Staying safe, feeling welcome, being seen: How spatio-temporal configurations affect relations of care at an inclusive health and wellness centre.

BACKGROUND: People experiencing homelessness also experience poorer health and frequently attend acute care settings when primary health care would be better equipped to meet their needs. Existing scholarship identifies a complex mix of individual and structural-level factors affecting primary health care engagement driving this pattern of health services utilisation. We build on this existing knowledge, by bringing the spatio-temporal configurations of primary health care into focus. Specifically, we interrogate how space and time inflect situated practices and relations of care. METHODS: This study took an ethnographic approach and was conducted 2021-2022 at an inclusive health and wellness centre ("the Centre") in Southeast Queensland, Australia. The data consists of 46 interviews with 48 people with lived experience of homelessness, including participants who use the services offered at the Centre (n = 26) and participants who do not (n = 19). We also interviewed 20 clinical and non-clinical service providers affiliated with the Centre and observed how service delivery took place. Interviews and observations were complemented by visual data, including participant-produced photography. All data were analysed employing a narrative framework. RESULTS: We present three interrelated themes demonstrating how space and time affect care, that is 'staying safe', 'feeling welcome' and 'being seen'. 'Staying safe' captures the perceptions and practices around safety, which sit in tension with making service users feel welcome. 'Feeling welcome' attends to the sense of being invited to use services free of judgment. 'Being seen' depicts capacities to see a health care provider as well as being understood in one's lived experience. CONCLUSION: Spatio-temporal configurations, such as attendance policies, consultation modalities and time allocated to care encounters afford differential opportunities to nurture reciprocal relations. We conclude that flexible service configurations can leverage a relational model of care. PATIENT OR PUBLIC CONTRIBUTION: Service providers were consulted during the design stage of the project and had opportunities to inform data collection instruments. Two service providers contributed to the manuscript as co-authors. People with lived experience of homelessness who use the services at the inclusive health centre contributed as research participants and provided input into the dissemination of findings. The photography they produced has been featured in an in-person exhibition, to which some have contributed as consultants or curators. It is hoped that their insights into experiences of welcomeness, safety and being seen will inform flexible and relational primary health care design, delivery, and evaluation to better cater for people experiencing housing instability and poverty.

Bystander Intervention in Intimate Partner Violence: A Scoping Review of Experiences and Outcomes.

Governments across the globe are increasingly implementing policies that encourage bystanders to prevent intimate partner violence (IPV) by intervening in violent or potentially violent situations. While a wealth of research examines the most effective mechanisms for increasing potential bystanders' feelings of self-efficacy and rates of intervention, there is significantly less evidence demonstrating how effective bystander intervention is at preventing or interrupting IPV. This article thus presents a scoping review of the literature examining the experiences and outcomes of bystander intervention in IPV. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, extension for Scoping Reviews guidelines, six databases were searched for relevant peer-reviewed studies published in English between 2001 and 2021. A total of 13 articles were ultimately included in the review. The review highlights that although current knowledge on the topic is highly limited, the combined findings of the studies indicate that immediate responses to bystander intervention are heavily context dependent: victims (and perpetrators) tend to react differently to bystander intervention depending on the type of intervention, the type of violence being used, and their relationship to the bystander. However, we have little to no understanding of the outcomes of bystander intervention, or how these outcomes might vary across different contexts. We argue that a more comprehensive understanding of the immediate and long-term implications of bystander intervention across different contexts is crucial if we are to maximize the effectiveness and minimize the potential for harm resulting from bystander interventions in IPV.

Increases in income-support payments reduce the demand for charity: A difference-in-difference analysis of charitable-assistance data from Australia over the COVID-19 pandemic.

Charities play an increasingly important role in helping people experiencing poverty. However, institutionalized charity shifts the burden of poverty reduction away from the state and exposes recipients to stress and stigma. In this paper, we examine whether the need for institutionalized charity can be offset through enhanced state support. As in other countries, the Australian government responded to the COVID-19 pandemic by substantially increasing the level of income support to citizens through several temporary payments. We draw on this natural experiment and time-series data from the two largest charity organizations in Queensland, Australia to examine how these payments altered the demand for institutionalized charity. We model these data using difference-in-difference regression models to approximate causal effects. By exploiting the timing and varying amounts of the payments, our analyses yield evidence that more generous income support reduces reliance on charity. Halving the demand for charity requires raising pre-pandemic income-support by AUD$42/day, with supplements of approximately AUD$18/day yielding the greatest return on investment.

