Characteristics of the Homeless Mentally III in Case Management: Differentiation Using Major Diagnostic Categories

The homeless mentally ill are more disabled than other homeless people and require more services, but important variations exist. This study examined relationships between broad Axis I diagnostic clusters and demographic and service variables for 328 clients receiving case management at a community program for the chronic mentally ill homeless. Demographic characteristics, medical history, educational, psychological, and marital history, and case management variables were examined for psychotic, affective, and miscellaneous other clients. Differences were found in such areas as suicide attempts and current suicide status, psychiatric treatment history, education, overall impairment of functioning, length of time homeless, and time in case management but not in status at termination or number of senlices required. Psychotics had lower adaptive functioning, spent less time in case management, but had as successful outcomes as affective clients. Psychiatric diagnosis provides information that might assist case management for the homeless mentally ill.     

Tracking residential outcomes of supported independent living programs for persons with serious mental illness

This study seeks to document patterns and reasons of leaving housing, and identify factors associated with different types of exits for a cohort of 452 residents with serious mental illness entering supported independent living (SIL) in Philadelphia, PA. The study cohort was tracked through an integrated administrative database comprised information on basic demographic and clinical characteristics, length of stay, homeless shelter use, and publicly funded behavioral health services use. A convenience sample of 46 SIL leavers and their support staff provided data on scenarios of leaving. The findings of this study suggest that departure from SIL is not a unitary phenomenon, but involving plausibly favorable as well as unfavorable circumstances. Multivariate analysis based on administrative tracking data suggests demographic and clinical factors, housing setting, and service use factors to have effects on leaving SIL and distinct types of exit examined in this study. Data procured from the convenience sample highlight the potential roles that program rules and resident–staff relationships play in affecting housing tenure. Implications of the findings for the development of permanent supportive housing for persons with serious mental illness are discussed.     

A habitus of instability: youth homelessness and instability

This research introduces the concept of a habitus of insecurity to account for the lives of homeless young people. It outlines how conditions of existence are internalised and how homeless young people come to expect and in turn recreate instability in their lives. This research addresses the internalisation and naturalisation of experiences of instability, insecurity and marginalisation and how people can come to subjectively aspire to what they are socialised to see as objectively probable or ‘for the likes of them'. The research draws on ethnographic research and participant observation to examine the complex lives of homeless young people and how they are shaped by instability and insecurity inculcated before, during and after experiences of homelessness. This research highlights that people should not be defined merely by their experiences of homelessness of housing status, but by the complex array of conditions that shape their lives.     

Characteristics of urban male homeless veterans and non-veterans in Omaha,Nebraska

The current study examined differences between urban homeless veterans and non-veterans on sociodemographics, housing, clinical characteristics, and psychosocial factors. We recruited a sample of 196 homeless men (101 veterans, 95 non-veterans) from the Omaha, Nebraska metropolitan area. Structured interviews were conducted by research staff. The results showed that the two groups were similar in most respects, though there were several notable differences. Homeless veterans were found to be older and more educated than non-veterans, more likely to have married, and reported having fewer non-adult children. Multivariable models controlling for age further showed that veterans reported a higher number of medical problems and were more likely to report being diagnosed with major depression or PTSD than non-veterans. Comparison with previous studies suggests changes in certain characteristics of homeless veterans over the past few decades that may reflect the growing proportion of veterans from the all-volunteer force, initiated after the draft ended in 1975. Findings from this study were consistent with previous comparative studies suggesting limited changes in recent decades in the characteristics of homeless veterans as compared to non-veterans, although the high prevalence of major depression and PTSD merit special treatment for these disorders.     

The family caregiving context among adults with disabilities: A review of the research on developmental disabilities,serious mental illness,and traumatic brain injury

ABSTRACT

A majority of adults with serious disabilities are cared for in the home by family members. Guided by an ecological framework, this article presents the findings of a literature review of research on family caregiving and family support for adults with disabilities. This review included 33 research studies published between 2000 and 2015 focused on three disabilities: Developmental disabilities, serious mental illnesses, and traumatic brain injury. A synthesis of the findings underscores the critical role that family caregivers occupy in addressing the needs of their loved one with a disability; however, the needs of the caregiver are insufficiently met by existing service approaches. A better understanding of the unique needs and strengths of the family support context of caregivers and care recipients is needed, giving greater attention to ethnic, racial, and cultural considerations in future research.     

