High Rates Of Homelessness Research Articles

The Effect of Homelessness on Management of Menstruation and Dysmenorrhea in Pomona, California [ID 2683481

INTRODUCTION: Given the challenges to menstrual hygiene many women face and the high rate of homelessness in Pomona, California, we suspected women without housing would have increased difficulty managing their menstrual hygiene and dysmenorrhea primarily due to resource inaccessibility. METHODS: After IRB approval and beta testing, we partnered with local homeless shelters and a student-run clinic to screen for eligible participants, obtain verbal consent, and conduct anonymous interviews. Each interview lasted 15 minutes with 26 questions spanning demographics, menstrual hygiene and dysmenorrhea management, and history of homelessness. RESULTS: Analysis of 50 surveys (96% response rate) revealed that 37% of participants reportedly relied on shelter pantries for access to menstrual hygiene products, 27% of participants admitted to stealing their preferred products, and almost 10% of participants reported resorting to using alternate methods such as free bleeding and old clothes to catch their menstrual flow. For management of dysmenorrhea-associated painful cramping, 96% of participants reported preferring medication management but not having access to it when homeless so instead their only option was to “just deal with it” (60%). CONCLUSION: The results of this study illuminate the gap in existing literature regarding the specific struggles that homeless people face when managing their menstrual hygiene and dysmenorrhea. The discrepancies in management of hygiene and pain when housed versus unhoused come down to lack of access to essential resources. Shelter pantries do not have enough funding to effectively support the size and demand of the growing menstruating homeless population.

A descriptive study of domestic and family violence presentations to an emergency department in the Northern Territory.

Examine the nature of domestic and family violence (DFV) presentations to an ED in the Northern Territory and identify potential gaps in service delivery. Prospective descriptive study of DFV presentations in November 2021. A total of 70 presentations were identified, representing 1.2% of all presentations aged 16 years and older. Disproportionately impacted were First Nations people (90%), women (77.1%) and those aged less than 40 years (67.1%). Most (81.4%) arrived outside of business hours and only 37.1% were assessed by the social worker. Case complexity was increased by high rates of homelessness (30%), concurrent alcohol consumption (44.3%) and pregnancy (11.1% of females). More than a third (37.1%) had attended on one to four occasions in the previous 6 months with a DFV-related injury. Compared to non-DFV attendances, the median ED length of stay was approximately twice as long (456 vs 210 min), admissions rates to the ED short stay unit five times higher (25.7% vs 5.7%; P < 0.01, odds ratio [OR] = 5.7 and 95% confidence interval [CI] = 3.3-9.8) and rates of self-discharge prior to completion of care 9 times higher (12.9% vs 1.5%; P < 0.01, OR = 9.5 and 95% CI = 4.6-19.7). The data highlights the need for a 24 h trauma-informed, culturally safe and integrated service to support people experiencing DFV. This could be achieved by a specialist unit designed and staffed by First Nations health practitioners.

Higher Rates Of Homelessness Are Associated With Increases In Mortality From Accidental Drug And Alcohol Poisonings.

Alcohol and drug overdoses have multiple complex causes. In this article we contribute to the literature that links homelessness, the most extreme form of housing disruption, to accidental SUD-related poisonings. Using plausibly exogenous variation from a state's landlord-tenant policies that influence evictions, we estimated the causal impact of homelessness on SUD-related mortality. We found large effects of homelessness on SUD-related poisonings (for example, a 10percent increase in homelessness led to a 3.2percent increase in opioid poisonings in metropolitan areas). Our findings indicate that reducing local homelessness rates from the seventy-fifth to the fiftieth percentile levels could have saved more than 1,900 lives from opioid overdoses across all metropolitan localities in the final year of our study data. We conclude that strengthening the social safety net in terms of housing security could help curb the ongoing SUD-related poisoning epidemic in the US.

The Association between Mental Health-Related 911 Calls and the Mental Health Professional Shortage in New York City.

