205 results on '"Knight, Kelly R."'
Search Results
2. The Impact of Intimate Partner Violence on Homelessness and Returns to Housing: A Qualitative Analysis From the California Statewide Study of People Experiencing Homelessness.
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Hargrave, Anita S, Knight, Kelly R, Dhatt, Zena K, Taylor, Grace, Martinez, Dez, and Kushel, Margot
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Social Work ,Criminology ,Human Society ,Homelessness ,Women's Health ,Violence Research ,Violence Against Women ,Behavioral and Social Science ,Mental Health ,Social Determinants of Health ,Peace ,Justice and Strong Institutions ,Gender Equality ,anything related to domestic violence ,domestic violence ,domestic violence and cultural contexts ,intervention/treatment ,Psychology ,Social work ,Clinical and health psychology - Abstract
Homelessness is a public health concern in California and throughout the United States. Intimate partner violence (IPV) is a risk factor for experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Qualitative methods can provide a greater understanding of the lived experience of IPV and homelessness to identify potential solutions. We purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. We administered semi-structured interviews focusing on IPV and six other topic areas pertaining to homelessness from October 2021 to May 2022. We created and applied a codebook with a multidisciplinary team using a hybrid of deductive and inductive logic. Our analysis included all participants who discussed IPV and homelessness across the seven studies. We conducted a thematic analysis using an interpretivist approach and informed by grounded theory. We found that violence within a partnership was multidimensional (physical, sexual, emotional, and financial) and bidirectional. We identified six themes: (1) IPV precipitated and prolonged homelessness; (2) Need for housing, financial stability, and material resources influenced staying in abusive relationships; (3) Alcohol and illicit substance use exacerbated violence between partners; (4) Participants struggled to find resources in domestic violence (DV) shelters; (5) The healthcare system did not provide substantial support; and (6) discrimination and stigma influenced equitable access to housing and DV resources. Experiencing IPV contributed to homelessness and impeded returns to housing. Limitations in current IPV resources impede care. We propose equitable expansion of survivor-centered services that improve access to long-term subsidized housing, prevent IPV and homelessness with flexible funding options, and facilitate rapid exits from homelessness through trauma-informed, non-congregate shelter that transitions to permanent housing.
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- 2024
3. “We remember the pain”: a qualitative study of intergenerational trauma among older adults experiencing homelessness in the HOPE HOME study
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Hargrave, Anita S, Garcia, Cheyenne M, Lightfoot, Marguerita, Handley, Margaret A, Weeks, John, Olsen, Pamela, Knight, Kelly R, and Kushel, Margot B
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Social Work ,Human Society ,Clinical Research ,Health Disparities ,Social Determinants of Health ,Behavioral and Social Science ,Aging ,trauma ,aging ,homelessness ,qualitative ,Homelessness ,Qualitative ,Trauma ,Criminology ,Development studies - Abstract
Rates of homelessness among adults aged 50 and over are rising. Common strategies for exiting homelessness rely on social and family support. However, intergenerational trauma may disrupt these social support networks and contribute to homelessness. Understanding the impact of intergenerational trauma on living with family or friends may give insight into addressing homelessness among older adults. We purposefully sampled 46 adults who reported living with family or friends from the HOPE HOME study cohort (350 community-recruited adults, ≥ 50 years and experiencing homelessness in Oakland, California) and 19 family/friends who had hosted the participants in their living spaces. We conducted independent, semi-structured interviews and used grounded theory methodologies to analyze data. We identified four major themes from the interviews: (1) Intergenerational trauma was common and made it difficult to stay with family or friends; (2) Participants and hosts sought to protect future generations from intergenerational trauma; (3) Relationships endured despite intergenerational trauma; and (4) social structures exacerbated the impact of intergenerational trauma and played a significant role in perpetuating homelessness. Trauma-informed policies that confront the structures that propagate or exacerbate intergenerational trauma may mitigate their impact and facilitate housing for older adults.
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- 2024
4. Loneliness among homeless-experienced older adults with cognitive or functional impairments: qualitative findings from the HOPE HOME study
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Yuan, Yeqing, Knight, Kelly R, Weeks, John, King, Stephen, Olsen, Pamela, and Kushel, Margot
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Epidemiology ,Health Services and Systems ,Public Health ,Health Sciences ,Behavioral and Social Science ,Homelessness ,Aging ,Basic Behavioral and Social Science ,Clinical Research ,2.3 Psychological ,social and economic factors ,Aetiology ,Male ,Humans ,Aged ,Loneliness ,Longitudinal Studies ,Social Isolation ,Ill-Housed Persons ,Cognition ,Older adults ,Homeless ,Mental health ,Social isolation ,Public Health and Health Services ,Health services and systems ,Public health - Abstract
BackgroundLoneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging in the United States; now, 48% of single homeless adults are 50 and older. We know little about loneliness among older adults who have experienced homelessness. We aimed to describe the loneliness experience among homeless-experienced older adults with cognitive and functional impairments and the individual, social, and structural conditions that shaped these loneliness experiences.MethodsWe purposively sampled 22 older adults from the HOPE HOME study, a longitudinal cohort study among adults aged 50 years or older experiencing homelessness in Oakland, California. We conducted in-depth interviews about participants perceived social support and social isolation. We conducted qualitative content analysis.ResultsTwenty participants discussed loneliness experience, who had a median age of 57 and were mostly Black (80%) and men (65%). We developed a typology of participants' loneliness experience and explored the individual, social, and structural conditions under which each loneliness experience occurred. We categorized the loneliness experience into four groups: (1) "lonely- distressed", characterized by physical impairment and severe isolation; (2) "lonely- rather be isolated", reflecting deliberate social isolation as a result of trauma, marginalization and aging-related resignation; (3) "lonely- transient", as a result of aging, acceptance and grieving; and (4) "not lonely"- characterized by stability and connection despite having experienced homelessness.ConclusionsLoneliness is a complex and heterogenous social phenomenon, with homeless-experienced older adults with cognitive or functional impairments exhibiting diverse loneliness experiences based on their individual life circumstances and needs. While the most distressing loneliness experience occurred among those with physical impairment and mobility challenges, social and structural factors such as interpersonal and structural violence during homelessness shaped these experiences.
