Dataset Information

Adverse childhood experiences and health among indigenous persons experiencing homelessness.

ABSTRACT:

Background

Current literature has established that adverse childhood experiences (ACEs) are associated with the onset of a variety of physical, mental, and behavioural illnesses. However, there are few studies that have thoroughly examined this association in low-income or marginalized groups.

Methods

To address this knowledge gap, this study used self-reported data on childhood experiences and adult health outcomes in a sample of 91 Indigenous persons experiencing homelessness. While the primary focus of the study was to assess the relationship between ACEs and health status, we also assessed reports on use and perceptions of health care services to test for potential illness-mitigating factors.

Results

Results indicated that reported number of ACEs was significantly associated with reported levels of mental illness (p < .001, d = 1.12). Significant associations were not observed for physical illness or patterns of substance use. We also found that the number of reported ACEs was significantly correlated with the number of formal health care services that an individual used (r = 0.32).

Conclusions

Our results reveal that the relationship between ACEs and adult illness is not as deterministic as the current literature suggests. Access to formal health care services may allow individuals to mitigate their adverse health, thereby eliminating some of the effects of ACEs. Conversely, current tools used to measure ACEs may not translate to an Indigenous population, which speaks to a need to revise ACE related surveys to include additional adversity categories.

SUBMITTER: Smith E

PROVIDER: S-EPMC7791826 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Adverse childhood experiences and health among indigenous persons experiencing homelessness.

Smith Eric E Milaney Katrina K Henderson Rita I RI Crowshoe Lyndon L

BMC public health 20210107 1

<h4>Background</h4>Current literature has established that adverse childhood experiences (ACEs) are associated with the onset of a variety of physical, mental, and behavioural illnesses. However, there are few studies that have thoroughly examined this association in low-income or marginalized groups.<h4>Methods</h4>To address this knowledge gap, this study used self-reported data on childhood experiences and adult health outcomes in a sample of 91 Indigenous persons experiencing homelessness. W ...[more]

PMID: 33413243

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Project description:BackgroundAdverse childhood experiences (ACEs) are associated with increased morbidity and mortality, lower levels of distress tolerance, and greater emotional dysregulation, as well as with increased healthcare utilization. All these factors may lead to an increased use of emergency department (ED) services. Understanding the experience of ED utilization among a group of ED users with high ACE scores, as well as their experiences as viewed through the lens of a trauma and violence informed care (TVIC) framework, could be important to their provision of care.MethodsThis is the qualitative portion of a larger mixed methods study. Twenty-five ED users with high ACE scores completed in depth interviews. Thematic analysis of the interview transcripts was undertaken and directed content analysis was used to examine the transcripts against a TVIC framework.ResultsThe majority of participants experienced excellent care although challenges to this experience were faced by many in the areas of registration and triage. Some participants did identify negative experiences of care and stigma when presenting with mental health conditions and pain crises, as did participants who perceived that they were considered "different" (dressed differently, living in poverty, young parents, etc.). Participants were thoughtful about their reasons for seeking ED care including lack of timely access to their family doctor, perceived urgency of their condition, or needs that fell outside the scope of primary care. Participants' experiences mapped onto a TVIC framework such that their needs and experiences could be framed using a TVIC lens.ConclusionsWhile the ED care experience was excellent for most participants, even those with a trauma history, there existed a subset of vulnerable patients for whom the principles of TVIC were not met, and for whom implementation of trauma informed care might have a positive impact on the overall experience of care. Recommendations include training around TVIC for ED leadership, staff and physicians, improved access to semi-urgent primary care, ED patient care plans integrating TVIC principles, and improved support for triage nurses and registration personnel.

Project description:ImportanceSeveral jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting.ObjectiveTo assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity.Design, setting, and participantsThis retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness.ExposureA physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder.Main outcomes and measuresCharacteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay.ResultsOverall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P < .001) and quarantine status (adjusted odds ratio, 2.6; 95% CI, 1.5-4.6; P = .001). In total, 346 of 549 patients (63%) were transferred from the county hospital; of 113 ineligible referrals, 48 patients (42%) had behavioral health needs exceeding I/Q hotel capabilities. Thirteen of the 346 patients transferred from the county hospital (4%) were readmitted for worsening COVID-19. Overall, direct transfers to I/Q hotels from emergency and outpatient departments were associated with averting many hospital admissions. There was a nonsignificant decrease in the mean hospital length of stay for inpatients with confirmed or suspected COVID-19 from 5.5 to 2.7 days from March to May 2020 (P = .11).Conclusions and relevanceTo support persons experiencing homelessness during the COVID-19 pandemic, San Francisco rapidly and safely scaled a hotel-based model of I/Q that was associated with reduced strain on inpatient capacity. Strategies to improve guest retention and address behavioral health needs not met in hotel settings are intervention priorities.

Dataset Information

Adverse childhood experiences and health among indigenous persons experiencing homelessness.

Background

Methods

Results

Conclusions

Publications

Adverse childhood experiences and health among indigenous persons experiencing homelessness.

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