“It Wasn't Just One Thing”: A Qualitative Study of Newly Homeless Emergency Department Patients

Doran, Kelly M.; Ran, Ziwei; Castelblanco, Donna; Shelley, Donna; Padgett, Deborah K.

doi:10.1111/acem.13677

Cited by 8 publications

(17 citation statements)

References 44 publications

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“…The interviews were conducted as part of a larger study with dual goals of examining the intersection of homelessness and substance use and informing a pilot ED‐based homelessness prevention intervention. Results related to patients' pathways to homelessness and the relationship between homelessness and substance use were reported previously 24,25 . The current analysis focuses on themes relevant to ED‐based housing screening and interventions.…”

Section: Methodsmentioning

confidence: 92%

“…Results related to patients' pathways to homelessness and the relationship between homelessness and substance use were reported previously. 24,25 The current analysis focuses on themes relevant to ED-based housing screening and interventions. We report our methods and results in accordance with the consolidated criteria for reporting qualitative research (COREQ).…”

Section: Me Thodsmentioning

confidence: 99%

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Patient views on emergency department screening and interventions related to housing

Kelly

Fazio

Padgett³

et al. 2022

Academic Emergency Medicine

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ObjectivesEmergency departments (EDs) serve as a health care "safety net" and may be uniquely suited to screening for and addressing patients' unmet social needs. We aimed to better understand patient perspectives on ED-based screening and interventions related to housing instability, as a step toward improving future efforts. MethodsWe present findings from a qualitative study using in-depth, one-on-one interviews with ED patients who had become homeless in the past 6 months. Qualitative interviewees were asked their thoughts on ED staff asking about and helping to address homelessness and housing issues. Interviews were professionally transcribed verbatim. Multiple coders identified interview text segments focused on ED-based housing screening and intervention, which were then independently analyzed thematically and discussed to reach consensus. Researchers also categorized each participant's overall opinion on ED housing screening and interventions as positive, neutral, or negative. Results Qualitative interviews were conducted with 31 patients. Four themes related to ED-based housing screening and interventions emerged: (1) patients generally welcome ED staff/providers asking about and assisting with their housing situation, with caveats around privacy and respect; (2) ED conversations about housing have potential benefits beyond addressing unmet housing needs; (3) patients may not consider the ED as a site to obtain help with housing; (4) patients' experiences navigating existing housing services can inform best approaches for the ED. Most participants expressed overall positive views of ED staff/providers asking patients about their housing situation. Conclusions How to cite this article: Kelly A, Fazio D, Padgett D, . Patient views on emergency department screening and interventions related to housing.

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Section: Methodsmentioning

confidence: 92%

Section: Me Thodsmentioning

confidence: 99%

Patient views on emergency department screening and interventions related to housing

Kelly

Fazio

Padgett³

et al. 2022

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

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“…Developing such relationships and working with community partners on research takes time and effort but can ultimately result in higher intervention quality and potential for lasting benefits 33,34 . Notably, our pilot intervention was also informed by input from ED patients themselves 30,35 …”

Section: Discussionmentioning

confidence: 99%

“…Additionally, because we were interested in learning how to improve the intervention in the future, at the follow‐up visit we conducted “end‐user” assessment of a handout and video developed to increase awareness of risks for homelessness and the likelihood that a patient would seek help. First, we showed participants a one‐page “Housing at Risk Flyer” (Supplement) developed based on prior research conducted by the study team revealing that many ED patients did not recognize that they were at risk for homelessness before it happened 30 . Next, we showed participants a 3.5‐minute YouTube video about Homebase developed by the NYC Human Resources Administration 31 .…”

Section: Methodsmentioning

confidence: 99%

“…First, we showed participants a one-page "Housing at Risk Flyer" (Supplement) developed based on prior research conducted by the study team revealing that many ED patients did not recognize that they were at risk for homelessness before it happened. 30 Next, we showed participants a 3.5-minute YouTube video about Homebase developed by the NYC Human Resources Administration. 31 The video tells the story of a family at risk of losing their housing and how Homebase helped them.…”