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- 2024
5. Using alone at home: What’s missing in housing-based responses to the overdose crisis?
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Fleming, Taylor, Boyd, Jade, Chayama, Koharu Loulou, Knight, Kelly R, and McNeil, Ryan
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Public Health ,Health Sciences ,Behavioral and Social Science ,Drug Abuse (NIDA only) ,Clinical Research ,Health Services ,Substance Misuse ,Prevention ,People who use drugs ,Overdose ,Housing ,Harm reduction interventions ,Humans ,Substance-Related Disorders ,Harm Reduction ,Peer Group ,Drug Overdose ,Public Health and Health Services ,Substance Abuse ,Health services and systems ,Public health - Abstract
BackgroundAgainst the backdrop of North America's overdose crisis, most overdose deaths are occurring in housing environments, largely due to individuals using drugs alone. Overdose deaths in cities remain concentrated in marginal housing environments (e.g., single-room occupancy housing, shelters), which are often the only forms of housing available to urban poor and drug-using communities. This commentary aims to highlight current housing-based overdose prevention interventions and to situate them within the broader environmental contexts of marginal housing. In doing so, we call attention to the need to better understand marginal housing as sites of overdose vulnerability and public health intervention to optimize responses to the overdose crisis.Harm reduction and overdose prevention in housingIn response to high overdose rates in marginal housing environments several interventions (e.g., housing-based supervised consumption rooms, peer-witnessed injection) have recently been implemented in select jurisdictions. However, even with the growing recognition of marginal housing as a key intervention site, housing-based interventions have yet to be scaled up in a meaningful way. Further, there have been persistent challenges to tailoring these approaches to address dynamics within housing environments. Thus, while it is critical to expand coverage of housing-based interventions across marginal housing environments, these interventions must also attend to the contextual drivers of risks in these settings to best foster enabling environments for harm reduction and maximize impacts.ConclusionEmerging housing-focused interventions are designed to address key drivers of overdose risk (e.g., using alone, toxic drug supply). Yet, broader contextual factors (e.g., drug criminalization, housing quality, gender) are equally critical factors that shape how structurally vulnerable people who use drugs navigate and engage with harm reduction interventions. A more comprehensive understanding of these contextual factors within housing environments is needed to inform policy and programmatic interventions that are responsive to the needs of people who use drugs in these settings.
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- 2024
6. The intersection of drug use discrimination and racial discrimination in the management of chronic non-cancer pain in United States primary care safety-net clinics: Implications for healthcare system and clinic-level changes
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Cooke, Alexis, Castellanos, Stacy, Koenders, Sedona, Joshi, Neena, Enriquez, Celeste, Olsen, Pamela, Miaskowski, Christine, Kushel, Margot, and Knight, Kelly R
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Chronic Pain ,Drug Abuse (NIDA only) ,Substance Misuse ,Neurosciences ,Clinical Research ,Pain Research ,Behavioral and Social Science ,8.1 Organisation and delivery of services ,Health and social care services research ,Good Health and Well Being ,Chronic non-cancer pain ,Discrimination ,Opioids ,Primary care ,Race ,Safety-net ,Substance use ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Substance Abuse - Abstract
BackgroundClinicians' bias related to patients' race and substance use history play a role in pain management. However, patients' or clinicians' understandings about discriminatory practices and the structural factors that contribute to and exacerbate these practices are underexamined. We report on perceptions of discrimination from the perspectives of patients with chronic non-cancer pain (CNCP) and a history of substance use and their clinicians within the structural landscape of reductions in opioid prescribing in the United States.MethodsWe interviewed 46 clinicians and 94 patients, using semi-structured interview guides, from eight safety-net primary care clinics across the San Francisco Bay Area from 2013 to 2020. We used a modified grounded theory approach to code and analyze transcripts.ResultsClinicians discussed using opioid prescribing guidelines with the goals of increased opioid safety and reduced bias in patient monitoring. While patients acknowledged the validity of clinicians' concerns about opioid safety, they indicated that clinicians made assumptions about opioid misuse towards Black patients and patients suspected of substance use. Clinicians discussed evidence of discrimination in opioid prescribing at the clinic-wide level; racialized stereotypes about patients likely to misuse opioids; and their own struggles to overcome discriminatory practices regarding CNCP management.ConclusionWhile clinicians and patients acknowledged opioid safety concerns, the practical application of opioid prescribing guidelines impacted how patients perceived and engaged with CNCP care particularly for patients who are Black and/or report a history of substance use. We recommend healthcare system and clinic-level interventions that may remediate discriminatory practices and associated disparities.
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- 2023
7. Barriers and facilitators to resolving older adult homelessness through stays with family: qualitative findings from the HOPE HOME study
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Cai, Christopher, Knight, Kelly R, Olsen, Pamela, Weeks, John, Handley, Margaret A, and Kushel, Margot B
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Social Work ,Human Society ,Aging ,Behavioral and Social Science ,Prevention ,Clinical Research ,Homelessness ,Rehabilitation ,family ,friends ,policy ,social ecological model ,Criminology ,Development studies - Abstract
Living with family and friends is a common strategy used to prevent or exit homelessness, but little is known about structural barriers that impede family and friends' ability to provide temporary or permanent housing for older homeless adults. We conducted semi-structured interviews with 46 homeless participants from the HOPE HOME study, a cohort of 350 community-recruited homeless adults age 50 or older in Oakland, CA, who reported having stayed with housed family/friends for 1 or more nights in the prior 6 months. We conducted semi-structured interviews with 19 hosts of homeless participants and 11 stakeholders in housing and homelessness. We found that homeless older adults and hosts perceived staying with family or friends as a form of temporary housing rather than as a permanent exit to homelessness. Structural barriers to family and friends providing housing for temporary stays or permanent exits from homelessness included housing regulations restricting visitors and changing rent obligations; decreased eligibility and priority for shelter and permanent housing; geographic and transportation challenges; and environments inconducive to older adults. We suggest four areas for policy reform: providing subsidies to hosts and homeless individuals, removing disincentives for homeless older adults to stay with family, changing lease regulations, and expanding the supply of affordable housing.
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- 2023
8. Temporary stays with housed family and friends among older adults experiencing homelessness: Qualitative findings from the HOPE HOME study
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Knight, Kelly R, Weiser, Jeremy, Handley, Margaret A, Olsen, Pamela, Weeks, John, and Kushel, Margot
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Social Work ,Human Society ,Behavioral and Social Science ,Aging ,Prevention ,Homelessness ,kinship care ,older adults ,family caregiving ,gerontology ,housing ,Political Science ,Social work - Abstract
BackgroundThe proportion of adults age 50 and older experiencing homelessness is growing. People at risk for homelessness may stay with family and friends to prevent homelessness. Moving in with housed family and friends is a strategy used to exit homelessness. Little is known about these stays with family and friends. This study examined the motivations for and challenges of older adults experiencing homelessness staying with or moving in with family or friends.MethodsWe purposively sampled 46 participants from the HOPE HOME study, a cohort of 350 community-recruited adults experiencing homelessness age ≥50 in Oakland, CA. Inclusion criteria included having stayed with housed family/friends for ≥1 nights in the prior 6 months. We sampled 19 family/friends who had hosted participants experiencing homelessness. We conducted separate, semi-structured interviews, summarized, memoed and coded data consistent using a grounded theory approach.ResultsOlder adults experiencing homelessness reported primarily temporary stays. Motivations for stays on the part of participants included a need for environmental, physical, and emotional respite from homelessness. Both individuals experiencing homelessness and hosts cited the mutual benefits of stays. Barriers to stays included feelings of shame, concerns about burdening the hosts, and interpersonal conflicts between older adults experiencing homelessness and host participants.ConclusionsThere are potential opportunities and concerns surrounding temporary stays between older adults experiencing homelessness and their family or friends. Policy solutions should support the potential mutual benefits of temporary stays, while addressing interpersonal barriers to strengthen kinship and friendship networks and mediate the negative impacts of homelessness.
