Black Lives Experiencing Homelessness Matter: A Critical Conceptual Framework for Understanding How Policing Drives System Avoidance among Vulnerable Populations

This paper examines racialized encounters with the police from the perspectives of people experiencing homelessness in San Diego, California in 2020. By some estimates, homelessness doubled in San Diego during the first year of the COVID-19 pandemic. We conducted a survey of (n = 244) and interviews with (n = 57) homeless San Diegans during initial shelter-in-place orders, oversampling for Black respondents, whose voices are often under-represented despite high rates of homelessness nationally. Our respondents reported high rates of police contact, frequent lack of respect;overt racism, sexism, and homophobia;and a failure to offer basic services during these encounters. Centering our Black respondents' experiences of criminalization and racism in what Clair calls "criminalized subjectivity," we develop a conceptual framework that brings together critical theoretical perspectives on the role of race in the governance of poverty and crime. When people experiencing extreme poverty face apathy, disrespect, and discrimination from police—as our data show—the result is a reluctance to seek services and to engage with outreach when offered. This reinforces stereotypes of unhoused people as not "wanting" help or "choosing" to be homeless. We reflect on these findings and our framework for envisioning a system of public safety that supports and cares for—rather than punishes—the most vulnerable members of our society. [ FROM AUTHOR] Copyright of Public Integrity is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

We Are Living It

The Centers for Disease Control and Prevention (CDC) identified certain populations as being particularly vulnerable during the COVID-19 pandemic, including racial and ethnic minority populations, people living in rural or frontier areas, people experiencing homelessness, essential and frontline workers, people with disabilities, people with substance use disorders, people in incarcerated populations, and individuals born outside of the United States (CDC 2020). Because the pandemic is affecting people and communities disproportionately, we knew students needed to explore the social and historical dimensions of the pandemic that resulted from systemic inequalities. Throughout the unit, they work toward a better understanding of the following ideas: * How the COVID-19 virus is transmitted between individuals and within communities * How mitigation strategies lower the chance of transmitting the COVID-19 virus between individuals and across communities * An understanding that there are differences in how diseases spread across different communities that cannot be explained without taking social, historical, and economic factors into account and that understanding the larger social context, policies, and practices can help us understand disproportionate impacts within and between communities * How others are affected during a public health crisis and how empathizing with them can help us better protect ourselves and the people in our communities Our commitment to providing the information that young people need to understand COVID-19 and other pandemics led to an interesting discovery about the NGSS. Attempt to make sense of the phenomenon or problem Students share the patterns they observed from the data and create initial models to explain how and why communities were affected by COVID-19 differently (see Figure 1). [...]social awareness is defined as the ability to (1) take the perspective of and empathize with others, including those from diverse backgrounds and cultures;(2) understand social and ethical norms for behavior;and (3) recognize family, school, and community resources and supports.

The impact of psychological strengths on Veteran populations' mental health trajectories during the COVID-19 pandemic.

PURPOSE: Mental health trajectories during the COVID-19 pandemic have been examined in Veterans with tenuous social connections, i.e., those with recent homelessness (RHV) or a psychotic disorder (PSY), and in control Veterans (CTL). We test potential moderating effects on these trajectories by psychological factors that may help individuals weather the socio-emotional challenges associated with the pandemic (i.e., 'psychological strengths'). METHODS: We assessed 81 PSY, 76 RHV, and 74 CTL over 5 periods between 05/2020 and 07/2021. Mental health outcomes (i.e., symptoms of depression, anxiety, contamination concerns, loneliness) were assessed at each period, and psychological strengths (i.e., a composite score based on tolerance of uncertainty, performance beliefs, coping style, resilience, perceived stress) were assessed at the initial assessment. Generalized models tested fixed and time-varying effects of a composite psychological strengths score on clinical trajectories across samples and within each group. RESULTS: Psychological strengths had a significant effect on trajectories for each outcome (ps < 0.05), serving to ameliorate changes in mental health symptoms. The timing of this effect varied across outcomes, with early effects for depression and anxiety, later effects for loneliness, and sustained effects for contamination concerns. A significant time-varying effect of psychological strengths on depressive symptoms was evident in RHV and CTL, anxious symptoms in RHV, contamination concerns in PSY and CTL, and loneliness in CTL (ps < 0.05). CONCLUSION: Across vulnerable and non-vulnerable Veterans, presence of psychological strengths buffered against exacerbations in clinical symptoms. The timing of the effect varied across outcomes and by group.

