Experiences Of Homeless Women Research Articles

Women’s Homelessness and the Justice System: A Study of Desistance and Social (Re)integration Among Canadian Women Who Used or Did Not Use Criminal Activities to Survive

Women experiencing homelessness (WEH) are a marginalized group who often lack support services, leading them to adopt alternative survival strategies that leave them at risk of being victimized and becoming involved with the justice-system. To better understand this problem, we analyzed the adaptive strategies Canadian WEH use to survive. Comparing the life histories of WEH who turned to criminal activities ( n = 4) with WEH who demonstrated prosocial resilience ( n = 4) makes it possible to identify protective and risk factors for criminal behavior and to propose adaptive strategies that can be used to support these women to adopt a prosocial lifestyle. The results provide a framework for understanding the needs of WEH, filling a gap that results from the focus on men needs in most scientific literature and by many resources, and suggesting that meeting those needs may reduce the likelihood that WEH will become involved with the justice-system.

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

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

Short Interpregnancy Intervals Among Women Experiencing Homelessness in Colorado

Short interpregnancy intervals (SIPIs) are associated with increased risk of adverse maternal and neonatal outcomes. Disparities exist across socioeconomic status, but there is little information on SIPIs among women experiencing homelessness. To investigate (1) differences in rates and characteristics of SIPIs between women experiencing homelessness and domiciled women, (2) whether the association of homelessness with SIPIs differs across races and ethnicities, and (3) whether the association between SIPIs of less than 6 months (very short interpregnancy interval [VSIPIs]) and maternal and neonatal outcomes differs between participant groups. This cohort study used a Colorado statewide database linking the Colorado All Payer Claims Database, Homeless Management Information System, death records, and infant birth records. Participants included all women who gave birth between January 1, 2016, and December 31, 2021. Data were analyzed from September 1, 2022, to May 10, 2023. Homelessness and race and ethnicity. The primary outcome consisted of SIPI, a binary variable indicating whether the interval between delivery and conception of the subsequent pregnancy was shorter than 18 months. The association of VSIPI with maternal and neonatal outcomes was also tested. A total of 77 494 women (mean [SD] age, 30.7 [5.3] years) were included in the analyses, of whom 636 (0.8%) were women experiencing homelessness. The mean (SD) age was 29.5 (5.4) years for women experiencing homelessness and 30.7 (5.3) years for domiciled women. In terms of race and ethnicity, 39.3% were Hispanic, 7.3% were non-Hispanic Black, and 48.4% were non-Hispanic White. Associations between homelessness and higher odds of SIPI (adjusted odds ratio [AOR], 1.23 [95% CI, 1.04-1.46]) were found. Smaller associations between homelessness and SIPI were found among non-Hispanic Black (AOR, 0.59 [95% CI, 0.37-0.96]) and non-Hispanic White (AOR, 0.57 [95% CI, 0.39-0.84]) women compared with Hispanic women. A greater association of VSIPI with emergency department visits and low birth weight was found among women experiencing homelessness compared with domiciled women, although no significant differences were detected. In this cohort study of women who gave birth from 2016 to 2021, an association between homelessness and higher odds of SIPIs was found. These findings highlight the importance of conception management among women experiencing homelessness. Racial and ethnic disparities should be considered when designing interventions.

Improving Traumatic Stress with Justice-Impacted Women and Women Experiencing Homelessness: A Pilot Study of Narrative Exposure Therapy