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- 2022
9. Structural Adaptations to Methadone Maintenance Treatment and Take-Home Dosing for Opioid Use Disorder in the Era of COVID-19
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Suen, Leslie W, Coe, William H, Wyatt, Janan P, Adams, Zoe M, Gandhi, Mona, Batchelor, Hannah M, Castellanos, Stacy, Joshi, Neena, Satterwhite, Shannon, Pérez-Rodríguez, Rafael, Rodríguez-Guerra, Esther, Albizu-Garcia, Carmen E, Knight, Kelly R, and Jordan, Ayana
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Pharmacology and Pharmaceutical Sciences ,Biomedical and Clinical Sciences ,Good Health and Well Being ,COVID-19 ,Humans ,Methadone ,Opiate Substitution Treatment ,Opioid-Related Disorders ,Medical and Health Sciences ,Public Health ,Biomedical and clinical sciences ,Health sciences - Published
- 2022
10. Structural competency and global health education
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Harvey, Michael, Neff, Joshua, Knight, Kelly R, Mukherjee, Joia S, Shamasunder, Sriram, Le, Phuoc V, Tittle, Robin, Jain, Yogesh, Carrasco, Héctor, Bernal-Serrano, Daniel, Goronga, Tinashe, and Holmes, Seth M
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Public Health ,Health Sciences ,Prevention ,Clinical Research ,Health Services ,Generic health relevance ,Good Health and Well Being ,Quality Education ,Curriculum ,Global Health ,Health Education ,Health Personnel ,Humans ,Social determinants of health ,structural competency ,global health ,education ,Public Health and Health Services ,Epidemiology ,Public health ,Policy and administration - Abstract
Structural competency is a new curricular framework for training health professionals to recognise and respond to disease and its unequal distribution as the outcome of social structures, such as economic and legal systems, healthcare and taxation policies, and international institutions. While extensive global health research has linked social structures to the disproportionate burden of disease in the Global South, formal attempts to incorporate the structural competency framework into US-based global health education have not been described in the literature. This paper fills this gap by articulating five sub-competencies for structurally competent global health instruction. Authors drew on their experiences developing global health and structural competency curricula-and consulted relevant structural competency, global health, social science, social theory, and social determinants of health literatures. The five sub-competencies include: (1) Describe the role of social structures in producing and maintaining health inequities globally, (2) Identify the ways that structural inequalities are naturalised within the field of global health, (3) Discuss the impact of structures on the practice of global health, (4) Recognise structural interventions for addressing global health inequities, and (5) Apply the concept of structural humility in the context of global health.
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- 2022
11. Radical hospitality: Innovative programming to build community and meet the needs of people who use drugs at a government-sanctioned overdose prevention site in San Francisco, California
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Wenger, Lynn D., Morris, Terry, Knight, Kelly R., Megerian, Cariné E., Davidson, Peter J., Suen, Leslie W., Majano, Veronica, Lambdin, Barrot H., and Kral, Alex H.
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- 2024
- Full Text
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12. "The idea is to help people achieve greater success and liberty": A qualitative study of expanded methadone take-home access in opioid use disorder treatment.
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Suen, Leslie W, Castellanos, Stacy, Joshi, Neena, Satterwhite, Shannon, and Knight, Kelly R
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Humans ,Opioid-Related Disorders ,Methadone ,Analgesics ,Opioid ,Qualitative Research ,Freedom ,Middle Aged ,United States ,Female ,Male ,Pandemics ,Drug Overdose ,COVID-19 ,Opioid use disorder ,addiction ,clinical-decision making ,methadone ,policy ,Drug Abuse (NIDA only) ,Health Services ,Behavioral and Social Science ,Prescription Drug Abuse ,Patient Safety ,Substance Misuse ,Clinical Research ,7.1 Individual care needs ,8.1 Organisation and delivery of services ,Management of diseases and conditions ,Health and social care services research ,Generic health relevance ,Mental health ,Good Health and Well Being ,Public Health and Health Services ,Psychology ,Substance Abuse - Abstract
Background: Prior to the COVID-19 pandemic, the United States (US) was already facing an epidemic of opioid overdose deaths. Overdose deaths continued to surge during the pandemic. To limit COVID-19 spread and to avoid disruptions in access to medications for opioid use disorder (MOUD), including buprenorphine and methadone, US federal and state agencies granted unprecedented exemptions to existing MOUD guidelines for Opioid Treatment Programs (OTPs), including loosening criteria for unsupervised take-home doses. We conducted a qualitative study to evaluate the impact of these policy changes on MOUD treatment experiences for providers and patients at an OTP in California. Methods: We interviewed 10 providers (including two physicians, five social worker associates, and three nurse practitioners) and 20 patients receiving MOUD. We transcribed, coded, and analyzed all interviews to identify emergent themes. Results: Patient participants were middle-aged (median age 51 years) and were predominantly men (53%). Providers discussed clinical decision-making processes and experiences providing take-homes. Implementation of expanded take-home policies was cautious. Providers reported making individualized decisions, using patient factors to decide if benefits outweighed risks of overdose and misuse. Decision-making factors included patient drug use, overdose risk, housing status, and vulnerability to COVID-19. New patient groups started receiving take-homes and providers noted few adverse events. Patients who received take-homes reported increased autonomy and treatment flexibility, which in turn increased likelihood of treatment stabilization and engagement. Patients who remained ineligible for take-homes, usually due to ongoing non-prescribed opioid or benzodiazepine use, desired greater transparency and shared decision-making. Conclusion: Federal exemptions in response to COVID-19 led to the unprecedented expansion of access to MOUD take-homes within OTPs. Providers and patients perceived benefits to expanding access to take-homes and experienced few adverse outcomes, suggesting expanded take-home policies should remain post-COVID-19. Future studies should explore whether these findings are generalizable to other OTPs and assess larger samples to quantify patient-level outcomes resulting from expanded take-home policies.
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- 2022
13. Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: a retrospective cohort study
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Jones, Benjamin L. H., Geier, Michelle, Neuhaus, John, Coffin, Phillip O., Snyder, Hannah R., Soran, Christine S., Knight, Kelly R., and Suen, Leslie W.
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- 2024
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14. “Get in and get out, get on with life”: Patient and provider perspectives on methadone van implementation for opioid use disorder treatment
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Suen, Leslie W., Steiger, Scott, Shapiro, Brad, Castellanos, Stacy, Joshi, Neena, Lambdin, Barrot H., and Knight, Kelly R.
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- 2023
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15. Responding to the Opioid Epidemic: Educational Competencies for Pain and Substance Use Disorder from the Medical Schools of the University of California
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Servis, Mark, Fishman, Scott M, Wallace, Mark S, Henry, Stephen G, Ziedonis, Doug, Ciccarone, Daniel, Knight, Kelly R, Shoptaw, Steven, Dowling, Patrick, Suchard, Jeffrey R, Shah, Shalini, Singh, Naileshni, Cedarquist, Lynette C, Alem, Navid, Copenhaver, David J, Westervelt, Marjorie, and Willis, Brigham C
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Prescription Drug Abuse ,Drug Abuse (NIDA only) ,Chronic Pain ,Pain Research ,Brain Disorders ,Substance Misuse ,Neurosciences ,Good Health and Well Being ,Analgesics ,Opioid ,Epidemics ,Humans ,Opioid Epidemic ,Opioid-Related Disorders ,Pain ,Practice Patterns ,Physicians' ,Schools ,Medical ,Substance-Related Disorders ,SUD ,Education ,Competencies ,Curriculum ,Clinical Sciences ,Pharmacology and Pharmaceutical Sciences ,Public Health and Health Services ,Anesthesiology - Abstract
ObjectiveThe University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD).MethodsThe six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic. The workgroup had diverse specialty and disciplinary representation. This workgroup focused on developing a foundational set of educational competencies for adoption across all UC medical schools that address pain, SUD, and public health concerns related to the opioid crisis.ResultsThe UC pain and SUD competencies were either newly created or adapted from existing competencies that addressed pain, SUD, and opioid and other prescription drug misuse. The final competencies covered three domains: pain, SUD, and public health issues related to the opioid crisis.ConclusionsThe authors present a novel set of educational competencies as a response to the opioid crisis. These competencies emphasize the subject areas that are fundamental to the opioid crisis: pain management, the safe use of opioids, and understanding and treating SUD.
