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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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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