Examining mortality among formerly homeless adults enrolled in Housing First: An observational study

BACKGROUND: Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population. Housing First (HF) is an evidence-based practice that effectively ends chronic homelessness, yet there has been virtually no research on premature mortality among HF enrollees. In the United States, this gap in the literature exists despite research that has suggested chronically homeless adults constitute an aging cohort, with nearly half aged 50 years old or older. METHODS: This observational study examined mortality among formerly homeless adults in an HF program. We examined death rates and causes of death among HF participants and assessed the timing and predictors of death among HF participants following entry into housing. We also compared mortality rates between HF participants and (a) members of the general population and (b) individuals experiencing homelessness. We supplemented these analyses with a comparison of the causes of death and characteristics of decedents in the HF program with a sample of adults identified as homeless in the same city at the time of death through a formal review process. RESULTS: The majority of decedents in both groups were between the ages of 45 and 64 at their time of death; the average age at death for HF participants was 57, compared to 53 for individuals in the homeless sample. Among those in the HF group, 72 % died from natural causes, compared to 49 % from the homeless group. This included 21 % of HF participants and 7 % from the homeless group who died from cancer. Among homeless adults, 40 % died from an accident, which was significantly more than the 14 % of HF participants who died from an accident. HIV or other infectious diseases contributed to 13 % of homeless deaths compared to only 2 % of HF participants. Hypothermia contributed to 6 % of homeless deaths, which was not a cause of death for HF participants. CONCLUSIONS: Results suggest HF participants face excess mortality in comparison to members of the general population and that mortality rates among HF participants are higher than among those reported among members of the general homeless population in prior studies. However, findings also suggest that causes of death may differ between HF participants and their homeless counterparts. Specifically, chronic diseases appear to be more prominent causes of death among HF participants, indicating the potential need for integrating medical support and end-of-life care in HF

Introducing Housing First in a Rural Service System: A Multistakeholder Perspective

Housing First (HF) represents a fundamental shift in thinking about how to address chronic homelessness that has taken place during the past two decades. Whether and how the logic of HF fits in rural systems of care has not been previously explored in the research literature. Using a case study approach and thematic analysis of accounts from 20 key stakeholders, this study investigated whether and how the introduction of HF into a small, rural state in the Northeastearn United States affected the dominant institutional logic. The overall account by multiple stakeholders remained largely consistent: The introduction of an outside HF program brought new resources and expertise, which resulted in a previously underserved population being effectively engaged in services. The extent to which the introduction of an outside provider with a specific, well-defined HF philosophy fit within the existing social services system was complicated by existing providers’ limited knowledge about or input during the grant submission that provided funding for the HF program. Numerous social forces and concerns regarding limited resources also influenced stakeholder perceptions. The impact of HF on existing institutional logics was not always clearly identified by stakeholders, yet HF’s emphasis on providing service options and allowing for client choice, as well as the demonstrated effectiveness of the approach, emerged as influential. Features of local environments (including systems of care but also funding, political, and cultural contexts) and their potential for triggering transformative change may influence the relative merits of implementing HF services by an outside provider with known expertise or supporting an existing provider to develop the infrastructure and foster a service philosophy based on an HF logic

Introducing Housing First in a Rural Service System: A Multistakeholder Perspective

Housing First (HF) represents a fundamental shift in thinking about how to address chronic homelessness that has taken place during the past two decades. Whether and how the logic of HF fits in rural systems of care has not been previously explored in the research literature. Using a case study approach and thematic analysis of accounts from 20 key stakeholders, this study investigated whether and how the introduction of HF into a small, rural state in the Northeastearn United States affected the dominant institutional logic. The overall account by multiple stakeholders remained largely consistent: The introduction of an outside HF program brought new resources and expertise, which resulted in a previously underserved population being effectively engaged in services. The extent to which the introduction of an outside provider with a specific, well-defined HF philosophy fit within the existing social services system was complicated by existing providers’ limited knowledge about or input during the grant submission that provided funding for the HF program. Numerous social forces and concerns regarding limited resources also influenced stakeholder perceptions. The impact of HF on existing institutional logics was not always clearly identified by stakeholders, yet HF’s emphasis on providing service options and allowing for client choice, as well as the demonstrated effectiveness of the approach, emerged as influential. Features of local environments (including systems of care but also funding, political, and cultural contexts) and their potential for triggering transformative change may influence the relative merits of implementing HF services by an outside provider with known expertise or supporting an existing provider to develop the infrastructure and foster a service philosophy based on an HF logic

Policy Recommendations for Meeting the Grand Challenge to End Homelessness

This brief was created forSocial Innovation for America’s Renewal, a policy conference organized by the Center for Social Development in collaboration with the American Academy of Social Work & Social Welfare, which is leading theGrand Challenges for Social Work initiative to champion social progress. The conference site includes links to speeches, presentations, and a full list of the policy briefs

Global point-of-care ultrasound education and training in the age of COVID-19.

