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Homeless Women

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by

Greg Gareau

on 30 September 2013

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Transcript of Homeless Women

Homeless Women
Degree of Homelessness
Priority Setting
Alcohol
Physical Abuse
Job insecurity
Reduce Inequities
Reduce Crime
Healthcare Efficiency
More Access To Care
Effective Interventions
Easier Follow Up

Drug and
Alcohol
Addiction

Maintenance
Relapse
Physical Abuse
Job Security
Mental Health

Understand Causes of homelessness

Sex trade
Exposure
High Risk Pregnancies
Birth Defects
Mental Disorders
Right To Health



Demands Action
HCP's Obligation
Society
Public Policy
Overlooked
Stigma
Rate Increasing
Currently:
Unidirectional Solutions
Inter-Sectorial Collaboration Needed
More Data
Implement Interventions
Success story
Secure Housing
Drugs and Mental Health
Safe
Secure
Home

Unsheltered
Advocacy
Intensive Community Treatment
Advocacy
Job Security
Mental Health
Interventions
Homelessness
Skills Development
Successes:
Reduction in physical abuse (1-2 years post intervention)
Quality of life improvement (?)
Reduction in depression and psychological distress (?)

Limitations:
Scales, questions, and outcomes…
Less-intensive advocacy is insufficient
How cost-effective is it?
Data, data, data

Advocacy

Function:
Empowerment
Goal oriented
Facilitate access to community resources

Providers:
Nurses
Therapists
Trained advocate

Structure:
12 to 80 hours in total
2 to 8 month period
Intensive Advocacy

Why are relapses so frequent?
Primarily due to lack of resources

What are some of their needs?
Employment
Housing
Legal assistance
Counseling
Social support
Health care


Physical Abuse

Demand Action!
Discrimination
Low Self-Esteem
Food Insecurity
Poor Dental Hygeine
Misunderstood
Downstream
Upstream
Harm Reduction
Problems
Interventions
Logic Model Addressing Homelessness
Other Considerations
Cultural
Residual Effects of
Residential School

Legal Issues
Immigrant Populations
Legal and Illegal
Refugees
PTSD

Appropriateness of Intervention
Level Education
Literacy
Languages
Building Trust

Continuity of Care

Community Reintegration

During Interventions:
Childcare
Finances

Food Security
Communal Involvement
Education For HCP's
Education
Awareness
Support Networks
Advocacy
Health Benefits
Non-health Benefits
Action Plan
Having and securing a well paying job is important for sustaining themselves

Many homeless people don’t have necessary means to find a job
-Address
-Skills
-Suffer from mental illness or stigma

Loss of job also a major trigger event leading to homelessness

Health problems

Females scored slightly better than males on measures of employment readiness but were half likely to get jobs (31% female vs. 57% male)*

Males’ jobs better paid than female jobs
-General labor, painting vs. baby sitting, retail

Low self-confidence may be factor as fewer females believed they were ready for employment, and they also expressed less hope than males of getting better job

Difficulties
*Canadian Housing and Renewal Association

Organizations such as Potential Place offers programs to develop a trade skill as well as “soft skills”
-Soft skills are skills that characterize relations with other people. ie. communication, language, habits etc.
-Aims to decrease stigma

Limitations
-Funding
-Finding employers to participate
-Limited temporary residencies

Intervention
Features:
Non-contingency housing program
Blended with a "harm reduction model"
For homeless persons with mental illness and/or substance abuse

Successes:
Reduction in hospital admissions and emergency department visits
Modestly increased societal costs
Decreased substance abuse
More likely to be domiciled at 18 months

Limitations:
Relevant only to persons who are single and chronically homeless, accounting for less than 20 percent of homeless persons.
Housing First
Assertive
Community
Treatment
Self-Defense
Skills
Development
Recommendations
Outreach
Housing
Lower Mortality and Morbidity of Acute and Chronic Health Conditions
Diabetes
CV Disease
Oral Health
Stress
Infectious Diseases
Improve Population Health
Accidental Injuries
We Must Be Careful...
Perpetuate Stigma
Do No Harm
Respect Autonomy
Evaluate Interventions
Re-Evaluate
Safe Secure Homes
Needs assessment
Apply These Interventions In Concert
Cost = Cost-Effect Study Quality Of Life = Qualitative

As Students:
Engage In Citizenship
Understand The Causes And Effects
Open mindedness
Reflect

As Dentists
Treat, Ask About Causes, Refer, Advocate!
Speak Up
Inter-Sectorial Collaboration
Philanthropy
Research and Re-Evaluate

As Canadians Vote!



