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Purpose Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia.Design/methodology/approach This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage.Findings Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support.Research limitations/implications The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality.Social implications MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions.Originality/value There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless. [ABSTRACT FROM AUTHOR]

Purpose Homeless people experience extreme health inequalities and high rates of morbidity and mortality (Aldridge et al., 2017). Use of primary care services are low, while emergency healthcare use is high (Mathie, 2012; Homeless Link, 2014). Duration of admission has been estimated to be three times longer for homeless patients who often experience poor hospital discharge arrangements (; ). This reflects ongoing and unaddressed care and housing needs (Blackburn et al., 2017). The paper aims to discuss these issues.Design/methodology/approach This paper reveals how GPs employed in secondary care, as part of Pathway teams, support improved health and housing outcomes and safe transfer of care into community services. It draws on published literature on role of GPs in working with excluded groups, personal experience of working as a GP in secondary care, structured interviews with Pathway GPs and routine data collected by the team to highlight key outcomes.Findings The expertise of GPs is highlighted and includes holistic assessment, management of multimorbidity or "tri-morbidity" – the combination of addictions problems, mental illness and physical health (Homeless Link, 2014; Stringfellow et al., 2015) and research and teaching.Originality/value The role of the GP in the care of patients with complex needs is more visible in primary care. This paper demonstrates some of the ways in which in-reach GPs play an important role in the care of multiply excluded groups attending and admitted to secondary care settings. [ABSTRACT FROM AUTHOR]

Purpose Comment on the contribution that housing can make to delivering better health and wellbeing outcomes. More specifically, the purpose of this paper is threefold: summarise recent evidence that makes the case for housing in helping to address health and social care issues; comment on the challenges and opportunities of partnership working; and describe examples of interesting and innovative local joint provision.Design/methodology/approach Draws on the author's briefing papers on housing, health and social care for housing quality network, which is a national housing consultancy organisation as well as the author's role as Chairperson of East Midlands Housing Care and Support, which is a regional housing association.Findings Collaboration between housing, health and social care is making slow progress at the national level in England. This is despite an ever-increasing evidence base highlighting that good housing can help to address issues, such as delayed discharges. Nevertheless, there are an increasing number of interesting examples of successful local initiatives on housing, health and adult social care. The way forward is to facilitate joint working at a local level.Originality/value Focusses on the success of examples of local joint working between housing, health and social care to achieve better outcomes for vulnerable people. [ABSTRACT FROM AUTHOR]

Purpose The 2017 Naylor Review has been the subject of some controversy, with some of the press, social media and other critics portraying its recommendations as a "fire sale" or privatisation of the NHS. The purpose of this paper is to examine preceding reports into efficiency and best value of the NHS, the evidence behind the review recommendations, and analyse data into housing affordability for the capital's NHS staff. It concludes by advocating for partnerships with housing associations to deliver social and financial value by utilising redundant NHS land to deliver the affordable housing that London and the rest of the UK so urgently needs.Design/methodology/approach The paper was developed using the content analysis of preceding independent reviews of NHS efficiency, published critiques of the Naylor Review and analysis of NHS produced data to consider the potential savings and opportunities for reinvestment in capital projects.Findings The paper identifies existing partnership models and examples of good practice and advocates the adoption of joint ventures and other forms of partnership to ensure that both best value is achieved from the sale of NHS assets, and publicly owned assets are reused for social purpose.Originality/value The paper uses existing data, analysis and context to map a route for achieving best value in managing the publicly owned asset base and reinvesting the proceeds of the sale of redundant properties into UK public services. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide a supply-side review of policies and practices that impact on the shortage of supply in the contemporary specialist housing market for older people in the UK.Design/methodology/approach The review is based on a review of academic literature, policy documents, reports and other sources.Findings There is a critical conflict between the key social purpose of specialist housing (i.e. living independent of socially provided care) and the values that underpin and ultimately limit the quantity of units in both the social and private sector. In the social sector, government policies prohibit rather than encourage local authorities and housing associations from increasing specialist housing stock. The nature of leasehold tenures in the private sector tends to commodify not only housing stock but also those who use it and therefore acts to instrumentalise housing supply in favour of the profit motive and the focus on the person and her or his needs is largely ignored.Originality/value While the shortage of specialist housing is well known, this paper is unique in that it provides a comprehensive and critical supply-side review of the factors that have created such conditions. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore keyworkers’ experience and perceptions working with people experiencing homelessness and the use of psychologically informed approaches in an Irish context.Design/methodology/approach In this paper a qualitative descriptive methodology was employed and face-to-face in-depth semi-structured interviews were conducted. Data collected were analysed using a thematic framework and transcribed by the researcher.Findings It was the view of the keyworkers psychological approaches allowed them greater understanding of psychological trauma and its effects promotes safe physical and emotional environments builds rapport between staff and clients and enables keyworkers to work more effectively with people with complex needs. There was also convincing evidence staff are quite receptive to training.Originality/value Given there is no research exploring the use of psychologically informed approaches in homelessness service settings, this study researched an area that has not yet been explored in Ireland. This qualitative descriptive research provides a platform from which further research can be conducted. It is hoped that highlighting the psychological issues of homeless people, the data obtained will help improve Irish homeless services, and the findings extracted beneficial in terms of future service developments, professional training and education. [ABSTRACT FROM AUTHOR]

