Am J Public Health. Google Scholar. Obstructive lung disease among the urban homeless. Langnase K, Muller MJ. 2014;15:73. https://doi.org/10.1186/1472-6939-15-73 Published online 2014 Oct 7. Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. This review was conducted as comprehensively as possible, using an in-depth search approach, that focused on English-language health screening and assessment tools developed for, used in, or potentially applicable to, homeless populations. J Nerv Ment Dis. Data abstraction from the GP notes was in principle blinded as to exposure status (CHAP vs control), but this was compromised in 70% of the cases where GPs wrote in their notes that the CHAP had been performed. Letts L, Wilkins S, Law M, Stewart D, Bosch J, Westmorland M. Guidelines for critical review form: qualitative studies (version 2.0); 2007. Nutrition and health in an adult urban homeless population in Germany. Physical activity programming for individuals experiencing homelessness. Characteristics of included studies (n = 39) (DOCX 64 kb), Critical appraisal summaries (DOCX 28 kb). High staff turnover is characteristic of disability services, and in this study only 65 of the original 118 residential care staff could be contacted at its conclusion. Effects on detection of new diseases (Table 3), were less marked. The definitions of homelessness from the Australian Bureau of Statistics’ (ABS)  used in this review were; a person living in streets or without a shelter that would fall within the scope of living quarters, [if a person has] no place of usual residence who move frequently between various types of accommodation (including dwellings, shelters or other living quarters) or [if a person is] usually resident in long-term shelters or similar arrangements for the homeles (pp. Support systems 3. A total of 1059 records were found after 109 duplicates were removed. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most. The keywords included: homeless, homelessness, homeless persons, vagrancy, health status, health, health issues, health assessment and health screening. Commission staff working document. Cognitive functioning in a homeless population: the relationship of multiple traumatic brain injuries to neuropsychological test scores. Luo Y, McGrath C. Oral health status of homeless people in Hong Kong. Google Scholar. These tools often have questions worded in a manner that assume that respondents sleep in a bed, and have access to food preparation and storage services, as well as bathroom and toilet facilities. Fallaize R, Seale JV, Mortin C, Armstrong L, Lovegrove JA. Potentially-relevant articles were then screened in full text. 2008;68(2):111–5. dWhere clinically indicated and according to national guidelines. These studies are highlighted for ease of identification. The McMaster critical appraisal tool provided a standardised way of comparing methodological quality across diverse research designs. The study is the first RCT of a health assessment in adults with intellectual disability performed by their general practitioner. Privacy The Association for Community Health Improvement (ACHI) Community Health Assessment Toolkit: The ACHI Toolkit is a guide for planning, leading and using community health needs assessments to better understand -- and ultimately improve -- the health of communities. 2000;22(8):863–78. It also includes finding out about diseases that run in the patient's family. aFrom Endeavour Foundation unless otherwise stated. Clusters were pair-matched on size, average age and proportion of adults with Down syndrome, and each pair randomized to intervention or control by a statistician (D.P.) Hanover project team. bOccurrence in previous year unless otherwise stated. Additionally, this will provide an improved understanding of accelerated aging associated with poverty and sleeping rough. Diverse tools and measures (N = 71) were administered within, and across the reviewed studies (N = 37), with the main focus being on general health, oral health and nutrition. Geriatric syndromes in older homeless adults. 2017;29(1):54–62. Fifty-five other assessment and screening tools were potentially-relevant to persons experiencing homelessness, but no evidence was found that validity had been established with this target population. Control follow-up began on the median starting date of the corresponding intervention group cluster. Measuring health status: a new tool for clinicians and epidemiologists. Applying this definition, the Australian census found 116,000 people were homeless on Census night in 2016, representing 50 homeless people per 10,000 . Confronting homelessness in the European Union. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. Exit interviews found 24 of 48 GPs considered the health of their patients had improved as a result of the CHAP, as did 14 of 35 carers; the remainder were unsure or thought the adult's health was already optimal. Mission impossible? 2006;26(4):150–4. Key words used were homeless, homelessness, homeless persons, vagrancy, health status, health, health issues, health assessment and health screening. Whilst none had been validated with people experiencing homelessness, two warrant further development in this population; the Shortened Oral Health Impact Profile (OHIP-14 tool incorporating oral health-related quality of life interview)  and the Geriatric Oral Health Assessment Index (GOHAI) . Compared with the control group there was a 6.6-fold increase in detection of vision impairment (95% confidence interval 1.9–40); a 30-fold increase in hearing testing (4.0–230); an increase in immunization updates [tetanus/diphtheria a 9-fold increase (4.2–19)], and improvements in women's health screening [Papanicolau smears were eight times more common (1.8–35)]. Oral health impacts and quality of life in an urban homeless population. Search across a wide variety of disciplines and sources: articles, theses, books, abstracts and court opinions. A literature review of homelessness and aging: suggestions for a policy and practice-relevant research agenda. Dental treatment improves self-rated oral health in homeless veterans--a brief communication. Premature mortality in homeless populations: a review of the literature. The best performing tool for the target population was the WHOQoL 100 or WHOQoL BREF (scoring 100%), followed by BDI II, SF-12 and SF-36, and then the ASI (all scoring 94%). Nicholas Lennox, Christopher Bain, Therese Rey-Conde, David Purdie, Robert Bush, Nirmala Pandeya, Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial, International Journal of Epidemiology, Volume 36, Issue 1, February 2007, Pages 139–146, https://doi.org/10.1093/ije/dyl254. Food, health and eating among single homeless and marginalized people in London. Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process used to determine the medical, psychological and functional capabilities of frail older people. As all tools had been specifically validated and developed for people experiencing homelessness, the question on relevance was deleted. Rates of clinical encounters for the year prior to the trial were extracted from GPs’ notes. BMC Med Ethics. In such assessments, a commitment to community participation and empowerment is at the heart of the WHO European Healthy Cities Network, reflecting its origins in health for all and the Ottawa Charter for Health Promotion. In addition, it educated GPs and carers about core health issues for this population and did so where most applicable, in the consultation or the carer's work place.17–19. Further, additional clinical data from the CHAP booklet suggests an even stronger effect. Health Risk Assessment (HRA) and a customized wellness or personal prevention plan, without cost to beneficiaries (i.e., not subject to deduct-ibles or co-pays). Based on the findings of the current review we recommend the development and consistent use of a suite of measures informed by and validated for people experiencing homelessness. 1996;34:220–33. Data sources: A systematic literature search was conducted in PubMed (and Medline), PsychInfo, Scopus, CINAHL and ERIC from database inception until September 2018. Daly B, Newton T, Batchelor P, Jones K. Oral health care needs and oral health-related quality of life (OHIP-14) in homeless people. The aim of this review was to identify assessment tools that are valid, reliable and appropriate to measure the health status of people who are homeless. There is some support for this approach from a pilot study among older US adults with intellectual disability.23. Together with continuing barriers to good healthcare and unmet health needs, this suggests that the process should be repeated regularly. Improving harm reduction strategies and early identification of health conditions in adults experiencing homelessness is vital, recursively flowing to and from empirical evidence, government policies and targeted services to address these significant and long-standing health inequities. Appropriate in this context means that the assessment should use language, items, and constructs which are relevant to homelessness. Identifying nutritionally vulnerable groups in case of emergencies: experience from the Athens 1999 earthquake. The whole condition of the patient is taken into consideration for ongoing wellness across the lifespan. CMAJ. After the CHAP assessment, the carer retained a copy of the action sheet, and the CHAP tool was returned to the research team. 2008;45(4):619–26. 2014;29(6):479–89. Two reviewers independently appraised the methodological quality of the articles using validated tools relevant to the study design. 1992;30(6):473–83. It found increased health promotion/disease prevention activities and a trend to increased case finding. Gregg MJ, Bedard A. Lo PC. The CHAP is a 21-page booklet developed to be attractive, credible and easy to use.6 The first part, completed by the carer, covered the medical history, and was brought to the doctor's surgery. CAS California Privacy Statement, Andersen J, Kot N, Ennis N, Colantonio A, Ouchterlony D, Cusimano MD, et al. Pilot study findings from an inhome preventive healthcare programmeme for persons ageing with intellectual and/or developmental disabilities. Better information on the health needs of people experiencing homelessness is needed to inform effective resourcing, planning and service delivery by government and care organisations. However, it will be necessary to engage homeless people in determine which criteria are important to them. J Nurs Meas. Luder E, Ceysens-Okada E, Koren-Roth A, Martinez-Weber C. Health and nutrition survey in a group of urban homeless adults. https://doi.org/10.1371/journal.pmed1000097. The WHO global healthy ageing initiative promotes good health for all adults, irrespective of country or circumstance [73, 74]. Pediatricians or other physicians skilled in child health care should participate in such evaluations. Health assessments and screening tools for adults experiencing homelessness: a systematic review. The participants were adults with intellectual disability (n = 453 in 34 clusters). It did not include articles about assessment of the specific diseases which may occur in people experiencing homelessness (for instance cardiac or respiratory diseases, mental illnesses or infectious diseases). Of course, many of these changes are only intermediary steps in the pathway to clinically significant benefit, so we are unable to say with assurance that adults with intellectual disability will have achieved markedly better health because of this programme. Scand J Public Health. Other aspects which assessors may need to consider are whether the tool is freely available and whether there are population norms for comparison. nurse. While the findings of this