The COVID-19 pandemic has disrupted traditional global point-of-care ultrasound (POCUS) education and training, as a result of travel restrictions. It has also provided an opportunity for innovation using a virtual platform. Tele-ultrasound and video-conferencing are alternative and supportive tools to augment global POCUS education and training. There is a need to support learners and experts to ensure that maximum benefit is gained from the use of these innovative modalities

A rising tide drowns unstable boats: how inequality creates homelessness

Is income inequality a driver of homelessness at the community level? We theorize that inequality affects homelessness both by crowding out low-income households from the rental market (what we call an “income channel”) and by causing home prices to rise (a “price channel”). We construct a dataset of information on inequality, homelessness, rent burden, and housing prices in 239 communities from 2007 to 2018 and use it to assess the income inequality–homelessness relationship. Our results suggest that income inequality is a significant driver of community homelessness and that the “income channel” is the more likely mechanism through which homelessness is created. We argue that broader policy efforts to reduce income inequality are likely to have the collateral effect of reducing homelessness, and we discuss the need for national and local policies to help low-income households afford housing.Accepted manuscrip

Solubilised bright blue-emitting iridium complexes for solution processed OLEDs

EZ-C acknowledges the University of St Andrews for financial support. IDWS and AKB acknowledge support from EPSRC (EP/J01771X). The authors would like to thank the Engineering and Physical Sciences Research Council for financial support for Adam Henwood: EPSRC DTG Grants: EP/J500549/1; EP/K503162/1; EP/L505097/1.Combining a sterically bulky, electron-deficient 2-(2,4-difluorophenyl)-4-(2,4,6- trimethylphenyl)pyridine (dFMesppy) cyclometalating C^N ligand with an electron rich, highly rigidified 1,1’-(α,α’-o-xylylene)-2,2’-biimidazole (o-xylbiim) N^N ligand gives an iridium complex, [Ir(dFMesppy)2(o-Xylbiim)](PF6), that achieves extraordinarily bright blue emission (ΦPL = 90%; λmax = 459 nm in MeCN) for a cationic iridium complex. This complex is compared with two reference complexes bearing 4,4’-di-tert-butyl-2,2’- bipyridine, and solution-processed organic light emitting diodes (OLEDs) have been fabricated from these materials.Publisher PDFPeer reviewe

The logics of invited and uninvited material participation: bringing blood pressure self-monitoring into the clinic

This paper addresses debates concerning the ‘participatory turn’ in healthcare. It focuses on the case of blood pressure self-monitoring, understanding this as a form of patient participation at the level of individual care. Drawing and expanding on the work of Marres and Wynne and their notions of material participation and of uninvited engagement, we examine how patients’ home blood pressure self-monitoring is incorporated into clinical care, how the materials of blood pressure self-monitoring mediate participation and how we might characterise the practices of participation found within everyday clinical care. Our analysis makes new conceptual links, suggesting that, in this context, invited participation appears to align with participation made easy, while uninvited participation involves more invested, more engaged participation. We offer two further developments of these concepts. First, we trouble characterisations of invited and uninvited participation as distinct and separate, observing movement between these. Second, through applying the logics of material participation in a new context, everyday clinical practice, we suggest that the logic of participation made easy might be extended beyond lay people, to apply to professionals as well. Our analysis illustrates how materials are mobilised to facilitate invited and uninvited participation within the context of the on-going asymmetries in doctor patient relationships

Conjugated, rigidified bibenzimidazole ancillary ligands for enhanced photoluminescence quantum yields of orange/red-emitting iridium(III) complexes

EZ-C acknowledges the University of St Andrews for financial support. We thank Umicore AG for the gift of materials. We would like to thank the Engineering and Physical Sciences Research Council for financial support for E.Z-C. (EP/M02105X/1) and for the studentship of A.H. (EP/J500549/1, EP/K503162/1, EP/L505097/1). We thank the EPSRC UK National Mass Spectrometry Facility at Swansea University for analytical services. We also would like to thank EaStCHEM and the School of Chemistry for supporting the computing facilities maintained by Dr. H. Früchtl.A series of six novel [Ir(C^N)2(N^N)](PF6) complexes (C^N is one of two cyclometalating ligands: 2-phenyl-4-(2,4,6-trimethylphenyl)pyridine, MesppyH, or 2- (napthalen-1-yl)-4-(2,4,6-trimethylphenyl)pyridine, MesnpyH; N^N denotes one of four neutral diamine ligands: 4,4’-di-tert-butyl-2,2’-bipyridine, dtbubpy, 1H,1’H-2,2’- bibenzimiazole, H2bibenz, 1,1’-(α,α’-o-xylylene)-2,2’-bibenzimidazole, o-Xylbibenz or 2,2’- biquinoline, biq) were synthesised and their structural, electrochemical and photophysical properties comprehensively characterised. The more conjugated MesnpyH ligands confer a red-shift in the emission compared to MesppyH but maintain high photoluminescence quantum yields due to the steric bulk of the mesityl groups. The H2bibenz and o-Xylbibenz ligands are shown to be electronically indistinct to dtbubpy but give complexes with higher quantum yields than analogous complexes bearing dtbubpy. In particular, the rigidity of the o-Xylbibenz ligand, combined with the steric bulk of the MesnpyH C^N ligands, give a red-emitting complex 4 (λPL = 586, 623 nm) with a very high photoluminescence quantum yield (ΦPL = 44%) for an emitter in that regime of the visible spectrum. These results suggest that employing these ligands is a viable strategy for designing more efficient orange-red emitters for use in a variety of photophysical applications.PostprintPeer reviewe