Experiencing Homelessness Research Articles

The Work of Youth Homelessness Prevention in Ontario: Points of Frustration, Points of Potential

Despite a rhetorical turn towards prevention in homelessness policy and research, the work of youth homelessness prevention continues to be frustrated by persistent structural barriers. In this article, we examine how youth homelessness prevention is being implemented in the province of Ontario, with a focus on targeted provincial support programs and local shelter diversion practices. Drawing on interviews with workers in the homeless-serving sector, we describe the implementation of these initiatives and identify points of frustration and potential that workers encounter as they try to prevent experiences of homelessness for youth. We contend that these points of frustration illuminate persistent structural barriers that continue to forestall the work of youth homelessness prevention. Meanwhile, points of potential demonstrate the importance of empowering workers to creatively adapt and offer responsive services. Taken together, these signal the critical importance of two aspects of contemporary homelessness prevention typologies—primordial prevention and empowerment. We end by offering aspirations for action, a political reframing of the policy recommendations sections more typical of social science research articles. We do so to affirm our commitment to advancing the work of structural transformation that is required to achieve the right to housing for all, including youth.

Comparison of Transportation Use Among Older and Younger Persons Experiencing Homelessness

Regardless of age, transportation determines access to necessary services and supports, including food, healthcare, shelter, and social connection for persons experiencing homelessness (PEH). This study compared experiences and perceptions of transportation among PEH aged <49 years old to PEH aged 50+ years. We conducted a secondary qualitative data analysis of semi-structured interviews with 18 PEH staying in emergency shelters in Salt Lake County, Utah. Using thematic analysis, we identified three points of comparison between older and younger PEH: 1) Modes of transportation used; 2) Reasons for using public transit; and 3) Perceptions of public transit. While there are some similarities across transportation modes used (e.g., public transit, dedicated homeless-services shuttle, walking), older PEH also reported using taxi services when it could be afforded or shared with others. In addition, older PEH more often discussed using public transit to get to healthcare appointments, while younger PEH reported needing transit to get to places of employment. Though both participant groups described the prohibitive costs of transit, OPEH recommended that to use transit most successfully there need to be places to sit and rest when walking, as well as more publicly available bathrooms and crosswalks for safety. This age-based comparison offers insight into ways to increase transportation equity and support PEH of all ages who similarly have unmet mobility needs.

Foot Health And Footwear For Persons Experiencing Homelessness: A Resource

Foot Health And Footwear For Persons Experiencing Homelessness: A Resource

Dismantling Barriers to Hepatitis B and Delta Screening, Prevention, and Linkage to Care among the PWUD Community in Philadelphia.

The prevalence of hepatitis B and delta viruses (HBV/HDV) among people who use drugs (PWUD) remains largely unknown. In the context of one Philadelphia-based harm reduction organization (HRO), this study aimed to assess HBV/HDV prevalence and facilitate linkage to care. Participants completed a demographic HBV/HDV risk factor survey and were screened for HBV and reflexively for HDV if positive for HBV surface antigen or isolated core antibody. Fisher's exact tests and regression were used to understand relationships between risks and HBV blood markers. Of the 498 participants, 126 (25.3%) did not have hepatitis B immunity, 52.6% had been vaccinated against HBV, and 17.9% had recovered from a past infection. Eleven (2.2%) participants tested positive for isolated HBV core antibody, 10 (2.0%) for HBV surface antigen, and one (0.2%) for HDV antibody. History of incarceration was associated with current HBV infection, while transactional sex and experience of homelessness were predictive of previous exposure. This study found high rates of current and past HBV infection, and a 10% HBV/HDV co-infection rate. Despite availability of vaccine, one quarter of participants remained vulnerable to infection. Findings demonstrate the need to improve low-threshold HBV/HDV screening, vaccination, and linkage to care among PWUD. The study also identified gaps in the HBV/HDV care cascade, including lack of point-of-care diagnostics and lack of support for HROs to provide HBV services.

577 Understanding Drivers of Fire Risk with People Experiencing Homelessness

577 Understanding Drivers of Fire Risk with People Experiencing Homelessness

Young Women's Experiences of Violence and Homelessness.

This article explores the lived experience of young women navigating and surviving domestic and family violence (DFV) and homelessness. Promoting the voices of young women through in-depth interviews, this article considers their story of violence, abuse, homelessness, and sense of safety. Such stories enable reflection on the ability of services to provide personal, material, emotional, and cultural safety in a way that recognizes the intersecting impact of trauma before, during, and after experiences of DFV. We conclude by arguing that providing emotional and cultural safety through the relational aspects of service delivery is essential to developing a strong foundation for young women's futures.