Purpose The perspectives of people with dementia and their care partners regarding “extra care” housing are currently unknown. The purpose of this paper is to report findings of a consultation study exploring the perceived barriers and facilitators of a relocation to extra care housing, from the perspective of people living with dementia, and their care partners.Design/methodology/approach Fieldwork consisted of paired or 1-1 interviews and small focus groups with potential users of an alternative model of extra care support for people living with dementia in the South of England. The consultation took place between June and August 2013. The interviews and focus groups were audio recorded, transcribed verbatim. The transcripts were analysed thematically.Findings Benefits of extra care were identified as the opportunity for couples to remain living together for longer, creating a supportive, dementia-friendly community, and a reduction in the strain experienced by the care partners. Barriers centred on a sense of loss, stress and uncertainty. Living and caring at home was perceived as preferable to shared care.Research limitations/implications The findings presented here have limited generalisability for two reasons. First, the shared care approach consulted on was very specific. Second, the participants form a purposive sample and as such are not representative of a wider population. Despite best intentions, the voice of people with dementia, are underreported in this consultation. Only one person with early on-set dementia was interviewed and the remaining two people with dementia were interviewed alongside their care partner.Practical implications The findings cast doubt on the viability of extra care facilities, designed for couples living with dementia, if extra care continues to be conceptualised and marketed as a preventative lifestyle choice. The findings indicate the value of consulting with people with dementia, and their care partners, when designing new forms of housing with care specifically for people living with dementia.Social implications The findings of this consultation exemplify the wish of couples living with dementia to remain together, in what they perceive to be “home”, for as long as possible. Couples living with dementia are therefore unlikely to wish to move into an extra care facility as a lifestyle choice option, early into their journey with dementia. This raises questions about the suitability of extra care, as a form of housing with care, for couples living with dementia.Originality/value This paper contributes to the body of literature, exploring the feasibility of new and innovative alternative care and housing options, for people with dementia. This paper is one of the first to explore extra care as a housing and social care option for couples with dementia. [ABSTRACT FROM AUTHOR]

Purpose People experiencing homelessness are high-users of hospital care in Canada. To better understand the scope of the issue, and how these patients are discharged from hospital, a national survey of key stakeholders was conducted in 2017. The paper aims to discuss this issue.Design/methodology/approach The Canadian Observatory on Homelessness distributed an online survey to their network of members through e-mail and social media. A sample of 660 stakeholders completed the mixed-methods survey, including those in health care, non-profit, government, law enforcement and academia.Findings Results indicate that hospitals and homelessness sector agencies often struggle to coordinate care. The result is that these patients are usually discharged to the streets or shelters and not into housing or housing with supports. The health care and homelessness sectors in Canada are currently structured in a way that hinders collaborative transfers of patient care. The three primary and inter-related gaps raised by survey participants were: communication, privacy and systems pressures.Research limitations/implications The findings are limited to those who voluntarily completed the survey and may indicate self-selection bias. Results are limited to professional stakeholders and do not reflect patient views.Practical implications Identifying systems gaps from the perspective of those who work within health care and homelessness sectors is important for supporting system reforms.Originality/value This survey was the first to collect nationwide stakeholder data on homelessness and hospital discharge in Canada. The findings help inform policy recommendations for more effective systems alignment within Canada and internationally. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an exploratory account of the links between devolution, homelessness and health in the UK. Specifically, it focusses on the policy context and governance structures that shape the systems of healthcare for homeless people in London, Scotland, Wales and Northern Ireland.Design/methodology/approach Empirically the paper draws on semi-structured interviews with a small sample of policy and practice actors from the devolved territories. Qualitative interviews were supplemented by a comparative policy analysis of the homelessness and health agenda within the devolved regions. Theoretically, it takes inspiration from Chaney’s concept of the “issue salience of homelessness” and explores the comparative character of healthcare as pertains to homeless people across the devolved territories.Findings The paper provides clear evidence of areas of divergence and convergence in policy and practice between the devolved regions. These features are shown to be strongly mediated by the interplay of two factors: first, the scope and scale of national and local homelessness prevention strategies; and second, intra-national variation in public health responses to homelessness.Originality/value The paper offers considerable insight from a comparative policy perspective into the nature of healthcare provision for homeless people in the devolved regions. [ABSTRACT FROM AUTHOR]

