Experiencing Homelessness Research Articles

Intersectional Structural Stigma: A Qualitative Study With Persons Experiencing Homelessness in the Southwest United States.

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

Development of the TIFFIN recommendations for co-producing palliative and end-of-life care research with individuals with lived experience of homelessness: A qualitative study.

Palliative care for people experiencing homelessness is a complex field. Due to the intricate nuances and heterogeneity in the experience of palliative care for people without secure housing, it is essential that research is informed by people with lived experience of homelessness. However, as homelessness is often associated with loss, trauma and high levels of exposure to death, any co-production of research, particularly in the field of palliative and end-of-life-care, must be trauma-informed. To produce recommendations for co-producing palliative and end-of-life-care research with people with lived experience of homelessness. A qualitative study comprising semi-structured interviews and focus groups. Data were analysed using iterative, reflexive thematic analysis. Twenty-seven participants were recruited. Sixteen professionals with experience of co-producing research with people with lived experience of homelessness; eleven people with lived experience of homelessness. Six key themes were developed: transparency, importance of engagement and rapport, facilitating equitable involvement via person centred approach, financial recognition of involvement, involvement and growth through a trauma-informed approach and navigating institutional resistance and attitudes. Recommendations corresponding to the core themes were developed (TIFFIN recommendations). Co-production of palliative care research with people with lived experience of homelessness is essential, but must be done carefully and sensitively. As a population with high levels of premature morbidity and mortality yet low access to palliative care, the TIFFIN recommendations could help to support the involvement of people with lived experience of homelessness in palliative and end-of-life-care care research.

Participatory Action Research, Critical Adult Education, and the Work of D.E. Smith for Research Praxis

From 2017-2021, the Youth Action Research Revolution (YARR) team documented the institutional histories of young people experiencing homelessness in Canada. Interviews with youth focused on educational, child welfare, healthcare, and criminal justice institutions. Situated at the intersections of critical adult education (CAE), participatory action research (PAR), and Institutional Ethnography (IE), we outline our mobilization of IE to ground learning and action within our team. We document the different phases of learning that we undertook, as a means of illustrating how CAE, PAR, and IE can be mutually supportive frameworks for praxis and activist learning. We highlight our use of IE to bring illuminate and resist the institutionalizing processes at work in post-secondary contexts and reflect on the importance of mutual aid as essential to realizing the social justice potential of participatory research. We suggest that co-creating IE research with young adults with lived experiences of homelessness constitutes a unique opportunity to mobilize CAE values and tangibly support community research that seeks to positively influence the lives of those implicated by the problems we study together.

Gender Matters: Exploring the Mental Health of Youth Experiencing Homelessness in Canada

The gender gap in adolescent mental health experiences is notable, with gender adding an additional layer to the already complex experience of being a young person who is experiencing homelessness. Yet, research in this area is limited. The purpose of this qualitative, interpretive description study was to understand how gender shapes the mental health of youth who are experiencing homelessness in the Niagara Region of Ontario, Canada. Eleven young people between the ages of 16 and 24 were recruited from a youth shelter and participated in individual semi-structured interviews. Thematic analysis and Gender-Based Analysis Plus was used to analyze the data, and findings revealed four contextual factors that appear to influence a young person’s mental health while homeless but that is experienced differently depending on one’s gender identity. These factors are: (1) housing acquisition is challenging, (2) physical presentation is meaningful, (3) cleanliness and hygiene are expected, and (4) utilizing mental health resources is complicated. Additionally, the many strengths that the youth identified and demonstrated in navigating their circumstances are highlighted in the results. These strengths involve (1) exhibiting resilience, (2) expressing the ability to survive, (3) imagining a world that is better, (4) articulating their needs, and (5) drawing on their social connections. The gendered lens that guides this study provides a challenge to the homogenous way that young people experiencing homelessness are often portrayed within the literature. Intersecting identities that include gender and age need to be considered within the mental health-related experiences of youth who live with homelessness. Ensuring that interventions are tailored to meet young people’s specific gendered needs is both a matter of human rights and health equity. Practical implications for service providers are discussed.

Sexually Transmitted Infection Prevention Services for Women Experiencing Homelessness: A Safety-Net Health System Quality Improvement Initiative.

