Experiencing Homelessness Research Articles

A Lifeline to Fill the Silence of Homelessness: Person-Centered Analysis of Digital Coping and Links to Mental and Physical Health.

Individuals experiencing homelessness are among the most vulnerable population for mental and physical health disparities. Despite navigating numerous stressors on a day-to-day basis, they are vastly underrepresented within coping research. Using a person-centered approach, this study addresses ways in which technology is leveraged to manage ongoing stressors associated with the experience of homelessness. We employed a two-step and k-means cluster analysis within a sample of unhoused individuals (n = 66). Two distinct clusters emerged, revealing unique patterning of digital coping, stress, self-efficacy, and technology use. Resulting clusters were validated across numerous health outcomes, including mental and physical health problems, as well as digital service use and experience of homelessness. High digital engagement/low self-efficacy individuals (65% of sample) reported high levels of digital self-efficacy, yet lower levels of general self-efficacy. In contrast, low digital engagement/high self-efficacy individuals (35% of sample) engaged in relatively lower digital coping and technology use, with lower stress and higher general self-efficacy. High digital engagement/low self-efficacy individuals, in turn, reported more mental and physical health problems; whereas low digital engagement/high self-efficacy reported somewhat decreased digital access. Relatively few differences emerged between the clusters on experiences of homelessness. Due to the transient nature of unhoused people, reaching such vulnerable populations via technology to support their digital coping and subsequently enhance well-being outcomes represents a critical next step for digital equity. This population is poised to benefit from digital equity efforts, with critical implications for reduced health disparities.

What Makes a Home.Evaluating a Novel Low Support Homeless Accommodation Model Using Co-design Methods

Abstract Background Homelessness is a global challenge, with a prevalence of 4%; the problem is underestimated due to limitations in data collection. In Ireland, 1% of the population, including children, adults, and families, experience homelessness due to housing shortages and systemic complexities. Homeless accommodation is defined as emergency and temporary; the wording is used interchangeably. The ETHOS typology of homelessness comprises two dimensions - housing-focused and support-focused. Supports range from high to low levels. This study evaluated an emergency housing accommodation with low support to assess its feasibility and impact. Methods Previous residents of an urban residential area with low support [introduced in August 2021] and key stakeholders, including policymakers and health and social care professionals, were invited to collaborate in a half-day co-design workshop [February 2024]. The workshop modified Stanford D’s five-stage design thinking processes to consider ‘How might we harness strengths and abilities to create a home and beyond’. Qualitative data were captured on flip charts, post-its, and via photographs over three rounds of activities following initial reflection regarding 1) identifying emerging challenges, 2) exploring potential solutions, and 3) considering resources for advocacy and success. Results Data analyses from 16 participants highlight 1)Personal insights: silence, freedom in decision-making, feeling overwhelmed, valuing independence and understanding accommodation transitions; 2)Organisational insights: developing and promoting independent skills, managing resident preferences and personalities, balancing regulations within emergency accommodation, and staff training. Space was critical in fostering therapeutic well-being and a sense of home environment. Conclusions Effective organisational structures are required to facilitate coherent transfers and transitions. Using co-design methods enabled real-world partnerships and engagement. Key messages • Homelessness is a significant public health challenge, and a model of low support emergency accommodation has value in supporting transition through and out of services. • Engaging with people with lived experience of homelessness is essential for developing supported accommodation models.

Empowering People Experiencing Homelessness for cancer prevention using the Health Navigator Model

