Homeless Research Articles

Lessons from the COVID-19 pandemic: the unequal burden of COVID-19 on vulnerable populations in the Brazilian Central-West.

This study aimed to estimate the prevalence and identify social factors and preventive strategies associated with the coronavirus disease 2019 (COVID-19) in socio and economically vulnerable people (recyclable waste pikers, immigrants/refugees, and homeless people) in Goiânia, Goiás State, Central-Western Brazil. A cross-sectional study was conducted from July 2020 to October 2020. COVID-19 positivity was defined as a positive total anti-SARS-COV-2 antibody test and/or RNA test for SARS-COV-2. Univariable and multiple regression analyses were performed to identify the variables associated with COVID-19. Of the 594 participants, 47.3% were recyclable waste pickers, 29.6% were immigrants/refugees, and 23.1% were homeless people. The positivity for SARS-CoV-2 RNA was 14.1%, whereas for anti-SARS-CoV-2 a total of 30.8% were positive, and 39.4% were positive for at least one COVID-19 marker. Among the 541 individuals, being immigrants/refugees, not wearing a surgical mask, and having three or more people sleeping in the same room were associated with SARS-CoV-2 infection, while using TV news as the main source of information about the pandemic was a protective predictor of COVID-19. This study revealed ethnic and socioeconomic inequalities in the prevalence of COVID-19 among impoverished people in Brazil. Additionally, a high prevalence of COVID-19 was detected in all three groups. Developing new strategies to combat and prevent communicable diseases affecting this population is essential for mitigating future and ongoing pandemics.

Exploring the inflammatory profile of homelessness population: a comprehensive analysis of individuals in two temporary shelters in Lisbon.

Homeless people are continuously facing adverse living conditions as poor access to basic nutrition, hygiene conditions and healthcare services, being at increased risk of severe infectious diseases as HIV and hepatitis as well as cardiovascular diseases and mental disorders. The characterization of homeless people's health is fundamental to identify their health care needs. Considering that the aforementioned diseases are associated with chronic inflammatory processes, the main goal of this study was to characterize the inflammatory profile of a homeless population through quantification in saliva of a panel of inflammatory cytokines. The inflammatory profile was assessed in 114 individuals residing in two temporary shelters located in Lisbon and that accepted to participated in the study. Inflammatory proteins were quantified using a Multiplex Immunoassay approach. Data analysis was performed using the GraphPad Prism software and statistical significance among the groups was assessed using the nonparametric Mann-Whitney test. Even though some protein levels might be masked by drug treatment, data analysis showed high levels of INF-ϒ, IL-10 and TNF-α in the infectious disease group, critical cytokines for the immune response against viruses and bacteria. Also, cytokines like IL-1β and IL-6 were detected at statistically significant levels in the cardiovascular disease group and all cytokines included in this study were quantified in the mental disorders group. These findings may help the healthcare services in the evaluation of treatment efficacy and disease monitoring, and in the development of effective public healthcare strategies and policy interventions to improve quality of life of the homeless population.

Nursing Students' Perceptions of People who are Homeless.

Public perceptions of people who are homeless tend to be negative, perpetuating unfair treatment. This study investigated the effect of a 3.5-hour interaction with homeless people on baccalaureate (BSN) students, including students' descriptions of the characteristics of the homeless. The BSN nursing students who interacted face-to-face with homeless people experienced positive changes in their perceptions of this population.

Active Case-Finding: An Effective Solution for Tuberculosis Detection in Vulnerable Groups - The Romanian Experience.

Tuberculosis (TB) remains a global health challenge, requiring enhanced active case finding (ACF) through screening strategies. This study assesses the effectiveness of such an approach in locating TB cases among vulnerable groups, such as homeless persons, injecting drug users, those detained in prison, and people living in rural areas. The study focuses on socio-economic characteristics and TB detection rates across Romanian counties using modern techniques including computer-aided detection of lesions on chest X-ray and GeneXpert tests. The results highlight the disproportionate burden of TB in vulnerable groups, by revealing significant differences in TB detection rates between regions. Notably, the TB detection rates among these vulnerable groups (250.85 per 100,000 population) are five times higher than the national incidence rate (46.1). These findings underscore the imperative integration of ACF into National TB Program to provide customized and efficient solutions for diverse vulnerable groups, thereby informing crucial public health initiatives and interventions.