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- 2021
16. Structural competency and global health education.
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Harvey, Michael, Neff, Joshua, Knight, Kelly R, Mukherjee, Joia S, Shamasunder, Sriram, Le, Phuoc V, Tittle, Robin, Jain, Yogesh, Carrasco, Héctor, Bernal-Serrano, Daniel, Goronga, Tinashe, and Holmes, Seth M
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Social determinants of health ,education ,global health ,structural competency ,Public Health ,Public Health and Health Services - Abstract
Structural competency is a new curricular framework for training health professionals to recognise and respond to disease and its unequal distribution as the outcome of social structures, such as economic and legal systems, healthcare and taxation policies, and international institutions. While extensive global health research has linked social structures to the disproportionate burden of disease in the Global South, formal attempts to incorporate the structural competency framework into US-based global health education have not been described in the literature. This paper fills this gap by articulating five sub-competencies for structurally competent global health instruction. Authors drew on their experiences developing global health and structural competency curricula-and consulted relevant structural competency, global health, social science, social theory, and social determinants of health literatures. The five sub-competencies include: (1) Describe the role of social structures in producing and maintaining health inequities globally, (2) Identify the ways that structural inequalities are naturalised within the field of global health, (3) Discuss the impact of structures on the practice of global health, (4) Recognise structural interventions for addressing global health inequities, and (5) Apply the concept of structural humility in the context of global health.
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- 2020
17. “It's no foundation, there's no stabilization, you're just scattered”: A qualitative study of the institutional circuit of recently-evicted people who use drugs
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Fleming, Taylor, Collins, Alexandra B., Boyd, Jade, Knight, Kelly R., and McNeil, Ryan
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- 2023
- Full Text
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18. Racial discrimination in the life course of older adults experiencing homelessness: results from the HOPE HOME study
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Paul, Dereck W, Knight, Kelly R, Olsen, Pamela, Weeks, John, Yen, Irene H, and Kushel, Margot B
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Social Work ,Human Society ,Aging ,Behavioral and Social Science ,Clinical Research ,Basic Behavioral and Social Science ,Homelessness ,Peace ,Justice and Strong Institutions ,housing ,racial discrimination ,structural racism ,health disparities ,homelessness ,Criminology ,Development studies - Abstract
Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness but little research has examined the relationship between race and homelessness. We aimed to understand the relationship between race and the experience of homelessness for older adults. We used grounded theory methodology to analyze in-depth qualitative interviews (n = 65) of persons experiencing homelessness. We recruited participants who were enrolled in two sub-studies of the Health Outcomes of People Experiencing Homelessness in Older Middle AgE (HOPE HOME) Study in Oakland California. We identified two major themes within interviews with Black participants (n=52) related to race: (1) participants experienced overt racial discrimination in early life and (2) structural racism precipitated and perpetuated adult homelessness. Further, we identified sub-themes of structural racism that contributed to participants becoming or staying homeless: criminal justice discrimination, employment discrimination, exposure to violence, premature death, and limited family wealth. We developed a theoretical model of how these elements of structural racism may increase susceptibility to homelessness. These relationships between racial discrimination and homelessness may serve as targets for policies aimed at preventing homelessness.
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- 2020
19. Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities.
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Neff, Joshua, Holmes, Seth M, Knight, Kelly R, Strong, Shirley, Thompson-Lastad, Ariana, McGuinness, Cara, Duncan, Laura, Saxena, Nimish, Harvey, Michael J, Langford, Alice, Carey-Simms, Katiana L, Minahan, Sara N, Satterwhite, Shannon, Ruppel, Caitlin, Lee, Sonia, Walkover, Lillian, De Avila, Jorge, Lewis, Brett, Matthews, Jenifer, and Nelson, Nicholas
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Humans ,Health Occupations ,Curriculum ,Students ,Medical ,Health Personnel ,San Francisco ,Cultural Competency ,Cultural Humility ,Diversity ,Health Disparities ,Health Equity ,Inclusion ,Racism ,Social Determinants of Health ,Structural Competency ,Structural Determinants of Health ,Structural Violence ,Prevention ,Clinical Research ,Health Services ,Generic health relevance - Abstract
IntroductionResearch on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care.MethodsWe report on a brief, interprofessional structural competency curriculum implemented in 32 distinct instances between 2015 and 2017 throughout the San Francisco Bay Area. In consultation with medical and interprofessional education experts, we developed open-ended, written-response surveys to qualitatively evaluate this curriculum's impact on participants. Qualitative data from 15 iterations were analyzed via directed thematic analysis, coding language, and concepts to identify key themes.ResultsThree core themes emerged from analysis of participants' comments. First, participants valued the curriculum's focus on the application of the structural competency framework in real-world clinical, community, and policy contexts. Second, participants with clinical experience (residents, fellows, and faculty) reported that the curriculum helped them reframe how they thought about patients. Third, participants reported feeling reconnected to their original motivations for entering the health professions.DiscussionThis structural competency curriculum fills a gap in health professional education by equipping learners to understand and respond to the role that social, economic, and political structural factors play in patient and community health.
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- 2020
20. Prenatal Opioid Use Disorder Treatment—the Importance of Shared Decision-Making
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Nguemeni Tiako, Max Jordan, primary, Knight, Kelly R., additional, and Schiff, Davida M., additional
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- 2024
- Full Text
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21. Sources and Impact of Time Pressure on Opioid Management in the Safety-Net
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Satterwhite, Shannon, Knight, Kelly R, Miaskowski, Christine, Chang, Jamie Suki, Ceasar, Rachel, Zamora, Kara, and Kushel, Margot
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Health Services and Systems ,Health Sciences ,Neurosciences ,Pain Research ,Chronic Pain ,Clinical Research ,8.1 Organisation and delivery of services ,Management of diseases and conditions ,7.1 Individual care needs ,Health and social care services research ,Generic health relevance ,Good Health and Well Being ,Adult ,Analgesics ,Opioid ,Attitude of Health Personnel ,Drug Prescriptions ,Female ,Guideline Adherence ,Humans ,Male ,Middle Aged ,Pain Management ,Physicians ,Primary Care ,Practice Guidelines as Topic ,Practice Patterns ,Physicians' ,Primary Health Care ,Qualitative Research ,Safety-net Providers ,Substance-Related Disorders ,Time Factors ,Chronic Disease ,Grounded Theory ,Minority Health ,Opioids ,Vulnerable Populations ,Public Health and Health Services ,General & Internal Medicine ,Health services and systems - Abstract
PurposeThis study sought to understand clinicians' and patients' experience managing chronic noncancer pain (CNCP) and opioids in safety-net primary care settings. This article explores the time requirements of safer opioid prescribing for medically and socially complex patients in the context of safety-net primary care.MethodsWe qualitatively interviewed 23 primary care clinicians and 46 of their patients with concurrent CNCP and substance use disorder (past or current). We also conducted observations of clinical interactions between the clinicians and patients. We transcribed, coded, and analyzed interview and clinical observation recordings using grounded theory methodology.ResultsClinicians reported not having enough time to assess patients' CNCP, functional status, and risks for opioid misuse. Inadequate assessment of CNCP contributed to tension and conflicts during visits. Clinicians described pain conversations consuming a substantial portion of primary care visits despite patients' other serious health concerns. System-level constraints (eg, changing insurance policies, limited access to specialty and integrative care) added to the perceived time burden of CNCP management. Clinicians described repeated visits with little progress in patients' pain or functional status due to these barriers. Patients acknowledged clinical time constraints and reported devoting significant time to following new opioid management protocols for CNCP.ConclusionsTime pressure was identified as a major barrier to safer opioid prescribing. Efforts, including changes to reimbursement structures, are needed to relieve time stress on primary care clinicians treating medically and socially complex patients with CNCP in safety-net settings.
