Lived Experience Of Homelessness Research Articles

“A Collection of Stories, Poetry and Theories”: Homelessness, Outsider Memoirs, and the Right to Theorize

This paper argues that memoirs of homelessness advance a form of social theory that emerges from the lived experience of homelessness and housing displacement. While scholars have called for greater recognition of previously neglected forms of social theory, academic scholarship remains—in practice—overwhelmingly influenced by the theories of a narrow group of high-profile intellectuals and specialist textual forms. Life narratives, in particular, have often been framed as atheoretical testimonies, and homeless thinkers have been largely denied the right to theorize. This paper argues that reading “outsider memoirs” as theoretical texts can be a method for expanding current understandings of the nature of social theory and taking seriously the epistemic rights of marginalized thinkers. It engages with the writings of homeless memoirists to argue for a new understanding of the explanatory power of social theory that does not collapse into abstraction or generalization, but is profoundly rooted in reflection and collaboration.

Experience of healthcare among the homeless and vulnerably housed a qualitative study: opportunities for equity-oriented health care

BackgroundPeople experiencing homelessness are often marginalized and are known to face barriers to accessing acceptable and respectful healthcare services. This study examines the experience of accessing hospital-based services of persons experiencing homelessness or vulnerable housing in southeastern Ontario and considers the potential of Equity-Oriented Health Care (EOHC) as an approach to improving care.MethodsFocus groups and in-depth interviews with people with lived experience of homelessness (n=31), as well as in-depth interviews of health and social service provider key informants (n=10) were combined with qualitative data from a survey of health and social service providers (n=136). Interview transcripts and written survey responses were analyzed using directed content analysis to examine experiences of people with lived experience of homelessness within the healthcare system.ResultsHealthcare services were experienced as stigmatizing and shaming particularly for patients with concurrent substance use. These negative experiences could lead to avoidance or abandonment of care. Despite supposed universality, participants felt that the healthcare system was not accountable to them or to other equity-seeking populations. Participants identified a system that was inflexible, designed for a perceived middle-class population, and that failed to take into account the needs and realities of equity-seeking groups. Finally, participants did identify positive healthcare interactions, highlighting the importance of care delivered with dignity, trust, and compassion.ConclusionsThe experiences of healthcare services among the homeless and vulnerably housed do not meet the standards of universally accessible patient-centered care. EOHC could provide a framework for changes to the healthcare system, creating a system that is more trauma-informed, equity-enhancing, and accessible to people experiencing homelessness, thus limiting identified barriers and negative experiences of care.

Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder

BackgroundPeople experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, harm reduction treatment for alcohol (HaRT-A) was developed together with people with lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. A three-month, two-arm randomized controlled trial was conducted to test the initial efficacy of HaRT-A compared to a services-as-usual control condition. MethodsPeople experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Self-reported alcohol use, alcohol-related harm, motivation, and QoL as well as urinary ethyl glucuronide were assessed over a 3-month follow-up. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: a) collaborative tracking of participant-preferred alcohol metrics, b) elicitation of harm-reduction and QoL goals, and c) discussion of safer-drinking strategies. ResultsCompared to control participants, HaRT-A participants reported significantly greater increases in confidence to engage in harm reduction and decreases in peak alcohol use, alcohol-related harm, AUD symptoms, and positive urinary ethyl glucuronide tests (ps < .05). Findings were inconclusive regarding group differences on QoL (ps > .12). ConclusionA low-barrier, low-intensity, patient-driven, harm-reduction approach has at least short-term efficacy in improving AUD outcomes in this population. Future studies are needed to establish its longer-term efficacy.

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review.

The aim of this systematic review was to identify and conceptualize the barriers and enablers to accessing dental services for people experiencing homelessness in the United Kingdom. A literature search for studies relevant to homelessness and dental care was conducted. The PRISMA and ENTREQ guidelines were followed. Electronic databases (EMBASE, MEDLINE, DOSS, CINAHL, SOCINDEX and PsycINFO) and grey literature sources (Electronic Theses Online Service - EThOS, Kings Fund, NICE Evidence, Open Grey, Google and the Health Foundation) were searched up to 28 August 2018. The critical appraisal was conducted using CASP and an adjusted version of a JBI Critical Appraisal tool. Thematic analysis was used to develop the themes and domains. Twenty-eight papers were included. Barriers to homeless people accessing dental care stemmed both from the lived experience of homelessness and the healthcare system. Within homelessness, the themes identified included complexity, emotions and knowledge. Regarding the healthcare system, identified themes included staff encounter, accessibility and organization issues. Homelessness can actively contribute to both an increased need for dental care and barriers to accessing that care. The arrangement of dental healthcare services can also act as barriers to care. This is the first systematic review to conceptualize the factors associated with access to dental care for people who are homeless. It provides a set of recommendations for overcoming the main barriers for homeless people to accessing dental care. It also offers directions for future research, policy and commissioning.