Exclusion, prejudice and the invisibility of homeless people at odds with the right to health

Objetivou-se discutir a exclusão, o preconceito e a invisibilidade de pessoas em situação de rua em desacordo ao direito à saúde. Trata-se de um estudo delineado pela Teoria Fundamentada nos Dados e Interacionismo Simbólico, com 36 participantes de municípios da região centro-oeste de Minas Gerais, Brasil, que evidencia a exclusão institucional das pessoas em situação de rua e preconceitos de usuários ao estar com essas pessoas no espaço da unidade de saúde. A falta de planejamento das ações da Atenção Primária inviabiliza o cuidado integral e oportuno e mantém a exclusão. A pesquisa também enfatiza a importância das redes de apoio social na superação das invisibilidades dessas pessoas e maior resolutividade com ações intersetoriais. Considera-se, como resultados deste estudo, que a atenção à saúde das pessoas em situação de rua ocorre mediante um agravo ou adoecimento, refutando a relevância das ações intersetoriais e comprometendo a garantia de acesso equânime à saúde, sem preconceitos.

Rua na Rede: um dispositivo para cuidado no âmbito do Consultório na Rua

The aim of this experience report is to present the Rua na Rede (Street in the Network) device, created by the Consultório na Rua (eCR) team in Florianópolis - SC, as a strategy for building integrality and longitudinal care for eCR users during hospitalization and after discharge. The authors’ experience of building the device was analyzed through their field diary, in dialogue with the scientific literature on the subject. The report underlines that Rua na Rede is guided by the Harm Reduction paradigm and faces an important challenge for the Brazilian National Health System: the link between Primary Care and Hospital Care. A nodal point for integrality and longitudinal care for homeless people.

When artistic is altruistic: the power of beauty from P. A. Sorokin's sociology to Building Beauty social project.

The article contributes to the ongoing debates on the social value and sociological relevance of the arts by examining the intuitions of the Russian-American sociologist P. A. Sorokin (1889-1968) on the concept of "beauty" as a force akin to what he calls "Altruistic Creative Love", both potentially catalysing a process of "fraternisation of humanity". Starting from the author's sociological reflections on the relationship between "Altruistic Love" and "beauty" and an analytical model of "altruistic artistic social action," the article proposes the analysis of a specific social project named Building Beauty, promoted in Turin (Italy) by universities, public bodies and the third sector, which aims to foster the social inclusion of homeless people through participatory processes, discovering expressions of beauty with aesthetic and sociological relevance simultaneously, able to move social transformations.

Pharmacist-led trial to assess impact of outreach on homeless people secures government funding

Pharmacist-led trial to assess impact of outreach on homeless people secures government funding

Composing work of art lives: a cartography of homeless people’s care territories

Resumo Este artigo parte da problematização da concepção de cuidado difundida pelo discurso biomédico, para assim pensar a produção de cuidado entre a população de rua, tendo como objetivo principal dar visibilidade à produção de territórios de cuidado nas ruas. O cuidado é um conceito complexo, tendo em vista sua dimensão ontológica, que nos leva a compreendê-lo como uma condição existencial, uma vez que existimos a partir e por meio do cuidado. Assim, para acompanhar os processos de composição de territórios de cuidado entre pessoas em situação de rua, lançou-se mão da cartografia como método de pesquisa. As cenas cartografadas apresentam a delimitação de territórios existenciais nas ruas, territórios que se caracterizam pelo seu nomadismo, não apenas por seu deslocamento no espaço e no tempo, mas também por suas variabilidades e composições de conexões rizomáticas. No processo cartográfico, foi possível observar produção de redes de cuidado no cotidiano da população de rua, um cuidado que se produz a partir das relações estabelecidas com a alteridade. Nesse sentido, há de se estar atento aos sinais que vêm da rua, conhecer e reconhecer suas linhas de fuga, a fim de aprender outros jeitos de se encontrar no mundo e produzir cuidado.