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- 2019
22. Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care
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Cooke, Alexis C, Knight, Kelly R, and Miaskowski, Christine
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Health Services and Systems ,Health Sciences ,Clinical Trials and Supportive Activities ,Substance Misuse ,Neurosciences ,Brain Disorders ,Pain Research ,Drug Abuse (NIDA only) ,Clinical Research ,Chronic Pain ,7.1 Individual care needs ,Management of diseases and conditions ,Good Health and Well Being ,Analgesics ,Opioid ,Attitude of Health Personnel ,Cannabinoids ,Cannabis ,Opioid-Related Disorders ,Pain Management ,Patients ,Physicians ,Primary Health Care ,San Francisco ,Co-use ,Opioids ,Chronic-pain ,Safety net ,Medical and Health Sciences ,Studies in Human Society ,Psychology and Cognitive Sciences ,Substance Abuse ,Public health ,Policy and administration - Abstract
BackgroundThe prevalence of opioid-associated morbidity and mortality underscores the need for research on non-opioid treatments for chronic non-cancer pain (CNCP). Pain is the most common medical condition for which patients request medical cannabis. Limited research indicates that patients are interested in cannabis as a potential addition to or replacement for opioid medication. This analysis reports on CNCP patient and clinician perceptions about the co-use of cannabis and opioids for CNCP management.MethodsWe interviewed 23 clinicians and 46 CNCP patients, using semi-structured interview guides, from six safety-net clinics across the San Francisco Bay Area, and 5 key stakeholders involved in CNCP management. We used a modified grounded theory approach to code and analyze transcripts.ResultsCNCP patients described potential benefits of co-use of cannabis and opioids for pain management and concerns about dosing and addictive potential. Patients reported seeking cannabis when unable to obtain prescription opioids. Clinicians stated that their patients reported cannabis being helpful in managing pain symptoms. Clinicians expressed concerns about the potential exacerbation of mental health issues resulting from cannabis use.ConclusionClinicians are hampered by a lack of clinically relevant information about cannabis use, efficacy and side-effects. Currently no guidelines exist for clinicians to address opioid and cannabis co-use, or to discuss the risk and benefits of cannabis for CNCP management, including side effects. Cannabis and opioid co-use was commonly reported by patients in our sample, yet rarely addressed during clinical CNCP care. Further research is needed on the risks and benefits of cannabis and opioid co-use.
- Published
- 2019
23. “We Really Help, Taking Care of Each Other”: Older Homeless Adults as Caregivers
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Rosenwohl-Mack, Sarah, Kushel, Margot, Ramsey, Claire, Handley, Margaret, and Knight, Kelly R
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Psychology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Applied and Developmental Psychology ,Social Determinants of Health ,Caregiving Research ,Clinical Research ,Aging ,Behavioral and Social Science ,Homelessness ,Good Health and Well Being ,caregiving ,home care ,disability ,living arrangements ,socioeconomic status ,Clinical sciences ,Applied and developmental psychology - Abstract
ObjectivesMany older homeless adults maintain contact with family. We conducted a qualitative study examining the role of family caregiving for older homeless adults.MethodWe conducted semi-structured qualitative interviews with a sample of 46 homeless participants who reported spending at least one night with a housed family member in the prior 6 months.ResultsA total of 13 of 46 older adult participants provided caregiving. Themes included (a) the death of the care recipient led to the participant's homelessness; (b) feeling a duty to act as caregivers; (c) providing care in exchange for housing; (d) caregivers' ability to stay was tenuous; (e) providing care conflicted with the caregiver's needs; and (f) resentment when family was ungrateful.DiscussionIn a sample of older homeless adults in contact with family, many provided caregiving for housed family. For some, caregiving precipitated homelessness; for others, caregiving provided temporary respite from homelessness, and for others, caregiving continued during homelessness.
- Published
- 2019
24. Women on the Edge
- Author
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Knight, Kelly R
- Subjects
opioids ,benzodiazepines ,women ,anxiety ,reproduction ,racialization - Abstract
The current “opioid epidemic” provides an opportunity to identify age-old social anxieties about drug use while opening up new lines of inquiry about how and why drug use epidemics become gendered. This paper reflects on the intertwined phenomena of opioid and benzodiazepine prescribing to U.S. women to examine how gender, race, and class inform social anxieties about reproduction and parenting. Multiple discourses abound about the relationship between women and the “opioid epidemic.” Epidemiological reports attribute premature death among White women to the deadly combination of opioids and antianxiety medications. The National Institute on Drug Abuse reports that “every 25 minutes a baby is born suffering from opioid withdrawal,” leading to costly hospital stays for infants and the potential for mother–child separation and other forms of family adjudication postpartum. Primary care providers are reluctant to distinguish diagnoses of chronic noncancer pain from anxiety among their female patients. Taken together, these discourses beg the question: What exactly are we worried about? I compare and contrast the narratives of two anxious women on opioids to raise larger structural questions about pregnancy, parenting, and drug use and to interrogate the public narrative that women on opioids threaten the American family and thwart the American Dream.
- Published
- 2017
25. Opioid pharmacovigilance: A clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use.
- Author
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Knight, Kelly R, Kushel, Margot, Chang, Jamie S, Zamora, Kara, Ceasar, Rachel, Hurstak, Emily, and Miaskowski, Christine
- Subjects
Humans ,Substance-Related Disorders ,Analgesics ,Opioid ,Qualitative Research ,Pain Management ,Chronic Pain ,Pharmacovigilance ,Practice Patterns ,Physicians' ,Chronic non-cancer pain ,Opioids ,Poverty ,Primary care safety net ,Social medicine ,United States ,Patient Safety ,Neurosciences ,Substance Misuse ,Pain Research ,Cancer ,Drug Abuse (NIDA only) ,Clinical Research ,Health Services ,Health and social care services research ,8.1 Organisation and delivery of services ,Generic health relevance ,Good Health and Well Being ,Medical and Health Sciences ,Economics ,Studies in Human Society ,Public Health - Abstract
There is growing concern among US-based clinicians, patients, policy makers, and in the media about the personal and community health risks associated with opioids. Perceptions about the efficacy and appropriateness of opioids for the management of chronic non-cancer pain (CNCP) have dramatically transformed in recent decades. Yet, there is very little social scientific research identifying the factors that have informed this transformation from the perspectives of prescribing clinicians. As part of an on-going ethnographic study of CNCP management among clinicians and their patients with co-occurring substance use, we interviewed 23 primary care clinicians who practice in safety-net clinical settings. In this paper, we describe the clinical and social influences informing three historic periods: (1) the escalation of opioid prescriptions for CNCP; (2) an interim period in which the efficacy of and risks associated with opioids were re-assessed; and (3) the current period of "opioid pharmacovigilance," characterized by the increased surveillance of opioid prescriptions. Clinicians reported that interpretations of the evidence-base in favor of and opposing opioid prescribing for CNCP evolved within a larger clinical-social context. Historically, pharmaceutical marketing efforts and clinicians' concerns about racialized healthcare disparities in pain treatment influenced opioid prescription decision-making. Clinicians emphasized how patients' medical complexity (e.g. multiple chronic health conditions) and structural vulnerability (e.g. poverty, community violence) impacted access to opioids within resource-limited healthcare settings. This clinical-social history of opioid prescribing practices helps to elucidate the ongoing challenges of CNCP treatment in the US healthcare safety net and lends needed specificity to the broader, nationwide conversation about opioids.