This study examines the relationship between designated Mental Health Professional Shortage Areas (MH HPSAs) and mental health-related 911 calls in New York City. Negative binomial regression models were used to estimate the relationship between MH HPSAs and MH 911 calls after adjusting for the population size and other neighborhood characteristics. The study found that neighborhoods designated as MH HPSAs had higher MH 911 calls compared to non-shortage areas, with a 27% increase in expected MH 911 calls after adjustment. Moreover, the results indicated that neighborhoods with higher rates of homelessness and poverty generated more MH 911 calls. The findings suggest a need to improve access to mental health services to reduce the burden on police and emergency services for crisis interventions in areas with limited resources.

“Being homeless can burn you out”: a qualitative study of individuals’ experience of administrative burden when accessing homeless services

ABSTRACT Despite significant efforts to address the homelessness in the United States, on any given night more than 500,000 individuals lack shelter/place to call home. This persistent and high rate of homelessness can be attributed to the shortage of affordable housing options, the eviction crisis, and unmet need for rental assistance. Administrative burdens tied to homeless services may also create barriers to housing for individuals experiencing homelessness, and to date have been under-explored in the literature. Our study explores administrative burden by examining 28 individuals’ experiences navigating homeless services in New Haven, Connecticut. Our analysis describes the learning, compliance and psychological costs individuals face. Our findings suggest that administrative burdens may lead to underutilization of services and prolonged homelessness. Further, they may promote new forms of inequities. We conclude with recommendations to reduce administrative burden and increase investments in homeless services and housing resources nationwide.

Emergency Department-Initiated Buprenorphine Treatment in a Population with a High Rate of Homelessness: An Observational Study

BackgroundBuprenorphine is an effective treatment for opioid use disorders. A previous randomized trial comparing emergency department (ED)-initiated buprenorphine to standard care showed dramatic improvement in follow-up. This is encouraging, but must be replicated to understand the generalizability of buprenorphine treatment. ObjectivesEvaluate the efficacy of an ED-initiated buprenorphine protocol similar to a previous randomized trial in a different population. MethodsThis ED-based descriptive study described the results of a project implementing an opioid use disorder treatment protocol that included buprenorphine. Patients with opioid use disorder were offered treatment with buprenorphine, a buprenorphine prescription whenever possible, and a follow-up visit to a clinic providing addiction treatment. The primary outcome was engagement in formal addiction treatment 30 days after the index visit. ResultsOf the 210 patients who accepted referral for outpatient medication-assisted treatment, 95 (45.2%) achieved the primary outcome. Two-thirds of these patients received a buprenorphine prescription at discharge; 40% were homeless. A regression analysis revealed one statistically significant predictor of the primary outcome: patients who were housed were 2.49 times more likely to engage in opioid use disorder treatment than patients who were homeless (p = 0.02). ConclusionsIn this descriptive study of an ED-initiated buprenorphine protocol, follow-up was less than that reported in a previous randomized controlled trial. Two important differences between our study and the randomized trial are the high rate of homelessness and the fact that not every patient received a prescription for buprenorphine. The efficacy of ED-initiated treatment may depend on certain population characteristics.

Opioid use disorder with chronic pain increases disease burden and service use.

To address the ongoing opioid epidemic, there has been an increased focus on the treatment and evaluation of opioid use disorder (OUD). OUD and chronic pain (CP) frequently co-occur; however, little is known about the additional comorbidities that present when they occur together as compared to when either condition presents alone. Using data from Fiscal Year 2012 Veteran's Health Administration, all veterans diagnosed with both OUD + CP were compared to those diagnosed with OUD or CP alone on socioenvironmental characteristics, medical and mental health diagnoses, and Veterans Affairs (VA) clinical service use. Veterans with OUD + CP (n = 33,166), compared to those with OUD only (n = 12,517), had higher numbers of medical conditions. Compared to those with CP only (n = 2,015,368), veterans with OUD + CP had higher rates of homelessness and substance use diagnoses. Most mental health diagnoses, numbers of psychotropic medication fills, opioid prescriptions, and use of all other services were higher in the OUD + CP group than in either single disorder group. Multinomial regression analysis revealed stronger effects for medical disorders and medical-surgical outpatient service use in the comparison of OUD + CP with OUD only and stronger effects for substance use and mental health disorders and use of prescription opiates in the comparison with CP only. These findings suggest that concurrent OUD + CP imposes exceptional disease and clinical service burdens that likely require the development of simultaneous, integrated approaches to treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pre-Paid Phone Distribution: A Tool for Improving Healthcare Engagement for People with Substance Use Disorder