An investigation of predictors of mental health in single men and women experiencing homelessness in three Canadian cities

Homelessness is related to poorer mental health, yet, there is limited understanding of the predictors of mental health of men and women experiencing homelessness. To support service providers in identifying individuals who might be at particular risk of poor mental health, this study investigated the predictors of mental health in 501 single men and women experiencing homelessness in Vancouver, Toronto, and Ottawa, Canada. Data were obtained via in-person, structured interviews. In order to identify whether predictors differ by gender, multiple linear regressions were conducted separately for men and women. Mental health status was measured by the Mental Component Summary score of the 12-item Short-Form Health Survey. Better mental health for men and women was associated with the presence of fewer chronic health conditions and a higher level of social support. An older age, not having experienced a recent physical attack, and absence of a mental health diagnosis were related to better mental health for women. The absence of unmet mental health needs within the past 12 months was associated with better mental health for men. The study highlights differences in factors associated with mental health for men and women. Service providers should be aware of the association of these factors with mental health to guide assessment and service planning.     

Language policy,homelessness and neoliberal urbanization: The case of San Francisco's Union Square

One example of the impact of neoliberalism on urbanization is that of the Business Improvement District (BID), where business and property owners collectively manage a district to ensure that it has an appropriate ‘business climate’. The responses of BIDs to the language practices of the homeless, such as panhandling, tend to be ambivalent because homelessness is an issue that requires sensitivity. Nevertheless, overly aggressive panhandling can have adverse repercussions for businesses. This paper focuses on San Francisco's Union Square, which is the city's commercial retail center, and makes two key points. One, language policy needs to be viewed as planned, unplanned or transgressive, where these characterizations are necessarily from the perspective of an specific actor, such as the Union Square BID. Two, there are interesting attempts to transform panhandling practices from above, pushing these towards neoliberalism with the consequence that the panhandlers themselves sometimes respond by reimagining panhandling as work or a business.     

Intersection of homelessness and mental health: A mixed methods study of young adults who accessed psychiatric emergency services

Young adults who experience homelessness have high rates of mental disorders, yet low rates of outpatient mental health service use. This mixed methods study examined the intersection of homelessness and mental health in a sample of 54 young adults (ages 18–25) who were hospitalized on a short-term, inpatient psychiatric unit. Nearly half (n = 26) reported being homeless in the prior year and more than a quarter were homeless at the time of admission (n = 15). Qualitative analyses identified key factors that contributed to both mental health problems and homelessness including disrupted support networks, fragile family relationships, foster care involvement, substance use and traumatic events. Homelessness was both a facilitator and a barrier to successfully accessing mental health services to manage mental health symptoms. Findings highlight the interconnection of homelessness and mental health and their common relationship with additional underlying risk factors. Providers across service settings need to recognize the overlap of client populations and provide integrated, trauma informed care to address housing instability, mental health, and substance use together.     

A theory based evaluation of an intervention to promote positive health behaviors and reduce social isolation in people experiencing homelessness

ABSTRACT

Homelessness adversely affects an individual's ability to access healthcare, opportunities for social interaction and recreational activities such as physical activity. This study aimed to evaluate the impact of a community-based physical activity and peer support intervention on the health and wellbeing of homeless participants. This study employed semi-structured interviews to investigate the perceived impact of the Street Fit Scotland intervention on the health and wellbeing of 10 homeless adults. Interviews were audio recorded and transcribed verbatim. A thematic analysis was conducted. Participants reported that their health and wellbeing had improved since attending the intervention. This was attributed to improvements in self-esteem, social interaction and mental wellbeing. Participants generally felt that their physical activity had increased since attending Street Fit Scotland, and a number of individuals reported that they were making healthier choices with regards to health behaviors. A theory of change logic model was developed that demonstrated how each component of the intervention influences the observed and intended outcomes. Attendance of Street Fit Scotland had positive effects on participant's health and wellbeing, particularly concerning self-esteem, health behaviors, social interaction, and physical activity. More efforts should be made to evaluate small-scale interventions that are reaching vulnerable population groups.     