- Published
- 2017
26. Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians.
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Neff, Joshua, Knight, Kelly R, Satterwhite, Shannon, Nelson, Nick, Matthews, Jenifer, and Holmes, Seth M
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Humans ,Focus Groups ,Program Evaluation ,Physician-Patient Relations ,Community Medicine ,Curriculum ,Internship and Residency ,Clinical Competence ,California ,Evaluation Studies as Topic ,Cultural Competency ,Health Status Disparities ,cultural competency ,medical education ,social determinants of health ,structural competency ,structural vulnerability ,General & Internal Medicine ,Clinical Sciences - Abstract
BackgroundThe influence of societal inequities on health has long been established, but such content has been incorporated unevenly into medical education and clinical training. Structural competency calls for medical education to highlight the important influence of social, political, and economic factors on health outcomes.AimThis article describes the development, implementation, and evaluation of a structural competency training for medical residents.SettingA California family medicine residency program serving a patient population predominantly (88 %) with income below 200 % of the federal poverty level.ParticipantsA cohort of 12 residents in the family residency program.Program descriptionThe training was designed to help residents recognize and develop skills to respond to illness and health as the downstream effects of social, political, and economic structures.Program evaluationThe training was evaluated via qualitative analysis of surveys gathered immediately post-training (response rate 100 %) and a focus group 1 month post-training (attended by all residents not on service).DiscussionResidents reported that the training had a positive impact on their clinical practice and relationships with patients. They also reported feeling overwhelmed by increased recognition of structural influences on patient health, and indicated a need for further training and support to address these influences.
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- 2017
27. Provider Experiences With the Identification, Management, and Treatment of Co-occurring Chronic Noncancer Pain and Substance Use in the Safety Net
- Author
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Chang, Jamie Suki, Kushel, Margot, Miaskowski, Christine, Ceasar, Rachel, Zamora, Kara, Hurstak, Emily, and Knight, Kelly R
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Health Services and Systems ,Health Sciences ,Prescription Drug Abuse ,Drug Abuse (NIDA only) ,Health Services ,Chronic Pain ,Clinical Research ,Substance Misuse ,Pain Research ,8.1 Organisation and delivery of services ,Health and social care services research ,Good Health and Well Being ,Female ,Health Personnel ,Humans ,Male ,Primary Health Care ,Substance-Related Disorders ,Chronic noncancer pain ,prescription opioids ,safety net ,primary care ,provider-patient interactions ,substance use treatment ,qualitative research ,provider–patient interactions ,Public Health and Health Services ,Psychology ,Substance Abuse ,Public health ,Applied and developmental psychology ,Clinical and health psychology - Abstract
BackgroundIn the United States and internationally, providers have adopted guidelines on the management of prescription opioids for chronic noncancer pain (CNCP). For "high-risk" patients with co-occurring CNCP and a history of substance use, guidelines advise that providers monitor patients using urine toxicology screening tests, develop opioid management plans, and refer patients to substance use treatment.ObjectiveWe report primary care provider experiences in the safety net interpreting and implementing prescription opioid guideline recommendations for patients with CNCP and substance use.MethodsWe interviewed primary care providers who work in safety net settings (N = 23) on their experiences managing CNCP and substance use. We analyzed interviews using a content analysis method.ResultsProviders found management plans and urine toxicology screening tests useful for informing patients about clinic expectations of opioid therapy and substance use. However, they described that guideline-based clinic policies had unintended consequences, such as raising barriers to open, honest dialogue about substance use and treatment. While substance use treatment was recommended for "high-risk" patients, providers described lack of integration with and availability of substance use treatment programs.ConclusionsOur findings indicate that clinicians in the safety net found guideline-based clinic policies helpful. However, effective implementation was challenged by barriers to open dialogue about substance use and limited linkages with treatment programs. Further research is needed to examine how the context of safety net settings shapes the management and treatment of co-occurring CNCP and substance use.
- Published
- 2017
28. Loneliness among older adults who have experienced homelessness: qualitative findings from the HOPE HOME study
- Author
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Yuan, Yeqing, primary, Knight, Kelly R., additional, Weeks, John, additional, King, Stephen, additional, Olsen, Pamela, additional, and Kushel, Margot, additional
- Published
- 2023
- Full Text
- View/download PDF
29. The intersection of drug use discrimination and racial discrimination in the management of chronic non-cancer pain in United States primary care safety-net clinics: Implications for healthcare system and clinic-level changes
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Cooke, Alexis, primary, Castellanos, Stacy, additional, Koenders, Sedona, additional, Joshi, Neena, additional, Enriquez, Celeste, additional, Olsen, Pamela, additional, Miaskowski, Christine, additional, Kushel, Margot, additional, and Knight, Kelly R., additional
- Published
- 2023
- Full Text
- View/download PDF
30. Risk factors for stimulant use among homeless and unstably housed adult women
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Riley, Elise D, Shumway, Martha, Knight, Kelly R, Guzman, David, Cohen, Jennifer, and Weiser, Sheri D
- Subjects
Pharmacology and Pharmaceutical Sciences ,Biomedical and Clinical Sciences ,Prevention ,Drug Abuse (NIDA only) ,Clinical Research ,Homelessness ,Substance Misuse ,HIV/AIDS ,Gender Equality ,Adult ,Central Nervous System Stimulants ,Cohort Studies ,Female ,Ill-Housed Persons ,Housing ,Humans ,Methamphetamine ,Middle Aged ,Risk Factors ,Sex Offenses ,Substance-Related Disorders ,Women ,Homeless ,Cocaine ,Stimulant ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Substance Abuse ,Biochemistry and cell biology ,Pharmacology and pharmaceutical sciences ,Epidemiology - Abstract
BackgroundOne of the most common causes of death among homeless and unstably housed women is acute intoxication where cocaine is present. While correlates of stimulant use have been determined in prior research, few studies have assessed risk factors of use specifically in this high-risk population.MethodsWe sampled biological women with a history of housing instability from community-based venues to participate in a cohort study. Baseline and 6-month follow-up data were used to determine the relative risk of stimulant use (crack cocaine, powder cocaine or methamphetamine) among individuals who did not use at baseline.ResultsAmong 260 study participants, the median age was 47 years, 70% were women of color; 47% reported having unmet subsistence needs and 53% reported abstinence from stimulants at baseline. In analyses adjusting for baseline sociodemographics and drug treatment, the risk of using stimulants within 6 months was significantly higher among women who reported recent sexual violence (Adjusted Relative Risk [ARR]=4.31; 95% CI:1.97-9.45), sleeping in a shelter or public place (ARR=2.75; 95% CI:1.15-6.57), and using unprescribed opioid analgesics (ARR=2.54; 95% CI:1.01-6.38).ConclusionWe found that almost half of homeless and unstably housed women used stimulants at baseline and 14% of those who did not use began within 6 months. Addressing homelessness and sexual violence is critical to reduce stimulant use among impoverished women.
