Unsheltered homelessness among veterans: correlates and profiles

We identified correlates of unsheltered status among Veterans experiencing homelessness and describe d distinct subgroups within the unsheltered homeless Veteran population using data from a screening instrument for homelessness that is administered to all Veterans accessing outpatient care at a Veterans Health Administration (VHA) facility . Correlates o f unsheltered homelessness included male gender, white race, older age, lower levels of VHA eligibility, substance use disorders, frequent use of VHA inpatient and infrequent use of VHA outpatient services, and residing in the West. We identified six disti nct subgroups of unsheltered Veterans; the tri - morbid frequent users represented the highest need group, but the largest group was comprised of Veterans who made highly infrequent use of VHA healthcare services. Differences between sheltered and unshelter ed Veterans and heterogeneity within the unsheltered Veteran population should be considered in targeting housing and other interventions.National Center on Homelessness Among Veteran

LA2050

LA2050 is an initiative to create a shared vision for the future of Los Angeles, and to drive and track progress toward that vision. Spearheaded by the Goldhirsh Foundation, the LA2050 Report has looked at the health of the region along well-defined indicators (Arts & Cultural Vitality, Education, Environmental Quality, Health, Housing, Income & Employment, Public Safety, and Social Connectedness), and made informed projections about where we'll be in the year 2050 if we continue on this current path

Homelessness and Public Health in Los Angeles

Los Angeles faces a housing crisis of unprecedented scale. After years of underinvestment, in 2016/2017 LA County voters approved Measures H and HHH, which provided an infusion of resources for homeless services, permanent housing, and integrated outreach through the LA County Homeless Initiative (HI). An estimated 58,936 individuals in LA County remain homeless as of January 2019, 75% of them unsheltered and living on streets, in tents, or encampments. Our best estimates suggest that the homeless population has grown since 2017.HI takes a Housing First approach to homelessness, with the largest amount of total funds allocated to housing solutions. However, rehousing is often subject to delays in construction and case management. These delays, combined with persistent market forces driving new homelessness, have left the county well short of its targets. While no forecasts were issued, the initial gap analysis for HI had assumed a 34% reduction in the total homeless count from 2016 to 2019. The count has in fact increased by 26% over that period, meaning 28,000 more homeless clients than anticipated on any night. Whereas cities with comparable homeless crises such as New York have focused on increasing the availability of emergency shelters and safe havens in addition to permanent housing, LA County’s relatively low investment in transitional options has resulted in persistent levels of unsheltered homelessness.Research has shown that homelessness has severe health consequences. Homeless individuals have a high risk of mortality, with a recent LA County Medical Examiner report finding an average age of death of 48 for women and 51 for men. Homeless individuals have much higher risks of mental illness, substance abuse, infectious disease, chronic illness, violence, and reproductive health risks than the general population. Much less is known about the health burdens associated with being unsheltered, but most evidence points to substantially greater health risks given the more intense exposures to violence, weather, pollution, poor sanitation, and behavioral risk. Research is just beginning to quantify the burdens of living on the streets.Our analysis of the LA County homelessness response drew on expert interviews, data analysis, and document review. Beyond the growing numerical gap between HI’s targets and actual trends, we identified five critical service gaps that require immediate attention: Taking a person-centered approach that recognizes both the diversity of client needs and the limitations of existing resources, yet honors the principle that everyone deserves housing; Improving access to emergency shelters by reducing legal and political barriers to construction and adopting “low barrier shelters” that facilitate entry; Delivering comprehensive street medicine and other services to unsheltered homeless populations using evidence-based models that support the path to housing and recovery Adopting more extensive outreach models that engage citizens, empower homeless clients and leverage mobile technology so that case workers can focus on clients most in need; Strengthening data collection and research methods to understand the consequences of unsheltered homelessness, pilot new service models, and evaluate rehousing efforts

Impact of Community Investment in Safety Net Services on Rates of Unsheltered Homelessness Among Veterans

Unsheltered homelessness among veterans has declined rapidly since 2009; however, more than one-third of veterans experiencing homelessness stayed in places not meant for human habitation during 2014. Research has identified a negative relationship between federal spending on the social safety net and community level rates of homelessness, but not specifically for veterans. The present study assessed whether investment in veteran-specific safety net resources predicted changes in the rate of unsheltered veteran homelessness. Increases in Veterans Affairs (VA) medical care expenditures were significantly associated with a decline in unsheltered veteran homelessness, perhaps explained by additional VA resources aimed at identifying and housing these veterans

An examination of students’ perceptions of their interprofessional placements in residential aged care