Consistent use of sexually transmitted infection (STI) prevention methods is proven to decrease transmission of STIs. Yet, rates continue to rise within the US, particularly among high-risk populations. Women experiencing homelessness may face barriers to access reproductive healthcare. This quality improvement (QI) initiative sought to examine perceived barriers to STI prevention and opportunities for expanding STI prevention services and education for women experiencing homelessness. Surveys were administered during a one-day health event in August 2023 at a clinic that predominately serves persons experiencing homelessness in North Texas. Respondents included adult, non-pregnant, English-speaking, individuals assigned female at birth with a history of homelessness. Demographic characteristics, sexual history, participants' knowledge of STIs, and perceived barriers to obtaining sexual health care were gathered. Participants had the opportunity to suggest methods for improving access to STI care. Among participants (n = 36), over half (59%) were tested for STIs within the past year. Most preferred condoms for STI prevention. The average knowledge score among questions about STI transmission and methods of prevention was 65%, with the lowest scores observed among trichomoniasis (39% correct), pre-exposure prophylaxis (PrEP; 31%), and dental dams (25%). Common barriers included cost (33%) and side effects (33%). One-third (36%) of participants reported no barriers to the use of prevention products. Findings highlight the need for educational opportunities among this population to increase knowledge of STI transmission and prevention. Patients may benefit from clinicians emphasizing education and increasing the visibility of services.

Mental health and wellbeing outcomes associated with social, medical, and legal gender affirmation among trans young people in Australia

Background Gender affirmation is known to improve mental health among trans adults, but its impact on young people has been questioned. This study examined the mental health outcomes associated with social, medical, and legal gender affirmation among trans young people in Australia. Methods Data from 1697 trans young people aged 14–21 who participated in an Australian national survey were analyzed using multivariable logistic regression analyses. We measured associations between gender affirmation and various mental health variables, including levels of happiness, psychological distress, anxiety, self-harm and recent suicidal ideation and suicide attempts. Associations between gender affirmation and young people’s wellbeing, including experiences of verbal harassment, homelessness, and drug use were also examined. Results Participants who had affirmed their gender legally and medically (via hormone therapy or surgery/ies) reported lower levels of anxiety and psychological distress, while legal gender affirmation was associated with lower suicidal ideation. Social affirmation was not directly associated with wellbeing outcomes but was linked to an increased likelihood of verbal harassment and homelessness. All forms of gender affirmation were associated with increased drug use, which likely reflects the greater opportunities for social connection and LGBTQ-community involvement that trans young people experience when they take steps to affirm their gender. Conclusion All forms of gender affirmation were positively associated with the wellbeing of trans young people. Though young people who had socially affirmed their gender faced higher likelihoods of experiencing verbal harassment and homelessness, this is likely linked to their increased visibility and subsequent vulnerability to discrimination. These findings highlight the need for targeted interventions to address transphobia and discrimination. A comprehensive approach to supporting the wellbeing of trans young people should include legal, medical, and social affirmation, as well as addressing potential negative outcomes via societal education.

The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review.

An estimated 5800 to 46,500 lives are lost due to homelessness each year. Experiencing homelessness and poor health are cyclically related, with one reinforcing the other. Mobile programs, which include vehicles that travel to deliver care, and street medicine, the act of bringing care to spaces where PEH live, may play a role in alleviating this burden by providing trusted, affordable, and accessible care to this community. We conducted a scoping review of peer-reviewed literature on the role of mobile clinics and street medicine in providing care for PEH by searching PubMed, Embase, and Web of Science on 10 August 2023. Articles from 2013 to 2023 specific to programs in the United States were included. The protocol was developed following the PRISMA-ScR guidelines. The primary outcome was the role of mobile programs for persons experiencing homelessness. A total of 15 articles were included in this review. The descriptive findings emphasized that street medicine and mobile clinics provide primary care, behavioral health, and social services. The utilization findings indicate that street medicine programs positively impact the health system through their ability to defer emergency department and hospital visits, providing financial benefits. The comparative findings between mobile programs and office-based programs indicate current successes and areas for improvement. Mobile clinics and street medicine programs that serve PEH provide a wide range of services. While more significant structural change is needed to address healthcare costs and housing policies in the United States, mobile clinics and street medicine teams can improve healthcare access and the healthcare system.

