美国《离家出走和无家可归青少年法案》综述研究

《离家出走和无家可归青少年法案》是美国在流浪儿童救助领域最为重要的法律之一。它的出台标志着美国联邦政府在制度与经费上全面介入了流浪儿童救助领域。也体现出美国社会对于流浪儿童的观念从“麻烦制造者”向“社会问题受害者”的转变。该法案包括三项主要救助计划,在美国流浪儿童的生活、教育、健康、就业等方面发挥了积极作用,但也存在导致部分流浪儿童更为边缘化的风险。     

Juvenile offender rehabilitation in Estonia: interprofessional collaboration in written assessments and specialists’ perceptions

Qualitative and quantitative research methods were used to study an interprofessional assessment model in rehabilitation services and its implementation in Estonia based on (1) a sample of rehabilitation plans for 160 juvenile offenders aged 7–18 and (2) expert interviews with 10 members of an interprofessional assessment team. Each specialist’s role was compared with the assessments. While each team member is assigned a discrete role based on discipline, in practice, the disciplines’ work overlapped considerably during the assessment process. The overlap seems to occur because team members conduct their assessments individually, rather than following the collaborative best practice model for interprofessional teams described in the literature. The expert interviews indicate that rehabilitation specialists perceive the individual-level elements of interprofessional teamwork to be consistent with the ideals articulated in the Perception of Interprofessional Collaboration Model, while the substantial overlap in assessments that occurred in practice could be related to lack of interprofessional collaboration at group and organizational levels. Recommendations to improve the functioning of teams serving juvenile offenders include establishing an interprofessional education system, increasing the flexibility of the legal framework for service provision, and improving the interprofessional assessment instrument.     

“I’d rather injure somebody else than get injured”: An introduction to the study of exposure to physical violence among young people experiencing homelessness

ABSTRACT

Homeless young people are at risk for a range of negative health and behavioral outcomes, and they commonly report exposure to physical violence, as both perpetrators and victims. Semi-structured interviews focusing on exposure to physical violence were conducted with 18 homeless young people in Victoria, Australia. Results showed perpetration of physical violence occurred as a form of self-protection. Painful experiences of physical victimization were also described. Injuries were sustained as a result of both physical violence perpetration and victimization. Results suggest an important duality exists between homeless young people’s acceptance of exposure to physical violence as normal and requiring emotional detachment at the time of its occurrence, and later reflection about exposure to physical violence with emotional engagement and problematizing the necessity of normalization and detachment. Shame, stigma, and unequal power relationships were described in relation to interactions with health professionals. Future research exploring violence as a response to vulnerability and subsequent feelings of shame and stigma in homeless young people is especially warranted.     

Relationships Between Psychosocial Risks and Stress in Homeless Children

Homeless children are typically exposed to the worst environmental conditions associated with poverty. Despite recent attention to psychosocial risks associated with homelessness, limited attention has been paid to stress-related symptoms in homeless children. Better understanding of homeless children’s experience of stress could point the way toward improvement of services for them. The purpose of the present exploratory study was to assess associations between child psychosocial riskfactors and emotional and behavioral symptoms of stress in homeless children, Twenty-two homeless nlothers of 29 children between the ages of 2 and 10 were surveyed about known psychosocial risks for homeless children and completed the Pediatric Emotional Distress Scale (PEDS), a 17-item measure of stress-related symptoms in children. Findings suggest that the stress-related symptoms of these children are related to the cumulative effects of environmental risk factors. The PEDS appears to be a sensitive measure of stress in children, and its brevity provides an advantage in assessments in high-stress situations. More developmental work with low-SES samples, however, is recommended.     

Anatomy of a Mean City: Including People Experiencing Homelessness in the Discussion

Abstract

In January 2006, a survey released by the National Coalition for the Homeless and the National Law Center on Homelessness and Poverty named Lawrence, Kansas the second “meanest city” to people who experience homelessness in the United States. The survey focuses on the increase in ordinances that make behaviors such as panhandling and sleeping on sidewalks illegal. A critical perspective missing from the 2006 study were the views of those experiencing homelessness. Therefore, this study was developed with the intention of providing a voice to individuals in the homeless community and to encourage other advocacy efforts to include those absent voices. Findings indicate that Lawrence may not be “mean” in terms of ordinance enforcement but suggest that homeless individuals encounter negative attitudes from the community at large and face barriers to employment and participation in community life. Implications for social welfare practice, policy and research are discussed.     

The Family Team at Boston Healthcare for the Homeless Program: an integrated approach to care in outreach settings

Since 1986, the Family Team at Boston Health Care for the Homeless Program has implemented an integrated, inter-professional, team-based model of care to serve families experiencing homelessness. The Family Team employs key strategies delineated by the well-established Health Care for the Homeless model, which emphasizes the importance of outreach medicine and a case management “one-stop shop approach”. We include an account of a specific case where the Family Team’s unique model helped a refugee family in Massachusetts access medical and social services otherwise more difficult to obtain. The Family Team’s onsite presence in the hotel-shelter and the team-based approach facilitated diagnosis of and successful treatment for cervical cancer in a mother of eight children. This case report suggests that the Health Care for the Homeless model of care should be more widely adopted in order to best serve homeless families.