Purpose – The critical potential of hospital discharge policies and practices to ameliorate the health and social care needs of homeless people has become the focus of considerable interest in England. Central to this rise in policy formation and practice development is an acute understanding of the multiple exclusions homeless people face in navigating public health and social care systems. In ways small and large this nascent landscape is serving to redefine and reshape hospital arrangements for homeless people, and opening-up new ways to deliver care across clinical, social and therapeutic boundaries. The purpose of this paper is to seek to add empirical vigour and theoretical rigour to this unfolding policy and practice terrain. Design/methodology/approach – This paper draws on findings from a case study concerned with exploring and explaining how statutory and voluntary sector organisations use specialist hospital discharge policies and practices to coordinate pathways of care for homeless people. Findings – This paper illustrates how people affected by homelessness and ill-health are routinely denied access to statutory housing support, social work assessments and district nursing provision through acts of institutional gatekeeping and professional abrogation. Originality/value – This paper makes an important contribution to understandings of the connections between hospital discharge arrangements for homeless people and statutory housing, social work and district nursing provision. [ABSTRACT FROM AUTHOR]

Purpose – Homelessness often results from the loss of social networks and individuals are tested in being able to sustain or develop new positive social networks necessary to rebuild lives. The purpose of this paper is to present findings from an exploratory study which investigated how different agencies and professionals support people experiencing multiple exclusion homelessness (MEH) to develop and maintain their social networks amid other competing priorities, such as reducing substance misuse and re-offending. Design/methodology/approach – The study was undertaken in England 2010-2011 in three case study sites. Data were collected in 76 interviews with practitioners and managers, from disciplines including housing support, social work, criminal justice, mental health and substance misuse services. Totally, 56 interviews and five focus groups were also undertaken with people with experiences of MEH. Data were analysed thematically. Data from one site in particular permitted a focus on personal relationships and social networks which were seen as beneficial but also potentially problematic. These data are drawn upon to reflect on the implications for housing providers and practitioners. Findings – While multiple factors had often led to the loss of social networks among homeless people, findings revealed that practitioners working with homeless people may be able to promote existing social networks, such as partnerships, help develop new ones, and support people withdrawing from less positive relationships. The authors conclude that practitioners should be alert to structural changes that threaten social networks and may need to enhance skills in creating opportunities to foster existing positive relationships in direct work with their clients and in collaboration with other professionals. The need to be careful of blurring professional boundaries is also observed. Practical implications – This paper suggests approaches that may encourage practitioner reflection and commissioning practice in achieving good outcomes for people with experiences of MEH by highlighting the importance of social networks and the potential for practitioners to foster supportive relationships. Originality/value – This paper considers the often under-researched area of day-to-day engagement with social networks and the implications of working to support these as part of the role of homelessness services. While drawing primarily on recent research in England the themes raised will have wider relevance to housing and care services generally. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to discuss the current state of provision for homeless people in Prague. Design/methodology/approach – This is primarily a narrative account, though supported by and referenced with contemporary Czech social policy scholarship. It first traces the roots of the current situation through the history of the Czech legal framework for citizenship; the effects of communist-era ideology, when homelessness was simply hidden; and the post-communist (new-era) economic and political climate. The range of existing services is then described and analysed with respect to the difficulties in the demands posed for people in this situation. Findings – The paper outlines the current approach with outreach (“terrain”), engagement (“threshold”) and “accommodation” (support and rehab) services; and the challenges in transition from one to the next. Many systemic barriers remain for the re-integration of homeless people, stemming from attitudes within the community and amongst professionals, as much as a sheer lack of resources, or the psychological and emotional difficulties of the homeless themselves. Originality/value – There are few papers published internationally on homelessness in the new EU states. The similarity in the structure of services to what are sometimes called “staircase models” may therefore be instructive. [ABSTRACT FROM AUTHOR]

