Permanent Housing Research Articles

Identifying Cigarette Smoking Trajectories from Homelessness to Housing

AbstractThis study examines cigarette smoking trajectories from homelessness to housing and assesses demographic and clinical characteristics associated with multiple longitudinal smoking behavior patterns. Data were drawn from a longitudinal prospective cohort study of 421 adults experiencing homelessness who entered permanent supportive housing (PSH). Four quantitative surveys (baseline [while homeless], 3-, 6-, and 12 months post-housing) gathered participants’ smoking frequency used for Repeated Measure Latent Class Analysis (RMLCA), which identified subgroups that share longitudinal smoking behavior patterns. Baseline and time-varying demographic, mental health (e.g., schizophrenia), and substance use (e.g., cannabis use) measures were examined as correlates of class membership. RMLCA estimates supported a three-class model: (1) mixed-frequency decreasers (n = 71): who smoked at differing frequencies while demonstrating a significant decrease over time; (2) high-frequency maintainers (n = 194): participants who smoked daily/almost-daily and maintained this smoking rate across waves; and (3) low-frequency increasers (n = 56): participants who generally were non-smokers at baseline and significantly increased to monthly or weekly consumption longitudinally. Compared to Black and African American participants, Hispanic and Latino participants had greater odds of low-frequency increaser and mixed-frequency decreaser membership. Schizophrenia and bipolar disorder diagnoses increased odds of high-frequency maintainer membership compared to the two less-frequent-using subgroups. Cannabis use increased longitudinally and was associated with greater odds of high-frequency maintainer membership. This is the first study to find smoking changes from homelessness to housing. While encouraging that some residents reduce their smoking post-housing, many maintained high smoking rates. Cessation services that address mental health and co-occurring substance use within PSH are warranted.

Variables Associated with Quality of Life Among Individuals Living in Permanent Supportive Housing.

This study identified individual sociodemographic and clinical characteristics and service use patterns associated with quality of life (QoL) among 308 individuals living in permanent supportive housing (PSH) in Québec (Canada). Data were collected between 2020 and 2022, and linear multivariate analyses produced. Results demonstrated that better individual psychosocial conditions were positively associated with higher QoL. As well, living in PSH located in good neighborhoods for at least 5 years, higher self-esteem and community integration were positively associated with greater QoL. Met needs, satisfaction with housing support services, and no use of acute care were also linked with positive QoL. Comprehensive efforts to improve treatment for mental health disabilities responsive to the needs of PSH residents, and sustained long-term housing may reinforce QoL. Encouraging active participation in community-based activities, incorporating biophilic design into the neighborhoods around PSH, and promoting satisfaction with care may also enhance QoL.

Everyday Health Management: Perspectives of Families Living in Permanent Supportive Housing

Abstract Date Presented 04/23/2023 This qualitative study explores the current strategies parents living in supportive housing use to manage their mental and physical health, the impact parenting has on health management, and how parents’ control affects their motivation. Primary Author and Speaker: Rose Digiulio Contributing Authors: Laura Vanpuymbrouck

Rehabilitasi dan Rekonstruksi Bidang Perumahan dan Pascabencana Tsunami Pandeglang untuk Pemulihan Kehidupan Masyarakat Terdampak

The construction of permanent housing in Pandeglang District is classified as very fast with very good building construction when compared to development in other regions in Indonesia. Thus, this study aimed to analyze the post-tsunami rehabilitation and reconstruction in Pandeglang District in the infrastructure and housing sectors in terms of coordination, financing, and community empowerment. This research used a descriptive qualitative method. The results showed that post-tsunami recovery in the infrastructure and housing sectors had good diagonal coordination between units with different functions and levels. Coordination is carried out starting from the planning, budgeting, implementation, and evaluation stages. In the financing aspect, the optimization of the infrastructure sector is constrained by budget constraints, while in the housing sector, financing comes from grants and the central government's budget. Community empowerment in the infrastructure sector is limited to the aspect of supervision, which is different from the housing sector, which uses the pattern of community groups starting from the planning, implementation, and supervision stages. The infrastructure sector has not optimally supported the recovery of the lives of the affected communities in Pandeglang District. The housing sector recovered within 3 years after the Sunda Strait Tsunami disaster with the added value of the status of houses becoming property rights, sturdy buildings modeled on the Instant Steel Frame House (Rumah Instan Struktur Baja - RISBA), facilities for bathing, washing, latrines, and waste disposal facilities.