Background The COVID-19 pandemic drove significant disruptions in access to substance use disorder (SUD) treatment and harm reduction services. Healthcare delivery via telemedicine has increasingly become the norm, rendering access to a phone essential for engagement in care. Methods Adult patients with SUD who lacked phones (n = 181) received a free, pre-paid phone during encounters with inpatient and outpatient SUD programs. We evaluated changes in healthcare engagement including completed in-person and telemedicine outpatient visits and telephone encounters 30 days before and after phone receipt. We used descriptive statistics, where appropriate, and paired t-tests to assess the change in healthcare engagement measures. Results Patients were predominantly male (64%) and white (62%) with high rates of homelessness (81%) and opioid use disorder (89%). When comparing 30 days before to 30 days after phone receipt, there was a significant increased change in number of telemedicine visits by 0.3 (95% CL [0.1,0.4], p < 0.001) and telephone encounters by 0.2 (95% CL [0.1,0.3], p = 0.004). There was no statistically significant change in in-person outpatient visits observed. Conclusions Pre-paid phone distribution to patients with SUD was associated with an increased healthcare engagement including telemedicine visits and encounters.

Independent living programs and services for youth 'aging out' of care in Canada and the U.S.: A systematic review

Evidence from American and Canadian studies over the last three decades demonstrates that youth exiting foster care are at a much higher risk to face a multiplicity of challenges than their peers who are not in care. These challenges result in negative outcomes, such as high rates of homelessness, under-education, unemployment or under-employment, poverty, mental health issues and post-traumatic stress, substance abuse and early pregnancy or parenthood. This systematic review addresses Independent Living Program (ILP) and Independent Living Services (ILS) studies in the U.S. and Canada published between 2000 and 2018. In order to compile a list of relevant ILP and ILS impact studies, a bibliographic search of six databases was conducted for the peer-reviewed literature, and the grey literature was searched using Google and expert consultation. The search yielded a total of 64 studies after applying our study selection protocol, with 50 from the peer review literature and 14 from the grey literature. The clear majority of studies originated from the U.S., with only three Canadian studies emerging from the grey literature. This is most likely due to differences in mandated data collection and reporting. In the U.S., data collection and reporting is mandatory under the Foster Care Independence Act in 1999. In Canada, there is no such mandatory reporting as child welfare services are under the sole jurisdiction of the provinces, with no Federal government involvement aside from First Nations children and youth. Studies to date suggest that ILP and ILS are not producing the intended outcomes, with limited to no impact demonstrated on youth leaving care wellbeing outcomes. In fact, some of the studies found a negative impact, especially related to social support. Much of the ILP and ILS studies did not incorporate the voices of youth in care, but rather focused on program process and components, staff experiences, and outcome measures such as social support, employment, income, housing and self-sufficiency. Of the limited ILP and ILS studies incorporating youth perspectives, youth in care often indicated that emotional support and mentoring are crucial needs during the transition to adulthood, which are often not the focus of ILP or ILS. Moreover, compared to the U.S., program impact studies in Canada are sorely lacking; more research needs to be done in this area to build our knowledge of evidence-based and best practices. This systematic review highlights two main conclusions: (1) Both the U.S. and Canada sorely need innovation with respect to preparing youth in care for the transition to adulthood; and (2) We also must commit to using rigorous research designs with such programming to determine the impact of such new approaches. In sum, we must reconceptualize our investment in youth in care and focus on their interdependence in order to realize their potential.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Variability in treatment outcomes from a housing intervention for young mothers misusing substances and experiencing homelessness by sexual identity