Objective We sought to investigate the feasibility, acceptability, and impact of a brief, manualized trauma-focused intervention aimed at improving PTSD symptoms in persons with complex PTSD, Narrative Exposure Therapy (NET). Design Using a mixed methods approach, we tested the feasibility, acceptability, and impact of NET in a sample of trauma-affected women in traumatogenic circumstances: justice-impacted women in prison and women experiencing homelessness in a shelter. We quantitatively assessed data using a single sample, pre-/post-intervention design. We qualitatively assessed self-described symptom change and opportunities for intervention adaptation using a content analysis approach. Methods Sixteen trauma-affected participants completed the intervention protocol. NET interventionists included one nurse practitioner, one registered nurse, and one nursing student. All NET participants attended pre-/post-intervention visits and active NET sessions. In-depth interviews were conducted at pre- and post-intervention, alongside a diagnostic battery. Results NET was both highly feasible and acceptable among participants. Participants significantly improved on the intervention-specific outcome of PTSD symptoms, as well as somatic symptom burden, with large effect sizes. Participants also improved on subjective self-described symptom change. Participants offered recommendations regarding opportunities to enhance population-specific intervention acceptability. Conclusions Results from this pilot study are consistent with previous evidence demonstrating that NET facilitates improvements in women with traumatic stress. Findings of high feasibility, acceptability, and impact supports the use of NET in JW and WEH. Integrating participant recommendations to optimize acceptability may further support scalability and reach of NET. Replication with a larger sample and within a randomized controlled design is required to definitively determine effectiveness.

Adaptation of a mindfulness-based intervention for trauma-exposed, unhoused women with substance use disorder.

Women experiencing homelessness (WEH) report exceedingly high rates of trauma exposure, posttraumatic stress disorder (PTSD), and substance use disorder (SUD). Mindfulness-based interventions including Mindfulness-based Stress Reduction (MBSR) may help lower traumatic stress-related symptoms and reduce SUD, but have been underexplored in community-based settings serving WEH with symptoms of PTSD and SUD. We used a mixed-method, community-engaged approach that implemented a Community Advisory Board and the ADAPT-ITT (assessment, decision, adaptation, production, topical experts, integration, training, testing) framework, including intervention demonstrations, to adapt and refine MBSR for WEH experiencing symptoms of PTSD/SUD. Trauma-exposed WEH (N = 28) living at a drug treatment site provided perspectives and feedback on an MBSR demonstration via quantitative questionnaires and four focus groups. Quantitative measures indicated high perceived acceptability and feasibility: Nearly all WEH reported MBSR activities (including yoga, meditation, body scans, class discussion, and home practice) would be at least "somewhat helpful"; between 71.43% to 89.29% reported each activity would be "a great deal helpful." Most reported the focus group sessions were useful for providing feedback relevant for improving program design and administration. Qualitative findings revealed four themes aligning with quantitative findings that provided useful suggestions to guide MBSR implementation with trauma-exposed WEH: (a) perception of feasibility and effectiveness of MBSR, (b) strategies for successful recruitment, (c) strategies for successful retention, and (d) characteristics of the MBSR trainer. Focus group recommendations could bolster intervention compliance, engagement, and completion for MBSR and community-based programs for WEH more generally. Results provide suggestions for implementing a trauma-sensitive approach when administering MBSR to trauma-exposed WEH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Effects of Traumatic Events on Mental Health Among Women Experiencing Homelessness: A Longitudinal Study.

In this longitudinal study, we aim to evaluate the prevalence and impact of interpersonal and non-interpersonal traumatic events among women experiencing homelessness in Madrid (Spain) (N = 136). The information was collected through a structured interview and standardized instruments at baseline and at a 12-month follow-up. The most prevalent events were physical assaults, intimate partner violence, and severe illnesses or accidents. Path analysis revealed that personal and non-interpersonal traumatic events had direct effects on mental health, but also had differential indirect effects. Greater efforts are needed to address the effects of various types of potentially traumatic events and to design effective trauma-informed interventions for women experiencing homelessness.

