Social justice considerations for occupational therapy: The role of addressing social determinants of health in unstably housed populations

Synovec, Caitlin; Aceituno, Laura

doi:10.3233/wor-203074

Cited by 6 publications

(5 citation statements)

References 51 publications

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“…In conjunction with the Politics of Difference, Young's Social Connection Model proposes that the same structure which creates inequalities for certain groups can simultaneously advance the opportunities and influence of other groups [81]. This highlighting of structural inequalities Multiple Statuses: (tally statuses below) [115][116][117][118][119] Poverty [120,121] Intellectual Disability [122,123] Physical Disability [124,125] Chronic Health & Chronic Mental Health [126,127] Addiction, including Neonatal Abstinence [128,129] Lifelong Caregiver [130,131] Foster Experience [132,133] Indigenous/ Aboriginal [134,135] Survivor of Abuse [136,137] Victim of Crime [138,139] Incarceration [140,141] Homelessness or Street/Shelter Experience [142,143] Race [144,145] Rural or Isolated Geography [146,147] Ageism: Children & Seniors [148] Gender [149,150] Hayvon International Journal for Equity in Health (2024) 23:106 is complemented by Young's argument for Five Faces of Oppression, which categorizes inequalities into: economic exploitation, socio-economic marginalization, powerlessness over one's work, cultural imperialism, and systematic violence [55]. In combination, Young's theories of social justice informs the synthesis of constructs number 1, 3, 5, 6, 7, 8.…”

Section: Results Of Individual Sources Of Evidencementioning

confidence: 99%

Action against inequalities: a synthesis of social justice & equity, diversity, inclusion frameworks

Hayvon

2024

Int J Equity Health

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Inequalities in health have long been recognized as interconnected with social, economic, and various other inequalities. The application of social justice and equity, diversity, inclusion (EDI) frameworks may help expand interdisciplinary perspectives in addressing inequalities. This review study conducted an environmental scan for existing syntheses of theories, models, and frameworks (TMFs) relevant to the social justice and EDI. Results from Web of Science, Scopus, PubMed, CINAHL, PsychINFO, and MEDLINE retrieved an existing implementation science framework intently centered upon health inequalities, and draws from a synthesis of postcolonial theory, reflexivity, intersectionality, structural violence, and governance theory. Given this high degree of relevance to the objective of this review, the framework was selected as a basis for expanded synthesis. Subsequent processes sought to identify social justice TMFs which could be integrated into the base framework selected, as well as to refine scope of the study. Based upon considerations of level of evidence and non-tokenistic integration, the following social justice and EDI TMFs were identified: John Rawls’ theory of justice; Amartya Sen’s Capabilities Approach; Iris Marion Young’s theories of justice; Paulo Freire’s critical consciousness; and critical race theory (CRT). The focus of the synthesis performed was scoped towards minimizing potential harms arising from actions intending to reduce inequalities. EDI considerations were not collated into a singular construct, but rather extended as a separate component assessing inequitable distribution of risks and benefits given population heterogeneity. Reflexive analysis amended the framework with two key decisions: first, the integration of environmental justice into a single construct, which helps to inform Rawls’ and Sen’s TMFs; second, a temporal element of sequential-analysis was employed over a unified output. The result of synthesis consists of a three-component framework which: (1) presents sixteen constructs drawn from selected TMFs, to consider various harms or potential reinforcement of existing inequalities; (2) aims to de-invisibilize marginalized groups who are noted to experience inequitable outcomes, and acknowledges the presence of individuals belonging to multiple groups; and (3) synthesizes seven considerations related to equitable dissemination and evaluation as drawn from TMFs, separated for sequential analysis after assessment of harms.

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Section: Results Of Individual Sources Of Evidencementioning

confidence: 99%

Action against inequalities: a synthesis of social justice & equity, diversity, inclusion frameworks

Hayvon

2024

Int J Equity Health

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“…Food insecurity is not routinely screened for in clinical settings. Notwithstanding, it is a prevalent issue among various patient populations, as are transportation issues and housing instability [28,80]. These can limit access to timely care, delay screening and time-to-diagnosis, and reduce compliance to treatments.…”

Section: Sdh Screening Tools and Domains Assessed In Clinical Settingsmentioning

confidence: 99%

“…Linking SDH screenings, referrals, and tracking with EMRs and EHRs to make it easier for the clinical staff to consistently and efficiently document patients' social needs. Doing so was recognized by the healthcare leadership, providers, and staff as an opportunity to expand research on how SDH integration could affect clinical outcomes, such as disease onset, severity, and length of hospital stay [55,61,80].…”