Interactional contributions of homeless people to urban sustainability

Resumo Será que é possível vislumbrar, no socialmente controverso tema do morar nas ruas, qualquer contribuição para a agenda das Nações Unidas (ONU) em prol da sustentabilidade urbana? Enfrentamos tal questão interpretativamente com base em procedimentos investigativos que potencializam o emprego de métodos qualitativos das Ciências Sociais em projetos transdisciplinares – de colaboração entre pesquisadoras/es e agentes da prática profissional –, acerca dos chamados Objetivos de Desenvolvimento Sustentável (ODS’s) da ONU. Argumentamos que as contribuições compreendem padrões de interação face a face por e acerca de pessoas em situação de rua nos espaços públicos urbanos. Em relação particularmente ao ODS 11, isto é, “tornar as cidades e assentamentos humanos mais inclusivos, seguros, resilientes e sustentáveis”, na São Paulo pandêmica (2020-2022), as contribuições abrangem interações de três tipos, aquelas ambientalmente (i) sustentáveis e (ii) inclusivas por pessoas em situação de rua com objetos materiais, animais e plantas em ruas e praças; e aquelas (iii) socialmente inclusivas protagonizadas por profissionais que assistem quem mora nas ruas. Enquanto os dois primeiros tipos interacionais são contribuições já vigentes, atuais de pessoas em situação de rua para as metas 11.6 e 11.7 do ODS 11, o terceiro é possibilidade futura para a Meta 11.1 por parte de profissionais dedicadas/os a essas mesmas pessoas.

The context of homeless people who live with ostomies

The context of homeless people who live with ostomies

노숙인의 정신적 습관 형성에 영향을 미친 경험

Mental habits could be considered a major determinant not only of physical health behaviors and status but also of mental health. However, there has been limited research on the concept of mental habits in Korea and internationally. As homeless people experience mental health issues more frequently than the general population, early detection and management could be crucial for improving their mental health. Therefore, this study aims to conduct a phenomenological study to discover common experiences of the homeless, focusing on the formation process of mental habits. Through the analysis of in-depth interviews with 12 homeless people, 21 themes, 11 theme clusters, and 6 categories were derived. The results suggested that the mental habits of the homeless were formed through experiences including social disconnection, addiction, unethical behavior, economic difficulties, social exclusion, chronic problematic environments, and intrinsic motivations for life. From childhood to the current homeless status, various experiences have led to complicated interactions affecting the interviewees in multiple ways: a single event could lead to multiple mental habits, or a combination of experiences could develop a single mental habit. Therefore, policies for homeless people should not simply aim to provide shelter but should also aim to end homelessness through supports for sustainable living. This should be built on an understanding of their experiences including life before homelessness, the process of becoming homeless, and their experiences as homeless individuals. Based on this, the researchers' policy recommendations are as follows: First, programs for the homeless should proactively aim to eliminate discrimination. Second, interventions for mental habits should incorporate specific and non-specific interventions. Lastly, interventions for the mental health of homeless people should focus on creating intrinsic motivations.

Kalifornijski test uczenia się językowego wśród polskich bezdomnych

IntroductionReports on the low intellectual level of the homeless are quite numerous and independent of the geographical location of the study.AimThe aim is to assess cognitive functions among the homeless as measured by the California verbal learning test (CVLT).Material and methodsIn our study we included 102 homeless people to assess the functioning of verbal memory using the CVLT. The absolute value of the sum of the results in tasks 1–5 amounted only to 36.21 (SD 10.63). Almost 42% of the subjects obtained a sten score of 1 or 2 for this task.Results and discussionIn all tested CVLT parameters the homeless people, who were the respondents of the present study, obtained results that were significantly below standards (low or very low).ConclusionsThese results indicate the presence of large numbers of people with severe verbal memory disorders among the homeless.

Kim są osoby bezdomne i jakie maja problemy? Przegląd literatury

IntroductionThe publications about homeless persons and homelessness are very popular among scientists. Entering the keyword ‘homeless’ returns about 17 thousand hits in the PubMed search engine. What is so interesting about homelessness that so many researchers devote their time and resources to this topic?AimOur paper is an attempt to answer the question about that, and partially about the genesis of homelessness.Material and methodsThe PubMed and Scopus databases have been researched. We selected the articles related to the most common pathologies among the homeless.Results and discussionThe background of the phenomenon of homelessness is described in the context of the most commonly reported shared elements i.e. poverty, social exclusion, high mortality rates, male predominance, alcohol and drug dependence, intellectual deficits, depressive disorders and suicides. We described the differences resulting from geographical location and environmental factors. We are trying to elucidate the reasons for the discrepancies between individual investigators studying similar problems at different places and at different times.ConclusionsHomeless people are not a different species. They are a derivate of societies on the margins of which these people live. They are therefore different in the geographical sense, but in a given area they change with time similarly to the local population.

