Assessing Health Care Needs Among Street Homeless and Transitionally Housed Adults

ABSTRACT

This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral health care services. Nearly a third of participants reported current unaddressed health problem(s); an inability to obtain needed health care; and feelings of unaddressed mental health issue(s) as well as substance abuse problem(s) in the past year. Future research on homelessness and health should focus on identifying different pathways to health and mental health services for this vulnerable population and the outcomes of these interventions.     

A 12-Month Follow-Up Evaluation of Integrated Treatment for Homeless Individuals With Co-Occurring Disorders

ABSTRACT

This study examined the effectiveness of the Comprehensive, Continuous, Integrated System of Care (CCISC) model in addressing co-occurring mental health and substance use disorders. Clients were eligible for participation if they had co-occurring disorders and were homeless or at risk of homelessness. Forty-eight clients received a comprehensive array of services consistent with the CCISC model. Measures assessing housing, employment, mental health, and substance use were completed at baseline, 6-month, and 12-month follow-up. Results demonstrated significant improvements in housing, employment, mental health, and substance use at 12-month follow-up. These results underscore the effectiveness of implementing evidence-based care.     

Applied Nonparametric Instrumental Variables Estimation

Instrumental variables are widely used in applied econometrics to achieve identification and carry out estimation and inference in models that contain endogenous explanatory variables. In most applications, the function of interest (e.g., an Engel curve or demand function) is assumed to be known up to finitely many parameters (e.g., a linear model), and instrumental variables are used to identify and estimate these parameters. However, linear and other finite‐dimensional parametric models make strong assumptions about the population being modeled that are rarely if ever justified by economic theory or other a priori reasoning and can lead to seriously erroneous conclusions if they are incorrect. This paper explores what can be learned when the function of interest is identified through an instrumental variable but is not assumed to be known up to finitely many parameters. The paper explains the differences between parametric and nonparametric estimators that are important for applied research, describes an easily implemented nonparametric instrumental variables estimator, and presents empirical examples in which nonparametric methods lead to substantive conclusions that are quite different from those obtained using standard, parametric estimators.     

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.     

Where Risks and Protective Factors Operate Differently: Homeless Sexual Minority Youth and Suicide Attempts

Using a sample of 628 homeless youth and young adults from eight US cities, this study examines whether the relationship between having been in custody of social services and suicide attempts, and the relationship between engaging in survival sex and suicide attempts differ based on sexual orientation. Findings suggest that being in custody of social services is associated with a significant increase in likelihood of suicide attempts for heterosexual youth, it does not, however, significantly change the already increased risk of suicide attempts for sexual minority youth. Engaging in survival sex appears to be associated with increased risks of suicide attempts for both heterosexual and sexual minority youth, but the increase in likelihood is much stronger for heterosexual youth than for sexual minority youth. Implications for practice and future research 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.     

The Relationship Between Length and Number of Homeless Episodes and Engagement in Survival Sex

Survival sex is associated with many health problems, including increased substance use and HIV risk. Current research on survival sex among homeless individuals has given little attention to the unique effects of how length and number of homeless episodes influence engagement in survival sex. Using secondary data analysis from the Washington, DC, Metropolitan Area Drug Study (DC*MADS) (N = 783), the authors examined the relationship of days and number of times homeless to engagement in survival sex, while controlling for other sociodemographic and clinical characteristics. Results showed that length of homelessness and number of homeless episodes, as well as current age, previous drug use, depression, and institutionalization, increased the odds of engaging in survival sex. Results support current efforts on interventions to transition homeless individuals into housing as rapidly as possible. Service providers assisting the homeless can affect engagement in survival sex and its associated risks through creating referral networks for integrated treatment programs for co-occurring substance use and mental health problems while advocating for early housing interventions and increased housing retention. Further research is needed regarding the ways in which length of homeless episodes affects risky behaviors such as survival sex, with a particular focus on all age groups.     

One-year rates of public shelter utilization by race/ethnicity,age, sex and poverty status for New York City (1990 and 1995) and Philadelphia (1995)

This study calculates public homeless shelter utilization rates by sex, race/ethnicity and age status for New York City (1990 and 1995) and Philadelphia (fiscal year 1995) to determine the relative risk for shelter use among different demographic groups in these cities. The resulting shelter utilization rates reveal large disparities among age groups and across racial/ethnic groups, as well as showing different trends in shelter utilization among the two cities. Among the results reported, the rate of shelter utilization declined by 11% in New York City over this period, while the overall utilization rate in Philadelphia has increased to where it is 40% higher than that of New York City. Children under age 5, at a rate of 0.0248, have the highest shelter utilization rate among the age groups studied and the overall rate for blacks is 2.3 times that of the overall population. And while shelter utilization rates among single men have decreased by 30% in New York City, a similar decrease has not occurred among women of early childbearing ages or among young children. Finally, policy implications related to these findings are discussed.     

Modeling the dynamism of HIV information diffusion in multiplex networks of homeless youth

Cascade and threshold models are widely used to predict information diffusion in social networks, yet their characterization of networks as static and monoplex limit their ability to accurately predict how information propagates in dynamic, multiplex social environments. Using data from a peer-led HIV prevention intervention for homeless youth, we determine whether manipulating the baseline social network by (1) adding ties observed at later time points, and (2) accounting for alternative relational contexts improves each model’s predictive accuracy. Results show that the addition of new ties improves the performance of both models, while substituting the context of interaction yields only minor improvements.     

An autopsy-based evaluation of deaths of homeless unknown persons (HUPs)

Background: India is a significant host to homeless unknown persons (HUPs) and subsequently to their untimely deaths due to various reasons. The autopsy-based evaluation has been always important in knowing the exact reasons behind it. Objective: To know about the epidemiological mortality profile such as magnitude, cause and manner of death, seasonality, and year-wise distribution of their untimely and unattended deaths. Materials and Methods: A retrospective autopsy-based evaluation of unnatural deaths among HUPs was done at LHMC, New Delhi for a total duration of 5 years (January 2006 to December 2010). Results: Out of 749 cases in the study group in this duration, 536 deaths have been caused due to some natural events and 213 due to some unnatural events. Among the natural deaths, the pulmonary pathology did contribute for 509 cases. Conclusion: The study population is a vulnerable segment of the society which often suffers the extreme adversity of natural and unnatural events in the form of their deaths. It is a significant host to the pulmonary infections that often spread to the other segments of the society at the point of contact. Thereby it deserves an urgent public health intervention and a policy response for the same for the well-being of HUPs and the general public at large.