Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry.

Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among people experiencing homelessness in two cities in Ontario, Canada. A total of 49 people experiencing homelessness who had been restricted from an emergency shelter program in the past year were recruited and included in the study analysis. A pragmatic and integrative approach was used for data analysis that involved the development of meta-matrices to identify prominent and divergent perspectives and experiences with regard to service restriction antecedents and consequences. Study findings underscored that service restrictions were often the result of violence and aggression, primarily between service users. There were regional differences in other service restriction reasons, including substance use and possession. Service restrictions affected the shelter status of almost all participants, with many subsequently experiencing unsheltered homelessness, and cycling through institutional health, social, and criminal justice services (i.e., institutional circuitry). Other health and social consequences included substance use relapses and hospitalizations; cold-related injuries due to post-restriction unsheltered homelessness; suicidality; food insecurity; diminished contact with support network and connections; and intense feelings of anger, fear, and hopelessness. Overall, the study findings advance our understanding of the role of homeless services in pathways into unsheltered homelessness and institutional circuitry, which raise critical questions about how to mitigate the harms associated with service restrictions, while concurrently facilitating safety and upholding the rights of people experiencing homelessness and emergency shelter staff.

Dementia and mild cognitive impairment screening in an emergency homeless shelter.

INTRODUCTION: Older adults represent the fastest growing segment of the homeless community. Little is known about the prevalence of dementia and mild cognitive impairment (MCI) in this population. METHODS: Dementia and MCI screening using the Montreal Cognitive Assessment (MoCA) was incorporated into the standard senior evaluation for adult clients aged ≥ 55 in a large emergency homeless shelter. RESULTS: In a 6-week period, 104 of 112 (92.9%) assessments were positive for dementia or MCI using a standard cutoff of 26, and 81 (72.3%) were positive using a conservative cutoff of 23. There was no significant difference in MoCA scores based on sex or education level, and no significant correlation between age and MoCA score. DISCUSSION: Older adults experiencing homelessness may have a high likelihood of dementia or MCI. Routine MoCA screening in older adults experiencing homelessness is feasible and can help to identify services needed to successfully exit homelessness.

Did the association between alcohol outlet density and crime change during COVID shelter-in-place orders?

INTRODUCTION: We investigated whether greater concentrations of on- and off-sale alcohol outlets were associated with crime and whether this association was moderated by COVID-19 shelter-in-place orders (SIP) that restricted on-premises consumption of alcohol. METHODS: Crimes (2019-2020) and addresses of licenced alcohol outlets in a medium-sized California city were geocoded within census block groups (N = 61). On- and off-sale alcohol outlet density was calculated as licenced outlets/2.59 km2 (1 square mile). Multilevel negative binomial regression analyses were conducted to examine associations between alcohol outlet density and crime, and possible moderating effects of SIP, controlling for block group demographic characteristics and density of other retail businesses. RESULTS: On-sale outlet density was positively associated with total crimes and Part 2 crimes, while off-sale outlet density was inversely associated with total crime and Part 2 crimes. Overall, SIP was not significantly associated with crime, but moderated the associations of on-sale density with total crime and Part 1 crimes such that reductions in crime during SIP were observed in higher density areas. The association of off-sale outlets with crime was not moderated by SIP policies. DISCUSSION AND CONCLUSION: On-sale outlet density, but not off-sale density, appears to be associated with increased crime. The results further indicate that restrictions in hours and service imposed by SIP policies reduced crime in high on-sale outlet density areas. These findings reinforce the importance of regulating alcohol outlet density and hours of service, especially for on-sale outlets, as a crime reduction strategy.

Interruptions in HIV and Behavioral Health Care for Criminal-Legal Involved People Living with HIV Following Implementation of Decarceration and Shelter in Place in San Francisco, California.

