Housing the Chronically Homeless

Kertesz, Stefan G.; Weiner, Saul J.

doi:10.1001/jama.2009.596

Cited by 61 publications

(16 citation statements)

References 9 publications

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“…56-59 However, additional research is needed to determine the impact of these interventions on health care use when expanded more broadly to the homeless population, rather than only those individuals who are frequent ED users. 60 Most notably, reducing frequent emergency health care use among homeless persons will require sustained efforts to reduce unmet needs for health care, particularly for mental health services, and improvement in the coordination of care across health and social services. 61 …”

Section: Discussionmentioning

confidence: 99%

High Utilizers of Emergency Health Services in a Population-Based Cohort of Homeless Adults

et al. 2013

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Objectives To identify predictors of emergency department (ED) use among a population-based prospective cohort of homeless adults in Toronto, Canada. Methods ED visit rates were assessed using administrative data (2005-2009). Logistic regression was used to identify predictors of ED use. Frequent users were defined as participants with rates in the top decile (≥4.7 visits per person-year). Results Among 1,165 homeless adults, 892 (77%) had at least one ED visit during the study period. The average rate of ED visits was 2.0 visits/person-year, while frequent users averaged 12.1 visits/person-year. Frequent users accounted for 10% of the sample but contributed over 60% of visits. Predictors of frequent use in adjusted analyses included birth in Canada, higher monthly income, lower health status, perceived unmet mental health needs, and perceived external health locus of control from powerful others; being accompanied by a partner and/or dependent children had a protective effect on frequent use. Conclusions Among homeless adults with universal health insurance, a small subgroup accounts for the majority of visits to emergency services. Frequent use was driven by multiple predisposing, enabling, and need factors.

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Section: Discussionmentioning

confidence: 99%

High Utilizers of Emergency Health Services in a Population-Based Cohort of Homeless Adults

et al. 2013

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“…Furthermore, having a primary care provider was positively associated with accessing addiction treatment and highlights the importance of engagement in care. This improved access to addiction treatment is critical given that substance use among persons who are homeless and vulnerably housed can be a barrier to residential stability and engagement in mental and physical health care [16], [20], [47], [48]. Interestingly, being homeless was associated with accessing addiction treatment.…”

Section: Discussionmentioning

confidence: 99%

Substance Use and Access to Health Care and Addiction Treatment among Homeless and Vulnerably Housed Persons in Three Canadian Cities

et al. 2013

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IntroductionWe examined the prevalence of substance use disorders among homeless and vulnerably housed persons in three Canadian cities and its association with unmet health care needs and access to addiction treatment using baseline data from the Health and Housing in Transition Study.MethodsIn 2009, 1191 homeless and vulnerably housed persons were recruited in Vancouver, Toronto, and Ottawa, Canada. Interviewer administered questionnaires collected data on socio-demographics, housing history, chronic health conditions, mental health diagnoses, problematic drug use (DAST-10≥6), problematic alcohol use (AUDIT≥20), unmet physical and mental health care needs, addiction treatment in the past 12 months. Three multiple logistic regression models were fit to examine the independent association of substance use with unmet physical health care need, unmet mental health care need, and addiction treatment.ResultsSubstance use was highly prevalent, with over half (53%) screening positive for the DAST-10 and 38% screening positive for the AUDIT. Problematic drug use was 29%, problematic alcohol use was lower at 16% and 7% had both problematic drug and alcohol use. In multiple regression models for unmet need, we found that problematic drug use was independently associated with unmet physical (adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI] 1.43–2.64) and unmet mental (AOR 3.06; 95% CI 2.17–4.30) health care needs. Problematic alcohol use was not associated with unmet health care needs. Among those with problematic substance use, problematic drug use was associated with a greater likelihood of accessing addiction treatment compared to those with problematic alcohol use alone (AOR 2.32; 95% CI 1.18–4.54).ConclusionsProblematic drug use among homeless and vulnerably housed individuals was associated with having unmet health care needs and accessing addiction treatment. Strategies to provide comprehensive health services including addiction treatment should be developed and integrated within community supported models of care.

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“…The Housing First approach includes several basic assumptions including that housing is a fundamental human right, recovery from mental illness is possible, and consumers can make competent choices (Tsemberis, 2005). In addition, Housing First is grounded on the premise that the provision of housing among homeless individuals will reduce their need for other public resources (Kertesz & Weiner, 2009). This approach assumes that individuals with severe psychiatric disabilities can maintain independent housing before their clinical status is stabilized (Tsemberis, 2005).…”

Section: Interventionmentioning

confidence: 99%

Housing and Support Services with Homeless Mothers: Benefits to the Mother and Her Children

Guo

Slesnick

Feng

2015

Community Ment Health J

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This study reports the mental health outcomes of a small randomized clinical trial (n = 60) that compared housing and supportive services (Ecologically-Based Treatment, EBT) to community based housing and support services (treatment as usual, TAU). Mothers receiving EBT, but not those receiving TAU, reported reductions in their children's behavioral health problems. Reductions in mothers' mental health problems and intimate partner violence were observed in both TAU and EBT. The current findings provide evidence supporting the efficacy of independent housing and integrated support services. Given that EBT showed similar, and in some cases superior findings to TAU, EBT may be an effective alternative for communities that do not have shelters available for those families experiencing homelessness.

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Housing the Chronically Homeless

Cited by 61 publications

References 9 publications

High Utilizers of Emergency Health Services in a Population-Based Cohort of Homeless Adults

High Utilizers of Emergency Health Services in a Population-Based Cohort of Homeless Adults

Substance Use and Access to Health Care and Addiction Treatment among Homeless and Vulnerably Housed Persons in Three Canadian Cities

Housing and Support Services with Homeless Mothers: Benefits to the Mother and Her Children

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