Recovery education for people experiencing housing instability: An evaluation protocol.

BACKGROUND: Recovery education centers (RECs) offer recovery supports through education rather than traditional health services. The Supporting Transitions and Recovery Learning Centre (STAR) in Toronto, Canada, is among the few that are internationally focused on individuals with histories of homelessness. Although research suggests that RECs positively impact participants, there is a paucity of rigorous studies and none address the engagement and impacts on homeless individuals. AIMS: This protocol describes a realist-informed evaluation of STAR, specifically examining (1) if STAR participation is more effective in promoting 12-month recovery outcomes than participation in usual services for individuals experiencing housing instability and mental health challenges and (2) how STAR participation promotes recovery and other positive outcomes. METHODS: This study uses a quasi-experimental mixed methods design. Personal empowerment (primary outcome) and recovery, housing stability, social functioning, health service use and quality of life (secondary outcomes) data were collected at baseline, and 6 and 12 months. Intervention group participants were recruited at the time of STAR registration while control group participants were recruited from community agencies serving this population after screening for age and histories of housing instability. Interviews and focus groups with service users and providers will identify the key intervention ingredients that support the process of recovery. RESULTS: From January 2017 to July 2018, 92 individuals were recruited to each of the intervention and control groups. The groups were mostly similar at baseline; the intervention group's total empowerment score was slightly higher than the control group's (M (SD): 2.94 (0.23) vs 2.84 (0.28), p = .02), and so was the level of education. A subset of STAR participants (n = 20) and nine service providers participated in the qualitative interviews and focus groups. CONCLUSION: This study will offer important new insights into the effectiveness of RECs, and expose how key REC ingredients support the process of recovery for people experiencing housing instability.

Perceived roles and barriers in caring for the people who are homeless: a survey of UK community pharmacists.

Background Community pharmacists can be an accessible source for advice and support for the people who are homeless, given their utilisation of a variety of currently available services such as dispensing of medicines, drugs and alcohol services. Objective To determine community pharmacists' training, experiences and behavioural determinants in counselling and management of homeless population. Setting UK community pharmacies. Method A questionnaire based on literature and theoretical domains framework was mailed to randomly sampled community pharmacies in England and Scotland (n = 2000). Data were analysed using descriptive and inferential statistics. Main outcome measures Pharmacists' perspectives, pharmacists' training, pharmacists' experiences and behavioural determinants. Results A total of 321 responses (RR 16.1%) were received. Respondents indicated lack of knowledge, skills, intentions as well as contextual factors such as lack of guidelines impacted on their counselling and management of homeless patients. Less than a third (n = 101, 32.2%) indicated that they knew where to refer a homeless patient for social support. Broaching the subject of homelessness was outside their comfort zone (n = 139, 44.3%). Only four (1.2%) respondents could correctly answer all knowledge assessment questions. Conclusions Community pharmacist identified lack of education, training opportunities and guidelines in counselling and management of homeless patients. Targeting community pharmacists' knowledge, skills and intention to provide care to the homeless patients may enable addressing health inequality through community pharmacy.

Evaluation of an Opiate Overdose Educational Intervention and Naloxone Prescribing Program in Homeless Adults Who Use Opiates.

Opiate overdose deaths are considered an epidemic by the Centers for Disease Control and Prevention. Homeless adults are disproportionately affected by opioid overdoses. The purpose of this project was to implement an opiate overdose training and routine naloxone prescribing program for patients at a Health Care for the Homeless clinic. Education consisted of overdose risk factors, signs of overdose, how to respond to an opiate overdose, and how to administer naloxone. Knowledge was measured with a pretest and a posttest. Intranasal naloxone was prescribed for each person who received the education, and prescription fill rates were tracked 1 week after the clinic visit. Patients had a significant increase in knowledge, and the overall naloxone fill rate was 33%. Fill rates varied by housing, insurance, and other prescription status. Opiate overdose education can effectively be delivered in a homeless medical clinic, although more research is needed regarding barriers to naloxone fill rates.