Decarceration policies, enacted for SARS-CoV-2 mitigation in carceral settings, potentially exacerbated barriers to care for people living with HIV (PWH) with criminal legal involvement (CLI) during Shelter-in-Place (SIP) by limiting opportunities for engagement in provisions of HIV and behavioral health care. We compared health care engagement for PWH with CLI in San Francisco, California before and after decarceration and SIP using interrupted time series analyses. Administrative data identified PWH booked at the San Francisco County Jail with at least one clinic encounter from 01/01/2018-03/31/2020 within the municipal health care network. Monthly proportions of HIV, substance use, psychiatric and acute care encounters before (05/01/2019-02/29/2020) and after (03/01/2020-12/31/2020) SIP and decarceration were compared using Generalized Estimating Equation (GEE) log-binomial and logistic regression models, clustering on the patient-level. Of 436 patients, mean age was 43 years (standard-deviation 11); 88% cisgender-male; 39% white, 66% homeless; 67% had trimorbidity by Elixhauser score (medical comorbidity, psychotic disorder or depression, and substance use disorder). Clinical encounters immediately dropped following SIP for HIV (aOR = 0.77; 95% CI: 0.67, 0.90) and substance use visits (aRR = 0.83; 95% CI: 0.70, 0.99) and declined in subsequent months. Differential reductions in clinical encounters were seen among Black/African Americans (aRR = 0.93; 95% CI: 0.88, 0.99) and people experiencing homelessness (aRR = 0.92; 95% CI: 0.87, 0.98). Significant reductions in care were observed for PWH with CLI during the COVID-19 pandemic, particularly among Black/African Americans and people experiencing homelessness. Strategies to End the HIV Epidemic must improve engagement across diverse care settings to improve outcomes for this key population.

Revision of "Nutritional Reference Values for Feeding at Evacuation Shelters" and Model Menus: A Qualitative Study.

OBJECTIVE: In 2011, the Japanese government issued nutritional reference values for energy; protein; vitamins B1, B2, and C; and salt to deal with poor meal quality in evacuation shelters. Because they were not widely used owing to their impracticality, the authors had examined the values according to the experience-based opinions of public health dietitians. Furthermore, we developed a usage tool containing a model menu that meets these values. This study aimed to confirm the usability of these revised values and model menus and collect ideas for improvement. METHODS: We conducted 8 semi-structured group interviews with 12 dietitians, 9 disaster management officers, and 2 public health nurses in local governments supposed to have been affected by a large-scale disaster. RESULTS: New reference values were highly evaluated by most participants. Interviewees said that model menus were helpful for evacuees or disaster officers who are unfamiliar with nutrition because they show combinations of food items that meet the reference values instead of the amounts of energy and nutrients. To improve their understanding, it was suggested that food items be categorized by staples, main dishes, and side dishes, encouraging them to complete these three components of a balanced diet. Because it was difficult to meet all the reference values in the immediate aftermath of the disaster, it was suggested that the time-dependent priority of each nutrient and model menus that supply the nutrient should be shown by disaster phases along with the assumed availability of utility for cooking in each phase. CONCLUSION: The new reference values were feasible to meet during emergencies. Although model menus were also appreciated, further improvements were necessary for better understanding.

The Impact of the COVID-19 Shelter-in-Place Order on Traumatic Brain Injuries in San Francisco, California.

BACKGROUND: In response to the COVID-19 pandemic, San Francisco, California issued a shelter-in-place (SIP) order in March 2020, during which emergency physicians noted a drop in trauma cases, as well as a change in traditional mechanisms of trauma. OBJECTIVES: Our objective was to determine the epidemiology of traumatic brain injury (TBI) pre- and post-COVID-19 SIP. METHODS: We reviewed the electronic medical record of the only trauma center in the city of San Francisco, to determine the number of and characteristics of patients with a diagnosis of head injury presenting to the emergency department between December 16, 2019 and June 16, 2020. Using chi-squared and Fisher's exact tests when appropriate, we compared pre- and post- COVID-19 lockdown epidemiology. RESULTS: There were 1246 TBI-related visits during the 6-month study period. Bi-weekly TBI cases decreased by 36.64% 2 weeks after the COVID-19 SIP and then increased to near baseline levels by June 2020. TBI patients during SIP were older (mean age: 53.3 years pre-SIP vs. 58.2 post-SIP; p < 0.001), more likely to be male (odds ratio 1.43, 95% confidence interval 1.14-1.81), and less likely to be 17 or younger (8.9% vs. 0.5%, pre- to post-SIP respectively, p = 0.003). Patients were less likely to be Hispanic (27.2% vs. 21.7% pre- to post-SIP, respectively, p = 0.029). The proportion of TBI visits attributable to cycling accidents increased (14.1% to 52.7%, p < 0.001), whereas those attributable to pedestrians involved in road traffic accidents decreased (37.2% to 12.7%, p = 0.003). CONCLUSIONS: Understanding the changing epidemiology of TBI during the COVID-19 pandemic can aid in immediate and future disaster resource planning.