Reclaimed Voices: The Silent Impact of Women’s Experiences of Homelessness

Background: Homelessness is a rising crisis that affects hundreds of thousands of individuals in America; but affects women differently than men. The experiences women face while homeless can translate into traumatic experiences and profoundly shape an individual's story of homelessness. These experiences prompt a need to change the systems that contribute to homelessness. Purpose: This study aims to highlight trauma across women's experiences of homelessness. Methods: Data collection for this research was conducted through qualitative interviews with eight women experiencing homelessness in Modesto, California. NVivo, a qualitative data analysis software, was used to format the interviews, identifying common code words that developed into overlapping themes. Results: The eight interviews of women experiencing homelessness identified core emerging themes of causes of homelessness, fear of loneliness, quality, and type of available services, perception of homelessness, and an understanding of the societal constructs of homelessness and gender. This research confirmed that some women experiencing homelessness are less likely to report traumatic experiences and seek support from their local social service community providers. The limitations of the smaller sample size only captured a small scale of the problem being analyzed to a potentially larger issue. Conclusion: Services should begin focusing on asking more trauma-informed questions, not only to improve care but to allow more women experiencing homelessness the chance to seek help; this is the only way to begin understanding how their traumatic experiences have impacted their livelihood.

Stigma in homelessness and health care: reflections from a Housing First program in Barcelona, Spain

The experience of homelessness is associated with strong stigmatization processes, which are often reflected in the treatment received from professionals and the healthcare system itself. This article aims to analyze the experiences of participants in a program for homeless individuals in Barcelona called Primer la Llar within the healthcare system, and how the stigma they suffer affects the care processes. This program follows the Housing First model, a social intervention that proposes providing housing without preconditions to individuals with long histories of street living, who suffer from severe mental disorders and/or addictions. Based on individual interviews with 20 participants conducted between 2016 and 2020, it is observed that in certain cases, entering the program, having housing availability, support from professionals, and the development of their own strategies had positive effects on improving their health, although they continue to perceive discriminatory attitudes in some medical settings. It is suggested that the transformation regarding stigmatization be understood broadly, affecting individuals, institutions, and society as a whole.

Minimally Invasive Blood Collection for an Mpox Serosurvey among People Experiencing Homelessness.

People experiencing homelessness (PEH) are underrepresented in public health and clinical research. Study methods that can improve participation by this group are needed. In late 2022, the Centers for Disease Control and Prevention conducted an mpox serological survey using venipuncture among PEH in San Francisco, California. Blood collection by a minimally invasive device was offered if venipuncture was not possible or preferred. Participants who had a successful blood draw using the device were asked about device acceptability. Of the 209 successful blood collections, 137 (66%) were among participants who underwent venipuncture and 72 (34%) were among participants who used the device. Use of the device increased overall blood collection participation by 53%. Participants reported high acceptability and preference for the device over venipuncture. Minimally invasive blood collection devices may increase participation and representation of PEH in serosurveys.

Psychoanalysis and the Experience of Homelessness.

Psychoanalysis is often viewed as a practice relevant only to educated people of means. This article describes a project that matches psychoanalytically trained clinicians with unhoused and formerly unhoused adults in a large urban community. D. W. Winnicott's ideas about impingement, the holding environment, fear of breakdown, and careful monitoring of the analyst's interiority have proven to be most valuable theoretical and clinical tools. A decade-long case example demonstrates the challenges and healing potentials of the work.

People Experiencing Homelessness in Miami: Insurance Enrollment Rates, Hypertension Trends

People Experiencing Homelessness in Miami: Insurance Enrollment Rates, Hypertension Trends

Social Determinants of Health and Psychological Capital Among Youth Experiencing Homelessness.

Social determinants of health affect health behaviors and outcomes. Youth experiencing homelessness suffer significant deprivation of resources such as inadequate housing, reduced education, poor health care, and decreased economic stability. Inner resources, such as psychological capital, may also be related to health behaviors and health outcomes. In this study, we sought to describe and explore associations among selected determinants of health and self-reported scores on indicators of psychological capital among youth experiencing homelessness. This cross-sectional secondary analysis was conducted with a randomized subsample of 148 youth. We calculated chi-square frequencies to describe the data, classical item analyses to evaluate responses, and correlation tests to examine significance of associations. Youth in this sample demonstrated that they possess inner resources associated with determinants of health. Education, health care, and social support were significantly associated with attributes of psychological capital (hope, efficacy, resilience, optimism). Sexual minority groups had high representation in this subsample (25.7%), indicating a need for more study and equitable services for this population. More research should be conducted to better understand the associations between determinants of health, psychological capital, and health behaviors among disadvantaged youth to advance health equity initiatives.

