Canadian Health Care Providers' Perspectives on Working with Older Homeless Adults in Outreach Settings.

Service providers have a unique understanding of older homeless adults' challenges and service needs. However, research on the experiences of health care providers (HCPs) who work with this population is limited. We aimed to gain a better understanding of the experiences (roles, challenges, and rewards) of HCPs who work with older homeless adults (age 50 and over) in outreach settings. We conducted individual semi-structured interviews with 10 HCPs who worked in these roles. Four themes emerged: (a) the client-provider relationship as an essential building block to HCPs' work; (b) progression of care that acknowledges the "whole person"; (c) collaboration as integral to providers' work; and (d) the importance of system navigation. Providers found their work personally and professionally fulfilling but were frustrated by system-level challenges. Findings can be used to identify strategies on how to further support providers in their roles and enhance service provision for older homeless individuals.

"A minha casa é na rua": vivências da população em situação de rua de Novo Hamburgo / "The streets are my home": experiences of the homeless population in Novo Hamburgo / "Mi casa está en la calle": vivencias de la población en situación de calle de Novo Hamburgo / «Ma maison est dans la rue¼: des expériences de la population sans-abri de Novo Hamburgo

Resumo Este estudo objetiva analisar as vivências de pessoas em situação de rua vinculadas ao Centro de Referência Especializado para População em Situação de Rua (Centro POP) da cidade de Novo Hamburgo, no Rio Grande do Sul. A pesquisa realizada com seis participantes é de caráter exploratório-descritivo com abordagem qualitativa. Utilizaram-se um questionário sociodemográfico e uma entrevista semiestruturada. Os dados foram submetidos à análise temática. Em relação às vivências na rua, a violência apareceu como um elemento central. Os participantes relataram diferentes tipos de violência e práticas que retiram a dignidade do sujeito e perpetuam o lugar de exclusão. Ademais, foram atribuídos à rua diferentes sentidos, pois se configura tanto como um local de vulnerabilidade e insegurança quanto um espaço de sobrevivência e construção de vínculos. Evidencia-se, assim, a necessidade de políticas públicas afirmativas que garantam a dignidade e os direitos dessa população, combatendo especialmente as práticas de violência.

Abstract This study aims to analyze the experiences of homeless persons who attend a Specialized Reference Center for the Homeless Population in the municipality of Novo Hamburgo, in Rio Grande do Sul. This exploratory-descriptive qualitative research was carried out with six participants. Sociodemographic questionnaires and semi-structured interviews were used. Thematic analysis was used to analyze the data. Violence was identified as a key element in volunteers' experiences of homelessness. Participants reported different types of violence and actions that violated subjects' dignity and perpetuated exclusion spaces. Moreover, different meanings were attributed to the streets since participants perceived them as both a place of vulnerability and insecurity and as a space for survival and construction of bonds. Thus, we have evinced the need for affirmative public policies that guarantee the dignity and rights of this population, especially to combat violence.

Resumen Este estudio pretende analizar las vivencias de personas en situación de calle vinculadas al Centro de Referencia Especializado para Población en Situación de Calle (Centro POP) de la ciudad de Novo Hamburgo, en Rio Grande do Sul (Brasil). La investigación realizada con seis participantes es exploratoria, descriptiva, de abordaje cualitativo. Se utilizaron un cuestionario sociodemográfico y una entrevista semiestructurada. Los datos se sometieron al análisis temático. Sobre las vivencias en la calle, la violencia fue un elemento central. Los participantes relataron diferentes tipos de violencia y prácticas que quitan la dignidad del sujeto y perpetúan la exclusión. Además, atribuyeron a la calle diferentes sentidos, pues esta se configura tanto como un sitio de vulnerabilidad e inseguridad como un espacio de supervivencia y construcción de vínculos. Se evidencia, así, la necesidad de políticas públicas afirmativas que garanticen la dignidad y los derechos de esa población, especialmente en combate a las prácticas de violencia.

Résumé Cette étude a le but d'analyser les expériences des personnes sans-abri liées au Centre de Référence Spécialisé pour la Population en Sans-Abri (Centro POP) de Novo Hamburgo, Rio Grande do Sul. Larecherche, réalisé eavec six participants, aun caractère exploratoire-descript if d'approche qualitative. On autilisé un questionnaire socio-démographique etune interview semi-structurée. Les données ont éte soumises à l'analyse thématique. La violence est considérée un élément central des expériences dans la rue. Les participants ont rapporté plusieurs types de violence et pratiques qui enlèvent leur dignité et perpétuent le lieu d'exclusion. Des différents sens sont aussi attribués à la rue, car elle se configure comme un lieu de vulnérabilité et insécurité, ainsi qu'un espace de survie et de construction de liens. Le besoin de politiques publiques affirmatives qui garantissent la dignité et les droits de cette population, en luttant contre les pratiques de violence est aussi relevé.