Poor Environmental Conditions Created the Acute Health Deteriorations in Evacuation Shelters after the 2016 Kumamoto Earthquake.

When disasters occur, affected people in evacuation shelters may experience health problems, such as exacerbation of chronic diseases or development of new diseases. This study examined the factors contributing to sudden illness in evacuation shelters used for the 2016 Kumamoto Earthquake. The subjects were evacuees of the Kumamoto Earthquake who were transported to hospitals from evacuation shelters by ambulance. Data on patients transported from evacuation shelters were obtained from emergency transport records at the Kumamoto City Fire Department and from medical institutions. The assessment of the living conditions in the shelter was obtained from the Emergency Medical Information System. A total of 576 patients were transported by ambulance from evacuation shelters in Kumamoto City. Of these, 300 patients for whom detailed information was obtained from medical institutions were included in the analysis. The median age was 71 years, and 213 patients (71%) were over 60 years old. There were 235 patients (78%) with pre-existing medical conditions. The most common reasons for emergency transport were falls and dyspnea, followed by fever, disturbance of consciousness, and abdominal pain. The most common final diagnosis at the medical institutions was trauma due to falls, followed by cardiovascular disease, infectious disease, and cerebral neurological disease. A survey of living conditions in the shelters identified problems with scarcity of space and provision of medical care and food. In order to prevent adverse health outcomes in evacuation shelters, the provision of appropriate living conditions and medical care is important from the acute phase of a disaster.

The impact of COVID-19 shelter-in-place policy responses on excess mortality.

As a way of slowing COVID-19 transmission, many countries and U.S. states implemented shelter-in-place (SIP) policies. However, the effects of SIP policies on public health are a priori ambiguous. Using an event study approach and data from 43 countries and all U.S. states, we measure changes in excess deaths following the implementation of COVID-19 shelter-in-place (SIP) policies. We do not find that countries or U.S. states that implemented SIP policies earlier had lower excess deaths. We do not observe differences in excess deaths before and after the implementation of SIP policies, even when accounting for pre-SIP COVID-19 death rates.

Operating an overdose prevention site within a temporary emergency shelter during the COVID-19 pandemic.

SETTING: A temporary emergency shelter was established inside the Commonwealth Stadium in Edmonton, Alberta, to reduce COVID-19 transmission and mitigate health risks among people experiencing homelessness. INTERVENTION: A non-profit organization, Boyle Street Community Services, opened an overdose prevention site (OPS) between February and March 2022 inside the temporary emergency shelter. People accessed the shelter-based OPS to consume unregulated drugs (via injection, intranasally, or orally), receive medical aid, access sterile drug use equipment, and be connected to additional health and social supports, without leaving the shelter. We conducted short interviewer-administered surveys with OPS participants to examine participant views and identify suggested improvements. OUTCOMES: The shelter-based OPS was accessed a total of 1346 times by 174 unique people. Fentanyl was the most common self-reported drug consumed (59%) and most consumption (99% of episodes) was by injection. OPS staff responded to 66 overdoses and reported no deaths. Survey respondents reported that the shelter-based OPS was convenient, with no need to forfeit their shelter spot or find transportation to another OPS. Respondents indicated that the OPS felt safe and accessible and reported that it reduced drug use in other shelter areas. Participants identified the OPS' exclusion of inhalation as a limitation. IMPLICATIONS: People who use unregulated drugs and are experiencing homelessness are at a higher risk of negative health outcomes, which COVID-19 exacerbated. Integrating temporary shelter/housing and harm reduction services may be an innovative way to lower barriers, increase accessibility, and improve well-being for this structurally vulnerable population. Future operators should consider incorporating inhalation services to further reduce service gaps.