Abstract Cancer poses a significant public health concern. Reports highlight that cancer-related mortality rates are double among people experiencing homelessness (PEH). CANCERLESS project delivered an innovative solution based on the Health Navigator Model (HNM). The HNM is an evidence-based patient-centred intervention that develops patient empowerment through health education and social support, promoting timely access to cancer prevention services. A pre-post design study conducted across four pilot sites in Europe (Austria, Greece, Spain, UK) involved 652 PEHs. Pilot interventions based on the HNM were implemented, with effectiveness evaluated at baseline and post-intervention. The study assessed the impact of the HNM on various factors including risk behaviors, lifestyles, quality of life, empowerment, health literacy, psychological distress and utilization of health and care services. Preliminary findings from CANCERLESS HNM intervention showed significant improvements (p= .000) in participants’ quality of life (55.82 (27.65) vs. 66.18 (22.27)) and sense of empowerment (25.58 (19.95) vs. 59.94 (43.10)). However, there were no observable impacts in health literacy (p= .509) or psychological distress (p= .140), which remained within acceptable ranges both pre- and post-intervention. Similarly, there were no significant changes observed in lifestyle or risk behaviours among PEHs. Nonetheless, the evaluation of effectiveness suggested that the HNM increase in the uptake of cancer prevention care, such as cancer screening (p= .000). The CANCERLESS HNM intervention significantly improved the quality of life and empowerment of PEHs. Additionally, it successfully promoted their involvement in cancer prevention efforts, addressing disparities in access to preventive healthcare services. Increased engagement in such initiatives can lead to early detection and treatment, ultimately reducing cancer morbidity and mortality rates, thereby positively impacting public health. Key messages • By promoting health equity and social justice, interventions like CANCERLESS HNM contribute to building healthier and more resilient public health systems. • CANCERLESS boosts cancer prevention awareness, tackles healthcare disparities, enhances cancer early detection, benefiting public health.

Understanding the Population of People Experiencing Homelessness in Cape Town and their Service Use

Cape Town, South Africa, has an estimated 14,357 people living on the street or in temporary shelters. Current responses to homelessness are either punitive—focusing on law enforcement and displacement—or compassionate, offering basic relief like food or handouts. Neither approach is effectively addressing the root causes of homelessness, and the number of homeless individuals continues to rise. This paper advocates for a developmental approach that provides structured support to help people exit homelessness. There is limited knowledge about the causes of homelessness in South Africa, the services utilized by those affected, and the kind of support needed for sustainable solutions. To address this gap, a survey of 350 homeless individuals in Cape Town was conducted, gathering data on demographics, service use, income sources, health, substance use, and interactions with legal systems. The results reveal that the average duration of homelessness is 8.6 years, with over 70% of respondents experiencing homelessness for more than a year. The main causes of homelessness were identified as structural issues such as lack of income, housing access, and loss of family support. Only 11% of participants were in temporary shelters, and their average daily income was around R78 (about $4 USD). Substance use disorders were prevalent, affecting 63% of respondents, while 54% reported being arrested at least once during their experiencing homelessness. Most had not accessed developmental services, highlighting a critical gap in support. If the current approach persists, homelessness will worsen, with more individuals becoming entrenched in chronic homelessness. A shift towards a developmental approach is urgently needed, focusing on personalized support, affordable housing, rehabilitation, psychosocial services, and employment programs to facilitate a meaningful exit from homelessness.

The Role of Companionship in Volunteer Homelessness Support Services: A Qualitative Study

Drawing on developments in the application of occupational science to issues of homelessness and tenancy sustainability, this paper will argue for the recognition of authentic, everyday relationships as a core part of tenancy support. Data from a small-scale evaluation of a volunteer-led homelessness support service will be explored through a framework of social support to show the importance of companionship in enabling individuals to exit homelessness. The data show that individuals valued the provision of social support from volunteers in everyday locations, as it replicated authentic relationships which individuals had sometimes lost through their experiences of homelessness. This paper argues that the facilitation of authentic, everyday relationships should be considered an important part of homelessness support.

Centring lived experience of homelessness in law and policy reform

This reflective work considers homelessness and provides a model of participation for improving homelessness responses through StreetCare, a NSW-based advisory committee of people with diverse lived experiences of homelessness. StreetCare provides unique, essential and pertinent advice to relevant stakeholders in the housing and homelessness sector at the local, state and national level. Through the example of StreetCare, this piece explains how the participation of those with lived experience in reform contributes to better outcomes, to the empowerment of lived experience advocates, and to more equitable laws.