Homelessness, psychiatric disorders, and violence in Denmark: a population-based cohort study

Homelessness is associated with adverse health and social outcomes. People experiencing homelessness have been found to have a high risk of violent crime victimisation as well as high prevalence of psychiatric disorders. It is poorly understood whether experiencing homelessness is associated with additional risks of violent offending and whether psychiatric disorders contribute to these risks. We examined the association between homelessness, psychiatric disorders, and first violence offence leading to conviction. We did a nationwide, register-based cohort study of all Danish residents who were alive at least 1 day during the study period, born between Jan 1, 1980, and Dec 31, 2006, and aged 15 years or older retrieved from the Danish Civil Registration System, which was linked to registers with information on homelessness, health care, and criminality. The exposure was any experience of homelessness, which was defined as having at least one contact with a homeless shelter during the study period. The outcome was first violent offence leading to a conviction. We calculated incidence rates per 10 000 person-years, incidence rate ratios (IRRs) using Poisson regression analysis, and probability of conviction of a violent offence using an Aalen-Johansen estimator. Analyses were stratified by sex and adjusted for calendar year of the study period, age, other sociodemographic factors, and psychiatric disorders. The study cohort included 1 786 433 Danish residents aged 15-42 years living in Denmark at some point from Jan 1, 2001, to Dec 31, 2021, contributing to 21 336 322 person-years at risk, of whom 57 084 (3·2%) individuals had their first violent offence leading to conviction during follow-up. 10 years after their first contact with a homeless shelter, 22·9% (95% CI 21·6-24·2) of men and 7·7% (6·8-8·7) of women had committed at least one violent crime leading to conviction. The fully adjusted IRRs of a violent offence leading to conviction were 4·8 (4·5-5·1) in men and 6·3 (5·6-7·2) in women experiencing homelessness compared with individuals who had not experienced homelessness. The IRR for a violent offence leading to conviction was highest in individuals experiencing homelessness and having co-occurring psychiatric disorders compared with those not experiencing homelessness and without co-occurring psychiatric disorders, especially drug use disorders (IRR in those experiencing homelessness and having a drug use disorder: 15·3 [14·1-16·7] in men and 40·1 [33·9-47·5] in women compared with individuals not experiencing homelessness and having no drug use disorder). Individuals experiencing homelessness had higher risks of a violent offence leading to conviction than those who had not experienced homelessness. In addition to preventing homelessness, public health and policy should consider how to reduce the risk of adverse outcomes in people experiencing homelessness. Lundbeck Foundation.

Ten tips on how to care for your CKD patients in episodes of extreme heat.

Climate change is responsible for ≈75% of extreme heat events throughout the world. Heat events are associated with an increased risk for acute kidney injury, which contributes to the development of chronic kidney disease (CKD) and cardiovascular events. Patients with CKD are especially vulnerable to heat stress for a variety of reasons. A disproportionate percentage of patients with CKD live in poverty; experience homelessness, mental illness or disabilities; work outside or are elderly, all demographics that overlap with populations most susceptible to episodes of extreme heat. Therefore, it is reasonable to conclude that exposure to episodes of extreme heat can lead to the progression of CKD and increases morbidity and mortality. Given these concerns, clinicians must be prepared to promptly recognize complications of heat in CKD patients and to help patients appropriately acclimate. We propose the following tips for clinicians to effectively care for their CKD patients during extreme heat days.

Literature Review of the Stigma of People Experiencing Homelessness

I live in a community with a large homeless population. I witness and take part in conversations with community members and have noted that a seemingly large portion of them have little empathy, education, or understanding of what it means to be homeless. These conversations are often very polarizing, as there are many stigmas regarding the homeless population. I am passionate about promoting change. I want to educate the community, to help them understand and have empathy. In my attempt to decrease the stigmas that homeless people face, I have completed a literature review to research what these stigmas are and how to address them effectively. I aim to find ways to most effectively educate my community on homelessness.