Section: • Recommendationsmentioning

confidence: 99%

“…These included individuals who were in public housing, homeless, migratory and seasonal agricultural workers, elderly, individuals with disability, those experiencing mental health issues or substance use disorder[50], and Medicaid and Medicare recipients. SDH integration through screenings were conducted in relation to chronic diseases[18,26,49,54,64,67,68,74,75,80,81,[84][85][86], mental health issues[49,53,54,75,83,85], and behavioral issues[28,55,56,59,75,79] compared to acute conditions. Primary care specialties (pediatrics, family medicine, and internal medicine) and facilities (clinic, health centers, academic medical centers, and safety net hospitals) were most commonly involved in integrating SDH in clinical settings, among urban or inner-city residents and communities.…”

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confidence: 99%

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Integrating Social Care into Healthcare: A Review on Applying the Social Determinants of Health in Clinical Settings

Novilla,

Goates,

Leffler

et al. 2023

IJERPH

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Despite the substantial health and economic burdens posed by the social determinants of health (SDH), these have yet to be efficiently, sufficiently, and sustainably addressed in clinical settings—medical offices, hospitals, and healthcare systems. Our study contextualized SDH application strategies in U.S. clinical settings by exploring the reasons for integration and identifying target patients/conditions, barriers, and recommendations for clinical translation. The foremost reason for integrating SDH in clinical settings was to identify unmet social needs and link patients to community resources, particularly for vulnerable and complex care populations. This was mainly carried out through SDH screening during patient intake to collect individual-level SDH data within the context of chronic medical, mental health, or behavioral conditions. Challenges and opportunities for integration occurred at the educational, practice, and administrative/institutional levels. Gaps remain in incorporating SDH in patient workflows and EHRs for making clinical decisions and predicting health outcomes. Current strategies are largely directed at moderating individual-level social needs versus addressing community-level root causes of health inequities. Obtaining policy, funding, administrative and staff support for integration, applying a systems approach through interprofessional/intersectoral partnerships, and delivering SDH-centered medical school curricula and training are vital in helping individuals and communities achieve their best possible health.

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“…In contrast, these same authors add that, when discussing the concept of inequity, it is closely linked to access to opportunities to maximize health states. It should not be influenced by social position or other socially determined circumstances ( 8 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Model of psychosocial determinants of health in processes of social exclusion

Cantos-Egea,

Tous-Pallarés,

Tierno-García

2023

Front. Public Health

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The substantial increase in the number of families facing social exclusion in Europe and its direct relationship with health inequities is a challenge for studies approaching the social determinants of health and policies dealing with welfare and social inclusion. We start from the premise that reducing inequality (SDG10), has a value and contributes on other goals such as improving health and well-being (SDG3), ensuring quality education (SDG4), promoting gender equality (SDG5) and decent work (SDG8). In this study, we identify disruptive risk factors and psychological and social well-being factors that influence self-perceived health in trajectories of social exclusion. The research materials used a checklist of exclusion patterns, life cycles and disruptive risk factors, Goldberg’s General Health Questionnaire (GHQ-12), Ryff’s Psychological Well-being (PWB) Scale and Keyes’ Social Well-being Scale. The sample consists of 210 people (aged between 16 and 64 years): 107 people in a situation of social inclusion and 103 people in a situation of social exclusion. The data treatment involved statistical analysis, including correlation study and multiple regression analysis, aimed at developing a model of psychosocial factors that may act as health modulators, considering social factors as predictors in the regression model. The results showed that individuals in the sample, in a situation of social exclusion, have a greater accumulation of disruptive risk factors, and these are related to having fewer psychosocial and cognitive resources to cope with stressful situations: less self-acceptance, less mastery of the environment, less purpose in life, less level of social integration and social acceptance. Finally, analysis showed that in the absence of social integration and purpose in life, self-perceived health statuses decline. This work allows us to use the model obtained as a basis for confirming that there are dimensions of psychological and social well-being that should be considered stress-buffering factors in trajectories of social exclusion. These findings can help design psychoeducational programs for prevention and intervention with the aim of improving psychological adjustment and health states, as well as to promote proactive and reactive policies to reduce health inequalities.

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Social justice considerations for occupational therapy: The role of addressing social determinants of health in unstably housed populations

Cited by 6 publications

References 51 publications

Action against inequalities: a synthesis of social justice & equity, diversity, inclusion frameworks

Action against inequalities: a synthesis of social justice & equity, diversity, inclusion frameworks

Integrating Social Care into Healthcare: A Review on Applying the Social Determinants of Health in Clinical Settings

Model of psychosocial determinants of health in processes of social exclusion

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