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Concept: Homelessness

168

BACKGROUND: While homelessness among youth is a serious problem, there is little information about evidence-based interventions for homeless youth. In cooperation with professionals and youths, Wolf (2012) developed Houvast (Dutch for ‘grip’): a strengths based method grounded in scientific and practice evidence. The main aim of Houvast is to improve the quality of life of homeless youths by focusing on their strengths, thus stimulating their capacity for autonomy and self-reliance.Method/Design: The effectiveness and fidelity of Houvast will be tested in ten Dutch services for homeless youth which are randomly allocated to an intervention group (n = 5), or a control group which provides care as usual (n = 5). Measurements of both objective and subjective quality of life and secondary outcomes (mental and physical health, substance use, coping, resilience, psychological needs, care needs, working relationship with the professional and attainment of personal goals) will be conducted among homeless youths (n = 251). Youths in both groups will be interviewed by means of a structured interview at baseline, at time of ending care or after having received care for six months (T1) and at nine months after baseline (T2). Model fidelity will be tested around T1. DISCUSSION: This study is unique as it includes a large number of homeless youths who are followed for a period of nine months, and because it focuses on a strengths based approach. If the Houvast method proves to be effective in improving quality of life it will be the first evidence-based intervention for homeless youth.Trail registration: Netherlands Trail Register (NTR): NTR3254.

Concepts: Scientific method, Poverty, Intervention, Youth, Interview, Homelessness, Street children, Maslow's hierarchy of needs

153

Tuberculosis prevalence is generally low in industrialized countries, but many cities now operate surveillance programmes to actively screen for tuberculosis in known risk groups including homeless people. While several studies have reported on individual screening programmes, this study is the first known systematic review specifically looking at chest x-ray screening programmes for tuberculosis in homeless populations.

Concepts: Poverty, Industrial Revolution, Tuberculosis, Cultural studies, Homelessness, Homelessness in the United States, Flo Rida

52

“Housing First” has been shown to improve housing stability in homeless individuals with mental illness, but had not been empirically tested in homeless youth. We aimed to evaluate the effect of “Housing First” on housing stability in homeless youth aged 18 to 24 years participating in At Home/Chez Soi, a 24-month randomized trial of “Housing First” in 5 Canadian cities.

Concepts: Poverty, Randomized controlled trial, Mental illness, Homelessness, Homelessness in the United States, Housing first

21

We assessed findings from a food-insecurity screening of a national sample of Veterans Administration clinics for homeless and formerly homeless veterans.

Concepts: Poverty, Homelessness

20

Patients experiencing homelessness represent a disproportionate share of emergency department (ED) visits due to poor access to primary care and high levels of unmet health care needs. This is in part due to the difficulty of communicating and following up with patients who are experiencing homelessness.

Concepts: Health care, Health care provider, Hospital, Poverty, Illness, Media, Homelessness, Health informatics

13

We examined factors associated with frequent hospitalizations and emergency department (ED) visits among Medicaid members who were homeless.

Concepts: Hospital, Homelessness, Homelessness in the United States, Department for Communities and Local Government

12

Anecdotal evidence suggests that autistic people experience an elevated risk of homelessness, but systematic empirical research on this topic is lacking. As a step towards filling this gap in knowledge, we conducted a preliminary investigation of the prevalence of Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism symptoms in a group of long-term homeless people. The entire caseload ( Nā€‰=ā€‰106) of a UK homeless outreach team was screened (excluding individuals born outside of the United Kingdom or Republic of Ireland) using an in-depth, semi-structured interview with keyworkers, based on Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic criteria. This showed adequate inter-rater reliability, as well as evidence of criterion and construct validity. Of the sample, 13 people (12.3%, 95% confidence interval (7.0, 20.4)) screened positive, meeting Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism criteria by keyworker report. A further nine people (8.5%, 95% confidence interval (4.5, 15.3)) were ‘marginal’, having autistic traits that were not quite sufficient to meet Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. Those with elevated autistic traits, compared to those without, tended to be more socially isolated and less likely to use substances. This study has provided initial evidence that autistic traits are over-represented among homeless people and that autistic homeless people may show a distinct pattern of characteristics and needs. Further investigation is required to build upon these provisional findings.

Concepts: Statistics, United Kingdom, Psychometrics, Autism, Homelessness, Evidence, Anecdotal evidence, Homelessness in the United States

12

Foot problems are common among homeless persons, but are often overlooked. The objectives of this systematic review are to summarize what is known about foot conditions and associated interventions among homeless persons.

Concepts: Homelessness

12

Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental health.

Concepts: LGBT, Poverty, Sexual orientation, Homelessness, Homosexuality, Bisexuality, Gay, Heterosexuality

11

Homeless people often suffer from complex and chronic comorbidities, have high rates of morbidity and die at much younger ages than the general population. Due to a complex combination of physical, psychosocial and addiction problems at the end of life, they often have limited access to palliative care. Both the homeless and healthcare providers experience a lot of barriers. Therefore, providing palliative care that fits the needs and concerns of the homeless is a challenge to healthcare providers. This systematic review aims to summarize evidence about the concerns, palliative care needs and preferences of homeless people, as well as barriers and facilitators for delivering high quality palliative care.

Concepts: Medicine, Homelessness