SWK 661 6.2 Assignment Literature Review 2.edited

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1 6.2 Assignment: Literature Review Tangala Parker Indiana Wesleyan University SWK 661: Research Proposal 1 Aaron Cheek February 11, 2024

2 Abstract The homeless community grapples with severe mental health disorders and physical disabilities, which make it difficult for them to find shelter or services that are equipped to handle their specific needs. However, utilizing a mentorship program to identify the homeless's in-depth problems can increase service participation. Homelessness remains a pressing issue that affects both the social fabric and the well-being of individuals, especially those grappling with mental illness. To truly make a positive impact on their quality of life and overall wellness, it is crucial for programs aimed at assisting homeless individuals with mental illness to prioritize two key aspects: ensuring stable housing and providing essential services to meet their basic needs and physical health requirements. Additionally, it is imperative to offer training that empowers individuals to prioritize their safety while also implementing strategies that effectively alleviate depressive symptoms. By addressing these multifaceted needs, we can pave the way for a brighter future for those experiencing homelessness and mental illness (Sullivan et al., 2000).

3 Introduction Various factors influence homelessness and mental health issues in today's world. Some of the most prevalent factors include poverty, mental illness, substance abuse, trauma, and discrimination. Poverty can lead to homelessness as individuals may lack the financial means to afford housing. People with mental illness may struggle to find the necessary resources and support to live independently, increasing their risk of homelessness. Substance use can also contribute to homelessness as it may hinder job stability and housing maintenance. Those who have experienced trauma may find it challenging to cope with daily life, increasing their vulnerability to homelessness. Discrimination can also play a role, as it may limit access to housing and resources. It is essential to recognize that these factors are not exhaustive, and each person's experience is unique. Literature Review The inaugural umbrella review (2020) presents the comprehensive prevalence of various mental disorders within the homeless population. By amalgamating the outcomes of evidence- based reviews, it becomes evident that there is a substantial burden of depressive disorders, anxiety disorders, schizophrenia spectrum and psychotic disorders, bipolar and mood disorders, substance use disorders, suicidal behavior and self-injury, posttraumatic stress disorders, neurocognitive disorders, and other psychiatric conditions. Notably, these high prevalence rates extend beyond adults and are also observed among homeless children and adolescents (Hossain et al., 2020). Evidence-based insights should be utilized to inform and shape future policies, programs, and services aimed at effectively preventing, diagnosing, and treating mental disorders among individuals experiencing homelessness (Hossain et al., 2020). According to Sleet and Francescutti, homelessness is strongly connected to the decline in physical and mental health.

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4 People who are homeless often face numerous health issues, alcohol and drug addiction, mental illness, tuberculosis, and other serious conditions. These health problems arise from various factors, such as lack of housing, racism, and discrimination, limited access to healthcare, inadequate food and protection, limited social services, and insufficient public health infrastructure. Attempts have been made to address homelessness through legal and policy interventions, although not always considering public health. Having shelter is a fundamental human need. However, there is limited understanding of all the factors that contribute to homelessness and why so many people lack adequate housing. Non-housing plays a crucial role in addressing homelessness and is extensively studied as a social determinant of health. Some professionals argue that housing is synonymous with good health and that offering better housing options to homeless individuals and families would enhance the population's overall health. (Sleet & Francescutti, 2021). In social science research, a few studies explored the connection between individual characteristics, such as race and gender. They forced displacement from housing despite the long-standing interest of researchers and policymakers in housing discrimination. Many studies on housing discrimination concentrate on the unfair treatment's impact on racial residential segregation when it comes to buying or renting housing (Desmond & Gershenson, 2017). The "state of the art" review states that peer support is a process whereby individuals who lived experience of a particular phenomenon can provide support to others by sharing their personal experience. People who experience homelessness have some of the most complex intersecting health and social challenges". The review provides a systematic search and synthesis of literature examining peer support models within services for people impacted by homelessness and substance use problems (Miler et al., 2020). According to the Sparc study (2021), racial

5 disparities and homelessness in the United States use a combination of research methods in eight communities. They compare the racial and ethnic backgrounds of individuals experiencing homelessness to the general population and those living in poverty. Additionally, it examined how race and ethnicity are linked to housing outcomes. The interviews with 195 people of color explore the factors that contribute to homelessness and its effects. The findings reveal that Black/African Americans and Native Americans are disproportionately represented among the homeless population in each community. The interview data suggested that people of color face obstacles such as limited access to housing and economic opportunities, racism and discrimination within homeless services, and involvement in multiple systems, including the criminal justice system. The association between race, ethnicity, and outcomes varies among youth, single adults, and families. They express the importance of addressing racial justice in homelessness research and policymaking (Olivet et al., 2021). Rachael Dobson’s article examines how institutions address the needs of homeless adults. It argues that there is much discussion and research on the various challenges homeless individuals face. These challenges are seen as both mental and physical health issues, as well as a need for care and support. Personal experiences and societal events, including trauma, influence them. The responses to these complex needs are seen as innovative, proactive, and aimed at prevention and positivity. Different factors are driving these responses, such as legislation, policies, and funding in the fields of homelessness, housing support, and adult social care in England. However, ongoing debates exist about what constitutes social needs and the effective ways to address them. These debates are also present in international discussions about homelessness support models in the Western North. The term "complex needs" is a flexible