Of Good Mothers and Violent Fathers: Negotiating Child Protection Interventions in Abusive Relationships.

This article examines the efficacy of a supportive housing program aiming to provide mothers in violent relationships with the practical resources to minimize child protection intervention. Drawing on qualitative interviews with program mothers, child safety officers, and program practitioners, we explore the extent to which the program enabled mothers and children to live free from fathers' violence and disengage from the child protection system. We find that, although valuable, the program did not fully mitigate the risks posed by violent fathers. We therefore argue that responsibility must be shifted onto violent fathers to change their behavior and build their parenting capacities.

What About Men? The Marginalization of Men Who Engage in Domestic Violence.

In an international policy context that is increasingly recognizing the gendered nature of domestic violence, governments are becoming more attuned to the importance of improving policy responses for women who have domestic violence enacted against them. This has not, in general, been accompanied by a similar focus on improving policy responses to men who engage in domestic violence, despite a burgeoning body of scholarship suggesting that improved responses to such men are required to more effectively prevent domestic violence from occurring. Importantly, current scholarship also highlights the significant and complex tensions that may arise when policy informed by gendered understandings of domestic violence increases its focus on the men who enact it. Drawing on a critical discourse analysis methodology, we analyze how these tensions are negotiated in domestic violence policy in the Australian state of Queensland. Findings from this analysis demonstrate that the way government policy discursively constructs men who engage in domestic violence has important implications for how such policy targets and engages with members of this group. The article demonstrates that when such men are constructed as outsiders to the community, they may be viewed as undeserving of inclusion and support. This can result in governments failing to prioritize interventions targeted at men who engage in domestic violence, and prevent the active inclusion of such men in the development of policy and interventions. These findings provide important lessons for international governments seeking to implement or strengthen policy responses to end domestic violence against women.

Striving for Gender Equality: Representations of Gender in "Progressive" Domestic Violence Policy.

International feminist scholarship highlights the benefits of approaching domestic violence policy through a gendered lens. Yet to be examined, however, is the extent to which explicitly gendered domestic violence policies may contain barriers that limit the potential benefits of a gendered approach. This qualitative research examines the assumptions embedded in explicitly gendered domestic violence policy in the Australian state of Queensland. Findings suggest that Queensland's "progressive" domestic violence policy is underpinned by dominant gendered assumptions that reinforce existing unequal social structures. These findings offer important lessons for international jurisdictions that aspire to adopt gendered domestic violence policy.

Bureaucratic encounters "after neoliberalism": Examining the supportive turn in social housing governance.

It is well established that encounters between welfare bureaucracies and their clients have been reconfigured under neoliberalism to address the problem of "welfare dependency." Contemporary bureaucratic encounters therefore entail measures to activate clients' entrepreneurial/self-governing capacities, and conditionality/sanctioning practices to deal with clients who behave "irresponsibly." Despite the dominance of the neoliberal model, recent research has identified a counter-trend in the practices of housing services away from entrepreneurializing and punitive strategies and towards a more supportive approach. This paper examines this counter-trend and its implications for neoliberal welfare governance. To do this, it presents findings from research into social housing governance in Queensland, Australia, where the neoliberal focus on welfare independence, conditionality and sanctioning has been tempered by a new supportive approach focused on assisting vulnerable clients to maintain and benefit from access to welfare/housing support. Following Larner, we argue that this shift signals the emergence of an "after neoliberal" governmental formation, wherein key features of neoliberal governmentality are replaced by, or redeployed in the service of, progressive initiatives that address neoliberalism's failings at the street level, but leave broader neoliberal policy settings undisturbed. We also challenge recent sociological accounts that construe supportive welfare practices as a function of an all-encompassing neoliberal project, arguing instead for appreciation of the contingency of these developments and the progressive political affordances that they entail.

Social domains of discrimination against people who inject drugs: Links with health and wellbeing.

