Homeless Individuals Research Articles

A prospective longitudinal study of tobacco use and tobacco use disorder in a homeless population.

Little is known about smoking habits and disorders among homeless populations. Previous research has not generally differentiated tobacco use from tobacco use disorders in this population. Known associations of tobacco use and morbidity and mortality in general populations may also apply to homeless populations. A 2-year longitudinal prospective study of 255 homeless individuals examined tobacco use and tobacco use disorders in association with other psychiatric disorders and service use and homeless outcomes. The majority of the sample used tobacco daily and had a tobacco use disorder, characteristics that changed little over the 2-year follow-up period. Tobacco use disorder was associated with greater substance, medical, and psychiatric service use during the 2 follow-up years. However, tobacco use was not associated with change in housing status over the 2-year follow-up period. Cessation of tobacco use was associated with cessation of alcohol use. Smoking is a major health issue for homeless populations. This study found that smoking status was unassociated with the achievement of stable housing. In addition, homeless people who smoke were found to be more likely to use health care services, indicating a potential source of intervention for smoking cessation.

Understanding service navigation pathways and service experiences among homeless populations

Previous homelessness research examined common pathways into homelessness, yet not much is known about how people navigate through services while experiencing homelessness. This study explored the service pathways of homeless individuals in the U.S. context, which show their connection with multiple organizations and their lived experiences of using services over time. We conducted 12 semi-structured in-depth interviews to grasp the history of service pathways, including the number of organizations, time gaps between services, and referral patterns. We also conducted participant observation shadowing with a subset of the study participants to understand how they interact with caseworkers. The length of service pathways varied, from less than five years to more than two decades. On average, participants went through at least three and up to eight organizations. Regarding service experiences, systemic- and individual-level themes were drawn for negative or positive experiences, such as strict organizational policies and the caseworker’s demeaning attitudes (negative), or supportive organizational culture and strong employee competencies (positive). The findings of this study provide deeper insights into homeless populations’ service trajectories and their experiences throughout the service-navigating process.

Challenges faced by people experiencing homelessness and their providers during the COVID-19 pandemic: a qualitative study.

Background:People experiencing homelessness are vulnerable to SARS-CoV-2 infection and its consequences. We aimed to understand the perspectives of people experiencing homelessness, and of the health care and shelter workers who cared for them, during the COVID-19 pandemic.Methods:We conducted an interpretivist qualitative study in Toronto, Canada, from December 2020 to June 2021. Participants were people experiencing homelessness who received SARS-CoV-2 testing, health care workers and homeless shelter staff. We recruited participants via email, telephone or recruitment flyers. Using individual interviews conducted via telephone or video call, we explored the experiences of people who were homeless during the pandemic, their interaction with shelter and health care settings, and related system challenges. We analyzed the data using reflexive thematic analysis.Results:Among 26 participants were 11 men experiencing homelessness (aged 28–68 yr), 9 health care workers (aged 33–59 yr), 4 health care leaders (aged 37–60 yr) and 2 shelter managers (aged 47–57 yr). We generated 3 main themes: navigating the unknown, wherein participants grappled with evolving public health guidelines that did not adequately account for homeless individuals; confronting placelessness, as people experiencing homelessness often had nowhere to go owing to public closures and lack of isolation options; and struggling with powerlessness, since people experiencing homelessness lacked agency in their placelessness, and health care and shelter workers lacked control in the care they could provide.Interpretation:Reduced shelter capacity, public closures and lack of isolation options during the COVID-19 pandemic exacerbated the displacement of people experiencing homelessness and led to moral distress among providers. Planning for future pandemics must account for the unique needs of those experiencing homelessness.

