Shelter Residents Research Articles

An Alternative to Regulation in the Control of Occupational Exposure to Tuberculosis in Homeless Shelters

Five million U.S. workers are exposed to TB in the course of their work each year. The occupational risk of exposure to TB at homeless shelters is particularly acute. TB rates among the homeless are estimated to be 150 to 300 times the nationwide rate. The U.S. Occupational Safety and Health Administration (OSHA) responded to the risk to homeless shelter workers by proposing a regulation mandating that shelters take prescribed actions to identify shelter residents who represent a potential risk and to remove those residents from the homeless shelter environment. This article concludes that the risk of TB exposure within homeless shelter workers is best viewed as a public health problem rather than as exclusively a worker protection problem. Accordingly, in addition to seeking worker protections through regulatory controls, OSHA should seek to promote occupational health and safety through a public health response as well.

At the Crossroads of Empires

In January 1844, Joseph Hekekyan, a British-trained engineer in Muhammad Ali's service, recounted how the Commission of Ornato (a joint commission of Europeans and Ottoman subjects charged with overseeing city planning and public health efforts in Alexandria) had toured the Maristan Qalīwūn, a hospital founded as a pious endowment in the thirteenth century, with the purpose of assessing its conditions and determining how many poor people could be sheltered in this institution. As Hekekyan reflected on the men, women, and children who had already made this “asylum for the poor” in Cairo their home, he noted how they were lodged, fed, and clothed “by the munificence of the Pasha” and how their presence represented the uninhibited charity of the Egyptian government. He was most concerned with how the government supported all of the shelter's residents without distinguishing between inhabitants of Egypt's countryside and those of Cairo and the length of residents' stay (many had married and had children during their residence). Hekekyan put forth his own suggestions for how the government should deal with the poor, calling for the introduction of atadhkirasystem (identifying the indigents' place of residence) and proposing that the parishes take care of their own poor (Hekekyan 1844, 2: folio 239).

System youth: a subgroup of substance-abusing homeless adolescents.

While many youths residing at homeless shelters will return home, many are placed in group or foster homes. Few researchers have examined the experiences of adolescents with a history of these out-of-home placements. This study examined shelter residents and compared the experiences of system and non-system youth. Information regarding youths' family functioning, substance use, depression and related problem behaviors was obtained from substance abusing system (n = 62) and non-system (n = 82) adolescents staying at local runaway shelters. System males engaged in significantly more delinquent behaviors than did non-system males and system females. Alcohol and drug problem consequences were positively associated with longevity in the system, while having ever attempted suicide was negatively associated with system longevity. System youth reported: 1) taking more prescribed psychotropic medications 2) experiencing more sexual abuse, and 3) less parental overprotection, as compared to non-system youth. Gender differences were found in which females reported more conflictual problem solving interactions with their parents than did males, as well as more comorbid diagnoses. Although longitudinal research is needed, findings argue that without intervention efforts targeted at identified problem behaviors, youth are at risk to continue their system involvement into adulthood.

Observations of sibling interactions in violent families

AbstractThis study examined sibling relationships of children from violent and non‐violent families. Participants included 20 children (10 dyads) who were shelter residents and their mothers and 40 children (20 dyads) from the community and their mothers. Mothers reported on children's behavior problems, sibling conflict resolution strategies, and the quality of the sibling relationship. Children reported on the quality of their sibling relationships. Sibling interactions were observed during both cooperative and competitive tasks. Shelter children had more internalizing problems than comparison children did. Mothers reported that siblings from violent homes used less verbal and physical aggression than the comparison group. Siblings in the shelter group were supportive. There were no significant differences in observed conflictual behavior. The importance of the sibling relationship and implications for intervention are discussed. © 2001 John Wiley & Sons, Inc.