AIMS: People who inject drugs frequently experience discrimination. However, little is known about how discrimination experienced in different social domains is linked to health and wellbeing. DESIGN: We used data collected in 2016 from the Illicit Drug Reporting System (IDRS), an Australian survey of people who inject drugs. We used a modified version of the Discrimination Scale (DISC-12) to assess discriminatory behaviours in diverse social domains, including public institutions, neighbours, family and friends. We used the Kessler-10 scale, the Personal Wellbeing Index and specific items from the IDRS questionnaire to assess participants' health and wellbeing. FINDINGS: Sixty three percent of participants who responded to the discrimination module included in the IDRS 2016 (N = 796) reported ever having experienced discrimination due to their injecting drug use and 53% reported having experienced discrimination in the past month. Discrimination in all social domains analysed was linked with poor health and wellbeing, except for housing. Self-reported mental health problems and poorer general health were most frequently associated with discrimination. Participants who experienced discrimination from friends were three times more likely to report mental health problems (AOR=3.0, CI95=1.5-6.0). CONCLUSIONS: There are significant associations between the domains in which discrimination takes place and the health and wellbeing of people who inject drugs. Our findings highlighted the importance of assessing the social domains of discrimination in relation to mental health. Further research needs to assess not just whether a group or individual is discriminated against, but rather how they are likely to perceive this discrimination and how this experience can affect their life as a whole.

Evidence for an integrated healthcare and psychosocial multidisciplinary model to address rough sleeping.

People who sleep rough/experience unsheltered homelessness face barriers accessing mainstream healthcare and psychosocial services. The barriers to service access exacerbate poor health, which in turn create additional challenges for rough sleepers to access health and psychosocial services, including stable housing. The study presents descriptive statistics to identify housing outcomes of people working with a Multidisciplinary Model that comprises integrated healthcare and psychosocial support, and qualitative data with clients and service providers to investigate how the Model is experienced and delivered in practice. Fieldwork was conducted between December 2016 and March 2018 with the Multidisciplinary Team operating in Cairns, in the far north of Australia. Qualitative data are drawn from in-depth interviews with 26 rough sleepers and 33 health and psychosocial service providers from the Multidisciplinary Team and the wider service system. Descriptive statistics show that 67% of clients who were sleeping rough were supported to immediately access stable housing, and at the end of the program, all clients remained housed. The qualitative findings illustrated how integrated healthcare and psychosocial outreach enabled people sleeping rough to overcome barriers they experienced accessing mainstream healthcare and other services. With the benefit of healthcare, people felt sufficiently well to engage with the psychosocial service providers to have their housing and other psychosocial needs addressed. This article demonstrates how individual responsibility for and control over healthcare is not only a matter of the individual, but also a matter requiring systems change and the active provision of resources to cater for the constraints and opportunities present in people's immediate environments.

Agency in advanced liberal services: grounding sociological knowledge in homeless people's accounts.

This paper aims to understand how people who are homeless respond to advanced liberal social services that endeavour to promote their autonomy and responsible actions. We prioritize the experiences and positions of people who are homeless, and what agentic action means to them. Sociological literature is selective about what accounts are deemed agentic. Agency is associated with accounts that resist or subvert dominant neoliberal framings of homelessness as failure of individuals. When people experiencing homelessness or poverty themselves foreground autonomy or responsibility, sociologists treat them as cultural dopes who have internalized neoliberal discourse. Our analysis is driven by an ethnographic study in an Australian homelessness shelter. We demonstrate how people who are homeless neither outright reject nor completely embrace advanced liberal practices to influence their actions and promote autonomy. People engaged in relational reasoning. Paternalist and advanced liberal social services were both lauded and rejected for their capacities and limitations to realize a good life. We contribute to the discussion for sociology to value people's accounts and experiences, rather than broader social process explaining their accounts. From the perspectives of people who are homeless, we show that just because something appears neoliberal does not mean it should be automatically rejected.

Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness.

Objectives The aims of the present study were to examine tenants' experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access. Methods The present study used a mixed-method survey design (n=75) and qualitative interviews (n=20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically. Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented. Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare. What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services. What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in permanent supportive housing enabled illness self-management and greater control over lifestyle, and was associated with self-reported improved health and life satisfaction in formerly homeless tenants. What are the implications for practitioners? Integrated health care and supportive housing for the formerly homeless can improve self-reported health outcomes, enable healthier lifestyle choices and facilitate pathways into more appropriate and effective health care.

The Florence Nightingale Effect: Organizational Identification Explains the Peculiar Link Between Others' Suffering and Workplace Functioning in the Homelessness Sector.