PHQ-2 Scores in Broward County’s Homeless: Prevalence, Barriers, and Proposed Solutions to Mental Health Disparities

Introduction: Florida ranks 9th in states with highest prevalence of mental illness among homeless individuals. The state also ranks 43rd of 52 states in providing adequate access for mental health concerns in homeless individuals. This study surveyed people experiencing homelessness in Broward County to investigate utilization of healthcare and mental health resources and accessibility of the target population to adequate care.. Aims included a collection of demographics concerning homelessness such as age and gender, prevalence of mental illness, history of substance use and emergency department, and then correlating these with scores from a standardized depression rating scale (PHQ-2). Methods: The Community Based Participatory Research model was employed while working with local volunteer organizations. Participants completed an 18 question survey and PHQ-2 at three feeding sites in Broward County, totaling 136 participants. . Results: 100% of participants surveyed had an income below $12,488, thereby falling in the Affordable Care Act (ACA) coverage gap. 66% stated “none” for insurance, 67% screened positive for depression with the PHQ-2 questionnaire, while 57% acknowledged having mental illness. Only 19% reported using the ER during mental health emergencies but 80% of this population had at least 1 ER visit within the year. Individuals who reported no to the question, “In the past year, was there ever a time when you were prescribed a drug but were unable to get it”, scored 1.23 points lower (95% CI: -0.33,-2.12) on the PHQ-2 than individuals who were able to obtain medications. Individuals who reported history of binge drinking, substance use and thoughts of suicide scored 1.21 points higher (95% CI: -0.14,-2.28) on the PHQ 2 than individuals who responded no. Discussion: Our results suggest a majority of homeless individuals need further assessment concerning depression. Based on the utilization of the ER, healthcare resource awareness is inadequately approached. Programs available are underutilized due to lack of awareness, accessibility and outreach. These findings encourage redistribution of funding and further advocate for resources available to this population.

Cultivated invisibility and migrants' experiences of homelessness during the COVID-19 pandemic.

The UK government's Everyone In scheme, announced in March 2020, required local authorities to temporarily house all homeless individuals in their area regardless of immigration status. In providing support through safe and secure accommodation, Everyone In also provided a crucial moment of visibility for migrants experiencing homelessness. Yet, just as it provided life-changing opportunities for some, the scheme was not straightforwardly a celebratory moment for migrants. It remained embedded within a wider context of immigration governance and social inequality in the UK, which has both invisibilised migrant homelessness as a crisis and hypervisibilised migrants as undeserving, suspicious or 'illegal' subjects. In this article, we explore life-story narratives co-produced with migrants across three urban contexts that capture their experiences of homelessness before and during the pandemic. In doing so, we introduce the notion of cultivated invisibility, referring to a habitual, deeply-ingrained mode of practice through which migrants respond to and navigate their experiences of being read as 'Other', in racialised or classed terms. It is developed through conditions of material scarcity and in the course of multiple engagements with racial capitalism's various 'faces of the state' in an increasingly hostile environment for migrants. Cultivated invisibility involves staying on the move and blending into the crowd or avoiding it altogether but it also includes the experience of being unseen despite having come forward for help. Importantly, we demonstrate that cultivated invisibility becomes a cause of illegalisation, just as much as a response to it.

The Impact of Housing Insecurity on Access to Care and Services among People Who Use Drugs in Washington, DC.

People who use drugs are highly marginalized communities and are disproportionately affected by environmental changes—e.g., neighborhood gentrification—that affect housing availability and stability, particularly in urban locations. These changes could negatively affect individuals’ access to and utilization of health care and social services, resulting in poorer health outcomes. This study examined the impact of gentrification and housing instability on drug users’ access to harm reduction and other health services. Data were collected from 139 clients of a large harm reduction organization. Results showed that 67% of the participants were either unstably housed or homeless, and about one-third of participants indicated that their current housing situations negatively affected their access to primary care (33.9%), behavioral health services (36.7%) and basic services (38.3%). While homeless individuals were still able to access services generally, a greater percentage—compared to those unstably or stably housed—reported difficulty accessing care. As these data were collected prior to the COVID pandemic, it is likely that many of our participants faced greater struggles with housing insecurity and health care access issues due to shutdowns and increased need for social isolation and quarantine. More work is needed to address housing instability and homelessness among already marginalized populations.