Biopsychosocial Model of Traumatic Stress Symptoms in Women Experiencing Homelessness: A Qualitative Descriptive Study

Trauma is nearly ubiquitous among women experiencing homelessness (WEH). WEH develop post-traumatic stress disorder (PTSD) at rates far exceeding the general population. The consequences of untreated PTSD can cascade, exacerbating existing physical, mental, and social health inequities, placing this population at risk for disproportionate biopsychosocial health adversity. Despite the outsized impact of PTSD, WEH are less likely to access or receive appropriate trauma-focused services. Understanding the unique and intersecting factors that contribute to the disproportionate PTSD toll on WEH may elucidate risk and protective factors, as well as possible intervention pathways to address the disparate trauma burden. This study employed a qualitative descriptive approach to develop understanding of the determinants of trauma risk, exposure, and outcomes among WEH. Semi-structured interviews were completed with 10 WEH, six shelter staff, four mental health professionals. Six deductively biopsychosocial model-derived themes were identified, alongside supporting categories. Themes/categories highlighted the role of biological, psychological, and socio-environmental determinants in shaping risk for and actualization of traumatic events and adverse outcomes. Trauma played an outsized role in shaping the health of WEH participants in this study, and the need for and interest in tailored trauma screening, treatment, psychoeducation options was highlighted. Recursive relationships between biopsychosocial determinants and trauma impact were identified. Participants emphasized population tailored trauma-focused interventions, specifically brief co-designed and community partner implemented interventions that address substance use behaviors, while leveraging the strengths of WEH. Addressing the marked trauma burden in WEH shows promise in promoting measurable biopsychosocial health improvements in this resilient yet overlooked population.

Abstract P6-08-12: Toward Comprehensive Cancer Prevention for Women Experiencing Homelessness: Demonstrating the Need for Onsite Mammography, Education, Navigation, and Cross Cancer Screenings

Abstract Background: Persons experiencing homelessness (PEH) rarely receive regular preventative health care or consistent cancer screenings. Late stage detection of cancer and barriers to care are prevalent among PEH. Novel programs such as onsite mobile mammography services represents an approach to improve breast cancer disparities among women experiencing homelessness (WEH) and allows for understanding of barriers to cancer screening amongst WEH and to develop best practices. Objectives: During onsite mobile mammography events at shelters for WEH, develop best practices for improving breast cancer screening utilization while developing approaches to increase use of other cancer screenings. Methods: In 2022, the Cleveland Clinic performed onsite mobile mammography screening events at area shelters and day centers. All seven screening events included onsite mammography, breast health education, and patient navigation. After WEH completed the education session, they completed the mammogram. Subsequently, at two events, patients had an opportunity for further consultation with an advanced practice provider (APP) including discussing additional screening tests (ex. colorectal, lung, cervical cancer) beyond mammograms with referrals as needed. Consultations also discussed approaches to reduce cancer risks with further education, referrals for dental care, and assistance securing a primary care provider (PCP). Results: At the events that included consultations, 30 patients received mammograms and 80% (n=24) of patients chose to speak with the APP. Patients seeking consultation were 21-73 years old and identified as Black/African American (n=5), White (n=16), and other (n=3). Topics of discussion included mammograms (n=24, 100%), smoking cessation referral and/or lung cancer screening (n=16, 67%), colorectal cancer screening (n=11, 46%), and cervical cancer/HPV screening (n=11, 46%). Additionally, 46% of patients (n=11) were assisted with securing a PCP and 8% of patients (n=2) were referred for dental services. Discussion: Our preliminary data demonstrate that most WEH undergoing onsite mammography screening are willing to engage in consultation to discuss additional cancer screenings with many patients eligible for additional cancer screenings. Additionally, this approach provided access to PCPs. Three best practices for cross cancer screenings include: 1) Onsite mobile mammography is an appropriate entry point for addressing breast health and also cancer screening broadly. 2) An onsite approach allows for education beyond cancer screening to provide access to primary care and other wrap around services. 3) Clinicians provide credibility and trust when they attend onsite mobile mammography events. Conclusion: Beyond breast cancer screening, WEH benefit from onsite mobile mammography, which can serve as a gateway to cross cancer screenings and access to primary care. Addressing disparities in this population should include wrap around services such as smoking cessation and connection to a PCP. Future research should examine best practices for following up with patients and completing navigation through cross cancer screenings. Citation Format: Pamela Combs, Heather M. Hurwitz, Markayla Mariner, NaSheema Anderson, Kate Mccaffrey, Raymond Jackson, Sarah Kilic, Tiffany Onger, Kimberly Sanders, Tyler Stimpert, Jeremy Suwarna, Jeremy Weleff, Chirag Shah. Toward Comprehensive Cancer Prevention for Women Experiencing Homelessness: Demonstrating the Need for Onsite Mammography, Education, Navigation, and Cross Cancer Screenings [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-12.