Housing Affordability Issues in Ukraine

The article is dedicated to the analysis of population’s housing provision in Ukraine and its certain regions considering the methodological features of assessing housing affordability indicators, as well as the losses in the housing stock as a result of military invasion. The purpose of the paper is the methodological determination of housing affordability indicator, assessment of its pre-war trend in Ukraine; and determination of an acceptable for modern conditions institutional mechanism for improving housing affordability based on the principle of rent. The novelty of the research is the substantiation of use of permanent housing lease mechanism. These schemes can be implemented at the state and regional levels with the direct participation of investors and local self-government bodies within the framework of public-private partnerships. In the paper the pros and cons of the current mechanisms of housing construction and obtaining are identified; prospective directions and possible financial mechanisms for state housing policy implementation in the current condition of construction industry and population welfare are shown. Research methods are the following: correlational, analog, time series for the analysis of regional differentiation of housing affordability in Ukraine. Housing affordability has become much more complicated due to the need to restore damaged and destroyed dwellings. In view of current situation, prospective dynamics of living area commissioning indicator aimed at bringing the level of housing provision of Ukrainian citizens closer to the indicators of European countries was determined. In the absence of official housing purchase estimates at the national level, the ratio of median cost per square meter of living area to the median wage was used as the housing affordability ratio. The housing affordability ratio for the regions of Ukraine was calculated. According to the generally accepted classification of housing markets by affordability criterion, the purchase of housing in the country is significantly complicated. The correlation between the housing affordability indicator and the living area commissioning indicator was calculated, which was negative and indicated that the regional programs for providing the population with housing are critically unsatisfactory. The positive and negative features of the financial instruments for ensuring the housing affordability for the population and their compliance with the strategic goals of the housing policy development were determined. The financial and organizational mechanism of lease as a target vector for providing the population with housing was proposed.

Permanent Supportive Housing Receipt and Health Care Use Among Adults With Disabilities.

This study assessed whether permanent supportive housing (PSH) participation is associated with health service use among a population of adults with disabilities, including people transitioning into PSH from community and institutional settings. Our primary data sources were 2014 to 2018 secondary data from a PSH program in North Carolina linked to Medicaid claims. We used propensity score weighting to estimate the average treatment effect on the treated of PSH participation. All models were stratified by whether individuals were in institutional or community settings prior to PSH. In weighted analyses, among individuals who were institutionalized prior to PSH, PSH participation was associated with greater hospitalizations and emergency department (ED) visits and fewer primary care visits during the follow-up period, compared with similar individuals who largely remained institutionalized. Individuals who entered PSH from community settings did not have significantly different health service use from similar comparison group members during the 12-month follow-up period.

