Obstacles to research analysis

1. The homeless population is composed of subgroups with varying mental health status and needs. 2. Different research designs and data collection methods require differing psychosocial abilities and skills on the part of the respondent. 3. As a result of the psychosocial abilities required and method of sampling, studies are likely to either underrepresent or overrepresent the severely mentally ill homeless. 4. Caution must be exercised in drawing conclusions from any one study.     

Health Issues of Homeless Youth

The purpose of this paper is to provide an overview of what is currently known about the health issues of homeless youth, focusing on risk-taking behaviors, health status, and access to care. The paper addresses the health issues of homeless youth in the U.S. within an international context. Existing data suggest that homeless adolescents exhibit high rates of risk-taking behaviors, face additional barriers to access of health care, and suffer from a high burden of poor health. However, most research on the health of homeless youth has been cross-sectional and has relied on convenience sampling. Future research should focus on conducting more methodologically rigorous studies on the specific health needs of homeless youth. Research should include eliciting information directly from the youth about their preferred health care interventions.     

Barriers and facilitators to shelter utilization among homeless young adults

Rates of shelter use among homeless youth are low compared to use of other supportive services, yet research on barriers to shelter use has been conducted in limited regions, specifically in West Coast or Midwest cities. Additionally, while studies have generally focused on barriers to shelter use, studies on what might facilitate shelter use are lacking. This study explores barriers and facilitators to shelter use among homeless young adults from a large city in the Southwest region. Focus groups were conducted with a diverse sample of 49 homeless young adults ages 18–24. Drawing on models of health service use, findings were categorized into two domains – attitudinal and access. Themes related to attitudinal barriers include stigma/shame and self-reliance/pride. Attitudinal facilitators include the desire to extricate themselves from street life and turn their lives in a new direction. Access-related themes include barriers such as a lack of shelters and services available to meet the needs of youth, adverse shelter conditions, staff attitudes that are not acceptable to youth, restrictive shelter rules, restrictive definitions of homelessness, and a desire to differentiate themselves from older homeless individuals. Certain characteristics or circumstances (e.g., being pregnant), having supportive others, and shelters’ ability to connect them to other services emerged as access facilitators to shelter use. Implications for policymakers, service providers, and future research are discussed.     

Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective

This article reports on results of a one-day public health survey conducted in six states by homeless youth providers to measure and compare risk factors between lesbian, gay, and bisexual (LGB) homeless youth and non-LGB homeless youth. This article intends to inform the child welfare field on existing gaps in services and areas where more training and technical support is necessary in providing services to homeless LGB youth. The findings point to substantial differences within the homeless youth sample and demonstrate that in addition to the public health risks young people face merely by being homeless, the risks are exacerbated for those who self-identify as lesbian, gay, or bisexual. The article informs child welfare providers and policymakers about the substantial vulnerability of LGB youth beyond that of non-LGB homeless youth and the need to fund programming, training, technical assistance and further research to specifically respond to the complex needs of this population.     

Public health research – multidisciplinary,high-benefit,undervalued

The major health problems faced by policy-makers and practitioners at national and local levels require public health approaches. However, public health research is the “poor relative” of biomedical research: it is worthy, but not rich. In the European Commission's health research programme, biomedicine gets 90% of the funding, whereas public health research gets less than 10%. This pattern is repeated nationally in most countries, reflecting public policies to support industries – pharmaceuticals, biotechnology, medical devices – where profits are to be made, rather than not-for-profit, public health research. SPHERE, a study coordinated through the European Public Health Association, conducted bibliometric analyses across public health research themes and mapped the European and national structures and priorities for research. Whilst most European countries have national strategies (and some programmes) for public health, few have public health research strategies and the coordination of public health research is weak. Three further studies are being undertaken. In STEPS, the contribution of civil society organizations in the new EU member states to public health research will be discussed at national workshops with the ministries of health, the science/research councils and the national public health associations. In PHIRE, thematic Sections and the national member associations together evaluate the impact of European-funded health projects within member states. In FAHRE, the specific theme of food and health will be addressed, bridging industry and non-profit research sectors. Arguments for public health research can be made through lobbying at European level, but researchers and practitioners also need to influence the development of public health research within individual countries – leading to a European Public Health Research Area.     

Vignette development and administration: a framework for protecting research participants

This paper is a discussion regarding vignette development and administration as a means of protecting research participants in social research. Health and social care researchers investigate a plethora of issues that may be sensitive or upsetting, for example, abuse or bereavement. This exposes participants to potential emotional harm caused by revisiting the original trauma. Using research methods that offer a protective layer is important. Evidence suggests that vignettes provide protection for research participants by placing distance between their experience and that of the vignette character. However, there are few methodological papers regarding vignette use. Utilising examples from our own research, we engage in a critical discussion regarding vignette development and administration. The paper offers a new framework to support researchers – particularly those in health and social care – in the development and administration of vignettes. We contend that the framework supports best practice in vignette use, particularly when researching sensitive issues.     