Social inclusion of homeless people with mental illness: a community-based intervention

Introducción: Experiencia de una comunidad de barrio capitalino (Asunción-Paraguay), movilizada por la grabación de un corto documental a cargo de estudiantes de cinematografía, que inician un proceso de participación para mejorar la calidad de vida de una persona con trastornos mentales y discapacidad psicosocial en situación de calle, logrando su inclusión social. Objetivo: Identificar los elementos claves que favorecieron la participación comunitaria, derivando en el proceso de reinserción social de una persona con trastorno mental y discapacidad psicosocial para contribuir con estrategias innovadoras de modelos de atención basados en la comunidad con enfoque de derechos humanos. Materiales y métodos: Estudio cualitativo de diseño narrativo, utilizando datos de la historia de una persona y la experiencia de una comunidad para describir, analizar e identificar elementos que se consideran claves para los resultados logrados. La experiencia comunitaria fue observada y registrada de cerca durante más de 4 años. Resultado: Participación comunitaria activa en torno a un objetivo colectivo impulsado por un proyecto cinematográfico logrando la reinserción social de una persona con trastorno mental o discapacidad psicosocial que se encontraba en situación de calle. Conclusión: El cine o arte generan un impacto emocional y sensibilizador que acompañados con estrategias sostenibles; facilitación, tecnología, recursos económicos, lugares de residencia o acogida, acompañamiento; permiten aprovechar y movilizar recursos comunitarios, con participación y enfoque de derechos humanos. El resultado en este caso es la inclusión social de una persona con trastornos mentales y discapacidad psicosocial, que se encontraba en el extremo de exclusión social: vida en calle por más de 20 años.

Pathways to Homelessness and Social Exclusion: Research with Rough Sleepers in Croatia

This new study explores pathways into homelessness and identifies ‘turning points’ among persons currently experiencing rooflessness. Besides their explanations, this research also holistically examines individual biographies to see how other issues have permeated their lives. Although the reasons people described for becoming homeless were complex and multi-layered, the study identifies six pathways into homelessness, as well as some turning points. This research shows that pathways into homelessness do not develop in isolation from life circumstances, but rather that life pathways and pathways into homelessness were closely interwoven into a web, making sustainable exits from homelessness more difficult.