Purpose – Part One of this duo of papers outlined the appreciative inquiry (AI) philosophy, a strengths-based “positive psychology” and organisational development (OD) approach which is intrinsically creative and generative, and has been found to work well in many fields. The purpose of this paper is to describe its application in homeless hostels and demonstrates the benefits of using AI with the staff and residents, as both a personal development and an OD tool for hostels who want to become a psychologically informed environment (PIE). Design/methodology/approach – This is a case study exploring a new approach to the development of a PIE. The background of the approach and the way it contributes to a PIE as described in Part One is briefly summarised, and the implementation pilot project is discussed; the appreciative conversation and the 5 D cycle are key AI “tools” which were used. The inclusion of positive psychology approaches is referenced. In addition, in the spirit of evidence-generating practice in PIEs, preliminary quantitative and qualitative findings are reported to identify the outcomes of the approach – including client motivation, desire to build positive relationships, and increased emotional awareness. Findings – Residents responded very well to the approach, and a high proportion continued to apply their learning, making major steps towards independent living. This was backed up by quantitative data demonstrating effective outcomes for the supported housing sector, and qualitative themes start to illuminate the psychological processes behind the outcomes. The openness of PIEs to alternative psychologies is further demonstrated. The model was rolled out to other Westminster hostels. Originality/value – AI is well-established as an OD process and less well known as a personal development approach; but has not previously been articulated as a tool for working with hostel residents or for developing PIEs. This strength-based approach is an alternative to some of the problem-based psychological approaches that have been used. In addition, the AI intervention illustrated defining features of a PIE such as reflective awareness. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to present an overview of the current state of evidence on the effect of housing circumstances, and housing-related interventions, on adult mental health and well-being. It covers the entire range of health from chronic illness to positive thriving, and both individual and community-level/public health. Design/methodology/approach – The paper is based upon a purposive review, commissioned originally for the UK Department of Health; and therefore is selective in giving priority to research relevant to public policy considerations, and to the UK context. Research with a variety of methodological foundations is considered, where robust enough by its own standards. Findings – The available evidence gives conditional support to policies accentuating empowerment at individual and community levels; early intervention; locality or place-based interventions; and integrated working practice. The complexity of methodological issues emerges as a key challenge for research in this field, and for the prospect of evidence-based national policy. Meanwhile local knowledge and interpretation of data in context may be more reliable than context-blind studies. Research limitations/implications – Where "hard evidence" is unavailable, reports of the lived experience of individuals and in communities remain a legitimate basis for policy and commissioning. Originality/value – This appears to be the first attempt in print to cover such a wide canvas in one overview. [ABSTRACT FROM AUTHOR]

Purpose – Housing First has been upheld as an evidence-based best practice for transitioning homeless individuals into permanent housing in a maximally cost-effective and humane manner. However, there is much variance in the implementation and structure of Housing First programming in the USA. This paper aims to focus on a collaborative, interdisciplinary Housing First effort to house and provide case management and ancillary services to chronically homeless individuals in The City of San Mateo, California. Design/methodology/approach – The paper is a case study in which the philosophy, structure, and impact of San Mateo's outreach and housing team are discussed. To explore the project's impact, data concerning arrests and other criminal justice contacts, as well as health costs associated with these clients, both prior to and post housing and services, were collected and analyzed. These are corroborated with qualitative data on client outcomes. Findings – After participants received housing and wrap-around supportive services provided through the collaboration of police, local stakeholders, and non-profits, the cost of medical care and criminal justice interventions were dramatically reduced. While challenges such as the availability of housing units remain, the findings of this study strongly support the interdisciplinary outreach team as a model for Housing First programming. Research limitations/implications – This is an in-depth study, derived from a particularly innovative project; and therefore the sample size is limited by the size of the project. Originality/value – The originality of this study lies in its analysis of a Housing First model which incorporates an interdisciplinary outreach team designed to provide highly individualized care for clients. The San Mateo permanent supportive housing pilot project is itself unique in that it incorporates a Homeless Outreach Team (HOT) comprised of the police, other government entities, local stakeholders, and other non-profits engaged with homelessness. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to critically evaluate an innovative collaboration between health, housing and social care by exploring the “short stay project” apartments from service users’ perspectives and considering the effectiveness of this service model as part of enabling provision locally.Design/methodology/approach The qualitative methodology for this evaluation was interpretative phenomenological analysis (Smith, 2011), critically exploring service users’ personal lived experience of the “short stay project”. Three service users (n=3) participated in semi-structured interviews.Findings This study has identified the “short stay project” can prevent admission into and facilitate discharge from care and health services by offering a temporary stay in self-contained, adapted accommodation. Service users found value in staying at the apartments for differing reasons. However, practitioners must address service users’ emotional and social needs as well as physical needs to reduce the risk of occupational deprivation.Research limitations/implications Sample size is not fully representative of the total population making transferability limited.Practical implications This research found there is demand for temporary housing provision for service users with health, housing and/or social care needs.Social implications Key drivers of demand for the service are social inequalities relating to homelessness, poverty and gender-based violence rather than the health-related issues that could have been expected. Further research into the development of effective integrated services which maximise service users’ wellbeing and occupational performance is recommended.Originality/value Service models which integrate health, housing and social care can be innovative and maintain service users’ independence and wellbeing in the community. Commissioners across health, housing and social care could utilise the Better Care Fund to deliver integrated services to meet rising demands. [ABSTRACT FROM AUTHOR]