The Use of Turning Points in Understanding Homelessness Transitions: A Critical Social Psychological Perspective

ABSTRACT We argue for use of the narrative concept of the “turning point” in homelessness research from a critical social psychology perspective. BackgroundTurning points are often understood as rifts in the life course followed by significant change in direction. However, within narrative theory they are not events but subjectively significant features of the person’s life-story. The turning point as narrative toolThe analysis identified how turning points were deployed by participants in a study of homelessness experiences. Participants used the turning point in constructing themselves as agentic, reformed individuals who had gained insight. However, this did not necessarily bring positive life changes. Data extracts are used to illustrate the power of adopting a constructivist, narrative theoretical orientation in understanding turning points in accounts of homelessness. Implications for practiceViewing turning points in this way may help us understand how best to provide support for people without housing.

The Role of Childhood Violence in Adult Victimization Among Women Experiencing Homelessness in Spain.

Persons experiencing homelessness represent one of the principal manifestations of the phenomenon of social exclusion, with homeless women constituting a group in a particularly vulnerable situation. The article analyzed the experience of violence in childhood and adolescence, and its implications in terms of violence experienced as an adult, in a sample of women experiencing homelessness in Madrid (Spain) (n = 138). All participants were of legal age and had spent the night before the interview in a shelter or other facility for the homeless, on the street, in public spaces or in places not suitable for sleeping. Information was gathered through a structured interview. The results show that the interviewees had experienced a high percentage of physical, psychological, and/or sexual violence, both in their childhood and adolescence and throughout their lives, with a strong correlation between the experience of violence in childhood and the experience of violence in adulthood, particularly sexual assaults, intimate partner violence, and sex work. The experience of childhood sexual abuse among women experiencing homelessness appears to have had particularly negative consequences in adulthood. Public policies, prevention programs, and care mechanisms with a gendered perspective must be implemented, aimed at reducing the number and intensity of situations of violence experienced by women and girls at risk of social exclusion or in a homeless situation.

Digital health access, uptake, literacy and trust in people with experience of homelessness.

Although digital health promises improved healthcare efficiency and equity, access and uptake might be low indisadvantaged populations. We measured access todigital health technology, the uptake of digital health, digital health literacy and COVID-19 vaccination intentions in an inner-city Australian population experiencing homelessness. An existing Australian survey, including a validated digitalhealth literacy measure (eHealth Literacy Scale [eHEALS]), was modified and distributed in three general practices specifically targeting the homeless population. Data analysis used appropriate descriptive statistics and correlation coefficients. Eighty-three respondents completed the survey in 2021. Digital health uptake was much lower than in the general Australian population in 2019-20, despite good access to working smart phones and connectivity. Digital health literacy was positively associated with uptake. Internet-sourced information was trusted less than information from a general practitioner. Further work is needed to understand the perceived usefulness and sociocultural compatibility of digital health in different subpopulations experiencing homelessness, including susceptibility to misinformation.

Program Evaluation and Improvement by a Homeless Community Using a Human Centered Design Approach

People experiencing homelessness are often absent from the development and implementation of new housing projects. As mounting evidence demonstrates the link between health and housing, it seems ineffective to design solutions without the participation and insight of those who are chronically unhoused. This study describes a method for program and product evaluation that people with lived experience of homelessness can use to determine the value of new offerings and then design improvements based on their evaluation. Specifically, this article reports the experience of evaluating a handbook describing the operations of a new type of housing for people experiencing homelessness. The research team, which included people with lived experience of homelessness, performed interviews to evaluate plans in the handbook, analyzed those results, and designed improvements in the operations of the housing based on the program evaluation. The team utilized participatory analysis of the interview data and then used a Human-Centered Design approach to generate ideas based on the analysis and develop concepts to improve the operational plan. The evaluation identified four high-priority problems with the operational plan and the group then designed three unique solutions to address those problems. This project demonstrates that people with lived experience of homelessness can participate as equal partners in the evaluation of a program and the subsequent program improvement design that was based on their evaluations.