The Experience of Psychosis in Psychiatric Inpatients During the COVID-19 Pandemic Among Unhoused Individuals.

This research investigates the impact of Coronavirus-2019 on individuals without housing and experiencing psychosis using semi-structured qualitative interviews and a case study format. We found that for our participants, life in the pandemic was generally more difficult and filled with violence. Further, the pandemic seemed to impact the content of psychosis directly, such that in some cases voices referred to politics around the virus. Being unhoused during the pandemic may increase the sense of powerlessness, social defeat, and the sense of failure in social interactions. Despite national and local measures to mitigate virus spread in unhoused communities, the pandemic seemed to be particularly hard on those who were unhoused. This research should support our efforts to see access to secure housing as a human rights issue.

Burden of long COVID among adults experiencing sheltered homelessness: a longitudinal cohort study in King County, WA between September 2020-April 2022.

BACKGROUND: People experiencing homelessness (PEH) are at increased risk for acquiring SARS-CoV-2, but the burden of long COVID in this population is unknown. METHODS: We conducted a matched prospective cohort study to assess the prevalence, characteristics, and impact of long COVID among sheltered PEH in Seattle, WA between September 2020-April 2022. Adults ≥ 18 years, residing across nine homeless shelters with active respiratory virus surveillance, were eligible to complete in-person baseline surveys and interval follow-up phone surveys. We included a subset of 22 COVID-19-positive cases who tested positive or inconclusive for SARS-CoV-2 and 44 COVID-19-negative controls who tested negative for SARS-CoV-2, frequency matched on age and sex. Among controls, 22 were positive and 22 were negative for one of 27 other respiratory virus pathogens. To assess the impact of COVID-19 on the risk of symptom presence at follow-up (day 30-225 post-enrollment test), we performed log-linear regression with robust standard errors, adjusting for confounding by shelter site and demographic variables determined a priori. RESULTS: Of 53 eligible COVID-19 cases, 22 (42%) completed ≥ 1 follow-up survey. While five (23%) cases reported ≥ 1 symptom at baseline, this increased to 77% (10/13) between day 30-59 and 33% (4/12) day 90 + . The most commonly reported symptoms day 30 + were fatigue (27%) and rhinorrhea (27%), with 8 (36%) reporting symptoms that interfered with or prevented daily activities. Four (33%) symptomatic cases reported receiving medical care outside of a medical provider at an isolation facility. Of 44 controls, 12 (27%) reported any symptoms day 90 + . Risk of any symptoms at follow-up was 5.4 times higher among COVID-19 cases compared to controls (95% CI: 2.7-10.5). CONCLUSIONS: Shelter residents reported a high prevalence of symptoms 30 + days after their SARS-CoV-2 detection, though few accessed medical care for persistent illness. The impact of COVID-19 extends beyond acute illness and may exacerbate existing challenges that marginalized populations face in maintaining their health and wellbeing.

Pursued, Besieged by Coronavirus

People in isolation or quarantine, and people confined in nursing homes, insane asylums, prisons, and refugee camps are cut off from the outside world, where the coronavirus invisibly drifts. It besieges our homes. And the virus invades, through heating ducts and on packages delivered. Our home is no longer a refuge of rest, tranquility, substance, and sustenance, no longer the place of hospitality. And the coronavirus pursues the homeless, sleeping in municipal shelters or under bridges and overpasses. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022.

Critical junctures as complex processes: examining mechanisms of policy change and path dependence in the Canadian pandemic response to homelessness

Policy change is not an instantaneous or linear process. In fact, change includes several mechanisms working in tandem and even against one another. This article examines the impacts of the COVID-19 pandemic on homelessness policy in Canada. In a sector that is already plagued with emergency responses - rather than long-term solutions - the pandemic has initiated a critical juncture where policy change is possible, but not guaranteed. Although the existing failures to alleviate homelessness in Canada make policy failings even more obvious, aspects of the pre-existing Canadian response to homelessness negate change. The pandemic, however, has led to temporary solutions and created a setting where long-term change is possible. Using over 150 primary sources, this article analyses mechanisms of change and path dependence in the pandemic response to homelessness. The presence of such mechanisms is tested in three major Canadian cities.

