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The shift in policy discourse towards individualism is affecting service provision and access, which has become increasingly conditioned on individual agency and the “deservingness” of the recipient. Gendered and intersectional experiences of homelessness and excluded populations less likely to be living on the streets remain overlooked and unaddressed. This study thus aims to uncover what drives “invisibility” in services for women experiencing multiple disadvantage and the gendered constraints the women are facing when exiting and navigating multiple disadvantage.

The paper draws on in-depth interviews with women who face severe and multiple disadvantage and their support staff. Data is also gathered through survey data and observations with a wide range of frontline service providers, as well as support notes and numerical progress data recorded by one of the service providers.

Contradicting the common assumption that people act as rational actors in their interaction with services, the author found that women’s decisions to (dis)engage may be blinded by forces of multiple disadvantage and mistrust. These are often developed as a result of systemic and gendered constraints that limit women’s capabilities and exercise of choice. Barriers in service access often amplified the personal barriers they were facing and reinforced women’s decisions to not engage with services.

The author hopes that this paper sheds light on the particular set of barriers women with multiple disadvantage face, which will be vital to reach women who face severe disadvantage and provide more effective policies, care and support.

This study gives voice to a particular hidden population: women with multiple disadvantage. It contributes to existing frameworks on agency and choice by understanding gendered barriers behind service engagement and how services themselves may be contributing to women’s invisibility.

The purpose of this paper – the second of three – is to report the findings from a service user needs assessment in those who have contact with a local homelessness service in the North-West of England.

Data were collected using a semi-structured questionnaire that included a section exploring Adverse Childhood Experiences. Aggregated data from a total of 100 completed questionnaires were analysed to understand the nature and scope of those accessing the Homelessness and Vulnerable Adults Service (HVAS).

Homeless people accessing HVAS face a number of challenges, which reflect their upbringing and chaotic and complex lifestyles. Reports of multiple disadvantage, social isolation, physical and mental health problems were common among the cohort.

This was a small cohort study, and the authors accept that this may potentially limit the scope of the findings. Themes identified are, however, reflected in wider research and official data collection sources. Future research may seek to widen the data collection methods to offer a more representative cohort.

The provision of co-ordinated multi-agency support is essential to tackle health inequalities experienced by those who are homeless.

The complex issues often experienced by those who are homeless can further compound the impact of social exclusion on health and well-being. The reduction of statutory support and increased emphasis on self-reliance can further impact those people on the margins of society.

This study identifies how multiple deprivations and social isolation impacts upon health and well-being, further compounding a person’s ability and willingness to engage with services. It raises the question of the systems failure to respond effectively.

Homelessness has many causes and also is stigmatized in the United States, leading to much misunderstanding of its causes and what policy solutions may ameliorate the problem. The problem is of course getting worse and impacting many communities far removed from the West Coast cities the authors examine in this study. This analysis examines the socioeconomic variables influencing homelessness on the West Coast in recent years. The authors utilize a panel fixed effects model that explicitly includes measures of healthcare access and availability to account for the additional health risks faced by individuals who lack shelter. The authors estimate a spatial error model (SEM) in order to better understand the impacts that systemic shocks, such as the COVID-19 pandemic, have on a variety of factors that directly influence productivity and other measures of welfare such as income inequality, housing supply, healthcare investment, and homelessness.

Due to ongoing inequities in the social determinants of health and systemic barriers, homelessness continues to be a significant concern that disproportionately impacts racialized communities. Despite constituting a small proportion of the population, Black individuals are over-represented among people experiencing homelessness in many Canadian cities. However, although Black homelessness in Canada is a pressing issue, it has received limited attention in the academic literature. The purpose of this paper is to examine the reported prevalence of Black homelessness across Canada.

By consulting enumerations from 61 designated communities that participated in the 2018 Nationally Coordinated Point-in-Time Count and two regional repositories – one for homeless counts supported by the government of British Columbia and another from the Rural Development Network – this paper reports on the scale and scope of Black homelessness across Canada.

Significantly, these reports demonstrate that Black people are over-represented among those experiencing homelessness compared to local and national populations. These enumerations also demonstrate significant gaps in the reporting of Black homelessness and inadequate nuance in data collection methods, which limit the ability of respondents to describe their identity beyond “Black.”

This research provides an unprecedented examination of Black homelessness across Canada and concludes with recommendations to expand knowledge on this important and under-researched issue, provide suggestions for future iterations of homeless enumerations and facilitate the development of inclusive housing policy.

