O asseguramento dos direitos sociais a partir da política de Assistência Social para populações em situação de rua / Ensuring social rights based on the Social Assistance policy for homeless people

Este texto tem por objetivo apresentar, na trajetória histórica brasileira, desde a Constituição Federal de 1988, os processos e o asseguramento dos direitos da população em situação de rua, sob a perspectiva da política pública de Assistência Social. A partir do arcabouço legal, aponta a restrição de acesso e a necessidade de estrutura para o atendimento das demandas dessa popula-ção. É na resistência e nas diferentes formas de manifestação desta população, que se tem a contribuição para o processo de garantia dos direitos sociais. No entanto, além de problematizar desafios, destaca também as conquistas junto à política de Assistência Social.

This text aims to present, in Brazilian historical trajectory, since the Federal Constitution of 1988, the processes and the assurance of the rights of the homeless population, from the perspective of the public policy of Social Assistance. Based on the legal framework, it points to a restriction of access and the need for a structure to meet the demands of this population. It is in the resistance and in the different forms of manifestation of this population that the contribution to the process of guaranteeing social rights is made. However, in addition to problematizing challenges, it also highlights the achievements with the Social Assistance policy.

A state of emergency: Dominant cultural narratives on homelessness in Hawai'i.

This exploratory study aimed to identify the dominant cultural narratives on homelessness in Hawai'i-an area of the United States that has seen a precipitous increase in homelessness amid overall national decline. Because media is a primary way in which these narratives are created, solidified, and perpetuated, this study sought to understand the role the local media played in constructing homelessness narratives during this homelessness "crisis." This study used thematic content analysis of a random sample of 648 articles of Hawai'i media coverage between 2012 and 2017. The analysis found that media coverage of homelessness in Hawai'i emphasized structural-level causes and solutions, while simultaneously relying on stereotypes and stigmatizing characteristics. However, coverage became more complex over time and was open to revision based on new information. This study suggests that media could be a viable target of interventions seeking to produce healthy and accurate narratives.

The development of the Police Practices Scale: Understanding policing approaches towards street-based female sex workers in a U.S. City.

Policing is an important structural determinant of HIV and other health risks faced by vulnerable populations, including people who sell sex and use drugs, though the role of routine police encounters is not well understood. Given the influence of policing on the risk environment of these groups, methods of measuring the aggregate impact of routine policing practices are urgently required. We developed and validated a novel, brief scale to measure police patrol practices (Police Practices Scale, PPS) among 250 street-based female sex workers (FSW) in Baltimore, Maryland, an urban setting with high levels of illegal drug activity. PPS items were developed from existing theory and ethnography with police and their encounters with FSW, and measured frequency of recent (past 3 months) police encounters. The 6-item scale was developed using exploratory factor analysis after examining the properties of the original 11 items. Confirmatory factor analysis was used to model the factor structure. A 2-factor model emerged, with law enforcement PPS items and police assistance PPS items loading on separate factors. Linear regression models were used to explore the relative distribution of these police encounters among FSW by modeling association with key socio-demographic and behavioral characteristics of the sample. Higher exposure to policing was observed among FSW who were homeless (ß = 0.71, p = 0.037), in daily sex work (ß = 1.32, p = 0.026), arrested in the past 12 months (ß = 1.44, p<0.001) or injecting drugs in the past 3 months (ß = 1.04, p<0.001). The PPS provides an important and novel contribution in measuring aggregate exposure to routine policing, though further validation is required. This scale could be used to evaluate the impact of policing on vulnerable populations' health outcomes, including HIV risk.

Resetting Policies to End Family Homelessness.

Homelessness is a devastating experience for children and their families. Families, the majority of whose members are children, now comprise more than one-third of the overall US homeless population. Most of these children are less than six years old. Various assumptions have driven policy and the allocation of resources to programs serving these families. Although decades of research and field experience suggest strategies for preventing and reducing this problem, perspectives differ, hindering the development of effective solutions. In this article, we explore some of these assumptions, including (a) definitions of homelessness used to count the numbers of families and determine resource allocation, (b) the needs of children and responses to the impact of adverse childhood experiences, and (c) whether services matter and should be integrated with affordable housing. We conclude by suggesting various directions to ensure that these children are protected and have the opportunity to grow and thrive.

Homelessness in mental illness: Opportunities & prospects in the Indian context.

Homelessness is considered a serious public health concern. Bidirectional relationship has been established between homelessness and mental illness by research studies and its association with compromised well-being, poor quality of life and low productivity. Recent legislative enactments in India have necessitated on the part of the state to address issues related to the rights of persons with mental illness including shelter and housing. Therefore, it becomes imperative to discuss opportunities and prospects in India towards rehabilitating homeless mentally ill in context of existing programs, policies and legislations.