Rights and obligations of refugees by the legislation of Ukraine

This article describes the basic rights and obligations of refugees by the legislation of Ukraine.The rights and obligations of refugees by the legislation of Ukraine are properly established in accordance with international legal standards, and the main problem in modern Ukraine is compliance with the legislation on the rights of refugees. This category of individuals often experiences difficulties in connection with registration at the place of residence, obtaining permanent or temporary housing, employment at a new place of residence. There are difficulties with medical care and pension provision.The rights of refugees are a general component of the human rights system, the presence of a special mechanism for the protection of their rights does not mean for them exclusion from the general system of protection of human rights and freedoms, but it is organically included in the system of international legal protection of human rights.The presence of a large number of refugees in the world indicates numerous problems in the peaceful coexistence of states in various regions of the planet, including, unfortunately, in Europe, where more than 10 million Ukrainians have already become refugees as a result of full-scale brazen Russian aggression, in addition, there are many refugees in Europe, from conflicts in Afghanistan, Somalia, Syria, Iraq, Georgia, Kosovo, Nagorno-Karabakh. As a result of objective circumstances, all these people were forced to leave their native homes and become refugees. The presence of millions of refugees from different parts of the world indicates the need for radical reforms of the UN, which is increasingly finding it difficult to ensure international law and order and conflict resolution, and also indicates the need to improve the mechanism for the protection of human rights at the universal level.Human rights, protection and promotion of the realization of rights have always been and remain a priority area of activity of our state. At the current stage, in the conditions of the military regime introduced in Ukraine, the need to improve the existing mechanisms for the protection of human rights, including refugees and forced migrants who are forced to leave their places of permanent residence, is becoming extremely urgent. The activities of the UN High Commissioner for Refugees and his cooperation with the Government of Ukraine are important in this area.

The POP (Permanent Supportive Housing Overdose Prevention) Study: protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial

BackgroundPermanent supportive housing (PSH)—subsidized housing paired with support services such as case management—is a key part of national strategic plans to end homelessness. PSH tenants face high overdose risk due to a confluence of individual and environmental risk factors, yet little research has examined overdose prevention in PSH.MethodsWe describe the protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial (RCT) of overdose prevention practice implementation in PSH. We adapted evidence-based overdose prevention practices and implementation strategies for PSH using input from stakeholder focus groups. The trial will include 20 PSH buildings (with building size ranging from 20 to over 150 tenants) across New York City and New York’s Capital Region. Buildings will be randomized to one of four 6-month intervention waves during which they will receive a package of implementation support including training in using a PSH Overdose Prevention (POP) Toolkit, time-limited practice facilitation, and learning collaboratives delivered to staff and tenant implementation champions appointed by each building. The primary outcome is building-level fidelity to a defined list of overdose prevention practices. Secondary and exploratory implementation and effectiveness outcomes will be examined using PSH staff and tenant survey questionnaires, and analysis of tenant Medicaid data. We will explore factors related to implementation success, including barriers and facilitators, using qualitative interviews with key stakeholders. The project is being conducted through an academic-community partnership, and an Advisory Board including PSH tenants and other key stakeholders will be engaged in all stages of the project.DiscussionWe describe the protocol for a hybrid type 3 stepped-wedge cluster RCT of overdose prevention practice implementation in PSH. This study will be the first controlled trial of overdose prevention implementation in PSH settings. The research will make a significant impact by testing and informing future implementation strategies to prevent overdose for a population at particularly high risk for overdose mortality. Findings from this PSH-focused research are expected to be broadly applicable to other housing settings and settings serving people experiencing homelessness.Trial registrationClinicalTrials.gov, NCT05786222, registered 27 March 2023.

A COVID-19 isolation facility for people experiencing homelessness in Berlin, Germany: a retrospective patient record study.

