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The purpose of this paper is to assess the programmatic effectiveness of a post-incarceration support service, Jail In-Reach, to rapidly and permanently re-house newly released offenders with a documented history of homelessness, substance abuse and mental health disorders.

Data were obtained from SEARCH Homeless Services using the Adult Texas Recommended Assessment Guidelines survey instrument by the Texas Department of State Health Services. Repeated measures analysis of variance were performed to determine the effects of select predictors on the likelihood of permanent housing, which, for this research, is considered programmatic success.

Results indicate clients exhibited decreased risks of self-harm, employment problems, housing instability, co-occurring substance use, and criminal justice involvement as well as increased social support. Over half of the program participants either disappeared from the program or only secured temporary housing.

This was a small pilot project with limited generalizability. There have been no follow-up studies to examine long term permanent housing success. No data were available as to why participants dropped out of the program.

Intensive advocacy and support services provided pre- and post-institutional release could provide formerly homeless inmates with co-occurring substance abuse and mental health issues with positive outcomes.

Housing stability and connections to social service agencies are key factors for ensuring ex-offenders do not become re-incarcerated.

This paper contributes to the literature related to reducing homelessness among ex-offenders, to the effectiveness of critical time intervention-based programming, and the need for building social capital amongst this unique and underserved population.

Studies have shown positive housing retention and quality of life outcomes in moving on initiatives (MOIs). However, less is known about how movers’ health service use changes post-move. This paper aims to explore physical and mental health service use over time for participants in New York City’s MOI program.

This paper uses data collected at baseline, 12-months post move and 24-months post move to explore patterns in mental and physical health service use and their association with mental and physical health status for participants (N = 41). Health status was measured with the Medical Outcomes Study Short Form Survey Instrument.

Three mental health service use patterns emerged: service use at all time points, inconsistent service use across time points and no service use at any time point. Significant group differences in mental health were found at baseline and 12 months. Two physical health service use patterns emerged: service use at all three time points and inconsistent service use across time points. Significant group differences were found in mental health at 12  and 24 months.

This study showed that physical and mental health service use varied slightly over time for participants, with the majority of service use being for outpatient/non-acute care. The findings also point to possible relationships between service use and mental health status. Positive and negative implications of these findings are framed within the broader context of PSH and MOI goals.

Many individuals in drug treatment courts (DTCs) have co-occurring mental health and substance use disorders (COD), which can negatively impact treatment engagement, behavioral health and criminal justice outcomes. This paper aims to report results of DTC participants with a COD, who received a 12-month wraparound treatment intervention called MISSION-Criminal Justice (MISSION-CJ) alongside DTC to improve treatment engagement and behavioral health outcomes and reduce reincarcerations.

In this pre-post, single-group pilot, 48 clients enrolled and 81% completed 12-month follow-up assessments (N = 39) and weekly MISSION-CJ fidelity for type and intensity of services delivered. Generalized linear mixed models (GLMMs) were computed with a fixed term for fidelity (e.g. high or low MISSION-CJ), time and a fidelity x time interaction term.

Among participants, at 12 months, 81% of the participants remained engaged in treatment at study completion, and 89% had high MISSON-CJ fidelity. Clients demonstrated significant reductions from baseline to 12 months in average nights in jail (B = −0.1849511, p < 0.0344), mental health symptoms via the Behavior and Symptom Identification Scale (BASIS) total and subscale scores (B = −0.121613, p < 0.0186) and trauma symptoms on the PTSD Checklist-5 (PCL-5) (B = −0.928791, p < 0.0138). High MISSION-CJ fidelity further improved criminal justice, and behavioral health outcomes.

This was the first reported 12-month MISSION-CJ trial. While feasible to implement, given the design limitations, future research should include a large randomized controlled trial.

This paper aims to provide a summary of current policy and research related to pre‐school overweight and obesity, and to provide a rationale for why early years settings are being placed at the forefront of strategies to address the problem.

The paper is based on a narrative review of current research, policy and practice.

Today 22.9 per cent of four and five year olds are overweight or obese. The Healthy Weight, Healthy Lives strategy is a cross‐government initiative, which aims to make England the first major country to reverse the obesity epidemic. The pre‐school period represents a critical time for interventions, which could prevent excess weight gain and its associated physical and psychological damage to health.

Practitioners in early years settings have a significant contribution to make to promoting the healthy weight of children.

Concerns about overweight in childhood have received much attention. This paper seeks to raise awareness of the importance of the pre‐school period, and to provide a useful review of current research, policy and sources of support for those who are best placed to address the issue.

The purpose of this paper is to propose a practice framework for disaster resilience education (DRE) with homeless communities.

A survey with 163 homeless service providers together with 45 interviews with people with a lived experience of homelessness, homeless service providers and emergency services.

Key principles for DRE with the homeless community were: safe relationships, collaboration, strengths-based, empowerment, providing essential resources, and inclusivity. Recommendations for the design of DRE foregrounded partnerships and knowledge sharing between the homeless community and emergency services. Locally relevant risk information and material supports, together with sharing stories and eliciting values were important considerations for developing DRE content. Preferred delivery methods were outreach to build on trusted relationships and existing services, together with written material in large font emphasising images for distribution through drop in centres, food vans and new tenancy packages.

The key principles, together with the detailed suggestions outlining ways to translate the principles into actions, can be used by emergency and homeless services to develop effective DRE materials and programmes.