Abbreviations: Boston Health Care for the Homeless Program (BHCHP); Emergency Assistance (EA); Health Care for the Homeless (HCH); Massachusetts General Hospital (MGH)     

Social networks and sexual risk factor differences between cisgender heterosexual and cisgender LGBQ homeless youths

ABSTRACT

Cisgender lesbian, gay, bisexual, and queer/questioning (LGBQ) homeless youths are more likely to engage in sexual risk behaviors relative to cisgender heterosexual homeless youths. Homeless youths (N = 1,046) were recruited and surveyed from three drop-in centers in Los Angeles, California. This study assessed differences in demographics, background experiences, and perceived social network norms in order to understand the disparities in rates of unprotected sex and concurrent sex between these two subgroups. Results indicate significant differences in engagement in risk factors as well as social network norms. Findings provide support for tailored sexual risk-reduction interventions that cater specifically to LGBQ homeless youths.     

Homelessness and hunger

We employ data from the National Survey of Homeless Assistance Providers and Clients to examine the character and correlates of hunger among homeless people. Our analysis, couched in an adaptation framework, finds more support for the differentiation hypothesis than for the leveling hypothesis: Complex patterns of food insecurity exist at the individual level, and they vary with the resources available (e.g., higher monthly income, regular shelter use) and obstacles faced (e.g., alcohol, drug, and physical and mental health problems). The chronically homeless, who suffer from multiple deficits, appear particularly food-insecure, a finding that favors the desperation hypothesis over its street-wisdom alternative. We conclude that hunger is not uniformly experienced by members of the homeless population. Rather, some individuals are better situated than others to cope with the stressful nature of homelessness when addressing their sustenance needs.     

A Theory of Mental Health and Optimal Service Delivery for Homeless Children

Homeless children are a vulnerable group with high risk for developing mental health disorders. The pathways to disorders among homeless children have not been fully elucidated, with significant logistical and measurement issues challenging accurate and thorough assessment of need. The environments of homeless children are uniquely chaotic, marked by frequent moves, family structure changes, household and neighborhood disorder, parenting distress, and lack of continuous services. Despite high rates of service use, mental health outcomes remain poor. This paper reviews the literature on homeless children’s mental health, as well as prior theoretical explorations. Finally, the paper proposes a theoretical model that explains elevated rates of mental health problems among homeless children as consequences of harmful stress reactions triggered by chronic household instability along with repeated service disruptions. This model draws upon existing conceptual frameworks of child development, family poverty, health services utilization, and the biology of stress to clarify the role of environmental chaos in the development of child emotional and behavioral problems. Potential strategies to mitigate the risk for mental health disorders among homeless children and future research directions are discussed.     

Using WhatsApp for a homeless count

The study analyses how the use of instant messaging (WhatsApp) alongside other ICT tools is adequate to complement the count of homeless people in an area. In particular, it describes the methodology used in order to organize the first official count of homeless people in Girona (Catalonia, Spain). Given that this is the first count of individuals experiencing homelessness in the city, it is difficult to say that it is an improvement, but it could be suggested that the app might make the future counts more efficient. Both professional and volunteers and homeless people used WhatsApp to send information. A total of 283 homeless people were detected. Results show that the usage of this application optimized the results of the count. 36.1% of the data were obtained online. Homeless people, who were reluctant to contact directly with the professional team, used WhatsApp to communicate with them, adding up to 19.4% of the data obtained. Results show how communication between homeless people and health and mental health services can be potentially improved with this type of application.     

A place to heal: a qualitative focus group study of respite care preferences among individuals experiencing homelessness*

Homeless patients have longer hospital stays than housed persons due, in part, to a lack of safe discharge locations. Respite care for homeless individuals decreases hospital length of stay and readmissions rates. This study aimed to develop client-centered recommendations for medical respite care. We conducted four focus group interviews (n?=?25 participants) between August 2010 and February 2013 of homeless adult residents in Minnesota. Four domains of respite care were identified from content analysis of interviews: physical, relational, facilitation, and amenities. Novel recommendations include (a) a facility equipped to address mental health and substance dependence needs, (b) a standardized training protocol for respite staff, (c) the creation of a patient advocate, and (d) the creation of a respite case manager to facilitate post-discharge instructions and connection to primary care and social services. These new and actionable recommendations could help inform policies and the development of future medical respite care facilities.     

Improving Educational Opportunities for Students With Disabilities Who Are Homeless

Students who are homeless constitute a unique subset within today's school population; those who also have disabilities face even greater challenges. This article highlights the uniaue needs of students with disabilities who are homeless, legislative mandates for serving these students (the McKinney Act and the Individuals with Disabilities Education Act), and promising practices for overcoming educational and institutional obstacles to service delivery. Suggestions will focus on developing collaborative relationships at multiple levels, creating responsive systems through staff development and procedural revisions, and providing students with the social and instructional support they need to be successful.     

