The use of photovoice with people with intellectual disabilities: reflections,challenges and opportunities

Photovoice is part of the growing use of participatory research approaches with people with intellectual disabilities. In this paper we explore the process, opportunities and challenges associated with the use of photovoice with people with intellectual disabilities, illustrated through a research project entitled ‘This Is Me’. Photovoice requires researchers to share power and control in the research process and to tolerate uncertainty. Large investments in time and money are also required. These challenges, however, are outweighed by the benefits of the use of photovoice with people with intellectual disabilities. Photovoice creates a space where people with intellectual disabilities can meaningfully participate and exert control in the research process, and as such is an empowering experience. As a participatory research approach, photovoice is accessible and offers the opportunity for people with intellectual disabilities to develop new skills, confidence and experience inclusiveness in their own terms.     

Suicidality among homeless people: Testing the mediating effects of self-efficacy and depression

ABSTRACT

This cross-sectional study examined the mediating effect of PTSD on suicide ideation and suicide attempt through two mediators, self-efficacy and depression, among homeless adults. We recruited a non-random, purposive sample of 156 homeless adults from seven homeless people shelters in Kansas. SEM results suggest that self-efficacy and depression were significant mediators between PTSD and suicide ideation, but not between PTSD and suicide attempt. This study’s findings can be used to identify risk factors associated with suicidal behaviors that can be used to design service programs aimed at preventing suicidal ideation and attempt among people who are homeless.     

Rolling forward: addressing needs in the homeless community

ABSTRACT

The purpose of this pilot study was to use a bottom up, or grounded, approach to understand, from the perspective of the individuals living in the homeless community, what they feel would enable them to become housed and stay permanently housed. Organizations which serve homeless individuals often use a top down approach and implement programs without asking the homeless what they most need to find permanent housing. This project used intensive interviews to determine the needs of unhoused individuals in a mid-sized city with a tourist-centered economy in the south eastern United States. Working local homeless shelters, and various other intermediaries we collected data from 102 homeless individuals and 11 service providers. The major theme that emerged in our research is that the homeless individuals we interviewed were, for the most part, they were able to meet many of their basic needs, such as securing food, clothing, a place to bathe and wash their clothes, as well as obtain physical and mental care. However, they perceived lack of reliable and affordable transportation to be a significant barrier to obtaining and maintaining employment, making and keeping appointments, and maintaining their social support network.     

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.     

Sense of community through supportive housing among formerly homeless individuals with serious mental illness

Much research documents the correlation between homelessness and mental illness. Often, existing research focuses on deficits that live at the intersection of these phenomena. The present study utilizes a sense of community (SOC) framework to interrogate the ways in which formerly homeless individuals with serious mental illness perceive and experience community in supportive housing. Through focus groups with 18 consumers, this study contextualizes dimensions of SOC (membership, emotional connection, needs fulfillment, and influence) for the aforementioned population. Analysis of focus group data produced 16 themes and subthemes that support and extend our understanding of SOC for a population often conceptualized as isolated and alone. Implications for policy and practice emphasize: (1) the importance of supportive housing communities and the call for policymakers to increase funding for such programing; and, (2) that practitioners facilitate housing members’ voices to effectuate change in supportive housing and increase SOC.     

Moving On From Supportive Housing (MOSH): Development and evaluation of a transitional skill-building curriculum for providers helping residents exit homeless services

This article describes the development and evaluation of MOSH (Moving On From Supportive Housing), a transitional skill-building curriculum for providers helping residents exit homeless services to mainstream housing without embedded supports. In this evaluation, we assess the feasibility, acceptability, fit, and potential efficacy of the MOSH curriculum to improve proximal provider-level outcomes, including self-efficacy to provide MOSH-related independent living skills and supports. Homeless-services providers (N = 49) from a range of programs and settings participated in the training. Findings from focus groups and pre- and posttest surveys indicate high levels of overall satisfaction with the training. The majority of trainees perceived the training to be useful to their work and potentially useful for service recipients, felt the training would fit well within their existing day-to-day work, and said they were very likely to use MOSH skills in such work. Statistically significant improvements in self-efficacy regarding all skills but one were also found. MOSH holds promise as an intervention that can enhance provider practice and promotion of independent living skills in homeless services. Although these initial findings on MOSH are encouraging, further research will be needed to evaluate provider knowledge gains and effective use of these skills in practice.     