Low Barrier Tele-Buprenorphine in the Time of COVID-19: A Case Report

Background: To reduce the spread of coronavirus disease 2019 (COVID-19), many substance use disorder treatment programs have transitioned to telemedicine. Emergency regulatory changes allow buprenorphine initiation without an in-person visit. We describe the use of videoconferencing for buprenorphine initiation combined with street outreach to engage 2 patients experiencing homelessness with severe opioid use disorder (OUD). Case Presentation: Patient 1 was a 30-year-old man with severe OUD who had relapsed to injection heroin/fentanyl after incarceration. A community drop-in center outreach harm reduction specialist facilitated a videoconference with an addiction specialist at an OUD bridge clinic. The patient completed a community buprenorphine/naloxone initiation and self-titrated to his prior dose, 8/2 mg twice daily. One week later, he reconnected with the outreach team for a follow-up videoconference visit. Patient 2, a 36-year-old man with severe OUD, connected to the addiction specialist via a syringe service program harm reduction specialist. He had been trying to connect to a community buprenorphine/naloxone provider, but access was limited due to COVID-19, so he was using diverted buprenorphine/naloxone to reduce opioid use. He was restarted on his previous dose of 12/3 mg daily which was continued via phone follow-up 16 days later. Conclusion(s): COVID-19-related regulatory changes allow buprenorphine initiation via telemedicine. We describe 2 cases where telemedicine was combined with street outreach to connect patients experiencing homelessness with OUD to treatment. These cases highlight an important opportunity to provide access to life-saving OUD treatment for vulnerable patients in the setting of a pandemic that mandates reduced face-to-face clinical interactions.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.

Social exclusion and pandemic: the experiences of homeless people

Homelessness is an extreme form of social exclusion which, although universally present in contemporary societies, has tended to be invisible. This lack of visibility has once again been highlighted by the measures put in place to tackle COVID-19. Although since the onset of the health emergency there have been various research studies that have examined the impact of COVID-19 on the Spanish population, few proposals have been devoted to analysing the specific impact of the pandemic on homeless people. In this sense, the aim of this paper is to analyse the experiences of homeless people during the confinement and pandemic, delving into the specific impact that the COVID-19 crisis has had on the reality of these citizens. The research is based on a mixed methodological design using a questionnaire survey and a semi-structured in-depth interview. On the one hand, the questionnaire was administered to a sample of 641 homeless people. On the other hand, 18 homeless people participated in the interviews. The results confirm that the place where they were confined is fundamental to understanding the experiences of the participants. Furthermore, it is noted that the negative experiences of homeless people were a consequence of the measures put in place to cope with the pandemic and prevent contagion, especially those related to the closure of services where their basic needs were met. This is especially significant considering the transformations that the responses to the health emergency have imposed on some dimensions of their lives. The results also allow us to conclude that pre-existing social inequalities have played a significant role in the impact of the pandemic on citizens, with particularly severe consequences for people affected by extreme social exclusion. (English) [ FROM AUTHOR] El sinhogarismo constituye una forma extrema de exclusión social que, aunque presente de manera universal en el seno de las sociedades contemporáneas, ha tendido a ser invisibilizada. Esta falta de visibilidad quedó de nuevo en evidencia ante las medidas puestas en marcha para hacer frente a la COVID-19. Aunque desde el inicio de la situación de emergencia sanitaria surgieron diferentes investigaciones que profundizaban en el impacto de la COVID-19 sobre la población española, son escasas las propuestas que se han dedicado a analizar el impacto específico de la pandemia entre las personas en situación de sinhogarismo. En este sentido, el presente trabajo tiene como objeto analizar las experiencias vividas por las personas en situación de sinhogarismo durante el confinamiento y pandemia, profundizando en el impacto específico que la crisis de la COVID-19 ha tenido en la realidad de esta ciudadanía. La investigación parte de un diseño metodológico mixto mediante el uso de la encuesta a través de cuestionario y la entrevista en profundidad semiestructurada. Por un lado, el cuestionario ha sido administrado a una muestra de 641 personas en situación "sin hogar". Por otro lado, 18 personas en situación de sinhogarismo han participado en las entrevistas. Los resultados confirman que el lugar en el que pasaron el confinamiento resulta fundamental para entender las experiencias de las personas participantes. Además, se apunta que las experiencias negativas vividas por las personas en situación de sinhogarismo fueron consecuencia de las medidas desarrolladas para hacer frente a la pandemia y evitar los contagios, especialmente aquellas relacionadas con el cierre de servicios donde atendían a sus necesidades básicas. Esto es especialmente significativo considerando las transformaciones que las respuestas a la emergencia sanitaria han impuesto en algunas dimensiones de sus vidas. Asimismo, los resultados permiten concluir que las desigualdades sociales preexistentes han tenido un papel central en el impacto de la pandemia en la ciudadanía, con consecuencias especialmente severas para las personas afectadas por la exclusión social extrema. (Spanish) [ FROM AUTHOR] Copyright of EMPIRIA: Revista de Metodología de Ciencias Sociales is the property of Editorial UNED and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