Youth homelessness and self identity: a view from Canada

ABSTRACT

This paper is based on the analysis of data collected from the National Canadian Homeless Youth Survey and addresses the question: why do some youth who received support from social service agencies that cater to the needs of homeless youth self-identify as being homeless while others do not? According to self-report survey data obtained from 1103 young people from over 50 youth homeless service centres from across Canada, findings show that youth who self-identified as being homeless shared several backgrounds and current situational characteristics not common among youth in the sample who did not consider themselves to be homeless. The findings illustrate the importance of past trauma and the intensity of day to day hardship in self-identifying as a homeless young person.     

Cold-related injuries in a cohort of homeless adults

People experiencing homelessness have an increased risk of cold-related injuries. This study determined the rate of emergency department (ED) visits for cold-related injuries among homeless adults and low-income controls in Toronto, Canada. Homeless individuals were recruited at shelters and meal programs. Age- and sex-matched controls living in low-income neighborhoods were selected. ED utilization was ascertained over 4-years of follow-up (2005–9) using administrative databases. A total of 16 ED visits for cold-related injuries were observed among 587 homeless men and 296 homeless women. The rate of ED visits was 6.7 (95% CI, 4.2–12.4) per 1000 person-years of observation among homeless men and 0.9 (95% CI, 0.03–5.6) among homeless women. ED visit rates were significantly higher among homeless men compared to low-income men (P?<?0.001) and significantly higher among homeless men compared to homeless women (P?=?0.03). Targeted public health interventions are needed to reduce the risk of cold-related injuries among people experiencing homelessness.     

Horizons for Homeless Children: A comprehensive service model for homeless families

Horizons for Homeless Children is a not-for-profit organization that provides services to homeless children and their families. The organization has two primary programs: the Playspace programs, which are children's recreation and informal education places set up in shelters, and Community Children's Centers, which provide full-time early childhood education for preschool homeless children and on-site job training and GED classes for their parents. This article summarizes the operational experiences of the organization and examines the efficacy of the services it delivers.     

Longitudinal cost of services in a homeless sample with cocaine use disorder

ABSTRACT

Homeless people with cocaine use disorder have multiple comorbidities and costly service needs. This study examined service costs associated with cocaine use and substance service use in substance, psychiatric, and medical service sectors. 127 homeless participants with cocaine use disorder were interviewed annually. Self-report and agency-report service use and cost data were combined. Pairwise comparisons were made with cocaine abstinence and substance service use in relation to mean and yearly proportional service costs in 3 service sectors. Among substance service users, the achievement of abstinence was not associated with decreased substance service costs. Cocaine abstinence was associated with proportional reduction of substance service costs over time. Substance service use was associated with proportional reduction of psychiatric service costs over time among the abstinent subgroup. Conversely, substance service use was associated with continuing higher medical service expenditures in the abstinent subgroup and higher psychiatric service expenditures in those not abstinent. Homeless individuals who achieved cocaine abstinence after using substance services had decreased substance service expenditures. Individuals with continued substance service use had greater medical and psychiatric service costs. Policy-based on maximizing benefits while minimizing costs appears insufficiently complex to incorporate the multiple needs and associated with the costs of treating homeless populations.     

Gender and Policy Implementation: Analyzing and Predicting the Progress of Congressional Bills Targeting Homeless Women, 1977–1987

This study examines congressional policymaking and funding support for homeless women during the 1980s. Contemporary research shows that this time period marked an important demographic shift in the composition of homeless individuals in the United States, as women, children, and families comprised a larger portion of homeless populations. Using Schneider and Ingram’s (1993; 1997) Degenerative Policy Design, I used logistic regression and predicted probabilities to analyze federal congressional bills on homelessness during a 10-year period from 1977 to 1988. Results indicate that bills targeting homeless women, children, and families increased over time, but there was substantive policy action for these groups. This aligns with Schneider and Ingram’s theory that groups like homeless women, who are constructed as dependent and needy but politically powerless, garner congressional elite sympathy but no monetary resources at the national level.     

Gender differences in health risks and physical symptoms among the homeless

Gender differences in health risks and symptoms are compared for a survey sample of 100 homeless persons and for the general population. Homeless men appear at greater risk of exhibiting symptoms. Nonetheless, homeless women report more symptoms, a result consistent with general population trends. Predisposing illnesses were the most accurate predictors of the number of reported symptoms, but gender explained a significant amount of variation in reported symptoms after other health risks were controlled. The findings inform the debate on the relative importance of biological factors, acquired risks, illness perception and behavior, and reporting bias in explaining why women report more symptoms in survey research. It appears likely that female reporting bias and gender differences in illness perception are underestimated in general population surveys because even under extreme conditions, men are less likely than women to report symptoms.