[Welcoming and caring for homeless people]. / Accueillir les personnes sans abri et en prendre soin.

Dedicated care facilities can accommodate homeless people who are in situations that may lead to neglect due to their social insecurity, psychiatric and/or cognitive disorders. This is the case of the reception and hospital care centre in Nanterre (92), in the Paris suburbs. The professionals there provide a humane welcome to people whose physical condition, health and hygiene are often very poor. Taking care of them is the richness of the experience.

Diálogos entre gênero e as experiências com a população de rua / Dialogues between gender and experiences with the street population / Diálogos entre género y las experiencias con las personas sin hogar / Dialogues entre les questions de genre et les expériences avec la population sans-abri

Este artigo buscou compreender a relação entre as experiências da população de rua - articuladas com o Movimento Nacional da População de Rua em Santa Catarina (MNPR/SC) - e as questões de gênero. Para tanto, realizamos uma pesquisa qualitativa com base na cartografia, através do acompanhamento das reuniões e ações do Movimento. A análise crítica destas informações aliou-se aos estudos feministas, com ênfase no pensamento de Judith Butler. Os resultados apontam que as discussões de gênero tem se constituído elemento de problematização e configuração de pautas de luta, principalmente frente às demandas das mulheres na rua. Analisamos que a dimensão de gênero atua como uma categoria implicada na produção de relações binárias e corrobora a manutenção de privilégios dos homens sobre as mulheres e a população LGBT+. Ainda, consideramos que a normatividade de gênero produz efeitos nas condições de reconhecimento, (in)visibilidade e apreensão das vidas nas ruas, intensificando sua condição precária.

This article sought to understand the relation between the experiences of the street population - articulated with the Street Population National Movement in Santa Catarina (MNPR/SC) - and gender issues. To this end, we carried out a qualitative and cartography-based research, accompanying the Movement's meetings and actions. The critical analysis of these information was allied with feminist studies, with emphasis on Judith Butler's thoughts. The results indicate that gender discussions have become an element of problematization and setting political fight agendas, especially regarding the demands of homeless women. We analyzed that the gender dimension acts as a category implicated in the production of binary relations and corroborates to the maintenance of male privilege over women and the LGBT+ population. Furthermore, we consider that the gender normativity produces effects on the conditions of recognition, (in)visibility and apprehension of lives on the streets, intensifying their precarious condition.

Este artículo buscó comprender la relación entre las experiencias de personas sin hogar, relacionadas con el Movimiento Nacional de Población sin Hogar en Santa Catarina (MNPR) y las cuestiones de género. Para eso, realizamos una investigación cualitativa basada en la cartografía, a partir de un seguimiento de las reuniones y acciones de este colectivo. El análisis crítico de estas informaciones se alió a los estudios feministas, con énfasis en el pensamiento de Judith Butler. Los resultados apuntan que las discusiones de género se constituyen como elementos de problematización y configuración de pautas de lucha, principalmente frente a las demandas de las mujeres en la calle. Analizamos que la dimensión de género actúa como una categoría implicada en la producción de relaciones binarias y corrobora el mantenimiento de privilegios de los hombres sobre las mujeres y la población LGBT. Además, consideramos que la normatividad de género produce efectos en las condiciones de reconocimiento, (in) visibilidad y aprehensión de las vidas en las calles, intensificando su condición precaria.

Cet article a pour but de comprendre la relation entre les expériences de la population sans-abri - articulées au Mouvement National de la Population sans-abri de Santa Catarina (MNPR / SC) - et les questions de genre. Pour cela, nous avons mené une recherche qualitative basée sur la cartographie, à travers le suivi des rencontres et des actions de ce Mouvement. L'analyse critique de ces informations a été réalisée à partir des études féministes, en mettant l'accent sur les propos de Judith Butler. Les résultats montrent que les discussions sur le genre ont été un élément de problématisation et de configuration des programmes de lutte, en particulier face aux demandes des femmes sans domicile fixe. En effet, notre conclusion montre que la dimension de genre agit comme une catégorie impliquée dans la production de relations binaires et corrobore le maintien des privilèges des hommes sur les femmes et la population LGBT +. En outre, nous considérons que la normativité de genre présente des effets sur les conditions de reconnaissance, de (in)visibilité et d'appréhension des vies de ceux/celles qui appartiennent à cette population, intensifiant leur précarité.