Purpose Many homeless people have significant levels of early adverse experiences and consequent mental health difficulties. The purpose of this paper is to examine the experiences of residents and staff living and working in a psychologically informed environment (PIE), a new model of hostel for homeless people which aims to update and make more flexible the principles of the therapeutic community, thereby meeting the psychological and emotional needs of residents.Design/methodology/approach Semi-structured interviews were carried out with nine residents, ten staff and five psychotherapists at two PIE hostels in London. The data were analysed using thematic analysis with a phenomenological epistemological approach.Findings Analysis generated 18 themes for residents and staff combined, organised into five domains: what makes a home, resident needs, managing relationships, reflective practice and theory vs practice of PIEs. The study suggests that PIEs broadly meet their aim in providing a different type of environment from standard hostels. Efforts to build relationships with residents are particularly prioritised. This work can be challenging for staff and reflective practice groups provide a supportive forum. There are limits to the extent to which the theoretical PIE can be put into practice in the current political and economic climate.Originality/value This is one of the first qualitative studies of PIEs. It provides perspectives on their theoretical background as well as how they operate and are experienced in practice. It may be informative to services intending to establish a PIE and to commissioners in assessing appropriate resources. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to extend our understanding of the issues facing those who experience multiple moves around homelessness projects. It considers these issues and how they relate to best practice, informing the delivery of psychologically informed environments (PIEs).Design/methodology/approach A qualitative design was employed, with interviews undertaken with men currently residing in hostels for those with additional needs. These men had already experienced multiple moves within the hostel system. Interpretative phenomenological analysis was used to analyse the data.Findings Main themes consider issues and challenges associated with hope and moving forward; help and the conditional or temporal nature of this; identity and stigma; and intimacy and relationships. Clinical implications of these findings are discussed.Research limitations/implications Implications include best practice for future planning with service users, the relational nature of hope, how best to manage endings and practical guidance for service developments in these settings.Originality/value These findings further the understanding of the challenges faced by service users with complex needs and how best to address them. They build on PIE guidance, offering tangible advice for practice. [ABSTRACT FROM AUTHOR]

Purpose -- This paper aims to offer a commentary on Psychologically Informed Services: A Good Practice Guide, a recently published operational guidance document on developing psychologically informed environments (PiEs) in services for homeless people. Design/methodology/approach -- The paper is an invited opinion piece and comment based on the author's specialist knowledge gained from undertaking research addressing the experiences and needs of young runaways. Findings -- The new operational guidance is welcomed but should be extended so that psychologically informed environments are provided in services for young runaways under the age of 16, who often encounter abuse, mental health issues and problematic substance misuse and experience homelessness post 16 and into adulthood. Originality/value -- Commissioners and practitioners should encourage the development of psychologically informed environments for young runaways to meet their needs, aid recovery and reduce the likelihood of experiencing homelessness as they move into adulthood. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to describe an example of a practical evidence-based approach to improvement in the current climate of funding cuts.Design/methodology/approach - The paper describes synthesizing insights from leadership, change management and psychodynamic theory to inform a practical change programme to develop services that meet the needs of clients more efficiently.Findings - The paper finds that rather than simply doing less - cutting staff or reducing services to meet the constraints of funding cuts - it is worth taking a long term and strategic review approach and doing something quite differently.Practical implications - New ways of working can improve client outcomes and deliver better services and the funding cuts can provide an opportunity to thoroughly re-examine existing provision; but, significant changes will only be accomplished by change processes that pervade the whole organisation - they cannot just be add-ons/afterthoughts. The implications of the new way of working are that: even when funding increases, old ways of practice will not be restored; that the use of theoretical approaches from a variety of disciplines can deliver innovative responses that are likely to be sustainable in the medium term; and to improve service standards and outcomes into the future.Originality/value - This paper finds value by looking to neurobiology, clinical psychotherapy, recovery-oriented practice, change management theory and practice, and client involvement to try to resolve the current housing crisis. [ABSTRACT FROM AUTHOR]