Sexual minority (SM) youth have twice the risk of experiencing homelessness compared to their heterosexual peers. Further, SM youth experiencing homelessness (YEH) report greater depression symptoms and substance use compared to heterosexual YEH. Housing First is an intervention that provides scattered-site individual apartments, without any prerequisite conditions for eligibility, and additional services to support long-term housing sustainment; however, few studies have examined the effectiveness of this approach for SM youth. The current study utilized data from a RCT that provided housing to young mothers experiencing homelessness to examine if treatment effects varied by mothers’ sexual identity. Mothers were randomly assigned to services as usual (i.e., provided a referral sheet of all services available in the community; SAU), Housing only (i.e., three months of utility and rental assistance; Housing), or housing and supportive services (integrates independent housing, Strengths-Based Outreach and Advocacy (SBOA), HIV prevention, and substance use/mental health counseling; Housing + SS). Latent growth curve models were estimated to assess how substance use and depression symptoms changed over the 12 months. SM mothers receiving SAU or Housing did not experience a significant change in substance use or depression symptoms. All groups of heterosexual mothers and SM mothers receiving Housing + SS had less substance use and depression symptoms at twelve months, with SM mothers in Housing + SS evidencing a steeper decline in substance use and depression symptoms. This study provides some of the first evidence that Housing First can mitigate the mental health and substance use concerns of SM YEH. Given SM’s higher rates of homelessness, substance use, and depression symptoms, Housing First should be further explored as an intervention to address their unique needs.

Supportive Housing for Sexual and Gender Minority Individuals With Criminal Justice Histories: Challenges and Opportunities Identified by Providers and Clients

Sexual and gender minority (SGM) individuals experience high rates of homelessness and criminal justice system involvement, underscoring the need for supportive housing services. To explore the service needs of this population, we interviewed providers (n = 11) and clients (n = 10) from eight supportive housing organizations working with SGM populations in Los Angeles County, California, USA. We used the Consolidated Framework for Implementation Research to synthesize interview responses into themes (by domain and cross-cutting). Takeaways included the need for investment in systems of care for vulnerable SGM populations; the particular marginalization of Trans individuals and providers that serve them; the roles of supportive housing staff, residents, and leadership in cultivating an affirming environment; the prevalence of discrimination and stigma within supportive housing programs and broader society; and the complex interrelationships among SGM identity, homelessness, and criminal justice system involvement. These findings have important implications for supportive housing services and related policy.

What Does it Mean to be Homeless? How Definitions Affect Homelessness Policy

Government agencies use varying criteria in defining homelessness. While scholars debate over and use different definitions of homelessness, little research has explored the impacts the definition has on perceived problem severity and the types of communities receiving aid. I first explore four definitions of child and youth homelessness used by United States’ federal agencies. I then use panel data for school districts, which report homelessness by subgroup, to analyze how the definition of homelessness changes its prevalence and leads to disparate impacts. I find the definition of homelessness including students living doubled-up leads to a higher growth rate. Definitions also change which districts have high rates of homelessness and characteristics of these districts, suggesting resources following students experiencing homelessness go to different types of communities. Scholars should consider how a problem is defined, differences in the measurement used between studies, and how the definition affects where resources go.

"The SUMMIT Team is All I Got": perspectives of medically and socially complex patients seen in intensive primary care.

