Matching Items (7)

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On and off the street and somewhere in between: identity performance among adolescents living on (and off) the streets of Lima, Peru

Description

In this dissertation I present data gathered from an eleven-month qualitative research study with adolescents living and working on the streets of Lima, Peru. Through the pairing of photovoice with

In this dissertation I present data gathered from an eleven-month qualitative research study with adolescents living and working on the streets of Lima, Peru. Through the pairing of photovoice with participant observations, this work incorporates distinctive methodological and theoretical viewpoints in order to complicate prevailing understandings of street life. In this dissertation, I examine the identities that children and adolescents on the street develop in context, and the ways in which photography can be a useful tool in understanding identity development among this population. Through a framework integrating theories of identity and identity performance with spatial theories, I outline how identity development among children and adolescents living on the street is directly connected to their relationships with the urban landscape and the outreach organizations that serve them. The organizations and institutions that surround children on the street shape who they are, how they are perceived by society, and how they view and understand themselves in context. It is through the interaction with aid organizations and the urban landscape that a street identity is learned and developed. Furthermore, as organizations, children and adolescents come together within the context of the city, a unique street space is created. I argue that identity and agency are directly tied to this space. I also present the street as a thirdspace of possibility, where children and adolescents are able to act out various aspects of the self that they would be unable to pursue otherwise. Weaved throughout this dissertation are non-traditional writing forms including narrative and critical personal narrative addressing my own experiences conducting this research, my impact on the research context, and how I understand the data gathered.

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Agent

Created

Date Created
  • 2011

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Tricks of the shade: heat-related coping strategies of urban homeless persons in Phoenix, Arizona

Description

This research is about urban homeless people's vulnerability to extreme temperatures and the related socio-spatial dynamics. Specifically, this research investigates heat related coping strategies homeless people use and how

This research is about urban homeless people's vulnerability to extreme temperatures and the related socio-spatial dynamics. Specifically, this research investigates heat related coping strategies homeless people use and how the urban environment setting impacts those coping strategies. Semi-structured interviews were conducted with homeless people in Phoenix, Arizona during the summer of 2010. The findings demonstrate that homeless people have a variety of coping strategies and the urban environment setting unjustly impacts those strategies. The results suggest a need for further studies that focus spatial environmental effects on homeless people and other vulnerable populations.

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Agent

Created

Date Created
  • 2011

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Phoenix's place for the homeless: stories from the Maricopa County Human Services Campus

Description

This thesis investigates how homeless men and women who use one of only six human services campuses (hscs) in the nation negotiate the stigmatization they may feel as homeless people

This thesis investigates how homeless men and women who use one of only six human services campuses (hscs) in the nation negotiate the stigmatization they may feel as homeless people living in Phoenix, Arizona. An hsc centralizes services to one area of the city to decrease the run around of scattered-site service delivery. It also creates a legitimized space for the homeless in the city. A place for the homeless can be a rarity in cities like Phoenix that have a history of implementing revanchist policies and neo-liberal land use planning, most notably found in its downtown revitalization efforts. During Phoenix's development as a major metropolitan area, the homeless population emerged and lived a life on the margins until the 2005 creation of the Human Services Campus. This research unearths the experiences of homeless men and women who use the HSC today. I used qualitative methods, including document review, 14 in-depth interviews with homeless men and women, 7 interviews with service providers, informal conversations with additional homeless clients, and 14 months of field observations at the HSC to collect the data presented in this thesis. The results of this research illustrate reasons why the homeless clients interviewed were sensitive to the stigmatization of their social status, and how they managed their stigmatization through relationships with homeless peers and staff on the HSC. The presence of an action plan to exit homelessness was critical to the nature of these relationships for clients, because it influenced how clients perceived their own stigmatization as a homeless person.

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Agent

Created

Date Created
  • 2011

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Access to Healthcare Among Those Experiencing Homelessness: A Depression Screening Project

Description

Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health.

Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).

The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.

A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.

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Agent

Created

Date Created
  • 2020-05-04

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Increasing Influenza Immunization Rates at a Homeless Clinic Through Staff Education

Description

Background: Healthy People 2020, a government organization that sets health goals for the United States, has established the benchmark objective of 70% influenza vaccination coverage. National trends show immunization rates

Background: Healthy People 2020, a government organization that sets health goals for the United States, has established the benchmark objective of 70% influenza vaccination coverage. National trends show immunization rates are a dismal 41.7% for the adult population. Persons
experiencing homelessness are a vulnerable population in which access to preventative health care services is lacking. Prevention of acute illness, whenever possible, is crucial to maintaining the health of this population. The purpose of this project is to increase influenza vaccinations through staff education at a homeless clinic.