Purpose Social support is a significant factor in the life of homeless people, as it helps them meet their life challenges more efficiently and increases the likelihood of return to a normal life. Social support plays a different role in homeless women’s life, as gender culture often causes them to be exposed to more risks. The purpose of this paper is to identify homeless people’s access to social support from their network members, with a comparison between men and women.Design/methodology/approach In this study, a survey method was used with an administrated questionnaire. Participants were recruited from among the homeless people (men and women) who used the municipal social services in shelters and social service centers in Tehran. The main variables in this study included frequency of contact, social support, and gender.Findings The results have shown significant differences between homeless men and homeless women in terms of frequency of contact and receipt of social support. Homeless women contacted their network members more often than did homeless men and also received more support. There seems to be a strong correlation between the receipt of social support and women’s greater ability for social communication, as well as with traditional culture, which considers women to be weak and dependent so that they receive more support compared with men. The weakness of social support, especially among homeless men, requires serious attention; however, homeless women are not in a favorable situation either.Originality/value The social networks of homeless people who usually live on the streets and in public places without permanent shelter are weak because of various reasons, including poverty, addiction, immigration, and divorce. The weakness of social support leads to an escalation of their vulnerabilities. Thus, it is necessary, in social policy and services, to improve the social network of high-risk people such as homeless people, which would help the rehabilitation process and reduce the probability of exposure to harm. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to investigate how service professionals involved in the provision of services to clientele who use solvents and are often without stable housing understand the process of healing and recovery in their work. Design/methodology/approach – Using a narrative methodology, semi-structured interviews were conducted with 12 human service professionals (i.e. social workers, case managers, etc.) employed in providing recovery-based services to individuals who use volatile solvents. Findings – Despite the dominant cultural story about “street addicts” and solvent users’ limited possibilities for recovery, professionals indicate that they view their clients as “just like everyone else.” The dominant storyline was that of advocating for the capability of the client group. These stories are discussed in relation to hope for professionals who provide health and housing services to clientele with complex and multi-systemic needs. Originality/value – The findings have implications for how human service providers maintain hope and purpose in their work with stigmatized populations (e.g. homeless individuals, those with alcohol or other drug-related problems). This study highlights how human service professionals make sense of their role in their work and how they maintain hope for themselves and for the recovery of the clientele they work alongside. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to consolidate policy, research, evidence and good practice around strategies tackling fuel poverty and affordable warmth for older people aged over 60 to support the development of more effective services for this life course stage and to tackle physical and mental health inequalities. Design/methodology/approach – The authors consolidate current policy, research, evidence and examples of good practice in exploring effective interprofessional approaches that contribute to affordable warmth for older people through “desktop analysis”. The authors support this with qualitative data from Health and Wellbeing Boards (HWBs), health inequalities and environmental health from research comprising four longitudinal case studies in the Midlands and North of England over 18 months and semi-structured interviews with members and support officers. A total of 50 interviews were undertaken and 55 hours of HWB meetings observed. Findings – There are numerous older people living in fuel poverty. The depth of fuel poverty increases with age particularly the over 75s and physical and mental ill health are affected. There are an increasing number of tools to help estimate health care costs around the cost effectiveness of interventions and there is a real need for more local evidence about what is working well, how and why. However, there is no mandatory requirement for fuel poverty strategies and more creative local strategies are required taking organisational and interprofessional relationships into account. The emphasis in integrated care provides new impetus and scope to encourage preventative services but these new partnerships need to be effective in what is a complex policy environment. There is still a long way to go in places. The challenges of ageing are numerous, complex and not fully understood and sit across multiple policy areas. Originality/value – Fuel poverty strategies tend to be delivered on a geographical or income bases rather than by life course approach and a focus on older people. We need to focus more specifically on older people, a rapidly growing population and to better understand thermal properties of our ageing housing stock and how best to intervene to protect and improve health and safety. Emerging approaches need to overcome artificial statutory and non statutory divides and move towards sustainable, evidence based affordable warmth strategies for older people to protect and improve health. [ABSTRACT FROM AUTHOR]

Purpose – Homeless populations are a politically contentious problem and researchers struggle to achieve a balanced approach. They place emphasis on sharply contrasting factors, such as; institutional structures, ideologies or individual dispositions and differences. Central questions remain unanswered, i.e., is homelessness an outcome of society’s failings related to housing shortages, or a personal choice, as in the status of “intentional homelessness?” The purpose of this paper is to set aside assumptions, to explore experiences of homelessness and psychosis. Design/methodology/approach – An existentially informed hermeneutic phenomenological analysis; exploring transcribed narratives from semi-structured interviews with three men. Findings – These participants started to wander as a spontaneous response to distressing life experiences. Without any plan they travelled to new locations living on the street. Being contained and treated against their will in the psychiatric system was another source of distress. They did not choose homelessness through a rational calculation of their best interests. They felt at odds with society, which did not protect them and failed to meet their needs. Research limitations/implications – In qualitative research, findings are not generalisable to other settings. Practical implications – Homeless services should be enhanced by psychological expertise along with more person-centred emphatic approaches; the authors of social policies should consider their philosophical assumptions. Social implications – Systemised mental healthcare does not solve complex problems; fails to meet needs. Originality/value – The