Prevalence of gambling disorder and its correlates among homeless men in Osaka city, Japan

Internationally, the prevalence of gambling disorder has been reported to be higher among homeless people than the general population; however, little is known about the factors associated with gambling disorder in this population. The present study aimed to investigate the prevalence of gambling disorder and its associated factors among homeless men using shelters in Osaka City. A cross-sectional survey was conducted from 30 to 2018 to 4 January 2019, using the 2017 Japanese National Survey of Gambling (JNSG) questionnaire, supplemented with questions about homeless experiences, drinking, and smoking. Using the South Oaks Gambling Screen, the presence of gambling disorder was determined by a score ≥ 5 out of 20. Multivariate logistic regression was conducted to explore factors associated with lifetime gambling disorder. Lifetime and past-year prevalence of gambling disorder among 103 participants was 43.7% (95% confidence interval [CI]: 34.5–53.3) and 3.9% (95% CI: 1.5–9.6), respectively, which are higher than the 6.7% and 1.5% found among men in the 2017 JNSG. Reasons reported for currently gambling less were primarily financial. Factors associated with lifetime GD included “more than 20 years since the first incidence of homelessness” (adjusted odds ratio [AOR]: 4.97, 95% CI: 1.50–16.45) and “more than five incidences of homelessness” (AOR: 4.51, 95% CI: 1.06–19.26). When homeless individuals with gambling disorder try to rebuild and stabilize their lives, the presence or resurgence of gambling disorder may hinder the process and pose a risk of recurring homelessness. Comprehensive support services for homeless individuals with gambling disorder are required. (250 words)

Antibody- and T Cell-Dependent Responses Elicited by a SARS-CoV-2 Adenoviral-Based Vaccine in a Socially Vulnerable Cohort of Elderly Individuals.

Background: In spite of compelling evidence demonstrating safety and immunogenicity of adenoviral-based SARS-CoV-2 vaccines in the general population, its effects in socially vulnerable elderly individuals are poorly understood. Here we aimed to investigate the efficacy of two doses of combined vector vaccine, the Gam-COVID-Vac (Sputnik-V vaccine), at 14, 42, and 180 days after immunization, in a nursing home for underprivileged population and homeless individuals. Methods: A phase 3, open-label clinical trial involving administration of two adenoviral vectors (Ad26-Ad5) vaccine, in elderly individuals over the ages of 60 years was performed. SARS-CoV-2 Spike RBD-specific IgG antibodies at days 21-, 42- and 180 post-vaccination was analyzed in sera of individuals receiving two doses of the Sputnik-V vaccine with an interval of 21 days. SARS-CoV-2-specific CD8+ T cell responses, measured by intracellular tumor necrosis factor (TNF) was determined by flow cytometry following antigen-specific cultures. Results: A total of 72 elderly adults with a mean age of 72.6 ± 9.5 years-old was selected after applying the inclusion criteria, all corresponding to an underprivileged population. Two-doses vaccination with Sputnik-V vaccine elicited an antibody-mediated immune response (revealed by quantitative detection of SARS-CoV-2-specific IgG antibodies, CMIA) 70% at day 21, 90% at day 42, and 66.1% at day 180. Fully vaccinated individuals had robust SARS-CoV-2-specific T cell responses, evidenced by TNF production in CD4+ and CD8+ T cells in all time periods analyzed. Conclusion: Six months after receipt of the second dose of the Gam-COVID-Vac vaccine, SARS-CoV-2-specific IgG levels declined substantially among the tested population, whereas CD4+ and CD8+ T-cell-mediated immunity remained at high levels. These data suggest that two doses of combined adenoviral-based vaccine elicits a considerable level of SARS-CoV-2 immune responses in elderly individuals, highlighting its safety and immunogenicity in this highly vulnerable population.

