R01NR021986

HEALTH AND HOUSING IMPACTS OF UNSHELTERED HOMELESS ENCAMPMENT RESOLUTION PROGRAMS - PROJECT ABSTRACT THE NUMBER OF PEOPLE EXPERIENCING HOMELESSNESS (PEH) IN THE U.S. HAS REACHED RECORD LEVELS, RISING BY 13% SINCE 2020. A GROWING PROPORTION OF PEH ARE EXPERIENCING CHRONIC HOMELESSNESS, ILLUSTRATING INCREASING CHALLENGES IN CREATING EFFECTIVE PATHWAYS TO STABLE HOUSING. THE SHORT SUPPLY OF AFFORDABLE HOUSING IN COMMUNITIES ACROSS THE U.S. COMPLICATES EFFORTS TO SCALE EVIDENCE-BASED, PERMANENT SUPPORTIVE HOUSING PROGRAMS TO MEET THE SCALE OF THE HOMELESSNESS CRISIS. FACED WITH A GROWING POPULATION OF PEH LIVING UNSHELTERED IN HOMELESS ENCAMPMENTS, MANY MUNICIPALITIES HAVE BEEN DEVELOPING NEW, INNOVATIVE PROGRAMS FOCUSED ON “ENCAMPMENT RESOLUTION”. ENCAMPMENT RESOLUTION PROGRAMS (ERPS) UTILIZE HARM REDUCTION POLICIES SIMILAR TO HOUSING FIRST PROGRAMS AND PROVIDE A RANGE OF INTERIM HOUSING OPTIONS. ERPS HAVE BEEN ENDORSED AS A WAY TO QUICKLY CLEAR THE STREETS AND HELP REDUCE HEALTH DISPARITIES AND MORTALITY AMONG PEH AS THEY TRANSITION TO PERMANENT HOUSING. HOWEVER, THERE IS ALSO A RISK THAT THESE PROGRAMS COULD CREATE A REVOLVING DOOR, SENDING PEH BACK TO THE STREETS AND WORSENING HEALTH DISPARITIES BY SEVERING THEIR CONNECTIONS TO TRUSTED SOCIAL AND HEALTHCARE NETWORKS. HUNDREDS OF MILLIONS OF DOLLARS HAVE BEEN ALLOCATED TO SUPPORT ERPS, YET THERE IS LIMITED EMPIRICAL EVIDENCE EXAMINING THEIR EFFECTIVENESS IN REDUCING HOMELESSNESS AND IMPROVING HEALTH OUTCOMES. THIS PROPOSED PROJECT WILL USE A MIXED METHOD DESIGN TO PROVIDE THE FIRST LONGITUDINAL EVIDENCE ON THE POTENTIAL HEALTH BENEFITS OF ERPS. THE STUDY IS INFORMED BY AN INTEGRATED WEATHERING FRAMEWORK THAT LINKS THE ENVIRONMENTAL STRESSORS ASSOCIATED WITH UNSHELTERED HOMELESSNESS TO INDICATORS OF ACCELERATED AGING. OUR WORK IS SITUATED IN LOS ANGELES COUNTY, CA, WHICH HAS THE NATION’S LARGEST HOMELESS POPULATION, WITH 75% LIVING UNSHELTERED. WE WILL RECRUIT 400 ERP ENROLLEES INTO A UNIQUE AND EXISTING LONGITUDINAL STUDY OF ~500 UNSHELTERED PEH KNOWN AS THE PERIODIC ASSESSMENT OF TRAJECTORIES OF HOUSING, HEALTH AND HOMELESSNESS STUDY, OR PATHS. USING MONTHLY AND BIANNUAL SURVEYS, WE WILL ASSESS THE EFFECTS OF ERPS ON LONG-TERM HOUSING TRAJECTORIES AND A RANGE OF HEALTH OUTCOMES BY COMPARING THE NEWLY RECRUITED ERP COHORT TO THE EXISTING REPRESENTATIVE COMPARISON COHORT FROM PATHS. OUTCOMES WILL INCLUDE THOSE RELATED TO ACCELERATED AGING, ITS UNDERLYING DRIVERS, AND THE SOCIAL DETERMINANTS OF HEALTH. WE WILL EXAMINE THE OVERALL EFFECTS OF THE ERP PROGRAM ON HEALTH, AND DISAGGREGATE THE RESULTS BASED ON WHETHER INDIVIDUALS PROGRESS TO PERMANENT HOUSING, REMAIN IN INTERIM HOUSING, OR RETURN TO THE STREETS. THESE FINDINGS WILL BE COMPLEMENTED BY QUALITATIVE INTERVIEWS WITH ERP PARTICIPANTS ABOUT THEIR HEALTH AND HOUSING EXPERIENCES. BASED ON THESE RESULTS, WE WILL DEVELOP INNOVATIVE HOUSING POLICY GUIDELINES TO SUPPORT POLICYMAKERS AND PRACTITIONERS IN IMPROVING THE HEALTH AND WELL-BEING OF PEH.