analysis informs the design of further research, prompts practitioners to review their understandings and provides grounds for the rewriting of policies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report on a small telehealth pilot in local authority sheltered housing in NE England. This explored the training and capacity building needed to develop a workforce/older person, telehealth partnership and service that is integrated within existing health, social care and housing services. Design/methodology/approach – A qualitative case study approach on the implementation and deployment of a pilot telehealth service, supporting sheltered housing tenants with Chronic obstructive pulmonary disease (n=4). Findings – Telehealth training and capacity building, needs to develop from within the workforce/older person partnership, if a usable and acceptable telehealth service is to be developed and integrated within existing health, care and housing services. To be adaptable to changing circumstances and individual need, flexible monitoring is also required. Practical implications – Service users and workforces, need to work together to provide flexible telehealth monitoring, that in the longer term, may improve service user, quality of life. Originality/value – The pilot explored a workforce/older person partnership to consider how to add and implement telehealth services, into existing health and housing services. [ABSTRACT FROM AUTHOR]

Purpose – This participatory health research project of researchers and women prisoners examined housing and homelessness as perceived by incarcerated women to understand this public health concern and help guide policy. The paper aims to discuss these issues. Design/methodology/approach – A participatory research team designed and conducted a survey of 83 incarcerated women in BC, Canada. Using descriptive statistics, the authors examined socio-demographic factors related to social support networks and family housing and women’s housing preference upon release. Findings – In total, 44 percent of participants reported no family home upon release while 31 percent reported lost family ties due to their incarceration. Most vulnerable subpopulations were women aged 25-34, aboriginal women and those with multiple incarcerations. Housing preferences differed between participants suggesting needs for varied options. Further implementation, evaluation and appraisal of social programs are required. Research limitations/implications – This study surveyed one correctional facility: future research could utilize multiple centers. Practical implications – Addressing housing instability among released incarcerated individuals is important fiscally and from a public health lens. Improved discharge planning and housing stability is needed through policy changes and social programs. A social support network, “Women in2 Healing,” has developed from the research group to address these issues. Social implications – Housing stability and recidivism are closely linked: providing stable housing options will lessen the social, fiscal and medical burden of individuals returning to crime, substance abuse, illness and poverty. Originality/value – Housing instability addresses an important social determinant of health and focussing on incarcerated women builds upon a small body of literature. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the lived experiences of women without children experiencing housing instability and homelessness in Calgary, Canada; and narratives of what triggered their journeys were constructed according to the tenets of hermeneutic phenomenology, and suggest a framework for assisting these women. Design/methodology/approach – The design for this study is qualitative, approached through hermeneutic phenomenology rooted in Gadamerian philosophical hermeneutics (Gadamer, 2004). Hermeneutic phenomenology, as a research method has provided insight into understanding phenomena and human experiences that are important to human science professionals. Findings – The experience of homelessness for women without children started while they still lived at home, but after they lost all sense of “being at home” as a consequence of identifiable negative home experiences, such as abuse. The effects or impacts of stable childhood or adult home experiences and the implications of such in contributing to the feelings of homelessness were pervasive in the stories told by these women. Practical implications – Access to housing does not mean getting out of the feeling of homelessness, because the trauma that triggers the experience for the clients often last for a life time. Long-term engagement with the client will be synonymous to increasing the possibility that they can be stabilized permanently. Resources dedicated to these clients must be tailored to each client’s needs, with strong agency collaboration with the mainstream systems. Social implications – Community health nurses and other support workers for individuals experiencing homelessness need to build bridges with inter-professional groups to close the gap created by societal attitudes toward women and domestic abuse survivors through advocacy and education, especially in countries where women are still treated as second class citizens. Originality/value – Although there has been a considerable amount of research conducted on the determinants of homelessness and housing instabilities in women or their pathways into homelessness, the plight of women without children and their experiences while homeless have received little attention in literature. This study explored the lived experiences of women without children experiencing homelessness and narratives of what triggered their journeys were constructed according to the tenets of hermeneutic phenomenology, and suggest a framework for assisting these women. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to inform funders and potential funders alike of the likely outcomes of their financial contributions. Additionally, the authors reported on the assessment of the underlying logic model or theoretical underpinnings of what the authors will term the “Habitat Model.” Design/methodology/approach – This study utilized a one-shot case study design to obtain data. In a one-shot case study the experimental group is exposed to the independent variable (X), then observations of the dependent variable (O) were made. No observations were made before the independent variable was introduced. A one-shot case study design was necessary as this is the first impact study conducted by BAHFH because of the changes within BAHFH over the years as well as the lack of consistent archival data on families and operations. Findings – Most of the feedback obtained from stakeholders was positive. Many of the demographic variables showed significant improvement in partner family life style since moving into a Habitat house. Practical implications – The findings of this study provide evidence of positive economic, social, and psychological impacts on families participating in BAHFH homeownership and on their communities. It also showed substantial economic impacts on the communities served. Furthermore, this study showed that other stakeholders in the process were substantially and positively impacted. Finally, this study pointed to a number of things that BAHFH needed to change such as homeowner education, financial counseling, and the opening of a local ReStore. Originality/value – The current study provides data that provide evidence of positive economic, social, and psychological impacts on families participating in BAHFH homeownership opportunities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide rationale, methodological guidance and clarity in the use of case study designs and theory driven approaches to evaluation of interventions to end homelessness.Design/methodology/approach – Using an evaluation of a transitional shelter program aiming to support permanent exits from homelessness as an example, the authors show how case study designs and theory driven evaluation is well suited to the study of the effectiveness of homelessness interventions within the broader socio-political and economic context in which they are being implemented. Findings – Taking account of the context as part of program evaluation and research on homelessness interventions moves away from blaming programs and individuals for systemic failures to better understanding of how the context influences successes and failures. Case study designs are particularly useful for studying implementation and the context which influences program outcomes. Theory driven evaluations and the use of realist evaluation as an approach can provide a broader understanding of how homelessness interventions work particularly for whom and under what conditions. These methodological and theoretical approaches provide a consistent strategy for evaluating programs aimed at ending homelessness. Originality/value – There is a need for greater capacity in the homelessness sector to apply approaches to evaluation that take into account the broader socio-political and economic context in which programs are being implemented. Through the use of a case example, the authors provide guidance for application of case study design and theory driven approaches as a strategy for approaches programs aimed at ending homelessness. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the significance of social isolation and the factors that create social isolation for residents of inner-city high-rise apartment communities. We critically examine how the physical environment and perceptions of safety in apartment buildings and the inner-city implicate the quality of interactions between residents and with their neighbourhood community. Design/methodology/approach – The authors used mixed-methods consisting of survey questionnaires supplemented by semi-structured interviews and focus group discussions using stratified random sampling to access predetermined key strata of inner-city high-rise resident population. Using coefficient of correlation we examine the significance of the association between social isolation, age and ethnicity amongst Auckland's inner-city high-rise residents. Findings – The authors found the experience and expression of social isolation consistent across all age groups, with highest correlation between functional social isolation and “being student”, and older adults (60+ years), length of tenure in current apartment and length of time residents have lived in the inner-city. Research limitations/implications – As a case study, we did not seek in this research to compare the experience and expressions of social isolation in different inner-city contexts, nor of inner-city high-rise residents in New Zealand and other countries, although these will be useful areas to explore in future studies. Practical implications – This study is a useful starting point to build evidence base for professionals working in health and social care services to develop interventions that will help reduce functional social isolation amongst young adults and older adults in inner-city high-rise apartments. This is particularly important as the inner-city population of older adults grow due to international migration, and sub-national shifts from suburbs to the inner-cities in response to governmental policies of urban consolidation. Originality/value – By identifying two forms of social isolation, namely functional and structural social isolation, we have extended previous analysis of social isolation and found that “living alone” or structural social isolation did not necessarily lead to functional social isolation. It also touched on the links between functional social isolation and self-efficacy of older adults, particularly those from immigrant backgrounds. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to add to the understanding of homelessness by exploring and analysing the homeless pathway of a young expectant mother as she negotiates her way through temporary accommodation and comes to terms with her circumstances and new identity as a person without a home. Design/methodology/approach – A phenomenological interviewing approach was used in order to gain insights into the subject's lived daily world from her perspective. Themes were then identified that encapsulated the essential qualities of the interview. Findings – The stress and negative emotions of being homeless appear to be accentuated significantly due to pregnancy, taking the potential for the positive feelings associated with pregnancy away from the participant. Structural factors such as the homelessness legislation and affordable housing supply had a strong influence over her homeless pathway, resulting in feelings of a loss of control over her destiny and choices and subsequent feelings of low self-worth, which she had to try to come to terms with. However, the pregnancy was also used as a positive coping strategy, as was family support. Originality/value – Minimal research has been undertaken on the experiences of homeless women who are pregnant. The results point to the need to understand the deeply negative impacts that homelessness can have on individuals, particularly expectant mothers. The value of examining homelessness as a pathway is also shown. [ABSTRACT FROM AUTHOR]