Recognising the regenerative impacts of Canadian women tourism social entrepreneurs through a feminist ethic of care lens

PurposeThe overarching aim of this project is to understand the role women tourism social entrepreneurs (TSEs) play in contributing to regenerative practices in Canada.Design/methodology/approachSemi-structured interviews were carried out with women food TSEs with snowball sampling. This paper challenges the assumption that the masculine experience is the human experience. Accordingly, this research is informed by a feminist ethic of care lens to recognise the important role of Canadian women TSEs. Methodologically, the authors employed the strategies of a constructivist grounded theory to guide the analysis (Charmaz, 2011). This process involved carefully engaging in a close line by line reading of the transcripts, developing codes based on the authors’ dealings with the data including summarising, synthesising and sorting the data (Charmaz, 2011).FindingsThe analysis revealed three categories: (1) Adopting a regenerative mindset and enhancing well-being, (2) Supporting the consumption of real food and (3) Educating communities for regenerative and just futures. The analysis revealed the importance of women TSEs in adopting a regenerative and caring mindset to enhance the well-being of their communities and beyond.Research limitations/implicationsThe study focusses on the learnings from 11 entrepreneurs from Canada. There is a scope to expand the discussion with more interviews. The impact of this pandemic on the small businesses resulted in affecting the researchers’ participation by presenting some unique challenges in participant recruitment. Maybe the studies in the near future will focus on grounding the research papers based on other sexual orientations and indigenous social entrepreneurs.Practical implicationsThe authors hope future studies centre diversity and attend to the role of women in their communities to better under the diverse contributions. The work presented here is part of a broader study on the role and impact of women TSEs and so only reveals the tip of the Canadian iceberg. Forthcoming studies will attend to some of the gender-specific barriers faced by women TSEs and the supports required particularly in the wake of COVID-19. The authors hope other scholars continue to build on this work, adopting feminist approaches to enhance our understanding of the role women play in contributing to just, caring and regenerative futures.Social implicationsContributing to Higgins-Desbiolles and Monga's (2021) in-depth case study using an ethic of care to examine an Australian events business supporting homeless individuals, the analysis of the 11 in-depth interviews with Canadian TSE provides evidence of alternative ways women are delivering social value. Using an ethic of care lens has elicited the impacts created by the informants and the ripple effects particularly in light of regenerative practices which are crucial in the tourism sector as borders and destinations reopen to tourism as noted by Ateljevic (2020).Originality/valueThere are few studies in the tourism social entrepreneurship literature that recognise the agency and centres the vocies of women. Kimbu and Ngoasong (2016) made a call for more research to understand how women engage in social entrepreneurial activities and benefit their local communities. There are limited analyses on regenerative tourism in practice in the scholarly literature. To respond to this gap the authors examine the regenerative practices of women TSEs in Canada.

Distressing unusual experiences and beliefs in the lives of previously homeless individuals: a narrative analysis of the stories of white British men

ABSTRACT Background Research suggests a correlation between homelessness and the prevalence of distressing unusual experiences and beliefs. This study aimed to explore how previously homeless individuals make sense of distressing unusual experiences and beliefs, by hearing their stories. Method Narrative analysis was used to understand the stories of six previously homeless White British males who reported distressing unusual experiences and beliefs. Results Participants’ stories involved a holistic and whole-life approach when making sense of distressing unusual beliefs and experiences. Plots included interpersonal experiences (trauma and abuse; loss; judgemental attitudes; fitting in and relational coping), and their intrapersonal consequences (physical wellbeing; substance use; spiritual, religious, and paranormal experiences; and safety, security, and stability). Discussion A holistic, psychosocial, and whole-life approach may be helpful to support homeless individuals to make sense of distressing unusual experiences and beliefs and their coping responses. It may also be helpful to consider the changing sense of power, agency and autonomy when hearing their stories.

Impact of COVID-19 on Physical Activity, Diet, and Stroke Awareness in Homeless Individuals of Chicago (P1-1.Virtual)

Impact of COVID-19 on Physical Activity, Diet, and Stroke Awareness in Homeless Individuals of Chicago (P1-1.Virtual)

The Association of Traumatic Brain Injury with Neurologic and Psychiatric Illnesses among Individuals Experiencing Homelessness: A Systematic Review and Meta-analysis

A systematic review was performed with searches in Medline, Embase, and PsychINFO for studies reporting on homeless persons with TBI and neuropsychiatric illnesses. A random-effects model was used to calculate odds ratios for having any neuropsychiatric diagnosis. Of 420 articles indexed, 19 were included for systematic review and 17 for meta-analysis reporting on 11,474 and 8,757 individuals, respectively. The pooled odds of a homeless individual with a TBI having any neurologic illness were 2.57 (95% CI [1.97, 3.44]; I2 = 68.0%) and 2.01 (95% CI [1.81, 2.25]; I2 = 79.2%) for any psychiatric illness. The odds of having a neuropsychiatric illness among homeless individuals with TBI are substantially higher than in the domiciled population with TBI.