This article aims to present a systematic review and synthesis of evidence on the experiences, role and use of IPE in IH fields by using a meta-ethnographic approach including key concepts, reciprocal and refutational translation and lines of argument. Inclusion health (IH) practice suggests that the needs of excluded groups are more effectively addressed through collaborative working. Interprofessional education (IPE) occurs when two or more professions engage in shared practice and learning, resulting in improved collaboration and quality of care. Studies on IPE to train staff in fields relating to IH exist, but without a settled consensus on the best approaches/activities to foster inclusive practice.

This synthesis is underpinned by a meta-ethnographic approach. It provides explicit stages of data collection and interpretation, while providing space to engage with emerging themes and concepts iteratively (reflecting on author experiences) and inductively (reasoning and interpretation). This study made use of electronic databases and journals for English language peer reviewed articles between 2000 and 2020. Of the 2217 articles, 19 papers were included. The lead author and reviewer completed the review process and a second reviewer reviewed 10% at each stage. The quality was assessed using a modified CASP checklist. Iterative analysis involved PPI and staff stakeholders.

A total of 16 concepts embedded in 19 papers provide insight into the nature of IPE in IH (IH) for staff. It was found that IPE in IH covers a broad group of practitioners and is a complex activity involving individual and organisation readiness, practical and pedagogical factors, influenced by setting, method, curriculum, lived experience, reflection and a learner-driven approach. Barriers to design, implementation and translation into practice were also found to exist.

Most studies used a combination of core learning and group work. Educational modes include mentoring or coaching, reflective practice, immersive learning and people lived experience of exclusion involved in or facilitation thematically centred in trauma-informed informed care, cultural competence, communities of practice and service learning. The aim of these methods was to promote collaboration through identifying shared experiences, problems and tensions and critical reflection of services and organisations. Such transformative learning is reported to challenge stigma, discrimination and misinformation and promote collective empowerment to address social injustice through human connection. Effective models of IPE re-instated the therapeutic relationship and alliances between patients and staff.

This review also calls for the development of health and care workers’ professionalism in relation to their own reflexivity, establishing anti-racist curricula, challenge stigma and ensuring clinicians are aware of and able to negotiate tension and difference identified within the consultation and between themselves. Apart from developing generalist skills, this analysis suggests that IPE in IH may be able to challenge stigma and discrimination towards IH groups by destabilising existing norms and siloed working with the aim of achieving robust interprofessional practice.

IPE in IH is a complex activity affected by individual and organisation readiness, setting, experiential, practical and pedagogical factors. Models of teaching are focused on re-instating the therapeutic relationship. There are no systematic reviews in this field and previously there was no settled consensus on the best approaches and learning activities to foster inclusive and collaborative practice.

This study aims to co-develop a Frailty, Health and Care Needs Assessment (FHCNA) questionnaire for people experiencing homelessness and explore the feasibility of its use by non-clinical staff in homeless hostels.

The FHCNA, aimed at identifying frailty and other health and care priorities for people experiencing homelessness, was co-designed in workshops (online and in person) with homelessness and inclusion health staff. Its feasibility was tested by staff and their clients in two hostels, with pre- and post-study focus groups held with hostel staff to gain input and feedback.

The FHCNA was co-developed and then used to collect 74 pairs of resident and key worker inputted data (62% of eligible hostel residents). The mean age of clients was 48 years (range 22–82 years). High levels of unmet need were identified. Over half (53%) were identified as frail. Common concerns included difficulty walking (46%), frequent falls (43%), chronic pain (36%), mental health issues (57%) and dental concerns (50%). In total, 59% of clients reported difficulty in performing at least one basic activity of daily living, while only 14% had undergone a Care Act Assessment. Hostel staff found using the FHCNA to be feasible, acceptable and potentially useful in facilitating explorations of met and unmet health and social care needs of hostel clients. By identifying unmet needs, the FHCNA has the potential to support staff to advocate for access to health and social care support.

To the best of the authors’ knowledge, this is the first study to co-develop and feasibility test a questionnaire for use by non-clinically trained staff to identify frailty and other health and care needs of people experiencing homelessness in a hostel setting.

This study investigates barriers to social impact bond (SIB) implementation through a review of academic and gray literature. A SIB is a type of public policy instrument that leverages payment for performance (P4P), contracting together with private investments in the delivery of welfare programs. Outcome-based contracts, such as SIBs, are gaining attraction for public service providers in developed countries, but research regarding their implementation remains underexplored both empirically and theoretically.