A Peer-led Diabetes Education Program in a Homeless Community to Improve Diabetes Knowledge and Empowerment.

Peer-led diabetes education has been shown to be as effective, or more effective, than traditional education in improving glycemic control and diabetes self-care measures. A 4-week peer-led diabetes education program was conducted in a homeless community in Grand Rapids, Michigan to increase diabetes knowledge and empowerment. Knowledge scores increased significantly during sessions covering signs, symptoms, and complications of diabetes and diabetes medications (ps <.05). Empowerment scores after attending the 4-week program were significantly increased when compared to scores prior to the first session (p = .027). Field notes and postimplementation focus group support increased empowerment and knowledge among participants.

Feasibility and Acceptability of a Pilot Housing Transition Program for Homeless Adults with Mental Illness and Substance Use.

The purpose of this study was to determine if a housing transition program was feasible and acceptable to homeless clients with mental illness and substance use histories. Ten male residents of a homeless shelter participated in the 3-week housing intervention. The intervention used a DVD format with instructional videos, graphics, and opportunities for hands-on practice of functional skills in a simulated apartment environment. Outcome measures included goal attainment scale scores (GAS), satisfaction surveys, and case manager reports. Six of the 10 participants completed the program and achieved GAS scores at a greater level than expected at baseline (T > 50). Participants reported the intervention to be engaging and enhanced their knowledge of the housing transition process. The intervention appears to have assisted the participants in the attainment of housing skills and warrants further study.

[EFFECT OF EDUCATIONAL LEAFLETS ON KNOWLEDGE AND ATTITUDE TO TUBERCULOSIS AMONG HOMELESS PERSONS IN TOKYO, JAPAN].

SETTING: Delay in seeking care is one of the critical issues in tuberculosis (TB) control among homeless persons in Japan. Yet knowledge of and attitude towards TB among homeless persons have remained unclear and limited efforts have been made to disseminate information related to TB among homeless persons. OBJECTIVE: To evaluate the effect of TB leaflets, produced and distributed to homeless persons by a group of ex-homeless TB patients, and to understand what homeless persons know about TB. DESIGN: Self-administered questionnaire was conducted among homeless persons before and after distribution of the TB leaflets. Changes in the responses to each question were also subjected to principal component analysis to group questions into types according to response patterns and identify constructs of TB-related knowledge. RESULTS: Results of 88 participants were analyzed. TB knowledge score related to risks and symptoms significantly improved after the intervention (from 54.3% to 70.6%, p < 0.05), while knowledge on treatment cost did not. Two components were identified, namely, the "improvement in TB impression" and "improvement in TB knowledge". CONCLUSION: TB leaflets were effective in improving certain aspects of TB knowledge. However, its effect on knowledge regarding treatment cost, which may be crucial in improving delay, was limited and thus the messages need to be revised.

Effectiveness of peer educators on the uptake of mobile X-ray tuberculosis screening at homeless hostels: a cluster randomised controlled trial.

TRIAL DESIGN: Cluster randomised controlled trial. OBJECTIVE: To compare current practice for encouraging homeless people to be screened for tuberculosis on a mobile digital X-ray unit in London, UK, with the additional use of volunteer peer educators who have direct experience of tuberculosis, homelessness or both. PARTICIPANTS: 46 hostels took part in the study, with a total of 2342 residents eligible for screening. The study took place between February 2012 and October 2013 at homeless hostels in London, UK. INTERVENTION: At intervention sites, volunteer peer educators agreed to a work plan that involved moving around the hostel in conjunction with the hostel staff, and speaking to residents in order to encourage them to attend the screening. RANDOMISATION: Cluster randomisation (by hostel) was performed using an internet-based service to ensure allocation concealment, with minimisation by hostel size and historical screening uptake. BLINDING: Only the study statistician was blinded to the allocation of intervention or control arms. PRIMARY OUTCOME: The primary outcome was the number of eligible clients at a hostel venue screened for active pulmonary tuberculosis by the mobile X-ray unit. RESULTS: A total of 59 hostels were considered for eligibility and 46 were randomised. Control sites had a total of 1192 residents, with a median uptake of 45% (IQR 33-55). Intervention sites had 1150 eligible residents with a median uptake of 40% (IQR 25-61). Using Poisson regression to account for the clustered study design, hostel size and historical screening levels, there was no evidence that peer educators increased uptake (adjusted risk ratio 0.98; 95% CIs 0.80 to 1.20). The study team noted no adverse events. CONCLUSIONS: This study found no evidence that volunteer peer educators increased client uptake of mobile X-ray unit screening for tuberculosis. Further qualitative work should be undertaken to explore the possible ancillary benefits to peer volunteers. TRIAL REGISTRATION NUMBER: ISRCTN17270334.