SARS-CoV-2 SEROPREVALENCE AMONG PEOPLE WHO INJECT DRUGS IN BALTIMORE

Background: People who inject drugs (PWID) may be at a greater risk of SARS-CoV-2 infection and COVID-19 due to socio-structural inequities, high-risk behaviors and comorbidities;however, PWID have been underrepresented in case-based surveillance due to lower access to testing. We characterize temporal trends and correlates of SARS-CoV-2 seroprevalence among a community-based sample of current and former PWID. Method(s): A cross-sectional study was conducted among participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study-a community-based cohort of adults with a history of injection drug use in Baltimore, Maryland. Participants' first serum sample collected at routine study visits between December 2020 and July 2022 was assayed for antibodies to the nucleocapsid (N) (past infection) and spike-1 (S) (past infection and/or vaccination) proteins using the MSD V-Plex Panel 2 IgG SARS-CoV-2 assay. For each correlate, we estimated adjusted prevalence ratios (PR) via separate Poisson regression models adjusted for calendar time, age, sex and race. Result(s): Of 561 participants, the median age was 59 years (range=28-77), 35% were female, 84% were Black, 36% were living with HIV (97% on ART), and 55% had received >=1 COVID-19 vaccine dose. Overall, anti-N and anti-S prevalence was 26% and 63%, respectively. Prevalence of anti-N increased from 23% to 40% between December 2020-May 2021 and December 2021-July 2022, with greater increases in the prevalence of anti-S from 34% to 86% over the same period (Figure). Being employed (PR=1.53 [95%CI=1.11-2.11]) and never being married (PR=1.40 [0.99-1.99]) were associated with a higher prevalence of anti-N, while female sex (PR=0.75 [0.55-1.02]) and a history of cancer (PR=0.40 [0.17-0.90]) were associated with a lower prevalence of anti-N. Younger age, female sex (PR=0.90 [0.80-1.02]), and homelessness (PR=0.78 [0.60-0.99]) were associated with a lower prevalence of anti-S. Although HIV infection was not associated with anti-N, it was associated with a higher prevalence of anti-S (PR=1.13 [1.02-1.27]). Substance use was not associated with anti-N or anti-S. Conclusion(s): Anti-N and anti-S levels increased over time, suggesting cumulative increases in SARS-CoV-2 incidence of infection and vaccination among PWID;however, disparities in seroprevalence remain. Younger and female PWID and those experiencing homelessness were less likely to be anti-S positive, suggesting programs should aim to improve vaccination coverage in such vulnerable populations.

Homelessness and mental health

The contemporary definition of homelessness has to be seen as a multifaceted societal issue with specific factors at play in different settings. Relative poverty, insecure housing, unemployment, and insecure unemployment can all contribute to homelessness and it is worth noting that these factors will vary across cultures. Homelessness is often expressed as a crisis -a break in the typical, cultured means of civilizations. In addition, severe mental disorders have been noted and reported in homeless populations for a considerable period of time. Individuals with severe mental illness often experience a range of housing settings depending on their personal and financial conditions or the available rehabilitation programmes, which will depend upon healthcare systems (2), in addition to societal conditions and local policies on social care, employment housing, and so on. Whilst the number of people currently experiencing homelessness cannot be precisely estimated due to varying definitions across countries and cultures, the link between homelessness and mental health disorders is undeniable. Both are strongly affected by social and economic determinants such as poverty, migration, unemployment, access to healthcare, and urbanization and, as a result, providing optimal care in the community requires understanding of the cultural context. This unique resource provides an overview of the connection between homelessness and mental health around the globe. Over 27 chapters it offers up-to-date research and policy evidence with an emphasis on developing models of social care and rehabilitation at a local level that enable easy access to mental health services. Written and edited by experts drawn from different cultural and geographical perspectives, this unique resource covers key topics such as COVID-19, dental issues, and chronic pain, the experiences of specific vulnerable groups, as well as case studies from specific countries. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Intervention Efficacy on Covid-19 Testing and Vaccination in People Who Inject Drugs