Somewhere to be permanent for a minute: Time and space perceptions of older adult men experiencing chronic homelessness in Detroit

Within the landscape of postwar era Detroit, space is vast, but places are hard to find. As people tumble down the side of Maslow’s pyramid into abject homelessness, they attempt to anchor themselves in locations that suspend the otherwise situational free fall. This article analyzes how time and space are perceived by people experiencing chronic homelessness and how those individual perceptions are informed by the objective time and space urban environment. We conducted our community-based participatory research into the experiences of chronic homelessness both from perspectives of chronically homeless older adult men and from front-line service providers. Themes that emerged are as follows: (1) temporary permanence, (2) permanent temporariness, and (3) lostness. The article concludes with policy implications regarding the procedures for measuring the extent of homelessness and the needs of those who live it.     

Self- and caregiver-reported experiences of young adults with developmental disabilities

The purpose of this study was to describe the experiences of young adults with developmental disabilities (DD) who were living in community settings with the aid of government-supported services. Six male and 10 female volunteer subjects (mean age = 24 years) were interviewed and the narrative data were analyzed revealing themes in six categories: (1) Home Life, (2) Relationships, (3) Health and Health Care, (4) Personal Growth and Accomplishments, (5) Occupation, and (6) Transportation. Subjects' most positive experiences were associated with integrated, comprehensive and timely services delivered by knowledgeable and sensitive service providers. Strong parental advocacy facilitated these features. Additionally, experiences were most positive when daily activities occurred within the sphere of either family or the disability community, as opposed to the broader community. Research is suggested to further understand the dynamics of integration in the broader community and to devise strategies to successfully facilitate this integration.     

Life histories as counter-narratives against dominant and negative stereotypes about people with intellectual disabilities

The history of intellectual disabilities is largely a story of discrimination and social exclusion portraying people with intellectual disability as abnormal and inferior. This article describes a particular methodological approach to inclusive life history research with a small group of women with intellectual disabilities in Iceland. The article documents how, through a four-year collaborative research process, the life histories became counter-narratives to dominant historical beliefs and stereotypes. In addition to the personal empowerment of the women and the construction of a collective memory, this project has also resulted in public sharing of their stories through speaking up and giving presentations, and thus potentially also changing the historical memory.     

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.     

Homelessness,housing instability,intimate partner violence,mental health,and functioning: A multi-year cohort study of IPV survivors and their children

Abstract

Homelessness and housing instability frequently accompany intimate partner violence and can negatively impact health and functioning. When children are exposed to homelessness or housing instability their ability to develop and function is compromised. The purpose of this study is to examine the differential impact of homelessness and unstable housing on health and functioning of women and their children over a 2-year period. Two hundred and seventy-seven mothers reporting intimate partner violence (stalking, physical, or sexual violence by an intimate partner) were asked about housing stability, abuse, risk for murder, mental health, employment/wages, and their child's functioning over a 2-year period. Outcomes of mothers reporting homelessness and unstable housing were compared to mothers reporting stable housing. Over one-third (36%) of the mothers reported at least one episode of unstable housing over the 2-year period and 11% reported homelessness. Measures of maternal mental health and child functioning were worse for both unstably housed and homeless women, compared to stably housed women, with a higher risk for sexual abuse and risk for murder for homeless women. New models of rapid rehousing are needed that address not only the housing problems of women who have experienced intimate partner violence but also the mental health and safety issues that the women and their children face.     

