Suchergebnisse

Purpose: To gain insight into client experiences with shelter or community care services for homeless people, homeless youth, and abused women and identify priority improvement areas. Methods: Seven hundred and forty-four clients rated their experiences and 116 clients rated the services' importance. Results: Clients had most positive experiences with the client–worker relationship and least positive experiences with the results of services. Abused women's service providers scored higher than homeless adults and youth service providers. Day and night shelters scored lowest, followed by crisis shelters, supported housing, and outreaching teams. The results of care have the highest need for quality improvement for homeless adults and youth. Discussion: Clients' experiences with shelter and community care services in the Netherlands are generally positive, with a strong client–worker relationship forming the basis of good quality care. Monitoring outcomes and increasing the focus on results are integrated in recent approaches aimed at improving the quality of shelter care.

BACKGROUND: Population segmentation and risk stratification are important strategies for allocating resources in public health, health care and social care. Social exclusion, which is defined as the cumulation of disadvantages in social, economic, cultural and political domains, is associated with an increased risk of health problems, low agency, and as a consequence, a higher need for health and social care. The aim of this study is to test social exclusion against traditional social stratifiers to identify high-risk/high-need population segments. METHODS: We used data from 33,285 adults from the 2016 Public Health Monitor of four major cities in the Netherlands. To identify at-risk populations for cardiovascular risk, cancer, low self-rated health, anxiety and depression symptoms, and low personal control, we compared relative risks (RR) and population attributable fractions (PAF) for social exclusion, which was measured with the Social Exclusion Index for Health Surveys (SEI-HS), and four traditional social stratifiers, namely, education, income, labour market position and migration background. RESULTS: The analyses showed significant associations of social exclusion with all the health indicators and personal control. Particular strong RRs were found for anxiety and depression symptoms (7.95) and low personal control (6.36), with corresponding PAFs of 42 and 35%, respectively. Social exclusion was significantly better at identifying population segments with high anxiety and depression symptoms and low personal control than were the four traditional stratifiers, while the two approaches were similar at identifying other health problems. The combination of social exclusion with a low labour market position (19.5% of the adult population) captured 67% of the prevalence of anxiety and depression symptoms and 60% of the prevalence of low personal control, as well as substantial proportions of the other health indicators. CONCLUSIONS: This study shows that the SEI-HS is a powerful tool for identifying ...

Objective: To test the effectiveness of Houvast: a strengths-based intervention for homeless young adults. Method: A cluster randomized controlled trial was conducted with 10 Dutch shelter facilities randomly allocated to an intervention and a control group. Homeless young adults were interviewed when entering the facility and when care ended. Repeated-measures analyses and logistic regression analyses were conducted by the principle of intention-to-treat framework ( N = 251). Results: Improvements were demonstrated on quality of life; satisfaction with family relations, finances, and health; employed or in school; depression; care needs; autonomy; competence, and resilience in both conditions. A higher proportion of homeless young adults who received care according to Houvast were still receiving care at follow-up and successfully completed the trajectory compared to those who received care as usual. Conclusion: Homeless young adults seem to benefit from service provision in general. Further research on the effectiveness of Houvast is needed after sufficient model fidelity has been achieved.

peer-reviewed ; Background Addressing Citizen's perspectives on homelessness is crucial for the design of effective and durable policy responses, and available research in Europe is not yet substantive. We aim to explore citizens' opinions about homelessness and to explain the differences in attitudes within the general population of eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden. Methods A nationally representative telephone survey of European citizens was conducted in 2017. Three domains were investigated: Knowledge, Attitudes, and Practices about homelessness. Based on a multiple correspondence analysis (MCA), a generalized linear model for clustered and weighted samples was used to probe the associations between groups with opposing attitudes. Results Response rates ranged from 30.4% to 33.5% (N = 5,295). Most respondents (57%) had poor knowledge about homelessness. Respondents who thought the government spent toomuch on homelessness, people who are homeless should be responsible for housing, people remain homeless by choice, or homelessness keeps capabilities/empowerment intact (regarding meals, family contact, and access to work) clustered together (negative attitudes, 30%). Respondents who were willing to pay taxes, welcomed a shelter, or acknowledged people who are homeless may lack some capabilities (i.e. agreed on discrimination in hiring) made another cluster (positive attitudes, 58%). Respondents living in semi-urban or urban areas (ORs 1.33 and 1.34) and those engaged in practices to support people who are homeless (ORs > 1.4; p<0.005) were more likely to report positive attitudes, whereas those from France and Poland (p<0.001) were less likely to report positive attitudes. Conclusion The majority of European citizens hold positive attitudes towards people who are homeless, however there remain significant differences between and within countries. Although it is clear that there is strong support for increased government action and ...

BACKGROUND: Social exclusion (SE), or the inability to participate fully in society, is considered one of the driving forces of health inequalities. Systematic evidence on this subject is pertinent but scarce. This review aims to systematically summarise peer reviewed studies examining the association between the multidimensional concepts of SE and social inclusion (SI) and health among adults in EU and OECD countries. METHODS: The protocol was registered on Prospero (CRD42017052718). Three major medical databases were searched to identify studies published before January 2018, supplemented by reference and citation tracking. Articles were included if they investigated SE or SI as a multidimensional concept with at least two out of the four dimensions of SE/SI, i.e. economic, social, political and cultural. A qualitative synthesis was conducted. RESULTS: Twenty-two observational studies were included. In the general population, high SE/low SI was associated with adverse mental and general health. For physical health, the evidence was inconclusive. In groups at high risk of SE, support was found for the association between high SE/low SI and adverse mental health but no conclusions could be drawn for physical and general health. CONCLUSIONS: This review found evidence for the association between high SE/low SI and adverse health outcomes, particularly mental health outcomes. The evidence is mainly based on cross-sectional studies using simple and often ad hoc indicators of SE/SI. The development and use of validated measures of SE/SI and more longitudinal research is needed to further substantiate the evidence base and gain better understanding of the causal pathways.

Objectives To examine the lifetime, 5-year and past-year prevalence of homelessness among European citizens in eight European nations. Design A nationally representative telephone survey using trained bilingual interviewers and computer-assisted telephone interview software. Setting The study was conducted in France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain and Sweden. Participants European adult citizens, selected from opt-in panels from March to December 2017. Total desired sample size was 5600, with 700 per country. Expected response rates of approximately 30% led to initial sample sizes of 2500 per country. Main outcome measures History of homelessness was assessed for lifetime, past 5 years and past year. Sociodemographic data were collected to assess correlates of homelessness prevalence using generalised linear models for clustered and weighted samples. Results Response rates ranged from 30.4% to 33.5% (n=5631). Homelessness prevalence was 4.96% for lifetime (95% CI 4.39% to 5.59%), 1.92% in the past 5 years (95% CI 1.57% to 2.33%) and 0.71% for the past year (95% CI 0.51% to 0.98%) and varied significantly between countries (pairwise comparison difference test, p1.5). Conclusions The prevalence of homelessness among the surveyed nations is significantly higher than might be expected from point-in- time and homeless service use statistics. There was substantial variation in estimated prevalence across the eight nations. Coupled with the well-established health impacts of homelessness, medical professionals need to be aware of the increased health risks of those with experience of homelessness. These findings support policies aiming to improve health services ...