6 concept that guides interventions in different locations. The article also describes the institutional mechanisms in managing complex needs as "new markets of vulnerability" (Dobson, 2019). The homelessness sector should not only focus on providing services to those currently or at immediate risk of homelessness but also on addressing factors that hinder the development of affordable housing, the willingness of neighborhood residents and leaders to support such housing, and its accessibility to individuals who are or may become homeless. Research can enhance policymaking and service provision by identifying the most effective designs for housing services, programs, and subsidies and examining how these programs interact with other systems like healthcare and education. Additionally, not all effective services will work equally well in different contexts or benefit diverse populations similarly. Therefore, it is crucial to understand and address systemic inequities when designing responses to homelessness that are both fair and efficient. Moving forward, we need improved and integrated data on service utilization, increased support for innovative discharge planning, and stronger institutional accountability to prevent health care, criminal justice, and foster care systems from simply pushing individuals toward homelessness. We also require creative strategies to overcome neighborhood opposition to emergency shelters and affordable housing, enabling policymakers to have a more effective impact both upstream and downstream (O’Regan et al., 2021). According to The Voices Be Heard research, they conducted a project from a post- positivist perspective. The project created a platform for people to share their stories of homelessness, explore themes of resilience and compassion, and share stories and findings with the broader community for educational advocacy to improve service delivery. The findings show that interactions with service providers were crucial in addressing the three levels of oppression in homelessness. Service providers and the systems they work in have the power to either

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7 perpetuate oppressive attitudes or foster relationships and opportunities where individuals can feel themselves again (Schneider et al., 2019), understanding that creating an empowering environment that encourages individuals to share their stories can be done in various settings, such as shelters, permanent supportive housing, drop-in centers, and community-based homeless service organizations. Based on the stories shared by their participants, the following strategies were recommended to address individual and cultural oppression: seeing the person beyond their problems, inviting their complete story, building relationships, and eliciting stories of survival and wisdom. At the systemic level, reevaluating protocols and service structures, looking beyond the present, incorporating storytelling, and investing in staff development and support will increase service participation (Schneider et al., 2019). Researchers in Mobile, Alabama, conducted a study at a homeless day shelter in downtown Mobile to explore the perceptions of healthcare experiences among homeless individuals. The study revealed that many guests reported troubling encounters with healthcare providers who disregarded their needs. Understanding the experiences and perceptions of homeless individuals can help healthcare providers better engage with this vulnerable population. Interestingly, when clinicians were asked about their attitudes towards homeless people, they refused to participate due to extreme distress. This contrasts with the homeless participants in the study, who were eager to share their healthcare experiences. It raises questions about how professional experiences influence attitudes toward people experiencing homelessness and how professionals reconcile these beliefs with their codes of conduct. Additionally, the study suggests that organizational cultures and influential individuals may contribute to developing negative beliefs or group thinking. Further research is needed to gain insight into the perceptions and

8 interactions between providers and homeless patients to improve outcomes and experiences for both groups (Moore-Nadler et al., 2019). Previous research on homelessness focused on how people became homeless, but little is known about how they accessed services while experiencing homelessness. One study examined the service pathways of homeless individuals in the United States. They conducted 12 in-depth interviews to understand the history of accessing services, including the number of organizations they interacted with, the time gaps between services, and referral patterns. A subset of participants and how they interacted with caseworkers were observed. The length of service pathways varied, ranging from less than five years to over two decades. On average, participants accessed services from three to eight organizations. This identified both negative and positive experiences in accessing services, such as strict organizational policies and demeaning attitudes from caseworkers (negative) or supportive organizational culture and competent employees (positive) (Lee et al., 2022). Hopkins and Narasimhan both expressed that enhancing the accessibility of high-quality health services and promoting the adoption of self-care interventions is imperative to actively involve individuals facing homelessness as integral contributors to the solution. Support organizations dedicated to assisting those experiencing homelessness should engage individuals who have previously experienced homelessness as “peer educators." Peer educators can offer personalized guidance, furnish dependable information regarding self-care interventions, and facilitate the provision of top-notch health services (Hopkins & Narasimhan, 2022). According to D’Souza and Mirza (2021), despite healthcare facilities in smaller cities, individuals with high support needs and homeless service users (HSUs) encountered various obstacles in obtaining foot care services and maintaining their overall well-being. The absence of primary care options