Incorporating translation into sociolinguistic research: Translation policy in an international non‐governmental organisation

This article explores aspects of translation, multilingualism and language policy in the field of transnational civil society. By focusing on translation policies at Amnesty International, an international non‐governmental organisation that performs a key role in global governance, this article seeks to contribute to a globalisation‐sensitive sociolinguistics. It argues that combining a sociolinguistic approach – more precisely linguistic ethnography – with translation studies leads to an increased understanding of the language practices under study. Furthermore, the article calls for more interdisciplinary research, stating that there is space for sociolinguistics and translation studies to contribute to research in international relations and development studies by highlighting the role of multilingualism and challenging the traditionally powerful position of English in transnational civil society.     

Experiencing Homelessness: A Review of Recent Literature

Homelessness holds a longstanding place on the sociological research agenda, and has become particularly prominent in sociological literature since the 1980s. Recent literature reviews have summarized this research, but have only briefly considered the body of work focused on the experience of homelessness. I use this literature review to provide a more complete summary of this work on the daily lives, activities, subcultures, social relationships and networks, and social interactions of homeless individuals. I then explore variations in these experiences across important characteristics – such as gender, race and ethnicity, family status, and sexual orientation – as well as within three particular contexts that have been studied by sociologists: the streets, shelters and other service organizations, and social movements and collective action. I also consider how the homeless encounter and manage stigma and salvage the self. In addition to reviewing this literature, I consider how this work contributes to sociological understandings more broadly, and potential future research directions.     

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.     

Resolving design issues in developing a nutrition app: A case study using formative research

Mobile phone apps have become ubiquitous in health, but they often fail to demonstrate effectiveness in achieving behavior outcomes among intended users. A failure to conduct formative research on app content or functions may contribute to some of this shortfall. We describe simple research procedures we followed when building a nutrition app for low-income household cooks. Our studies improved the placement and design of key screen controls, helped select and guide an illustrator who created graphic support for textual content, and tested whether adding secondary users to the primary audience would attract additional app use.Whether because of these preliminary tests, or for other reasons, our app has generated heavy use by its intended market and has demonstrated desired effects on client behavior. We offer our experiences in formative evaluation as potential tools for other app developers to adapt to their circumstances.     

Remembering,Apologies, and Truth: Challenges for Social Work Today

Abstract

In 2003, over 41?000 families with accompanying children throughout Australia were assisted by homeless services. Sole fathers with children in their care who are homeless are a minority group within this overall population of homeless families and, as such, little is known about their experiences of homelessness and fathering. The present paper reports on an exploratory study of sole fathers with children in their care who were homeless in the Australian Capital Territory. The study identifies the fathers’ pathways into and experiences of homelessness, and the fathers share their stories of what it means to be a sole father. The paper identifies the issues fathers may experience when dealing with homelessness and fatherhood. An increased understanding of these experiences can contribute to the development of further research and improved practice with such families.     

Social support among homeless and housed mothers: an integrative review

Homelessness has been associated with levels of stress beyond the normal strain of living in poverty. For mothers who are homeless, support from their social networks may provide a buffer from some of the stresses associated with being homeless. To better understand the relationship between social support and female-headed homeless families, an integrative review was conducted of 12 research articles that compare social support among low-income housed mothers and homeless mothers, using guidelines set forth by Ganong. The included studies revealed four significant attributes of social support among housed and homeless mothers: size of the social support network; composition of the social support network; contacts with members of the social support network; and perceived support from members of the social support network. Nurses who work with homeless families are in a position to help develop ways for these families to cultivate and maintain their social support networks while homeless. Nurses can be available to offer support, including the necessary mental health services or referrals.     

Men with learning difficulties doing research: challenging views of learning difficulties

This paper explores the views of men with learning difficulties living in a secure environment. Reflecting findings from a doctoral thesis based upon a research project where the participants looked at the processes and concepts of research, the dialogues within the study were analysed using critical discourse analysis. Thesis aims relevant here include investigating given ‘truths’ about the positives of having a learning disability. The men are not only categorised as having a learning difficulty, but also have the added stigma of being offenders, and commonly having mental health issues which expose them to the worst of myths surrounding learning difficulty. Despite this, the findings suggest that the men are very positive about their lives – reporting that they have many attributes and talents – and view having a learning difficulty as an advantage at times. This affirms Foucauldian ideas on the way that dominant knowledge may be challenged.     

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.     

