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The paper aims to explore the relationship between rough sleepers, welfare and policy in the city of Liverpool, taking Liverpool City Council's Homelessness Strategy 2008‐2011 as a starting point. The paper takes as its premise the notion of rough sleepers as among the most vulnerable and marginalised in society, and questions how well they are protected by policy.

The approach used is analysis and contextualisation of the strategy document in terms of welfare and criminological perspectives.

The paper posits that the city's European Capital of Culture Status for 2008 has acted as a springboard for further consumerist and regeneration‐driven aspirations, facilitated by restriction of entitlement to access city space for groups such as rough sleepers. The piece explores responses to rough sleepers and other “undesirable” city centre space users in Liverpool and contends that their behaviour and activities are criminalised. Ultimately, it is argued that the city, whilst it prioritises its goal of becoming a “world‐class city”, fails to deliver in terms of its welfare obligations.

It is argued that the failure of the strategy to adequately consider the direct needs of rough sleepers renders them subject to other approaches, namely criminalisation. The article is valuable to both academics interested in aspects of social justice and practitioners engaged in policy making, in that it highlights some of the ways in which policy can fail to meet its basic requirements.

This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

Homelessness has been a growing problem in many countries since the 1980s. The purpose of this paper is to examine homeless peoples’ perspectives on public library services, and to compare these with the attitudes of library staff.

Eight interviews have been conducted with rough sleepers and formerly homeless library patrons to examine their experiences, needs and expectations or the library. In addition, four library staff have been interviewed about their attitudes to services for members of the homeless community.

Most rough sleepers and formerly homeless patrons who participated in this research viewed the public library as a safe place because it offered a welcoming atmosphere, access to a variety of resources and services targeted at the homeless. Nonetheless, sleeping has always been a major reason for their use of the library. Most staff members agreed that providing services targeted toward rough sleepers changed the dynamic between staff and the homeless patrons, but there was some disagreement between staff members about whether targeted services were the most appropriate approach.

Understanding homeless and rough sleepers’ expectations for public library services may be useful in revising policy and developing services for this community. In particular, developing partnerships with organisations supporting the homeless is an effective way of developing relevant services for this often-marginalised group.

Little research has considered public library services from the perspective of homeless people. This research is intended to fill that gap.

With the temporary housing of rough sleepers in response to the Covid-19 emergency, some commentators have been tempted to believe that the rising population of rough sleepers in the UK has finally been reversed. This paper aims to examine the choices made by persistent rough sleepers and how far they are influenced by the perverse incentives of social policies, in order to challenge the view that they sleep rough out of choice.

Evidence for this paper is derived from two teams of frontline service providers with routine familiarity with the rough sleeping population: a street outreach team and a team of support workers working with adults with multiple and complex needs. Primary data from focus groups were combined with the secondary analysis of both numerical and narrative accounts routinely recorded by both teams.

The exercise of agency by persistent rough sleepers is constrained by a mixed baggage of complex needs, past negative risk assessments, limited resources and regulatory deterrents to generate choices to reject help that appear irrational. These need to be understood if recent policy initiatives to end rough sleeping are to be effective.

The paper draws on the experience and comprehensive records of practitioners with intimate knowledge of the rough sleeping population. It extends narrative accounts of causes by focusing on key choices to show how the perverse incentives of policy combine with personal factors to incline rough sleeping to persist.

The purpose of this paper is to describe research into attachment styles of rough sleepers and considersthe implications for practice.

The research was structured interviews with a cohort of rough sleepers analysed through evidence-based techniques, and the implications were drawn out with reference to current best practice.

The rough sleepers in the cohort had a very different pattern of attachment styles to the housed population, with 100% insecure vs c35%, and 50% insecure disorganised vs >15%.

The limitation is that the cohort was relatively small, n = 22 and was a sample of convenience. The implications are that homelessness services working with rough sleepers need to be attachment-informed as much as trauma-informed.

Practical implications are that homelessness services need to have a more rounded psychological perspective such as psychologically informed environments rather than just a trauma-informed approach.

Rough sleepers suffer from deeply pervasive and severe attachment disorders, and this may be causal to their becoming rough sleepers and is certainly a factor in whether or not they are successfully rehoused.

There is almost no other original research published into the attachment styles of rough sleepers or homeless people. The current trend is for trauma-informed services: the call for attachment-informed ones is original.

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.

This paper explores the experiences of people who have been homeless and in contact with learning disability services. The research adds to the very limited evidence, particularly in the UK, on how services can better meet the health and social needs of this group. All people with learning disabilities who were homeless and known to either local social services or health learning disability services in a large city in the North East of England were identified. Semi‐structured interviews were conducted with 14 participants at their current accommodation. Content analysis was used to identify common themes. Interview data indicated that breakdown of social support was the main cause of homelessness, and that in temporary accommodation people with learning disabilities were vulnerable to exploitation by other residents. Concerns were also expressed about the quality of housing, mental health was a recurring theme and the importance of ensuring that people with learning disabilities receive adequate treatment for these difficulties is discussed. Access to health care in general is facilitated by support in arranging and attending appointments. Mediation services may play a key role in preventing people with learning disabilities from becoming homeless through relationship breakdown. The study also suggests that improvements in temporary accommodation are needed, including housing designed specifically for people with learning disabilities, in order to react effectively to episodes of homelessness.

The purpose of this paper is to positively confirm a new and different approach used to engage with entrenched rough sleepers, using the more personalised approach already adopted in social care.

This is a first hand experience of the impact of the approach.

That a personalised approach can achieve positive results with a hard to reach client group.

This is the first published paper on this particular project.

Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting people to safe and secure housing needs to be part of the health system response. The paper aims to discuss these issues.

This mixed-methods paper presents emerging findings from the collaboration between an inner city hospital, a specialist homeless medicine GP service and Western Australia’s inaugural Housing First collective impact project (50 Lives 50 Homes) in Perth. This paper draws on data from hospitals, homelessness community services and general practice.

This collaboration has facilitated hospital identification and referral of vulnerable rough sleepers to the Housing First project, and connected those housed to a GP and after hours nursing support. For a cohort (n=44) housed now for at least 12 months, significant reductions in hospital use and associated costs were observed.

While the observed reductions in hospital use in the year following housing are based on a small cohort, this data and the case studies presented demonstrate the power of care coordinated across hospital and community in this complex cohort.

This model of collaboration between a hospital and a Housing First project can not only improve discharge outcomes and re-admission in the shorter term, but can also contribute to ending homelessness which is itself, a social determinant of poor health.

Coordinated care between hospitals and programmes to house people who are homeless can significantly reduce hospital use and healthcare costs, and provides hospitals with the opportunity to contribute to more systemic solutions to ending homelessness.

This article summarises the findings of a research study conducted to establish the links between homelessness, begging and drug misuse. It concludes that drug misuse is widespread amongst beggars and rough sleepers. It discusses some of the issues concerning care and support services available to the homeless.