At the Intersection of Homeless Encampments and Heroin Addiction: Service Use Barriers, Facilitators, and Recommendations from the City of Philadelphia’s Encampment Resolution Pilot

Cusack, Meagan; Graham, Fritz; Metraux, Stephen; Metzger, Dave; Culhane, Dennis P

doi:10.1080/19371918.2021.1877591

Cited by 7 publications

(24 citation statements)

References 26 publications

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“…Several specific aspects of RH program structure likely contributed to housing retention and engagement. Prior work [ 28 ] has identified the inability for couples to be housed together as a key factor that perpetuates encampments, since couples are typically required to separate in order to enter programs and/or housing. Many RH residents were members of couples, and they reported anecdotally that being able to stay together in housing made a crucial difference in their decision to enter and remain in the program, since they were not willing to separate from their partner.…”

Section: Discussionmentioning

confidence: 99%

Facilitating exit from encampments: combining low-barrier transitional housing with stabilizing treatment for substance related problems

Komaromy,

Stone,

Peterson

et al. 2023

Addict Sci Clin Pract

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Background Tent encampments in the neighborhood surrounding Boston Medical Center (BMC) grew to include 336 individuals at points between 2019 and 21, prompting public health concerns. BMC, the City of Boston, and Commonwealth of Massachusetts partnered in 2/2022 to offer low-barrier transitional housing to encampment residents and provide co-located clinical stabilization services for community members with substance use disorders (SUDs) experiencing homelessness. Methods To meet the needs of some of the people who had been living in encampments, BMC established in a former hotel: 60 beds of transitional housing, not contingent upon sobriety; and a low-barrier SUD-focused clinic for both housing residents and community members, offering walk-in urgent care, SUD medications, and infection screening/prevention; and a 24/7 short-stay stabilization unit to manage over-intoxication, withdrawal, and complications of substance use (e.g., abscesses, HIV risk, psychosis). A secure medication-dispensing cabinet allows methadone administration for withdrawal management. Housing program key metrics include retention in housing, transition to permanent housing, and engagement in SUD treatment and case management. Clinical program key metrics include patient volume, and rates of initiation of medication for opioid use disorder. Results Housing: Between 2/1/22–1/31/2023, 100 people entered the low-barrier transitional housing (new residents admitted as people transitioned out); 50 former encampment residents and 50 unhoused people referred by Boston Public Health Commission. Twenty-five residents transferred to permanent housing, eight administratively discharged, four incarcerated, and four died (two overdoses, two other substance-related). The remaining 59 residents remain housed; none voluntarily returned to homelessness. One hundred residents (100%) engaged with case management, and 49 engaged with SUD treatment. Clinical: In the first 12 months, 1722 patients (drawn from both the housing program and community) had 7468 clinical visits. The most common SUDs were opioid (84%), cocaine (54%) and alcohol (47%) and 61% of patients had a co-occurring mental health diagnosis in the preceding 24-months. 566 (33%) patients were started on methadone and accepted at an Opioid Treatment Program (OTP). Conclusions During the 1st year of operation, low-barrier transitional housing plus clinical stabilization care was a feasible and acceptable model for former encampment residents, 49% of whom engaged with SUD treatment, and 25% of whom transitioned to permanent housing.

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Section: Discussionmentioning

confidence: 99%

Facilitating exit from encampments: combining low-barrier transitional housing with stabilizing treatment for substance related problems

Komaromy,

Stone,

Peterson

et al. 2023

Addict Sci Clin Pract

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“…82 Many rapid studies seeking to understand barriers to healthcare access make use of deductive templates or matrices to chart data or use 'one sheet of paper' techniques to aid rapid analysis and presentation of findings. [82][83][84][85][86] Miles and Huberman have argued that data reduction, display, and the drawing of conclusions happens simultaneously in qualitative analysis (p10), 87 and that the use of matrices can drive credibility and trustworthiness. 88 Whilst the use of a priori codes and/or themes to populate a framework template may save time at the analysis stage and potentially reduce the skill requirement, the burden of work is shifted to an earlier stage of the project rather than eliminated.…”

