Search Results (518)

Background: Access to substance use disorder (SUD) treatment remains a concern in Brazil, particularly among socioeconomically disadvantaged populations affected by cocaine and crack-cocaine use. Community-based services such as the HUB de Cuidados em Crack e Outras Drogas (HUB) in São Paulo aim to engage vulnerable individuals but often face a “revolving door” pattern of repeated admissions. Evidence on predictors of readmission in community-based support services, particularly gender differences, remains limited. This study examines gender-specific predictors of readmission to the HUB within 12 months and changes in clinical characteristics over time. Methods: This is a retrospective observational design study. Records from all individuals who sought treatment for their alcohol and/or drug use in HUB between June 2024–2025 were analysed (number of records = 13,645; number of service users = 6528). This timeframe refers to the study period during which data were collected. Results: Among 6528 service users, most were men (92.6%), with higher readmission rates than women (53.4% vs. 38.6%). Homelessness and synthetic cannabinoid use predicted readmission for both genders. Among men, younger age, substance use patterns, and greater clinical severity were associated with readmission. Among women, recent crack-cocaine use was linked to lower readmission. Over time, men showed worsening substance use and clinical indicators, while women showed reduced stimulant use but increased psychotic symptoms and help-seeking. Conclusions: The “revolving door” pattern of repeatedly entering and leaving services without continuity of care is common in community-based support services like HUB. Risk profiles differ between men and women. The limited predictors identified for women suggest that routine clinical assessments may overlook important social and structural vulnerabilities. These findings highlight the need for gender-sensitive approaches that account for distinct emotional and cognitive pathways and the service needs of men and women. Full article

Background and Objectives: Individuals with heroin-related opioid use disorder are at high risk of poor oral health and impaired oral health-related quality of life (OHRQoL). However, data on the determinants of OHRQoL in this population remain limited. This study aimed to assess oral health status and OHRQoL and to identify key predictors of OHRQoL among hospitalized patients with heroin-related opioid use disorder. Materials and Methods: A cross-sectional study was conducted among 97 hospitalized patients with heroin-related opioid use disorder. Data were collected through structured interviews and clinical oral examinations, including the Decayed, Missing, and Filled Teeth (DMFT) index and the Simplified Oral Hygiene Index (OHI-S). OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14). Spearman correlation and multiple linear regression analyses were performed to examine associations and identify predictors of OHRQoL. Results: Participants had poor oral health, with high DMFT (19.1 ± 6.1) and OHI-S (2.0 ± 1.2) scores. OHRQoL was markedly impaired, with a mean OHIP-14 score of 29.6 ± 7.0, particularly in the psychological and social domains. OHIP-14 scores were strongly correlated with DMFT (r = 0.754, p < 0.001) and OHI-S (r = 0.552, p < 0.001). Longer duration of heroin use was associated with higher DMFT scores, poorer oral hygiene, and greater OHRQoL impairment. Multiple linear regression analysis identified unstable housing/homelessness (β = 0.166, p = 0.012), DMFT (β = 0.624, p < 0.001), and OHI-S (β = 0.272, p = 0.007) as significant predictors of poorer OHRQoL. Conclusions: Individuals with heroin-related opioid use disorder experienced substantial oral health burden and impaired OHRQoL, strongly associated with caries experience, poor oral hygiene, and housing instability. These findings highlight the need to integrate prevention-oriented dental care into addiction treatment services and to address the broader social determinants of oral health. Full article

Background/Objective: Research has indicated that providing care during the COVID-19 pandemic negatively impacted healthcare providers’ wellbeing and burnout. Much of the literature has focused on emergency department (ED) physicians and nurses, including the distinct challenges they faced caring for persons experiencing homelessness (PEH), including addressing unmet basic needs, limited discharge options, and disruptions to community-based health and social services during the pandemic. Comparatively little research has examined the experiences of other multidisciplinary team members caring for PEH. This study explored the shared experiences of multidisciplinary ED staff caring for PEH during the COVID-19 pandemic to inform workforce planning and future pandemic preparedness. Methods: Using inductive qualitative analysis, we examined self-reported experience, mental health impacts and solutions for workforce planning and pandemic preparedness of multidisciplinary ED staff caring for PEH. Three virtual focus group discussions involving 12 multidisciplinary ED staff (registered nurses, clerical staff, security staff, community support workers, and a clinical assistant) were conducted during the first two years of the COVID-19 pandemic, a period characterized by evolving public health restrictions, uncertainty, and disruptions to health and social services. Results: Inductive qualitative analysis identified four key themes: (1) emotional experiences of care provision (including gratitude, compassion fatigue, and moral distress), (2) hospital- and community-led adaptations to support care delivery, (3) strategies for wellness and resilience building among staff, and (4) recommendations for future workforce planning and pandemic preparedness. Conclusions: Caring for PEH during the intense pandemic period intensified staff distress by exposing them to unmet social needs and system-level resource gaps, while also fostering interprofessional collaboration and resilience. Staff collaborated to facilitate organizational adaptations that enabled continuity-of-care. Future pandemic preparedness should include targeted mental health supports for staff, flexible institutional contingency planning, and formalized hospital–community partnerships to sustain care for PEH and other socially vulnerable populations. Full article