COVID-19 Vaccination Uptake, Infection Rates, and Seropositivity Among Youth Experiencing Homelessness in the United States.

People experiencing homelessness are at greater risk of exposure and poor health outcomes from COVID-19. However, little data exist on the prevalence and correlates of COVID-19 among homeless populations. To mitigate the spread and severity, uptake of the COVID-19 vaccine is needed. This can be challenging among youth experiencing homelessness who are more likely to be unvaccinated when compared to stably housed youth. We conducted this study to determine the prevalence and correlates of COVID-19 among youth experiencing homelessness. We examined experiences of COVID-19 symptoms, self-report of infection, and rates of COVID-19 antibodies and distinguished between natural and vaccinated immunity among youth experiencing homelessness ( N = 265) recruited in one large metropolitan area in the south. Based on self-report, very few participants experienced any symptoms, and 80% had never been diagnosed with COVID-19. Of those with COVID-19 antibodies (68%), the proportion with antibodies resulting from natural infection was 44%. The vaccination rate was 42%. Younger and vaccinated participants and those in shelters were likelier to have COVID-19 antibodies. Black and Hispanic youth were more likely than White youth to have had COVID-19. Those who adopted only one or two prevention behaviors were more likely to acquire a natural infection than those who adopted three or more prevention behaviors. Youth experiencing homelessness report low vaccination rates, disrupted access to healthcare and social supports, and underlying chronic conditions, which may explain why they face poorer outcomes when infected with COVID-19. Vaccination and risk mitigation strategies to combat the high prevalence of COVID-19 are especially needed for sheltered youth who are at high risk yet are often asymptomatic.

Health Technology Access and Peer Support Among Digitally Engaged People Experiencing Homelessness: Qualitative Study.

Although the effects of digital health are receiving wide scientific attention, very little is known about the characteristics of digitally engaged people experiencing homelessness, especially in Central and Eastern Europe. Our previous research revealed a considerable level of internet use in the homeless population of Budapest, Hungary, for general purposes (350/662, 52.9%) and medical purposes (229/664, 34.6%). Moreover, a digitally engaged subgroup was identified (129/662, 19.5%). The aim of this exploratory study was to map out the resources, attitudes, and behaviors of digitally engaged homeless individuals in relation to digital technology to set the basis for potential health policy interventions, which will enable better access to health services through strengthening of the digital components of the existing health care system. Between August 18, 2022, and October 27, 2022, a total of 12 in-depth semistructured interviews were conducted in 4 homeless shelters in Budapest, Hungary. Upon analysis by 3 independent evaluators, 2 interviews were excluded. The interviewees were chosen based on purposive sampling with predefined inclusion criteria. Thematic analysis of the transcripts was conducted. In the thematic analysis, 4 main themes (attitude, access, usage patterns, and solutions for usage problems) emerged. Health-related technology use mostly appeared in health information-seeking behavior. Online search for prescribed medications (5 interviews), active ingredients of medications (4 interviews), medicinal herbs believed to replace certain pills (2 interviews) or foods, and natural materials (1 interview) were mentioned. Moreover, mobile health app use (3 interviews) was reported. The intention to circumvent or check on mainstream health care solutions was mainly associated with previous negative experiences in the health care system. Several gaps in the daily use of technology were identified by the interviewees; however, more than half of the interviewees (6/10) turned out to be contact points for their peers for digital problem-solving or basic digital literacy skill enhancement in the homeless shelters. Furthermore, a lack of institutional support or special programs targeting senior clients was noted. Digitally engaged homeless individuals might become mediators between their peers and comprehensive digital health programs. They have the trust of their peers, can recognize and harness the benefits of digital technology, and are able to provide meaningful help in technology- and usage-related issues through experience. Digital health services have great promise in community shelters for managing and preventing health issues, and digitally engaged individuals might be important for the success of such services.

Homeless but not hopeless: overcoming the challenges of managing diabetes in people with lived experience of homelessness

Using a case vignette by way of illustration, Dr Jack Colley, Dr Mustafa Mahdi and Dr Ruth Poole here provide key practical advice on how to manage diabetes in individuals with lived experience of homelessness.

Sexual and Reproductive Health Care Utilization for Youth Experiencing Homelessness.

Sexual and Reproductive Health Care Utilization for Youth Experiencing Homelessness.