This study expands on the Andersen-Newman health services utilization (HSU) model. In a community-based homeless sample (n = 363) baseline predisposing, enabling, and needs-based variables predicted hospitalization and ambulatory outpatient service utilization within 1 year after baseline. Standard predisposing and enabling variables were supplemented with latent constructs representing substance use, mental illness, poor housing status, social support, community support, and barriers to health care. Need is represented by baseline health status. Poor physical health, more barriers, drug use, African American ethnicity, less community support, and less education predicted hospitalization, the least desirable form of HSU. Poor health, female gender, a regular source of care, community support, drug use, and fewer alcohol problems predicted an office visit. Because outpatient visits for acute conditions provide an opportunity for generally neglected preventive services and health screenings, this study suggests convenient multiservice health-related programs for the homeless that include drug and alcohol treatment.

Predicting Health Services Utilization Among Homeless Adults: A Prospective Analysis

A sample of 51 homeless people in Cambridge, UK completed a questionnaire featuring adapted Animal Empathy and Companion Animal Bonding Scales. Concepts of crime, drug use, and health matters amongst the homeless, both dog owning and non-dog owning, were investigated, as well. Ninety members of the general public completed a similar questionnaire which sought their opinions on homeless people who own dogs. There was a highly significant difference (p < 0.01) between the homeless and the securely housed on their animal empathy and attachment scores, with the homeless sample displaying higher values. Gender and dog ownership status had no effect on these scores. A near significant result (U = 2, n1 = 13, n2 = 58, p = 0.06) was revealed for animal empathy scores of those who gave money to dog-owning homeless people and those who gave to non-dog owning homeless people. Of the public respondents, women were significantly more likely to show concern for a homeless person's dog's welfare than men (X2(1) ...

Homelessness and dog ownership: an investigation into animal empathy, attachment, crime, drug use, health and public opinion

(2001). Homelessness and Mental Disorders. International Journal of Mental Health: Vol. 30, No. 4, pp. 79-96.

/pdf/homelessness-and-mental-disorders-2wcg4pjqrs.pdf

Homelessness and Mental Disorders

Background:Homelessness, a worldwide psychosocial phenomenon, is now also prevalent in Greece, mainly in Athens area.Methods:The possible psychiatric morbidity related to help-seeking and the underlying factors were explored in a sample of 254 homeless people from Greater Athens area, using the Mini International Neuropsychiatric Interview (M.I.N.I.).Results:The sample was predominantly male (74%) with mean age of 51 years, being in their majority homeless for over 25 months, 34.3% of them living in rough sleeping places. Overall, 56.7% of the sample met the criteria for a current Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV) psychiatric disorder with 20.8% comorbidity. Only 36.2% of the identified psychiatric cases had any recent psychiatric care, while 44.4% were taking non-prescribed medication and 20.2% have been hospitalized in the last year. On the contrary, 70% of alcohol- and drug-dependent persons have been treated in a psychiatric agency, while 60.0% of them parti...

Homeless mentally ill in Athens area: A cross-sectional study on unmet needs and help-seeking

The research has two central aims. The first is to assess the evidence for the effectiveness of health and social care interventions for homeless people; the second is to measure the effectiveness of a health advocate for temporarily homeless people in Liverpool. The comprehensive criterion-based systematic review of publications between 19661999, revealed few health and social care interventions to have been evaluated within controlled studies. Only nine studies were considered to be of adequate methodological rigour; none evaluated interventions for homeless families. Characteristics considered worth highlighting were: integration within mainstream provision; multi disciplinary teams with inter agency collaboration; and a comprehensive and coordinated approach to support needy individuals, often using a case manager. The empirical study measured the effectiveness of a health advocate for temporary homeless patients in a large health centre in inner-city Liverpool. A prospective quasirandomised controlled trial was used to test the intervention. Patients (mainly homeless families) were sequentially allocated to intervention or `usual care' groups in alternating periods of 1-3 months over a total intake period of 3 years. 400 adults and 438 children were included in the study of health service utilisation outcomes and 117 adults were included in the 3 month follow up study which examined health related quality of life outcomes (Nottingham Health Profile, Life Fulfilment Scale and Faces Scale). This thesis concludes that the health advocacy approach was effective for homeless people who received early intervention: health related quality of life improved over time and less primary health care team resources were utilised compared to patients who received usual primary care. Both aspects of this thesis provide an original contribution to homelessness research and confirm the value of adopting controlled designs when testing interventions.

Addressing the health problems of the (inner city) homeless : a systematic review and a controlled trial

Homeless adults attending a drop-in voluntary project were approached to assess their views on the project, pathways into homelessness, physical and mental health needs and history of substance misuse. Over a six week period, 70 users were interviewed. Of these 54 (77%) were men and the rest women. Twenty five (35%) were living in insecure accommodation. A significant proportion 61% (43) acknowledged having suffered from emotional or mental health problems in the past and nearly half (47%) admitted to having received a psychiatric diagnosis. Nearly one third reported past criminal record. The use of substances (drugs and alcohol) was fairly common. There were no ethnic differences in the findings although the numbers from ethnic minorities remain small. This is not a typical homeless sample but the findings suggest vulnerability of such a group. The group was by and large satisfied with the open access and flexible approach of the project. The findings are discussed in relation to the acceptable services provided by voluntary organisations and suggestions made for further studies.

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