O PalhaSUS e a Saúde em Movimento nas Ruas: relato de um encontro / The PalhaSUS and the Family Health Strategy for Homeless People: a report of the meeting / PalhaSUS y salud en movimiento por las calles: informe de una unión

Relatamos a experiência gerada pelo encontro entre os projetos PalhaSUS e Estratégia Saúde da Família para População em Situação de Rua (ESF POP RUA), identificando (i) sua afinidade metodológica com a Educação Popular em Saúde e (ii) a singularidade do território de atuação, a rua, ambiente propício para esse casamento. O encontro foi mediado, por um lado, pela Coordenação de Saúde da Família e pelo Núcleo de Cultura, Ciência e Saúde, da Secretária Municipal de Saúde e Defesa Civil do Rio de Janeiro, e, por outro lado, pelo PalhaSUS desenvolvido no Instituto Oswaldo Cruz, introduzido no processo formativo da primeira equipe da ESF POP RUA. Após as atividades, os agentes de saúde assumiram um segundo papel, como palhaços mediadores da promoção da saúde com alegria, confirmando o potencial de integração da Dialogia do Riso nas ações e políticas de combate à miséria...

We report the experience generated by the union between the projects PalhaSUS and Family Health Strategy for Homeless People (ESF POP RUA), identifying (i) their methodological affinity with popular health education and (ii) the singularity of the street, which is the best environment for this union. The encounter was mediated, by one side, by the Coordination of Family Health and the Center for Culture, Science and Health, from the city government of Rio de Janeiro, and by the other side, by the PalhaSUS project developed at Oswaldo Cruz Institute, which was introduced in the formative process of the first ESF POP RUA team. After the activities, Health Agents have aggregated a new role: clowns mediating health promotion with joy, confirming the potential of integrating Dialogy of Laughter in actions and policies to fight poverty...

Relatamos la experiencia entre el encuentro de los proyectos PalhaSUS y la Estrategia de Salud de la Familia para Indigentes (ESF POP RUA), identificando (i) la afinidad metodológica con la educación popular en salud y (ii) la singularidad del território, ambiente propicio para esta unión. El encuentro fue mediado por la Coordinación de Salud de la Familia y por el Centro de Cultura, Ciencia y Salud de la Secretaría Municipal de Salud y Defensa Civil de Río de Janeiro y por PalhaSUS, proyecto desarrollado en el Instituto Oswaldo Cruz e introducido en el proceso de formación del primer equipo de ESF POP RUA. Después de las actividades, los profesionales de esta área tuvieran un papel en la promoción de la salud como payasos-agentes de alegría, confirmando el potencial de la risa en las acciones y políticas para combatir la pobreza...

Caries and oral health related behaviours among homeless adults from Porto, Portugal.