The impact on taxpayer costs of a jail diversion program for people with serious mental illness

Mental illness is prevalent among those incarcerated. Jail diversion is one means by which people with mental illness are treated in the community – often with some criminal justice system oversight – instead of being incarcerated. Jail diversion may lead to immediate reductions in taxpayer costs because the person is no longer significantly engaged with the criminal justice system. It may also lead to longer term reductions in costs because effective treatment may ameliorate symptoms, reduce the number of future offenses, and thus subsequent arrests and incarceration. This study estimates the impact on taxpayer costs of a model jail diversion program for people with serious mental illness. Administrative data on criminal justice and treatment events were combined with primary and secondary data on the costs of each event. Propensity score methods and a quasi-experimental design were used to compare treatment and criminal justice costs for a group of people who were diverted to a group of people who were not diverted. Diversion was associated with approximately $2800 lower taxpayer costs per person 2 years after the point of diversion (p < .05). Reductions in criminal justice costs drove this result. Jail diversion for people with mental illness may thus be justified fiscally.     

Unmet service needs of families of young children with chronic illnesses and disabilities

Data about health and educational services were collected from 187 families with young children (under two years) who have chronic illnesses and disabilities. The purpose was to assess parents' satisfaction with services their families received and to identify families' unmet service needs as well as the reasons for these unmet needs. Although families' ratings of the adequacy of services are relatively high, 28% of the families report unmet service needs. The unmet needs most often reported are occupational, physical, or speech therapy; respite care/child care; and special education. Lack of funding is the most commonly given reason for unmet needs. Children with multiple impairments are at highest risk for unmet needs. Only 22% of unmet needs reported at the initial interview have been met by the time of the six-month follow-up. Increased coordination and monitoring of services across service sectors are indicated. Her research interests include the effects of disability on family identity and families' responses to minority stress. She received her Ph.D. from the University of Minnesota. She gratefully acknowledges Shelley Blazis and Nadav Casuto for statistical consulting. Her research interests focus on the impact of chronic illness and disability on families. She received her Ph.D. from the University of Minnesota. Her research interests include families and health and chronic illness and disability in children. She received her Ph.D. in Family Social Science at the University of Minnesota. His areas of interest include neurodevelopmental outcomes of low birth weight infants and training in developmental pediatrics. He was graduated from the University of Minnesota Medical School. His areas of interest include adolescents with chronic illness and disabilities, adolescent sexual decision making, and international adolescent health care issues. He was graduated from Howard University College of Medicine was awarded his earned doctorate in Health Policy from the University of Minnesota. Preparation of this article was supported by the National Institute on Disability and Rehabilitation Research Grant #H133890012.     

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.     

Homelessness and Children's Use of Mental Health Services: A Population-Based Study

This study examined whether children who become homeless differ from other low-income children in their mental health service use before and after their first homeless episode, and to what extent homelessness is associated with an increased likelihood of mental health service use. Differences between children with and without new onset of sheltered homelessness in the use of mental health services emerged following homelessness and widened over time. Sheltered homelessness and foster care placement history were associated with increased odds of receiving inpatient and ambulatory mental health services. Findings underscore the importance of collaborations between homeless assistance, foster care, and mental healthcare in efforts to mitigate family homelessness and collateral needs among homeless children.     

The Expansion of the Peer Adviser Workforce: Opportunities and Challenges for Social Work

ABSTRACT

Peer adviser roles are becoming an increasingly common—and celebrated—aspect of agencies where social workers are located. This article reports on a qualitative research study exploring the experiences of staff within a homelessness outreach service in which three peer advisers (people with a lived experience of homelessness) commenced employment. Drawing on action research principles, the study explored the experiences of the peer advisers and the broader team following the introduction of the peer adviser roles. Themes identified include, realising the skills of peer advisers, defining the role, taking a “whole of team” approach, and reflecting on power. This study demonstrates that the introduction of peer adviser roles into human service organisations is a promising strategy for creating services that are more likely to respond effectively to the needs of service users. However, social workers need to be aware of the pitfalls of tokenism and the devaluing of experiential knowledge.

IMPLICATIONS

• Peer advisers in health and welfare agencies add significant benefits to an agency’s capacity to respond to the needs of service users.

• The introduction of the peer workforce is aligned to social work values of service user empowerment and the valuing of experiential knowledge.

• In order to avoid tokenism, the introduction of peer adviser roles should be supported by both the attitudes and actions of other staff members, as well as organisational support structures.