People experiencing homelessness (PEH) are disproportionately affected by the COVID-19 pandemic. For many PEH it is impossible to isolate due to the lack of permanent housing. Therefore, an isolation facility for SARS-CoV-2 positive PEH was opened in Berlin, Germany, in May 2020, offering medical care, opioid and alcohol substitution therapy and social services. This study aimed to assess the needs of the admitted patients and requirements of the facility. This was a retrospective patient record study carried out in the isolation facility for PEH in Berlin, from December 2020 to June 2021. We extracted demographic and clinical data including observed psychological distress from records of all PEH tested positive for SARS-CoV-2 by RT-PCR. Data on duration and completion of isolation and the use of the facilities' services were analyzed. The association of patients' characteristics with the completion of isolation was assessed by Student's t-test or Fisher's exact test. A total of 139 patients were included in the study (89% male, mean age 45 years, 41% with comorbidities, 41% non-German speakers). 81% of patients were symptomatic (median duration 5 days, range 1-26). The median length of stay at the facility was 14 days (range 2-41). Among the patients, 80% had non-COVID-19 related medical conditions, 46% required alcohol substitution and 17% opioid substitution therapy. Three patients were hospitalized due to low oxygen saturation. No deaths occurred. Psychological distress was observed in 20%, and social support services were used by 65% of PEH. The majority (82%) completed the required isolation period according to the health authority's order. We did not observe a statistically significant association between completion of the isolation period and sociodemographic characteristics. The specialized facility allowed PEH a high compliance with completion of the isolation period. Medical care, opioid and alcohol substitution, psychological care, language mediation and social support are essential components to address the specific needs of PEH. Besides contributing to infection prevention and control, isolation facilities may allow better access to medical care for SARS-CoV-2 infected PEH with possibly positive effects on the disease course.

Estimating long-term K-12 student homelessness after a catastrophic flood disaster

Despite efforts to end homelessness in the United States, student homelessness is gradually growing over the past decade. Homelessness creates physical and psychological disadvantages for students and often disrupts school access. Research suggests that students who experience prolonged dislocation and school disruption after a disaster are primarily from low-income households and under-resourced areas. This study develops a framework to predict post-disaster trajectories for kindergarten through high school (K-12) students faced with a major disaster; the framework includes an estimation on the households with children who recover and those who experience long-term homelessness. Using the National Center for Education Statistics school attendance boundaries, residential housing inventory, and U.S. Census data, the framework first identifies students within school boundaries and links schools to students to housing. The framework then estimates dislocation induced by the disaster scenario and tracks the stage of post-disaster housing for each dislocated student. The recovery of dislocated students is predicted using a multi-state Markov chain model, which captures the sequences that households transition through the four stages of post-disaster housing (i.e., emergency shelter, temporary shelter, temporary housing, and permanent housing) based on the social vulnerability of the household. Finally, the framework predicts the number of students experiencing long-term homelessness and maps the students back to their pre-disaster school. The proposed framework is exemplified for the case of Hurricane Matthew-induced flooding in Lumberton, North Carolina. Findings highlight the disparate outcomes households with children face after major disasters and can be used to aid decision-making to reduce future disaster impacts on students.

Changes in Health Care Utilization and Associated Costs After Supportive Housing Placement by an Urban Community Mental Health Center.

Permanent supportive housing (PSH) for individuals experiencing homelessness and living with mental illness can reduce utilization of crisis care services and increase utilization of outpatient care, although the extent to which pre-housing utilization patterns influence post-housing utilization remains unclear. Therefore, pre- and post-housing health service utilization was examined in 80 individuals living with a chronic mental illness who were and were not utilizing health care services in the years pre- and post-housing. Overall, the proportion of tenants utilizing outpatient services, including outpatient behavioral health services, increased from pre- to post-housing. Tenants who did not use outpatient behavioral health services prior to housing were disproportionately less likely than their peers to use those services after being housed. Among tenants who utilized crisis care services prior to being housed, reductions were observed in the number of crisis care visits. Results suggest PSH leads to changes in health care utilization and associated costs.

Integrated cognitive behavioral treatment for substance use and depressive symptoms: a homeless case series and feasibility study