Section: Figure 3: Overview Of the Sequential Mixed-methods Approachmentioning

confidence: 99%

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

Allen,

Karanja,

Gichangi

et al. 2024

Preprint

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Introduction Evidence suggests that certain groups face substantial barriers to accessing eye care services. This study seeks to explore barriers and potential solutions as perceived by members of the population groups who are least able to access care in the context of four national eye screening programmes. We aim to use rapid yet robust mixed methods that allow us to identify generalisable findings and testable service modifications to improve equitable access to care. Methods and analysis This is a multi-phased exploratory sequential mixed methods study. First, we will conduct interviews with people purposively selected from the sociodemographic subgroups with the lowest odds of accessing care within each screening programme. Taking a phenomenological approach, we will explore their perceptions of barriers and potential service modifications that could boost attendance at eye clinics among people from these "left behind" groups. We will use a deductive analytic matrix to facilitate the rapid analysis of qualitative data. Space will be made for the inductive identification of themes that are not necessarily captured in the framework. Sample size will be determined by thematic saturation. Next we will conduct a survey with a representative sample of non-attenders from the same left behind groups, asking them to rank each suggested service modification by likely impact. Finally, we will convene a multistakeholder workshop to asses each service modification based on ranking, likely impact, feasibility, cost, and potential risks. The most promising service modifications will be implemented and evaluated in a follow-on randomised controlled trial, the methods for which will be reported elsewhere. Ethics and dissemination This project has been approved by independent research ethics committees in Botswana, Kenya, India, Nepal and the UK. We will disseminate our findings through local community advisory boards, national eye screening meetings, in peer-reviewed journals, and at conferences.

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“…A single study 41 that stated it took a length of <14 days to complete was also included (totalling 44 studies; Figure 1). Across the 44 included studies, 41-84 30 countries were represented, with 19 studies (43%) based in high-income countries 41,48,52,53,55,56,63,[65][66][67]70,71,73,74,76,79,81,82,84 and the remaining 57% based in lowand middle-income countries (LMICs). [42][43][44][45][46][47][49][50][51]54,[57][58][59][60][61][62]64,68,69,72,75,77,78,80,83 Overall, 12 studies came from the US; 41,48,52,56,[65...…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Nearly three-quarters of studies (73%) had been published since 2010 (Figure 3). [41][42][43][44][46][47][48][49][50][51][52][53][56][57][58][59][60][61][62][63][64][65]67,68,71,[73][74][75][76][77][78]80 All studies were published in English.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[41][42][43] Bedford et al obtained ethical approval from local 'county health teams', with 'support' from the UNICEF Country Office (2017), and 14 studies did not provide any information on ethical review. 44,45,55,[69][70][71][72][73][74][75][76][77][78][79][80] Shimkhada et al's Twitter study was exempted by the University of California, Los Angeles university ethics board. 81 Othieno obtained written consent before conducting IDIs and FGDs with immigrants and refugees living with HIV, but stated that their organisation (the Minnesota HIV Planning Council) did not require external ethical review for this or any other needs assessments.…”

Section: Ethical Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Rapid Methods for Identifying Barriers and Solutions to Improve Access to Community Health Services: A Scoping Review

Allen

Azab

Jonga³

et al. 2023

SSRN Journal

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At the Intersection of Homeless Encampments and Heroin Addiction: Service Use Barriers, Facilitators, and Recommendations from the City of Philadelphia’s Encampment Resolution Pilot

Cited by 7 publications

References 26 publications

Facilitating exit from encampments: combining low-barrier transitional housing with stabilizing treatment for substance related problems

Facilitating exit from encampments: combining low-barrier transitional housing with stabilizing treatment for substance related problems

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

Rapid Methods for Identifying Barriers and Solutions to Improve Access to Community Health Services: A Scoping Review

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