A framework for disaster resilience education with homeless communities

PurposeThe purpose of this paper is to propose a practice framework for disaster resilience education (DRE) with homeless communities.Design/methodology/approachA survey with 163 homeless service providers together with 45 interviews with people with a lived experience of homelessness, homeless service providers and emergency services.FindingsKey principles for DRE with the homeless community were: safe relationships, collaboration, strengths-based, empowerment, providing essential resources, and inclusivity. Recommendations for the design of DRE foregrounded partnerships and knowledge sharing between the homeless community and emergency services. Locally relevant risk information and material supports, together with sharing stories and eliciting values were important considerations for developing DRE content. Preferred delivery methods were outreach to build on trusted relationships and existing services, together with written material in large font emphasising images for distribution through drop in centres, food vans and new tenancy packages.Practical implicationsThe key principles, together with the detailed suggestions outlining ways to translate the principles into actions, can be used by emergency and homeless services to develop effective DRE materials and programmes.Social implicationsThe proposed DRE framework aims to not only enhance disaster risk knowledge, but also address the exclusion, isolation and disempowerment experienced by people who are homeless. By building on an effective intervention models within homeless services (Trauma-Informed Care) DRE can enhance the social connection, self-confidence and well-being goals of homeless services and clients.Originality/valueThe DRE framework is based on the first comprehensive Australian research with homeless services, clients and emergency managers on best practice for improving extreme weather preparedness in the homeless community.

Content analysis of homeless smokers’ perspectives on established and alternative smoking interventions

BackgroundCigarette smoking is 5 times more prevalent among homeless individuals than in the general population, and homeless individuals are disproportionately affected by smoking-related morbidity and mortality. Homeless smokers report interest in changing their smoking behavior; however, established smoking cessation interventions are neither desirable to nor highly effective for most members of this population. The aim of this study was to document homeless smokers’ perceptions of established smoking interventions as well as self-generated, alternative smoking interventions to elucidate points for intervention enhancement. MethodsParticipants (N=25) were homeless smokers who responded to semistructured interviews regarding smoking and nicotine use as well as experiences with established and alternative smoking interventions. Conventional content analysis was used to organize data and identify themes. ResultsParticipants appreciated providers’ initiation of conversations about smoking. They did not, however, feel simple advice to quit was a helpful approach. Instead, they suggested providers use a nonjudgmental, compassionate style, offer more support, and discuss a broader menu of options, including nonabstinence-based ways to reduce smoking-related harm and improve health-related quality of life. Most participants preferred engaging in their own self-defined, alternative smoking interventions, including obtaining nicotine more safely (e.g., vaping, using smokeless tobacco) and using behavioral (e.g., engaging in creative activities and hobbies) and cognitive strategies (e.g., reminding themselves about the positive aspects of not smoking and the negative consequences of smoking). Abrupt, unaided quit attempts were largely unsuccessful. ConclusionsThe vast majority of participants with the lived experience of homelessness and smoking were uninterested in established smoking cessation approaches. They did, however, have creative ideas about alternative smoking interventions that providers may support to reduce smoking-related harm and enhance quality of life. These ideas included providing information about the relative risks of smoking and the relative benefits of alternative strategies to obtaining nicotine and avoiding smoking.

Content Analysis of Advantages and Disadvantages of Drinking Among Individuals With the Lived Experience of Homelessness and Alcohol Use Disorders

ABSTRACTBackground: Alcohol use disorders (AUDs) are more prevalent among people who are homeless than in the general population. Thus, homeless individuals experience disproportionately high levels of alcohol-related problems and associated publicly funded criminal justice and healthcare system utilization. Available treatment services, however, are not effective at engaging and treating this population. To better tailor treatment services to their needs, it is imperative we understand this population's perceptions of their alcohol use. Objectives: The aim of this study was to provide description and relative rankings of the advantages and disadvantages of alcohol use from this population's perspectives. Methods: Participants were 44 individuals with lived experiences of AUDs and homelessness who received services at community-based agencies in Seattle, Washington. Open-ended prompts were used in interviews conducted in 2013–2014 to assess the perceived role of alcohol in participants’ lives, including participants’ perceptions of the advantages and disadvantages of their current drinking, and a conventional content analysis was conducted. Results: The most frequently mentioned advantages of drinking included positively and negatively reinforcing psychological reasons, perceived control over drinking, and social benefits. Physical effects, concerns about dependence on alcohol, and health problems were the most commonly mentioned disadvantages. Conclusions/importance: By documenting the perceived advantages and disadvantages of drinking among people with the lived experience of homelessness and AUDs, this study supplies information providers may use to better tailor treatment services to this multimorbid, high service-utilizing population's needs and interests.

Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions.

Promoting timely and continuous care for people experiencing homelessness has been a challenge in many jurisdictions, plagued by access barriers and service fragmentation. As part of a larger programme evaluation, this study used qualitative methods to examine the role of a brief interdisciplinary intervention in supporting continuity of care for this population in a large Canadian urban centre. The intervention provides time-limited case management, primary and psychiatric care, and peer accompaniment to homeless adults with unmet health needs discharged from hospital. Data were collected from 52 study participants between July 2013 and December 2014. Three focus groups were conducted with service providers and people with lived experience of homelessness, and 29 individual, semi-structured interviews were conducted with service users and other key informants. Transcripts were analysed using thematic analysis. Analysis was informed by existing frameworks for continuity of care, while remaining open to additional or unexpected findings. Findings suggest that brief interdisciplinary interventions can promote continuity of care by offering low-barrier access, timely and responsive service provision, including timely connection to long-term services and supports, appropriate individualised services and effective co-ordination of services. Although brief interdisciplinary interventions were perceived to promote access, timeliness and co-ordination of care for this population with complex health and social needs, gaps in the local service delivery context can present persisting barriers to care comprehensiveness and continuity.

Involving People with Lived Experience of Homelessness in Electronic Health Records Research

ABSTRACTObjectivesWe held a public engagement workshop to involve people with lived experiences of homelessness and social exclusion, experts by experience (EBE), in our research. The purpose of the workshop was to provide context to the findings of a review series on Inclusion Health and to inform future research using electronic health records (EHRs) of homeless and socially excluded people.&#x0D; ApproachParticipants included 16 volunteers and one staff member from Groundswell (a registered charity that promotes inclusive solutions to homelessness), four academics, one clinical provider, and two note-takers/photographers. The full-day workshop was held at University College London. We used innovative participatory activities specifically designed for use with hidden and marginalised populations to stimulate open dialogue. Methods included general discussion, conceptual mapping, modelling, electronic voting, brainstorming, ranking, graphing, stakeholder analysis, and evaluation surveys. Activities were fast-paced and conducted in small groups, as the whole group, individually, or in pairs. The meaning of Inclusion Health, barriers that lead to exclusion, and values and actions that promote inclusion were discussed. Health statistics on homeless and other socially excluded groups were presented and informed conversations about EHR research, including data collection (new data versus collation of administrative data), data linkage, consent, anonymisation, data security, and ‘the surveillance society.’&#x0D; ResultsNotes from the workshop and the evaluation surveys indicated that the workshop was engaging, inclusive, and successful. When clearly explained, EBE were positive towards research using EHRs to improve Inclusion Health, including data linkage of sensitive health and social data. EBE expressed that housing, advocacy, and psychosocial therapies were the most important interventions for improving health of people who are homeless; however, we found limited evidence for these interventions in our review. Overall, findings demonstrate the value of involving the people who have been socially excluded to develop research priorities and to interpret findings.&#x0D; ConclusionUsing a participatory and dynamic approach to involve people with lived experience of homelessness and exclusion is an effective public engagement methodology for complex topics such as EHR research and data linkage. Information provided in the workshop was useful for interpreting findings, identifying strengths and gaps in health and social services, and developing research and practice recommendations.

Integrating Hospital and Community Care for Homeless People with Unmet Mental Health Needs: Program Rationale, Study Protocol and Sample Description of a Brief Multidisciplinary Case Management Intervention

