Extending Palliative Approaches to Care Beyond the Mainstream Health Care System: An Evaluation of a Small Mobile Palliative Care Team in Calgary, Alberta, Canada.

Background: People experiencing houselessness (PH) endure worse health outcomes than their housed counterparts and often have inadequate care when nearing end of life. Innovative palliative care approaches are necessary when considering socially vulnerable populations. Aim: Evaluate the implementation and early outcomes of the Calgary Allied Mobile Palliative Program (CAMPP) after the first four years of servicing people experiencing extreme social marginality. Setting/Participants: Participants include CAMPP clients and service providers (SPs) who work adjacently to CAMPP in the social services/health sectors. Design: This is a mixed-methods evaluation, including an SP survey (n = 31); client interviews (n = 5); collection of program metrics; and case note reviews. Results: The CAMPP has served 128 clients to date. The CAMPP supported clients by connecting them to 62 services, programs, agencies, and/or resources totaling 485 connections. The most referred-to resource was for social support in the community for PH at 61 referrals. The second was for transportation with 57 referrals, followed by referrals to palliative and Home Care programs (n = 53 referrals). Another common referral was for food assistance with 30 referrals. The survey showed that 97% of SPs agreed that CAMPP is "an essential service in the area of palliative care." Twenty-six of 30 (87%) "Strongly Agreed" or "Agreed" that their knowledge in working with people with life-limiting illnesses has improved since working with CAMPP. The SPs suggested that the team should focus on referral clarity and improved communication with the wider health care team. Finally, clients reported high levels of satisfaction with CAMPP services. Clients also reported challenges navigating the complexity of care in the social/health services sector. Conclusions: The CAMPP bridges the gap in care between health/social services. The CAMPP connects clients to community resources and is effective in adapting to client needs. This evaluation provides four recommendations to improve and build on the existing program.

Explaining the Occupational Structure of Depressive Symptoms: Precarious Work and Social Marginality across European Countries.

The idea that socioeconomic differences are a "fundamental cause" of health and well-being is the basis for large volumes of research. However, one of the challenges in this area is that of linking socioeconomic positions to etiological mechanisms in theoretically informative ways. The situation is doubly challenging because the expression and meaning of socioeconomic positions and the mechanisms they activate change over time. Focusing on depression and applying mediation analysis to data from a large multinational sample from European countries, we find strong support for a three-stage model where occupational differences are largely mediated by exposure to precarious work, which itself is mediated by social marginality. The model is largely robust across welfare state regimes. Ultimately, the research extends fundamental cause perspectives by highlighting connections between "old" and "new" dimensions of socioeconomic status and the social and social psychological sequelae that connect them to psychological well-being.

Interpersonal relationships and drug use over time among homeless people: a qualitative study.

BACKGROUND: Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users. METHOD: We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis. RESULTS: Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 - Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 - Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 - Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 - Cross-cutting factors: death of relatives and substance use. CONCLUSION: The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life.

Posmodernidad yeeducación: imperativos categóricos de la pobreza contemporánea / Postmodernism and education: categorical imperatives of contemporary ovverty / Pós-mdernidade ee educação: imperativos categóricos da pobreza contemporâeaa

Este artículo se fundamenta en los postulados de la teoría del círculo vicioso de la pobreza, analizando la situación de marginalidad social, desigualdad y vulnerabilidad que aqueja a un porcentaje de la población mundial. Metodológicamente el estudio se aborda desde una perspectiva deductiva y holística de la realidad, se analiza el fenómeno de la pobreza en sus diferentes dimensiones sistémicas en un contexto histórico definido por la aplicación cíclica de modelos y paradigmas económicos. El objetivo es demostrar cómo la pobreza se ha convertido en un tema mítico donde las doctrinas económicas y sociales no la han podido definir ni medir eficazmente. La pobreza, cabalgando entre modernidad ilustrada y la postmodernidad emancipadora, constituye la frustración de ideologías, teorías y principios que tuvieron la pretensión de ser depositarios éticos de la verdad en sus axiomas, al tiempo que perpetuaba la marginalidad social.

The article is based on the postulates of the theory of the vicious circle of poverty, analyzing the situation of social marginalization, inequality and vulnerability that is a significant percentage of the world population. Methodologically the study is approached from a deductive and holistic view of reality; the phenomenon of poverty in its various systemic dimensions is analyzed in a historical context defined by the cyclic application of economic models and paradigms. The aim is to show how poverty has become a mythical theme where economic and social doctrines have not been able to define and measure effectively. Poverty, riding between illustrated modernity and emancipator postmodernism, constitutes the frustration of ideologies, theories and principles that had the ambition to be ethical custodians of the truth in its axioms and at the same time perpetuating social marginality.

Este artigo baseia-se nos postulados da teoria do círculo vicioso da pobreza, analisando a situação de marginalidade social, a desigualdade e a vulnerabilidade que atinge uma porcentagem da população mundial. Metodologicamente o estudo é abordado a partir de uma visão dedutiva e holística da realidade, se fez o analise do fenómeno da pobreza nas suas diferentes dimensões sistêmicas num contexto histórico definido pela aplicação cíclica de modelos e paradigmas econômicos. O objetivo é demonstrar como a pobreza tornou-se um tema mítico onde as doutrinas econômicas e sociais não têm sido definidas nem se medir de forma eficaz. A pobreza, indo entre a modernidade ilustrada e a pós-modernidade emancipatória, constitui a frustração de ideologias, teorias e princípios que tiveram a pretensão de serem depositários éticos da verdade nos seus axiomas, ao tempo que perpetuara a marginalidade social.

Detrás del muro: estudio en familias marginales en Bogotá, Colombia / Behind the Wall: A Study of Socially Marginalized Families in Bogotá, Colombia

Introducción: Estudio descriptivo de un grupo de 106 familias de Bogotá (Colombia) a partir de un abordaje terapéutico. Todas las familias tienen la característica de estar en un proceso de inclusión social determinado por los servicios sociales del gobierno local; todos los padres son farmacodependientes. Objetivo: Conocer la idiosincrasia de la cultura de estas familias marginales para abordar y plantear soluciones a sus problemas desde una perspectiva coherente, respetuosa de los valores y las creencias. Método: Estudio cualitativo de tipo descriptivo, centrado en el genograma de cada grupo familiar. Resultados y conclusiones: La muestra de familias con marginalidad social presenta características en interacciones, patrones, estructuras, roles y jerarquías que mantienen el equilibrio y se organizan socialmente por medio de historias compartidas con valor semejante a los mitos. La marginalidad se construye socialmente; los planteamientos institucionales sobre la marginalidad necesitan una nueva conceptualización y un replanteamiento de la labor de los profesionales de la salud mental en este medio.

Introduction: This is a descriptive study of a group of 106 families from Bogotá (Colombia). All the families are undergoing a social inclusion process, determined by the social services of the local government. Objective: To gain knowledge of the social characteristics of these marginalized families in order to come up with solutions to these problems from a coherent point of view, respectful of their values and beliefs. Method: Qualitative study of a descriptive type focused on the genogram of each family group. Results and conclusions: The sample of families with social marginalization exhibit certain features in interactions, patterns, structures, roles and hierarchies that maintain the balance; they are socially organized through shared stories with a value similar to myths. Marginalization is socially constructed. Institutional actions on marginalization are in need of a new approach and conceptualization.