Cabrio Teams, Primary Care for Homeless People In Belgium- Limburg

Cabrio aims to prevent homelessness with a cross-sector, multidisciplinary and autonomous team that establishes contact with homeless people in their living environment in an outreach manner, offers customized support and connects to social facilities. The team aims to help homeless people in finding sustainable housing. In the Belgian province of Limburg there are 3 Cabrio teams that serve 5 local authorities. The welfare organisation CAW Limburg coordinates the 3 Cabrio teams.
 Cabrio is active within the framework that is offered by the Flemish Action Plan to combat homelessness 2020-2024.
 https://www.departementwvg.be/welzijn-en-samenleving/welzijnswerk/dak-en-thuisloosheid 
 Objectives: 
 •Making contact in the social environment of homeless people and building a close relationship with homeless people.
 •Offer support in various life domains and realize a connection with services (network). Guarantee continuity in care.
 •Strengthening the personal network of clients.
 •Working on sustainable housing with social and other housing services.
 •Working on connection through small-scale projects with a high level of participation of the target group. This is part of the socialization of care.
 •Signalling structural barriers to local policy makers. 
 Methodical framework: Cabrio works in an outreaching and multidisciplinary way and uses methods from addiction care, counselling for people with psychological vulnerability and welfare work. Cabrio works from a shared vision of homelessness.
 Outreach work: Counsellors contact clients in the public space, at their home or in the semi-public space (e.g. institution, facility) with a participative basic attitude. They focus on making a connection with 'distrustful' clients
 Multidisciplinary work: To aim for care continuity the Cabrio team brings together different disciplines: general social work (CAW Limburg), addiction care (ZorGGroepZin), psychiatric home care (Beschut Wonen, Mobiel Herstelteam Psychiatrie), special youth care (CANO Pieter Simenon), outreach work (straathoekwerk).
 •Expertise of supervisors is shared in the Cabrio team.
 •Different perspectives and different expertise provides customized guidance.
 •The collaboration and sharing of expertise strengthens the communication and trust between the client and the team and improves the follow-up of specific cases.
 •Supervisors acquire new insights and methods in guiding homeless people to their own work setting.
 Special methods: Harm reduction (or harm-limiting work), motivational interviewing, circle of behaviour change Prochaska and Diclemente, making quarters, guideline for dealing with ethical dilemmas, Housing First.
 1.4.Registration by the Local Homeless Consultation
 The local authorities organize a Local Homeless Consultation (LDO) in which various welfare organizations participate that have contacts with homeless people through their daily practice. The LDO has 3 tasks: 
 •Making an inventory of homeless people in the work area.
 •Coordinating which service/counsellor takes care of the specific client.
 •Tackling signals or structural barriers.
 The LDO refers to the Cabrio team if the client:
 •Does not have stable housing (see Ethos).
 •Scores bad on several life domains and struggles with special problems (e.g. addiction, psychological vulnerability, medical problems, ...)
 •Has a disrupted personal network or does not have or has a few contacts with care services (also called care avoiders).

Connecting with Rough Sleepers: Community Volunteer Training and Partnership

Background: A nationwide study on homelessness in 2019 reported high prevalence of poor health among rough sleepers in Singapore. There are rough sleepers supported by volunteers and community partners within Singapore General Hospital service boundary. Community nursing team engaged Ministry of Social and Family Development (MSF) Partners Engaging and Empowering Rough Sleepers (PEERS) Network and Homeless Heart, a volunteer group, to reach out to this vulnerable population and to understand challenges faced by volunteers. The learning needs survey among 39 volunteers was conducted and showed that less than 8% of them were equipped with basic healthcare knowledge and skills. The top three learning needs were i) healthcare resource for homeless (92.1 %), ii) mental Health (68.4%), iii) basic triaging skills (68.4%).
 Interventions: A virtual volunteer training programme was developed based on survey findings and inputs from PEERS Network during COVID-19. It was further extended to shelter operators supporting rough sleepers. The training was conducted by community nurses on alternate weekend from February to March 2022. The mode of delivery included didactic teaching and case discussion. A referral process to community nursing for rough sleepers requiring assistance in chronic disease monitoring was established to ensure care continuity. 
 Outcomes: A total of 46 participants attended training. All found the program content was useful, relevant to their volunteer activities, and easy to understand. Nearly 80% will recommend this program to their peers. Till date, a total of 5 referrals to Community Nurse Posts were made by volunteers. Nurses conducted health coaching and medication re-consolidation to rough sleepers and also guided volunteers for the subsequent follow up.
 Learning Points and Future Plan: It is the first training programme provided by community nurses to volunteers and staff supporting rough sleepers. The programme was tailored to meet participants’ experience and learning needs. Community nursing will further collaborate with PEERS for outreach events and provide onsite training to facilitate effective learning experience. Moving forward, community nurse team will extend the training program to other community service provides and grassroots volunteer, to support the residents’ physical and psychological well-being in the community .

Words to find common ground for action. Bridging social and health services through concertation on accessibility to vulnerable groups in Brussels