It is essential that health professionals are trained to provide optimal care for our ageing population. Key to this is a positive attitude to older adults along with the ability to work in teams and provide interprofessional care. There is limited evidence on the impact an interprofessional education (IPE) placement in a residential aged care facility (RACF) has on students. In 2015 in Western Australia, 51 students (30 % male, median age 23 years), from seven professions, undertook a placement between 2 and 13 weeks in length at 1 RACF. Pre- and post-placement measurements of attitudes to the elderly were collected using the Ageing Semantic Differential (ASD) questionnaire and level of readiness for interprofessional learning with the Readiness for Interprofessional Learning Scale (RIPLS). A total of 47 students completed matched ASD and RIPLS surveys. The mean total score on the ASD survey decreased significantly from pre- to post-placement from 116.0 to 108.9 (p = 0.033), indicating attitudes became increasingly positive towards older adults. Significant differences post-placement were seen indicating better readiness for interprofessional learning, for two out of four subscales on the RIPLS, namely “teamwork & collaboration” (42.1 – 44.0; (p = 0.000)) and “positive professional identity” (18.2 – 19.3 (p = 0.001)). The degree of change is similar to findings from other settings. The results support IPE-focussed student placements within RACF positively influence student’s attitudes towards the older adult as well as increase student’s readiness for interprofessional learning, confirming RACF are valuable places for training health professional

The Policy Nexus: Panhandling, Social Capital and Policy Failure

In this paper, we analyze a unique mixed methods data set based on survey responses (n=108) and intensive interviews (n=18) with panhandlers in Austin, Texas. We examine the way in which failures of primary and secondary social capital interact to create the conditions of extreme poverty and homelessness that lead to panhandling. We find that a large majority of these individuals are working-age adults who lack access to social policy supports that would allow them to weather periods of unemployment produced by health issues and other personal difficulties

Community participation among people who are homeless

Thesis (Sc.D.)--Boston UniversityCommunity participation has been regarded as a goal for people with rehabilitation needs, but there is a lack of consensus about the definition and measurement of community participation. In addition, there is limited knowledge about the community participation of individuals who are homeless. This dissertation contains three studies aimed at furthering our understanding about community participation among individuals who are, or were previously, homeless. Study 1 systematically reviewed instruments that measure community participation in people with disabilities and compared these instruments by analyzing the content based on the International Classification of Functioning, Disability and Health Perspective (ICF) classification. Seventeen instruments were identified as containing community participation items. None of these instruments covered the full breadth of community participation domains, but each addressed community participation to some extent. Furthermore, most of the instruments lose precision by treating diverse activities as a single concept. [TRUNCATED]2018-09-0

A mixed-methods evaluation using effectiveness perception surveys, social network analysis, and county-level health statistics: A pilot study of eight rural Indiana community health coalitions

Community health coalitions (CHCs) are a promising approach for addressing disparities in rural health statistics. However, their effectiveness has been variable, and evaluation methods have been insufficient and inconsistent. Thus, we propose a mixed-methods evaluation framework and discuss pilot study findings. CHCs in our pilot study partnered with Purdue Extension. Extension links communities and land grant universities, providing programming and support for community-engaged research. We conducted social network analysis and effectiveness perception surveys in CHCs in 8 rural Indiana counties during summer 2017 and accessed county-level health statistics from 2015-16. We compared calculated variables (i.e., effectiveness survey k-means clusters, network measures, health status/outcomes) using Pearson’s correlations. CHC members’ positive perceptions of their leadership and functioning correlated with interconnectedness in their partnership networks, while more centralized partnership networks correlated with CHC members reporting problems in their coalitions. CHCs with highly rated leadership and functioning developed in counties with poor infant/maternal health and opioid outcomes. Likewise, CHCs reporting fewer problems for participation developed in counties with poor infant/maternal health, poor opioid outcomes, and more people without healthcare coverage. This pilot study provides a framework for iterative CHC evaluation. As the evidence grows, we will make recommendations for best practices that optimize CHC partnerships to improve local health in rural areas

Estimating homelessness in the Netherlands using a capture-recapture approach

This study focuses on the homeless population in the Netherlands, as an indicator of social exclusion. By applying the capture-recapture (CRC) methodology to three registers, not only the size of the homeless population could be estimated, but also its composition in terms of gender, age, place of living, and origin could be depicted. Because of the use of three registers and the availability of background characteristics for each of the registers, the usual stringent assumptions of capture recapture methodology is circumvented. This advanced application of CRC to estimate the homeless population on the national level, has led to official figures for five subsequent reference dates (January 1st of 2009, 2010, 2011, 2012 and 2013). In 2009 the size of the total homeless population in the Netherlands was estimated at 17,767, of which 5169 were registered on one of the three lists. Between 2009 and 2012 the estimated size of the population increased, which was largely due to the financial crisis. For all reference dates, the composition of this population showed that generally more men than women were registered and that homeless people in the age category of 30–49 years old were registered more than the younger or older age groups. Compared to the general Dutch population, the homeless population includes relatively many men, many people aged 30–49 years and people with a non-western backgroun