Conduct problems among children at battered women's shelters: Prevalence and stability of maternal reports

The present research was designed to (1) replicate prevalence estimates of clinical levels of conduct problems in a large (n = 401) sample of children residing at a shelter for battered women, and (2) assess the stability of mothers' reports of child conduct problems following shelter departure. According to mothers' reports on standardized questionnaires and diagnostic interviews obtained during shelter residence, approximately one third of the children between 4 and 10 years of age exhibited clinical levels of conduct problems. Prior research has demonstrated elevated maternal distress during shelter residence and suggests that such distress may influence mothers' reports of child conduct problems. To examine this issue, a subset of families with children exhibiting clinical levels of conduct problems (n = 68) was reassessed following their shelter departure. Mothers' reports of child conduct problems remained stable despite significant reductions in mothers' distress after shelter exit.

Issues in the treatment of Mycobacterium tuberculosis in patients with human immunodeficiency virus infection.

The HIV/AIDS pandemic has led to a rise in the incidence of tuberculosis and an epidemic of co-infection in many developing countries. Treatment of Mycobacterium tuberculosis in persons with HIV infection presents several challenges to the clinician particularly in resource-poor countries. As will be discussed in this paper diagnosis of latent tuberculosis relies on tuberculin skin testing which has poor sensitivity and reproducibility in immunocompromised patients. The World Health Organization (WHO) recommends treatment of active tuberculosis as the primary means of global tuberculosis control. In practice treatment of active tuberculosis typically requires that a symptomatic patient self-report to a health service for evaluation and management. Even if this approach to tuberculosis control were sufficient many logistic and clinical problems remain involving tuberculosis diagnosis and therapy in the patient with HIV/AIDS. Recognizing the significant clinical and public health challenges surrounding the treatment of tuberculosis in patients with HIV infection this paper will address a number of issues relevant to the care of co-infected patients. These include current guidelines for the treatment of active tuberculosis as well as the diagnosis and treatment of latent tuberculosis in HIV-positive patients. The paper concludes with a discussion of promising new drugs for tuberculosis treatment. (excerpt)

Mental health training in emergency homeless shelters.

The prevalence of mental illness among homeless persons points to the importance of providing mental health training to emergency shelter staff. The authors report on their own work and argue that such training offers the potential to significantly improve shelter staffs ability to respond to the needs of shelter residents with mental illness, and to the behavioral problems some of these individuals may pose for shelter operation. Mental health care providers should take into consideration organizational dynamics when planning and implementing such training.

Postexposure effectiveness of varicella vaccine.

1) To describe the postexposure effectiveness of varicella vaccine in a homeless shelter; and 2) to demonstrate an effective public health intervention and its implications. A prospective observational study. A women and children's shelter in Philadelphia with 2 cases of varicella before intervention. Varicella in vaccinated and unvaccinated shelter residents; vaccine effectiveness for prevention of varicella when administered after exposure among children <13 years of age. Sixty-seven shelter residents received varicella vaccine after exposure, including 42 children <13 years of age. One child who was unvaccinated developed varicella, but no vaccinated child developed typical disease. Vaccine effectiveness was 95.2% (95% CI, 81.6%-98.8%) for prevention of any disease and 100% for prevention of moderate or severe disease among the children <13 years of age. When used within 36 hours after exposure to varicella in a setting where close contact occurred, varicella vaccine was highly effective in preventing further disease. This study provides support for the recent recommendation by the Advisory Committee on Immunization Practices to administer varicella vaccine after exposure: this practice should minimize the number of moderate or severe cases of disease and prevent prolonged outbreaks.

The Makings of Personhood in a Shelter for People Considered Homeless and Mentally III

This paper is about the pragmatic makings of identity and personhood in a Boston shelter for people considered homeless and mentally ill. Drawing upon the philosophical writings of Amelie Rorty, it examines the ways in which the words and actions of shelter residents and staff effected certain discourses of selfhood and personhood. In the course of their everyday engagements with staff and others, residents took the form of or were quietly depicted as, variably constituted "characters," "individuals," "figures," "persons," or "selves." Differentials of power were crucial to such dialogic constructions, for many of the residents' presentations of self developed in rhetorical, tactical response to the dominant imageries advanced by others.

Residents' Views of the Efficacy of Shelter Services for Assaulted Women

Although shelters for abused women are common across North America, few have been evaluated. This qualitative study consisted of in-depth interviews with 63 shelter residents. Thirty-five of these women were interviewed in follow-ups 4 to 6 months later. In each interview, they were asked what they found helpful during their shelter stay. Residents were positive about the supportive nature of the staff, safety, relationships with other residents, and the child care. Residents expressed some concerns about the availability of counseling from busy staff and the appropriateness of some shelter residents. Generally, the women endorse shelters as resources that save lives.