Context: There is great interest in intensive primary care (IPC) interventions to address the needs of medically and socially complex patients, however it is unknown how these interventions impact patient experience. Objective: Describe the experience of patients on the Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT), an IPC for patients with complex needs at a federally qualified health center serving patients with high rates of homelessness. Study Design: Qualitative study using semi-structured interviews with 25 patients enrolled in the SUMMIT intervention. We conducted a thematic analysis using a hybrid inductive/deductive approach. Results: Prior to SUMMIT, patients often felt it was difficult to engage with the healthcare system, in part due to their complex medical conditions, but also factors including prior trauma, poverty, substance use, and providers' stigma. We identified four themes related to how and why patients felt SUMMIT improved their care: 1) Investment: Patients perceived the team as truly invested in them and expressed how the team walked side by side in their care journeys to overcome stigma, low-self efficacy, and prior negative experiences with the healthcare system 2) Family: Patients reported feeling a strong sense of family with SUMMIT team members and believed that the team had genuine duty and obligation toward them, interacting with them in a non-judgmental, culturally competent manner. 3) Feeling valued: Patients expressed that the team's flexible design, continuity of team membership, care coordination and addressing unmet needs and social determinants led them to feel valued and hope. 4) Evolution of self-efficacy: Patients experienced improved self-efficacy, and were able to engage with health care proactively, instead of avoiding care. Conclusion: Medically and socially complex patients experience trauma and stigma that shape perceptions of care. Patients appreciated humanizing interactions with team members along with the additional support SUMMIT provided to overcome barriers to care. They spoke of the team as family members who valued them and they recognized how the program had helped them take a more active role in improving their own health. Our findings suggest that effectiveness of IPC interventions may lie, in part, on the use of team members who have the skills and commitment to deliver non-judgemental, culturally competent, longitudinal relationship-focused care.

Sociodemographic and clinical profile of crack cocaine treatment-seeking individuals living in “Crackland”, Brazil

ABSTRACT Objective: São Paulo‘s Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this crossectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Crackland region. Methods: A sample of nighty eight individuals were screened for DSM-V substance use disorders, including substance use, impulsiveness, and psychiatric symptoms. Recent crack cocaine use was also tested using biologic specimens. Results: Results indicated severe social vulnerability, as participants experienced high rates of homelessness (46.9%), unstable housing (50%), unemployment (60.4%) and early school drop-out (27.5%). The average age of crack use onset was 20 years (SD = 6.9) and the mean duration of continuous crack use was 15 years (SD = 9.7). Most participants presented with concomitant mental health disorders, particularly alcohol use disorder (87.8%), as well high rates of psychiatric symptomatology and impulsiveness. More than half of the sample reported at least one previous inpatient (73.5%) and outpatient (65.3%) addiction treatment attempt. Conclusion: This population profile should inform mental healthcare services, promoting the provision of tailored assistance by targeting specific demands at all levels of treatment.

The Social Context of Unhealthy Alcohol Use Among Emergency Department Patients: A Cross Sectional Study.

Housing status and additional social determinants of health are important data for clinicians and policy makers to design and implement effective interventions for emergency department (ED) patients with unhealthy alcohol use (UAU). We surveyed patients in an urban, safety-net ED from June to August 2018. UAU was assessed by a validated single-item screening question endorsed by the National Institute on Alcohol Abuse and Alcoholism. Housing status was assessed using items validated for housing stability. Seven hundred fifty-eight patients completed the survey (60% response rate), and 296 (39%; 95% confidence interval: 36%-43%) reported UAU. Patients with and without UAU had the same rates of ED visits (median 2, interquartile range: 1-4; P = 0.69) and hospitalizations (median 0, interquartile range: 0-0; P = 0.31) in the 12 months before index visit. Patients with UAU were more likely to lack stable housing compared to patients without UAU (69% vs 59%; P = 0.006). Illicit drug use and prescription drug misuse was more common in patients with UAU compared to those without UAU (29% vs 14%, P &lt; 0.001; and 18% vs 10%; P &lt; 0.001, respectively). Only 60 (20.3%) of the 296 patients with UAU had a documented diagnosis of UAU in the medical record. UAU is common in the general ED patient population and usually not clinically recognized. Patients with UAU have high rates of homelessness and co-occurring substance use. Future studies should consider strategies to incorporate social determinants of health and harm reduction treatments into ED-based interventions for UAU.

