Homeless Shelters’ Policies on Sex Offenders: Is This Another Collateral Consequence?

The primary focus of sex offender research has been on the efficacy and collateral consequences of sex offender registration and notification (SORN) and residence restrictions. Past scholarship has found these laws to cause numerous re-entry barriers for sex offenders. Such barriers have affected sex offenders’ ability to find and maintain housing, employment, and social support. Moreover, registered sex offenders (RSOs) have become homeless due to such laws. 

Although previous scholarship has highlighted the collateral consequences of SORN, there is a lack of scholarship addressing homeless sex offenders. Specifically, the current study assesses policies regarding RSO access to homeless shelters in a four-state region, focusing on the effect of structural, procedural, and geographic factors, as well as a shelter’s proximity to children. 

Drawing on the loose coupling organizational framework, the findings suggest that a small maximum occupancy, unwritten policies for RSOs, being in Kentucky or Tennessee, being located near a school, and being near a higher proportion of homes with children all decrease the odds that a homeless shelter allows RSOs. Furthermore, although unwilling to make exceptions to the policies regarding RSOs, shelters were generally willing to make exceptions to other policies governing shelter accessibility.

Purchase full article at:   http://goo.gl/e0cSZM  PDF of thesis: http://goo.gl/6ymBdq

By:  Shawn M. Rolfe1⇑, Richard Tewksbury1, Ryan D. Schroeder1

¹University of Louisville, KY, USA

Shawn M. Rolfe, University of Louisville, Brigman Hall, Louisville, KY 40292, USA. Email: shawn.rolfe@louisville.edu

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A Test of Outreach and Drop-in Linkage versus Shelter Linkage for Connecting Homeless Youth to Services

Outreach and service linkage are key for engaging marginalized populations, such as homeless youth, in services. Research to date has focused primarily on engaging individuals already receiving some services through emergency shelters, clinics, or other programs. Less is known about those who are not connected to services and, thus, likely the most vulnerable and in need of assistance. 

The current study sought to engage non-service-connected homeless youth (N = 79) into a strengths-based outreach and advocacy intervention. Youth were randomly assigned to receive 6 months of advocacy that focused on linking youth to a drop-in center (n = 40) or to a crisis shelter (n = 39). All youth were assessed at baseline and 3, 6, and 9 months post-baseline. 

Findings indicated that youth prefer drop-in center services to the shelter. Also, the drop-in center linkage condition was associated with more service linkage overall and better alcohol and HIV-related outcomes compared to the shelter linkage condition. 

Findings highlight the importance of outreach and service linkage for reconnecting service-marginalized youth, and drop-in centers as a primary service option for homeless youth.

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By:  Slesnick N1, Feng X2, Guo X3, Brakenhoff B2, Carmona J2, Murnan A2, Cash S4, McRee AL5.

• 1Department of Human Sciences, The Ohio State University, Columbus, OH, USA. slesnick.5@osu.edu.
• 2Department of Human Sciences, The Ohio State University, Columbus, OH, USA.
• 3Xiamen University, Xiamen, China.
• 4College of Social Work, The Ohio State University, Columbus, OH, USA.
• 5College of Public Health, The Ohio State University, Columbus, OH, USA. 

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Two-Year Predictors of Runaway and Homeless Episodes Following Shelter Services among Substance Abusing Adolescents

Given high levels of health and psychological costs associated with the family disruption of homelessness, identifying predictors of runaway and homeless episodes is an important goal. The current study followed 179 substance abusing, shelter-recruited adolescents who participated in a randomized clinical trial. Predictors of runaway and homeless episodes were examined over a two year period. Results from the hierarchical linear modeling analysis showed that family cohesion and substance use, but not family conflict or depressive symptoms, delinquency, or school enrollment predicted future runaway and homeless episodes. Findings suggest that increasing family support, care and connection and reducing substance use are important targets of intervention efforts in preventing future runaway and homeless episodes amongst a high risk sample of adolescents.

In the U.S., approximately 1.7 million adolescents runaway each year, with an estimated 19.4% of adolescents experiencing a runaway/homeless episode by the time they are 18-years-old (Hammer, Finkelhor, & Sedlack, 2002; Pergamit, 2010). Furthermore, 51.2% of runaway adolescents report multiple runaway/homeless episodes (Pergamit, 2010). While some adolescents chose to leave home, others are forced or encouraged to leave home (Hammer et al., 2002). Runaway adolescents are exposed to several risks both prior to and after leaving home (Hammer et al., 2002). The majority of these adolescents report negative family environments, with high rates of family conflict and low rates of support and connection (Slesnick et al., 2009). While away from home, adolescents are exposed to further risks, with many adolescents reporting substance abuse and depressive symptoms (Greene, Ennett, & Ringwalt, 1997;Thompson, Pollio, Constantine, Reid, & Nebbit, 2002; Yates, MacKenzie, Pennbridge, & Cohen, 1988). In order to address the risks experienced by these adolescents, interventions have been developed to address both family and individual challenges.