PURPOSE: To describe caries prevalence and oral-health-related behaviours in a sample of homeless adults from the city of Porto, Portugal. MATERIALS AND METHODS: Subjects attending any of two temporary shelters or two institutions that provide meal programmes were consecutively invited (n = 196); 42 (21.4%) refused to participate. Trained interviewers applied a structured questionnaire to obtain sociodemographic, behavioural, health and oral health status data. An oral examination was conducted to evaluate the past and present history of caries (Decayed Missing Filled Teeth [DMFT] index) and the presence of oral lesions. Those classified as houseless were considered for the present analysis (n = 141). The association between homelessness, sociodemographic and behavioural characteristics and oral health indexes was quantified through crude ß coefficients and ß coefficients adjusted for age, gender, education, nationality and duration of homelessness, as well as the respective 95% confidence intervals (CI). RESULTS: The median age of the participants was 45 years, most were male (86.3%), reported having less than a 9th grade education (80.1%) and were unemployed (82.1%). The median duration of homelessness was 24 months. The mean (SD) DMFT index, number of decayed, lost and filled teeth were 12.8 (7.9), 4.2 (4.4), 8.0 (7.6) and 0.6 (1.9), respectively. Older subjects and those homeless for longer periods presented higher DMFT index scores (ß = 3.4, 95% CI: 0.0 to 6.8) and higher number of decayed teeth (ß = 2.8, 95% CI: 0.4 to 5.2). Filled teeth were more frequent among the more educated (>9 vs ≤4 years: ß = 1.6, 95% CI: 0.7 to 2.6). CONCLUSIONS: This population of homeless subjects showed poor oral health, particularly with respect to caries and missing teeth, resulting in high oral treatment needs.

Impact of nursing intervention on improving HIV, hepatitis knowledge and mental health among homeless young adults.

In a prospective two-group pilot study of a convenient sample of 156 young adults, we assessed improvement in HIV cognitive and transmission knowledge, hepatitis knowledge, and mental health at six-month follow-up. Multiple linear regression analysis revealed higher six-month scores in total HIV/AIDS knowledge, HIV/AIDS cognitive knowledge, HIV transmission knowledge and HBV and HCV knowledge at 6 months in the Hepatitis Health Promotion (HHP) group compared to the Art Messaging (AM) group. Moreover, homeless young participants who reported having significant others in their lives, and excellent or very good health did better than their counterparts. Youth who were attempting to get their lives together had higher scores for all types of knowledge except HBV. Hallucinogen users had significantly worse scores on all knowledge measures than non-users. Lastly, the HHP group revealed an improvement in psychological well-being compared to the AM group.

Confrontations and donations: encounters between homeless pet owners and the public.

This study examines the interactions between homeless pet owners and the domiciled public with a focus on how the activities of pet ownership help construct positive personal identities. Homeless people are often criticized for having pets. They counter these attacks using open and contained responses to stigmatization. More often, they redefine pet ownership to incorporate how they provide for their animals, challenging definitions that require a physical home. Homeless pet owners thus create a positive moral identity by emphasizing that they feed their animals first and give them freedom that the pets of the domiciled lack. Through what we call "enabled resistance," donations of pet food from the supportive public provide the resources to minimize the impact of stigmatization.

"Near and far": social distancing in domiciled characterisations of homeless people.

For domiciled individuals, homeless people provide a disturbing reminder that all is not right with the world. Reactions to seeing homeless people frequently encompass repulsion, discomfort, sympathy and sometimes futility. This paper considers domiciled constructions of homeless people drawn from interviews with 16 participants recruited in the central business district of a New Zealand city. It documents how, when trying to make sense of this complex social problem, domiciled people draw on shared characterizations of homeless people. The concept of "social distance" is used to interrogate the shifting and sometimes incongruous reactions evident in participant accounts. "Social distancing" is conceptualised as a dynamic communal practice existing in interactions between human beings and reflected in the ways that domiciled people talk about their experiences with homeless individuals.

Faith-based social services: saving the body or the soul? A research note.

Faith-based organizations might be ideal social service providers, claiming to transform clients' lives with holistic support while meeting immediate needs. While organizations have such goals, their success is impacted by constituencies with differing goals for the organization. Clients with goals not commensurate with an organization's may compromise its ability to attain its goals. Three questions are examined here: What are the goals of faith-based service providers? When asked what they think about the services, do clients share the organizational goals? Are organizations likely to meet either set of goals? Homeless persons patronizing faith-based soup kitchens were interviewed; service activities of organizations were observed. Clients' goals focused on survival in their current situation. Organizations' goals ranged from meeting clients' immediate needs to transforming clients through spiritual restoration. Congregations studied met clients' immediate needs. However, clients' accommodational goals were potentially problematic for organizations with spiritual goals.

