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.

Prevalence and vulnerability of homeless people to HIV infection in Sao Paulo, Brazil

OBJECTIVE: To assess the prevalence and vulnerability of homeless people to HIV infection. METHODS: Cross-sectional study conducted with a non-probabilistic sample of 1,405 homeless users of shelters in the city of Sao Paulo, southeastern Brazil, from 2006 to 2007. They were all tested for HIV and a structured questionnaire was applied. Their vulnerability to HIV was determined by the frequency of condom use: those who reported using condoms only occasionally or never were considered the most vulnerable. Multinomial and logistic regression models were used to estimate effect measures and 95% confidence intervals. RESULTS: There was a predominance of males (85.6%), with a mean age of 40.9 years, 72.0% had complete elementary schooling, and 71.5% were non-white. Of all respondents, 15.7% reported being homosexual or bisexual and 62,0% reported having casual sex. The mean number of sexual partners in the last 12 months was 5.4. More than half (55.7%) of the respondents reported lifetime drug use, while 25.7% reported frequent use. Sexually-transmitted disease was reported by 39.6% of the homeless and 38.3% reported always using condoms. The prevalence of HIV infection was 4.9% (17.4% also tested positive for syphilis) and about half of the respondents (55.4%) had access to prevention programs. Higher HIV prevalence was associated with younger age (18-29 years, OR = 4.0 [95% CI 1.54; 10.46]); past history of sexually-transmitted disease (OR = 3.3 [95% CI 1.87; 5.73]); homosexual sex (OR = 3.0 [95% CI 1.28; 6.92]); and syphilis (OR = 2.4 [95% CI 1.13; 4.93]). Increased vulnerability to HIV infection was associated with being female; young; homosexual sex; having few partners or a steady partner; drug and alcohol use; not having access to prevention programs and social support. CONCLUSIONS: The HIV epidemic has a major impact on homeless people reflecting a cycle of exclusion, social vulnerability, and limited access to prevention.

Federal programs to help homeless people /

Includes indexes.

How many homeless people are there?

Mode of access: Internet.

A genealogy of the problematic of homelessness and the homeless in Australia

The homeless have been subject to considerable scrutiny, historically and within current social, political and public discourse. The aetiology of homelessness has been the focus of a large body of economic, sociological, historical and political investigation. Importantly, efforts to conceptualise, explain and measure, the phenomenon of homelessness and homeless people has occurred largely within the context of defining “the problem of the homeless” and the generation of solutions to the ‘problem’. There has been little consideration of how and why homelessness has come to be seen, or understood, as a problem, or how this can change across time and/or place. This alternative stream of research has focused on tracing and analysing the relationship between how people experiencing homeless have become a matter of government concern and the manner in which homelessness itself has been problematised. With this in mind this study has analysed the discourses - political, social and economic rationalities and knowledges - which have provided the conditions of possibility for the identification of the homeless and homelessness as a problem needing to be governed and the means for translating these discourses into the applied domain. The aim of this thesis has been to contribute to current knowledge by developing a genealogy of the conditions and rationalities that have underpinned the problematisation of homelessness and the homeless. The outcome of this analysis has been to open up the opportunity to consider alternative governmental possibilities arising from the exposure of the way in which contemporary problematisation and responses have been influenced by the past. An understanding of this process creates an ability to appreciate the intended and unintended consequences for the future direction of public policy and contemporary research.

The relationship between well-being, future planning and intentions to utilise intervention programmes: what can be learned from homeless service users?

There has been an increasing interest in the impact of individual well-being on the attitudes and actions of people receiving services designed to offer support. If well-being factors are important in the uptake and success of service programmes it is important that the nature of the relationships involved is understood by service designers and implementers. As a contribution to understanding, this paper examines the impact of well-being on the uptake of intervention programmes for homeless people. From the literature on well-being a number of factors are identified that contribute towards overall well-being, which include personal efficacy and identity, but also more directly well-being can be viewed as personal or group/collective esteem. The impact of these factors on service use is assessed by means of two studies of homelessness service users, comparing the implementation of two research tools: a shortened and a fuller one. The conclusions are that the factors identified are related to service use. The higher the collective esteem – esteem drawn from identification with services and their users and providers – and the less that they feel isolated, the more benefits that homeless people will perceive with service use, and in turn the more likely they are to be motivated to use services. However, the most important factors in explaining service use are a real sense that it is appropriate to accept social support from others, a rejection of the social identity as homeless but a cultivation of being valued as part of a non-homeless community, and a positive perception of the impact of the service.