Pandemic preparedness and response in service hub cities: lessons from Northwestern Ontario

Purpose Responding to the needs of homeless and marginally housed persons has been a major component of the Canadian federal and provincial responses to the COVID-19 pandemic. However, smaller, less-resourced cities and rural regions have been left competing for limited resources (Schiff et al., 2020). The purpose of this paper is to use a case study to examine and highlight information about the capacities and needs of service hub cities during pandemics. Design/methodology/approach The authors draw on the experience of Thunder Bay – a small city in Northern Ontario, Canada which experienced a serious outbreak of COVID-19 amongst homeless persons and shelter staff in the community. The authors catalogued the series of events leading to this outbreak through information tracked by two of the authors who hold key funding and planning positions within the Thunder Bay homeless sector. Findings Several lessons may be useful for other cities nationally and internationally of similar size, geography and socio-economic position. The authors suggest a need for increased supports to the homeless sector in small service–hub cities (and particularly those with large Indigenous populations) to aid in the creation of pandemic plans and more broadly to ending chronic homelessness in those regions. Originality/value Small hub cities such as Thunder Bay serve vast rural areas and may have high rates of homelessness. This case study points to some important factors for consideration related to pandemic planning in these contexts.

OUD Overdose, Suicide Risk in Veterans Four Times Higher Without Buprenorphine

Back to table of contents Previous article Next article Clinical & ResearchFull AccessOUD Overdose, Suicide Risk in Veterans Four Times Higher Without BuprenorphineTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:24 Aug 2021https://doi.org/10.1176/appi.pn.2021.8.23AbstractMost suicide/overdose deaths among veterans with opioid use disorder who do not take buprenorphine involve prescription or illicit opioids.Veterans with opioid use disorder (OUD) who do not receive treatment with buprenorphine are more than four times as likely to die by suicide or overdose than those who do take the medication, a study in the American Journal of Preventive Medicine has found.If patients with OUD stop buprenorphine treatment because of a relapse or other unplanned discontinuation, the care team should work toward re-engaging them, says Priyanka Vakkalanka, Ph.D.University of Iowa/Thomas LangdonPriyanka Vakkalanka, Ph.D., an assistant research scientist in the Department of Emergency Medicine at University of Iowa Hospitals and Clinics in Iowa City, and colleagues analyzed the records of more than 29,000 veterans who were diagnosed with OUD and treated with buprenorphine in the Veterans Health Administration (VHA) system between January 1, 2008, and December 31, 2017. The researchers measured a combined outcome of death by suicide and overdose, noting that they grouped suicide and overdose together because it is not always clear whether an overdose is intentional. They were able to determine from the veterans’ records whether those who died had been actively taking buprenorphine at the time of death.Over five years of follow-up, 964 of the veterans in the study died of suicide/overdose. Among these deaths, 89.9% involved overdose (some of the deaths were documented as suicide but not overdose), and 71% of overdose deaths involved a prescription or illicit opioid. On any given day during follow-up, the risk of suicide/overdose death was 4.33 times greater in veterans with OUD who were not taking buprenorphine compared with those who were, even after accounting for those who might have been taking other medication treatment such as methadone.“Perhaps one explanation [for this result] is that the medication works, and this work supports the growing body of literature out there about the long-term benefits of medications for OUD management,” Vakkalanka told Psychiatric News. “Additionally, maybe those who were getting pharmacotherapy treatment for OUD were also accessing other mental health services such as counseling or even primary care appointments for preventive health measures. While that was not something we investigated in this work, it might be of interest to explore how there might be different levels of health care utilization that could also be impacting long-term survival outcomes.”The risk of suicide/overdose appeared to be greatest 8 to 14 days after treatment with buprenorphine was discontinued, but Vakkalanka said that this result should be interpreted with caution.“It may be that the longer half-life of buprenorphine helps and that there is a sustained protective effect in the first few days,” she said.Comorbid psychiatric conditions were common among the entire study population. More than 73% of veterans were diagnosed with depression, more than 60% were diagnosed with anxiety disorders, and more than 50% were diagnosed as having more than one substance use disorder.“Like with the general population, OUD [among veterans] is not an isolated issue. There may be additional mental health conditions that may also need to be managed or treated along with OUD,” Vakkalanka said. “Veterans in particular may represent a unique population that has some additional challenges, including physical and mental trauma, chronic pain and injury, and higher rates of homelessness.”Vakkalanka noted several ways of helping veterans who take buprenorphine for OUD.“It might be important to offer counseling services, increase access and availability of treatment, and reduce any stigma associated with care management,” she said. “If a discontinuation of medication occurs, there should be good communication, support, and follow-up between the care team and the veteran. If [patients] stop treatment because of a relapse or other unplanned discontinuation, the care team should work toward re-engaging them or helping them.”This study was supported by the National Institute on Drug Abuse, the Centers for Disease Control and Prevention/National Institute of Occupational Health and Safety, the Heartland Center for Occupational Health and Safety, and the Department of Veterans Affairs Health Care System. ■“Association Between Buprenorphine for Opioid Use Disorder and Mortality Risk” is posted here. ISSUES NewArchived