RéSUMé: LIEU: Un refuge d'urgence temporaire avait été établi dans le stade du Commonwealth à Edmonton (Alberta) pour réduire la transmission de la COVID-19 et atténuer les risques pour la santé chez les personnes en situation d'itinérance. INTERVENTION: Un organisme sans but lucratif, Boyle Street Community Services, a ouvert un centre de prévention des surdoses (CPS) entre février et mars 2022 à l'intérieur de ce refuge d'urgence temporaire. Les gens avaient accès au CPS du refuge pour consommer des médicaments non réglementés (par injection ou par voie intranasale ou buccale), recevoir de l'aide médicale, se procurer du matériel de consommation stérile et être mis en rapport avec d'autres intervenants et intervenantes de la santé et des services sociaux sans sortir du refuge. Nous avons mené de brefs sondages administrés par l'enquêteur ou l'enquêtrice auprès des participantes et des participants du CPS pour étudier leurs points de vue et formuler des suggestions d'améliorations. RéSULTATS: Le CPS du refuge a été utilisé 1 346 fois par 174 personnes. Le fentanyl a été le médicament le plus souvent consommé selon les utilisateurs et utilisatrices (59 %), et la plupart du temps (dans 99 % des cas), il était consommé par injection. Le personnel du CPS est intervenu lors de 66 surdoses et n'a rapporté aucun décès. Les répondantes et répondants aux sondages ont indiqué que le CPS du refuge était pratique, car il n'était pas nécessaire d'abandonner leur place dans le refuge, ni de trouver un moyen de se rendre dans un autre CPS. Ces personnes ont trouvé le CPS sûr et accessible et ont dit qu'il avait réduit la consommation de drogue dans d'autres zones de refuge. Les participantes et participants ont indiqué que l'exclusion de la consommation par inhalation dans le CPS était toutefois une contrainte. CONSéQUENCES: Les personnes en situation d'itinérance qui consomment des médicaments non réglementés courent un plus grand risque d'avoir des résultats cliniques négatifs, ce que la COVID-19 a exacerbé. L'intégration de refuges/logements temporaires et de services de réduction des méfaits peut être un moyen novateur de réduire les obstacles, d'accroître l'accessibilité et d'améliorer le bien-être de cette population structurellement vulnérable. Les futurs gestionnaires devraient songer à intégrer des services d'inhalation pour réduire encore davantage les lacunes dans les services.

The Pent-Up Demand for Breastfeeding Among US Women: Trends After COVID-19 Shelter-in-Place.

Objectives. To estimate changes in national breastfeeding trends immediately before and after COVID-19‒related workplace closures in early 2020. Methods. The implementation of shelter-in-place policies in early 2020, when 90% of people in the United States were urged to remain at home, represents a unique natural experiment to assess the pent-up demand for breastfeeding among US women that may be stymied by the lack of a national paid leave policy. We used the 2017-2020 Pregnancy Risk Assessment Monitoring System (n = 118 139) to estimate changes in breastfeeding practices for births occurring before and after shelter-in-place policies were implemented in the United States. We did this in the overall sample and by racial/ethnic and income subgroups. Results. There was no change in breastfeeding initiation and a 17.5% increase in breastfeeding duration after shelter-in-place, with lingering effects through late 2020. High-income and White women demonstrated the largest gains. Conclusions. The United States ranks worse than similar countries when it comes to breastfeeding initiation and duration. This study suggests that this is partly attributable to inadequate access to postpartum paid leave. This study also demonstrates inequities introduced by patterns of remote work during the pandemic. (Am J Public Health. 2023;113(8):870-873. https://doi.org/10.2105/AJPH.2023.307313).

Evidence for Sex Differences in Depression, Sexual Attitudes, and Impulsivity as Predictors of Breaking Shelter-in-Place Orders During the COVID-19 Pandemic.

Although the call to understand how sexual behaviors have been impacted by the COVID-19 pandemic has been established as an important area of study, research examining the extent to which gender, sexual attitudes, impulsivity, and psychological distress predicted breaking shelter-in-place (SIP) orders to engage in sexual behaviors with partners residing outside the home is undefined. Obtaining a deeper examination of the variables which predict risky sexual behaviors during SIP has important implications for future research at the intersection of public health, sexuality, and mental health. This study addressed the gap in the literature by considering how partnered sexual behaviors may be used during the COVID-19 pandemic to alleviate stress, as measured by breaking SIP orders for the pursuit of sexual intercourse. Participants consisted of 186 females and 76 males (N = 262) who predominately identified Caucasian/White (n = 149, 57.75%) and heterosexual/straight (n = 190, 73.64%) cultural identities with a mean age of 21.45 years (SD = 5.98, range = 18-65). A simultaneous logistic regression was conducted to examine whether mental health symptoms, sexual attitudes, and impulsivity predicted participants' decision to break SIP orders to engage in sexual intercourse. Based on our results, breaking SIP orders to pursue sexual activities with partners residing outside the home during the COVID-19 pandemic may be understood as an intentional strategy among men with less favorable birth control attitudes to mitigate the effects of depression. Implications for mental health professionals, study limitations, and future areas of research are additionally provided.