The Hope and Goals of Youth Experiencing Homelessness

The Hope and Goals of Youth Experiencing Homelessness

“Trying to find a rabbit hole to fall down”: A phenomenological case study of a queer youth parent seeking services for homelessness and intimate partner violence

Queer youth are vulnerable to experience intimate partner violence (IPV), which is compounded for those who also experience homelessness and are parents. Among these, transgender and gender non-conforming (TGNC) youth are especially vulnerable. Accordingly, it is important to have queer-affirming services related to both homelessness and IPV that consider parents’ needs. This phenomenological case study centers the voice of one queer youth parent who experienced IPV in a context of homelessness and their experiences of accessing services. The survivor’s data were supplemented with data from two social workers at the organization where the survivor received services. Findings suggest that experiences of homelessness and the need to access related services took precedence over IPV-related aid. Cis-heteronormativity in services made help-seeking difficult and being a parenting limited access to queer-affirmative, youth-focused supports as those supports were not designed to accommodate parents.

Association of Involuntary Displacement of People Experiencing Homelessness and Crime in Denver, CO: A Spatiotemporal Analysis.

In 2022, approximately 580,000 people experienced homelessness in the United States. In response, many cities have implemented "camping ban" policies enforced by involuntary displacement of homeless encampments. Displacement has been cited as a strategy to protect public health and safety. However, there is mixed evidence that displacement is effective in reducing crime, while it is associated with other adverse health outcomes. To evaluate the neighborhood-level association between displacement and crime, we performed a retrospective (November 2019 to July 2023) pre-post spatiotemporal analysis using administrative data from Denver, CO. We used the Knox test statistic to detect excess clustering and change in total crime, as well as crime stratified by the National Incident-Based Reporting System (NIBRS) category, within spatiotemporal proximity to displacement events. We found that, on average, clustering of crime is high both before and after displacement. Within a 0.25-mile radius, displacement is associated with a statistically significant but modest decrease in crime, between - 9.3% within 7days (p < 0.001) and - 3.9% within 21days (p = 0.002). We found no consistent change in composite crime at a 0.5- or 0.75-mile radius. Hyperlocal decreases were driven by significant decreases in public disorder and auto theft, while crimes against persons increased and displayed high clustering post-displacement. There were no changes in any other offense type. Involuntary displacement is not consistently associated with changes in clustering of crime and may exacerbate violence in nearby areas.

Value and Affordability of Shelter-Based Opioid Treatment Among People Experiencing Homelessness

Value and Affordability of Shelter-Based Opioid Treatment Among People Experiencing Homelessness

The Association Between Chronic Pain, Substance use, and Primary Care Experience Among Veterans with Ongoing or Recent Homelessness.

Chronic pain and problematic substance use are prevalent among Veterans with homeless experience (VHE) and may contribute to a challenging primary care experience. To examine the association of chronic pain and problematic substance use with unfavorable primary care experiences among VHE and to explore the association of pain treatment utilization and unfavorable care experiences in VHE with chronic pain. We surveyed VHE (n = 3039) engaged in homeless-tailored primary care at 29 Veterans Affairs Medical Centers (VAMCs). We assessed unfavorable primary care experiences with four validated Primary Care Quality-Homeless (PCQ-H) scales: multivariable logistic regressions explored associations between unfavorable care experiences for VHE with chronic pain and problematic substance use, chronic pain alone, problematic substance use alone, or neither. We then examined the association between receipt of pain treatments and unfavorable experiences among VHE with chronic pain. Last, we identified PCQ-H items that had the greatest difference in unfavorable response rates between VHE with and without chronic pain. The prevalence of unfavorable primary care experience was higher on all four scales for patients reporting chronic pain (with or without problematic substance use) (all p < 0.001), but not for problematic substance use alone, compared to VHE with neither pain nor problematic substance use. In analyses limited to VHE with chronic pain, those on long-term opioids were less likely to report an unfavorable experience (OR = 0.49, 95%CI 0.34-0.69). Receipt of occupational therapy was associated with lower odds of reporting an unfavorable experience (OR = 0.83, 95%CI 0707-0.98). PCQ-H items related to trust, relationships, and provider communication had the greatest differences in dissatisfaction ratings (all p < 0.001). Chronic pain is associated with unfavorable primary care experiences among VHE, potentially contributing to poor care outcomes. Strategies are needed to enhance patient-provider trust and communication and increase VHE's access to effective pain treatments.