Impact of a supported housing prioritization system using vulnerability and high service utilization

For people experiencing chronic homelessness, supportive housing with intensive social, health, and behavioral health services reduces the likelihood of re-entering homelessness and the public costs of associated acute medical care, shelter use, and incarceration. Due to a limited supply of supportive housing, it must be allocated to those most in need. This paper examines findings from a unique, region-wide method for prioritizing individuals for supportive housing based on utilization of high-cost public services and vulnerability if left on the street. A sample of 196 individuals were prioritized for housing based on this method, while a comparison group of 102 were housed not using the method. Results showed that those housed under the prioritization method achieved greater reductions in utilization of high-cost public services, but were also less likely to have positive dispositions when exiting the housing programs, suggesting the need for a greater intensity of supports and/or multiple “doses” of supportive housing before stability can be expected. The method described in the paper can provide a starting point for developing regional, comprehensive systems of coordinated, prioritized entry into supportive housing, such as those now required by US Department of Housing and Urban Development.     

How to integrate digital media into a drop-in for homeless young people for deepening relationships between youth and adults

This paper reports on a curriculum called New Tech for Youth Sessions, designed for homeless young people, aged 13-25. Motivated by the ordinariness of digital media and its importance in communicating with society's institutions, the primary goal of the curriculum was to develop students' life skills for information technology and digital media. A crucial secondary goal was to position students to recognize their self-worth, through meeting challenges, positive communication with adults, and reciprocal peer support. The paper describes how these goals were addressed by incorporating a community technology center into a multi-purpose drop-in for homeless young people and by a curriculum that guides students through an integrated series of activities related to finding employment. The paper discusses the principles underlying the curriculum, the class processes, and the social structure that supports the learning environment. A far-reaching result, based on offering 13 classes to over 75 youth over 16 months, is the hypothesis that instruction in digital media can create visceral, life-affirming experiences of challenges overcome, which can help strengthen relationships between the youth and the drop-in staff. The paper concludes with a discussion of lessons learned for incorporating digital media into drop-ins for enabling access and for improving life skills.     

Prevalence and correlates of diabetes mellitus among homeless veterans nationally in the Veterans Health Administration

Abstract

Background: Homeless people are at high risk for many chronic medical conditions although their risk of diabetes has not been well studied. Current epidemiological studies of diabetes prevalence among homeless adults have been based mostly on self-report data not supported by clinical assessments.

Objectives: To determine the prevalence and risk factors for diabetes mellitus (DM) among homeless veterans in the Veteran Health Administration (VHA).

Methods: The sample included 3?464?364 veterans with documented body mass indexes (BMI), 137?720 (4%) of whom had been homeless. Logistic regression models were used to determine the odds of having DM among homeless veterans compared to non-homeless veterans. Bivariate and multi-variate analyses were then used to identify potential risk factors for DM among homeless veterans.

Results: The prevalence of DM in homeless veterans was 19%. Homeless veterans with DM, compared to those without it were older, more likely to have a BMI?>?40 and more likely to have DM-related co-morbidities.

Conclusions: There is a high prevalence of DM among homeless veterans in the VHA compared to previous reports for homeless adults (8%). Tailored approaches to improve access to DM screening, prevention, and treatment could benefit homeless veterans.     

Housing interventions for homeless,pregnant/parenting women with addictions: a systematic review

Family homelessness is a growing problem in North America with most of these families headed by single women. Homeless women also experience high rates of pregnancy and addiction (drugs and alcohol). Housing interventions have been identified as key to addressing the complex needs of pregnant/early parenting, homeless women with addictions. The aim of this systematic review is to determine what housing models and programs for this population yield the best outcomes. We systematically searched 10 databases and retrieved eight articles describing four distinct studies that met the inclusion criteria for this review. Overall, improved outcomes were found for all intervention groups with the most recent and rigorous studies favoring models combining Housing First and case management. However, methodological limitations, study quality, and varied outcomes made comparison across studies difficult. Further research must be done in this area using standardized outcomes and rigorous designs to develop evidence-based best practice guidelines to address the unique needs of this population.     