The Coordinated Access to Care for Homeless People (CATCH) program is a brief multidisciplinary case management intervention for homeless adults discharged from hospital in Toronto, Canada. Here we describe the rationale for CATCH program development, details of the mixed methods evaluation underway, and the characteristics of 225 CATCH service users. Funded in 2010 by the local health authority, CATCH aimed to improve access, continuity of care, health and service use outcomes for homeless adults discharged from hospital. To assess the feasibility, acceptability and impact of the program, a mixed methods case study was undertaken in 2013. In total, 225 CATCH program users were enrolled in the study and completed quantitative survey measures at program entry to assess key health and social outcomes using a pre-post cohort study design. Follow-up assessments took place at 3- and 6-months. At study entry, most participants were male (79%), white (65%), Canadian-born (74%), single or never married (60%), and their average age was 39.9 ± 12.0 years. Nearly all participants (88%) had at least one emergency department visit in the past 6 months, more than half (53%) indicated at least three chronic health conditions, and 44% indicated at least three mental health diagnoses. In addition, qualitative data was collected to evaluate the experiences of continuity of care and challenges during care transitions for this population using in-depth interviews with a sample of CATCH service users (n = 22) and managers of partnered organizations (n = 7), as well as focus groups with CATCH staff (n = 8), other service providers (n = 7) and people with lived experience of homelessness (n = 8). Improving health and health service use outcomes among homeless adults with chronic health conditions are key priorities in many jurisdictions. Future findings can inform service delivery to homeless adults discharged from hospital, by exposing factors associated with positive program outcomes, as well as barriers and facilitators to continuity of care for this disadvantaged population.

Community Voices: Insights on Social and Human services from People with Lived Experiences of Homelessness

&lt;p&gt;Community Voices is a participatory action research study conducted in collaboration with people with lived experiences of homelessness in Calgary, Alberta to gather insights into service provision. Following convenience and snowball recruitment strategies, seven focus groups with members of the homeless community were conducted by trained facilitators. Participants and other community members were invited as co-researchers to analyze focus group transcripts, highlight key issues, develop themes and recommendations, and share key findings with stakeholders. Study findings suggest that people who are homeless experience oppression at the personal, cultural and structural levels which make it less likely for them to exit homelessness. Our findings suggests that a housing first approach coupled with intensive personalized case management embedded within a human rights framework has the capacity to reduce homelessness and overcome the barriers that prevent individuals from exiting homelessness. Such interventions, however, require substantial investment to increase the stock of affordable housing units, improve current shelter facilities, educate personnel in anti-oppressive practices and a political commitment to recognize housing as a human right. &lt;/p&gt;

In their own words: Content analysis of pathways to recovery among individuals with the lived experience of homelessness and alcohol use disorders

BackgroundAlcohol use disorders (AUDs) are more prevalent among homeless individuals than in the general population, and homeless individuals are disproportionately affected by alcohol-related morbidity and mortality. Unfortunately, abstinence-based approaches are neither desirable to nor highly effective for most members of this population. Recent research has indicated that homeless people aspire to clinically significant recovery goals beyond alcohol abstinence, including alcohol harm reduction and quality-of-life improvement. However, no research has documented this population's preferred pathways toward self-defined recovery. Considering principles of patient-centred care, a richer understanding of this population's desired pathways to recovery may help providers better engage and support them. MethodsParticipants (N=50) had lived experience of homelessness and AUDs and participated in semi-structured interviews regarding histories of homelessness, alcohol use, and abstinence-based treatment as well as suggestions for improving alcohol treatment. Conventional content analysis was used to ascertain participants’ perceptions of abstinence-based treatment and mutual-help modalities, while it additionally revealed alternative pathways to recovery. ResultsMost participants reported involvement in abstinence-based modalities for reasons other than the goal of achieving long-term abstinence from alcohol (e.g., having shelter in winter months, “taking a break” from alcohol use, being among “like-minded people”). In contrast, most participants preferred alternative pathways to recovery, including fulfilling basic needs (e.g., obtaining housing), using harm reduction approaches (e.g., switching from higher to lower alcohol content beverages), engaging in meaningful activities (e.g., art, outings, spiritual/cultural activities), and making positive social connections. ConclusionsMost people with the lived experience of homelessness and AUDs we interviewed were uninterested in abstinence-based modalities as a means of attaining long-term alcohol abstinence. These individuals do, however, have creative ideas about alternative pathways to recovery that treatment providers may support to reduce alcohol-related harm and enhance quality of life.

Racial vibrations, masculine performances: experiences of homelessness among young men of colour in the Greater Toronto Area

This article explores the connections between race, masculinity and urban space in the lives of Canadian-born young men of colour (aged 17–26) who have experienced homelessness in the Greater Toronto Area (GTA). It is based on ethnographic research including 40 interviews and eight ‘Where-I-Live-Tours’ of the city by the author and participants. This study explores the intersections between racial emergences and masculine performances in the lived experiences of homelessness, drawing connections between spatial representations and material experiences. It utilizes the concepts of affect and ‘racial vibrations’ to show how race emerges differently in different areas of the GTA. There exists a constant racial ‘vibe’ in the suburban areas of the GTA, whereas there is a vibrating whiteness that obscures racial events in downtown Toronto spaces. In both cases, the emergence of race contributes to continued oppression based on the intersections of racialized masculinities and homelessness.

