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"Homelessness -- Australia"
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Beside One's Self
What is it to feel homeless? How does it feel to be without the orienting geography of home? Going beyond homelessness as a housing issue, this book uniquely explores the embodied, emotional experiences of homelessness. In doing so, Robinson reveals much about existing gaps in service responses, in community perceptions, and in the ways in which homelessness most often becomes visible as a problem for policy makers. She argues that the emotional dimension of displacement must be central to contemporary practices of researching, understanding, writing, and responding to homelessness. She situates the issue of homelessness at the nexus of important, broader intellectual and methodological developments that take bodily and spatial experience as their starting point.
eBook
Indigenous homelessness : perspectives from Canada, Australia, and New Zealand
Being homeless in one's homeland is a colonial legacy for many Indigenous people in settler societies. The construction of Commonwealth nation-states from colonial settler societies depended on the dispossession of Indigenouspeoples from their lands. The legacy of that dispossession and related attempts at assimilation that disrupted Indigenous practices, languages, and cultures-including patterns of housing and land use-can be seen today in the disproportionate number of Indigenous people affected by homelessness in both rural and urban settings.Essays in this collection explore the meaning and scope of Indigenous homelessness in the Canada, Australia, and New Zealand. They argue that effective policy and support programs aimed at relieving Indigenous homelessness must be rooted in Indigenous conceptions of home, land, and kinship, and cannot ignore the context of systemic inequality, institutionalization, landlessness, among other things, that stem from a history of colonialism.\"Indigenous Homelessness: Perspectives from Canada, New Zealand and Australia\" provides a comprehensive exploration of the Indigenous experience of homelessness. It testifies to ongoing cultural resilience and lays the groundwork for practices and policies designed to better address the conditions that lead to homelessness among Indigenous peoples.
eBook
The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations
In the European Union, more than 400 000 individuals are homeless on any one night and more than 600 000 are homeless in the USA. The causes of homelessness are an interaction between individual and structural factors. Individual factors include poverty, family problems, and mental health and substance misuse problems. The availability of low-cost housing is thought to be the most important structural determinant for homelessness. Homeless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated ageing. Although engagement with health services and adherence to treatments is often compromised, homeless people typically attend the emergency department more often than non-homeless people. We discuss several recommendations to improve the surveillance of morbidity and mortality in homeless people. Programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals, and the child welfare system, and the introduction of national and state-wide plans that target homeless people are likely to improve outcomes.
Journal Article
Wongee Mia: An Innovative Family-Centred Approach to Addressing Aboriginal Housing Needs and Preventing Eviction in Australia
Background: Aboriginal Australians are disproportionately affected by homelessness, with traditional housing models failing to recognise the importance of kinship obligations and ongoing systemic racism. The Wongee Mia project is a pilot initiative emerging out of a Housing First project tackling homelessness among Perth’s most vulnerable rough sleepers. The project takes a different approach to working with and providing long-term housing to Aboriginal families in Perth, Western Australia. Methods: The Wongee Mia project is centred around one person “Robby” and his family to prevent eviction. Data are collected from monthly action research meetings, yarning sessions with family Elders, and case notes. Results: The project identified 32 family members who had potential to place “Robby’s” tenancy at risk. As at December 2019, 29 members of Robby’s family have been supported by the Wongee Mia case workers, and five have been housed. Key elements of Wongee Mia are the broader links to end homelessness initiatives (the Housing First program), the cultural backgrounds of the case workers and their ability to connect in a meaningful way with the family, Elder involvement (including the co-production of this paper), and an underlying action research model enabling program delivery improvements. Conclusion: The Wongee Mia project offers an innovative way of working with families to prevent unnecessary eviction by working through the whole family’s needs rather than those of an individual in relation to housing.
Journal Article
The effect of a financial incentive on COVID-19 vaccination uptake, and predictors of uptake, in people experiencing homelessness: A randomized controlled trial
People who are homeless are at increased risk of COVID-19 infection, and of poorer associated outcomes. Delivering vaccinations to, and ensuring uptake of multiple doses in, people who are homeless is complex. Financial incentives may improve vaccination uptake, particularly in people who have not received routine vaccinations previously, though evidence about the effect of incentives is limited and variable.