Housing in crisis: A qualitative study of the socio-legal contexts of residential evictions in Vancouver's Downtown Eastside.

BACKGROUND: People who use drugs (PWUD) commonly experience housing vulnerability due to the intersection of drug laws, housing policies, gentrification, and social marginalization. Housing vulnerability produces social suffering amongst PWUD and is linked to health and social harms. In Vancouver, Canada, the rapid gentrification of the Downtown Eastside - a low-income inner-city neighbourhood - and the lack of affordable housing has led to residential evictions emerging as a key community concern. This study sought to understand the policies and practices that produced evictions among PWUD, situating vulnerabilities to evictions within the context of wider structural vulnerability of PWUD. METHODS: Between June 2015 and March 2016, baseline and 3-6 month follow-up qualitative interviews were conducted with recently evicted (past 60 days) PWUD in the Downtown Eastside. Participants were recruited by Peer Research Assistants. Baseline interviews (n = 56) focused on causes and socio-legal contexts of evictions, with follow-up interviews (n = 41) focusing on longer-term impacts. Interviews were analyzed thematically and interpreted by drawing on the concept of structural vulnerability. RESULTS: Most participants were evicted unlawfully, unfairly, and into homelessness. Participants were rendered structurally vulnerable to unlawful evictions by the shortcomings of existing residential tenancy laws and current dispute mechanisms. Residents of non-profit buildings, for whom it was unclear if provincial residential protections apply, found their housing security further undermined through the denial of rights extended to privately-housed tenants. Attempts to assert tenant rights further increased participants' vulnerability to eviction through landlord retaliation and targeting. CONCLUSION: Findings demonstrate the inadequacy of existing housing policies and tenancy supports to account for the structural vulnerability of PWUD and their role in driving harms. Policy reforms are needed to address unlawful evictions and increase tenancy security, and must be accompanied by low-barrier interventions to more fully address this key driver of social suffering among PWUD.

Pediatric Emergency Department Visits for Homelessness After Shelter Eligibility Policy Change.

BACKGROUND AND OBJECTIVES: In 2012, Massachusetts changed its emergency shelter eligibility policy for homeless families. One new criterion to document homelessness was staying in a location "not meant for human habitation," and the emergency department (ED) fulfilled this requirement. Our aim for this study is to analyze the frequency and costs of pediatric ED visits for homelessness before and after this policy. METHODS: This is a retrospective study of ED visits for homelessness at a children's hospital from March 2010 to February 2016. A natural language processing tool was used to identify cases, which were manually reviewed for inclusion. We compared demographic and homelessness circumstance characteristics and conducted an interrupted time series analysis to compare ED visits by homeless children before and after the policy. We compared the change in ED visits for homelessness to the number of homeless children in Massachusetts. We analyzed payment data for each visit. RESULTS: There were 312 ED visits for homelessness; 95% (n = 297) of visits were after the policy. These visits increased 4.5 times after the policy (95% confidence interval: 1.33 to 15.23). Children seen after the policy were more likely to have no medical complaint (rate ratio: 3.27; 95% confidence interval: 1.18 to 9.01). Although the number of homeless children in Massachusetts increased 1.4 times over the study period, ED visits for homelessness increased 13-fold. Payments (average: $557 per visit) were >4 times what a night in a shelter would cost; 89% of payments were made through state-based insurance plans. CONCLUSIONS: A policy change to Massachusetts' shelter eligibility was associated with increased pediatric ED visits for homelessness along with substantial health care costs.

Conducta delictiva en las personas sin hogar con trastorno mental grave / Criminal behavior among homeless individuals with severe mental illness

Introducción. Varios estudios estadounidenses han investigado la conducta delictiva en las personas sin hogar con trastorno mental grave. Pero hasta la fecha ninguno se ha realizado en España. Metodología. Estudio observacional retrospectivo, en una muestra de 118 pacientes, seleccionados de un programa de atención psiquiátrica para personas sin hogar con trastorno mental grave. Se analizaron los factores asociados a la conducta delictiva mediante la comparación de 2 grupos, con y sin antecedentes penales. Resultados. El 24,6% de la muestra tenía algún antecedente penal y el 58,6% de este grupo había ingresado en prisión. Se encontraron diferencias significativas entre ambos grupos para las variables: sexo, condenas pendientes, duración del sinhogarismo, comorbilidad con politoxicomanía, conciencia de enfermedad y gravedad de los síntomas psicóticos. Conclusiones. En la población de personas sin hogar con trastorno mental grave, con independencia del sexo, la coexistencia de comorbilidad con politoxicomanía y una duración prolongada del sinhogarismo, constituyen el factor de riesgo más importante para la conducta delictiva