Problematic alcohol use history among persons experiencing homelessness in Northwest Arkansas

ABSTRACT Little research has attempted to simultaneously understand the myriad of social factors that might amplify or mitigate alcohol misuse patterns among persons experiencing homelessness. Using a sample of homeless adults in Northwest Arkansas (n = 168), the current study explores the role of social vulnerabilities, individual risks, and social and psychological resources on a history of self-reported problematic alcohol use. A series of ordinary least squares regressions were used to model relationships between social vulnerabilities, individual risks, social and psychological resources, and a history of problematic alcohol use. Findings support the notion that social vulnerabilities and individual risks were associated with problematic alcohol use histories. In particular, homeless individuals that were older, male, experiencing recent incarceration, and reported suicidal ideation were more likely to report a higher incidence of a history of problematic alcohol use. We find no evidence that social and psychological resources mitigated problematic alcohol use histories. The study partially corroborates prior evidence of demographic and psychosocial factors associated with understanding the history of problematic alcohol use among persons experiencing homelessness. However, these findings differ measurably with regards to social connectedness, mastery, and an expression of spirituality not being associated with problematic alcohol use histories.

BEAUT: An ExplainaBle Deep LEarning Model for Agent-Based PopUlations With Poor DaTa

When working with an agent-based system, it may be desirable to develop an algorithm that can predict future time periods for each individual. One such approach that works to accomplish this is the Markov decision process, which takes as its input available actions, unique agent reward functions, and a model of the overall environment. However, it can be difficult to identify the underlying factors that influence decision making when attempting to simulate the behavior of real-world populations. For example, when modeling the transitions of homeless individuals between states such as street and shelter, it can be a challenging task as the external factors impacting them (e.g., weather) may not be readily apparent. Therefore, this paper proposes and evaluates an approach to capture this information in an explainable way from aggregate, real-life data produced by the At Home/Chez Soi project. The proposed algorithm “BEAUT” is a consolidation of a modified deep q-learning (MDQL) and modified neural fitted q-iteration (MNFQ) algorithm that work together to generate a set of probabilistic transition matrices to describe state transitions. BEAUT is evaluated with experimental results that compare its accuracy against similar methods for time-series forecasting using real-world data. Our tests show that BEAUT provides an explainable forecasting model without a loss of accuracy, and in some instances results in higher accuracy.

Accelerated Brain Atrophy and Changes in White Matter Diffusivity are Associated With Mortality, Declining Health, and Declining Cognitive Functioning Among Homeless and Precariously Housed Individuals: A Longitudinal Study

Individuals who are homeless or precariously housed experience poorer health and earlier mortality compared to the general population. We evaluated longitudinal changes in quantitative MRI measures of brain structure, and how these changes are related to mortality, and change in health and functioning.

Work condition, Exploitation, and Mistreatment of Study of Street Children of Kathmandu Valley

All vulnerable and homeless individuals congregate on the street. Many people, ranging in age from youngsters to the elderly, can be seen begging on the street. The purpose of this research was to learn more about the working conditions, exploitation, and mistreatment of street children in the Kathmandu valley. The study used a structured questionnaire survey to obtain data from 234 street children. According to the findings, 39.4 percent of street youngsters were begging rather than doing any type of laborious work. 51.3 percent of street children were subjected to misbehavior and harassment by passers-by. Physical, psychological, sexual, and other forms of abuse and mistreatment were perpetrated on street children. The concerned authority should ensure the safety and security of these street children because they have also right of life.