BackgroundHomelessness is associated with high prevalence of psychiatric disorders such as substance use disorders, including alcohol use disorder, and depression.MethodsThis case series and feasibility trial evaluated a novel integrated cognitive behavioral treatment (ICBT), which was adapted specifically for homeless individuals and developed to treat substance use and depressive symptoms simultaneously. The ICBT was delivered among four homeless individuals enrolled in the Treatment First program (a social services program where treatment is offered in conjunction with temporary transitional housing), who had access to stable and sober housing milieus.ResultsThe ICBT was rated high in expectancy of improvement, credibility, and satisfaction, with few treatment-related adverse events, and fairly high treatment retention. At 12 months follow-up, three of four participants were not homeless anymore. Some participants experienced short-term reductions in substance use and/or depressive symptoms.ConclusionsThe study provided preliminary support that the ICBT can be a feasible and potentially effective treatment for homeless individuals with substance use and/or depressive symptoms. However, the delivery format within the Treatment First program was not feasible. The ICBT could be offered within the social services Housing First program instead (where permanent housing is offered before treatment), or to non-homeless individuals.Trial registrationThe study was registered retrospectively at ClinicalTrials.gov (NCT05329181).

Ideological orientations, intergroup stereotypes, and opposition to permanent supportive housing

AbstractThe number of people experiencing homelessness has continuously increased in the United States in the last decade. Researchers have shown that permanent supportive housing is an effective method for addressing chronic homelessness. However, housing programs and policies often meet with opposition from people in the community. Using theorizing from the dual‐process model of prejudice and the stereotype content model, we examined whether ideological orientations of right‐wing authoritarianism (RWA) and social dominance orientation (SDO) predicted opposition to permanent supportive housing through different stereotypes and emotional prejudices. Across two studies (NTotal = 579), we measured Californians’ ideological orientations (RWA, SDO), stereotypes and emotional prejudices toward homeless individuals, and their attitudes toward housing programs. Study 1 focused on permanent housing in a community, while Study 2 focused on a state‐wide policy that funds permanent housing. Across both studies, stronger SDO predicted negative competence stereotypes, less pity and more contempt toward homeless individuals, and opposition to housing programs. SDO consistently predicted opposition to social programs through stronger contempt and less pity. RWA is differently related to outcomes across the studies. Results suggest that people's preference for maintaining hierarchy and power structures, which underlies SDO, is a key predictor of people's housing attitudes.

Investigating the Comparative Effectiveness of Place-Based and Scatter-Site Permanent Supportive Housing for People Experiencing Homelessness During the COVID-19 Pandemic: Protocols for a Mixed Methods, Prospective Longitudinal Study.

Permanent supportive housing (PSH) is an evidence-based practice to address homelessness that is implemented using 2 distinct approaches. The first approach is place-based PSH (PB-PSH), or single-site housing placement, in which an entire building with on-site services is designated for people experiencing homelessness. The second approach is scatter-site PSH (SS-PSH), which uses apartments rented from a private landlord while providing mobile case management services. This paper describes the protocols for a mixed methods comparative effectiveness study of 2 distinct approaches to implementing PSH and the patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk. People experiencing homelessness who are placed in either PB-PSH or SS-PSH completed 6 monthly surveys after move-in using smartphones provided by the study team. A subsample of participants completed 3 qualitative interviews at baseline, 3 months, and 6 months that included photo elicitation interviewing. Two stakeholder advisory groups, including one featuring people with lived experience of homelessness, helped guide study decisions and interpretations of findings. Study recruitment was supposed to occur over 6 months starting in January 2021 but was extended due to delays in recruitment. These delays included COVID-19 delays (eg, recruitment sites shut down due to outbreaks and study team members testing positive) and delays that may have been indirectly related to the COVID-19 pandemic, including high staff turnover or recruitment sites having competing priorities. In end-July 2022, in total, 641 people experiencing homelessness had been referred from 26 partnering recruitment sites, and 563 people experiencing homelessness had enrolled in the study and completed a baseline demographic survey. Of the 563 participants in the study, 452 had recently moved into the housing when they enrolled, with 272 placed in PB-PSH and 180 placed in SS-PSH. Another 111 participants were approved but are still waiting for housing placement. To date, 49 participants have been lost to follow-up, and 12% of phones (70 of the initial 563 distributed) were reported lost by participants. Recruitment during the pandemic, while successful, was challenging given that in-person contact was not permitted at times either by program sites or the research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs in Los Angeles County. To overcome recruitment challenges, flexible strategies were used, which included extending the recruitment period and the distribution of cell phones with paid data plans. Given current recruitment numbers and retention rates that are over 90%, the study will be able to address a gap in the literature by considering the comparative effectiveness of PB-PSH versus SS-PSH on patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk, which can influence future public health approaches to homelessness and infectious diseases. ClinicalTrials.gov NCT04769349; https://clinicaltrials.gov/ct2/show/NCT04769349. DERR1-10.2196/46782.

