Browsing by Subject "homelessness"
Item ASSESSING REPRODUCTIVE INTERCONCEPTION CARE BEHAVIORS, BARRIERS, AND FACILITATORS AMONG WOMEN RECENTLY PREGNANT AND HOMELESS(2022-08) Galvin, Annalynn M.; Thompson, Erika; Lewis, Melissa; Walters, Scott T.Interconception care, care provided to mothers between pregnancies, reduces short birth interval risks such as prematurity and low birthweight. Women experiencing homelessness have higher rates of unintended pregnancy and may experience stronger benefits from reproductive interconception care through either unintended pregnancy reductions or healthy pregnancy promotion via family planning. It is critical to build on limited research on interconception care within this population to potentially reduce poverty and cyclical, intergenerational homelessness. By utilizing a sequential explanatory mixed-methods design, this proposed study aimed to first determine prevalence ratios of interconception behaviors such as attendance of maternal postpartum visits, birth spacing and family planning counseling, and postpartum contraception outcomes of women experiencing homelessness, then identify the most salient interconception barriers and facilitators related to interconception information (e.g., knowledge), motivation (e.g., personal attitudes), and behavioral skills (e.g., perceived self-efficacy) among postpartum women who experienced homelessness during pregnancy. Using the 2016-2019 Pregnancy Risk Assessment and Monitoring System, the prevalence of interconception care behaviors among women experiencing homelessness and the associations between housing status and interconception care behaviors were estimated. The sample (n=100,706) was primarily non-Hispanic White (59.4%), married (61.9%) women with private insurance (59.4%) and less than a 4-year degree (63.0%). Approximately 2.4% of participants experienced housing instability in the 12 months before their child was born. Perinatal housing instability was significantly associated with lower odds of attending a postpartum maternal visit (aOR=0.45, 95% CI 0.37, 0.56) and (aOR=1.30, 95% CI 1.07, 1.57) when compared to women who did not experience homelessness in the last 12 months from the time of the interview. Findings from aim 1 determined specific interconception care behavior deficits to further explore via one-hour semi-structured interviews with 12 women experiencing homelessness while pregnant who had given birth within the last four years. Eligible women were recruited through local agency partnerships using purposive sampling. Interviews were audio-recorded, coded to consensus, and analyzed for themes. Information-related themes included knowledge and misconceptions about perinatal processes (e.g., pregnancy, labor and delivery, becoming pregnant, preventing pregnancy) as well as information-seeking themes. Motivation-related themes included attitudes about recent interconception care experiences, perinatal social influences, perceived susceptibility to future pregnancy, and attitudes regarding reasons for not engaging in postpartum pregnancy prevention. Behavioral skill-related themes included objective ability to engage in perinatal behaviors during housing instability, as well as perceived self-efficacy related to barriers and facilitators to engaging in reproductive interconception pregnancies as well as ease of pregnancy. Macro-related themes included housing effects on perinatal period, how perinatal experiences affected seeking stable housing, and how the interconnected nature of housing and other macro-level factors influenced reproductive interconception care. These findings establish a baseline understanding of interconception behaviors and the associated barriers and facilitators related to interconception care information, motivation, and behavioral skills among women experiencing homelessness. Findings may potentially strengthen current interconception practices and augment reductions in unintended pregnancy, short birth intervals, or adverse birth outcomes in future pregnancies, thus improving pregnancy outcomes and improving the health of women before, during, and after pregnancy.Item Current Endeavors to Support the Homeless Population of Fort Worth(2017-03-14) Alavi, Michael; Burgess, Lauren; Dolan, Kathryn J.; Phillips, KaitlinPurpose: The aim of this research was to identify and explore current solutions in supporting the homeless population in Fort Worth, Texas, particularly through the services provided by local non-profit organizations. Methods: We identified the terms of eligibility, services provided, service access, and barriers to effective outreach provided by five local non-profit organizations, including John Peter Smith Health Network, Tarrant County Samaritan Housing, Arlington Life Shelter, Salvation Army DFW, and Union Gospel Mission of Tarrant County. Results/Conclusions: Frequent terms of eligibility include valid U.S. identification and proof of low-income or homeless status, and common service access methods include hospital referrals, word of mouth, and flyers in well-populated public areas. Services provided included shelter, aid in employment search, navigation to health services, and a variety of supportive services to integrate those who have been recently homeless into society. These organizations have encountered multiple barriers to effective outreach, such as client mental illness, client lack of appropriate paperwork, shortage of affordable housing, and transportation difficulties. Non-profit organizations in Fort Worth provide varying degrees of support for the homeless population and have identified areas for improvement that that citizens, volunteers, local government, and the organizations themselves can consider in broadening their outreach.Item WHAT ARE THE NEEDS OF PERMANENT SUPPORTIVE HOUSING RESIDENTS? A SURVEY OF CASE MANAGERS IN TARRANT COUNTY(2014-03) Marshall, Brittany; Walters, Scott; Spence-Almaguer, Emily; Abraham, StacyThis research served as a pilot study to help us develop a program for homeless persons in Tarrant County to improve their quality of life. Purpose (a): Permanent Supportive Housing (PSH) is used as a method of reducing homelessness and its associated costs. The insight of case managers is integral to determine factors that may facilitate or inhibit the health and quality of life of PSH residents in Tarrant County. Methods (b): An online survey was conducted with PSH case managers (n=24) to assess the percentage of PSH residents affected by various health and wellness domains, barriers to improving health, and potential motivational levers. Data was analyzed using SPSS. Results (c): Case Managers reported that clients were most affected by poor mental health (74%), poor social support (69%) physical health (64%) and substance abuse (46%). Case managers identified furniture, transportation, and food as their clients’ top needs. Case managers believed clients were somewhat motivated to work on improving social support, physical and mental health, and poor nutrition. Approximately 60% of case managers believed their clients were not at all or a little motivated to work on improving medication adherence and substance abuse issues. Conclusions (d): Findings will guide the development of the Interactive Community Health Assistance for Tenants (iCHAT), which aims to reduce alcohol and drug use, reduce symptoms of depression, and improve quality of life amongst PSH residents.