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PubMed1990

A nursing model for addressing the health needs of homeless families.

Homelessness in the United States continues to be a major social problem directly affecting an estimated three million persons, of whom nearly 30 percent belong to families without permanent shelter. This paper reviews recent research concerning homeless families and the conditions in which they live and outlines the significant health and mental health problems that these families experience. Effective nursing interventions for homeless families using Peszneckers' Model of Poverty are proposed. Nurses must advocate for changes in the social and political conditions that bring about homelessness since the resources to meet the needs of these families are either nonexistent or woefully inadequate.

Child↗
PubMed2005

Impact of a positive hepatitis C diagnosis on homeless injecting drug users: a qualitative study.

BACKGROUND: Increasing numbers of injecting drug users are presenting to primary care and a growing number of general practices are specifically providing care for homeless people. Injecting drug users are at the greatest risk of hepatitis C infection and homeless drug misusers, because of their drug-taking behaviour and patterns, have been identified as being at greater risk of harm of blood-borne diseases than the general population. However, little work has been conducted with injecting drug users or homeless people who have hepatitis C and little is known about how the virus may affect them. AIM: To explore the impact of a positive hepatitis C diagnosis on homeless injecting drug users. DESIGN OF STUDY: This study employed qualitative research. In-depth interviews allowed the exploration of the impact of a potentially life-threatening diagnosis within the context of a person's expressed hierarchy of needs. SETTING: A primary care centre for homeless people in the north of England. METHOD: In-depth interviews about the impact of a positive hepatitis C diagnosis on their lives were conducted with 17 homeless injecting drug users who had received a positive hepatitis C diagnosis. The interviews were audiotaped, transcribed, and analysed using the framework approach. RESULTS: Receiving a positive diagnosis for hepatitis C resulted in feelings of shock, devastation, disbelief, anger, and questioning. A positive diagnosis had lasting social, emotional, psychological, behavioural, and physical effects on homeless injecting drug users, even years after the initial diagnosis. Most responders were diagnosed by a doctor in primary care or by hospital staff; however, not all had sought testing and a number were tested while inpatients and were unaware that blood had been taken for hepatitis C virus serology. CONCLUSIONS: The implications for clinical policy and primary care practice are discussed, including the issues of patient choice, confidentiality, and pre- and post-test discussions. Posttest discussions should be followed up with additional social, psychological, and medical support and counselling.

Adult↗
PubMed1997

Tuberculosis among foreign-born persons in New York City, 1992-1994: implications for tuberculosis control.

OBJECTIVE: To study the pattern of transmission of tuberculosis (TB) among foreign-born persons living in New York City. DESIGN: A retrospective multicenter study comparing 158 foreign-born patients to 231 US-born patients diagnosed with TB between 1992 and 1994. The patients were stratified according to their Mycobacterium tuberculosis isolate DNA fingerprint patterns. RESULTS: Nineteen (16%) of 122 isolates from foreign-born TB patients and 75 (42%) of 180 isolates from US-born TB patients had DNA fingerprint patterns (cluster patterns) indicative of recent exogenous transmission (P < 0.001). All cluster pattern strains from foreign-born cases were identical to those found among US-born patients. The likelihood of infection with a cluster pattern strain among foreign-born persons increased with duration of residence in the US, and was significantly associated with being homeless (P < 0.05), or having multidrug-resistant TB (P = 0.00072). CONCLUSION: Although most (84%) cases of TB among foreign-born persons in New York City appear to result from reactivation of infections they acquired abroad, the ones who acquire new infections become infected with strains that are already circulating among the US-born TB patients in New York City, and they have risk factors similar to those faced by US-born tuberculosis patients.

Adult↗
PubMed1997

The socio-spatial stigmatization of homelessness and HIV/AIDS: toward an explanation of the NIMBY syndrome.

A central element of community response to controversial human service facilities is the socio-spatial construction of stigma. This paper develops a conceptual framework for understanding the constitution and role of stigma in community rejection of human services, particularly those associated with homelessness and HIV/AIDS. Three facets of stigma concerning homelessness and HIV/ AIDS (non-productivity, dangerousness, and personal culpability) are offered as a way of understanding the rising tide of community rejection toward human service facilities.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Barriers to enrollment in drug abuse treatment and suggestions for reducing them: opinions of drug injecting street outreach clients and other system stakeholders.