- Published
- 2015
31. Recent violence in a community-based sample of homeless and unstably housed women with high levels of psychiatric comorbidity.
- Author
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Riley, Elise D, Cohen, Jennifer, Knight, Kelly R, Decker, Alyson, Marson, Kara, and Shumway, Martha
- Subjects
Biomedical and Clinical Sciences ,Health Sciences ,Behavioral and Social Science ,Mental Health ,Brain Disorders ,Homelessness ,Clinical Research ,Violence Against Women ,Violence Research ,Mental health ,Peace ,Justice and Strong Institutions ,Gender Equality ,Adult ,Female ,Health Behavior ,Ill-Housed Persons ,Housing ,Humans ,Male ,Mental Disorders ,Middle Aged ,Risk Factors ,Sex Offenses ,Social Isolation ,Socioeconomic Factors ,Spouse Abuse ,Violence ,Medical and Health Sciences ,Public Health ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectivesWe determined associations between co-occurring psychiatric conditions and violence against homeless and unstably housed women.MethodsBetween 2008 and 2010, we interviewed homeless and unstably housed women recruited from community venues about violence, socioeconomic factors, and psychiatric conditions. We used multivariable logistic regression to determine independent correlates of violence.ResultsAmong 291 women, 97% screened positive for 1 or more psychiatric conditions. Types of violence perpetrated by primary partners and persons who were not primary partners (non-primary partners) included emotional violence (24% vs 50%; P < .01), physical violence (11% vs 19%; P < .01), and sexual violence (7% vs 22%; P < .01). The odds of primary partner and non-primary partner violence increased with each additional psychiatric diagnosis and decreasing levels of social isolation.ConclusionsAll types of violence were more commonly perpetrated by non-primary partners, suggesting that an exclusive focus on domestic violence screening in health care or social service settings will miss most of the violence in this population. Contrary to some previous studies, the odds of violence decreased as social isolation increased, suggesting that social isolation may be protective in homeless and unstably housed communities with high levels of comorbidity and limited options.
- Published
- 2014
32. Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care
- Author
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Cooke, Alexis C., Knight, Kelly R., and Miaskowski, Christine
- Published
- 2019
- Full Text
- View/download PDF
33. A Roadmap for Adapting an Evidence-Based HIV Prevention Intervention: Personal Cognitive Counseling (PCC) for Episodic Substance-Using Men Who Have Sex with Men
- Author
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Knight, Kelly R, Das, Moupali, DeMicco, Erin, Raiford, Jerris L, Matheson, Tim, Shook, Alic, Antunez, Erin, Santos, Glenn-Milo, Dadasovich, Rand, Dilley, James W, Colfax, Grant N, and Herbst, Jeffrey H
- Subjects
Clinical and Health Psychology ,Public Health ,Health Sciences ,Psychology ,Behavioral and Social Science ,Pediatric AIDS ,Prevention ,Drug Abuse (NIDA only) ,Clinical Research ,Substance Misuse ,Sexual and Gender Minorities (SGM/LGBT*) ,Pediatric ,Alcoholism ,Alcohol Use and Health ,HIV/AIDS ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Prevention of disease and conditions ,and promotion of well-being ,Good Health and Well Being ,Adolescent ,Adult ,Cognitive Behavioral Therapy ,Coitus ,Counseling ,Evidence-Based Medicine ,HIV Infections ,Homosexuality ,Male ,Humans ,Male ,Middle Aged ,Risk Factors ,San Francisco ,Substance-Related Disorders ,HIV prevention ,Evidence-based intervention ,Adaptation ,Episodic substance use ,MSM ,Public Health and Health Services ,Substance Abuse ,Public health ,Clinical and health psychology - Abstract
Episodic (less than weekly) drug use and binge drinking increase HIV-related sexual risk behaviors among men who have sex with men (MSM), yet no evidence-based interventions exist for these men. We describe an adaptation process of the Personalized Cognitive Counseling (PCC) intervention for utilization with high-risk, HIV-negative episodic, substance-using MSM. Participants (N = 59) were racially diverse, and reported unprotected anal intercourse and concurrent binge drinking (85%), use of poppers (36%), methamphetamine (20%) and cocaine (12%). Semi-structured interviews with 20 episodic, substance-using MSM elicited sexual narratives for engaging in unprotected anal intercourse while using alcohol or drugs. Emergent qualitative themes were translated into self-justifications and included in a revised PCC self-justification elicitation instrument (SJEI). The adapted SJEI was pretested with 19 episodic, substance-using MSM, and the final adapted PCC was pilot-tested for acceptability and feasibility with 20 episodic, substance-using MSM. This process can be used as a roadmap for adapting PCC for other high-risk populations of MSM.
- Published
- 2014
34. Opioid pharmacovigilance: A clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use
- Author
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Knight, Kelly R., Kushel, Margot, Chang, Jamie S., Zamora, Kara, Ceasar, Rachel, Hurstak, Emily, and Miaskowski, Christine
- Published
- 2017
- Full Text
- View/download PDF
35. Risk factors for stimulant use among homeless and unstably housed adult women
- Author
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Riley, Elise D., Shumway, Martha, Knight, Kelly R., Guzman, David, Cohen, Jennifer, and Weiser, Sheri D.
- Published
- 2015
- Full Text
- View/download PDF
36. The Opioid Industry Documents Archive: A Living Digital Repository
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Caleb Alexander, G., primary, Mix, Lisa A., additional, Choudhury, Sayeed, additional, Taketa, Rachel, additional, Tomori, Cecília, additional, Mooghali, Maryam, additional, Fan, Anni, additional, Mars, Sarah, additional, Ciccarone, Dan, additional, Patton, Mark, additional, Apollonio, Dorie E., additional, Schmidt, Laura, additional, Steinman, Michael A., additional, Greene, Jeremy, additional, Knight, Kelly R., additional, Ling, Pamela M., additional, Seymour, Anne K., additional, Glantz, Stanton, additional, and Tasker, Kate, additional
- Published
- 2022
- Full Text
- View/download PDF
37. Single room occupancy (SRO) hotels as mental health risk environments among impoverished women: The intersection of policy, drug use, trauma, and urban space
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Knight, Kelly R., Lopez, Andrea M., Comfort, Megan, Shumway, Martha, Cohen, Jennifer, and Riley, Elise D.
