Homelessness and Health Disparities: A Health Equity Lens

Bowen, Elizabeth A.; Savino, Ryan; Irish, Andrew

doi:10.1007/978-3-030-03727-7_3

Cited by 8 publications

(9 citation statements)

References 139 publications

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“…In Albuquerque, 44% of people living on the streets self-identified as Native while only being 4% of the total city population (New Mexico Coalition to End Homelessness, 2017; Worth, 2019). Being unhoused increases the likelihood for a person to meet the criteria for co-occurring mental health and substance use conditions; and multi-morbidity of two or more chronic health conditions (Bowen et al, 2019; Padgett et al, 2011; Zlotnick et al, 2013; Zlotnick & Zerger, 2009). Housing security and recovery services are key social determinants of health objectives (Bowen et al, 2019; Healthy People 2030, 2022).…”

Section: A Comprehensive Safety Strategymentioning

confidence: 99%

“…Being unhoused increases the likelihood for a person to meet the criteria for co-occurring mental health and substance use conditions; and multi-morbidity of two or more chronic health conditions (Bowen et al, 2019; Padgett et al, 2011; Zlotnick et al, 2013; Zlotnick & Zerger, 2009). Housing security and recovery services are key social determinants of health objectives (Bowen et al, 2019; Healthy People 2030, 2022). Having a place to live is the first step to housing security.…”

Section: A Comprehensive Safety Strategymentioning

confidence: 99%

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A relational ecology for crisis prevention among unhoused indigenous peoples in Albuquerque.

Stanley

2023

Journal of Psychotherapy Integration

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The purpose of this study was to inform the development of a crisis prevention process model focusing on the qualities present in relationships among unhoused Indigenous peoples and integrated healthcare providers when crisis is prevented. The scope of the study is on multidisciplinary healthcare teams (MHT) and removing barriers for clients to access the resources they need. This key-informant study conducted 24 semistructured interviews including (14) unhoused Indigenous people and (10) members of their MHT in 2021. The study consisted of two phases beginning with identifying study and interview questions through a participatory evaluation process. During the second phase, interviews were conducted and recorded by researcher. Coding assistance by the research team supported heuristic content analysis. An integrated healthcare provider's cultural understanding of a client emerged as a fundamental tenant for a client to experience a sense of belonging on their MHT. Seventy-two significant statements were identified, two themes were acquired, structured into three categories, and synthesized into eight codes: cultural understanding, sense of belonging, focusing, strengths, listen, communication, informed, and intraorganizational systems. Ethical distress contributed to escalated crises and prevention barriers while MHT cohesion enhanced the capacity to support a client's success. Participant experiences shaped theoretical integration of the relational-cultural theory, motivational interviewing, and the Community Resiliency Model prevention process model to improve MHT safety planning. The implications for integrated healthcare and housing policy are to increase multilevel support for organizations to sustain MHT cohesion and maintain intraorganizational systems. Public Health Significance StatementThis study addresses the problem of health disparities among unhoused Indigenous peoples with focus on reducing safety incidents in community behavioral health settings. The integration of relational and somatic clinical models expands on trauma-informed care to further the paradigm shift from a deficit model to an emphasis on resilience and healing in recovery. Public health implications are identified on the interpersonal, multidisciplinary, organizational, and structural policy and practice levels.

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Section: A Comprehensive Safety Strategymentioning

confidence: 99%

Section: A Comprehensive Safety Strategymentioning

confidence: 99%

A relational ecology for crisis prevention among unhoused indigenous peoples in Albuquerque.

Stanley

2023

Journal of Psychotherapy Integration

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“…This scoping review responds to this gap by exploring the extent to which rehabilitation, including the types of rehabilitation interventions, are available to, or used by, individuals experiencing homelessness and TBI. This review also explicitly charts and summarizes evidence on age, sex, gender, ethnicity, race, and other identities and experiences, as individuals experiencing homelessness also experience health disparities that are shaped by their intersecting identities (33). The results of this scoping review inform (a) opportunities to adapt existing rehabilitation for individuals who experience homelessness and TBI, (b) considerations for education and training on TBI, and (c) recommendations for future research.…”