Alcohol and other drug abuse (AOD) treatment is a major means of HIV/AIDS prevention, yet clients of street outreach programs (SOP) who are injection drug users (IDU), and outreach workers and staff as well, report various obstacles to enrolling clients in AOD programs. This study assessed the barriers to AOD enrollment facing high risk street outreach clients and obtained suggestions for reducing them. Data were obtained from semistructured field interviews with: 1) IDU outreach clients (N = 144) of the six SOPs in New York City (NYC) and northern suburbs supported by the Office of Alcoholism and Substance Abuse Services (OASAS), the single state agency in New York State for AOD prevention and treatment, 2) outreach workers and staff of the six SOPs (N = 55), 3) staff of detox and AOD treatment programs in major modalities treating IDUs (N = 71), and 4) officials and administrators (N = 11) in OASAS, the AIDS Institute of the Department of Health (addresses all aspects of the HIV/AIDS epidemic in New York State), and the agency for public assistance in New York City, the Human Resources Administration (HRA). Principal barriers for street outreach clients included personal-family issues, lack of insurance/Medicaid, ignorance, suspicion, and/or aversion to AOD treatment (methadone maintenance especially), "hassles" with Medicaid, lack of personal ID, lack of "slots," limited access to intake, homelessness, childcare-child custody issues. Further, about 18% had no desire for AOD services, reported no barriers, or were too enmeshed in addiction to enroll. Outreach staff cited prospective client's lack of ID and lack of Medicaid, lack of "slots," and stakeholder agency bureaucracy. Treatment staff cited lack of client readiness, "hassles" posed by welfare reform, AOD programs' own "red tape," waiting lists, and near exclusionary preference for the Medicaid-eligible. Finally, agency managers cited client factors, inadequate funding and lack of appropriate programs, treatment program requirements, and societal stigmatization of addicts. Proposed remedies included dropping ID and insurance requirements for admission, major increases in resources, funding the transporting of outreach client treatment candidates to AOD services sites, education and training initiatives, increased inter-agency cooperation, and the need for stakeholder agencies, OASAS especially, to more effectively integrate abstinence-oriented AOD services with harm reduction and the public health aspects of AOD problems.

Adult↗
PubMed2002

Community medicine in action: an integrated, fourth-year urban continuity preceptorship.

OBJECTIVE: To provide an opportunity for fourth-year students at the University of Wisconsin Medical School in Madison to immerse in urban community medicine during a 34-week program. This experience enhances the integrity of the fourth year as well as merges medicine and public health perspectives in medical education as called for by the Medicine and Public Health Initiative. DESCRIPTION: A limited number of fourth-year Wisconsin medical students have the opportunity to select a one-year, continuity-based preceptorship at the Milwaukee clinical campus with a focus in one of three domains: family medicine, internal medicine, or women's health. Students participate in the following clinical activities: a one-year, integrated preceptorship (one to three half days per week in a primary preceptor's office), medicine subinternship, senior surgery clerkship, selectives (16-20 weeks of clerkships relevant to preceptorship focus area), and one month of out-of-city electives. Complementing this community-based clinical experience is the opportunity to develop an increased appreciation for urban community health issues and resources by participating in a required urban community medicine clerkship and a mentored student scholarly project focusing on an aspect of urban community medicine and population health. All students begin the year in July with a four-week urban community medicine clerkship, which is based on the St. Luke's family practice residency's community medicine rotation and arranged by residency faculty. They conduct a "windshield survey" of a Milwaukee neighborhood, observing health hazards and identifying assets, and then present these observations to others in the clerkship. During this first month, students are introduced to the work of a variety of social service agencies, the Milwaukee City Health Department, and the Aurora Health Care/UW community clinics, which serve the state's most diverse zip codes. They meet with providers and researchers who share their expertise in infectious disease, preventive medicine, perinatal epidemiology, domestic violence, sexual assault, and disease management. Students develop increased understanding of barriers to health and personal resilience by listening to focus groups conducted with homeless men and undocumented Latino women. They participate in a resident and faculty development retreat on enhancing community medicine knowledge and skills. By August, students select an advisor and outline a project designed to expand understanding in the areas of urban population health research, community health education, professional education, or health intervention planning and evaluation. Faculty members at the Center for Urban Population Health work closely with the students throughout the year, which includes two weeks in the spring that are dedicated to intensive work on the projects. DISCUSSION: This fourth-year, urban community-based preceptorship is designed to provide students with an alternative fourth year that integrates skill development in clinical and community medicine, offers a continuity primary care experience, and showcases innovative urban health resources and role models. It is hoped that these students will pursue graduate medical education in Milwaukee, incorporate a population perspective in their practice, and choose to work in neighborhoods that are currently underserved.