Exploring homeless people’s use of outreach services: applying a social psychological perspective

A number of critiques have been published drawing attention to the gaps in research methods applied to issues surrounding homelessness and service utilisation in Britain. This paper discusses the use of social identity, a theory drawn from the field of applied social psychology, and synthesises it with the pathways model, thereby providing a framework to further explore service utilisation. The synthesised framework was used to predict the uptake of outreach services in a prospective study of 121 homeless people in a major UK city. In general, homeless people's use of intervention services was affected by the extent to which they identified with the support services themselves. The study demonstrates the central role of social identity in understanding service utilisation patterns, and shows the importance of applying fresh techniques to fine-tune our understanding of uptake in the long term.

The role of efficacy and well-being in guiding the use of education and training services by young homeless mothers

This paper builds on previous work applying the concept of well-being to the field of housing. It uses the concepts of self-esteem, efficacy and social identity to explore the situations of a group of young homeless mothers. In particular, it focuses on the impact of well-being factors, among others, in understanding the uptake of education and training services. The paper concludes by arguing that well-being issues are crucial for housing agencies and others who want to engage with young homeless people.

Estimating the Size of the Homeless Population in Budapest

Since 1990, the issue of homelessness has become increasingly important in Hungary as a result of economic and structural changes. Various suggestions as to how the problem may be solved have always been preceded by the question "How many homeless people are there?" and there is still no official consensus as to the answer. Counting of the homeless is particularly difficult because of the bias in the initial sampling frame due to two factors that characterise this population: the definition of homelessness, and its 'hidden' nature. David aimed to estimate the size of the homeless population of Budapest by using two non-standard sampling methods: snowball sampling and the capture-recapture method. Her calculations are based on three data sets: one snowball data set and two independent list data sets. These estimators, supported by other statistical data, suggest that in 1999 there were about 8000-10000 homeless people in Budapest.

Homeless mortality in Harris County in 2008

Little research has been on homeless mortality, but what has been done indicates that homeless people have higher mortality rates than the general population. Homeless decedents in Harris County in 2008 who were referred to the Harris County Medical Examiner's Office (HCMEO) were described by age, race/ethnicity, sex, and marital status and compared to the homeless population as enumerated by the Coalition of the Homeless (COH) in 2007. Of the 47 decedents, eight (17%) were female and 39 (83%) were male, 24 (51.1%) were non-Hispanic white, 11 (23.4%) were black, and 12 (25.5%) were Hispanic, none of the decedents were listed as married, however, a large number (29, 61.5%) were listed as “unknown,” and the average age of decedents was 50 years, six years older than the average of 44 years in the general homeless population. Most common causes of death were injuries, which included motor vehicle accidents, homicides and suicides and poisonings, (acute overdose and chronic substance use). Homeless decedents were representative to the larger Harris County homeless population. ^

Homeless access to dental health care: Creation of a dental service model

This project involved developing a model for planning a dental emergency treatment center that could function as an embedded component of a shelter for the homeless population. The dental services provided by such a clinic should include treatment for tooth pain, dental caries or cavities, chipped or broken teeth, broken partials, abscessed teeth, emergency cleanings, periodontal disease or gum disease and fillings. These are the dental services that are most often sought by homeless people in hospital emergency rooms.^ The underlying assumption for this project was that the oral health needs of the homeless community can most effectively be addressed by implementing small dental clinics in existing facilities that provide shelter and other services for this population. The model described in this project identifies oral health care services that would be provided by the clinic, facility (physical plant) requirements and associated infrastructure to operate an embedded dental clinic, methods for obtaining funding, strategies of recruiting dental professionals to staff the facility, and methods to assess the outcomes of the embedded clinic strategy. As an example, this project describes a strategy for developing such an embedded clinic at San Antonio Metropolitan Ministries SAMM shelter based on recommendations from community health care leaders, managers of homeless shelters, members of the homeless community and dental professionals^