Housing instability amongst takatāpui and LGBTIQ+ people in Aotearoa New Zealand

AbstractAlthough awareness and understanding of LGBTIQ+ people's experiences of homelessness are rising, their broader housing experiences remain under‐researched. This paper uses qualitative interview data to explore takatāpui and LGBTIQ+ people's experiences of housing instability in Aotearoa New Zealand. In expanding the focus to housing instability, this paper explores how LGBTIQ+ people experience and navigate the housing system, which sheds light on the upstream factors that contribute to the disproportionately high rates of homelessness amongst LGBTIQ+ communities worldwide. A reflexive thematic analysis of the data generated four themes to takatāpui and LGBTIQ+ people's experiences of housing instability; personal experiences are political, survival within inequitable systems is nuanced, instability is relational, and selfhood is mediated through instability. These results highlight the impact of policy and structural failures on LGBTIQ+ communities.

Service Engagement Among People Experiencing Homelessness and Mental Disorders: A Call for Person-centred Innovations.

In recent years, there has been increased support for the use of coercive policies to address the seemingly intractable problem of homelessness among people with mental disorders in North America. Although these policy approaches respond to a critical issue, rising rates of unsheltered homelessness, low service engagement and concerns about disruptive behaviors in public settings, they are unlikely on their own to be successful. To avoid coercive practices, there is an urgent need to consider alternative, person-centred approaches to promote service engagement among people experiencing homelessness and mental disorders, with input from those with lived experience and frontline homeless service providers. Three person-centred approaches are proposed for consideration: (1) cross-sectoral service delivery models, (2) peer-led services, and (3) financial incentives. These approaches merit further study to support voluntary treatment engagement and exits from homelessness among people with mental and substance use disorders and safeguard the human rights of this population.

Evidence-based Gambling Interventions for People Experiencing Homelessness: A call to Action

Evidence-based Gambling Interventions for People Experiencing Homelessness: A call to Action

Digital Media to Support Healing from Trauma: A Conceptual Framework Based on Mindfulness.

Digital media which involve narrative storytelling are increasingly used in nursing and health research, including clinical applications such as cinematherapy. A pilot study was conducted on how digital media self-accessed by marginalized individuals may be beneficial toward mindfulness and healing from trauma. Qualitative interviews were conducted with individuals (n = 8) who self-reported marginalizations via: race; gender; rural geography; socioeconomic status; indigenous or colonial experience; survivor of abuse; experiences of homelessness; or disability. Results indicated that trauma-narratives often organically emerge through discussions on digital media, with notable intersections with mindfulness-based practices and interventions. First, digital media can create a mindfulness of trauma as valid to discuss and disseminate. Mindfulness of authentic resolution also emerged as critical, as trauma may be employed in media narratives for attention or sympathy with no intent to support healing. Participant responses illustrate value in being mindful of individuals with severe trauma, who may be less likely to benefit from digital media. Digital media can foster sense-of-belonging and community-building amidst isolation; additionally, parasocial relationships may help foster supportive identities and ideologies on vulnerability. Findings are outlined in a preliminary conceptual framework, toward supporting future digital media with intent to create mindfulness or heal trauma.

The view from ‘My Pitch’: Homeless voices in The Big Issue during the cost-of-living crisis

This paper presents a framing analysis of 12 editions of The Big Issue published in the last 3 months of 2023. The study employs framing analysis to investigate the language used by the magazine to report on poverty and homelessness. The paper analyses the ‘My Pitch’ column which represents the voice of the often-homeless vendors who sell the magazine. Using Entman’s approach to framing we analyse how individuals with lived experience of poverty and homelessness define the causes and solutions to poverty and homelessness. Furthermore, the paper offers a critical examination of the claims of the magazine to provide a platform for marginalised voices. We find that the magazine offers a platform for people with lived experience of poverty and/or homelessness to have their voices heard, although the My Pitch column offers limited space to inform the magazine’s readers of the wider context of homelessness. It also reinforces social enterprise solutions to poverty and homelessness. This framing avoids discussing shortfalls in the UK welfare system although the narrative logic of these profiles offers latent evidence of welfare dysfunction.