The effect of a non-congregate, integrated care shelter on health: A qualitative study.

To describe the experiences of unstably housed, medically vulnerable residents living at the Haven, a novel, non-congregate integrated care shelter operating in a historic hotel during the COVID-19 pandemic. A qualitative descriptive design. Semi-structured qualitative interviews were conducted in February and March 2022 with a purposive sample of 20 residents living in the integrated care shelter. Data were analyzed in May and June 2022 using the thematic analysis methods described by Braun and Clarke. Six women and 14 men, ages 23-71 (M=50, SD=14), were interviewed. Lengths of stay at the time of the interview ranged from 74 to 536 days (M=311 days). Medical co-morbidities and substance use details were collected at baseline. Three themes were identified: (1) Autonomy, (2) supportive environments, and (3) stability and the need for permanent housing. Participants characterized the integrated care, non-congregate model as having multiple advantages over traditional shelter systems. Participants emphasized the role of nurses and case managers in providing a respectful, caring environment in the integrated shelter model. Participants described acute physical and mental health needs which were largely met by the innovative integrated shelter care model. The effect of homelessness and housing insecurity on health is well documented, but few solutions exist that promote autonomy. Participants in this qualitative study emphasized the benefits of living in a non-congregate integrated care shelter and the services which promoted their self-management of chronic diseases. Patients were the participants in the study, but were not involved in the design, analysis of interpretation of the data, or preparation of the manuscript. Due to this project's small scope, we could not involve patients or the public after the study concluded data collection.

Discrete-event simulation modeling for housing of homeless populations.

The San Francisco Bay Area has experienced a rapid rise in homelessness over the past decade. There is a critical need for quantitative analysis to help determine how to increase the amount of housing to meet the needs of people experiencing homelessness. Noting that the shortage of housing available through the homelessness response system can be modeled as a queue, we propose a discrete-event simulation to model the long-term flow of people through the homelessness response system. The model takes as input the rate of additional housing and shelter available each year and delivers as output the predicted number of people housed, sheltered, or unsheltered in the system. We worked with a team of stakeholders to analyze the data and processes for Alameda County in California and use this information to build and calibrate two simulation models. One model looks at aggregate need for housing, while the other differentiates the housing needs of the population into eight different types. The model suggests that a large investment in permanent housing and an initial ramp up of shelter is needed to solve unsheltered homelessness and accommodate future inflow to the system.

Risk Factors Associated with Pneumonia among under 5 Years Children at Banadir Hospital, Mogadishu, Somalia