Spirituality and religiosity are increasingly recognized as important factors influencing mental health, particularly among women exposed to diverse vulnerabilities such as interpersonal violence, trauma, HIV infection, homelessness, and socioeconomic disadvantage. This systematic review aimed to synthesize evidence on the associations between spiritual or religious resources and mental health outcomes in these populations. A systematic search was conducted in Scopus, PubMed, and Web of Science to identify studies examining the association between spirituality, religiosity, and mental health outcomes in vulnerable women. A total of 28 studies were identified, including cross-sectional, longitudinal, and mixed-methods designs, which measured spirituality and religiosity using validated instruments such as SWBS, DUREL, FACIT-Sp-12, and Brief RCOPE, alongside standardized mental health measures. Narrative synthesis revealed that the majority of studies (n = 15) reported that higher spiritual well-being, intrinsic religiosity, and adaptive religious coping were associated with lower depression, anxiety, and post-traumatic stress, and with higher resilience, quality of life, and post-traumatic growth. These associations appeared to be shaped by contextual factors, including the type and severity of trauma, cultural and religious frameworks, and the lived experiences of the populations studied. Negative associations were primarily linked to negative religious coping (n = 5 studies), rather than religiosity per se. Additional factors that attenuated or reversed the expected positive effects included higher trauma severity or ongoing adversity (n = 4), reactive patterns in which greater psychological distress was associated with increased use of religious coping (n = 3), maladaptive religious beliefs such as interpretations of trauma as divine punishment (n = 2), and cultural or contextual influences (n = 3). Overall, the evidence suggests that spirituality and specific dimensions of religiosity (e.g., intrinsic religiosity, religious coping) can support mental health among vulnerable women, though personal, cultural, and situational factors shape their impact. These findings suggest the potential value of integrating spiritual resources into interventions and the need for further longitudinal and culturally sensitive research. Full article

Youth experiencing homelessness and housing instability (YEH) face disproportionate health risks and structural barriers to health equity, which were intensified during the COVID-19 pandemic. We conducted a community-based participatory research study with 21 adolescents (ages 13–17) and transitional-aged youth (ages 18–26) experiencing homelessness or housing instability in San Diego, California, USA. Between February and July 2023, we conducted six “arts-based engagement sessions” (5 in English, 1 in Spanish) that blended expressive arts and focus group approaches to examine how YEH accessed, evaluated, and applied health information, and how trust and material and structural resource constraints shaped engagement with COVID-19 information and prevention guidance. We analyzed data via applied thematic analysis. Participants described how COVID-19 restrictions and economic disruption amplified pre-existing housing precarity, worsening material conditions and mental health. Participants selectively trusted COVID-19 information based on who provided it, how credible it felt, and whether it aligned with their lived experiences. Community-based providers and, for some, churches and cultural or ancestral knowledge were key information sources. Trust in government and public health messaging was conditional and shaped by perceptions of credibility, coherence, and political motivation. Participants described information overload and rapidly changing guidance as overwhelming and often incompatible with their material realities, leading to disengagement, reliance on intuition, or deprioritization of prevention behaviors. Effective communication during future health emergencies must center trusted relational messengers, align guidance with lived realities, and address the structural conditions that shape whether health information can be meaningfully acted upon. Full article

This article presents the results of two qualitative studies, realized in Italy, aimed at investigating if and how social love informs social workers’ practices and interventions designed to address situations of poverty and homelessness. In particular, the aim of these studies was to further develop the line of inquiry initiated by a preliminary exploratory study conducted in Italy some years ago, which recognized traces of agapic action within helping relationships in the context of social services addressing conditions of social exclusion and poverty, and found that these agapic actions produce a reality sui generis: a unity between subjects which, from reciprocal action, leads to a ‘generative social mechanism’, existing beyond the parties involved and overabundant. The results of the two studies presented in the article offer further evidence to support this hypothesis. The article highlights the existential and professional perspective with which social workers approach the challenging task of helping vulnerable individuals. Elements of social love have been highlighted that contribute to making professional assistance more sustainable and effective, moving away from neoliberal and managerialist approaches that often ignore the emotional and relational dimensions. Social love fuels motivation for positive change despite social and personal limitations and risks of failure. Full article

