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PubMed1990

Stigma is in the eye of the beholder: a hospital outreach program for treating homeless mentally ill people.

Homeless mentally ill people, particularly those in large urban centers, are one of the most stigmatized groups in American society. The author describes a specialized short-term hospital treatment program initiated by New York City that helped reduce stigmatization of this group by medical personnel. He suggests that training staff workers and increased government commitment to such inpatient programs with outreach capacity can foster a change in attitude among treaters, thereby improving treatment outcome of the homeless mentally ill.

Commitment of Persons with Psychiatric Disorders↗
PubMed1989

Stability and change in an urban homeless population.

Few studies have produced the over-time observational data needed to draw valid conclusions about changes in urban homeless populations during the 1980s. One place for which such data exist is Nashville, Tennessee. An ongoing series of enumerations lends little support to Nashvillians' perception that the number of homeless in their city is growing rapidly. Enumeration results also (1) contradict expectations regarding the rise of "new homeless" groups and (2) show two types of spatial redistribution--from indoor to outdoor and core to peripheral locations--to be under way. The applicability of the enumeration methodology to other communities is discussed, as are the discrepancies between purported and measured demographic changes in homelessness.

Demography↗
PubMed2004

Homelessness among families, children, and adolescents: an ecological-developmental perspective.

This paper reviews and evaluates the literatures on children in families that are homeless and on adolescents who are homeless on their own. After presenting several emerging theoretical approaches, we propose a broad ecological-developmental perspective that recognizes that, although persons in these groups often lack resources and experience negative events that can amplify the risk for poor outcomes, they also have resources and adaptive potential. The perspective also recognizes that homelessness may have different meanings and outcomes at different points in development and that we need to consider interactions between individual development and multiple levels of social organization in order to foster new solutions to homelessness. On the basis of this perspective, we discuss directions for treatment and preventive interventions as well as social policy.

Adolescent↗
PubMed1991

The Los Angeles system of care for runaway/homeless youth.

Runaway and homeless young people generally do not seek help unless they are in a severe personal crisis. For the past 7 years, the Division of Adolescent Medicine, Childrens Hospital of Los Angeles, has learned a good deal about how to intervene effectively with these youths and divert them from high-risk behaviors such as prostitution and drug abuse. The program model we have developed has five major components: 1) networking and consolidation, 2) outreach, 3) short-term crisis shelter, 4) comprehensive medical and psychosocial care, and 5) long-term shelter and case management. Our approach has been collaborative; we subcontract a substantial portion of the work to other youth agencies in the community in order to build and strengthen the network of existing services. In the process, we have moved steadily closer to developing a comprehensive system of care for homeless street youth throughout Los Angeles County. Where programs previously operated in relative isolation, representatives from 40 private and public agencies now meet regularly at Childrens Hospital of Los Angeles to discuss ways to improve services. Systematized data collection has helped agencies understand how they can work together and has prompted additional funding for needed services.

Adolescent↗
PubMed1994

Benefits and liabilities of pets for the homeless.

Observations in the streets and parks of San Francisco East Bay cities and suburbs suggested that many of the homeless people own and maintain pet animals in spite of circumstances and environmental conditions. Accordingly, 105 homeless adult men and women, half of whom owned pets, were interviewed for this pilot study. Responses indicated that homeless pet-owners were extremely attached to their pets and had owned significantly more pets during childhood and adolescence than nonowners although there were no significant differences in attachment to pets between parents and nonparents or between married and single persons. Providing food and veterinary care for pets, however, was a very significant problem for the majority of the homeless pet-owners. It was clear that many homeless adults did have pets which were important for their mental and physical health and that pet care was associated with unique problems.

Adolescent↗
PubMed2001

Developing a strategy for community-based health promotion targeting homeless populations.

There is a need for targeted health promotion aimed at homeless populations. A survey of 100 Big Issue newspaper vendors was conducted, along with in-depth interviews and focus groups, in order to identify health promotion needs. Drug and alcohol problems, the effects of cold weather, nutritional deficiencies, and poor personal hygiene were reported as the main health concerns. However, health was not always an immediate priority for the homeless, with daily concerns predominating, such as shelter and getting money for food. A range of information needs were highlighted and a number of key health promotion topics identified. Social network and social activity data were collected from 14 Big Issue vendors to assess their penetration of groups of homeless people. Both generic and targeted health promotion activities are recommended, and the role of health advocacy and peer education should be further explored.

Adult↗
PubMed2005

Ectoparasitism and vector-borne diseases in 930 homeless people from Marseilles.

