Meeting the challenge? Transitions out of long-term homelessness

Journey to Social Inclusion (J2SI) is a pilot project designed to break the cycle of long-term homelessness. The project provides intensive support for up to three years to assist people who are long-term homeless receive the range of services they need. This is the second of four reports evaluating the J2SI project. It documents the social outcomes and the economic costs and benefits from the first 24 months. The evaluation uses a randomised controlled trial that tracks the outcomes of J2SI participants (Group J) and compares their outcomes with those of a comparison group (Group E) who are being supported by existing services. After 24 months the evidence shows a sustained improvement in the housing circumstances of the J2SI participants compared to those in the control group. Critically, most (86%) have maintained their housing. While the move to independent housing was difficult in the beginning, the high rate of housing retention suggests that most of the participants are developing the skills and confidence needed to keep their housing. The report contains the results of a cost-benefit analysis of the program after 2 years of operation. The evaluation was conducted by researchers from RMIT University and the Melbourne Institute of Applied Economic and Social Research. Authors: Guy Johnson, Daniel Kuehnle, Sharon Parkinson, Yi-Ping Tseng

Policy shift or program drift? Implementing housing first in Australia

This Essay critically analysed how the Housing First approach can be successfully applied to the system of supported housing in Australia

Use of Social Media in Dental Schools: Pluses, Perils, and Pitfalls from a Legal Perspective

One of the ways dental education is changing the way it is preparing the next generation of learners is through efficient utilization of interactive social media. Social media, which facilitates interaction and sharing of new ideas, is being utilized to educate students, residents, and faculty. Unfortunately, as with most improvements in technology, there are growing pains. Faculty, student, and patient interaction on social media platforms, such as Facebook and Twitter, can lead to inappropriate or embarrassing situations. Striking the appropriate balance between free speech rights of students and faculty and the need for colleges and universities to have efficient operations is often left to the judicial system. The concepts of free speech and contract law and how each is applied in educational settings should be understood by students, faculty, and administrators. This article provides a review of legal cases that led to current social media policies, as well as present-day cases that exemplify the application of these principles, to help dental educators gain a greater understanding of the boundaries of protected speech. It also provides a set of sample guidelines for communicating through these media

Sustaining exits from long-term homelessness

Executive Summary: Journey to Social Inclusion was a three year pilot that provided intensive support designed to break the cycle of long-term homelessness. This report presents the social and economic outcomes of the J2SI pilot. It covers the three years the trial ran, and the 12 month period following the completion of the trial. The evaluation used a randomised controlled trial to track and compare the outcomes of the J2SI participants (Group J) with those of an equivalent group of long-term homeless people (Group E) who were supported by existing services. After 48 months 67% of the original participants remained involved in the trial. The evidence suggests that J2SI had a positive impact on the lives of most participants, over time and relative to the control group. The physical health of Group J improved, with the proportion reporting no bodily pain increasing from 27% to 45% over the four year period. In other measures of bodily pain Group J also report larger gains over time and relative to Group E. Although there is some variation in the use of health services with both groups showing greater improvements in some areas relative to the other group, the most important pattern to note is that Group J’s average use of emergency hospital services and their average number of days hospitalised in general hospitals and psychiatric units declined by about 80% over the 48 month period. Group E’s need for emergency hospital treatment increased by 21%. While the average number of days Group E spent in hospital declined by about one third, the reduction is considerably less than observed in Group J. These results represent a substantial health care impact and suggest that an intervention comprising of stable housing and intensive case management can reduce the public burden associated with the over-utilisation of health services. The report also shows improvements over time and relative to Group E in the use of welfare and homelessness services, and the amount of time incarcerated. In the absence of the J2SI Program, Group J’s use of welfare service has started to rise. Finally, there was only a modest improvement in the extent to which the participants’ felt connected to and supported by the community over the four years. However, the trend was always in a positive direction, and in the final survey J2SI participants recorded their highest scores on both social support and social acceptance indexes. There are signs, however that the impact of J2SI is declining in some areas. After three years 85% of J2SI participants were housed compared to 41% of those who were receiving existing services. In the 12 months following its closure the proportion of J2SI participants who were housed dropped by 10 percentage points to 75%. Although this was substantially higher than at baseline, compares favourably with international studies, and is still 17 percentage points higher than that reported by the control group (58%), it was the first ‘substantial’ decline we have observed over the four year period. Similarly, while the emotional health of the J2SI participants improved and they report lower levels of stress, anxiety and depression after four years compared to where they were at the start of the trial, the results are not much different to those reported by Group E. Similarly, although there had been substantial gains in the labour force participation rate during the trial, these gains were not sustained when J2SI closed. Throughout the trial we found little change in the substance use behaviour of the participants, although this is a common finding in studies evaluating service impacts among the long-term homeless. Finally, we found the short-term economic benefit to be modest but trending upwards, with a return of 0.25 for every dollar invested. Taking into account lives saved over a 10 year time frame the economic benefit was more substantial, with a $1.32 return for every dollar invested. J2SI shows that breaking the cycle of long-term homelessness is possible and that intensive support coupled with stable housing can reduce demand on expensive health, justice and welfare services. However, some of the successes and improvements were not sustained and some individuals subsequently became homeless once J2SI support ended. About one quarter of the participants would have benefitted from ongoing support. The agencies they had been referred to after J2SI ended failed to provide the level and breadth of support necessary for ongoing stability. This presents two challenges for policy makers. First, many services, particularly clinical health services, are configured in such a way as to exclude the long-term homeless for the very issues they seek assistance with. Second, policy makers need to explicitly acknowledge that a small minority of homeless people require ongoing and indefinite support. Among those who had succeeded in maintaining their housing some had made a successful journey out of homelessness and were continuing to move on with their lives. Equally, it was clear that having a home did not lead to social acceptance and social inclusion for everyone. With limited employment options, few social networks outside of the homeless population, and few alternative social activities, opportunities for social inclusion remain limited for many individuals whose experience of social exclusion is both wide and deep. In this context programs designed to permanently end long-term homelessness such as J2SI need to temper their expectations and accept that years immersed in homelessness not only have physical and emotional effects, but long-term social and economic effects as well. Further, despite sharing many similar characteristics and experiences the long-term homeless are a heterogeneous group. Recognising similarities and differences among the long-term homeless is important in terms of designing appropriate interventions – whereas some participants would benefit from ongoing support, for others the support requirements were less. Much has been learnt from the J2SI pilot – what works, what doesn’t, for whom and why. The key now is to translate these findings into a more balanced policy framework that is sensitive to the challenges and complexities of permanently ending long-term homelessness