Development of the Fogg Intent-to-Screen for HIV (ITS HIV) questionnaire.

In this paper, we describe the development and psychometric properties of the Fogg Intent-to-Screen for HIV questionnaire (ITS HIV), which measures peoples' beliefs and intentions toward HIV screening. The ITS HIV was developed using the Theory of Planned Behavior as the framework for a developmental process that included qualitative interviews, a validation phase, two pilot tests, and a field test of the final 55-item questionnaire. The field test involved 312 homeless persons from five New England states. Cronbach alphas of the direct measures scales ranged from .72 to .90. Findings from a path analysis verified the construct validity. The psychometric estimates from these analyses suggest the ITS HIV questionnaire is appropriate for use in clinical practice or to evaluate the effectiveness of interventions.

The exclusion of (failed) asylum seekers from housing and home: towards an oppositional discourse.

"Housing" - the practical provision of a roof over one's head - is experienced by users as "home" - broadly described as housing plus the experiential elements of dwelling. Conversely, being without housing, commonly described as "homelessness", is experienced not only as an absence of shelter but in the philosophical sense of "ontological homelessness" and alienation from the conditions for well-being. For asylum seekers, these experiences are deliberately and explicitly excluded from official law and policy discourses. This article demonstrates how law and policy is propelled by an "official discourse" based on the denial of housing and the avoidance of "home" attachments, which effectively keeps the asylum seeker in a state of ontological homelessness and alienation. We reflect on this exclusion and consider how a new "oppositional discourse" of housing and home - taking these considerations into account - might impact on the balancing exercise inherent to laws and policies concerning asylum seekers.

"Weak-Center" Gentrification and the Contradictions of Containment: deconcentrating poverty in downtown Los Angeles.

This case study of recent efforts to deconcentrate poverty within the Skid Row area of Los Angeles examines processes of "weak-center" gentrification as it applies to a "service dependent ghetto," thus filling two key gaps in prior scholarship. We document the collaboration between the government, business and development interests, and certain non-profit agencies in this process and identify two key mechanisms of poverty deconcentration: housing/service displacement and the criminalization of low income residents. Following Harvey, we argue that these efforts are driven by pressures to find a "spatial fix" for capital accumulation through Downtown redevelopment. This process has been hotly contested, however, illustrating the strength of counter-pressures to gentrification/poverty deconcentration within "weak-center" urban areas.

Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA.

BACKGROUND: Fatal opioid overdose is a significant cause of mortality among injection drug users (IDUs). METHODS: We evaluated an overdose prevention and response training programme for IDUs run by a community-based organisation in Los Angeles, CA. During a 1-h training session participants learned skills to prevent, recognise, and respond to opioid overdoses, including: calling for emergency services, performing rescue breathing, and administering an intramuscular injection of naloxone (an opioid antagonist). Between September 2006 and January 2008, 93 IDUs were trained. Of those, 66 (71%) enrolled in the evaluation study and 47 participants (71%) completed an interview at baseline and 3-month follow-up. RESULTS: Twenty-one percent of participants were female, 42% were white, 29% African American, and 18% Latino. Most were homeless or lived in temporary accommodation (73%). We found significant increases in knowledge about overdose, in particular about the use of naloxone. Twenty-two participants responded to 35 overdoses during the follow-up period. Twenty-six overdose victims recovered, four died, and the outcome of five cases was unknown. Response techniques included: staying with the victim (85%), administering naloxone (80%), providing rescue breathing (66%), and calling emergency services (60%). The average number of appropriate response techniques used by participants increased significantly from baseline to follow-up (p<0.05). Half (53%) of programme participants reported decreased drug use at follow-up. CONCLUSION: Overdose prevention and response training programmes may be associated with improved overdose response behaviour, with few adverse consequences and some unforeseen benefits, such as reductions in personal drug use.