Promoting parent-infant responsiveness in families experiencing homelessness.

My Baby's First Teacher is an intervention designed specifically for parents with infants staying in emergency homeless shelters. Infants are overrepresented in shelter populations and face considerable risk to their development, including mental health. We utilized a randomized controlled design across three family shelters to evaluate the program's effectiveness with 24 dyads assigned to the intervention compared to 21 dyads in care-as-usual. Dyads were randomized by round at each site to account for shelter effects. We used path analysis to illustrate change over time and in relation to intervention assignment.

El Primer Maestro de mi Bebé es una intervención diseñada específicamente para progenitores con infantes que se alojan en refugios de emergencia para personas sin casa. En la población de los refugios, los infantes están sobrerrepresentados y enfrentan un considerable riesgo en cuanto a su desarrollo, incluyendo la salud mental. Utilizamos un diseño de control al azar a través de tres refugios de familias para evaluar la eficacia del programa con 24 díadas asignadas al grupo de intervención que fueron comparadas con 21 díadas bajo el cuidado usual. A las díadas se les colocó al azar por etapas en cada lugar para tener en cuenta los efectos del refugio. Usamos un análisis de trayectoria para ilustrar el cambio a través del tiempo y en relación con la asignación de intervención. Resultados claves: los resultados indicaron mejoras en la observada sensibilidad de progenitor-infante relacionada con la intervención en el lugar, con un control en cuanto a los niveles iniciales de sensibilidad. Los resultados fueron consistentes entre un modelo de intención de tratar y un modelo para probar la participación cierta en la intervención. No encontramos ningún efecto significativo para el estrés de crianza o la ansiedad del progenitor, aunque las tendencias sugirieron más altos puntajes para las familias de la intervención. Implicaciones para la práctica y las políticas: presentamos los resultados considerando retos específicos en contextos de casos sin casa para la salud mental infantil. Este trabajo puede servir de base para los esfuerzos de quienes proveen servicios y encuentran familias que experimentan el estar sin casa, así como también las políticas sobre los recursos para programaciones en albergues de emergencia.

Le Premier Enseignant de Mon Bébé est une intervention conçue spécialement pour les parents dont les bébés restent dans des foyers d'urgence pour sans-abris. Les bébés sont sur-représentés dans les populations de ces foyers et ils font face à un risque considérable pour leur développement, y compris pour ce qui concerne leur santé mentale. Nous avons utilisé un schéma expérimental contrôlé pour 3 trois foyers familiaux afin d'évaluer l'efficacité du programme avec 24 dyades désignées pour l'intervention comparé à 21 dyades dans le groupe de soins habituels. Les dyades ont été randomisées par ronde sur chaque site afin de contrôler les effets du foyer. Nous avons utilisé une analyse causale pour illustrer le changement au fil du temps et en relation au groupe d'intervention. Constatations Clés: Résultats a indiqué des améliorations dans la réaction observée parent-bébé liée à l'intervention en fin d'étude, contrôlant les niveaux initiaux de réaction. Les résultats sont cohérents entre un modèle intention-de-traiter et un modèle testant la véritable participation à l'intervention. Nous n'avons trouvé aucun effet important pour le stress de parentage ou la détresse du parent, bien que des tendances suggèrent des scores plus élevés pour les familles d'intervention. Nous présentons des résultats en considérant les défis uniques aux contextes de la vie des sans-abris pour la santé mentale du nourrisson. Ce travail peut orienter les efforts des prestataires de services qui rencontrent des familles faisant l'expérience d'une vie sans abri ainsi que les lois et pratiques concernant les ressources pour des programmes dans des foyers d'accueil d'urgence.

[One homeless person out of ten suffers from cognitive disorders: What do we know about these impairments? A systematic review of homeless people's cognition]. / Une personne SDF sur 10 souffre de troubles cognitifs : que sait-on de ces troubles ? Une revue de littérature sur la cognition des personnes SDF.