Knowledge of dementia : Do family members understand dementia as a terminal condition?

Current research identifies advanced dementia to be the terminal phase of this progressive and incurable condition. However, there has been relatively little investigation into how family members of people with advanced dementia understand their relative’s condition. In this article, we report on semi-structured interviews with 10 family members of people with advanced dementia, in a residential aged care facility. Using a qualitative, descriptive design, we explored family members’ understandings of dementia, whether they were aware that it was a terminal condition, and the ways they developed their understandings. Findings revealed that the majority of family members could not recognize the terminal nature of dementia. Relying on predominantly lay understandings, they had little access to formal information and most failed to conceptualize a connection between dementia and death. Moreover, family members engaged in limited dialogue with aged care staff about such issues, despite their relatives being in an advanced stage of the disease. Findings from our study suggest that how family members understand their relative’s condition requires greater attention. The development of staff/family partnerships that promote shared communication about dementia and dying may enhance family members’ understandings of the dementia trajectory and the types of decisions they may be faced with during the more advanced stages of the disease

Poverty and Australian housing: findings from an Investigative Panel

This research investigates the key links between housing and poverty. Its purpose is to draw together different dimensions of the relationships between housing costs and poverty, including policy settings, tax and transfer systems, housing assistance and place-based dimensions and individual capabilities. The causal relationships between housing and poverty are complicated. Housing costs commonly comprise the largest share of living costs and can increase the risk of poverty. Insecurity caused by excessive housing costs relative to income over extended periods of time can lead to entrenched poverty that can be hard to escape. Reconceptualising poverty creates opportunities for targeted housing policy towards social goals. First, poverty should be identified as the consequence of policies and systems decision making. Second, poverty alleviation should be the responsibility of institutions of society acting in partnership with individuals experiencing poverty. It should not be placed upon individuals alone. Seeing housing as a basic right, and of the need for a universal approach to housing provision, is necessary for poverty eradication. Both shelter and non-shelter housing outcomes need to be understood as valuable to society. This perspective aligns well with housing being reframed and understood as both essential infrastructure and an infrastructure of care

Regulation of residential tenancies and impacts on investment

This research reviews the evidence-base about factors impacting and shaping rental investment; reviews the state of residential tenancies laws across Australia; and presents options for a renewed reform agenda. The regulation of the Australian private rental sector (PRS) directly affects about 40 per cent of Australian households: the 26 per cent who live in private rental housing as tenants, and the 14 per cent who own it as landlords. Reform of regulation of residential tenancies processes are underway or have recently concluded in different jurisdictions. These processes, however, have mostly been uncoordinated at a national level and significant divergences and gaps have opened up in the laws. The research finds little evidence that Australian residential tenancies law has impacted investment in private rental housing. On the contrary, Australian residential tenancies law has accommodated, even facilitated, the long-term growth of the PRS and of its particular structure and dynamic character. However, the small-holding, frequently-transferring character of the PRS presents basic problems for tenants trying to make homes in it. The research also presents a number of issues that could be considered as part of a national agenda for residential tenancy law reform

Ovine multiparity is associated with diminished vaginal muscularis, increased elastic fibres and vaginal wall weakness: implication for pelvic organ prolapse

This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/Pelvic Organ Prolapse (POP) is a major clinical burden affecting 25% of women, with vaginal delivery a major contributing factor. We hypothesised that increasing parity weakens the vagina by altering the extracellular matrix proteins and smooth muscle thereby leading to POP vulnerability. We used a modified POP-quantification (POP-Q) system and a novel pressure sensor to measure vaginal wall weakness in nulliparous, primiparous and multiparous ewes. These measurements were correlated with histological, biochemical and biomechanical properties of the ovine vagina. Primiparous and multiparous ewes had greater displacement of vaginal tissue compared to nulliparous at points Aa, Ap and Ba and lower pressure sensor measurements at points equivalent to Ap and Ba. Vaginal wall muscularis of multiparous ewes was thinner than nulliparous and had greater elastic fibre content. Collagen content was lower in primiparous than nulliparous ewes, but collagen organisation did not differ. Biomechanically, multiparous vaginal tissue was weaker and less stiff than nulliparous. Parity had a significant impact on the structure and function of the ovine vaginal wall, as the multiparous vaginal wall was weaker and had a thinner muscularis than nulliparous ewes. This correlated with “POP-Q” and pressure sensor measurements showing greater tissue laxity in multiparous compared to nulliparous ewes

Erratum: Author Correction: Identification of genes required for eye development by high-throughput screening of mouse knockouts.

[This corrects the article DOI: 10.1038/s42003-018-0226-0.]