Crisis shelters are the primary intervention for runaway adolescents (Greene, Ringwalt, & Iachan, 1997). Since the majority of adolescents return home following their stay in a shelter, family therapy interventions have also been developed and recommended for these families (Slesnick & Prestopnik, 2005). Following participation in treatment, adolescents report improved outcomes, including reduced substance use and improved behavioral and emotional functioning (Barber et al., 2005; Slesnick & Prestopnik, 2005; Slesnick, Erdem, Bartle-Haring, & Brigham, in press). However, many of the positive effects of treatment fade over time and repeat runway/homeless episodes are common (Baker et al., 2003; Pollio, et al. 2006). Among a study of shelter using youth, Baker and colleagues (2003) found 18% of first time runaways and 34% of repeat runaways returned to the shelter within a year following discharge. While previous studies have identified factors that predict an initial runaway episode, less is known about factors that predict repeat runaway and homeless episodes following participation in treatment. Since both individual and family factors predict initial runaway episodes, the current study sought to identify both individual and family factors that predict repeat runaway and homeless episodes across time following adolescents’ stay in a runaway shelter and participation in treatment.

Full article at: http://goo.gl/qa8cbX

By:   Natasha Slesnick, Ph.D.,1 Xiamei Guo, M.S., Brittany Brakenhoff, M.S., and Xin Feng, Ph.D.

Human Development and Family Science, The Ohio State University

¹Corresponding Author. Department of Human Development and Family Science, The Ohio, State University, 135 Campbell Hall, 1787 Neil Ave, Columbus, OH 43210. Phone: (614) 247-8469; FAX: (614) 292-4365. Email: ude.uso@5.kcinsels

 

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Social and Recovery Capital amongst Homeless Hostel Residents Who Use Drugs and Alcohol

BACKGROUND:

Homeless people who use drugs and alcohol have been described as one of the most marginalised groups in society. In this paper, we explore the relationships of homeless drug and alcohol users who live in hostels in order to ascertain the nature and extent of their social and recovery capital.

METHODS:

Data were collected during 2013 and 2014 from three hostels. Each hostel was in a different English city and varied in size and organisational structure. Semi-structured interviews were conducted with 30 residents (21 men; 9 women) who self-reported current drink and/or drug problems. Follow-up interviews were completed after 4-6 weeks with 22 residents (16 men; 6 women). Audio recordings of all interviews were transcribed verbatim, systematically coded and analysed using Framework.

RESULTS:

Participants' main relationships involved family members, professionals, other hostel residents, friends outside of hostels, current and former partners, and enemies. Social networks were relatively small, but based on diverse forms of, often reciprocal, practical and emotional support, encompassing protection, companionship, and love. The extent to which participants' contacts provided a stable source of social capital over time was, nonetheless, uncertain. Hostel residents who used drugs and alcohol welcomed and valued interaction with, and assistance from, hostel staff; women appeared to have larger social networks than men; and hostels varied in the level of enmity between residents and antipathy towards staff.

CONCLUSION:

Homeless hostel residents who use drugs and alcohol have various opportunities for building social capital that can in turn foster recovery capital. Therapies that focus on promoting positive social networks amongst people experiencing addiction seem to offer a valuable way of working with homeless hostel residents who use drugs and alcohol. Gains are, however, likely to be maximised where hostel management and staff are supportive of, and actively engage with, therapy delivery

Full article at:  http://goo.gl/Y1dYL1

By:  Neale J1, Stevenson C2.

• 1Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, London SE5 8AF, UK; Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia.
• 2Department of Psychology, Social Work and Public Health, Oxford Brookes University, Jack Straws Lane, Marston, Oxford OX3 0FL, UK. Electronic address: cstevenson@brookes.ac.uk. 