Frontline employees in the helping professions often perform their duties against a difficult backdrop, including a complex client base and ongoing themes of crisis, suffering, and distress. These factors combine to create an environment in which workers are vulnerable to workplace stress and burnout. The present study tested two models to understand how frontline workers in the homelessness sector deal with the suffering of their clients. First, we examined whether relationships between suffering and workplace functioning (job satisfaction and burnout) would be mediated by organizational identification. Second, we examined whether emotional distance from clients (i.e., infrahumanization, measured as reduced attribution of secondary emotions) would predict improved workplace functioning (less burnout and greater job satisfaction), particularly when client contact is high. The study involved a mixed-methods design comprising interview (N = 26) and cross-sectional survey data (N = 60) with a sample of frontline staff working in the homelessness sector. Participants were asked to rate the level of client suffering and attribute emotions in a hypothetical client task, and to complete questionnaire measures of burnout, job satisfaction, and organizational identification. We found no relationships between secondary emotion attribution and burnout or satisfaction. Instead, we found that perceiving higher client suffering was linked with higher job satisfaction and lower burnout. Mediation analyses revealed a mediating role for identification, such that recognizing suffering predicted greater identification with the organization, which fully mediated the relationship between suffering and job satisfaction, and also between suffering and burnout. Qualitative analysis of interview data also resonated with this conceptualization. We introduce this novel finding as the 'Florence Nightingale effect'. With this sample drawn from the homelessness sector, we provide preliminary evidence for the proposition that recognizing others' suffering may serve to increase job satisfaction and reduce burnout - by galvanizing organizational identification.

Two pathways through adversity: Predicting well-being and housing outcomes among homeless service users.

People who experience homelessness face many challenges and disadvantages that negatively impact health and well-being and form barriers to achieving stable housing. Further, people who are homeless often have limited social connections and support. Building on previous research that has shown the beneficial effect of group identification on health and well-being, the current study explores the relationship between two social identity processes - multiple group memberships and service identification - and well-being and positive housing outcomes. Measures were collected from 76 participants while they were residing in a homeless accommodation service (T1) and again 2-4 weeks after leaving the service (or 3 months after T1 if participants had not left the service). Mediation analyses revealed that multiple group memberships and service identification at T1 independently predicted well-being at T2 indirectly, via social support. Further, both social identity processes also indirectly predicted housing outcomes via social support. The implications of these findings are twofold. First, while belonging to multiple social groups may provide a pathway to gaining social support and well-being, group belonging may not necessarily be beneficial to achieve stable housing. Second, fostering identification with homeless services may be particularly important as a source of support that contributes to well-being.

Discrimination and well-being amongst the homeless: the role of multiple group membership.

The homeless are a vulnerable population in many respects. Those experiencing homelessness not only experience personal and economic hardship they also frequently face discrimination and exclusion because of their housing status. Although past research has shown that identifying with multiple groups can buffer against the negative consequences of discrimination on well-being, it remains to be seen whether such strategies protect well-being of people who are homeless. We investigate this issue in a longitudinal study of 119 individuals who were homeless. The results showed that perceived group-based discrimination at T1 was associated with fewer group memberships, and lower subsequent well-being at T2. There was no relationship between personal discrimination at T1 on multiple group memberships at T2. The findings suggest that the experience of group-based discrimination may hinder connecting with groups in the broader social world - groups that could potentially protect the individual against the negative impact of homelessness and discrimination.

Homeless identities: enacted and ascribed.

Homelessness has been a perennial concern for sociologists. It is a confronting phenomenon that can challenge western notions of home, a discrete family unit and the ascetics and order of public space. To be without a home and to reside in public places illustrates both an intriguing way of living and some fundamental inadequacies in the functioning of society. Much homelessness research has had the consequence of isolating the 'homeless person' as distinct category or indeed type of individual. They are ascribed with homeless identities. The homeless identity is not simply presented as one dimensional and defining, but this imposed and ill-fitting identity is rarely informed by a close and long-term engagement with the individuals it is supposed to say something about. Drawing on a recent Australian ethnographic study with people literally without shelter, this article aims to contribute to understandings of people who are homeless by outlining some nuanced and diverse aspects of their identities. It argues that people can and do express agency in the way they enact elements of the self, and the experience of homelessness is simultaneously important and unimportant to understand this. Further, the article suggests that what is presumably known about the homeless identity is influenced by day-to-day lives that are on public display.