Community Medicine↗
PubMed1992

Wasting malnutrition and inadequate nutrient intakes identified in a multiethnic homeless population.

The few previous studies of the nutritional status and dietary intakes of the homeless have been limited by small sample sizes. We collected information from a multiethnic sample of 277 homeless men and women in Miami, Fla. Data collected included a brief personal history, anthropometric variables, and a detailed 24-hour dietary recall. An additional 24-hour dietary recall was collected from a subsample of 36 men. Socioeconomic characteristics of our sample were similar to that of other samples of the homeless. Using measurements of the upper arm muscle area, we identified wasting malnutrition in 20% of the men. Dietary intakes (percentage of the Recommended Dietary Allowances [RDAs] +/- standard error of the mean) for energy (82 +/- 2.88%), calcium (63 +/- 3.28%), zinc (56 +/- 2.61%), and vitamin B-6 (68 +/- 3.93%) were significantly below RDA guidelines for all ethnic groups. In addition, thiamin (75 +/- 6.34%) intakes for whites and vitamin A (61 +/- 12.53%) and riboflavin (74 +/- 7.72%) intakes for Hispanics were below RDA guidelines. Compared with men, women consumed significantly less energy, calcium, and zinc.

Adult↗
PubMed1995

Childhood risk factors for homelessness among homeless adults.

OBJECTIVES: This effort used data from the Course of Homelessness study and comparative secondary data on the general population to identify negative childhood and family background experiences that may increase risk for adult homelessness. METHODS: Frequencies of negative childhood experiences were examined among a probability sample of 1563 homeless adults. Differences in risk for such experiences were calculated by sex, age cohort, and racial/ethnicity status. Where possible, rates of negative childhood experiences among the homeless were compared with the general population. RESULTS: Substantial numbers of this sample experienced multiple problems as children across several domains: poverty, residential instability, and family problems. Women and Whites disproportionately reported experiences suggestive of personal or family problems; non-Whites disproportionately reported experiences suggestive of personal or family problems; non-Whites disproportionately reported experiences suggestive of poverty. Homeless adults were at increased risk of childhood out-of-home placement, tenure in public housing, and homelessness, but not at greater risk for physical abuse. Women appeared to be at greater risk for sexual abuse. CONCLUSIONS: The problems that homeless individuals experience as adults have very clear analogs in their childhoods. Vulnerability to homelessness stems from factors unevenly distributed across age, sex, and race/ethnicity groups.

Adolescent↗
PubMed1983

Down and out in the city: the homeless mentally ill.

The plight of the homeless in New York City and other urban areas has become the focus of increasing attention. In an effort to clarify and understand the problems of the homeless, the authors studied the demographic characteristics, psychiatric diagnoses, histories, and dispositions of 100 homeless patients treated at Bellevue Psychiatric Hospital's emergency service. The most striking finding was that 96.6 percent of the sample had had a previous psychiatric hospitalization. Seventy-two percent of these homeless patients were diagnosed as suffering from schizophrenia; the second most common diagnosis was personality disorder, which accounted for 13.3 percent of the sample. The authors discuss other demographic findings of their study and explore the roots of the problem of homelessness, review the psychiatric literature on the subject, and delineate some of the unique treatment needs of this population.

Adult↗
PubMed2000

Hemodialysis and homelessness: a literature review and a call for research.

As the U.S. population ages, the number of persons with chronic conditions increases. Social isolation, declining health status, unemployment, and/or decreased income levels can all contribute to a forced change in residence. People on hemodialysis who are living in precarious housing situations are an under-recognized and silent population. Anecdotal evidence suggests that there is a larger population of hemodialysis patients living in various nontraditional situations than the literature reveals. This article describes both the homeless and chronic renal disease populations and demographic overlay, and issues a call for research.

Ill-Housed Persons↗
PubMedDate not supplied

Use of the Addiction Severity Index with homeless substance abusers.

The Addiction Severity Index (ASI) is a widely adopted assessment instrument that provides severity ratings of the multiple problems exhibited by alcohol and drug dependent persons and allows for quantitative assessment (composite scores) of client status in these problems areas over time. ASI change scores of homeless and near homeless substance abusers, generated by contrasting ASI composite scores at two points in time, show a high level of agreement to objective relapse data from the Massachusetts Bureau of Substance Abuse Services Management Information System. Clients readmitted to a publicly funded detoxification facility exhibited significantly lower mean change scores on five of the seven problems areas measured by the ASI. These data illustrate the applicability of the ASI to homeless men and women and the utility of the ASI in measuring client improvement.

Adult↗