Background: People who inject drugs (PWID) are vulnerable to SARS-CoV-2 and severe disease but have low rates of COVID-19 testing and vaccination due to multilevel barriers. We partnered with a mobile syringe service program (SSP) in San Diego County, CA, to develop the theory-informed LinkUP intervention to increase COVID-19 testing and vaccination among PWID. Method(s): From March-June 2022, we conducted a pilot randomized controlled trial (RCT;ClinicalTrials.gov #NCT05181657) to assess efficacy of LinkUP vs. a didactic attention-matched control condition in increasing COVID-19 testing uptake and acceptance of vaccination referrals. Based on Social Cognitive Theory, trained, SSP-hired peer counsellors delivered tailored education, motivational interviewing, and problem-solving and planning to the active LinkUP intervention arm. We referred eligible participants (PWID, >=18 years old, San Diego County residents without recent voluntary COVID-19 testing or fully vaccinated status) to mobile SSP sites that had been randomized by week to offer LinkUP or the control condition;all participants were then offered on-site rapid COVID-19 antigen testing and vaccination referrals. Our intent-to-treat analysis used Chi-square tests to compare intervention groups' outcomes and log-binomial regression to estimate preliminary intervention efficacy and explore potential moderation. Result(s): Among 150 participants, median age was 41 years, 33% identified as Latinx and 65% as male, 73% were experiencing homelessness, and 45% had prior mandatory COVID-19 testing. Overall, we only detected one SARS-CoV-2 case. However, more active intervention vs. control participants agreed to COVID-19 testing (77.3% vs. 22.7%;p< .001) and vaccine referrals (32.4% vs. 13.3%;p=0.006). Homelessness moderated intervention effects: LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted risk ratio [aRR]: 1.64;95% CI: 1.27-2.12) than those not experiencing homelessness (aRR: 1.25;95% CI: 0.99-1.56). Conclusion(s): Findings from this RCT support the efficacy of LinkUP in increasing COVID-19 testing and acceptance of vaccination referrals among PWID presenting at mobile SSP sites, particularly for those experiencing homelessness. This research underscores the significance of communityacademic partnerships when working with PWID and identifies a promising model that could be adapted to increase access to other underutilized vaccines in this vulnerable population.

Coronavirus disease 2019 (COVID-19) and homelessness: Global perspectives on the 'dual pandemic

Homelessness has been identified as a 'social evil' worldwide, a growing social pandemic in itself. Unfortunately, it needs a large-scale infectious outbreak like COVID-19 to alarm us about the possible health risks to the homeless. As COVID-19 strikes the world hard, and societies appear concerned about economies and international relations, millions of homeless globally suffer from their unique vulnerabilities, either on open streets or temporary shelters. When pandemics cross paths with homelessness, a critical zone of unmet needs is created, that needs urgent attention from stakeholders at all levels. Accountability, empathy, understanding, awareness, and research can help influence policy reforms. COVID-19 will surely modify pandemic legislation all across the world. It remains to be seen whether the challenges of the homeless and their special subgroups (such as the mentally ill) get addressed or not. The societal blind eye turned towards them, enhanced by socioeconomic class difference and capitalism, can be counterproductive, to eventually boomerang the larger community as the viral spread will not respect these arbitrary human-made classes. Keeping that in context, this chapter summarizes the global problems of homelessness and the ongoing pandemic, their special needs, the policy implications so far, and the possible way forward. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Hiv Viral Load and Time-to-Covid-19 Vaccination among People Who Inject Drugs

