Working across boundaries to improve health outcomes: a case study of a housing support and outreach service for homeless people living with HIV

This paper reports the findings of an evaluation of the ‘Housing Support, Outreach and Referral’ service developed to support people living with HIV who were homeless or at risk of homelessness. The service was set up as part of the Supporting People Health Pilot programme established to demonstrate the policy links between housing support services and health and social care services by encouraging the development of integrated services. The paper considers the role of housing support in improving people's health, and considers the challenges of working across housing, health and social care boundaries. The evaluation of the health pilot employed two main sources of data collection: quarterly project evaluation reports, which collected process data as well as reporting progress against aims and objectives, and semi-structured interviews with professionals from all key stakeholder groups and agencies, and with people who used services. Over the course of 15 months, 56 referrals were received of which 27 were accepted. Fifteen people received tenancy support of whom 12 were helped to access temporary accommodation. At the end of the 15 months, all of the tenancies had been maintained. In addition, 18 people registered with a general practitioner and 13 registered with an HIV clinic. Interviews with professionals emphasised the importance of the local joint working context, the involvement of the voluntary sector and the role of the support workers as factors that accounted for these outcomes. Those using services placed most emphasis on the flexibility of the support worker role. Importantly, interviews with professionals and those using services suggest that the role of support worker incorporates two dimensions – those of networker/navigator as well as advocate – and that both dimensions are important in determining the effectiveness of the service.

Moving on, not out: when young people remain homeless

This article explores the contours of continued housing instability among a group of young people who are participants in a qualitative longitudinal study of youth homelessness in Dublin, Ireland, and considers the limitations of the ‘acculturation’ thesis in explaining long-term homelessness amongst the young. Baseline interviews were conducted with 40 young people, aged 14–23 years, in 2004, and follow-up interviews were conducted with 30 research participants successfully ‘tracked’ in 2005–06. By the time of follow-up, 17 of those interviewed had exited homelessness and 13 remained homeless. The article focuses on the latter group with the aim of exploring the processes and experiences associated with their continued homelessness. The findings presented demonstrate the adverse impact of their ongoing movement through emergency services targeting the under-18s, including their greater immersion in drug and criminal lifestyles. A majority had experienced one or more period of incarceration by the time of follow-up, and many were users of adult homeless services. Whilst some dimensions of young people's accounts are suggestive of a process of acculturation to street and hostel life, we argue that their continued homelessness is better explained as a consequence of their ongoing and unresolved transience and, in particular, their continued dependence on emergency hostel accommodation. The implications of the findings for policy and service provision for homeless young people are discussed.

Homeless young people, families and change.:Family support as a facilitator to exiting homelessness.

The families of homeless young people are most often portrayed as a precipitating factor in their homelessness. However, recent studies, particularly those taking a longitudinal approach, have drawn attention to the enabling role of family members and their positive influence on the housing trajectories of homeless youth. Drawing on selected findings from an ongoing longitudinal qualitative study of homeless young people in Dublin, Ireland, this paper aims to build on this relatively fertile area of research. We demonstrate the supportive role of the families of young people who experience homelessness (often as a consequence of difficult family environments) and specifically examine how family re-engagement is negotiated and achieved. The findings highlight a number of dimensions of transition and change. Prominent among these is the importance of renewed trust and communication. Young people and their parents also had to accept responsibility for areas of life that previously served to undermine their relationships and were implicated in the circumstances surrounding a young person's premature home-leaving. Tensions and resistances on the part of young people are highlighted, demonstrating the adaptive mechanisms at work as they attempt to re-engage with family members. The implications of the findings for social work intervention with homeless youth are discussed.

The Meaning of Drug Use among Homeless Young People:A longitudinal pathways analysis

A strong link between drug use and homelessness has long since been documented in the international literature. However, much of the research has concentrated on the direction of the relationship between drug use and homelessness, seeking to establish drug use as a cause or consequence of homelessness, with far less attention to the intersection of drug and homeless ‘careers’. This paper examines the drug and homeless pathways of young people who are participants in a qualitative longitudinal study of homeless youth in Dublin, Ireland. The findings highlight downward drug transitions as associated with exiting homelessness and continued or escalated consumption as associated with remaining homeless. Analyses of the meanings young people attach to drug use over time reveal the importance of housing as an enabler to engaging with treatment and as assisting the process of becoming and remaining drug free. Young people who remained homeless did not accept their situations, as ‘acculturation’ accounts would suggest; rather, they aspired to changing their situations. However, they also face strong barriers to accessing housing which in turn hamper their efforts to address the matter of their drug use. The implications for how the homeless/drug use ‘nexus’ is conceptualised and understood, as well as implications for policy, are discussed.

Young people exiting homelessness: An exploration of process, meaning and definition

In the past decade in particular, research attention has shifted from an almost exclusive focus on routes or pathways into homelessness towards the investigation of exits from homelessness. As well as demonstrating the multiple paths possible for young people who become homeless, recent research, and longitudinal studies in particular, has contributed to a more nuanced understanding of the complexity of the homeless pathways of young people. Nonetheless, knowledge and understanding of the nature of homeless exits, and of the mechanisms that facilitate the transition out of homelessness, is far from complete. This paper explores the processes surrounding the exit routes taken by young people out of homelessness and the meanings attached by them to these housing transitions based on selected findings from an ongoing qualitative longitudinal study of homeless youth in Dublin, Ireland. More broadly, the paper considers the utility of distinguishing between the types of routes that young people take out of homelessness, with particular attention to the notions of ‘independent’ and ‘dependent’ exits. The paper aims to further the discussion and debate on the conceptualisation of homeless exits and also discusses a number of policy implications arising from the study's findings.

GiveMe Shelter: a people-centred design process for promoting independent inquiry-led learning in engineering

It has become increasingly common for tasks traditionally carried out by engineers to be undertaken by technicians and technologist with access to sophisticated computers and software that can often perform complex calculations that were previously the responsibility of engineers. Not surprisingly, this development raises serious questions about the future role of engineers and the education needed to address these changes in technology as well as emerging priorities from societal to environmental challenges. In response to these challenges, a new design module was created for undergraduate engineering students to design and build temporary shelters for a wide variety of end users from refugees, to the homeless and children. Even though the module provided guidance on principles of design thinking and methods for observing users needs through field studies, the students found it difficult to respond to needs of specific end users but instead focused more on purely technical issues.