Aims: Pneumonia burden among children aged five years and below in Somalia remains one of big health problems. Higher risk factors of child Pneumonia in Somalia includes child stunting, child wasting and indoor air pollution. The main objective of this study was to investigate the risk factors associated with pneumonia among under 5 years children attending Banadir Hospital, Mogadishu, Somalia. The specific objectives were to determine the prevalence of pneumonia among children aged under 5 years; to establish the socio-demographic factors, environmental factors and health facility related factors associated with Pneumonia among children aged under 5 years.
 Study Design: The study adopted cross-sectional study design.
 Place and Duration of Study: Banadir Hospital, Mogadishu, Somalia in 2022.
 Methodology: The study used a systematic random sampling technique to select 188 under 5 children with pneumonia. A structured questionnaire and interview guide were employed in collecting data. Qualitative data was analyzed using content technique. Quantitative data was analyzed using descriptive and inferential statistics. The inferential statistics entailed the multivariable logistic regression analysis to determine the risk factors that predict pneumonia among the under 5 years children.
 Results: The results indicated that the social demographic factors that were protective and decreased the odds of prevalence of pneumonia among under 5 years children were age of 4 - 5 years (Odds= 1.125, P=0.008<0.05); caretakers who had attended university (0.964;P=0.010<0.05); caretakers who earned 300-400$ (Odds=1.315; P=0.006<0.05); birth weight over 3kgs (Odds=2.422; P=0.014<0.05); permanent housing (Odds= 0.810; P=0.007<0.05). The environmental factors that were associated with high prevalence of pneumonia among under 5 years children were living in an environment without safe air quality (Odds= 1.402; P=0.033<0.05); and living in an environment where firewood is used for cooking (Odds=0.704;P=0.038<0.05). The health related factors that were protective and decreased the odds of prevalence of pneumonia among under 5 years children were pneumonia vaccination (Odds=0.948; P=0.008<0.05).
 Conclusion: The study concluded that the risk factors for pneumonia among children aged under 5 years were age, level of education, income, birth weight, exclusive breast feeding, pneumonia vaccination, postnatal care, and history of acute respiratory tract infection. The study recommends that the health centres should equip the mothers and the caregivers with the basic knowledge regarding health and the hospitals to conduct post-natal training programs to the mothers and caregivers.

Stratifying Disaster: State Aid, Institutional Processes, and Inequality in American Communities

Abstract Disaster aid is an increasingly costly form of social spending and an often-overlooked way that welfare states manage new forms of risk related to climate change. In this article, I argue that disaster aid programs engender racial and socioeconomic inequalities through a process of assistance access constituted by distinct state logics, administrative burdens, and bureaucratic actors. I test this claim empirically by analyzing 5.37 million applicant records from FEMA’s Individuals and Households Program (IHP) from 2005 to 2016. Results demonstrate that key institutional features—the conditions of eligibility and sufficiency, burdens of proof, and assessments by contracted inspectors—combine in a stepwise process to funnel permanent repair resources to homeowners in whiter communities, while temporary rental aid is granted disproportionately to households in communities of color. Analyses of denial codes suggest racial disparities in appraisals of disaster damage. Among those approved for aid, more benefits accrue to those from comparatively higher income communities, and a decoupling of permanent and temporary housing aid further stratifies socioeconomic growth during recovery. Theoretically, this research advances an account of institutional processes transferable to other analyses of social programs, and it introduces climate risk as a new form of social risk against which welfare states insure citizens.

BETWEEN SEDENTISM AND NOMADISM: LIFEWAYS ON THE FOREST-STEPPE FRONTIER OF THE LEFT BANK OF DNIEPER IN SCYTHIAN TIME

The paper is devoted to the issue of reconstruction of the lifeways and economics of the part of tribes in the forest-steppe region of the Left Bank of Dnieper during the Scythian period. The question of the role of nomads and semi nomads in the ethnic and cultural history of the population is one of the most important, since the correct assessment of the interaction between the forest-steppe agricultural population and the different groups of nomads depends on the reconstruction of ethnic processes in the Left-bank forest-steppe du­ring Scythian time. It can be assumed that the Dnieper Left-bank forest-steppe by its environment and convenient ways attracted both farmers and nomads. This led to the use of several ecological niches, which was reflected in the spread of the settlement structure of farmers in the areas that are most suitable for agriculture (chernozem soils of various types) and rich in resources for life, construction, etc. (access to water, forest areas). The nomadic population that has subjugated farmers has repeatedly penetrated the region several times. Nomads mostly used the steppe areas and floodplains of the region, leaving behind the main type of sites — the mounds, burial rites of which are fundamentally different from the settled agricultural population.
 The study proposes the conditional use of the term «nomads» for groups of mobile pastoralists only at the time of their penetration into the region. In the new conditions, their lifeways significantly changed. The term reflects a transition to mobile stockbreeding within a limited territory of movement, permanent winter houses near the settlements and hillforts of the settled population of the region, prevailing transhumance, etc. At the moment, the term «semi nomads» is the most adequate for those groups of mobile pastoralists who remained in the forest-steppe region of the Left Bank of Dnieper during the Scythian time. Judging by the flat necropolis in Barvinkova Gora tract near Bilsk hillfort, a part of the migrants from the south turned to a sedentary way of life in the 4th century BC. In general, it can be assumed that the migration of nomads into the region significantly impacted lifeways of the local sedentary population.