Barriers to cancer prevention among women experiencing homelessness who receive onsite mammography, patient navigation, and education (HOPE).

111 Background: While incidence rates of cancer are lower among women experiencing homelessness (WEH), cancer mortality remains higher. Barriers to screening include economic, transportation, housing, childcare and other barriers. This study evaluates barriers to mammographic screening as part of a prospective program that provides onsite mammography services to WEH. Methods: Cleveland Clinic partnered with shelters to provide breast health education, patient navigation, and mobile mammograms onsite at shelters. Also, participants received a meal, a bra, and hygiene items. 75 women and persons of other genders completed a mammogram. 55 WEH participated in the study by completing a survey for a response rate of 73.3%. The survey included questions about barriers and demographics. We conducted a preliminary analysis to improve study quality and plan for a follow up study. Results: Participants were 40-75 years old and identified as American Indian/Alaska Native (5.5%), Black/African American (60%), and White (40%). 16% of participants received their first ever mammogram. 34% noted a family history of breast cancer and 22% had previously been advised to return for additional imaging. One participant was a breast cancer survivor. On average, participants’ last mammogram was four years prior with the greatest screening lapse being 18 years prior. A majority (n = 39, 70.9%) disagreed or strongly disagreed with the statement, “I’m afraid the mammogram will be painful.” Likewise, a majority (n = 46, 83.7%) disagreed or strongly disagreed with the statement, “I’m embarrassed about having a mammogram.” A majority (n = 44, 80.0%) also disagreed or strongly disagreed with the statement, “I’m busy and do not have time.” Almost all participants (n = 51, 96.2%) responded “yes” to the statement, “I believe in preventative care screenings.” However, participants’ responses to the statement, “I’m afraid of finding breast cancer” varied widely from strongly disagree (n = 7, 13.0%) and disagree (n = 10, 18.5%), to neutral (n = 15, 27.8%), to agree (n = 12, 22.2%) and strongly agree (n = 10, 18.5%). Conclusions: Our preliminary data shows that most participants believe in preventative screening, showing that novel services such as onsite mammography may address the lack of screening in this population. 40.7% of participants stated they are afraid of finding breast cancer, indicating this is a barrier to screening in the WEH population. Future research should explore reasons for fear (financial burden, mortality, lack of access to care, etc.) and why this may result in a lack of screening.

A multi-method exploration of mindfulness as a coping tool: Perspectives from trauma-exposed, unhoused women residing at a drug treatment facility.

This multi-method study examined perspectives on mindfulness and coping strategies used by trauma-exposed women experiencing homelessness (WEH), residing in a state-funded residential drug treatment site in Southern California (United States). Questionnaires and in-depth focus group interviews were utilised to examine traumatic experiences over the lifespan, probable-posttraumatic stress disorder (PTSD), and coping strategies. Mindfulness was explored as a potential way to improve coping; potential benefits and challenges associated with implementing a mindfulness-based intervention (MBI) with trauma-exposed WEH were also investigated. A Community Advisory Board (CAB) was formed to identify key issues experienced by WEH and to develop a semi structured interview guide (SSIG). Using the SSIG, women participated in one of four focus groups (total N=28; n=7 per group). Quantitative data on demographic indicators, probable-PTSD, and trauma exposure were collected. Almost 90% of women met criteria for probable-PTSD; trauma exposure was exceedingly high; most women had experienced multiple traumas throughout their lives. Four main themes emerged from qualitative analyses, which drew from Grounded Theory and used open, selective, and axial coding: (1) ways of coping with trauma; (2) perspectives on mindfulness; (3) prior experiences with mindfulness; and (4) challenges for conducting a mindfulness programme. Overall, WEH used a variety of coping techniques to deal with their trauma, had some familiarity with mindfulness, and were optimistic an MBI would be helpful, despite identifying several challenges to implementation. MBIs may be helpful adjuncts to traditional care for trauma-exposed, WEH, recovering from substance use disorder. Population-specific considerations may improve implementation and participation.

