Many transgender and gender-expansive young people live outside of mainstream society, due to structural barriers that limit access to employment, health care, education, and public accommodations, as well as prejudice and discrimination within their families and communities. These structural barriers can be understood as cisgenderism. Though a growing body of research examines lesbian, gay, bisexual, and transgender (LGBT) youth homelessness, gaps in knowledge about the specific experiences of transgender and gender-expansive homeless youth remain. This phenomenological qualitative investigation explored aspects of transgender and gender-expansive youth's experiences related to homelessness. This article focuses on participants' understanding of their pathways into homelessness.

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There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it. This is the peer reviewed version of the following article Karadzhov, D., Yuan, Y. and Bond, L. (2020) Coping amidst an assemblage of disadvantage: a qualitative metasynthesis of first-person accounts of managing severe mental illness while homeless.

Background and Objectives Adults who have experienced chronic homelessness are considered to be “old” by age 50 due to accelerated aging. While permanent supportive housing (PSH) has been found effective for these individuals, there is limited focus on the needs of adults “aging in place” in PSH. This study examined (1) how older adults in PSH identify and rank their life priorities, (2) how they describe these priorities in their own words, and (3) how life course adversity deepens an understanding of these priorities. Research Design and Methods A convergent parallel mixed methods design was used in which qualitative case study analyses informed by a life course perspective provided a deeper understanding of how 14 older residents of PSH viewed their life priorities using quantitative card-sort rankings of 12 life domains. Results Housing, family, mental health, physical health, and partner were the most frequently endorsed life priorities. Four themes emerged from the cross-case analyses: “aging in, aging out,” “carefully restoring relationships,” “life goes on,” and “housing is fundamental.” Convergent findings indicated that life adversity—social losses and interrupted lives—influenced both the high- and low-ranked card-sort priorities. Discussion and Implications This study demonstrated that participants were aware of their advancing years yet they sought to overcome adversity and losses through maintaining mental health and sobriety, improving physical health, and cautiously rebuilding relationships. As the numbers of older homeless rise, the inclusion of age-related services will be an important component of PSH services for residents as they age.

The aim of this study was to examine the extent of and variation in person-centered care across programs within community mental health clinics. Service plans ( N = 160) from programs within eight clinics were assessed for person-centered care planning using an objective fidelity measure. Univariate statistics calculated overall fidelity to person-centered care planning and mixed-effect regression models examined person-centered care planning by program type. Overall, providers demonstrated low levels of competency in person-centered care planning. There were significant differences according to program type, with providers from assertive community treatment programs demonstrating the highest level of competency. Providers need more training and support to implement person-centered care consistently across community mental health programs. Those program types with associated fidelity measures that include person-centered care had a higher level of competence confirming the value of fidelity measurement in promoting quality services.