A Population-Based Susceptible, Infected, Recovered Simulation Model of the Spread of Influenza-Like-Illness in the Homeless versus Non-Homeless Population

PurposeTo examine the prevalence and characteristics of influenza-like illness (ILI) related presentations among people experiencing homelessness compared to the general population as well as to use the Susceptible, Infected, Recovered (SIR) simulation model parameters β and γ to model infectious interactivity, recovery rate, and population-level basic reproduction number (R0). MethodsUsing administrative health data from emergency department (ED) visits in the province of Ontario, Canada from 2010 to 2017, an SIR model was used to calculate the R0 for ILI in both the general population and the population of homeless individuals. ResultsFrom 2010 to 2017, a total of 17,056 homeless and 85,553 non-homeless individuals presented with an ILI to an ED in Ontario. The estimated infectious interactivity (β) was lower while the recovery rate (γ) was longer for infected people experiencing homelessness. ConclusionsOur results suggest that infections of ILI will result in more secondary cases in the homeless population compared to the homed population. This evaluation of the dynamics of ILI spread in the homeless population provides insight into how illnesses such as COVID-19 may be much more infectious in this population compared to the homed population.

Hospitalizations During the COVID-19 Pandemic Among Recently Homeless Individuals: a Retrospective Population-Based Matched Cohort Study.

BackgroundHospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions.ObjectiveTo examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control.DesignPopulation-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020.ParticipantsIn total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden.Main MeasuresPrimary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions.Key ResultsAverage rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7–3.8), non-elective (10.3, 95% CI: 10.1–10.4), and psychiatric admissions (128.1, 95% CI: 126.1–130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47–0.47), non-elective (0.80, 95% CI: 0.79–0.80), and psychiatric admissions (0.86, 95% CI: 0.84–0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17–September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23–1.69), kidney disease (1.29, 95% CI: 1.14–1.47), and trauma (1.19, 95% CI: 1.07–1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals.ConclusionsPersistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07506-4.

Homelessness during the Coronavirus Pandemic. Exploratory Study in Switzerland

ABSTRACT The coronavirus pandemic has negatively affected people of all social strata, and continues to do so, but its effect has been the most severe on members of the most precarious populations. In this exploratory study conducted in Switzerland, the specific situation of homeless people, a particularly vulnerable population, is examined from a criminological perspective. In total, we surveyed 32 homeless individuals: 14 during the first wave of the pandemic (March-September 2020) and 18 during the second wave (December 2020-March 2021). Results corroborate that the pandemic has had adverse effects on the respondents – both socioeconomic and psychological. Most of the participants do not use drugs and, overall, those who reported drug use did not report an increase during the epidemic. The occurrence of both victimization and offending is low among the participants. Ethical and methodological considerations such as the minimization of social desirability bias, satisficing, as well as the recruitment of difficult-to-reach participants and data collection more broadly during a pandemic are discussed.

Evaluating knowledge and utilization of community health resources to promote autonomous decision-making among people experiencing homelessness in New Orleans

ABSTRACT People experiencing homelessness encounter barriers to self-directed community health resource use that may limit autonomous decision-making. Tailored educational material is needed to increase knowledge, promote well-informed resource access, and improve community health system navigability. This study aimed to 1) assess homeless individuals' baseline knowledge and utilization of community health resources and 2) evaluate use of a pocket-sized resource guide. Participants (N = 103) were recruited at a no-cost medical clinic in New Orleans to complete pre- and post-surveys assessing knowledge and utilization of community health resources listed on the guide. Over a third (38.8%) of participants indicated having low knowledge of resources at baseline. Utilization of resources varied substantially, ranging from a majority (66.7%) to a select few (6.9%) participants reporting attendance at sites. Among participants who completed the follow-up survey, self-rated knowledge of resources significantly increased (p = 0.029); however, the number of resources used in the past month slightly declined. These results may speak to participants who used the resource guides having an improved ability to selectively access resources for their specific needs. Interventions to improve health resource knowledge can, thus, aid more efficient and autonomous decision-making and are needed to improve community health system accessibility for populations experiencing homelessness.