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All-Cause, Drug-Related & HIV-Related Mortality Risk by Trajectories of Jail Incarceration & Homelessness among Adults in New York City

We studied a cohort of 15,620 adults who had experienced at least 1 jail incarceration and 1 homeless shelter stay in 2001-2003 in New York City to identify trajectories of these events and tested whether a particular trajectory was associated with all-cause, drug-related, or human immunodeficiency virus (HIV)-related mortality risk in 2004-2005. 

Using matched data on jail time, homeless shelter stays, and vital statistics, we performed sequence analysis and assessed mortality risk using standardized mortality ratios (SMRs) and marginal structural modeling. We identified 6 trajectories. Sixty percent of the cohort members had a temporary pattern, which was characterized by sporadic experiences of brief incarceration and homelessness, whereas the rest had the other 5 patterns, which reflected experiences of increasing, decreasing, or persistent jail or shelter stays. Mortality risk among individuals with a temporary pattern was significantly higher than those of adults who had not been incarcerated or stayed in a homeless shelter during the study period; all-cause and HIV-related SMRs in other patterns were not statistically significantly different. 

When we compared all 6 trajectories, the temporary pattern was more strongly associated with higher mortality risk than was the continuously homelessness pattern. Institutional interventions to reduce recurrent cycles of incarceration and homelessness are needed to augment behavioral interventions to reduce mortality risk.

Full article at: http://goo.gl/WyuLRa

By: Lim S, Harris TG, Nash D, Lennon MC, Thorpe LE.

  

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Effectiveness of Peer Educators on the Uptake of Mobile X-Ray Tuberculosis Screening at Homeless Hostels: A Cluster Randomised Controlled Trial

To compare current practice for encouraging homeless people to be screened for tuberculosis on a mobile digital X-ray unit in London, UK, with the additional use of volunteer peer educators who have direct experience of tuberculosis, homelessness or both.

46 hostels took part in the study, with a total of 2342 residents eligible for screening. The study took place between February 2012 and October 2013 at homeless hostels in London, UK.

At intervention sites, volunteer peer educators agreed to a work plan that involved moving around the hostel in conjunction with the hostel staff, and speaking to residents in order to encourage them to attend the screening.

Cluster randomisation (by hostel) was performed using an internet-based service to ensure allocation concealment, with minimisation by hostel size and historical screening uptake.

Only the study statistician was blinded to the allocation of intervention or control arms.

The primary outcome was the number of eligible clients at a hostel venue screened for active pulmonary tuberculosis by the mobile X-ray unit.

A total of 59 hostels were considered for eligibility and 46 were randomised. Control sites had a total of 1192 residents, with a median uptake of 45% (IQR 33-55). Intervention sites had 1150 eligible residents with a median uptake of 40% (IQR 25-61). Using Poisson regression to account for the clustered study design, hostel size and historical screening levels, there was no evidence that peer educators increased uptake (adjusted risk ratio 0.98; 95% CIs 0.80 to 1.20). The study team noted no adverse events.

This study found no evidence that volunteer peer educators increased client uptake of mobile X-ray unit screening for tuberculosis. Further qualitative work should be undertaken to explore the possible ancillary benefits to peer volunteers.

Below:  Maps of London by local authority detailing: rates of tuberculosis (A); total eligible clients at all homeless hostels (B); total number of clients screened at hostels as part of the study (C).

Full article at: http://ht.ly/SLF69

By: Aldridge RW1, Hayward AC1, Hemming S1, Possas L1, Ferenando G1, Garber E1, Lipman M2, McHugh TD3, Story A4.

• 1Institute of Health Informatics, University College London, London, UK The Farr Institute of Health Informatics Research.
• 2Royal Free London NHS Foundation Trust, London, UK Centre for Clinical Microbiology, Division of Medicine, University College London, London, UK.
• 3Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK.
• 4University College London Hospitals, London, UK. 

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HIV Risk & Awareness & Interest in Pre-Exposure & Post-Exposure Prophylaxis among Sheltered Women in Miami

Pre- and non-occupational Post-Exposure Prophylaxis for prevention of HIV infection are recommended for adults at substantial risk for HIV infection. Women experiencing homelessness have increased risk for HIV infection compared with stably housed women. 

We conducted a survey of 74 sheltered women at Lotus House Women's Shelter (Lotus House) in Miami to assess risk behaviour as well as knowledge and perception of pre- and non-occupational post-exposure prophylaxis in this population. 

