH populations, we synthesized findings from 12 peer-reviewed articles published between 2012 to 2020 which enumerated YEH or SGM YEH infectious disease burden in locations across the U.S. or Canada. Pathogens presented in the studies were limited to sexually transmitted infections (STIs) and bloodborne infections (BBI). Only three studies enumerated infectious diseases among SGM YEH. There was a dearth of comparison data by housing status (ex., sheltered versus unsheltered youth), SGM identity, or other relevant counterfactual groups in the identified studies. We also introduce three publicly available, national-level surveillance datasets from the U.S. or Canada that quantify certain STIs, BBIs, and tuberculosis among YEH, which may be used for future disease burden assessments. Our review calls for more comprehensive YEH-centered research that includes multimodal data collection and timely disease surveillance to improve estimates of infectious diseases among this vulnerable population.

Exploring Mental Health Services for Youth Experiencing Homelessness in East Asian Pacific Regions: A Systematic Scoping Review.

Youth experiencing homelessness (YEH) in East Asian Pacific (EAP) regions represent one of the most at-risk populations due to cultural and geographical factors. Effective mental health interventions, primarily researched in Western contexts, may not fully apply to YEH in EAP. Their lack of stable shelter, disrupted social networks, and limited access to mental health services elevate their susceptibility to adverse mental health, making urgent interventions essential to address their needs. The objective of this study is to explore and systematically search the types of mental health services and interventions available for YEH in EAP and their impact on overall quality of life and wellbeing. Electronic databases (e.g., Medline, PsycINFO, PubMed, Scopus) were systematically searched (publication dates between 1 January 1990 and 13 May 2023), as well as additional online resources specific to homelessness. Articles were screened, and a critical appraisal assessed the quality of the included studies. Eight studies with different interventions were identified in Indonesia (n = 2), Malaysia (n = 1), South Korea (n = 3), and the Philippines (n = 1). These were thematically clustered into six categories: art, cognitive behavioural therapy, life skills education, resilience enhancement, family strengthening, and government interventions/services. This review highlights effective mental health interventions' positive impact on YEH mental health outcomes and quality of life in EAP, stressing the urgent need to implement socio-culturally sensitive services. Future research should address knowledge gaps through comprehensive studies covering diverse EAP regions and populations, prioritising socio-culturally specific psychological measures.

Advocacy and legal aid for homeless people. Challenges and insights from a study of voluntary organisation in Italy

ABSTRACT The connection between homelessness, social exclusion, and the deprivation of fundamental rights has been extensively studied. The intricate interplay of laws, policies, regulations, institutions, and service practices forms a complex network of mutually reinforcing factors, that can pose a significant challenge to the homeless. This article presents the findings of a qualitative study focused on the Italian nonprofit organisation called ‘Street Lawyers’ (SL) which provides legal assistance and advocacy for homeless people. Due to social exclusion, homeless experience daily violations in exercising their rights and encounter many obstacles within the welfare system. The aim of the research was to investigate how SL's mission is implemented, what needs are met and the complexity of their interventions. The findings demonstrate how, despite the organisation's legal mandate, SL face various difficulties and needs that emphasise the hardships experienced by the homeless people. These issues extend beyond the legal sphere and offer insightful perspectives on the trajectories and support system of the homeless. By revealing the obstacles homeless people face in claiming and enjoying their rights, the article shows the potential of this legal aid practice, particularly when it goes beyond a formal legalistic approach and embraces a socio-political interpretation of rights.

Homelessness—The perspectives of people with intellectual disability and/or Autistic spectrum disorder and their families

AbstractPeople with intellectual disability (ID) and/or autism spectrum disorder (ASD) are over‐represented in the homelessness population. A lack of available and suitable social housing leads to an over‐reliance on a private rental market where high rents are prevalent. Yet, people with ID and/or ASD, are more at risk of living in poverty and as such excluded from the private rental market. The current study reports on the lived experience of homelessness for a sample of people with ID and/or ASD and families supporting adult /children with ID/ASD. Their stories illuminate the complexity and challenges in securing a stable, safe and secure home.

The Impact of Intimate Partner Violence on Homelessness and Returns to Housing: A Qualitative Analysis From the California Statewide Study of People Experiencing Homelessness.

Homelessness is a public health concern in California and throughout the United States. Intimate partner violence (IPV) is a risk factor for experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Qualitative methods can provide a greater understanding of the lived experience of IPV and homelessness to identify potential solutions. We purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. We administered semi-structured interviews focusing on IPV and six other topic areas pertaining to homelessness from October 2021 to May 2022. We created and applied a codebook with a multidisciplinary team using a hybrid of deductive and inductive logic. Our analysis included all participants who discussed IPV and homelessness across the seven studies. We conducted a thematic analysis using an interpretivist approach and informed by grounded theory. We found that violence within a partnership was multidimensional (physical, sexual, emotional, and financial) and bidirectional. We identified six themes: (1) IPV precipitated and prolonged homelessness; (2) Need for housing, financial stability, and material resources influenced staying in abusive relationships; (3) Alcohol and illicit substance use exacerbated violence between partners; (4) Participants struggled to find resources in domestic violence (DV) shelters; (5) The healthcare system did not provide substantial support; and (6) discrimination and stigma influenced equitable access to housing and DV resources. Experiencing IPV contributed to homelessness and impeded returns to housing. Limitations in current IPV resources impede care. We propose equitable expansion of survivor-centered services that improve access to long-term subsidized housing, prevent IPV and homelessness with flexible funding options, and facilitate rapid exits from homelessness through trauma-informed, non-congregate shelter that transitions to permanent housing.