Section: Outcomes and Measuresmentioning

confidence: 99%

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ED‐Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use

Fazio

Zuiderveen²,

Guyet³

et al. 2022

Academic Emergency Medicine

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Background: Housing insecurity is prevalent among emergency department (ED) patients. Despite a surge of interest in screening for patients' social needs including housing insecurity, little research has examined ED social needs interventions. We worked together with government and community partners to develop and pilot test a homelessness prevention intervention targeted to ED patients with drug or unhealthy alcohol use. Methods: We approached randomly sampled patients at an urban public hospital ED, May to August 2019. Adult patients were eligible if they were medically stable, not incarcerated, spoke English, had unhealthy alcohol or any drug use, and were not currently homeless but screened positive for risk of future homelessness using a previously developed risk screening tool. Participants received a three-part intervention: (1) brief counseling and referral to treatment for substance use delivered through a preexisting ED program; (2) referral to Homebase, an evidence-based community homelessness prevention program; and (3) up to three troubleshooting phone calls by study staff. Participants completed surveys at baseline and 6 months. Results: Of 2183 patients screened, 51 were eligible and 40 (78.4%) participated; one later withdrew, leaving 39 participants. Participants were diverse in age, gender, race, and ethnicity. Of the 32 participants reached at 6 months, most said it was very or extremely helpful to talk to someone about their housing situation (n = 23, 71.9%) at the baseline ED visit. Thirteen (40.6%) said their housing situation had improved in the past 6 months and 16 (50.0%) said it had not changed. Twenty participants (62.5%) had made contact with a Homebase office. Participants shared ideas of how to improve the intervention.

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Four Ways to Limit Use of Force in Care of Persons Experiencing Homelessness

2021

AMA Journal of Ethics

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Experiencing homelessness is traumatizing and can exacerbate mental illnesses and substance use disorders. When persons experiencing homelessness are a danger to themselves or others, petitioning for involuntary placement is clinically, ethically, and legally indicated. The process of involuntary commitment is often traumatic and can fracture already fragile relationships that persons experiencing homeless have; involuntary commitment should be used only when necessary. It is society's obligation to prevent crises but, when needed, to support persons in crisis by responding with care to their health needs.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Mental Illness and HomelessnessThere are complex, multidirectional relationships among homelessness, mental illness, substance use disorder (SUD), and trauma. Serious mental illness (SMI) and SUD can compromise patients' insight, perception, cognition, and behavior in ways that make it difficult for them to maintain housing, employment, and relationships. Both financial and behavioral implications of SUD can lead to homelessness, 1 and those who experience the trauma of homelessness often use alcohol or drugs to self-medicate. 2 One study showed that up to 68% of persons experiencing homelessness in childhood reported 4 or more adverse childhood events. 3 Chronic injuries from physical trauma, such as traumatic brain injury, can generate cognitive and behavioral deficits, which also contribute to homelessness. 4 Lack of affordable housing, loss of public support, SMI, SUD, or trauma history increase the likelihood that a person will experience homelessness. 1 Deinstitutionalization during the US civil rights era also contributed to an epidemic of homelessness among persons with SMI, 5 whose health is compromised by lack of community housing and rehabilitation policy and overreliance on incarceration for housing. 5 Upstream, not downstream, resources need to be integrated into the health care system to address health, food, and shelter needs of persons experiencing homelessness.

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“It Wasn't Just One Thing”: A Qualitative Study of Newly Homeless Emergency Department Patients

Cited by 8 publications

References 44 publications

Patient views on emergency department screening and interventions related to housing

Patient views on emergency department screening and interventions related to housing

ED‐Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use

Four Ways to Limit Use of Force in Care of Persons Experiencing Homelessness

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