A literature review is conducted in which two types of documents are included: (1) empirical research papers and (2) evaluations of completed SIB projects. In total, 43 documents have been investigated. The study engages in a comparative design where insights across sectors (healthcare, social care and employment/education), are leveraged. The insights rest on evidence from the UK and US.

The investigation reveals five types of barriers to SIB implementation related to: (1) the SIB model, (2) organizational competencies, (3) data infrastructure, (4) stakeholder engagement and (5) the institutional context. The study discusses ways of managing these barriers and develops a conceptual framework for empirically investigating SIB implementation.

This study is the first academic paper to systematically assess insights regarding the implementation of SIBs. Also, the article proposes a conceptual framework for investigating SIB implementation.

This study aims to examine the role of performance management systems (PMSs) in enabling logic blending to manage institutional complexity and tensions arising from coexisting institutional logics.

This research uses a case study of an Australian non-government organisation (NGO) operating in an institutional field dominated by the state government, in which policy reform jolted the balance between institutional logics. Data was collected through semi-structured interviews, archival documents and observations.

We find the policy reform required the NGO to transform from a wholly care focus to accommodate a more balanced approach with a focus on care coupled with efficiency, outcome delivery and performance measurement. The NGO responded by revising its purpose, strategy and operational model and by seeking to address the imperatives of two dominant and often competing care and managerial logics. We find this was achieved through logic blending, in which PMSs played a pivotal role, with the formalisation and collaboration processes mobilising different elements of PMSs, mobilising some elements differently or not mobilising some elements at all.

This study highlights the central role of PMSs in managing tensions between and the complexity arising from coexisting institutional logics through logic blending, a form of enduring compromise. This study extends the accounting logics and performance management literature by developing the understanding of what constitutes logic blending and how it is distinct from other forms of compromise.

Health disparities affecting lesbian, gay, bisexual, transgender and queer (LGBTQ) populations have been reported in many countries. For Singapore, no large quantitative studies on mental health and well-being in the local LGBTQ community have been published. The authors conducted a community-based survey (National LGBT Census Singapore, 2013; NLCS2013) that covered a comprehensive set of demographic, social and health indicators. Here, the authors investigated mental health status and its correlates in 2,350 LGBTQ individuals within the NLCS2013 sample.

The NLCS2013 was an anonymous online survey conducted amongst self-identified LGBTQ adults (aged ≥ 21 years) residing in Singapore. The survey included the World Health Organisation Well-being Index (WHO-5) as a measure of mental well-being, with low WHO 5 scores (<13/25) indicating poor mental well-being. The authors analysed relationships between low WHO-5 score and a range of respondent characteristics using multivariate logistic regression.

Strikingly, 40.9% of 2,350 respondents analysed had low WHO-5 scores, indicating poor mental well-being. Parental non-acceptance, experience of conflict at home and bullying/discrimination in the workplace or educational environments were all significantly associated with poor mental well-being. Conversely, community participation appeared protective for mental well-being, as respondents who participated in LGBTQ community organisations or events were less likely to have poor mental well-being than non-participants.

The NLCS2013 represents one of the first broad-based efforts to comprehensively and quantitatively capture the sociodemographic and health profile, including mental health status, within Singapore’s resident LGBTQ population. These findings affirm the need to address the mental health needs of LGBTQ individuals in Singapore and to foster safe spaces and allyship.

Looked after children (LAC) are criminalised at five times the rate of children in the general population. Children in contact with both child welfare and child justice systems have higher rates of neurodisability and substance use problems, and LAC in general have high rates of school exclusion, homelessness and unemployment. This study aims to understand whether these factors persist in LAC who are in prison as adults.

Administrative data collected by the Do-IT profiler screening tool in a prison in Wales, UK, were analysed to compare sentenced prisoners who were LAC (n = 631) to sentenced prisoners who were not LAC (n = 2,201). The sample comprised all prisoners who were screened on entry to prison in a two-year period.

Prisoners who were LAC scored more poorly on a functional screener for neurodisability (effect size = 0.24), and on four self-report measures capturing traits of dyslexia (0.22), attention-deficit hyperactivity disorder (0.40), autism spectrum disorders (0.34) and developmental co-ordination disorder (0.33). Prisoners who were LAC were more likely to have been to a pupil referral unit (0.24), have substance use problems (0.16), be homeless or marginally housed (0.18) and be unemployed or unable to work due to disability (0.13).

This study uniquely contributes to our understanding of prisoners who were LAC as a target group for intervention and support with re-integration into the community upon release. LAC in prison as adults may require additional interventions to help with employment, housing and substance use. Education programmes in prison should screen for neurodisability, to develop strategies to support engagement.