Background: Community-based mental health and social interventions focusing on housing stability, integrated care and psychosocial support are being increasingly recognised as essential for improving the mental health and wellbeing of people experiencing homelessness. However, evidence regarding the effectiveness of these interventions remains fragmented across different models of care and study designs. This review synthesises how these interventions address mental health and social determinants of health. Methods: Following PRISMA 2020 guidelines, a systematic search of six electronic databases (2019–2025) was conducted (PROSPERO: CRD420250653260). The review included 29 quantitative, qualitative, and mixed-methods studies examining community-based interventions for people experiencing homelessness and mental health conditions according to predefined eligibility criteria. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Results: Community-based interventions, particularly Housing First models, were frequently associated with improved housing stability, mental health outcomes, and programme retention. Integrated multidisciplinary services and outreach promote psychosocial wellbeing, continuity of care and reducing emergency service use. Peer-led programmes support social integration, although evidence regarding technology-based interventions was inconsistent, with some studies reporting improved engagement and access to support, while others found limited effects on mental health outcomes. Conclusions: Addressing social determinants of health through structured community-based interventions is essential to tackle mental health inequalities. The findings support the implementation of integrated community-based services combining housing, mental health, and social support. These results may inform policymakers, healthcare providers, and community organisations seeking to reduce mental health inequalities among people experiencing homelessness. Full article

In Burke County, North Carolina, a Hepatitis A outbreak among unsheltered residents exposed gaps in access to clinic-based care and prompted early, ad hoc “backpack medicine” outreach efforts to deliver care directly in nontraditional settings. While this approach addressed immediate needs, it highlighted the inadequacy of isolated interventions, prompting local partners to pursue more structured, coordinated, and community-driven approaches to homeless health system design. This project report describes how Burke County Public Health, in partnership with the University of North Carolina at Chapel Hill, applied systems thinking, community coalition building, and human-centered design to transition from reactive outreach to a structured, sustainable mobile health delivery model for people experiencing homelessness. Guided by Community Coalition Action Theory (CCAT), partners used human-centered design methods to engage over 40 community stakeholders and 10 individuals with lived experience of homelessness or housing instability. Through empathy mapping, iterative prototyping, and thematic analysis, the team identified priority service gaps, defined operational requirements, and developed prototype service models, while building cross-agency readiness for implementation. Full article

First launched in Boston, MA in January 2018, Community Care in Reach^® is a mobile addiction model that uses mobile clinics to deliver harm reduction and clinical services to people at high risk of drug-related morbidity and mortality and who are unhoused or at risk of losing housing. Through a public/private partnership, the model has grown to include six programs across Massachusetts. Using the RE-AIM framework, this initial, descriptive evaluation for this multisite project included quantitative and qualitative methods to give insight into reach and performance. From 1 January 2022 to 30 June 2024, there were 17,887 harm reduction encounters and 16,117 clinical encounters providing care to 4645 individuals. Buprenorphine-based treatment (a key medication for opioid use disorder) was initiated among 1227 individuals, of whom 15% remained in buprenorphine-based treatment after 180 days. Evaluation across multiple organizations posed unique challenges; however, results demonstrated universal engagement of hard-to-reach individuals. Full article

Homelessness is a major public health concern, and successful rehousing is an important outcome for people experiencing homelessness (PEH). However, limited evidence exists on which individual factors are associated with rehousing after transitional care; this study examined characteristics associated with being rehoused at discharge from Durham Homeless Care Transitions (DHCT). We analyzed data from DHCT, a transitional care program serving PEH. Independent variables included demographic characteristics, self-efficacy, mental healthcare status, and unmet identity and communication access (ICA) needs, including lack of personal identification documentation and technology access. We performed bivariate analyses and multivariable regression to assess associations with being rehoused at discharge. In both bivariate and multivariable analyses, non-White PEH were less likely to be rehoused at discharge than White PEH. Greater unmet ICA needs were also significantly associated with lower likelihood of rehousing. These findings add to the mixed prior literature regarding racial inequities in rehousing among PEH. The concept of ICA needs has not previously been studied and may offer an actionable target for transitional care programs seeking to improve rehousing outcomes and advance equity. Full article