Un/Helpful Help and Its Discontents: Peer Researchers Paying Attention to Street Life Narratives to Inform Social Work Policy and Practice

This qualitative study explores narrative interviews of street-involved individuals with mental health issues and reflects on how they speak to experiences of both helpful and unhelpful social and mental health service provisions, and the disconnections between what they articulate as needing, and what services and supports they are able to receive. The article draws on and contributes to the field of peer research as the authors use lived experience of homelessness and/or mental health issues to inform both the approach to and analysis of the narratives. This study confirms that participants find the emerging, recovery-oriented structures of service provision more helpful than the dominant, biomedical structures, but that there is a continued disconnect in accessing emerging structure service deliveries.

Clarifying the link between traumatic brain injury and homelessness: Workshop proceedings

Purpose: To disseminate the proceedings of a 1-day multidisciplinary stakeholder workshop aimed at examining the inter-relationship between traumatic brain injury (TBI) and homelessness.Methods: Thirty-seven stakeholders participated in the workshop, including frontline workers with individuals who are homeless, physicians, nurses and other healthcare workers, researchers, policy-makers, students and individuals with lived experience of homelessness. Didactic presentations, large group discussions and break-out sessions were used to disseminate knowledge, identify service and research gaps, develop a research agenda and facilitate networking.Results: The participants identified barriers to service provision for individuals who are homeless and have sustained TBI with a focus on age- and gender-related issues, co-morbid TBI and mental illness and jurisdictional differences. Challenges and strategies related to engaging stakeholders in research with this population, as well as disseminating knowledge were discussed and research questions were identified.Conclusion: There is very little empirical literature on the topic of TBI and homelessness. The workshop identified key issues for consideration, including gaps in knowledge related to this topic.

‘A place to rest’: the role of transitional housing in ending homelessness for women in Calgary, Canada

The purpose of this study was twofold: (1) to determine the role of transitional housing in ending homelessness for women and (2) to explore how gender-specific experiences of homelessness may inform housing service delivery models. Using a participatory research methodology, photovoice, and focus group discussion, nine women with lived experience of homelessness were engaged over 10 weeks in a process of reflection and critical dialogue about their previous experiences in a YWCA transitional housing facility and their current YWCA permanent housing in Calgary, Canada. Through this process women revealed that the key aspects of transitional housing that helped them exit homelessness were the interplay of four important factors: safety, time, a community of women with similar experiences, and a supportive environment with access to appropriate services in which to recover from trauma. Although moving directly from homelessness to permanent housing may be appropriate for some women, findings from this study demonstrate that this may not be the case for all. Our results suggest that once permanently housed women, especially those with histories of trauma, struggle with the trade-off between the rules that kept them safe in transitional housing and living as independent, autonomous adults in the community.

Homelessness in the Suburbs: Engulfment in the Grotto of Poverty

This paper describes findings of a research inquiry into the lived experience of homelessness in Peel, a suburban region located in the Greater Toronto Area in Ontario, Canada. It is based on the data from a collaborative project undertaken by members of the Faculties of Health and Education of York University with two local community organizations. The dominant theme of the narratives was that suburban homelessness is similar to being engulfed in a grotto of poverty, isolated from the rest of the community and invisible to it. Once entrapped in the grotto, it is almost impossible to escape from it. There were four sub-themes: (a) falling into the grotto, (b) living/struggling in the grotto, (c) envisioning escape routes from the grotto, and (d) beauty, community and hope in the grotto. Following a discussion of the findings, researchers describe strategies to address homelessness through promotion of social justice for all.

Building a responsive network of support and advocacy for older African American homeless women through developmental action research

This paper describes the Leaving Homelessness Intervention Research Project (LHIRP), a multimodal intervention that addresses the structural barriers and personal issues older African American women face in overcoming homelessness in a large mid-western city of the United States. The project incorporates a developmental action research design in partnership with homeless and formerly homeless women. Through developmental testing of interventions, LHIRP identifies promising practices at the individual, group life, intentional community, and city levels. The paper offers a rationale for the integration of both developmental research and action research, particularly community-based participatory inquiry. The authors document the nature of the helping network, identify and describe the project’s aims, organizing framework, and methods that document the lived experience of homelessness. Action research strategies that support the design and intervention activities are described, as are the tools used to test promising practices that are useful in helping older women transition and remain out of homelessness. The paper identifies the knowledge products of the intervention project including lexicon, theory, and frameworks, considers the vicious cycle that serves as an advanced organizer of relevant intervention, illuminates core principles, and examines the importance of the web of affiliation that the project seeks to form among participants, staff, and technical assistants.