Background: Structural barriers to care among people who inject drugs (PWID) raise concerns about disproportionate access to essential services like COVID-19 vaccination. Given the heightened risk of serious complications resulting from SARS-CoV-2 infection, particularly among people living with HIV (PWH) with unsuppressed viral load, its critical to understand the role of HIV care among other factors associated with timely vaccination. We aimed to assess the role of HIV care on COVID-19 vaccination uptake among PWID. Method(s): We included 960 adult PWUD participating in the ALIVE (AIDS Linked to the Intravenous Experience) longitudinal study in Baltimore, Maryland, who were alive and in follow up as of April 2020. We ed COVID-19 vaccination data from electronic medical records linked to participants via the regional health information exchange. We conducted survival analysis to estimate time from broad vaccine eligibility (April 6, 2021) to completion of the COVID-19 vaccination primary series by HIV status (uninfected, virally suppressed PWH [HIV-RNA< 400 copies/mL], unsuppressed PWH [HIV-RNA >400 copies/mL]) and Cox Proportional Hazards regression to adjust for potential confounding by health status and substance use variables. Result(s): Our sample (N=960) was primarily black (77%) and male (65%) with 31% reporting recent injection drug use. Among 265 people living with HIV (PWH) in our sample (27%), 84% were virally suppressed. As of February 22, 2022, 539 (56%) completed the primary series, 131 (14%) received a single dose of mRNA vaccine and 290 (30%) remained unvaccinated. Compared to PWID without HIV, virally suppressed PWH were significantly more likely to complete the primary series (Adjusted Hazard Ratio [AHR]:1.23,95% Confidence Interval [95%CI]:1.07,1.50), while PWH with higher viral loads were less likely (AHR:0.72,95%CI:0.45,1.16). Sensitivity analyses with a subsample restricted to PWH confirmed significant differences in time to vaccination by viral load status (log-rank p-value: 0.016) and modeling with an origin of Dec. 12, 2020, yielded similar adjusted results. Conclusion(s): Among PWID with HIV, viral suppression is associated with quicker vaccination uptake, likely due to HIV care engagement. Alongside interventions targeting social determinants (e.g. low income, homelessness) and substance use behaviors (e.g. active injecting, stimulant use), targeted improvements along the HIV care continuum and other efforts to engage PWID may bolster vaccine uptake. Figure 1. Kaplan-Meier survival curve demonstrating time-to-vaccination (completion of COVID-19 primary series) in weeks by HIV status accounting for viral load (HIV-, HIV+ [VL <= 400 cells/muL], HIV+ [VL > 400 cells/muL]), including results for Log-rank tests for homogeneity among strata (p-value).

Place and the Structuring of Cross-Sector Partnerships: The Moral and Material Conflicts Over Healthcare and Homelessness.

Local places, such as communities, cities, and towns, host many cross-cross sector partnerships, many geared primarily toward alleviating local social and environmental issues. Yet, existing literatures focus predominantly on largescale systemic impact and global challenges such as climate change, paying scant attention to the role of local, geographically bounded dynamics in shaping these partnerships. In this article, I conceptualize places as geographic locations imbued with specific meaning systems and material resources to unpack how local embeddedness shape the structure of cross-sector partnerships. Specifically, I investigate how place-based conflict, arising from tensions between the moral and material aspects of a partnership, can shape formalized aspects of organizational structure. These include the scope of operations, partners' roles, and shared resources. I unpack these relationships using a case study of Occupy Medical, a local partnership between the civic society and the local government in Eugene, Oregon, tackling the problem of providing healthcare to the homeless and other marginalized and disenfranchised communities. The analysis covers the nine-year period of 2011-2020 and spans three major restructurings of the organization, the latest prompted by the onset of the COVID-19 pandemic in March 2020. I theorize two forms of structural arrangements for cross-sector partnerships, confined and leveraged, and further elaborate on the role of cross-sector partnerships in crises response on the local level.

Mpox Case Reports in an Urban Homeless Population and a Proof of Concept for a Street-Based Mobile Mpox Vaccination Clinic.