Homeless people are particularly exposed to ectoparasites, but their exposure to arthropod-borne diseases has not been evaluated systematically. A medical team of 27 persons (7 nurses, 6 infectious disease residents or fellows, 2 dermatologists, and 12 infectious disease specialists) visited the 2 shelters in Marseilles, France, for 4 consecutive years. Homeless volunteers were interviewed, examined, and received care; and blood was sampled for cell counts and detection of bacteremia, antibodies to louse-borne (Rickettsia prowazekii, Bartonella quintana, and Borrelia recurrentis), flea-borne (R. typhi, R. felis), mite-borne (R. akari), and tick-borne (R. conorii) bacterial agents. We selected sex- and age-adjusted controls among healthy blood donors. Over 4 years, 930 homeless people were enrolled. Lice were found in 22% and were associated with hypereosinophilia (odds ratio, 5.7; 95% confidence intervals, 1.46-22.15). Twenty-seven patients (3%) with scabies were treated with ivermectin. Bartonella quintana was isolated from blood culture in 50 patients (5.3%), 36 of whom were treated effectively. The number of bacteremic patient increased from 3.4% to 8.4% (p = 0.02) over the 4 years of the study. We detected a higher seroprevalence to Borrelia recurrentis, R. conorii, and R. prowazekii antibodies in the homeless. Our study shows a high prevalence of louse-borne infections in the homeless and a high degree of exposure to tick-borne diseases and scabies. Despite effective treatment for Bartonella quintana bacteremia and the efforts made to delouse this population, Bartonella quintana remains endemic, and we found hallmarks of epidemic typhus and relapsing fever. The uncontrolled louse infestation of this population should alert the community to the possibility of severe re-emerging louse-borne infections.

Adolescent↗
PubMed2005

Involvement with the criminal justice system among new clients at outpatient mental health agencies.

OBJECTIVE: This study assessed involvement with the criminal justice system among new clients of community mental health centers and self-help agencies in order to determine the characteristics and service needs of this population. Such information has implications for improving the care available for persons with mental illness who have been involved with the criminal justice system. METHODS: Interview assessments and criminal records were obtained for 673 new clients of 21 outpatient mental health agencies. Descriptive statistics, chi square tests, and multivariate analysis of variance were used to describe these new help-seekers and their involvement with the criminal justice system. RESULTS: A total of 303 study participants (45 percent) had at least one contact with the criminal justice system before arriving at the agency, with an approximately equal percentage at community mental health centers and self-help agencies. The mean+/-SD number of contacts with the criminal justice system was 7.81+/-9.12. A total of 240 individuals (36 percent) had at least one criminal conviction, including 128 (19 percent) with a felony conviction. Common charges and convictions included petty theft, assault and battery, felony theft, narcotics offenses, and misdemeanor drug offenses. Clients who had been involved with the criminal justice system were more likely to be homeless, to have drug dependence, to have greater psychological disability, and to have less personal empowerment than other clients. CONCLUSIONS: The population overlap between the mental health system and criminal justice system and the multiple problems facing criminally involved clients argues for greater collaboration between the two systems and a comprehensive package of services to meet the multiple needs of this population. The equal distribution of these individuals and similar offense patterns at both types of agencies necessitates further consideration of the role that nontraditional service providers have in serving individuals with a history of involvement with the criminal justice system.

Adult↗
PubMedDate not supplied

Policy development in disaster preparedness and management: lessons learned from the January 2001 earthquake in Gujarat, India.

INTRODUCTION: During the last decades, several humanitarian emergencies have occurred, with an increasing number of humanitarian organizations taking part in providing assistance. However, need assessments, medical intelligence, and coordination of the aid often are sparse, resulting in the provision of ineffective and expensive assistance. When an earthquake with the strength of 7.7 on the Richter scale struck the state of Gujarat, India, during the early morning on 26 January 2001, nearly 20,000 persons were killed, nearly 170,000 were injured, and 600,000 were rendered homeless. This study identifies how assigned indicators to measure the level of health care may improve disaster preparedness and management, thus, reducing human suffering. METHODS: During a two-week mission in the disaster area, the disaster relief provided to the disaster-affected population of Gujarat was evaluated. Vulnerability due to climate, geography, culture, religion, gender, politics, and economy, as each affected the outcome, was studied. By assigning indicators to the eight ELEMENTS of the Primary Health Care System as advocated by the World Health Organization (WHO), the level of public health and healthcare services were estimated, an evaluation of the impact of the disaster was conducted, and possible methods for improving disaster management are suggested. Representatives of the major relief organizations involved were interviewed on their relief policies. Strategies to improve disaster relief, such as policy development in the different aspects of public health/primary health care, were sought. RESULTS: Evaluation of the pre-event status of the affected society revealed a complex situation in a vulnerable society with substantial deficiencies in the existing health system that added to the severity of the disaster. Most of the civilian hospitals had collapsed, and army field hospitals provided medical care to most of the patients under primitive conditions using tents. When the foreign field hospitals arrived five to seven days after the earthquake, most of the casualties requiring surgical intervention already had been operated on. Relief provided to the disaster victims had reduced quality for the following reasons: (1) proper public health indicators had not yet been developed; (2) efficient coordination was lacking, (3) insufficient, overestimated, or partly irrelevant relief was provided; (4) relief was delayed because of bureaucracy; and (5) policies on the delivery of disaster relief had not been developed. CONCLUSION: To optimize the effectiveness of limited resources, disaster preparedness and the provision of feasible and necessary aid is of utmost importance. An appropriate, rapid, crisis intervention could be achieved by continual surveillance of the world's situation by a Relief Coordination Center. A panel of experts could evaluate and coordinate the international disaster responses and make use of stored emergency material and emergency teams. A successful disaster response will depend on accurate and relevant medical intelligence and socio-geographical mapping in advance of, during, and after the event(s) causing the disaster. More effective and feasible equipment coordinated with the relief provided by the rest of the world is necessary. If policies and agreements are developed as part of disaster preparedness, on international, bilateral, and national levels, disaster relief may be more relevant, less chaotic, and easier to estimate, thus, bringing improved relief to the disaster victims.

Disaster Planning↗