Hospital Guardianship: A Quality Needs Assessment of "Unbefriended" Patients Who Lack Decisional Capacity.

The "unbefriended" patient does not demonstrate capacity to make their own medical decisions, does not have an advance directive, and lacks a surrogate decision maker. For these patients without a designated health care proxy, hospitals may need to petition for public guardianship, a notoriously arduous process with undefined impact on hospital resources. The objective of this study was to describe the characteristics, system needs, and financial impact of unrepresented inpatients in an academic, tertiary care, urban medical center. The Northwestern Memorial Hospital Quality and Patient Safety Committee approved a systematic needs assessment. Retrospective chart review was conducted for patients admitted from September 1, 2013 to August 31, 2019 for whom the hospital petitioned for a public guardian. From fiscal years 2014 to 2019, 156 patients were petitioned for public guardianship. The number of cases rose sequentially from 8 in 2014 to 44 in 2019. The 2 most common conditions that impaired capacity were neurocognitive disorders (56.4%) and psychotic disorders (17.9%). The psychiatry consultation service consulted 71.2% of cases vs 71.1%. There were 2347 medically unnecessary hospital days related to the pursuit of guardianship, and the associated costs to the health system were estimated to be more than $5.8 million. The number of unbefriended patients who lacked decisional capacity necessitating public guardianship dramatically escalated over 5 years. These patients had high rates of homelessness and psychiatric illness, consistent with previous research. Further investigation is needed to understand and address the needs of this vulnerable population.

Urban Land-Based Healing: A Northern Intervention Strategy

&#x0D; &#x0D; &#x0D; Urban Indigenous populations face significant health and social disparities across Canada. With high rates of homelessness and substance use, there are often few options for urban Indigenous Peoples to access land-based healing programs despite the increasingly known and appreciated benefits. In May 2018, the first urban land-based healing camp opened in Yellowknife, Northwest Territories, Canada, one of the first to our knowledge in Canada or the United States. This camp may serve as a potential model for an Indigenous-led and Indigenous-based healing camp in an urban setting. We present preliminary outcome data from the healing camp in a setting with a high-risk population struggling with substance use and homelessness. Reflections are presented for challenging logistical and methodological considerations for applications elsewhere. This northern effort affords us ample opportunity for expanding the existing knowledge base for land- based healing applied to an urban Indigenous high-risk setting.&#x0D; &#x0D; &#x0D;

Building Bridges to Housing for homeless adults with intellectual and developmental disabilities: outcomes of a cross-sector intervention.

Adults with intellectual and developmental disabilities (IDD) have high rates of homelessness. This observational study evaluates Bridges to Housing, a cross-sector intervention offering immediate access to housing and supports to this population in Toronto, Canada. Twenty-six participants, enrolled between April 2016 and December 2017, were assessed at baseline, six and 12months post-enrolment. Descriptive statistics and generalized linear modelling evaluated quality of life (QOL) and service needs outcomes. Twenty-one service users and providers participated in semi-structured interviews between August 2017 and June 2018 to elicit their experiences of the intervention, which were analysed thematically. Twelve months post-enrolment, 24 participants were successfully housed and reported increased QOL scores (F(2,43)=13.73, p=<.001) and decreased perceived unmet service needs (Wald χ2 (2)=12.93, p=.002). Individual-, intervention- and system-level characteristics facilitated housing stability in this population. Cross-sector approaches can improve outcomes for homeless adults with IDD and may have an important role in supporting this marginalized population.