Emergency Department Use by Women Experiencing Homelessness in Los Angeles, California, USA.

Background:This article reports on the use of hospital Emergency Departments (EDs) in women experiencing homelessness in Los Angeles, California. Women 18 years of age or older were recruited from homeless day centers in Los Angeles to participate in this study.Materials and Methods:A self-report questionnaire on health status, demographics, and emergency service use was completed by study participants.Results:In this study of women experiencing homelessness, 64% utilized the ED within the past year. The mean number of ED use was 3.63 (range 0–20) visits in the past year. Higher frequency visits were significantly associated with several mental health conditions (p = 0.016), physical disability (p = 0.001), and traumatic brain injury (p = 0.013).Conclusions:The physical and psychological impacts of the homelessness experience can be enormous, affecting the homeless individually and collectively. Study findings may help to understand how to improve services that support and meet the needs of women experiencing homelessness such as patient and family-centered care and trauma-informed care in the ED.

“I ain’t getting enough rest”: A Qualitative Exploration of Sleep among Women Experiencing Homelessness

ABSTRACT Women experiencing homelessness may face additional challenges related to sleep. Extant research indicates women in general are more likely to report sleep problems than men, including insufficient and disturbed sleep. This qualitative investigation explores the perceptions of sleep health among 16 women residing in transitional and emergency housing shelters. Participants noted the importance of sleep, sleep location, the importance of relaxation and rest to their well-being, and how work schedules often conflicted with sleep opportunities in housing programs. Participant recommendations for sleep promotion in housing programs included flexibility surrounding sleep hours for working clients and separate quarters for working vs. nonworking clients. Implications for sleep health promotion among women experiencing homelessness are discussed.

Factors Associated With Symptoms of Depression and Anxiety Among Women Experiencing Homelessness and Unstable Housing During the COVID-19 Pandemic

The prevalence of depression among individuals in the US has increased 300% during the COVID-19 pandemic, with a greater burden of illness in individuals with lower incomes.1 With the goal of informing adaptation of services for socioeconomically marginalized individuals, we surveyed mental health symptoms and social challenges experienced during the COVID-19 pandemic among women experiencing homelessness and unstable housing (HUH). Extrapolating from the available evidence,2,3 there are approximately 440 000 women experiencing HUH in the US.

The Prevalence and Nature of Violence Against Women Experiencing Homelessness: A Quantitative Study.

Individuals experiencing homelessness-an extreme form of social exclusion-have considerably higher risk of being victims of violence than the general population. We analyze the episodes of violence suffered by 504 individuals experiencing homelessness in Spain, as well as the differences between men and women. The results indicate high levels of violence and suggest that gender (specifically, being a woman) is the primary factor driving exposure to violence among this group. Highlighting the reality of women experiencing homelessness can help social, mental health, and addiction services adjust responses to better address the needs of this group and offer comprehensive care.

“I’ve Been Through It”: Assessing Employment Barriers among Unaccompanied Women Experiencing Homelessness

Abstract Women represent a growing segment of the homeless population; however, little work has examined employment among an important segment of this population: women unaccompanied by children. This study addressed the following research questions: Which common employment barriers (that is, physical health, mental health, substance abuse, or domestic violence) influence employment of unaccompanied women experiencing homelessness? How do these barriers influence the employment experiences of the women? The authors analyzed a cross-sectional sample of unaccompanied women in one community’s homeless management information system (n = 1,331). Then they completed semistructured interviews (n = 20) with a subsample of these women. Logistic regression analyses indicated that no employment barrier significantly related to current employment status. Interview data indicated that women perceived physical and mental health issues as barriers to full-time employment. Women reported a struggle to maintain housing even when they had employment. Integrated quantitative and qualitative analyses identified how agency data regarding barriers and employment may miss central barriers (for example, stigma, physical presentation) and employment engagement. Study findings provide support for programs that address housing and current barriers before other employment barriers, the importance of improving federal measures, and recommendations to strengthen agency-level data collection to inform program development and community-based research.