Hauntology: The Emotional Costs of Social Policy for Mothers Experiencing Homelessness

ABSTRACT The article is concerned with the emotional effects of homelessness on women who are mothers. It develops a multi-disciplinary conceptualization of “haunting” to bring understanding to the ongoing grief and trauma associated with losing a home and children. It explores how women’s embodied and affective experiences are not just responses to deeply distressing events, but inextricably intertwined with the unfurling of housing and child protection policies, sometimes long after a policy decision (eviction, child removal). Drawing on biographical research with 26 women, the article contributes new insights into both our limited understanding of women’s homelessness but also scholarly work that recognizes the diffuse power of social policy and its harms. The article advances a novel understanding of women’s lived experience of homelessness by conceptualizing and empirically investigating the emotional effects of policy decisions as hauntings that permeate past, present and anticipated futures.

126. The Sexual and Reproductive Health Concerns of Youth Experiencing Homelessness Presenting to an Urban Pediatric Emergency Department: a descriptive study

126. The Sexual and Reproductive Health Concerns of Youth Experiencing Homelessness Presenting to an Urban Pediatric Emergency Department: a descriptive study

Estimating the Rates of Undiagnosed Prediabetes and Diabetes Among People Experiencing Homelessness

ObjectivesThe rising prevalence of type 2 diabetes in Canada poses a significant health challenge. Despite the convenience of screening for diabetes with glycated hemoglobin (A1C) concentration, people experiencing homelessness (PEH) often face barriers to accessing diabetes screening, potentially leading to underdiagnosis. In this study, we aim to assess the prevalence of undiagnosed diabetes among PEH in Calgary, Alberta, and contribute insights for planning health-care services and public health initiatives. MethodsFour screening clinics were held, and participants were recruited through posters and word of mouth. Participants underwent point-of-care A1C testing using the Siemens DCA Vantage point-of-care analyzer. Descriptive statistics were used to identify the proportions of prediabetes and diabetes, whereas CANRISK survey scores were used to identify the pre-test probability of diabetes. ResultsThe mean age of participants (n=102) was 47.6 years, and the self-reported causes of homelessness among the participants were diverse, including housing and financial issues (n=53), interpersonal and family issues (n=35), and health- or corrections-related factors (n=27). The average A1C was 5.60% (standard deviation 0.57%), with 5 values in the diabetes range and 12 in the prediabetes range, for a total of 17 participants found to have previously undiagnosed dysglycemia. ConclusionsThe high rate of undiagnosed prediabetes and diabetes among PEH reflects at least what is already seen in the general population in Canada. More resources are required to reduce the barriers to screening for diabetes among this population.

Using the Plan-Do-Study-Act Evaluation Framework to Improve the Recruitment of Women Experiencing Homelessness: Lessons Learned.

Strategic recruitment is necessary to reach recruiting goals when conducting research with vulnerable and transient populations, such as postpartum women experiencing homelessness. The current study evaluated the recruitment process for a qualitative study using the Plan-Do-Study-Act (PDSA) method. In a study conducting semistructured interviews about reproductive interconception care barriers and facilitators for local women who were recently pregnant and homeless in 2022, PDSA cycles were used to improve community organizations' assistance with identifying participants, facilitate screening and interviewing processes, and ensure participants were safeguarded. Iterative PDSA cycles were conducted across a 20-week period. Ultimately, 12 women were interviewed, with increasing participant location and organizational assistance over time. Following 4 key lessons were identified: provide in-person and remote options for conducting data collection; include fair compensation that balances time versus study coercion; weigh feasibility versus importance of sample size with eligibility criteria; and support partnerships with organization connections. The PDSA method served as a parsimonious framework for evaluation. The lessons learned will help facilitate future recruitment efforts for this difficult-to-recruit and vulnerable population.