Typologies of stably housed youth who experienced independent homelessness

Experiencing homelessness as an adolescent has significant effects on a person’s life course outcomes. This includes lower grades and graduation rates, as well as, serving as a barrier to the creation of healthy social networks and stable employment. Previous research focuses on homelessness and the experience youth have on the street. The current research examines the process of exiting homelessness and reconnecting with social institutions. Using the National Study of Adolescent to Adult Health (Add Health), we run hierarchical cluster analysis (HCA) to propose a typology of youth exiting homelessness. We build on previous work by establishing a fourth category to the typology of youth exiting homelessness, which we call “tenuously stable”. Additionally, we find that risky behavior, substance use, and childhood trauma are important factors in determining youth’s successful exits. Overall, our findings support the importance of wrap-around services that empower youth, as well as focus on education and employment.

Patient and Public Involvement in Research Evaluating Integrated Care for People Experiencing Homelessness: Findings From the PHOENIx Community Pharmacy Pilot Randomised-Controlled Trial.

There is a paucity of research on and a limited understanding of patient and public involvement (PPI) in the context of research in homelessness and, in particular, direct involvement of people with lived and living experience of homelessness (PEH) as expert advisors. We aim to report on outcomes and reflections from lived experience advisory panel (LEAP) meetings and PPI activities, held throughout the study lifecycle of a pilot randomised-controlled trial (RCT) focused on evaluating integrated health and practical support for PEH. Community Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx (PHOENIx Community Pharmacy RCT) is an integrated health and social care intervention for people experiencing homelessness who present to community pharmacy. Intervention includes weekly support from a pharmacist prescriber and a third sector support worker for up to 6 months. PPI activities undertaken throughout the study were documented, including outcomes of LEAP meetings. Outcome reporting followed Guidance for Reporting Involvement of Patients and the Public 2 Short Form (GRIPP2-SF). In total, 17 members were recruited into the LEAP; six meetings (three in two study sites) were held. PPI input was also received through representation from homelessness third sector organisation staff as study co-applicants and core membership in the trial steering committee. Together, the PPI activities helped shape the study proposal, design of study materials, data analysis and dissemination materials. LEAP panel members offered valuable input via their experience and expertise into the delivery and refinement of interventions. Although longitudinal input was received from some LEAP members, ensuring repeat attendance in the pre-planned meetings was challenging. People who face social exclusion and marginalisation can provide highly valuable input as equal partners in co-design and delivery of interventions seeking to improve their health and well-being. Fluid membership and flexible methods of seeking and incorporating advice can offer pragmatic approaches to minimising barriers to continued involvement in research. This study reports findings and learning relevant to involvement of people with lived and living experience of homelessness as advisors in a research study. It is important for researchers to offer fluid memberships and use diverse methods to receive input from lived experience members, as traditional PPI methodology may be insufficient to ensure inclusivity. Staff and volunteers from third sector organisations were important PPI partners who bring their experience based on frontline service provision, often as the first port of call for people experiencing severe and multiple disadvantage. ISRCTN88146807.

249 A Survey of People Experiencing Homelessness at a County Level Safety Net Emergency Department Assessing Communication and Comprehension of Discharge Instructions

249 A Survey of People Experiencing Homelessness at a County Level Safety Net Emergency Department Assessing Communication and Comprehension of Discharge Instructions

327 - Examining Lower Urinary Tract Symptoms and Bathroom Access in People Experiencing Homelessness

327 - Examining Lower Urinary Tract Symptoms and Bathroom Access in People Experiencing Homelessness