Introduction. Several US studies have investigated the criminal behaviour among homeless individuals with severe mental illness. But to date, no studies have been carried out in Spain. Method. A retrospective observational study was conducted on a sample of 118 patients selected from a psychiatric care program for homeless individuals with severe mental illness. Factors associated with criminal behaviour were analysed by comparing 2 groups, with and without criminal records. Results. Of the total sample studied, 24.6% had a criminal record, and 58.6% of them had entered prison. Significant differences between groups were found for the variables of gender, pending sentences, duration of homelessness, multiple substance use, disease awareness, and severity of psychotic symptoms. Conclusions. In the population of homeless individuals with severe mental illness, regardless of gender, the co-existence of comorbidity with multiple substance use, and a prolonged duration of homelessness, is the most important risk factor for criminal behavior

Medical-Legal Partnerships At Veterans Affairs Medical Centers Improved Housing And Psychosocial Outcomes For Vets.

Medical-legal partnerships-collaborations between legal professionals and health care providers that help patients address civil legal problems that can affect health and well-being-have been implemented at several Veterans Affairs (VA) medical centers to serve homeless and low-income veterans with mental illness. We describe the outcomes of veterans who accessed legal services at four partnership sites in Connecticut and New York in the period 2014-16. The partnerships served 950 veterans, who collectively had 1,384 legal issues; on average, the issues took 5.4 hours' worth of legal services to resolve. The most common problems were related to VA benefits, housing, family issues, and consumer issues. Among a subsample of 148 veterans who were followed for one year, we observed significant improvements in housing, income, and mental health. Veterans who received more partnership services showed greater improvements in housing and mental health than those who received fewer services, and those who achieved their predefined legal goals showed greater improvements in housing status and community integration than those who did not. Medical-legal partnerships represent an opportunity to expand cross-sector, community-based partnerships in the VA health care system to address social determinants of mental health.

Youth Homelessness and Vulnerability: How Does Couch Surfing Fit?

Youth homelessness is a problem characterized by high levels of vulnerability. The extent to which couch surfing - moving from one temporary housing arrangement to another - is part of youth homelessness is not well understood. Chapin Hall's Voices of Youth Count, a national research initiative, involves a multicomponent approach to studying youth homelessness. This study reports emerging findings regarding couch surfing and homelessness primarily from a national survey of 13,113 adults with youth ages 13-25 in their households or who are themselves ages 18-25. Findings suggest that couch surfing is relatively common, particularly among the older age group. Among households with 13- to 17-year-olds and 18- to 25-year-olds, 4.0% and 20.5%, respectively, reported that any of them had couch surfed in the last 12 months. There are notable social, economic, and educational differences, on average, between youth reporting homelessness and those reporting only couch surfing. However, most youth who report experiencing homelessness also report couch surfing, and these youth who experience both circumstances present high levels of socioeconomic vulnerability. Couch surfing encompasses a range of experiences, some of which likely include need for services. Interviews currently in the field, and expanded analysis of data, will contribute more nuanced policy insights.

The homeless pregnant woman.

Women who are pregnant and homeless constitute a unique group at significant risk of adverse foetal and maternal outcomes. Despite this heightened risk profile, social housing support to this group of women is less than satisfactory. Concerted effort and more collaborative working is needed by all who provide social, and healthcare services to homeless pregnant women, to improve the lot of these women. Clear definitions and legislative provisions in respect of the homeless will go a long way in reducing ambiguity and close loopholes which currently act to deny the homeless pregnant woman social housing support at a time when it is most needed.

Patterns of Shelter Use Among Men New to Homelessness in Later Life: Duration of Stay and Psychosocial Factors Related to Departure.

People who become homeless for the first time in late life are a growing but understudied population. This study draws on administrative data from one shelter (N = 1,214 first-time homeless) to assess the extent to which age is related to shelter stay and, to examine psychosocial factors that may be associated with shelter departure. Our bivariate and survival analysis results suggest that older homeless men stay in the shelter 2 weeks longer than younger clients. Older men with pending legal issues and mobility concerns were more likely to leave the shelter than those without such concerns. Findings highlight the impact of age and other psychosocial variables on shelter stay, and provide direction from which to address homelessness among men who are new to homelessness in later life.

Partnerships Between Health Care and Legal Providers in the Veterans Health Administration.

Medical-legal partnerships (MLPs) represent an innovative service model in which lawyers are integrated into health care teams to address diverse legal problems that affect vulnerable populations. The Veterans Health Administration (VHA) operates the largest safety-net health care system in the country and serves many low-income and disabled veterans who could benefit from MLP services. In this column, the authors describe the development and operations of MLPs at four VHA medical centers that serve veterans who are homeless or who have serious mental illness. The authors also briefly report on the characteristics of 700 veterans served by these MLPs from 2014 to 2016. MLPs can fit within the interdisciplinary, comprehensive system of care provided by VHA, and they offer opportunities to expand VHA-community partnerships to address social determinants of health.