Staying safe, feeling welcome, being seen: How spatio-temporal configurations affect relations of care at an inclusive health and wellness centre.

BACKGROUND: People experiencing homelessness also experience poorer health and frequently attend acute care settings when primary health care would be better equipped to meet their needs. Existing scholarship identifies a complex mix of individual and structural-level factors affecting primary health care engagement driving this pattern of health services utilisation. We build on this existing knowledge, by bringing the spatio-temporal configurations of primary health care into focus. Specifically, we interrogate how space and time inflect situated practices and relations of care. METHODS: This study took an ethnographic approach and was conducted 2021-2022 at an inclusive health and wellness centre ("the Centre") in Southeast Queensland, Australia. The data consists of 46 interviews with 48 people with lived experience of homelessness, including participants who use the services offered at the Centre (n = 26) and participants who do not (n = 19). We also interviewed 20 clinical and non-clinical service providers affiliated with the Centre and observed how service delivery took place. Interviews and observations were complemented by visual data, including participant-produced photography. All data were analysed employing a narrative framework. RESULTS: We present three interrelated themes demonstrating how space and time affect care, that is 'staying safe', 'feeling welcome' and 'being seen'. 'Staying safe' captures the perceptions and practices around safety, which sit in tension with making service users feel welcome. 'Feeling welcome' attends to the sense of being invited to use services free of judgment. 'Being seen' depicts capacities to see a health care provider as well as being understood in one's lived experience. CONCLUSION: Spatio-temporal configurations, such as attendance policies, consultation modalities and time allocated to care encounters afford differential opportunities to nurture reciprocal relations. We conclude that flexible service configurations can leverage a relational model of care. PATIENT OR PUBLIC CONTRIBUTION: Service providers were consulted during the design stage of the project and had opportunities to inform data collection instruments. Two service providers contributed to the manuscript as co-authors. People with lived experience of homelessness who use the services at the inclusive health centre contributed as research participants and provided input into the dissemination of findings. The photography they produced has been featured in an in-person exhibition, to which some have contributed as consultants or curators. It is hoped that their insights into experiences of welcomeness, safety and being seen will inform flexible and relational primary health care design, delivery, and evaluation to better cater for people experiencing housing instability and poverty.

Bystander Intervention in Intimate Partner Violence: A Scoping Review of Experiences and Outcomes.

Governments across the globe are increasingly implementing policies that encourage bystanders to prevent intimate partner violence (IPV) by intervening in violent or potentially violent situations. While a wealth of research examines the most effective mechanisms for increasing potential bystanders' feelings of self-efficacy and rates of intervention, there is significantly less evidence demonstrating how effective bystander intervention is at preventing or interrupting IPV. This article thus presents a scoping review of the literature examining the experiences and outcomes of bystander intervention in IPV. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, extension for Scoping Reviews guidelines, six databases were searched for relevant peer-reviewed studies published in English between 2001 and 2021. A total of 13 articles were ultimately included in the review. The review highlights that although current knowledge on the topic is highly limited, the combined findings of the studies indicate that immediate responses to bystander intervention are heavily context dependent: victims (and perpetrators) tend to react differently to bystander intervention depending on the type of intervention, the type of violence being used, and their relationship to the bystander. However, we have little to no understanding of the outcomes of bystander intervention, or how these outcomes might vary across different contexts. We argue that a more comprehensive understanding of the immediate and long-term implications of bystander intervention across different contexts is crucial if we are to maximize the effectiveness and minimize the potential for harm resulting from bystander interventions in IPV.

Increases in income-support payments reduce the demand for charity: A difference-in-difference analysis of charitable-assistance data from Australia over the COVID-19 pandemic.

Charities play an increasingly important role in helping people experiencing poverty. However, institutionalized charity shifts the burden of poverty reduction away from the state and exposes recipients to stress and stigma. In this paper, we examine whether the need for institutionalized charity can be offset through enhanced state support. As in other countries, the Australian government responded to the COVID-19 pandemic by substantially increasing the level of income support to citizens through several temporary payments. We draw on this natural experiment and time-series data from the two largest charity organizations in Queensland, Australia to examine how these payments altered the demand for institutionalized charity. We model these data using difference-in-difference regression models to approximate causal effects. By exploiting the timing and varying amounts of the payments, our analyses yield evidence that more generous income support reduces reliance on charity. Halving the demand for charity requires raising pre-pandemic income-support by AUD$42/day, with supplements of approximately AUD$18/day yielding the greatest return on investment.

Of Good Mothers and Violent Fathers: Negotiating Child Protection Interventions in Abusive Relationships.

This article examines the efficacy of a supportive housing program aiming to provide mothers in violent relationships with the practical resources to minimize child protection intervention. Drawing on qualitative interviews with program mothers, child safety officers, and program practitioners, we explore the extent to which the program enabled mothers and children to live free from fathers' violence and disengage from the child protection system. We find that, although valuable, the program did not fully mitigate the risks posed by violent fathers. We therefore argue that responsibility must be shifted onto violent fathers to change their behavior and build their parenting capacities.

What About Men? The Marginalization of Men Who Engage in Domestic Violence.

In an international policy context that is increasingly recognizing the gendered nature of domestic violence, governments are becoming more attuned to the importance of improving policy responses for women who have domestic violence enacted against them. This has not, in general, been accompanied by a similar focus on improving policy responses to men who engage in domestic violence, despite a burgeoning body of scholarship suggesting that improved responses to such men are required to more effectively prevent domestic violence from occurring. Importantly, current scholarship also highlights the significant and complex tensions that may arise when policy informed by gendered understandings of domestic violence increases its focus on the men who enact it. Drawing on a critical discourse analysis methodology, we analyze how these tensions are negotiated in domestic violence policy in the Australian state of Queensland. Findings from this analysis demonstrate that the way government policy discursively constructs men who engage in domestic violence has important implications for how such policy targets and engages with members of this group. The article demonstrates that when such men are constructed as outsiders to the community, they may be viewed as undeserving of inclusion and support. This can result in governments failing to prioritize interventions targeted at men who engage in domestic violence, and prevent the active inclusion of such men in the development of policy and interventions. These findings provide important lessons for international governments seeking to implement or strengthen policy responses to end domestic violence against women.

Striving for Gender Equality: Representations of Gender in "Progressive" Domestic Violence Policy.

International feminist scholarship highlights the benefits of approaching domestic violence policy through a gendered lens. Yet to be examined, however, is the extent to which explicitly gendered domestic violence policies may contain barriers that limit the potential benefits of a gendered approach. This qualitative research examines the assumptions embedded in explicitly gendered domestic violence policy in the Australian state of Queensland. Findings suggest that Queensland's "progressive" domestic violence policy is underpinned by dominant gendered assumptions that reinforce existing unequal social structures. These findings offer important lessons for international jurisdictions that aspire to adopt gendered domestic violence policy.