New Caucus on Social Determinants of Mental Health to Meet During Annual Meeting

Back to table of contents Previous article Next article Annual MeetingFull AccessNew Caucus on Social Determinants of Mental Health to Meet During Annual MeetingMark MoranMark MoranSearch for more papers by this authorPublished Online:27 Mar 2023https://doi.org/10.1176/appi.pn.2023.04.4.17AbstractThe caucus aims to help translate research on social determinants to policy and clinical care.The APA Caucus on Social Determinants of Mental Health (SDoMH) is seeking new members who are interested in the ways that social, economic, and environmental factors—such as food, housing, access to health care, education, and proximity to green space—influence the health of patients.The caucus, APA’s newest, held its first meetings in February and March and will be meeting in May at this year’s Annual Meeting in San Francisco. The date and time will be announced in the PN Update enewsletter.“We need to think in a holistic way about social determinants and have a diversity of voices that reflect how these factors affect everyone,” said Eric Rafla-Yuan, M.D., chair of the APA Caucus on Social Determinants of Mental Health.Eric Rafla-Yuan, M.D., was appointed chair of the caucus by APA President Rebecca Brendel, M.D., J.D.; his term expires in September. During the Annual Meeting, elections will be held for a chair-elect and other caucus positions.Members interested in joining the caucus are urged to visit the Join a Caucus page on the APA website.Rafla-Yuan noted that one of the first official actions of the caucus has been to cosponsor the proposed APA position statement on Housing, Homelessness, and Mental Health with the Council on Advocacy and Government Relations, the Council on Minority Health and Health Disparities, and the Council on Health Systems and Financing. The statement is expected to be submitted to the Joint Reference Committee later this year.The proposed position statement asserts: “Studies have shown that the majority of homelessness triggers are not related to mental health disorders but are economic, such as the loss of a job and debt. Additionally, although individuals with mental illness are at increased risk for homelessness, multiple studies have also shown that the majority of individuals who are unhoused have neither mental illness nor substance use disorders.“Conflation of mental health disorders with poverty and homelessness worsens stigma toward people with mental illness and toward people who are unhoused. … Large-scale trials demonstrate improved health outcomes and cost savings from scalable interventions such as permanent supportive housing. This includes the Housing First approach, which combines permanent housing with rehabilitation, support, and recovery services for people with disabilities. Housing First emphasizes choice and the belief that housing is a basic human right.”Said Rafla-Yuan, “There is a general consensus that social determinants are extremely important and affect the health of our patients. It’s an active area of research, but the question for us as clinicians is how to translate that research into interventions that can impact the health of our patients. We must also recognize that social determinants of heath do not occur in a vacuum, but arise from policy decisions that we as psychiatrists can have a say in.”He noted as well that while social determinants disproportionately negatively affect poor and disadvantaged communities, they can also be leveraged to influence health and mental health in positive ways that affect everyone.“We need to think in a holistic way about SDoMH and have a diversity of voices that reflect how these factors affect our patients, ourselves, and the communities we live and practice in,” he said. “We are looking for psychiatrists who will take the research on social determinants and help APA apply it to policy, clinical care, and education. We want to train the next generation so that psychiatrists have an awareness of these issues and the tools to act and advocate on them.” ■APA members can join the caucus by visiting the Join a Caucus page on the APA website. ISSUES NewArchived