Objectives: This study aimed to identify the oral health conditions of homeless individuals in Rome, the most frequently required dental treatments, and to describe a standardized, replicable clinical protocol tailored to the specific needs and access barriers of this vulnerable population. Methods: Five hundred homeless individuals received comprehensive dental examinations at the Primary Care Services of the Dicastery for the Charity Services (Vatican City) between September 2023 and January 2026. Clinical assessments included oral hygiene status, periodontal health, caries prevalence, and degree of edentulism. Treatment interventions were programmed by scheduling subsequent appointments. For patients requiring prosthetic rehabilitation, treatment was sequenced into distinct steps: preparatory treatments (hygiene, extractions, conservative procedures), impression taking, prosthesis try-in, and delivery. Results: Oral health assessment revealed poor or absent hygiene (85.4%), high DMFT scores (63.0%), and root residues (22.4%). Periodontal disease affected 94.0% of participants (gingivitis 73.0%, periodontitis 21.0%). Tooth loss patterns included partial edentulism (12.0%) and complete edentulism (24.0%). A total of 440 appointments were scheduled, with an attendance rate of 78.4%. Prosthetic rehabilitation was completed in 150 patients: 50 received partial dentures (33.3%) and 100 complete dentures (66.7%). Conclusions: The examined homeless individuals experienced severe oral health deterioration characterized by extensive tooth loss and advanced periodontal disease. A substantial prosthetic rehabilitation was needed in this sample. The proposed sequential treatment protocol demonstrated high feasibility and patient adherence in this vulnerable population. Comprehensive dental services that address both immediate emergency needs and long-term rehabilitative care are crucial for improving oral health-related quality of life and facilitating social reintegration. Patient-reported outcomes indicated meaningful improvements in digestive function, aesthetic satisfaction, and employment opportunities following prosthetic rehabilitation. Full article

Access to primary care services is essential for promoting mental health, yet immigrants experiencing homelessness face significant barriers to care. This study explores factors that influence access to primary care services in the UK. A qualitative design was employed, involving in-depth semi-structured interviews with 30 immigrants experiencing homelessness and 30 stakeholders across healthcare, voluntary, and local authority sectors. Data were analysed using thematic analysis, guided by the Levesque framework of healthcare access and an intersectionality lens. Findings reveal that access is influenced by intersecting structural barriers, including fear of detention and deportation, cultural stigma surrounding mental health, digital exclusion, and financial hardship. These barriers delay help-seeking and shift care-seeking toward emergency services. Increasing reliance on digital systems in primary care further excludes individuals with limited access to devices, connectivity, or digital skills. These findings indicate that barriers to accessing primary care services may hinder the early identification and preventive management of mental health needs among homeless immigrants. Improving access requires structural reforms that address legal, financial, and digital barriers, alongside more culturally responsive and trust-based care. Without such changes, digital health innovations risk reinforcing existing inequalities and limiting the role of primary care in early mental health intervention and prevention. Full article

This paper discusses emerging findings from a large-scale, ongoing UKRI-funded study (2024–2027) undertaken in twelve diverse areas of England. While the main project focuses on reducing health inequalities for refugees, asylum seekers and migrant populations, this interim paper focuses on emerging evidence related to the question of how perceptions of deservingness and route of entry link to access to housing and support services available to the four main refugee, asylum seeking and migrant groups who are the predominant focus within the wider research study. We argue that the level and type of support received and access to housing have a direct impact on the wellbeing of the populations. Housing is one of the key social determinants of health, with impacts on both mental health and broader wellbeing. Our findings show that nationality, together with route of entry, legal status and eligibility for statutory support (or lack thereof), clearly affects housing pathways. This, in turn, impacts on the likelihood of being housed in temporary/dispersal accommodation, as well as experiencing homelessness and longer-term housing precarity. These are factors which are widely recognised as affecting mental health and wellbeing, as well as the ability to receive uninterrupted health care for other conditions. This study explores how vulnerability, desirability, and deservingness shape different trajectories of refugee housing and resettlement and the resultant impacts on different migrant populations. Full article

Two-spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) youth disproportionately experience homelessness compared to cisgender and heterosexual youth; however, there is a distinct lack of population-based housing programs designed to meet their specific needs, particularly in suburban contexts. This study applies the socio-ecological model to examine the multi-level factors shaping the experiences, needs, and housing trajectories of 2SLGBTQ+ youth residing at the Blue Door INNclusion program—one of the first population-based housing programs for 2SLGBTQ+ youth in a suburban region of Ontario, Canada. Drawing on semi-structured interviews and survey data with residents of the Blue Door INNclusion program, we explore youths’ pathways into homelessness, their experiences during program participation, and their transitions toward independent living. Analysis focuses on how intrapersonal, interpersonal, organizational, and structural factors shape youths’ experiences of safety, belonging, and access to supports, as well as changes in mental health, social connections, employment, and education over time. Findings indicate that pre-entry experiences, including family rejection and housing instability, shaped youths’ needs and engagement within the program. Across socio-ecological levels, affirming relationships, inclusive organizational practices, and access to tailored supports were central to fostering safety and belonging. Over time, youth described improvements in mental health and social connectedness, alongside increased engagement in education and employment, while structural challenges such as financial precarity continued to influence their transitions toward independence. By situating youths’ experiences within a socio-ecological framework, this study offers theoretically grounded insights into the multi-level conditions that support housing stability and well-being among 2SLGBTQ+ youth in suburban transitional housing contests. Full article