220 The Unheard Voices of Clinical Trials: Fostering Inclusivity for People Experiencing Homelessness in Clinical Trials

OBJECTIVES/GOALS: Investigate the perspectives of people experiencing homelessness (PEH) on clinical trials to uncover knowledge gaps and attitudes. This study aims to offer insights for clinical researchers to enhance engagement with this marginalized group, ushering in a more inclusive clinical trial process. METHODS/STUDY POPULATION: A 14-question survey was developed in collaboration with the Street Medicine Team at the University of Southern California and other stakeholders of PEH research. Initial questions assess knowledge of clinical trials, followed by questions gauging sentiments on clinical trial participation, and final questions on the significance, benefits, and risks of clinical trials. Upon approval by the local Institutional Review Board, the survey will be administered in an interview format. Study participants will be from locations within the area of operations of the USC Street Medicine team–in and around Hollywood, South Los Angeles, and/or the Los Angeles Council District 1. RESULTS/ANTICIPATED RESULTS: We anticipate that the results of this study will offer valuable insights into the perspectives of PEH regarding clinical trials. Results will also provide varying levels of knowledge and understanding among PEH about clinical trials, along with their past experiences in clinical trial participation, and willingness for future involvement in such trials. Further, the results will reveal whether respondents feel they are being properly represented in clinical research projects that could impact themselves and their community. This project can also enhance our understanding of the expectations and concerns of PEH regarding their potential participation in clinical trials. DISCUSSION/SIGNIFICANCE: The outcomes of this research project have the potential to lay the groundwork for enhancing the involvement of PEH in translational science research, encompassing aspects from study design to participation. This improvement could benefit not only participants but also various stakeholders involved.

A Scoping Review of Medical Students’ Perception of People Experiencing Homelessness

A Scoping Review of Medical Students’ Perception of People Experiencing Homelessness

Homelessness: challenges and opportunities in the “new normal”

Purpose This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic. Design/methodology/approach Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS. Findings Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society. Research limitations/implications Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach. Practical implications This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population. Social implications This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems. Originality/value The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

Social Entrepreneurship, Empowerment of Women Experiencing Homelessness and Gender Equality

The relationship between social entrepreneurship and social change continues to generate interest among researchers. We apply Kabeer’s conceptualisation of empowerment and additionally, explore intersectionality, paradox of empowerment and change agents for gender equality, to consider the practices of a social enterprise supporting the empowerment of women experiencing homelessness in the UK. We reflect on the motivations and drivers behind its work, the extent to which the women were able to access and control resources, and the change agents enabling this transformation. While the practices of the social enterprise in our case study positively affected women’s empowerment, they also bring to the fore several areas for reflection for social entrepreneurship research; the incorporation of intersectionality into advocacy for marginalised women such as those in our study, the role of male leaders in advancing gender empowerment and the need to find the delicate balance between empowerment on the one hand, and paternalism and suppression on the other.

Perceptions from emerging adults with a history of homelessness on their experiences with housing, health and other support services

Homelessness is a significant public health problem in the U.S., where nearly 3.5 million emerging adults (ages 18–25) experience homelessness while unaccompanied by a parent or guardian. Emerging adults are a particularly vulnerable group, even without the added stress of homelessness. Being unhoused can exacerbate negative outcomes in wellbeing and functioning and also increase risky behaviors. These complex needs are important to consider for programs aimed at housing emerging adults with a history of homelessness. Drawing on in-depth interviews with 30 emerging adults who have experienced homelessness, this study explores a range of perspectives on challenges and opportunities for coordination of housing and social support services for emerging adults, particularly those that are perceived to contribute to housing stability. Overall, findings suggest a mix of positive and negative experiences with various approaches to case management among both stably and unstably housed participants, highlighting the overall importance of the case manager in the housing process experience. Results also indicate that stable housing may provide a platform for greater access to and utilization of physical health care resources. Important issues to be addressed in the future include perceived discrimination in service provision. These results offer policy implications, such as expanding age-related eligibility for support systems and increasing the consistency and timeliness of case management to improve the overall experience of trying to obtain and remain in stable housing.

On (not) being literate enough: The literacy experiences and literacy programme needs of people experiencing homelessness or who are at risk of homelessness

AbstractThis paper is focussed on literacy and the literacy experiences of people who are experiencing homelessness or are at risk of homelessness. Drawing on 23 in‐depth interviews with people who have lived experience of homelessness in Sydney, Australia, the paper examines literacy, literacy needs and interest in literacy programmes from a social practice perspective of literacy. Amartya Sen's (1999) capability approach is drawn on to examine the multidimensional barriers that impede access to literacy. Our findings show literacy needs and how literacy is understood and valued in the lives of people with lived experience of homelessness. We show the ways that spatial and temporal conditions enable and create (im)possibilities for the realisation of literacy as a capability. We also discuss how the capability is imagined to fit into existing worlds, as both an instrumental tool, as well as for personal satisfaction and broader participation in social life. Our interviewees also point to the possibilities of literacy learning and programmes supporting the realisation of other capabilities, emphasising the prospects of achieving multiple capability realisations through program design. We show how the findings bear out the principles of a social practices pedagogy in adult literacy programmes.