This randomized controlled trial (ANZCTR 383156) assessed the effect of a financial incentive (an A$10 grocery voucher) on uptake of the second COVID-19 vaccination in Australian adults who were homeless, and who had received their first dose. Participants were recruited through a vaccination program for people experiencing homelessness between September 2021 and January 2022. They were followed-up for a minimum of 6.5 months. Uptake was measured ‘on-time’ at 6 weeks, and at any time during the trial period. Vaccination status was checked on the Australian Immunisation Register. Demographic and vaccination program characteristics associated with uptake were also investigated.
Eighty-six people consented to participate, and 43 were randomly allocated to each of the ‘incentive’ and ‘no incentive’ groups. The incentive slightly increased the likelihood of a participant receiving a second vaccination on-time (risk difference (RD), 11.6 % [95 %CI, −9.0, 32.2 %]; p = 0.27), and at any time during the trial (RD, 14.0 % [95 %CI, –2.2, 30.1 %], p = 0.09). The incentive had a significant positive effect on uptake in people with no previous vaccination history, increasing their likelihood of receiving a second vaccination on-time (RD, 42.3 % [95 %CI, 15.7, 68.8 %]; p = 0.002) and at any time during the trial (RD, 38.7 % [95 %CI, 16.1, 61.3 %], p < 0.001).
Financial incentives may increase COVID-19 vaccination uptake in people who are homeless, and particularly those who have no previous vaccination history. Future research should consider alternative incentive values, types, and cost-effectiveness.
Journal Article
Describing the development and implementation of a novel collaborative multidisciplinary approach to deliver foot health supports for individuals experiencing homelessness and its outcomes
Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1.
Who needs to do what differently
? 2.
What are the barriers and enablers that need to be addressed
? 3.
Which intervention components could overcome the modifiable barriers and enhance the enablers
? 4.
How can the changes be measured
? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1
st
June 2019 and 31
st
December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point.
Journal Article
Long‐term effects of homelessness on mortality: a 15‐year Australian cohort study
To examine the effect of homelessness on mortality.
This 15‐year retrospective longitudinal cohort study compared mortality outcomes of homeless and non‐homeless adults attending the emergency department of an inner‐city public hospital in Melbourne, Victoria between 1 January 2003 and 31 December 2004. Homeless individuals had ≥1 recorded episodes of homelessness within the recruitment period, categorised by type: primary, secondary, tertiary, marginally housed. Non‐homeless individuals were stably housed throughout.
Over 15 years, homeless individuals had a higher mortality rate (11.89 vs. 8.10 per 1,000 person‐years), significantly increased mortality risk (rate ratio 1.47, 95% confidence interval [CI] 1.26–1.71) and younger median age at death (66.60 vs. 78.19 years) compared to non‐homeless individuals. Using adjusted Cox proportional hazards models, primary (hazard ratio [HR] 2.05, 95%CI 1.67–2.50), secondary (HR 1.60, 95%CI 1.23–2.10) and tertiary (HR 1.72, 95%CI 1.16–2.56) homelessness were independent risk factors for premature mortality.
At least one recorded episode of primary, secondary, or tertiary homelessness was associated with premature mortality and younger age at death over a 15‐year period.
Accurately identifying individuals experiencing primary, secondary or tertiary homelessness at the emergency department may enable targeted interventions that could potentially reduce their risk of premature mortality.
Journal Article
New reform proposals for Australian health care
In February, 2023, the Strengthening Medicare Taskforce, a group of health leaders formed by the Federal Government, released its much anticipated report on how to improve Australia's primary health-care system. Associate Professor Louise Stone from the College of Health and Medicine, Australian National University in Garran, who is also a GP who works with homeless young people in Canberra, explained that the current fee-for-service model rewards quick and easy consultations rather than complex care, such as for people with chronic disease or mental health problems. [...]doctors have described to The Lancet that the GP workforce is demoralised, with doctor shortages, clinics closing, and the uneven distribution of GPs worsening. The Taskforce recommends moving to a blended funding model to support general practice in the management of complex chronic diseases that are integrated with fee-for-service, “with funding for longer consultations and incentives that promote quality bundles of care for people who need it most”.
Journal Article