OBJECTIVES: Homelessness is associated with several issues (psychiatric and neurological disorders, neurodevelopmental difficulties, malnutrition…) which are also risk factors for cognitive disorders. However, little is known about the relationship between the cognition of homeless people and these eventual explicative etiologies. The aim of this work is to complete the results of Depp et al. about cognition in homelessness by proposing a systematic review of the neuropsychological disorders of homeless people associated with an analysis of the etiologies likely to explain these disorders. METHODS: We followed the PRISMA recommendations to build up this work. We analyzed the abstracts of 385 papers found on databases PSYCINFO and PubMed. Twenty-two studies have been selected for respecting our criteria (at least one valid neuropsychological test ; general group of homeless people and not a sub-group of this population ; study published in English). The prevalence quality has been evaluated through the criteria of Loney et al. Cognitive scores and etiological factors have been compared between studies. RESULTS: The 22 studies represent only nine countries. More than half of them are considered as having a poor prevalence quality. In total, 4,256 participants have been evaluated. Their mean age was around 40 years, and 85 % of the participants were men. The results show a prevalence of cognitive disorders (MMSE) in 8.77 % of the sample. The mean IQ was 87.47 and the premorbid IQ 94.59. We also notice possible disorders affecting the episodic memory and the executive functions. Mean scores for short-term memory, speech and visuo-spatial functions are relatively low. None of the studies evaluated the praxia, the gnosia or the social cognition. The heterogeneity of studies and the lack of data did not allow us to give general conclusions about the etiology of these disorders. However, we see that around 40 % of the time subjects had histories of brain injuries and 89 % of childhood trauma. Intellectual disability is found in 49 % of the sample of a single study. Also, 70 % of the homeless population have been diagnosed with substance-related disorders and 65 % with psychiatric disorders. It appears that the only factors correlated with cognitive disorders would be the history of brain injuries and childhood traumas. CONCLUSIONS: We confirm that homeless people often suffer from cognitive difficulties, and some of these difficulties (memory, executive functioning) are severe. Yet the etiology of these disorders remain relatively unknown: even if we observe a high prevalence of psychiatric, substance-related, neurodevelopmental and neurological issues by the homeless population, only a few of them (brain injury history and childhood trauma) seem to be correlated with cognition in homelessness. The potential explicative factors have been too rarely explored to bring a powerful explanation of cognitive disorders in homeless people. Further research needs to be done in order to give a more precise neuropsychological profile of the homeless population and to better understand what the disorders are rooted in. Last but not least, all this research and knowledge should be applied more to the care of homeless people by providing neuropsychological assessment and rehabilitation and by training the team to detect cognitive disorders and to support the person with a cognitive disability.

Boredom and meaningful activity in adults experiencing homelessness: A mixed-methods study.

BACKGROUND.: Boredom has been reported as a frequent problem experienced by homeless persons, with implications for mental and social well-being. PURPOSE.: This study aimed to explore the nature and impact of boredom in the lives of homeless and formerly homeless persons. METHOD.: A mixed-methods design was used to engage 13 participants in a structured 92-item quantitative interview using six standardized measures, followed by a semistructured qualitative interview. Correlational analyses were performed with the data compiled from the quantitative interviews, and grounded theory strategies were used to analyze our qualitative data. The two analyses were integrated at the stage of interpretation. FINDINGS.: Boredom was described as a profound and pervasive experience for homeless persons, imposing deleterious impacts on mental well-being and driving substance use. A strong positive correlation between meaningful activity and mental well-being (r s = .767, p <. 01) and a strong negative correlation between boredom and belonging in one's community (r s = -.771, p < .01) were identified. IMPLICATIONS.: Boredom is a critical topic of study for occupational therapy in the area of homelessness. Future research is needed to design and test interventions to optimize the mental well-being, participation, and social connectedness of this population.

Pesquisa-intervenção, políticas públicas e movimentos sociais: uma experiência junto à população em situação de rua / Intervention research, public policies and social movements: an experience with the homeless population / Investigación-intervención, políticas públicas y movimientos sociales: una experiencia junto a personas sin hogar / Recherche intervention, politiques publiques et mouvements sociaux: une expérience avec la population sans abri

Este artigo apresenta uma experiência de pesquisa-intervenção que teve como objetivos conhecer a população adulta em situação de rua; mapear e conhecer o funcionamento das políticas públicas para esta população; identificar as violações de direitos humanos e conhecer o cotidiano destas pessoas. Com base nos marcos teórico-metodológicos da Análise Institucional e da Cartografia, o trabalho de campo considerou diferentes estratégias metodológicas em cenários institucionais e na cidade, que geraram dados sobre as principais dificuldades vividas, itinerários institucionais e estratégias desenvolvidas por estas pessoas em várias políticas públicas, identificando e colocando em análise as linhas duras (instituído) e as linhas flexíveis (instituinte) nas relações com o Estado. A pesquisa-intervenção promoveu visibilidade às principais questões vividas por este segmento vulnerável, bem como fomentou sua organização política e empoderamento, com vistas à garantia de direitos.