Section: Introductionmentioning

confidence: 97%

Rehabilitation among individuals experiencing homelessness and traumatic brain injury: A scoping review

et al. 2022

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Traumatic brain injury (TBI) is disproportionately prevalent among individuals experiencing homelessness. While rehabilitation is critical to facilitating recovery after TBI, there is currently limited information on the extent to which rehabilitation is provided to individuals experiencing homelessness and TBI. If unaddressed, this knowledge gap can perpetuate TBI-related challenges and contribute to a repetitive cycle of TBI and homelessness. This scoping review explored the extent to which rehabilitation, including the types of rehabilitation interventions, are available to, or used by, individuals experiencing homelessness and TBI. A systematic search of electronic databases (MEDLINE, Embase, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, and Proquest Nursing and Allied Health) was conducted to identify peer-reviewed articles that met predetermined eligibility criteria. Gray literature and reference lists of eligible articles were also searched for relevant content. A descriptive numerical summary of extracted data was conducted, and qualitative analytic techniques were applied to analyze the data. Fifteen peer-reviewed articles and three gray literature reports were included, describing interventions for individuals experiencing homelessness and TBI (N = 4), rehabilitation for individuals experiencing homelessness without specific inclusion criteria for TBI (N = 11), and rehabilitation interventions that included individuals experiencing homelessness and TBI, without specific inclusion criteria for experiences of homelessness or TBI (N = 3). This review demonstrates that rehabilitation programs or interventions for this population already exist, and those that are focused on individuals experiencing homelessness are already serving individuals with TBI. Findings highlight opportunities to adapt existing rehabilitation for individuals who experience homelessness and TBI through screening for TBI, conducting cognitive and functional assessments, and tailoring interventions with multidisciplinary teams. Education and training for healthcare professionals working with individuals experiencing homelessness and TBI should be explored, including structured education and training, collaboration with a multidisciplinary team, and co-development of educational materials with service users. Research that considers the rehabilitation needs of diverse individuals experiencing homelessness and TBI is urgently needed.

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Section: Introductionmentioning

confidence: 99%

“…One such disadvantaged group is individuals with lived experience of homelessness (20,21), where TBI has been found to be disproportionately prevalent (22). Individuals experiencing homelessness suffer significant health inequities that are exacerbated by social determinants of health (e.g., poverty, adverse experiences and trauma, lack of education, unemployment, domestic violence, and social disconnection) (20,21). Such health inequities include poorer mental and physical health, higher morbidity and mortality, greater use of acute hospital services, and reduced likelihood of accessing primary and preventive health services (21).…”

Section: Introductionmentioning

confidence: 99%

A systematic review protocol for assessing equity in clinical practice guidelines for traumatic brain injury and homelessness

et al. 2022

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BackgroundWhen used optimally, clinical practice guidelines (CPGs) can reduce inappropriate variations in practice, improve application of research to practice, and enhance the quality of healthcare. However, a common criticism, despite its potential, is the lack of consideration for equity and disadvantaged populations.ObjectivesThis protocol is for a systematic review of CPGs for traumatic brain injury (TBI) and homelessness that aims to assess (1) the extent to which evidence regarding TBI and homelessness is integrated in CPGs for homelessness and TBI, respectively, and (2) equity considerations in CPGs for TBI and homelessness.Methods and analysisThe methodology for this review is guided by the PRISMA-P, validated search filters for CPGs, and methodological guides to searching systematic reviews and gray literature. CPGs will be identified from (a) databases for peer-reviewed literature (MEDLINE, Embase, CINAHL, and PsycInfo), (b) targeted websites and Google Search for gray literature, and (c) reference lists of peer-reviewed and gray literature that meet the eligibility criteria. Searching for gray literature, including from guideline-specific resources, is a critical component of this review and is considered an efficient approach to identifying CPGs, given the low precision of searching peer-reviewed databases. Two independent reviewers will screen all articles based on pre-determined eligibility criteria. A narrative synthesis will be conducted to identify the proportion of CPGs that integrate evidence about TBI and homelessness and how TBI and homelessness is or is not integrated in CPGs. Quality appraisal will take the form of an equity assessment of CPGs and will be completed independently by two reviewers.ConclusionThis protocol outlines the methodology for a systematic review of CPGs for TBI and homelessness. The resulting systematic review from this protocol will form an evidence-based foundation to advance CPGs for individuals with lived experience of TBI and homelessness.Systematic review registrationidentifier: CRD42021287696.

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Homelessness and Health Disparities: A Health Equity Lens

Cited by 8 publications

References 139 publications

A relational ecology for crisis prevention among unhoused indigenous peoples in Albuquerque.

A relational ecology for crisis prevention among unhoused indigenous peoples in Albuquerque.

Rehabilitation among individuals experiencing homelessness and traumatic brain injury: A scoping review

A systematic review protocol for assessing equity in clinical practice guidelines for traumatic brain injury and homelessness

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