Methods: Eighty-eight volunteer staff, at a student led homeless clinic, received education on the influenza vaccinations. The education occurred at the first orientation meeting of the fall semester in 2016 and consisted of; the importance of immunizations, goals of Healthy People 2020, and an emphasis on addressing patient objections. The effectiveness of the program
compared the percentage of patients immunized from August - December 2016 to 2015.

Results: Post intervention, 44% of the clinic patients were immunized against influenza,
compared to 18% (pre-intervention). This finding resulted in a statistically significant increase in
vaccinations (Z= -5.513, p= < .001, Wilcoxon signed rank test). Eighty-eight volunteers were
present at the influenza vaccination educational intervention and 82 returned their surveys
(response rate 93%). The average score of the posttest was 96% (range 70-100%).

Conclusions: These findings support staff education on influenza vaccinations as a strategy for
increasing vaccination in the homeless population. Such interventions provide promise to
increase influenza vaccinations, however, they fall short of meeting the goals of Healthy People
2020. Identifying innovative interventions is critical to meet the goals of Healthy People 2020.

Contributors

Agent

Created

Date Created
  • 2017-04-17

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Advance Directive Advocacy: Empowering Homeless Clients to Express Their End-of-Life Wishes

Description

As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have

As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental illness and substance abuse, alienation from potential healthcare proxies, and specific fears related to dying. Completion of an advance directive (AD) would address many of these barriers, as well as national goals of reducing medical costs associated with end of life care. A review of the literature indicates that homeless individuals, once educated on the purpose and significance of ADs, complete them at a higher rate than non-homeless people. Further, racial and ethnic disparities in document completion are minimized with educational interventions about an AD’s purpose.

King’s Theory of Goal Attainment provides the theoretical basis for the application of such an intervention in the setting of a medical respite center and a day resource center that both serve the homeless. Thirty-seven clients of the two sites and 14 staff members were administered a pre-and post-test measuring attitudes and knowledge relating to ADs on a Likert scale, resulting in an increase in knowledge about one of the two documents that traditionally comprise an AD, while not significantly affecting attitudes. Implications for practice include an inexpensive intervention that does not require a medically trained individual to deliver, enabling a broad application to a variety of settings with the goal of empowering a traditionally disenfranchised population to make health decisions related to the most vulnerable of life passages.

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Agent

Created

Date Created
  • 2016-05-07

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LifeLine: Mobile Phones and Health Care Continuity for the Homeless

Description

Due to complexities surrounding healthcare for the homeless, continuity of care is virtually nonexistent. Continuity of care refers to individualized, comprehensive health care services that are timely, accessible, and coordinated.

Due to complexities surrounding healthcare for the homeless, continuity of care is virtually nonexistent. Continuity of care refers to individualized, comprehensive health care services that are timely, accessible, and coordinated. Health care continuity has been demonstrated to reduce mortality and improve health outcomes. A literature review determined access to mobile phones could improve health care continuity among homeless individuals. LifeLine is a state and federal program providing free phones and phone service to impoverished Americans. Enrollment into LifeLine can be challenging for the homeless, who lack access to even the most basic necessities. A project was developed to assist homeless individuals with enrollment into LifeLine in order to increase mobile phone access and improve care continuity. For four weeks, LifeLine enrollment assistance was offered to homeless clients of a mobile health outreach organization in San Francisco, California. Original, anonymous pre- and post-intervention surveys were administered to collect data regarding phone access and healthcare utilization patterns among this population. All 13 participants endorsed mobile phone access; only one participant completed enrollment into LifeLine. Seventy percent of participants reported health care continuity was directly improved by phone access, endorsing consistent healthcare visits and low hospitalization rates. Ninety-two percent of participants reported preexisting awareness of LifeLine, which likely contributed to low program enrollment. This project yielded clinically significant results indicating access to mobile phones can improve health care continuity for the homeless. Improving health care continuity for this population has both ethical and economic implications and remains a public health priority.

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Agent

Created

Date Created
  • 2021-04-26