Covid-19 shelter-in-place, modified reopening orders, and order compliance impact on adolescent alcohol use and drinking contexts in California: A longitudinal analysis.

INTRODUCTION: This study evaluated how Shelter-in-Place (SIP), modified reopening orders, and self-reported compliance with these orders have affected adolescent alcohol frequency and quantity of use across contexts during the COVID-19 pandemic. MATERIALS AND METHODS: Differences-in-differences (DID) models and multi-level modeling analyses were conducted on longitudinal data collected as part of a larger study on alcohol use among adolescents in California. 1,350 adolescents at baseline contributed 7,467 observations for a baseline and 5 six-month follow-up surveys. Analytic samples ranged from 3,577-6,245 participant observations based on models. Alcohol use outcomes included participant frequency (days) and quantity (number of whole drinks) of alcohol use in past 1-month and past 6-month periods. Context-specific alcohol use outcomes included past 6-month frequency and quantity of use at: restaurants, bars/nightclubs, outside, one's own home, another's home, and fraternities/sororities. Participant self-reported compliance with orders in essential business/retail spaces and at outdoor/social settings were also assessed. RESULTS: Our DID results indicated that being under a modified reopening order was associated with decreases in past 6-month quantity of alcohol use (IRR = 0.72, CI = 0.56-0.93, p < 0.05). Higher self-reported compliance with SIP orders related to social outdoor/social settings was associated with decreases in overall drinking frequency and quantity as well as decreases in frequency and quantity of alcohol use in all contexts in the past six months. Compliance with SIP orders impacting essential businesses and retail spaces was associated with decreased frequency and quantity of use at other's home and outdoors. CONCLUSIONS: Results suggest that SIP and modified reopening policies may not directly affect adolescent alcohol use or drinking contexts, and that individual compliance with such orders may be a protective factor for alcohol use.

Spatial Layout Planning of Urban Emergency Shelter Based on Sustainable Disaster Reduction.

An urban emergency shelter provides a place of temporary life and shelter for victims after a disaster. As a very important public service facility, its spatial layout is greatly related to the security of lives and the property of the urban residents. Upholding the concept of sustainable disaster reduction, this study took the central urban area of Xuzhou as an example. Based on the analysis of ArcGIS software, this study analyzed and planned the spatial layout of emergency shelters in Xuzhou and visualized the service area ratio, service population ratio, service capacity ratio, and service overlap rate of each administrative district. Finally, 73 fixed emergency shelters were determined, among which eight were classified as central shelters. At the same time, through consulting the relevant data, it was found that similar problems such as potential safety hazard, blind areas, service overlapping, and mismatch of shelter layout and actual needs also exist in other cities. Finally, in light of the existing problems, relevant suggestions are provided for the adjustment and optimization of the layout of emergency shelters.

Care and Complexity in Emergency Housing: an Examination of the COVID-19 Shelter-in-Place (SIP) Hotel Program to House People Experiencing Homelessness in San Francisco.

In this study, we consider the patient, provider, and public health repercussions of San Francisco's (SF) COVID-related response to homelessness using tourist hotels to house people experiencing homelessness (PEH). We describe the demographics, medical comorbidities, and healthcare utilization patterns of a subset of PEH who accessed the shelter-in-place (SIP) hotel sites during the 2020-2021 pandemic. We focus on how SIP hotels impacted connection to outpatient care and higher-cost emergency utilization. Our mixed methods study integrates qualitative and quantitative data to consider the impact of this temporary housing initiative among a medically complex cohort in a time of increased morbidity and mortality related to substance use. We found that temporary SIP housing increased outpatient care and reduced higher-cost hospital utilization. Our results can inform the future design and implementation of integrated supportive housing models to reduce mortality and promote wellness for PEH.

The Effect of COVID-19 Shelter-in-Place Orders on Pediatric Craniofacial Trauma.