The proposed DRE framework aims to not only enhance disaster risk knowledge, but also address the exclusion, isolation and disempowerment experienced by people who are homeless. By building on an effective intervention models within homeless services (Trauma-Informed Care) DRE can enhance the social connection, self-confidence and well-being goals of homeless services and clients.

The DRE framework is based on the first comprehensive Australian research with homeless services, clients and emergency managers on best practice for improving extreme weather preparedness in the homeless community.

Purpose – This chapter describes the problem of and approaches to ex-inmates with psychiatric disabilities exiting correctional custody. Although all ex-inmates must find housing and employment, persons with psychiatric disabilities require linkages to various health-related services and supports. These linkages are necessary, but it is unknown whether they are sufficient because discharge planning services and transition programs for ex-inmates with psychiatric disabilities historically lack an evidence base.

Approach – After a decade, the first-generation re-entry programs for ex-inmates with psychiatric disabilities have yielded little in the way of empirical data, but they have provided models for program expansion and imperatives for second-generation program assessment. Related research findings for first- and second-generation programs are highlighted with an emphasis on a unique statewide program in Massachusetts.

Findings – A review of the first- and second-generation programs suggests that progress has been slow in identifying empirically supported best practices for this population. There is a growing evidence base that community reintegration outcomes for ex-inmates with psychiatric disabilities are the result of demographic and criminal history variations, yet implications of these variations needs further exploration in the realms of service access and receptivity as well as variations in postrelease adaptation.

Implications – More knowledge and innovative research is needed on the experience of ex-inmates with psychiatric disabilities and social integration. Resources for cost effectiveness studies as well as long-term follow-up qualitative studies are necessary.

The purpose of this paper is to describe the delivery of the first clinically led, inter-professional Pathway Homeless team in a mental health trust, within the King’s Health Partners hospitals in South London. The Kings Health Partners Pathway Homeless teams have been operating since January 2014 at Guy’s and St Thomas’ (GStT) and Kings College Hospital and expanded to the South London and Maudsley in 2015 as a charitable pilot, now continuing with short-term funding.

This paper outlines how the team delivered its key aim of improving health and housing outcomes for inpatients. It details the service development and integration within a mental health trust incorporating the experience of its sister teams at Kings and GStT. It goes on to show how the service works across multiple hospital sites and is embedded within the Trust’s management structures.

Innovations including the transitional arrangements for patients’ post-discharge are described. In the first three years of operation the team saw 237 patients. Improved housing status was achieved in 74 per cent of patients with reduced use of unscheduled care after discharge. Early analysis suggests a statistically significant reduction in bed days and reduced use of unscheduled care.

The paper suggests that this model serves as an example of person centred, value-based health that is focused on improving care and outcomes for homeless inpatients in mental health settings, with the potential to be rolled-out nationally to other mental health Trusts.

The purpose of this paper is to explore the impact of the Health and Social Care Act, 2012 on London’s rough sleepers as seen from the perspective of one former homeless service user (currently working as a support worker in a day centre providing outreach and “drop in” facilities for people who are street homeless and other vulnerable adults including female sex workers). The discussion centres on some of the unintended impacts of changes to healthcare commissioning; the new arrangements for patient, public representation; and the enhanced role of local councils.

This paper is grounded in front line practitioner reflection/opinion and draws on practical experience and observation at Spires, as well as research and government papers published by other service providers. The aspirations of the Health and Social Care Act, 2012 are set out before its practical application are examined from the rough sleeper’s dimension.

Putting clinicians and GPs centre stage in the commissioning and purchasing of healthcare may have some benefits for individual patient choice, but it can also dilute patient public involvement in health and social care with negative effects for vulnerable and excluded groups, including rough sleepers. The terms of reference ascribed to Local Healthwatch Organisations, the official representatives of the people, are narrower than previously and limit their ability to influence official policy. The Act centralises control whilst devolving operational responsibility, especially for public health provision on which rough sleepers often rely. It is suggested that local voluntary organisations and specialist “inclusion” health groups are increasingly being expected to take over responsibility for delivering health and social care and that mainstream collaboration is much reduced rather than enhanced by this fragmentation.

This review is based on the opinion of an “expert by experience” which may not be representative.

This is one of few papers which present a front line service user/practitioner perspective on the impact of clinical commissioning on services for marginalised groups.

The authors’ interest in the discharge of patients with no fixed abode (NFA) arose through repeatedly seeing patients discharged back to the streets. In 2017, the Royal United Hospital (RUH) treated 155 separate individuals with NFA, making up 194 admissions. Given these numbers, the best practice according to Inclusion Health’s tiered approach to secondary care services suggests that the hospital should be providing a dedicated housing officer and a coordinated discharge pathway. As this is currently lacking, the purpose of this paper is to establish a Homeless Healthcare Team (HHT) and design a hospital protocol for the discharge of NFA patients with strong links into community support.

The literature review identified six elements that make up a successful HHT, which has provided the structure for the implementation of the authors’ model at the RUH.

Along the way, the authors have faced a number of challenges whilst attempting to transform the model into a reality, including: securing funding; allocating responsibility; balancing conflicting priorities; coordinating schedules; developing staff knowledge and challenging prejudice. The authors are now working collaboratively with invested parties from the third sector, specialist primary and secondary care health services and local government to overcome these barriers and work towards the long-term goals.

Scarce literature exists on the practicalities of attempting to set up an HHT in a District General Hospital. The authors hope that the documentation of the authors’ experience will encourage others to broaden their horizons and persist through the challenges that arise.