Development and validation of the Attitudes Towards the Homeless questionnaire

CONTEXT: The homeless are a significant group within society, which is increasing in size. They have demonstrably greater physical and mental health needs than the housed, and yet often have difficulty accessing primary health care. Medical 'reluctance' to look after homeless people is increasingly suggested as part of the problem. Medical education may have a role in ameliorating this. OBJECTIVES: This paper reports on the development and validation of a questionnaire specifically developed to measure medical students' attitudes towards the homeless. METHOD AND RESULTS: The Attitudes Towards the Homeless Questionnaire, developed using the views of over 370 medical students, was shown to have a Pearson test-retest reliability correlation coefficient of 0.8 and a Cronbach's alpha coefficient of 0.74. CONCLUSIONS: The Attitudes Towards the Homeless Questionnaire appears to be a valid and reliable instrument, which can measure students' attitudes towards the homeless. It could be a useful tool in assessing the effectiveness of educational interventions.

Casa da Solidariedade: lugar de afirmação da vida

Esta pesquisa tem como objetivo analisar a vida de alguns Moradores de Rua no encontro com a Casa de Apoio Casa da Solidariedade ACASO, percebendo o que dessas vidas pode servir como analisador de nossas próprias vidas, analisando também a produção de assistencialismo, não autonomia e outros efeitos que uma prática deste tipo pode vir a causar. Em tempos de biopoder como estamos vivendo nos dias de hoje, em que a vida vale como uma mercadoria e Moradores de Rua são desqualificados como pessoas e estão sendo expulsos e vitimados pela força bruta do Estado, ousamos afirmar que a vida vale por si mesma. Esta tese também pretende analisar a Política para a Inclusão da População em Situação de Rua e enfrentar o tema da criminalização da pobreza, bem como a produção de vitimização desta população. Partindo dos conceitos de biopoder em Michel Foucault e Peter Pál Pelbart, bem como o de desfiliação em Robert Castel, analisa as tramas dos que escolhem a rua como lar. Um importante aspecto, também ressaltado pela tese, é a forma como a ACASO exerce suas práticas através da religião como forma de cuidado e acolhida ao diferente e àqueles e àquelas que se encontram excluídos da sociedade de consumo. Outro importante viés desta tese é a discussão de dois estereótipos da vida dos Moradores de Rua que os marcam cotidianamente, o de vítima e de criminoso

The fourfold serial killer in Bret Easton Elliss American Psycho

Patrick Bateman, o protagonista narrador do romance American Psycho (1991), de Bret Easton Ellis, confunde por ser rico, bonito e educado e, ao mesmo tempo, torturador, assassino e canibal. Mas esta personalidade antagônica não o torna singular. O que o particulariza são as quatro faces que ele apresenta ao longo de sua narrativa: (1) ele consome mercadorias e humanos, (2) compete para ter reconhecimento, (3) provoca horror por suas ações, e (4) não é um narrador confiável. Sendo um yuppie (termo popular usado nos Estados Unidos na década de 1980 para denominar jovens e bem sucedidos profissionais urbanos), Bateman é materialista e hedonista. Ele está imerso em uma sociedade de consumo, fato que o impossibilita de perceber diferenças entre produtos e pessoas. Sendo um narcisista, ele se torna um competidor em busca de admiração. No entanto, Bateman também é um serial killer e suas descrições detalhadas de torturas e assassinatos horrorizam. Por fim, nós leitores duvidamos de sua narrativa ao notarmos inconsistências e ambiguidades. Zygmunt Bauman (2009) afirma que uma sociedade extremamente capitalista transforma tudo que nela existe em algo consumível. Christopher Lasch (1991) afirma que o lendário Narciso deu lugar a um novo, controverso, dependente e menos confiante. A maioria das vítimas de Bateman são membros de grupos socialmente marginalizados, como mendigos, homossexuais, imigrantes e prostitutas, o que o torna uma identidade predatória, segundo Arjun Appadurai (2006). A voz autodiegética e a narrativa incongruente do protagonista, contudo, impedem que confiemos em suas palavras. Estas são as quatro faces que pretendo apresentar deste serial killer