Psychosocial Problems Associated With Homelessness in Sexual Minority Youths

Sexual minorities are overrepresented among homeless youths, and this is often related to reactions to their status as sexual minorities. While on the streets, they are at increased risk for victimization, substance and alcohol use, sexual risk behaviors, and mental health issues compared to homeless heterosexual youths. This article uses ecological systems theory to examine psychosocial problems associated with homelessness among sexual minority youths and reviews empirical literature examining outcomes related to homeless sexual minority youths including mental health, substance use, and sexual risk behavior. Implications for social work are discussed including practice, policy, and suggestions for future studies.     

“I’m not homeless,I’m houseless”: identifying as homeless and associations with service utilization among Los Angeles homeless young people

Little is known about homeless young people’s identification of being homeless and how that identity may or may not be associated with service utilization. This study of 444 homeless young people attending Los Angeles area drop-in centers explores the associations of demographic characteristics, homelessness characteristics, negative lifetime experiences, mental health symptoms, technology use, and past month service utilization with identifying as homeless. Fifty-two percent of the sample identified as being homeless. Being Black, a current traveler, and history of injection drug use were all significantly associated with a decreased likelihood in identifying as homeless. However, having fair/poor health, accessing shelter services, and reporting one’s own substance use as a reason for homelessness were all significantly associated with identifying as homeless. There are important service implications for reaching young people who are in need of services but may not identify with the target population label of homeless.     

The health of the homeless

Studies of homelessness and health date back to at least the 1970s. The current paper presents a summary on the state of the literature on homelessness and health since the onset of Housing First initiatives. Housing First initiatives represent a change in the previously used model used by social services providers and government agencies from recovery first to housing first, a recognition that homeless people should be housed before contending with other issues such as mental health treatment. Since this time, researchers have pushed research inquiry into areas that were only touched on lightly before. These new areas of research fall generally into that categories of access and utilization, newer demographics, and emerging health concerns. Each of these areas is thoroughly reviewed in the paper. Despite Housing First legislation, homelessness continues to threaten the health of the urban population and will continue to do so as long as it is allowed to persist.     

Swimming upstream: The challenges and rewards of evaluating efforts to address inequities and reduce health disparities

Racial and ethnic disparities in the health of Americans are widespread and persistent in the United States despite improvements in the health of Americans overall. Increasingly, strategies for reducing disparities have focused on addressing the factors that contribute to – if not fundamentally underlie – health disparities: social, economic, and environmental inequities, which limit access to resources and cause unhealthy exposures. As public health shifts to interventions that seek to improve the circumstances of disproportionately affected populations and achieve equity through policy change, alternative methods to evaluate these efforts are also required. This paper presents an example of such approaches to addressing asthma disparities through Regional Asthma Management and Prevention's (RAMP) programmatic efforts and an evaluation of these activities. The paper describes RAMP's targets and strategies, as well as the specific evaluation methods applied to each, including activity tracking, observations, surveys, key informant interviews, and case studies. Preliminary evaluation findings are presented, as are lessons learned about the efficacy of the evaluation design features – both its strengths and shortcomings. Findings discussed are intended to contribute to the growing literature that provides evidence for the application of emerging approaches to evaluation that reflect non-traditional public health and support others interested in expanding or replicating this work.     

Stress,Coping, and Mental Health Differences among Homeless People

People who are chronically homeless are assumed to have higher rates of mental health problems than episodically or new‐entry homeless individuals. It is unclear to what extent early‐life and current stressors account for this disadvantage. Guided by cumulative disadvantage theory and stress research, we analyze data from a national study of the US homeless population to examine how stressors and coping resources throughout the life course are implicated in differences among homeless people in psychiatric disorders and alcohol or other drug abuse disorders. Logistic regression analysis reveals that new‐entry homeless persons are less likely than their chronically and episodically homeless counterparts to have current psychiatric disorders. This is explained by stressors and coping resources experienced in childhood and during adult homeless spells. Alcohol and other drug abuse is common but comparable across the three homeless types and shares an association with selected stress and coping measures. Findings lend credibility to an accumulation of risks perspective, highlighting how past as well as contemporaneous stressors are related to the mental health of homeless people.     

Health care innovations for homeless families: Emerging opportunities under Medicaid and the Affordable Care Act

Prior to the Patient Protection and Affordable Care Act of 2010 (the ACA), the US health care system left many low-income families facing limited access to medical care, struggling with high-health costs, or lacking health insurance altogether. The ACA aims to increase access to care, improve the quality of care, and lower total health care costs. While the ACA can benefit all individuals and families, it has significant potential for expanding and improving services for those experiencing homelessness. This paper describes specific opportunities under the ACA and Medicaid that can be used to strengthen services for homeless families and provides examples of efforts under way. It also offers guidance for how homeless service agencies can effect change in their respective states. The examples described here are promising approaches to strengthening homeless services. Pursuing these ideas for homeless families will require initiative, creativity, and perseverance, but recent progress is encouraging.