9 increased reliance on emergency care services among HSUs. However, HSUs faced discrimination based on their identity and status. They expressed feelings of invisibility, neglect, disrespect, inadequate treatment, and unacknowledged requests. Additionally, they experienced stigma because of past discriminatory encounters, which led them to avoid seeking healthcare services due to the embarrassment caused by their hygiene (D’Souza & Mirza, 2021). The current body of evidence regarding the effectiveness of health system screening for social needs is still in its early stages, and the findings are inconclusive. Some authors have expressed concerns that implementing social needs screening may lead to an increase in stigma. In contrast, others argue that healthcare providers may need more time or resources to act upon the gathered information. These concerns emphasize the importance of implementing strategies considering and minimizing these potential risks. One systematic review discovered that identifying social needs resulted in an increased utilization of resources to address those needs. For example, individuals experiencing food insecurity were more likely to access food pantries. Additionally, two high-quality studies found that interventions combining social needs screening with referrals to community resources, such as housing assistance, were associated with a subsequent decrease in healthcare utilization. However, some studies have not found evidence of improved health outcomes following social needs screening. To effectively address the needs of homeless populations, interventions following screening will likely require a comprehensive and personalized approach. This may involve warm handoffs, where individuals are directly connected to appropriate resources and ongoing engagement to ensure continued support and assistance (Garcia et al., 2024). This literature review will highlight the challenges homeless individuals face in navigating services, including institutional barriers, limited social services, lack of housing,

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10 health care, and insufficient communication from service providers. This will also emphasize the need for financial support and various resources to address homeless people's health and social needs.

11 References Desmond, M., & Gershenson, C. (2017). Who gets evicted? Assessing individual, neighborhood, and network factors. Social Science Research , pp. 62 , 362–377. https://doi.org/10.1016/j.ssresearch.2016.08.017 Dobson, R. (2019). Complex needs in homelessness practice: A review of ‘new markets of vulnerability.’ Housing Studies , 37 (7), 1147–1173. https://doi.org/10.1080/02673037.2018.1556784 D’Souza, M. S., & Mirza, N. A. (2021). Towards Equitable Health Care Access: Community participatory research exploring unmet health care needs of homeless individuals. Canadian Journal of Nursing Research , 54 (4), 451–463. https://doi.org/10.1177/08445621211032136 Garcia, C., Doran, K., & Kushel, M. (2024). Homelessness and health: Factors, evidence, innovations that work, and policy recommendations. Health Affairs , 43 (2), 164–171. https://doi.org/10.1377/hlthaff.2023.01049 Hopkins, J., & Narasimhan, M. (2022). Access to self-care interventions can improve health outcomes for people experiencing homelessness. BMJ . https://doi.org/10.1136/bmj-2021- 068700 Hossain, M. M., Sultana, A., Tasnim, S., Fan, Q., Ma, P., McKyer, E. L., & Purohit, N. (2020). Prevalence of mental disorders among people who are homeless: An Umbrella Review. International Journal of Social Psychiatry , 66 (6), 528–541. https://doi.org/10.1177/0020764020924689 HUD, U. S. D. of H. and U. D. (n.d.). News releases: HUD releases 2019 Annual Homeless Assessment Report . HUD Archives. https://archives.hud.gov/news/2020/pr20-003.cfm

12 Lee, E., Lee, W., & Duncan, S. (2022). Understanding service navigation pathways and service experiences among homeless populations. Qualitative Social Work , 22 (5), 1031–1047. https://doi.org/10.1177/14733250221114477 Miler, J. A., Carver, H., Foster, R., & Parkes, T. (2020a). Provision of peer support at the intersection of homelessness and problem substance use services: A systematic 'state of the art' review. BMC Public Health , 20 (1). https://doi.org/10.1186/s12889-020-8407-4 Moore-Nadler, M., Clanton, C., & Roussel, L. (2019). Storytelling to capture the healthcare perspective of people who are homeless. Qualitative Health Research , 30 (2), 182– 195. https://doi.org/10.1177/1049732319857058 Olivet, J., Wilkey, C., Richard, M., Dones, M., Tripp, J., Beit-Arie, M., Yampolskaya, S., & Cannon, R. (2021). Racial inequity and homelessness: Findings from the SPARC study. The ANNALS of the American Academy of Political and Social Science , 693 (1), 82–100. https://doi.org/10.1177/0002716221991040 O’Regan, K. M., Ellen, I. G., & House, S. (2021). How to address homelessness: Reflections from research. The ANNALS of the American Academy of Political and Social Science , 693 (1), 322–332. https://doi.org/10.1177/0002716221995158 Schneider, D. A., Cretella, J., Ranaudo, S., Constantino, D., & Cota, C. F. (2019). Voices should be heard: What personal stories of homelessness teach us about practice. Families in Society: The Journal of Contemporary Social Services , 100 (3), 317–327. https://doi.org/10.1177/1044389419837069 Sleet, D. A., & Francescutti, L. H. (2021). Homelessness and public health: A focus on strategies and solutions. International Journal of Environmental Research and Public Health , 18 (21), 11660. https://doi.org/10.3390/ijerph182111660

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13 Sullivan, G., Burnam, A., Koegel, P., & Hollenberg, J. (2000). quality of life of homeless persons with mental illness: Results from the course-of-homelessness study. Psychiatric Services , 51 (9), 1135–1141. https://doi.org/10.1176/appi.ps.51.9.1135

SWK 661 6.2 Assignment Literature Review 2.edited

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