The Experience of Violence Against Women Who Use Injection Drugs: An Exploratory Qualitative Study.

While literature exists about persons who use injection drugs, few studies explore the experience of women who use these substances. Furthermore, even less research specifically focuses on the lives and experiences of homeless women who use injection drugs. What literature does exist, moreover, is often dated and primarily addresses concerns about infectious disease transmission among these women; and some highlight that these women have lives fraught with violence. To update this knowledge and better understand the lives of women who use injection drugs in the Canadian context. We undertook an exploratory qualitative study and we engaged in semi-structured interviews with 31 homeless women who use injection drugs in downtown Ottawa, Canada. We analyzed the data using the principles of applied thematic analysis. Our data identified that violence pervaded the lives of our participants and that these experiences of violence could be categorized into three main areas: early and lifelong experiences of violence; violence with authority figures (e.g., police, healthcare); and societal violence toward women who use injection drugs. We take these findings to mean that, violence toward women is rampant in Canada (not just internationally) and that healthcare workers play a role in propagating and addressing this violence.

The Role of Stressful Life Events among Women Experiencing Homelessness: An Intragroup Analysis.

The aim of this study is to examine stressful life events (SLEs) among homeless women and how SLEs were related to patterns and trajectories of homelessness. Specifically, the study aimed to replicate and build upon by Muñoz et al. (2005) by using cluster and discriminant analysis in a sample of 116 homeless women. The sample was classified based on SLEs, and the relationship between the resulting subgroups and sociodemographic characteristics, homeless trajectories, physical and mental health, and social support was examined. The results suggest that the three-cluster solution was theoretically and structurally meaningful: (a) the "Shorter homelessness trajectories and best health and mental health" subgroup was characterized by low levels of SLEs, a shorter homeless trajectory, lower prevalence of physical and mental health problems, and lower rates of alcohol and substances consumption; (b) the "Early onset of homelessness and poorer health and poorer mental health" subgroup was characterized by a higher prevalence of childhood and adolescence SLEs, an early onset of homelessness and greater chronification, mental health problems, and alcohol consumption; and (c) the "Chronic homelessness and poorest health and mental health" subgroup was mainly characterized by a higher prevalence of typically adulthood SLEs, as well as some SLEs that may be unique to women, a greater number of periods of homelessness, physical health problems, disabilities, and substance misuse. Increased knowledge about the different subgroups and trajectories of homeless women, as well as their specific characteristics and needs, will help us design social services and policies sensitive to all these differences.

Experiences of homeless women in accessing health care in community-based settings: a qualitative systematic review.