A community of singers: employing exploratory cluster analysis to reveal profiles of psychosocial characteristics among members of a street choir for homeless and formerly homeless individuals

This exploratory study employed cluster analysis to identify profiles of resilience, social support, stress, and mental health among members of a homeless and formerly homeless street choir; we examined the association between choir attendance and cluster membership, and the interaction of cluster membership and race. Respondents (N?=?111, 66% African American, 84% homeless) had participated in the choir for an average of 12 months (SD?=?12.02). We stratified the analysis according to homelessness status. Among those housed, k-means cluster analysis revealed two profiles: (1) relatively resourced but lower resilience, and (2) high resilience. Three profiles emerged among the homeless: (1) psychologically vulnerable, high stress and mental health concerns; (2) relatively resourced, showing average levels of mental health concerns and social support, minimally elevated stress, and higher resilience; and (3) low resilience. Examining the interaction, non-African American, housed participants in the high resilience cluster reported the most frequent choir attendance (M?=?4.00, SD?=?0.00); among the homeless, non-African Americans in the psychologically vulnerable cluster reported the most frequent attendance (M?=?3.88, SD?=?1.25). Results support the need for programs that address higher order needs concurrently with housing; they also highlight the ongoing need to provide particular outreach to minority populations.     

Home for now: A mixed-methods evaluation of a short-term housing support program for homeless families

The use of short-term rental subsidy vouchers offers a new approach to addressing the housing needs of families facing homelessness. In Massachusetts, the Family Home pilot program placed homeless families in housing instead of shelter, providing two years of rental subsidy plus support services with the goal of enabling families to maintain market rate housing. This mixed-method case study complements staff and participant interview data with participant survey and administrative data to evaluate the implementation and short-term outcomes of Family Home in one region. Data point to improved family well-being in housing but also persistent barriers to achieving longer-term housing and economic stability. Of the families who had exited the program at the end of the study, one quarter were able to retain their housing at market rate, only 9% returned to shelter, and one in five moved in with families/friends. Lack of affordable housing in a high rental cost region and jobs that pay living wages were among the major reasons that families struggled to maintain housing. This research points to the need for integrating supportive services from the program's start, including targeted workforce development, to plan for the end of the short-term rental subsidy.     

The system-of-care for homeless youth: perceptions of service providers

Service providers' perceptions of the system of care for homeless youth are described. Face-to-face structured interviews were conducted with staff at homeless youth agencies in Los Angeles County (L.A. County) regarding organizational and staff characteristics, issues affecting youth, types of available services, gaps in services, and barriers to service delivery.Overall, agencies were large, well established, and provided multiple services. Most agencies (62%) were concentrated in Hollywood, a cruise area of L.A. County. Clear distinctions emerged between large and small agencies; large agencies had more resources, more professional staff, were established longer, and were policy advocates. Typical of other US metropolitan areas, services for homeless youth in L.A. County are located in cruise areas, and are not as readily available in other geographic areas. Such geographic barriers to providing a comprehensive and coordinated system of care can affect youth's pathways out of homelessness.     

Changing Attitudes Toward the Homeless: The Effects of Prosocial Communication With the Homeless

One hundred, thirty-four undergraduate students participated in afield experiment designed to examine the effects of extended, prosocial communication with homeless persons, upon attitudes toward the homeless problem, of behavioral intentions towards the homeless, and of causal attributions about homelessness. It was expected that prosocial interaction with the homeless would produce shifts in attitudes and behavioral intentions toward the homeless and homelessness and result in greater attributions of external causes to explain homelessness. Nineteen experimental participants worked 15 hours at a local homeless shelter. Their responses to a posttestquestionnaire that measured a range of attitudinal and behavioral orientations toward the homeless were compared with control participants who did not work at the shelter. Subsequent analyses furnished strong evidence of positive changes in attitudes and intentions toward homelessness among the shelter workers. These participants evaluated homeless people as less blameworthy and more socially attractive than did control participants; moreover, shelter workers indicated more personal responsibility and behavioral commitment to helping the homeless than control participants. They also perceived the homeless problem to be more serious and were more likely to attribute homelessness to bad luck than control participants. However, the two groups were equally likely to attribute homelessness to various external causes such as the economy, housing costs, and governmental policies. The results are interpreted as having policy implications for volunteer service.     