Introduction: Linking general primary care, health and social services with non-profit organisations dedicated to vulnerable groups is the aim of an ongoing concertation process hosted by Brusano, the regional organisation aimed at fostering person-centred health and social-integrated services in Brussels.
 In the Belgian Capital, the most vulnerable people are often attended to by non-profit organisations dedicated to a specific target group or problem. These organisations are often overwhelmed, with people not moving towards general services as intended at some point. General primary care and social services remain insufficiently accessible to vulnerable people. Considering the integrated health and social policy reforms currently taking place at national and regional levels, health and social professionals felt the need to better understand each other and build common ground in order to work together and participate in the reform process. 
 Targeted population and stakeholders: The targeted population is care providers from all levels of care, home helpers and social workers in all kinds of settings. End beneficiaries are vulnerable groups - e.g. migrants, sex workers, people with addictions, prisoners and former inmates, isolated persons, homeless people... - and people who are at a high risk of exclusion when facing problems mixing health and social situations – low income, precarious housing, language barriers... The premise is that if services can include such vulnerable groups, they might achieve broader accessibility for all. 
 Participants: The concertation gathers professionals from multiple health sector disciplines- primary care, hospital, mental health - as well as from the social sector and dedicated non-profits. Nearly 150 professionals participate, with a mean attendance of 30 per meeting.
 Description of the initiative: In 2021-2022, the concertation resulted in an online publication, co-written by two partners, reviewed by 5 others, presented and discussed in 3 meetings, then further adjusted accordingly. The paper provides an overview of the organisation of the health and social systems, as well as a set of definitions. It acknowledges that different levels of care operate as first contact and often lack the means and skills to be fully inclusive and accessible to vulnerable groups. 
 Results / Impact: Stakeholders coined a new phrase - “inclusive practices” - to fully capture the expertise of the dedicated non-profits and to bring about inclusivity in different settings through collaborations. The definitions were included in the glossary used as a reference for the upcoming Regional Health and Social Policy Plan.
 
 Learning for the international audience: Building a common language for health and social professionals, while fully recognizing the expertise of non-profits dedicated to vulnerable groups bridges the gap between health and social services. It is a step towards better integration of health and social organisations, which is a major challenge to integrated care.
 Next steps: In the coming months, the concertation process will continue identifying and supporting inclusive practices whatever the service or level of care. It will be fully part of the Regional Health and Social Integrated Plan. 
 It develops as a model where a specific expertise supports services to the general population.

A person-centred approach to help services and commissioners to improve the experience of people who are homeless and secure better sustainability.

Successful implementation of evidence-based services in health and social care depends largely on the fit of the services with the values and priorities of users who are shaping and participating in their delivery and use. When looking at the implementation of innovative specialist hospital discharge schemes for people who are homeless, there is a lack of knowledge on homeless people’s preferences and perspectives on receiving out-of-hospital care.
 In England, the Department of Health and Social Care, Ministry for Housing and Local Government and Ministry of Justice allocated £16 million to further develop and test out hospital care for people experiencing homelessness. The out-of-hospital care model programme is seeking to scale successful hospital discharge models that were shown to be effective and cost-effective in an earlier pilot programme adapting these for new contexts and circumstances post Covid-19. Evaluation of the implementation of the out-of-hospital care model programme is currently underway in 17 local authority test sites across England. A specific component of the larger evaluation is aimed at capturing service users’ preferences for different types of specialist hospital discharge schemes.
 This is done using a flexible health economics tool for measuring choices in health and social care-related settings named discrete choice experiments (DCE). It measures preferences from individual decision-makers over alternative scenarios (or service provisions). Each alternative is described by several attributes (or characteristics) and the choices made between two or more competing scenarios subsequently determine how preferences are influenced by each attribute (eg, which attributes are valued as well as their relative importance). It can also provide a measure of the overall value attached to different alternatives (and identify optimal service provision that meets stakeholder requirements and have the best chance of sustainability in the long term). Hence a DCE survey has been developed to measure people’s preferences for what out-of-hospital care provides in terms of types of location of care, the professional who delivers most of their care, how often they receive care, how long they receive care after hospital discharge and rules about behaviour where they live.
 The attributes (characteristics) and their various levels were informed by our previous research. Webinar discussions regarding what stakeholders value about specialist services were used to validate and refine the attributes and levels. PPI stakeholders were also consulted on the development of the presentation, wording and format of the survey. Efficient experimental design techniques were applied to create the DCE questions. Due to the cognitive load involved in completing the survey, respondents are assisted in the completion of the questionnaire by members of the research team to secure responses from more than 250 people who are homeless. Data will be modelled using logit techniques and results will be ready for presentation in May 2023.
 Information on how service users value specialist hospital discharge schemes for people who are homeless is needed to better inform the implementation and development of the innovative out-of-hospital care model programme currently proposed in England at a national level. Identified learning will be shared at the conference.