Objectives: To investigate the impacts of the shelter-in-place orders on the injury patterns among children with craniofacial trauma. Materials and Methods: Pediatric (<18 years old) craniofacial trauma cases presenting to a regional level I trauma center 1 year before and after the initiation of Washington's shelter-in-place order were retrospectively reviewed. Demographic and injury-related variables were recorded, and bivariate and logistic regression analyses were computed. Results: One hundred nineteen children were evaluated over 2-year period (46 pre- and 73 post-shelter-in-place and were comparable in age, gender, and ethnicity (p ≥ 0.17)). The distribution of injury mechanisms between pre- and post-shelter-in-place were significantly different (p = 0.02), with the largest proportional increase in falls (10.5%) and had higher rates of associated brain injury (p ≤ 0.02). After adjusting for effect modifiers and confounders, children presenting during the post-shelter-in-place period were more likely to have associated brain injuries (odds ratio 3.4, 95% confidence interval: 1.11-10.6, p = 0.03). Conclusions: Among pediatric craniofacial injury cases, the shelter-in-place order was associated with a higher likelihood of brain injury and significant changes in injury mechanisms, with a higher proportion of falls.

Usefulness of Simple Meal Screening Using Dietary Assessment Sheets for Evacuation Shelters.

To maintain the health of evacuees, meals provided at emergency shelters should be monitored and improvement measures should be taken where necessary. Time and human resources are limited during devastating disasters; thus, the authors have developed the Dietary Assessment Sheets for Evacuation Shelters. This study examines whether the quality of meals can be assessed using simple check items on the Dietary Assessment Sheets.A total of 28 Dietary Assessment Sheets for 98 meals provided 16-19 days after the heavy rains in Kumamoto in July 2020 at 12 shelters were used in the analysis. Dietitians working for shelters were requested to fill the Dietary Assessment Sheets and food record sheets provided by the Prefectural Government. If any subitem was checkmarked, it was considered "checked," and if left blank, it was considered "not checked" and divided into categorical groups. Based on the food record sheets and meal photos, contents of energy, protein, and vitamins B1, B2, and C were calculated for each meal. Energy and nutrient contents were compared between the categorical groups.The study revealed that nutritionally poor meals were characterized as those comprising only "Grain dishes," those that were not "Boxed meals," and those involving "Self-Defense Forces," "Dietitians," or "Others." Their energy, protein, and vitamin B1, B2, and C content was significantly lower than that of meals with marks on other checkboxes in the same category.Shelters that provide these meals should be given priority for nutrition assistance due to their poor diets. The results imply that the Dietary Assessment Sheets could serve as a simple tool to determine the shelters that require nutritional assistance.

COVID shelter in place orders and mental health outcomes among college undergraduates.

ObjectiveThe purpose of this study is to examine the relationship , if any, COVID-19 shelter-in-place orders had on mental health outcomes for undergraduate students.ParticipantsThis study was comprised of 138 students, all of which were recruited from a single four-year college in the Midwest.MethodsA pre-/post-test comparative design was adopted and was leveraged to capture data regarding students' experiences before and after the shelter-in-place orders were enacted to determine if there was a marked effect between the pre-virus condition and the situation after stay at home orders went into effect.ResultsPaired sample t-test were conducted to determine whether the mental health outcomes of depression, anxiety and stress were significantly changed from before to after COVID-19 shelter in place disorders. While anxiety and stress scores were revealed no significant difference, significantly greater depression was revealed after COVID-19.ConclusionOverall, the results of this study highlight the need for colleges to be aware of the mental health toll that the pandemic and shelter-in-place orders may take on their students. Though this toll registered only directly in depression, there remains significant reasons to believe the situation may also affect stress and anxiety regardless of the absence of evidence for these factors in this study. There remains much to be done in assessing the ultimate impact of the pandemic on students' mental health.

Impact of mandatory COVID-19 shelter-in-place order on controlled substance use among rural versus urban communities in the United States.