Measurable Changes
Skills
Employment
Vaccination Rates
Nutritional Status
Crime
Substance Abuse
ER Visits
Preventable Diseases
Eclectic Approach


Appropriateness


Physical, Mental,
Spiritual, Emotional Health
Homeless Women
Novac S, Serge L, Eberle M, Brown J. On Her Own: Young Women and Homelessness in Canada [Internet]. Canadian Cataloguing in Publication Data; 2002 [Cited 2013 Sept 25]. Available from YWCA Canada: http://library.vcc.ca/downloads/VCC_VancouverStyleGuide.pdf

Potential Place [Internet]. Calgary: Potential Place; 2013 [Cited Sept 23]. Available from: http://www.potentialplace.org
Washington OGM, Moxley DP, Taylor JY. Enabling Older Homeless Minority Women to Overcome Homelessness by Using a Life Management Enhancement Group Intervention. NIH Public Access [Internet]. 2009 Feb [Cited 2013 Sept 13].30(2):86-97. Available from NIH Public Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894524/pdf/nihms-200981.pdf
Ramsay J, Carter Y, Davidson L, Dunne D, Eldridge S, Hegarty K, et. al. Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse (Review). Cochrane Database Syst Rev. 2009 Jul 8: (3): CD005043. doi: 10.1002/14651858.CD005043.pub2.
Ramsay J, Carter Y, Davidson L, Dunne D, Eldridge S, Hegarty K, et. al. Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse (Review). Cochrane Database Syst Rev. 2009 Jul 8: (3): CD005043. doi: 10.1002/14651858.CD005043.pub2.
Ramsay J, Carter Y, Davidson L, Dunne D, Eldridge S, Hegarty K, et. al. Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse (Review). Cochrane Database Syst Rev. 2009 Jul 8: (3): CD005043. doi: 10.1002/14651858.CD005043.pub2.
Housing First
Why are relapses so frequent?
• Ill-prepared to find and maintain the multiple services
• Lack the social and cognitive competence to follow through on the treatment.

Program targets:
• Individuals with severe mental illness who are at risk for hospitalization or homelessness:
•Schizophrenia, schizoaffective disorder, recurrent bipolar disorder, chronic or recurrent psychotic depression, certain personality disorders…
• Drug addictions
Mental Health - Substance Abuse
Prevalence estimates: 20 to 30% for severe mental illness and 30 to 50% for substance abuse or dual disorders
Assertive Community Treatment
Main Goals:
Maintaining a safe residence in the community
Compliance with antipsychotic and other prescribed medications
Minimal utilization of psychiatric and medical services

ACT model:
1) A multidisciplinary team-based approach
2) Assertive outreach to patients in their communities
3) Direct provision of clinical and other social services
4) Case managers with limited caseloads

Advantages:
Based on the principle of shared responsibility for each patient
No specific length of time. Level of care is gradually decreased
Understands the vulnerability of the population
Success:
Reducing Homelessness and in psychiatric symptoms, number of days hospitalized, different services used, contact with legal system

Increase in:
• Retention in care, Social functioning, employment status, quality of life….

Limitations:
Cost-effective
Data ( Impacted by: definition of mental illness, and method of measurement and selection of population studied )
Specific population…………
Assertive Community Treatment
Abusive Environment
Cultural And Racial Inequities
Access To Education
Low Self-Esteem
Stigma
Economy
Insufficient Financial Support
Little Community Involvement
Little Inter-Sectorial Interventions
“When my son was born, his father Patrick and I were renting a basement suite in Patrick’s father’s house. The birth of my son did not change Patrick. Patrick kept partying in the Downtown Eastside while I was on E. I. and maternity leave, and our finances ended up supporting his alcohol and drug habits. Patrick would sometimes bring other women home and would simply say that they needed somewhere to sleep”

Dieterich M, Irving CB, Park B, Marshall M, Intensive case management for severe mental illness, The Cochrane Collaboration, 2011
Juan Bustillo, Elizabeth Weil, Psychosocial interventions for severe mental illness, uptodate, last date viewed September 25, 2013
James J O'Connell, Robert H Fletcher, Thomas L Schwenk, Nancy Sokol, Healthcare of homeless persons, Boston Health Care for the Homeless Program, 2007
Job Security
http://vancouver.mediacoop.ca/story/shelter-hopping-my-son/7624
Full transcript