n-Ta Hsu

Transitioning from Homelessness: A “Fresh-Start” Event

Permanent supportive housing (PSH) has been recognized as central to the goal of ending chronic homelessness. This qualitative study considers the positive and negative expectations of 31 men and women in the Skid Row area of Los Angeles who are beginning the transition from homelessness to PSH through a Housing First approach. This study uses in-depth, qualitative interviews and an inductive approach informed by sensitizing concepts derived from the literature and thematic analysis of case summaries, interview transcripts, and interviewer feedback and observation. Three themes emerged from the data: (a) nowhere to go but up, (b) some things stay the same, and (c) neighborhood matters. These findings indicate that PSH is regarded as a fresh start and universally positive experience, and that the role of neighborhood highlights a tension in the pursuit of recovery from homeless between removing people from their neighborhoods versus keeping them close to their previous and familiar environments. Implications for social work practice include that maximizing a successful transition will require understanding and managing people’s expectations and reality.

Changes in Social Networks and HIV Risk Behaviors Among Homeless Adults Transitioning Into Permanent Supportive Housing A Mixed Methods Pilot Study

Permanent supportive housing (PSH) has been recognized by the U.S. federal government as the “clear solution” to chronic homelessness. Whether and how access to PSH affects HIV risk is unclear. This mixed methods pilot study uses a convergent parallel design in order to better understand social relationships and HIV risk during the transition from homelessness to PSH. Findings suggest that (a) Sexual activity and HIV risk behaviors increase with housing, (b) Social network size and composition appear to change as individuals transition into PSH, and (c) There is tension between moving forward and leaving behind the past once a person has housing. This study demonstrates that PSH constitutes a specific risk environment that has not been previously investigated.

Pilot Test of an Adapted, Evidence-Based HIV Sexual Risk Reduction Intervention for Homeless Women.

Women experiencing homelessness are at heightened risk for HIV, yet risk reduction interventions specifically designed for this population are lacking. This study reports on a pilot efficacy trial of a brief evidence-based intervention, Sister To Sister (STS), that we specifically adapted for homeless women in the temporary/emergency settings where they typically seek services. Seventy-nine women, recruited from three service sites in Los Angeles County, were assigned to the 40-min adapted STS intervention or an information-only control group. At 30-day follow-up, intervention participants reported significantly greater condom use, intentions to use condoms, and sexual impulse control (as well as marginally higher positive condom beliefs and condom self-efficacy) compared to control participants. Results provide preliminary evidence that HIV risk reduction can be achieved for homeless women through a brief skill-based intervention. A randomized controlled trial employing a longer follow-up period to monitor outcomes will be necessary to determine efficacy of the adapted intervention.

Risky Integration: A Social Network Analysis of Network Position, Exposure, and Suicidal Ideation Among Homeless Youth

BACKGROUND Although the protective value of social connectedness is emphasized in suicide prevention programming, little is known about the relationship between connectedness in high-risk runaway and homeless youth (RHY) networks and suicidal ideation. AIMS The study examined how social connectedness, in the form of social network position and network exposures, was associated with suicidal ideation among RHY. METHOD Using population-level social network data from 384 RHY, each youths network position and exposure to potentially suicidogenic peer attributes were calculated. Logistic regression analyses were used to examine associations between network position (core vs. periphery), peer exposures (e.g., depressed or suicidal peers), and suicidal ideation. RESULTS In univariable analyses, being in the core of the network and being connected to greater proportions of depressed and suicidal peers increased the likelihood of suicidal ideation. In the final multivariable model, higher exposure to depressed peers remained associated with suicidal ideation, and a marginal effect for network position was observed. CONCLUSION The risk of suicidal ideation was linked to depression among peers and to a lesser extent being more integrated into the RHY network. Identifying and treating depression in naturally occurring friendship groups, particularly in the core of the network, represents a promising network-level intervention.

Personal Networks: A Hypothesized Mediator in the Association Between Incarceration and HIV Risk Behaviors Among Women With Histories of Homelessness

Objective: Research on women with histories of homelessness shows both higher rates of incarceration and higher rates of HIV-risk behaviors. However, understanding homeless women’s experiences with the criminal justice system is hampered by the dearth of social network research with this population. To fill this gap and in an effort to enhance HIV-risk reduction among women with histories of homelessness, we examine whether incarceration history contributes to HIV-risk behaviors, and explore whether personal networks mediate the potential association between incarceration and HIV-risk behaviors. Method: This study uses a sample of 445 women with histories of homelessness. Women self-reported lifetime experience of incarceration and recent 6-month participation in 3 risk behaviors: multiple sex partnership, sex trade, and crack/cocaine use. Personal network characteristics included number of network members who had risky sexual behaviors and network members who had ever been incarcerated. Path analysis is used to answer whether incarceration is associated with the 3 risk behaviors and if risky personal networks mediate those relationships. Results: Findings indicate that incarceration is directly and indirectly (through personal networks) associated with all 3 risk behaviors. Though limited by the temporal structure of the data, the associations between incarceration, personal networks, and risk behaviors suggest incarceration can be a standalone correlate of HIV risk. Conclusion: This study validates a need to intervene earlier in the criminal justice process and to incorporate personal network composition into interventions for women with histories of homelessness and incarceration.

Adapting an Evidence- Based Intervention for Homeless Women: Engaging the Community in Shared Decision- making

As interest grows in the diffusion of evidence-based interventions (EBIs), there is increasing concern about how to mitigate implementation challenges; this paper concerns adapting an EBI for homeless women. Complementing earlier focus groups with homeless women, homeless service providers (n = 32) were engaged in focus groups to assess capacity, needs, and barriers with implementation of EBIs. Deductive analyses of data led to the selection of four EBIs. Six consensus groups were then undertaken; three each with homeless women (n = 24) and homeless service providers (n = 21). The selected EBI was adapted and pretested with homeless women (n = 9) and service providers (n = 6). The structured consensus group process provided great utility and affirmed the expertise of homeless women and service providers as experts in their domain. Engaging providers in the selection process reduced the structural barriers within agencies as obstacles to diffusion.

Location, Location, Location: Perceptions of Safety and Security Among Formerly Homeless Persons Transitioned to Permanent Supportive Housing

Objective: Low perceived safety and security might have adverse health consequences, especially for chronically homeless individuals who are at high risk of victimization on the street. Permanent supportive housing (PSH) is an effective strategy to address chronic homelessness and improve residents’ health and well-being. However, it is unclear how formerly homeless individuals’ perceptions of safety and security reflect the objective neighborhood environment in which the PSH is located. This article presents a study of the perceived safety and security of formerly homeless individuals transitioned to PSH in and around Skid Row. Method: This mixed-method study examines the perceptions of safety and security of 24 PSH residents living in the Skid Row area of Los Angeles. Subsequent block-based neighborhood observations were conducted informed by these qualitative findings. Results: Although participants felt safer relative to when they were homeless, residents living within Skid Row felt less safe than those who lived at the periphery. Participants housed within Skid Row also reported social isolation and exposure to situations reminiscent of past traumatic events. These findings correspond with objective neighborhood environmental differences in which more trash, malodors, and homeless people were observed on the blocks located near the center of Skid Row. Conclusions: Homeless individuals might experience an increase in their perceived safety after transitioning into PSH, but these perceptions might be contingent on the neighborhood environment. Future research should investigate how neighborhood characteristics influence perceived safety and whether these perceptions are influenced by the characteristics of the physical surrounding environment and/or past experiences of trauma.