PURPOSE: Mandatory COVID-19 shelter-in-place (SIP) orders have been imposed to fight the pandemic. They may also have led to unintended consequences of increased use of controlled substances especially among rural communities due to increased social isolation. Using the data from the American Association of Poison Control Centers, this study tests the hypothesis that the poison control centers received higher rates of calls related to exposures to controlled substances from rural counties than they did from urban counties during the SIP period. METHODS: Call counts received by the poison control centers between October 19, 2019 and July 6, 2020 due to exposure to controlled substance (methamphetamine, opioids, cocaine, benzodiazepines, and other narcotics) were aggregated to per-county-per-month-per-10,000 population exposure rates. A falsification test was conducted to reduce the possibility of spurious correlations. FINDINGS: During the study period, 2,649 counties in the United States had mandatory SIP orders. The rate of calls reporting exposure to any of the aforementioned controlled substances among the rural counties was higher (14%; P = .047) relative to the urban counties. This overall increase was due to increases in the rates of calls reporting exposure to opioids (26%; P = .017) and methamphetamine (39%; P = .077). Moreover, the rate of calls reporting exposures at home was also higher among the rural counties (14%; P = .069). CONCLUSION: The mandatory SIP orders may have had an unintended consequence of exacerbating the use of controlled substances at home in rural communities relative to urban communities.

Tiros na escola: algumas referências para a psicologia na assistência à comunidade escolar / School shotting: some references for psychology in school comunity support / Tíros em la escuela: algunas referencias para la psicología em la asistencia à comunidad escolar

A atuação em situações de emergências e desastres apresentam-se como um dos grandes desafios na atuação dos profissionais da Psicologia, demandando intervenções singulares, desde o primeiro contato com as vítimas e o com entorno afetado pelo ocorrido, passando pelo trabalho interdisciplinar e interinstitucional junto aos órgãos públicos de segurança, justiça, assistência e saúde. O presente artigo tem como objetivo apresentar, por meio da experiência na assistência às vítimas na Escola Estadual Raul Brasil, as particularidades e adversidades enfrentadas durante o primeiro semestre de intervenções emergenciais que antecederam a contratação de psicólogos por parte do poder público municipal para continuidade das ações. Por meio de relatos de experiência em intervenções psicológicas, obtidos em diferentes instituições para a assistência às vítimas, este trabalho também visa apresentar alternativas que possam servir de referências para a intervenção do psicólogo e da psicóloga em situações de emergências e desastres, especialmente ocorridas na comunidade escolar. Observou-se que a realização do trabalho interdisciplinar e interinstitucional somado à participação da direção da escola no planejamento das ações e a realização de plantões psicológicos e rodas de conversa junto à comunidade escolar foram fundamentais para a assistência às vítimas do ocorrido.(AU)

Timely response to emergency and disaster situations is a major challenge for Psychology professionals and require particular interventions, from initial contact with the victims and the affected environment to interdisciplinary and interinstitutional collaboration with public security, justice, assistance and health agencies. Based on the experience of providing assistance to the victims of the State School Raul Brasil, this paper presents the adversities and specificities faced during the first semester of emergency interventions implemented before psychologists were hired by municipal officials for the continuity of care. By analyzing experience reports on psychological interventions obtained from different institutions for victim assistance, this paper proposes alternatives to be used as reference for psychological intervention in emergency and disaster situations, especially those experienced by the school community. Interdisciplinary and interinstitutional collaboration with the school board for planning actions and offering psychological services and conversation circles for the school community was fundamental to assist the victims.(AU)

La actuación en situaciones de emergencias es uno de los grandes desafíos a los profesionales de la psicología, pues demanda intervenciones singulares desde el primer contacto con las víctimas y con el contexto afectado por lo ocurrido, pasando por la interdisciplinaridad e interinstitucionalidad junto a los organismos públicos de seguridad, justicia, asistencia y salud. Este artículo tiene como objetivo presentar, por medio de la experiencia de la asistencia a las víctimas del colegio estadual Raul Brasil (en São Paulo, Brasil), las particularidades y adversidades enfrentadas durante el primer semestre de las intervenciones de emergencia que antecedieron la contratación de psicólogos por parte del municipio para continuidad de las acciones. Por medio de reportes de experiencia en intervenciones psicológicas, obtenidos en diferentes instituciones para la asistencia a las víctimas, este estudio también pretende presentar alternativas que puedan servir de referencia en la intervención de psicólogos y psicólogas en situaciones de emergencia y desastres, especialmente ocurridas en la comunidad escolar. Se verificó que la realización del trabajo interdisciplinar e interinstitucional, la participación de la dirección del colegio en la implementación de acciones y la realización de guardias psicológicas y círculos de conversación con la comunidad escolar fueron fundamentales para una asistencia a las víctimas.(AU)