- Published
- 2014
- Full Text
- View/download PDF
38. “We remember the pain”: a qualitative study of intergenerational trauma among older adults experiencing homelessness in the HOPE HOME study
- Author
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Hargrave, Anita S., primary, Garcia, Cheyenne M., additional, Lightfoot, Marguerita, additional, Handley, Margaret A., additional, Weeks, John, additional, Olsen, Pamela, additional, Knight, Kelly R., additional, and Kushel, Margot B., additional
- Published
- 2022
- Full Text
- View/download PDF
39. Federal and State Regulatory Changes to Methadone Take-Home Doses: Impact of Sociostructural Factors
- Author
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Wyatt, Janan P., primary, Suen, Leslie W., additional, Coe, William H., additional, Adams, Zoe M., additional, Gandhi, Mona, additional, Batchelor, Hannah M., additional, Castellanos, Stacy, additional, Joshi, Neena, additional, Satterwhite, Shannon, additional, Pérez-Rodríguez, Rafael, additional, Rodríguez-Guerra, Esther, additional, Albizu-Garcia, Carmen E., additional, Knight, Kelly R., additional, and Jordan, Ayana, additional
- Published
- 2022
- Full Text
- View/download PDF
40. Sexual Risk Taking among HIV-Positive Injection Drug Users: Contexts, Characteristics, and Implications for Prevention
- Author
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Knight, Kelly R., Purcell, David, and Dawson-Rose, Carol
- Abstract
HIV-positive injection drug users (IDUs) (N = 161) were recruited to complete a qualitative interview and a quantitative survey about sexual behavior and transmission risk. We identified two contexts in which exposure encounters occurred most commonly for HIV-positive IDUs: in intimate serodiscordant relationships and in the drug/sex economy. Salient characteristics in both contexts included the role of intimacy, drug use and sexual decision making, disclosure of HIV status, and perceived responsibility. Although these characteristics emerged in both risk contexts, they operated differently within each context. The preservation of intimacy was paramount among those in serodiscordant relationships, and agreements to take risks were common. In the drug/sex economy, serostatus disclosure was uncommon and drug acquisition and use played a significant role in sexual risk taking. Our data emphasize a need to address the specific transmission risk contexts occurring among HIV-positive IDUs and to prioritize social and interpersonal factors when promoting safer sexual norms among HIV-positive IDUs.
- Published
- 2005
- Full Text
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41. Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users
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Mizuno, Yuko, Purcell, David W., Knowlton, Amy R., Wilkinson, James D., Gourevitch, Marc N., and Knight, Kelly R.
- Published
- 2015
- Full Text
- View/download PDF
42. Barriers and facilitators to resolving older adult homelessness through stays with family: qualitative findings from the HOPE HOME study
- Author
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Cai, Christopher, primary, Knight, Kelly R., additional, Olsen, Pamela, additional, Weeks, John, additional, Handley, Margaret A., additional, and Kushel, Margot B., additional
- Published
- 2022
- Full Text
- View/download PDF
43. “I wanted something that was more flexible”: A qualitative study of patient preferences on choosing buprenorphine over methadone in a large, safety-net hospital opioid treatment program
- Author
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Checkley, Laura, primary, Steiger, Scott, additional, and Knight, Kelly R., additional
- Published
- 2022
- Full Text
- View/download PDF
44. Outcomes Associated with Expanded Take-Home Eligibility for Outpatient Treatment with Medications for Opioid Use Disorder: A Mixed-Methods Analysis
- Author
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Nguyen, Oanh Kieu, primary, Steiger, Scott, additional, Snyder, Hannah, additional, Perrotta, Matthew, additional, Suen, Leslie W., additional, Joshi, Neena, additional, Castellanos, Stacy, additional, Shapiro, Brad, additional, Makam, Anil, additional, and Knight, Kelly R., additional
- Published
- 2021
- Full Text
- View/download PDF
45. The Impact of Intimate Partner Violence on Homelessness and Returns to Housing: A Qualitative Analysis From the California Statewide Study of People Experiencing Homelessness.
- Author
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Hargrave, Anita S., Knight, Kelly R., Dhatt, Zena K., Taylor, Grace, Martinez, Dez, and Kushel, Margot
- Subjects
- *
HOMELESS persons , *INTIMATE partner violence , *HOMELESSNESS , *HOUSING , *HOUSING subsidies , *SUBSTANCE abuse , *DISCRIMINATION in medical care - Abstract
Homelessness is a public health concern in California and throughout the United States. Intimate partner violence (IPV) is a risk factor for experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Qualitative methods can provide a greater understanding of the lived experience of IPV and homelessness to identify potential solutions. We purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. We administered semi-structured interviews focusing on IPV and six other topic areas pertaining to homelessness from October 2021 to May 2022. We created and applied a codebook with a multidisciplinary team using a hybrid of deductive and inductive logic. Our analysis included all participants who discussed IPV and homelessness across the seven studies. We conducted a thematic analysis using an interpretivist approach and informed by grounded theory. We found that violence within a partnership was multidimensional (physical, sexual, emotional, and financial) and bidirectional. We identified six themes: (1) IPV precipitated and prolonged homelessness; (2) Need for housing, financial stability, and material resources influenced staying in abusive relationships; (3) Alcohol and illicit substance use exacerbated violence between partners; (4) Participants struggled to find resources in domestic violence (DV) shelters; (5) The healthcare system did not provide substantial support; and (6) discrimination and stigma influenced equitable access to housing and DV resources. Experiencing IPV contributed to homelessness and impeded returns to housing. Limitations in current IPV resources impede care. We propose equitable expansion of survivor-centered services that improve access to long-term subsidized housing, prevent IPV and homelessness with flexible funding options, and facilitate rapid exits from homelessness through trauma-informed, non-congregate shelter that transitions to permanent housing. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
- View/download PDF
46. “The idea is to help people achieve greater success and liberty”: a qualitative study of expanded methadone take-home access in opioid use disorder treatment
- Author
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Suen, Leslie W., primary, Castellanos, Stacy, additional, Joshi, Neena, additional, Satterwhite, Shannon, additional, and Knight, Kelly R., additional
- Published
- 2021
- Full Text
- View/download PDF
47. Temporary stays with housed family and friends among older adults experiencing homelessness: Qualitative findings from the HOPE HOME study
- Author
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Knight, Kelly R, primary, Weiser, Jeremy, additional, Handley, Margaret A, additional, Olsen, Pamela, additional, Weeks, John, additional, and Kushel, Margot, additional
- Published
- 2021
- Full Text
- View/download PDF
48. Covid-19: A Catalyst for Change in Telehealth Service Delivery for Opioid Use Disorder Management
- Author
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Mehtani, Nicky J., primary, Ristau, Jessica T., additional, Snyder, Hannah, additional, Surlyn, Colleen, additional, Eveland, Joanna, additional, Smith-Bernardin, Shannon, additional, and Knight, Kelly R., additional
- Published
- 2021
- Full Text
- View/download PDF
49. Predictors of Current Housing Status Among HIV-Seropositive Injection Drug Users (IDUs): Results from a 1-Year Study
- Author
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Mizuno, Yuko, Purcell, David W., Zhang, Jun, Knowlton, Amy R., De Varona, Martina, Arnsten, Julia H., and Knight, Kelly R.
- Published
- 2009
- Full Text
- View/download PDF
50. Structural competency and global health education
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Harvey, Michael, primary, Neff, Joshua, additional, Knight, Kelly R., additional, Mukherjee, Joia S., additional, Shamasunder, Sriram, additional, Le, Phuoc V., additional, Tittle, Robin, additional, Jain, Yogesh, additional, Carrasco, Héctor, additional, Bernal-Serrano, Daniel, additional, Goronga, Tinashe, additional, and Holmes, Seth M., additional
- Published
- 2020
- Full Text
- View/download PDF
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