Of surveyed women, 

• 58.1% engaged in vaginal and/or anal sex while sheltered, 
• and of sexually active women 55.4% reported inconsistent condom use; 
• 83.8% of women reported no concern regarding HIV acquisition due to their behaviour. 
• Few women surveyed (20.8%) had previously heard of pre- or non-occupational post-exposure prophylaxis. 
• The majority (58.3%) of respondents indicated receptiveness to these prevention methods when introduced. 
• Those indicating that they would consider pre- or non-occupational post-exposure prophylaxis were significantly younger than those indicating that they would not consider these prevention strategies (p = 0.004). 

Education and referral for pre- and non-occupational post-exposure prophylaxis should be considered for sheltered women at risk for HIV infection. Additional research to optimise implementation of biomedical prevention strategies in this population is needed.

Via: http://ht.ly/Sspuf  Purchase full article at: http://goo.gl/JMoxt0

By: Doblecki-Lewis S1, Lester L2, Schwartz B2, Collins C3, Johnson R3, Kobetz E4.

• 1Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA sdoblecki@med.miami.edu.
• 2Department of Medical Education, MD/MPH Program, University of Miami Miller School of Medicine, Miami, FL, USA.
• 3Lotus House Women's Shelter, Miami, FL, USA.
• 4Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL, USA.

Risk Factors for Stimulant Use among Homeless & Unstably Housed Adult Women

One 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.

We 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.

Among 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, sleeping in a shelter or public place, and using unprescribed opioid analgesics.

We 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.

Via:  http://ht.ly/Shf1v 

By: Riley ED1, Shumway M2, Knight KR3, Guzman D4, Cohen J5, Weiser SD6.

• 1School of Medicine, Department of Medicine, University of California, San Francisco, CA, USA
• 2School of Medicine, Department of Psychiatry, University of California, San Francisco, CA, USA.
• 3School of Medicine, Department of Anthropology, History and Social Medicine, University of California, San Francisco, CA, USA.
• 4School of Medicine, Department of General Internal Medicine, University of California, San Francisco, CA, USA.
• 5School of Medicine, Department of Clinical Pharmacy, University of California, San Francisco, CA, USA.
• 6School of Medicine, Department of Medicine, University of California, San Francisco, CA, USA.

Human Papillomavirus Knowledge and Attitude among Homeless Women of New York City Shelters

Mean age was 44.7 ± 12.16 years. The majority were Black, heterosexual, and single; 50.6% were smokers. Almost all HPV knowledge and attitudes data were considerably below the national averages; 41.9% never heard of HPV. Only 36.5% knew that HPV is a sexually transmitted disease; 41.5% knew that HPV causes cervical cancer; and only 19.5% and 17.3% received provider counseling regarding HPV testing and vaccine, respectively. 

Among participants, 65.4% reported that they would vaccinate their eligible daughters for HPV. Lower rates of up-to-date Pap tests were associated with a lack of knowledge regarding relationship between HPV and abnormal Pap test.

We recommend improved HPV counseling by providers during any clinical encounter to reduce missed opportunities, coupled with employing patient teaching coach or navigators to improve health literacy and to connect patients to services regarding HPV and cervical cancer.

Via: http://ht.ly/SaS0S 

By: Asgary R1, Alcabes A2, Feldman R3, Garland V2, Naderi R4, Ogedegbe G5, Sckell B2.

• 1Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, New York University School of Medicine, New York, New York.
• 2Community Medicine Program, NYU Lutheran Family Health Centers, New York, New York.
• 3Department of Obstetrics and Gynecology, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
• 4Department of Medicine, New York University School of Medicine, New York, New York.
• 5Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, New York University School of Medicine, New York, New York.

Assessing the Relationship Between the Perceived Shelter Environment & Mental Health among Homeless Caregivers

Little attention has been given to how the environment of homeless shelters may impact the mental health of their residents. This study addresses this gap in the literature and presents a cross-sectional analysis of 209 caregivers nested within 10 family shelters across New York City. 

Multivariate regression was employed using hierarchical modeling to test the association between two shelter related variables (ie, the perceived social environment of the shelter and difficulty following shelter rules) and the mental health status of the caregiver residents. Less favorable perceptions of the social environment of the shelter and difficulty following shelter rules were both found to be associated with poorer mental health after controlling for demographic covariates as well as time in the shelter and first time in the shelter. 

These findings highlight the potential impact of the perceived social environment of shelters and methods of governance of shelters on the mental health of caregiver residents. In addition, the findings support the notion that interventions such as trauma informed care could potentially aid in addressing the mental health challenges that residents face.

Via: http://ht.ly/RTUPW

By: Beharie N1, Lennon MC, McKay M.

• 1a CUNY Graduate Center.