Homeless Families with Children

Previous studies of homelessness have not adequately addressed the relationship between deteriorating living conditions of inner-city neighborhoods and family homelessness. Interviews with 50 families with children who were residents of homeless shelters in two large cities in New York reveal that substandard housing, unscrupulous landlords, and drug-related violence and crime in neighborhoods, as well as nonpayment of rent and domestic violence, are significant causes of homelessness. The families also identified the unsafe neighborhood environment and substandard housing, as well as high rent, long waiting lists for public or subsidized housing units, and lack of transportation, as the major barriers to finding decent housing. Policy implications are discussed.

Dying Homeless but Not Alone: Social Support Roles of Staff Members in Homeless Shelters

This article provides an integrated examination of the process of death among the homeless and the integral role that shelter staff and residents play in this process. Several brief case studies illustrate a variety of ways in which shelter staff and friends who provide support networks in the final stages of life often are excluded by families and others from the rites and rituals of death. The authors suggest that the reliance of homeless people on support networks composed of shelter staff and residents, combined with the lack of legitimacy accorded to these associates, produces excessive strain and blocks opportunity for normal grieving. The article emphasizes the fact that few communities or social service providers are ensuring that staff and residents are given training and counseling to prepare them to deal effectively with such strain.

Mortality among homeless shelter residents in New York City.

This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions must address not only the health conditions of the homeless but also the societal conditions that perpetuate homelessness.

The community health nursing implications of the self-reported health status of a local homeless population.

This study explored the personal characteristics and the health and health-related concerns reported by members of the local homeless population in order to design population-specific health programming. The study also examined whether there were significant differences between homeless who are shelter residents and those who are not. An exploratory descriptive design was used to analyze retrospective data collected by a local County Health Department in interviews of 132 homeless adults. The demographic characteristics found reflect many common patterns: marked over-representation of males, mean age in the mid-thirties, education levels comparable to similar socio-economic groups, high unemployment rates, and low health insurance rates. One third of the sample reported self-assessed health statuses of fair or poor. The most frequently identified physical health issue was joint problems, followed by cardiovascular disease. Depression was mentioned most frequently as a self-identified mental health problem. Loneliness was the number one fear identified. Chi Square analysis showed that homeless who did not stay in shelters were significantly longer term residents (p < 0.0001) of the community and reported fear of loneliness significantly more frequently (p < 0.01). This study identifies health concerns that local homeless people themselves find important and provides direction for development of sound population-specific health programming.

Mental health issues of abused women: the perceptions of shelter workers.

While some studies have documented the mental health symptoms of battered women, we know little of the extent to which shelter residents present with mental health and substance abuse symptoms, or the effect of these issues on other residents, staff, and children. Further, it is not clear whether shelter staff feel sufficiently trained to safely and adequately address such concerns. The current survey was an effort to document what proportion of shelter residents present with severe symptomatology and its effect on the shelter environment. The survey was completed by 158 staff from 23 of Alberta's 30 shelters. Since shelters are one aspect of a community network of services, it was of interest to identify how well mental health and substance abuse services complement each other and whether shelters have developed strategies to better connect with other agencies.

The vulnerability of battered women to HIV infections

This research provides considerable circumstantial evidence that battered women are exposed to a large number of risk factors that may render them more vulnerable to contracting HIV. The article begins by contextualizing our research vista against the literature on the relationship between women and HIV and the emerging literature on the public health significance of domestic violence. Empirical data on battered women's exposure to the risk factors associated with HIV is gleaned from 510 interviews with battered women residents in spouse abuse shelters across Kentucky. These interviews were conducted by trained female interviewers who worked in the shelter in which the women were residing. Our data reveal the presence of injuries and multiple risk factors among batterers (increased likelihood of jail/prison time; greater likelihood of drug use; greater refusal to use condoms) that are known to lead to HIV infections. Given the alarming increase in heterosexual infections and the disproportionate increase among heterosexual women, we suggest that battering may be one potentially important transmission route. We conclude by discussing some of the policy implications of our findings.

