Little is known about pathways to homelessness among older adults. We identified life course experiences associated with earlier versus later onset of homelessness in older homeless adults and examined current health and functional status by age at first homelessness. We interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling. Participants reported age at first episode of adult homelessness and their life experiences during 3 time periods: childhood (<18 years), young adulthood (ages 18–25), and middle adulthood (ages 26–49). We used a structured modeling approach to identify experiences associated with first adult homelessness before age 50 versus at age 50 or older. Participants reported current health and functional status, including recent mental health and substance use problems. Older homeless adults who first became homeless before 50 had more adverse life experiences (i.e., mental health and substance use problems, imprisonment) and lower attainment of adult milestones (i.e., marriage, full-time employment) compared to individuals with later onset. After multivariable adjustment, adverse experiences were independently associated with experiencing a first episode of homelessness before age 50. Individuals who first became homeless before age 50 had higher prevalence of recent mental health and substance use problems and more difficulty performing instrumental activities of daily living. Life course experiences and current vulnerabilities of older homeless adults with first homelessness before age 50 differed from those with later onset of homelessness. Prevention and service interventions should be adapted to meet different needs.

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Background: The mental health of college students in the U.S. has become an undeniable concern to university administrators, service providers, and the higher education community at large. While universities seek to educate future great minds, their current policies and infrastructure do not unanimously prioritize mental health, thus, they often cannot meet the holistic needs of students and struggle to uphold their central mission.Aim: To outline the literature surrounding mental health in postsecondary education and the holistic needs of university students in order to target the national discussion of mental health toward actionable system change.Methods: A comprehensive review of the literature on college student mental health in the U.S.Results: The literature demonstrates that policy change is necessary to fully support students with psychiatric disabilities and mental health concerns.Conclusions: Mental health is a critical issue for young adults, and college presents a prime developmental context to equip students with the skills for a lifetime of mental health and wellbeing. Further research is needed to explore the impact of implementing innovative programs, curricular changes and supported education programs to support college students.

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Importance: A key objective of the Americans With Disabilities Act of 1990 (ADA) is community integration; yet, nearly 30 yr later, little is known about the participation of people with disabilities who transition from institutions to the community. Objective: To understand how people with disabilities describe full participation after transitioning from an institution to the community and to identify environmental barriers and facilitators to participation during and after this transition. Design: The ADA-Participatory Action Research Consortium (ADA-PARC), a collaboration among researchers, people with disabilities, and community organizations, is implementing a multimethod, participatory action research study of participation among people with disabilities posttransition. This article presents qualitative findings from semistructured interviews collected as part of the larger ADA-PARC project. Setting: ADA-PARC community partners across the United States. Participants: One hundred fifty-three adults with disabilities. Outcomes and Measures: We used a semistructured interview guide to ask participants about their experiences during and after transition to the community. Results: We identified four themes: (1) the process of transition as ongoing rather than a single event, (2) access to everyday occupations as full participation and what fully represents "living a life," (3) environmental barriers to participation, and (4) social identity as participation as the transformative process of moving from the disempowering isolation of the institution to being integrated into the community. Conclusions and Relevance: As people with disabilities transition into community settings, they require ongoing supports to facilitate their full, long-term participation. What This Article Adds: People with disabilities reported that transitioning from institutions to the community was itself not enough to support their full community participation; rather, they viewed transition as an ongoing process, and they needed services and supports to fully participate. Occupational therapy practitioners working in institutional and community settings can partner with local disability advocacy communities to support their clients' sense of identity and self-confidence during and after transition to the community. T he 1999 U.S. Supreme Court decision Olmstead v. L. C. (527 U.S. 581; Olmstead) ruled that unjustified segregation of people with disabilities is unlawful under the Americans With Disabilities Act of 1990 (ADA; Pub. L. 101-336). The court held that people with disabilities have a right to reasonable accommodations to enable them to live in the least restrictive community setting. The decision was a landmark for disability rights because it revealed the potential of the ADA to legislate the full inclusion of people with disabilities into their communities, with equal access to social participation and opportunities (Dinerstein, 2016). The realization of the full potential of the ADA is limited by several factors, including varia...