This article presents a research-intervention experience that had as objectives to know the adult population in homeless situation; map and know the operation of public policies for this population; to identify the violations of human rights and to know the daily life of these people. Based on the theoreticalmethodological frameworks, Institutional Analysis and Cartography, the field work considered different methodological strategies in institutional settings and in the city that generated data about the main difficulties, institutional itineraries and strategies developed by these people in the various public policies, identifying and analyzing the hard lines (instituted) and flexible lines (institute) in relations with the State. The intervention research promoted visibility of the main issues faced by this vulnerable segment, as well as fostered its political organization and empowerment with a view to guaranteeing rights.

Este artículo presenta una experiéncia de investigaciónintervención que intentó conocer la población adulta en situación de calle; mapear y conocer el funcionamiento de las políticas públicas para esta población; identificar las violaciones de derechos humanos y conocer el cotidiano de estas personas. Con base en los marcos teórico-metodológicos del Análisis Institucional y Cartografía, el trabajo de campo consideró diferentes estrategias metodológicas en escenarios institucionales y en la ciudad que generaron dados sobre las principales dificultades, itinerarios institucionales y estrategias desarrolladas por estas personas en varias políticas públicas, identificando y poniendo en análisis las líneas duras (instituido) y las líneas flexibles (instituyente) en las relaciones con el Estado. La investigaciónintervención promovió visibilidad las principales cuestiones vividas por este segmento vulnerable, así como fomentó su organización política y empoderamiento con miras a garantía de derechos.

Cet article présente une expérience de recherche-intervention visant à connaître la population adulte sans abri, à cartographier et à connaître le fonctionnement des politiques publiques en faveur de cette population. Elle vise également à découvrir les violations des droits de l'homme et à connaître la vie quotidienne de ces personnes. Basé sur les cadres théoriques et méthodologiques de l'analyse institutionnelle et de la cartographie, le travail empirique a examiné différentes stratégies méthodologiques dans les contextes institutionnels et dans la ville. Ceux-ci ont généré des données sur les principales difficultés rencontrées, les itinéraires institutionnels et les stratégies développées par ces personnes dans différentes politiques publiques, en identifiant et en analysant les lignes rigides (instituées) et flexibles (institut) dans les relations avec l'État. La recherche-intervention a favorisé la visibilité des principaux problèmes rencontrés par ce segment vulnérable, ainsi que son organisation politique et son autonomisation en vue de garantir des droits.

UNDERSTANDING PARENTING STRESS AND CHILDREN'S BEHAVIOR PROBLEMS AMONG HOMELESS, SUBSTANCE-ABUSING MOTHERS.

This article tested a model of parenting stress as a mediator between maternal depressive symptoms, emotion regulation, and child behavior problems using a sample of homeless, substance-abusing mothers. Participants were 119 homeless mothers (ages 18-24 years) and their young children (ages 0-6 years). Mothers responded to questions about their depressive symptoms, emotion regulation, parenting stress, and child behavior problems. A path analysis showed that maternal depressive symptoms were positively associated with child behavior problems through increased parenting stress whereas maternal cognitive reappraisal was negatively associated with child behavior problems through decreased parenting stress. Moreover, maternal expressive suppression was negatively related to child externalizing problems. Findings support the parenting stress theory and highlight maternal parenting stress as a mechanism associated with homeless children's mental health risk. This study has significant implications for understanding the parenting processes underlying child's resilience in the context of homelessness and maternal substance use.

"I'M OPENING MY ARMS RATHER THAN PUSHING AWAY:" PERCEIVED BENEFITS OF A MINDFULNESS-BASED INTERVENTION AMONG HOMELESS WOMEN AND YOUNG CHILDREN.

Family homelessness is associated with adverse outcomes in mothers and their young children. Evidence-based programs are needed to support the socioemotional needs of these families. The purpose of this qualitative study was to explore the perceived benefits of participating in a mindfulness program in mother-child dyads receiving services at a therapeutic nursery serving homeless children under the age of 3 years. A convenience sample of 17 predominantly African American mothers participated in in-depth qualitative interviews. Four themes were derived from the data regarding the perceived benefits of the mindfulness program: "me" time, maternal self-regulation, dyadic connectedness, and child well-being. Results demonstrate the perceived benefits of mindfulness on the parent-child relationship and have important implications for families at an increased risk of adverse outcomes. Because homelessness and residential instability confer considerable risk for young children, interventions to support effective parenting are critical.