Psychological distress mediates the link between bullying and truancy in Australian LGBQ+ adolescents with experiences of homelessness

ABSTRACT Homelessness is a high prevalence experience among lesbian, gay, bisexual, and queer (LGBQ+) youth, and potentiates both significant morbidity and future homelessness. While educational attainment is cited as a structural solution to homelessness, limited research exists on homeless LGBQ+ youths’ schooling experiences. A nationwide, cross-sectional survey involving 4,370 cisgender LGBQ+ participants aged 14–21 was conducted to address this gap. Regression analyses showed previous homelessness was associated with an increased odds of verbal, physical and sexual bullying and harassment within school contexts. Mediation analyses confirmed the mediating role of psychological distress on the associations between physical and sexual harassment and truancy, regardless of past homelessness. Previous experiences of homelessness are not associated with increased distress in relation to bullying or harassment. However, the indirect effect of harassment on truancy was significantly more pronounced for youth with past homelessness. Our findings crucially suggest that bullying presents both direct and indirect structural risks to cisgender LGBQ+ youth, and is particularly inconducive to continued engagement with schooling for youth with experiences of homelessness. Interventions aiming to address truancy among this group should aim to reduce the incidence of bullying within educational settings, whilst also providing assistance for managing the challenges associated with experiencing homelessness.

Cancer Prevention for Women Experiencing Homelessness: Onsite Mammography, Navigation, and Education.

Persons experiencing homelessness (PEHs) represent a medically underserved population with a disproportionately high rate of late-stage cancer diagnoses and cancer mortality. During mobile onsite mammography and breast health education events, we studied PEH's barriers to and uptake of cancer screenings. This study used patient surveys and review of the electronic health record. The main outcome measures included mammogram and diagnostic imaging (as needed) results. A questionnaire assessed patient's views and barriers related to social determinants of health. The study included women accessing community organization resources who were 40 years or older or who met criteria for screening mammography. Forty-six individuals completed mammograms and 41 individuals participated in the survey, for a response rate of 89%. Thirty-five participants (85%) held health insurance provided by a Medicaid managed plan. Thirty-six participants (87%) received a negative mammogram result, and five participants (12%) required follow-up for abnormal results. Of these five, two participants completed diagnostic follow-up with negative results, and three did not complete diagnostic follow-up. In addition to barriers related to housing insecurity, five patients (12%) reported transportation barriers. A majority (n = 28, 68%) disagreed or strongly disagreed with the statement, "I'm afraid the mammogram will be painful." A majority (n = 31, 76%) disagreed or strongly disagreed with the statement, "I'm busy and do not have time." Nearly all participants (n = 37, 90%) responded yes to the statement, "I believe in preventative care screenings." Eight participants (20%) completed at least one additional cancer screening. By creating enduring programs offering screening, navigation, and education, academic-community partnerships may begin to address the increased cancer mortality among PEHs by improving screening adherence.

"Just a knife wound this week, nothing too painful": An ethnographic exploration of how primary care patients experiencing homelessness view their own health and healthcare.

Community health needs assessments (CHNA) involving qualitative techniques help tailor health services to the specific needs of the population groups for whom they are designed. In light of increasing health disparities amongst people experiencing homelessness (PEH)-and to ensure the integration of their voices into a larger CHNA-this study used an ethnographic approach grounded in a social constructivist research paradigm to explore the perspectives of PEH attending a primary care and addiction service in Ireland on their priority health and healthcare needs. Participant observations and informal interviews were conducted with clients experiencing homelessness attending the service for three hours every Monday morning between October 2022 and April 2023. Field note data from active participant observation and informal conversations were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers' institutional Research Ethics Committee. Three main themes emerged from the analysis: self-identified priorities, satisfaction with health services, and migrant health. Clients' priority concerns relate to their mental health and personal safety, strengthening ties with children and families, finding a sense of purpose, and feeling better physically. These challenges differ from those of the general population in terms of their severity observed both prior to and during experiences of homelessness, coupled with disproportionately high levels of loss, fear, pain, fatigue, social stigma and other barriers to accessing satisfactory housing. In terms of services, clients are satisfied with their ability to access primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. Moving forward, health practitioners may consider holding more regular and open conversations with clients experiencing homelessness about the care they are receiving, its rationale, and whether or not changes are desired that can be safely made. The health needs of migrants and asylum seekers entering homelessness in Ireland are urgent and should be prioritised in future research.

Graduate and Undergraduate Medical Curricula That Address the Needs of People Who Experience Homelessness: A Scoping Review Protocol

Background The impact that increased homelessness has on the healthcare system should be of great concern to medical providers and the institutions that train them. While the demand for medical providers who understand the healthcare needs of homeless individuals is high, traditional medical curricula do not adequately address this. Objectives This scoping review aims to examine published undergraduate and graduate medical curricula that address the healthcare needs of homeless individuals to support the development and evaluation of homeless healthcare curricula globally. Methods This paper will utilise Arksey &amp; O’Malley’s framework for scoping reviews to ensure a systematic scoping review. Research will be conducted in accordance with the Joanna Briggs Institute's (JBI) Updated Methodological Guidance for the Conduct of Scoping Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Review (PRISMA-ScR). Due to financial and time constraints, only articles published after 2000 and written in English will be reviewed. A comprehensive search strategy will be developed that includes searches in PubMed, Scopus, Embase and CINAHL with additional hand-searching of key articles. Each article will be screened independently by two reviewers. A third reviewer will resolve any disagreements. Data extraction will begin with a pre-defined extraction form (Extended Data File 3) and will be subsequently analysed with JBI’s current guidelines on inductive approaches to qualitative content analysis. Conclusion Research findings will be distributed to individuals who oversee the university’s medical curricula at the Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences. Discussions will be held to assess opportunities for the implementation/integration of homeless healthcare curricula. Furthermore, these findings will be disseminated globally to healthcare providers and administrators at conferences, hospitals and clinics.