Homelessness among women is on the rise in the US and continues to be a concern globally. The challenges homeless women face are unique and vast, yet how they experience health care can greatly affect their desire to access health care in the future. The ability to shed light on what is meaningful to homeless women in their health care experiences can guide the changes necessary to provide appropriate patient-centered, impactful care with the goal of increasing access by this vulnerable population. This review aimed to identify, appraise and synthesize existing qualitative evidence on the experiences of homeless women when accessing community-based health care services. This review included studies on homeless women, both previously or currently, aged 18 or older. The phenomena of interest were homeless women's health care experiences, including perspectives, narratives and/or reflections, at any time during their period of homelessness. The review included health care services received by homeless women in community-based settings, shelter-based clinics and/or mobile clinics. Qualitative data including, but not limited to, the designs of phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research were considered. Using a three-step search strategy, databases of published and unpublished articles were searched from database inception to 2018. All included studies were assessed by two independent reviewers for methodological quality, and data was extracted and pooled using the JBI System for the Unified Management, Assessment and Review of Information. Findings were rated according to their level of credibility, categorized based on similarity in meaning, and subjected to a meta-synthesis. Two reviewers utilized a meta-aggregative approach. A total of 196 qualitative articles were identified of which 24 were included after critical appraisal. Meta-synthesis generated three synthesized findings: (1) Homeless women who access health care services at community-based settings feel as if their homelessness qualifies them as second-class citizens, which impedes future access; (2) Homeless women have an expectation of therapeutic communication from their health care providers, the lack of which can incite negative emotional responses, fear and knowledge deficits; (3) Homeless women with limited resources struggle to prioritize competing needs, such as transportation, time and money, which influences their ability to access health care. These synthesized findings were derived from 47 study findings that were subsequently aggregated into 10 categories. Of the 47 study findings, 32 were rated as unequivocal and 15 were rated as credible. The overall ConQual for each of the three synthesized findings was low due to common dependability issues across the included studies. A total of 454 participants were included. The included studies were published from 1997 to 2017. The review identified that homeless women's experiences when accessing health care in community-based settings, particularly in the US, have been poor and have negatively affected their desire to access health care in the future. The synthesized findings illustrate clear indicators for use of cultural competence and addressing provider bias in the delivery of health care to homeless women. This review also highlights the importance of understanding clinical experiences of providing direct care for these women in order to shed light on the type of advocacy needed to ensure equitable access to health care services. While this review uncovered issues with some global health care systems, the predominance of system constraints within the US highlights the need for health policy reform to improve the experiences of homeless women when accessing health care.

Finding home: Community integration experiences of formerly homeless women with problematic substance use in Housing First.

This study explored community integration among women participating in a Housing First program. Physical, social, and psychological dimensions of community integration were examined. This study used neighborhood walk-along and photo-elicitation interviews to explore 16 formerly homeless women's experiences of community integration. Participants described limited community integration. Health, poverty, service inaccessibility, and safety concerns shaped how they took part in activities in their neighborhoods. Participants primarily socialized with people in their buildings, though some preferred to keep to themselves. There was minimal sense of neighborhood belonging, with participants not interested in belonging to a community and being judged by others. Housing First promoted housing stability but did not contribute to community integration. Participants did not express a strong desire to integrate in their communities. Future research should consider the extent to which community integration remains a priority for marginalized populations, such as formerly homeless women.

Breast Cancer Treatment Delays at an Urban Safety Net Hospital Among Women Experiencing Homelessness.

Disparities in outcomes for vulnerable women is an ongoing problem. Homelessness and breast cancer treatment outcomes is understudied. This is a descriptive study exploring types of homelessness and treatment delays at an urban safety net hospital providing care to a vulnerable patient population.This study is a retrospective chart review of homeless female patients diagnosed with breast cancer between January 1, 2000 and December 31, 2014. Data for this study were acquired from the hospital cancer registry and electronic medical record. All demographic characteristics, time to treatment and factors related to delays to treatment were analyzed descriptively, reporting frequencies and proportions. The total number of individuals analyzed was 24. All except two subjects were delayed to treatment (≥ 30 days from diagnosis to treatment). Most women in this cohort were categorized as chronically homeless (46%) with the rest categorized as transitionally (29%) or episodically (12%) homeless. The majority of subjects (70%) were Black, non-Hispanic. All except one subject were publicly insured (71% Medicaid; 12% Medicare) or uninsured (8%). Regardless of type of homelessness, most subjects were either 30-60 or 60-90 days delayed. Those who were chronically homeless experienced significantly more delays to first treatment (56% of those who were delayed 30-60 days and 57% of those who were delayed 60-90 days; p value 0.006) than those who were episodically or transitionally homeless. Significant delays and barriers to breast cancer treatment exist among women experiencing homelessness. Further studies to improve breast cancer care for homeless women are warranted.