Los Angeles University Of California

NURSES UNDERSTAND THAT IMPROVING HEALTH AND WELL-BEING MEANS ADDRESSING PEOPLE'S NEEDS IN MULTIPLE SETTINGS, CONTEXTS, AND OVER THE WHOLE LIFE COURSE. SCIENCE SUPPORTED BY THE NATIONAL INSTITUTE OF NURSING RESEARCH (NINR) USES THIS HOLISTIC PERSPECTIVE TO IMPROVE INDIVIDUAL AND POPULATION HEALTH AND ADVANCE HEALTH EQUITY. NINR-SUPPORTED RESEARCH PROMOTES HEALTH AND WELL-BEING BY ADDRESSING NEEDS AT MULTIPLE LEVELS INDIVIDUAL, FAMILY, COMMUNITY, AND SOCIETAL LEVELS AND DEVELOPING TREATMENT AND PREVENTION STRATEGIES THAT ARE RESPONSIVE TO THE REALITY OF PEOPLE'S LIVES. NURSES KNOW PEOPLE, AND PEOPLE TRUST NURSES. PATIENT AND FAMILIES INTERACT WITH NURSES MORE THAN ANY OTHER CLINICIANS. NURSING SCIENCE USES THIS SPECIAL RELATIONSHIP TO BETTER UNDERSTAND PATIENTS, FAMILIES, AND COMMUNITIES AND THE MANY FACTORS THAT INFLUENCE THEIR HEALTH. NURSING SCIENCE SUPPORTED BY NINR USES THIS KNOWLEDGE TO DEVELOP STRATEGIES FOR IMPROVING HEALTH AND WELLNESS ACROSS POPULATIONS, HEALTH CARE SETTINGS, AND THE LIFESPAN, WITH AN EMPHASIS ON ACHIEVING HEALTH EQUITY. NINR-SUPPORTED SCIENTISTS HAVE DEVELOPED INTERVENTIONS FOR: SUPPORTING PARENTS OF PREMATURE INFANTS, PROMOTING HIV PREVENTION IN UNDERSERVED POPULATIONS, IMPROVING TRANSITIONAL CARE LEADING TO BETTER OUTCOMES AND COST-SAVINGS, AND HELPING INNER-CITY CHILDREN MANAGE ASTHMA. NURSING SCIENCE TRANSCENDS THE BOUNDARIES OF DISEASE AND RESEARCH DISCIPLINES TO BETTER UNDERSTAND THE EXPERIENCES OF INDIVIDUALS AND FAMILIES LIVING WITH ILLNESS AND TO DEVELOP PERSONALIZED APPROACHES THAT MAXIMIZE HEALTH AND WELL-BEING FOR INDIVIDUALS AT ALL STAGES OF LIFE, ACROSS DIVERSE POPULATIONS AND SETTINGS. NINR-SUPPORTED SCIENCE USES NURSING SCIENCE'S UNIQUE, PATIENT AND COMMUNITY-FOCUSED PERSPECTIVE AND WIDE REACH ACROSS CLINICAL AND COMMUNITY SETTINGS TO ADVANCE OUR UNDERSTANDING OF THE SOCIAL DETERMINANTS OF HEALTH: THOSE FACTORS THAT ARE AT THE ROOT OF THE INEQUITIES THAT WE SEE, SUCH AS FOOD INSECURITY AND ACCESS TO HEALTHCARE. NINR RESEARCH EFFORTS IN WELLNESS INVESTIGATE THE KEY BIOLOGICAL, BEHAVIORAL, AND SOCIAL FACTORS THAT PROMOTE LONG-TERM HEALTH AND HEALTHY BEHAVIORS AND PREVENT THE DEVELOPMENT OF ILLNESS ACROSS HEALTH CONDITIONS, SETTINGS, AND THE LIFESPAN. RESEARCH IN WELLNESS IS ALSO FOCUSED ON DEVELOPING AND TESTING CULTURALLY APPROPRIATE INTERVENTIONS TO PROMOTE HEALTH AND PREVENT ILLNESS IN MINORITY AND UNDERSERVED GROUPS. NINR ALSO SUPPORTS SCIENCE TO ASSIST INDIVIDUALS, FAMILIES, AND HEALTH CARE PROFESSIONALS IN MANAGING ADVANCED, SERIOUS ILLNESS, AND PLANNING FOR END-OF-LIFE DECISIONS. IN ADDITION, NINR PROMOTES TECHNOLOGICAL ADVANCEMENTS THAT ADDRESS A RANGE OF HEALTH CARE CHALLENGES AND FACILITATE THE DELIVERY OF REAL-TIME PERSONALIZED INFORMATION TO INDIVIDUALS AND FAMILIES, HEALTH CARE PROVIDERS, AND COMMUNITIES. FINALLY, NINR HAS A LONGSTANDING AND CONTINUING COMMITMENT TO DEVELOPING THE NEXT GENERATION OF NURSE SCIENTISTS: THOSE INDIVIDUALS AND TEAM MEMBERS WHO WILL CARRY THE FIELD OF NURSING SCIENCE INTO THE FUTURE. IN ORDER TO PREPARE AN INNOVATIVE, DIVERSE, AND TALENTED NEXT GENERATION OF NURSE SCIENTISTS, NINR SUPPORTS A VARIETY OF TRAINING OPPORTUNITIES FOR SCIENTISTS AND TRAINEES AT ALL CAREER LEVELS, PARTICULARLY THOSE AT AN EARLY CAREER STAGE WHO ARE SO CRITICAL TO SUSTAINING THE FUTURE OF INNOVATIVE RESEARCH AND HIGH QUALITY HEALTH CARE.

93.361 - Nursing Research

National Institute of Nursing Research (NINR) [HHS - NIH]

Los Angeles, California 900958347 United States

Single Zip Code

Advancing Health Equity through Interventions to Prevent and Address Housing Instability (R01 Clinical Trial Optional) (RFA-NR-25-001)