Cooperative Extension System/expanded Food and Nutrition Education Program/women, Infants and Children Nutrition Education Initiative

LEARNING OUTCOME: TO identify dietary changes in residents of homeless shelters after participation in a nutrition education program.Although Connecticut has the highest per capita income of any state, it also has several of the nation's poorest cities. More than 3,000 women and children use homeless shelters in Hartford and New Haven. Homelessness increases health risks to children and pregnant women during growth and development. EFNEP paraprofessionals worked in selected homeless shelters to provide nutrition education and increase the awareness of the Women, Infants and Children Supplemental Food Program (WIC). Advisory councils, including WIC, shelter and EFNEP staff were organized to guide nutrition education efforts. During the two-year period, 230 shelter residents (primarily women) received nutrition education via group sessions, individual counseling and food demonstrations. Dietary data were collected using a minimum of two twenty-four-hour recalls and analyzed with the EFNEP Evaluation and Reporting (ERS) computer system. ERS evaluates diets using formulas for nutrient adequacy (NAR=Nutrient Adequacy Ratio=Nutrient intake/RDA; MAR=Mean NAR values for protein, iron, calcium, vitamins A, C and B6). During year one, MAR changed from .78 to .95 in Hartford and from .85 to .96 in New Haven with improvements in fiber, iron, vitamins A and B6. During year two, MAR changed from .79 to .82 in Hartford and from .79 to .81 in New Haven with improvements in calcium, vitamins A and C, and a decrease in total fat. The EFNEP/WIC nutrition education model is effective for improving the diets of shelter residents.

Predictors of Permanent Housing for Sheltered Homeless Families

The authors analyze 10 years of data on homelessness to determine the characteristics of homeless families most likely to find permanent housing after leaving a shelter environment. They studied 1,156 families from 1983 to 1992 to determine where these families go after leaving the shelter and whether the pattern changed over time. Logistic regression analysis found that the larger the family size and being African American were factors that predicted a decreased likelihood of finding permanent housing. Families with one child were 1.5 times more likely to find permanent housing than were families with three children, and whites were 1.9 times more likely to find permanent housing than were African Americans. Furthermore, homeless shelter residents were five times more likely to find permanent housing in 1983 than in 1992, regardless of demographic predictors. Practice and policy implications are discussed.

Tuberculosis health education. Needs in homeless shelters.

Tuberculosis has reemerged as an important public health concern, particularly with the rise in multi-drug-resistant strains. The homeless are at increased risk for infection, for active disease, and for incomplete treatment. Public health authorities have recommended that tuberculosis health education materials be developed specifically for residents and staff of homeless shelters. In this study, a diverse sample of 20 adult homeless-shelter residents responded to open-ended questions regarding 1) their knowledge of tuberculosis and tuberculosis screening and treatment, 2) their perceptions of access to health care services related to tuberculosis, and 3) their views of health education regarding tuberculosis. The majority of the subjects had limited knowledge of tuberculosis and of screening and treatment for the disease. Many had misconceptions about the disease, particularly regarding its transmission. An analysis of the subjects' responses within the framework of the Health Belief Model indicated that basic tuberculosis health education programs for residents of homeless shelters are needed. The study findings indicated that a small-group educational format utilizing written materials and video aids might be most effective.

Size‐related differences in behaviour and spatial distribution of juvenile Atlantic salmon in a novel environment

Within a month of first feeding sibling juvenile salmon had developed not only large differences in size (up to fivefold in weight), but also significant differences in behaviour. Large fish remained in refuges (overhead cover) significantly longer after having been frightened. On leaving the shelters most small fish established individual territories on the bottom and. downstream of the shelters. The greater aggressiveness of small fish in a novel environment (from holding tank to experimental stream) was related to this apparent territoriality. The increased shelter residence time and delayed establishment of individual territories might be interpreted as greater caution in large fish, which are able to avoid risky situations due to their higher energy reserves. In contrast, smaller fish need to leave refuges more quickly and to establish individual territories in a novel environment.