Using Photovoice as a method to examine microaggressions: Conceptualizing culturally competent practice and curriculum with Asian Americans

ABSTRACT

In recent years, the racial microaggressions has increased significantly in the social work education and negative impact of racial microaggressions on individual’s family and group in their community well-being. Microaggressions can occur out of misunderstanding and lack of awareness of cultural differences and similarities. Microaggressions also are common everyday whether intentional or unintentional. The purpose of this study is to examine the evolving methodology, usage of photovoice, and conceptualizing culturally competent practice and curriculum with Asian Americans.     

A qualitative analysis of suicide risk factors,preferred means,and means restriction feasibility within a homeless shelter environment

Suicide completion rates among homeless individuals are approximately nine times higher than the general population. The purpose of this study was to capture the state of social support among homeless individuals, understand how homeless community members support peers in crisis, examine the awareness of suicidal ideation, identify common methods for suicide, and generate strategies for means restriction within a shelter. Twenty individuals residing at an emergency shelter were interviewed. Participants were of diverse cultural identities overrepresented in the sample relative to the general population. Interviews revealed that 40% of participants lacked social support. However, the majority indicated that if they encountered someone at risk for suicide, they would provide support and encouragement to the at-risk individual. Almost half of participants reported knowing of an individual in the shelter who had previously attempted suicide and/or was currently or previously feeling suicidal. Overdose was identified as a primary method for suicide; however, the majority of participants were unable to generate strategies for means restriction. The present study offers a glimpse into the experience of homeless individuals and provides valuable information regarding risk factors for suicide within this highly marginalized and underserved population.     

Social work and applied theatre: creative experiences with a group of homeless people in the city of Seville

This article presents a series of creative social intervention experiences developed with a group of homeless people in the Spanish city of Seville. These experiences are part of an applied research project that uses theatre as a tool to aid social work, and they are led by a group of homeless people who have become actors through this initiative. The group is known as ‘Theatre of Inclusion’ and has been running for a decade now. Using group social work and applied theatre techniques, this initiative creatively exposes the needs of this collective and also generates spaces in which they can reclaim their dignity. The systematisation of these experiences highlights the potential of combining disciplines such as social work and theatre to work with vulnerable collectives, in the same way Jane Addams did. The aim is also to move beyond the dominant welfare proposals in place in Spain currently, which are intended to meet the needs of homeless people.     

Factors preventing the social reintegration of homeless persons: A comparison between residents of long-stay hostels and individuals living on the street

Homelessness is a major social issue in all Western countries. In France, many homeless persons do not have access to the accommodation and help with social reintegration provided in long-stay hostels, and remain on the streets or in other forms of emergency shelter. The objective of the present study is to identify the variables preventing access to these hostels and, more generally, to a process of social reintegration. We compared a group of 10 individuals housed in long-stay hostels with a group of 16 who were still living in the streets. All participants were assessed on the Hospital Anxiety and Depression Scale and underwent a semi-structured interview. Results showed that individuals who had not been admitted to a hostel were characterized by high levels of depression and anxiety, the attribution of responsibility to external factors, a vagrant lifestyle, a lack of social support, a negative approach to reintegration, and an inability to look to the future. This study highlights various factors explaining the reintegration difficulties encountered by a proportion of the homeless population. It suggests new ways of improving support for the homeless.     

The experiences of “aging” among formerly homeless adults with chronic mental illness: A qualitative study

Little is known about the life course of older adults with serious mental illness who have also been homeless. Using 44 life history interviews with 25 study participants ages 40 to 62, this study used case study and thematic analysis to examine the lived experience of such individuals as they enter their mid- and later-life years. Participants, whose lives were marred by early-onset substance abuse, symptoms of mental illness and a descent into homelessness, spoke of an awareness of aging and premature mortality. Major themes that emerged were: (1) reflecting on losses, (2) growing older and wiser, (3) struggling with normality, (4) having space and time to reevaluate, and (5) awareness of the future and “time left.” Life histories which focus on the person-in-context and their subjective experiences provide a viable research method to further the understanding of one of the most underserved and hardest-to-reach populations.