Mpox is a new public health outbreak that particularly threatens the homeless population. Street Medicine Phoenix (SMP) is a student-led interprofessional volunteer organization that provides medical care and other essential services to individuals experiencing homelessness in Phoenix, Arizona. In addition to core services such as wound care; health screenings (blood pressure and blood glucose.); vision screenings; HIV testing; naloxone education and distribution; flu, COVID-19, and Hepatitis A vaccinations; and community resource referrals, SMP began offering mpox education and vaccination at outreach events. During an outreach event shortly after the onset of the mpox outbreak, SMP identified 2 suspected mpox cases. Accordingly, SMP has partnered with the Maricopa County Public Health Department to set up mobile mpox vaccination clinics on the streets outside of Phoenix Arizona's largest homeless shelter. We share the details of these 2 cases along with our early efforts vaccinating individuals experiencing homelessness for mpox via our mobile vaccination clinic. Our experiences demonstrate the importance of community agencies providing direct outreach to underserved populations where they are at, particularly the homeless population, to address public health concerns such as emerging disease outbreaks like mpox. In addition, these cases highlight the potential significant impact that street medicine programs can have on their respective homeless communities in the context of infectious disease mitigation and emphasize the importance of partnerships with local health departments.

Unconditional Cash Transfers and Association With Clinical Outcomes Among U.S. Veterans With Psychosis or Recent Homelessness.

OBJECTIVE: Three rounds of stimulus checks were distributed to middle- and low-income U.S. adults during the COVID-19 pandemic. This 15-month longitudinal study examined rates of receipt of these stimulus checks, planned expenses, and associations with clinical outcomes among three veteran groups. METHODS: In total, 158 veterans, consisting of 59 with a psychotic disorder, 49 recently homeless veterans, and a comparison group of 50 veterans without a history of psychosis or homelessness, were assessed five times between May 2020 and July 2021. Bivariate analyses were used to compare receipt of stimulus checks and planned expenses among the groups, and multivariable analyses examined how receipt of checks was related to mental health and substance use over time. RESULTS: No group difference was found in receipt of stimulus checks, and 74%-84% of veterans reported receipt of more than one check. Most participants reported plans to use their stimulus checks to pay for bills, groceries, credit card debt, and rent or mortgage or to save the money. Over time, participants who received a greater number of stimulus checks reported significantly decreased symptoms of depression (B=-0.48) and anxiety (B=-0.84) and improved social functioning (B=0.24). For the recently homeless group, a greater number of stimulus checks received was associated with decreases in days of alcohol intoxication and drug use, but the reverse was found for the psychosis group. CONCLUSIONS: Multiple short-term unconditional government cash transfers may improve mental and social functioning among vulnerable populations during major crises, a finding that contributes to the research literature and has policy implications for pandemic and emergency preparedness.

A qualitative analysis of COVID-19 vaccination intent, decision-making, and recommendations to increase uptake among residents and staff in six homeless shelters in Seattle, WA, USA

COVID-19 vaccines mitigate severe disease, yet uptake remains low among people experiencing homelessness (PEH) despite the risk of transmission in congregate settings like homeless shelters. This study evaluated retrospective COVID-19 vaccination intent and decision-making between March 2020-October 2021 to identify modifiable factors to improve vaccine acceptance among PEH. We conducted 31 semi-structured interviews and eight focus group discussions across six homeless shelters in Seattle-King County, Washington. Residents and staff aged >= 18 years were recruited through purposive sampling for interviews and convenience sampling for focus groups. Thematic analysis was conducted. Participants reported that too much contradictory and changing information about COVID-19 vaccines led to confusion. Information deemed trustworthy contributed to individual's knowledge and in some cases changed their vaccination intent. While many intended to get vaccinated without external motivators, others were motivated by incentives and requirements. Despite intention to vaccinate, participants reported barriers to COVID-19 vaccine access including availability of vaccine doses, timely eligibility for vaccination, and availability of appointments. Participants presented recommendations to improve COVID-19 information content and dissemination, access, and use of incentives in shelter settings. Future research should test recommended vaccination strategies rooted in the voices and experiences of PEH to determine feasibility and effectiveness in shelter settings.

Housing Insecurity Among Disabled Students During the COVID-19 Pandemic

The purpose of this paper is to examine rates of college students' housing insecurity from September to November 2020 during the COVID-19 pandemic, with a focus on whether there are differences in disabled and nondisabled students' housing insecurity controlling for additional demographic variables and pandemic-related experiences. Using a large sample of 70,210 students enrolled at 130 community and technical colleges and 72 four-year colleges, we discovered that students with chronic illnesses, physical disabilities, psychological disorders, and multiple disabilities had significantly greater odds of experiencing housing insecurity compared to their peers. Students with cognitive, learning, or neurological disorders or disabilities and those who had no disabilities or medical conditions had significantly lower odds of experiencing housing insecurity compared to other students.