Chapter 23: Homeless Populations Flashcards
US definition of homelessness determined by fed government, admin, legislative actions; responsibility for entering and managing fed homeless initiative assigned to 7 diff depts in executive branch;
HUD - governmental institutional responsibile for addressing homeless
Category 1. Literally Homeless:
Category 2. Imminent Risk of Homelessness:
Category 3. Homeless Under Other Federal Statutes:
Category 4. Fleeing/Attempting to Flee Domestic Violence (DV):
Department of housing and urban development (HUD) - definitions of homelessness
Individuals and families who lack a fixed, regular, and adequate nighttime residence meaning:
Place not fit for human habitation
Can live in shelters: private/public; more temp arrangements; not place where can take up residence on long-term basis
Has a primary nighttime residence that is public or private area that is not met for human habitation
Living in a publicly or privately operated shelter designated to provide temporary living arrangements (including shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, and local programs)
Exiting an institution where he or she has resided for 90 days or less and resided in an emergency shelter or place not meant for human habitation immediately before entering the institution
Category 1. Literally Homeless:
Individuals and families who will imminently at risk of losing their primary nighttime residence; risk losing home anyday; facing eviction and nowhere else to go
Category 2. Imminent Risk of Homelessness:
Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition. Includes children; aging out of foster sys
Category 3. Homeless Under Other Federal Statutes:
Individuals and families who are fleeing or attempting to flee domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence
Category 4. Fleeing/Attempting to Flee Domestic Violence (DV):
Works with HUD
Targeting students who are homeless
Admins McKinney-Vento Homeless Education Assistance Improvements Act of 2001 ensures that each child and each homeless youth has equal access to the same free, appropriate public education, including a public preschool education, as provided to other children and youths; direct state and local laws to ensure child and youth has equal access
Includes children and youth who are:
Department of education (ED) - definition of homeless student
Sharing the housing of other persons (frequently referred to as “doubling up”) - might be indiv living with friend/fam member - not literally homeless but are - not have home of own
Abandoned in hospitals or
Awaiting foster care placement - foster care works with ED closely
Includes children and youth who are:
Not 1 cause
Shortage of affordable housing
Income insufficiency
Inadequacy and scarcity of supportive services
These factors contribute to homelessness rather than cause homelessness.
3 Factors that contribute to homelessness
Major one
Housing Considered affordable if it costs no more than 30% of income
HUD operates programs that provides financial housing assistance to low-income families – the demand for these programs has far exceeded the supply
Include: market forces that inhibit private housing sectors production of affordable rental housing, decreases in fed spending on assisted housing fams, increase in inequality in low income groups in larger pop
Shortage of affordable housing
Another contributor
People who lack sufficient income - job but not may much; do have income but not sufficient for living - choose what get
With the lack of affordable housing and insufficient income, people have to spend much of their income on rent (30%+), leaving them without adequate resources for other necessities, such as food, clothing, and health care
Majority going to rent and have choose after paying rent of what pay
Consequence of shortage of affordable housing
Substantially increases risk for homelessness
Income insufficiency
Shortage of housing and income insufficiency; services not available in quanitity and quality
Think on consistent basis and accessible to the people who need it
Inadequacy and scarcity of supportive services
Adults who are homeless
Women who are homeless
Families
Youth
Many experience substance use disorders
Chronically homeless
Health status of homeless population
Higher morbidity rates than those occurring in comparable groups in the general population
Higher rates of acute physical health problems (including respiratory and trauma) - literally homeless and living not fit for human habitation/enviornment where lot pollution/chems going to have resp issues among other issues
Higher rates of chronic disorders - cannot get meds for chronic disorders, adhere to reg diet because just trying to find med, chronic prob will cause future issues and snowball issues
Serious acute mental illnesses and minor emotional problems occur more frequently than in the general population
High rates of alcohol and substance abuse problems in gen than gen pop
Adults who are homeless
Higher rates of pregnancy (often unintended) with higher preterm births and low-birth-rate infants; not have access to healthcare of gen pop so not have preterm care
More stressful life events, foster care as children, high rates of intimate partner violence, hospitalization for psychiatric issues - contributes to health probs as homeless; exacerbated by not having access to adequate resources needed
History of violence from childhood to adulthood (physical or sexual assault)
Women who are homeless
Fams and children Increased risk of physical and mental health probs and developmental delays
History of chronic physical and mental health conditions, substance abuse, victimization, and low education and job training of adults are also risk factors for compromised caregiver-child relations - cycle seen in family
Impact on children
Families
Higher rates physical problems, mental health problems, and developmental delays run in fam
Higher rates of adversely affected educational achievement
High risk of alcohol and drug use, depression, risky sexual behavior, victimization - cycle seen within the fam
Impact on children
Homeless adolescents experience health problems from high-risk behaviors at higher rates in homeless pop than the general adolescent population; mostly
Unintended pregnancy
STDs, physical/sexual abuse, skin disorders, anemia, drug/alcohol abuse, unintentional injuries, school failures
Depression; suicidal ideation; disorders of behavior, personality, or thought
Family disruption; school failures; prostitution or “survival sex”; involvement with the legal system
Social health severely compromised
Youth
unaccompanied adults who are homeless for extended or numerous periods and have one or more disabling conditions, which are very often severe mental and substance use disorders
Defn: High risk for death if homeless for 6 months or more with one or more of the following features:
More than three hospitalizations or emergency room visits in a year
More than three emergency room visits in the previous 3 months
60 years or older
More cases of Cirrhosis of the liver
End-stage renal disease
History of frostbite, immersion foot, or hypothermia
HIV/AIDS
Co-occurring psychiatric, substance abuse, and chronic medical conditions
Suicide
Drug or alcohol use
Chronically homeless –
Models of justice
Thinking upstream
Social Determinants of Health
Public Health Intervention Wheel
Framework for community/pub health nursing: care of/for homeless pops
Market justice system
Social justice system
Models of justice
Dominant model in US
Belief/suggest that people are entitled to valued ends (i.e., status, income, housing, and happiness) according to their own individual efforts - says low income/homeless because poor choices made when younger
Stresses individual responsibility, VERY minimal collective action as a community, and freedom from collective obligations other than respect for another person’s fundamental rights
Results in a downstream approaches to probs - addressing things at indiv level rather than upstream thinking at community level
Market justice system
Belief that all people are equally entitled to key ends (e.g., access to health care and minimum standards of income)
Says all members of society must accept collective burdens to provide a fair distribution of these ends
Model Is the/A foundational aspect of public health: as a community what do to help community as a whole to help be healthier
Not predominant model in US
Supports upstream thinking: address community issues so not have homeless people on streets
Social justice system
To improve the social health of the homeless, it is necessary to go upstream and focus on the primary contributors to homelessness itself (include: lack of affordable housing (MAJOR ONE), inadequate income, insufficient services) - improve societal issues
An upstream approach (community or systems level/standpoint not indiv standpoint) to homelessness is provided by the concept of social determinants of health
Thinking upstream
Definition – “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness”; conditions people live, work, and play in; more profound impact on wellbeing than genetics
Cover Five broad dimensions are included within Healthy People 2030: - SOCIAL DETERMINANTS OF HEALTH
To completely address homelessness need both upstream and downstream approaches to solve prob: Address homeless come about both approaches to solve prob since have people on street and need prevent people coming onto street
Social Determinants of Health