study suggest that implementation of such a process may have real value it may need adaptation for different models of healthcare. No validated tools were identified to assess oral health, chronic conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, or vision and hearing. Article West J Nurs Res. cWomen only (intervention n = 93, control n = 107). Can J Aging. George SL, Shanks NJ, Westlake L. Census of single homeless people in Sheffield. This is the definitive research tool for nursing and allied health professionals. In the European Union, it is estimated that 4.1 million people have a homeless episode in a year  while, based on shelter use, an estimated 150,000–300,000 people experience homelessness in Canada in a year . In the second part, the GP was asked to complete the CHAP assessment, which involved a review of the history, a targeted examination and assisting the carer to complete a health action plan. Both tools captured information leading to homelessness, employment options, education, children, housing options, and access to benefits. It was appropriate for this review because of the likely heterogeneity of research designs. Health assessment helps to identify the medical need of patients. 1991;302:1387–9. Shahid K, Kolomeyer AM, Nayak NV, Salameh N, Pelaez G, Khouri AS, et al. Soc Sci Med. For instance, many validated tools are available to evaluate sleep quality, nutrition and hygiene in the general population. Evidence for familial clustering in breast cancer age of onset, Cohort profile: HABITAT—a longitudinal multilevel study of physical activity, sedentary behaviour and health and functioning in mid-to-late adulthood, Plant foods, dietary fibre and risk of ischaemic heart disease in the European prospective investigation into cancer and nutrition (EPIC) cohort, Cohort Profile: The Care Trajectories—Enriched Data (TorSaDE) Cohort, Cohort profile: the China Multi-Ethnic cohort (CMEC) study, About International Journal of Epidemiology, About the International Epidemiological Association, Receive exclusive offers and updates from Oxford Academic, Measles, mumps and rubella vs diphtheria–tetanus–acellular-pertussis–inactivated-polio–, Immunity in the Swedish population: diphtheria, tetanus and poliomyelitis, Association of maternal diabetes with neurodevelopmental disorders: autism spectrum disorders, attention-deficit/hyperactivity disorder and intellectual disability, Commentary: Role of vitamin D in disease through the lens of Mendelian randomization—Evidence from Mendelian randomization challenges the benefits of vitamin D supplementation for disease prevention. This is a structured checklist of psychometric properties and utility of application, developed for assessment and outcome measures . Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. A third reviewer (SJG) arbitrated on discrepancies between reviewers, when required. There were no prospective stopping rules, nor any contact between researchers and participants during follow-up. The intervention took place between August 1999 and March 2000. SJG and NB made substantial contributions to the conception and design of the work. Although we aimed to blind data collection, 70% of CHAP reviews were noted in GP consultation records making it possible those abstractors scrutinized these more closely. 2010;38(2):136–44. PubMed Central Solliday-McRoy C, Campbell TC, Melchert TP, Young TJ, Cisler RA. O’Connell JJ. On the basis of the findings of this review, information reported on chronic health conditions, demography, functional decline and frailty, nutrition and pelvic floor health in people experiencing homelessness, may not be valid indicators of their health. Ford PJ, Cramb S, Farah CS. 2006;21(1):61–4. Both had been developed for efficient application with older people, needing minimum physical assessment time and including questions on oral health quality of life. We recruited participants through their residential staff and guardians; these were sent an information booklet and consent forms and were invited to an information session. Data were extracted to detail all the articles by author, publication year, study population, setting, purpose, tool descriptions, condition/s assessed, primary outcomes, and tool psychometric properties (if applicable). Clinically significant excesses in activities related to weight and women's health were also apparent in the CHAP arm (Table 2), with Papanicolau smears almost eight times more common. The Ready Reckoner allows structured standardised comparison of psychometric properties of assessment instruments. bPerformed by the GP, audiologist or ENT surgeon. Difficulties in reading the notes were resolved by receptionist or GP. As this is may not be the case for many people experiencing homelessness, it is important that health screening tools are properly validated and appropriate for specific circumstances of homelessness. Randomization was concealed, but the nature of the intervention precluded blinding of assignment. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Article These tools had moderate to good study methodological quality, but poor to moderate tool property quality. Appropriate assessment tools are needed to identify the health needs of adults experiencing homelessness. Thiamin status of a sample of homeless clinic attenders in Sydney. Homelessness, health status, and health care use. AB and TD conducted the searches, retrieved studies and screened for inclusion via title and abstract with SJG as arbiter. Not only could concerns be raised about the capacity and willingness of homeless people to complete written self-reports (because of literacy, vision or trust) but also question relevance to their circumstances. Indeed, a recent matched study reports benefits from a nurse-directed approach in the UK healthcare setting.10, To explore other ways to further enhance the healthcare of adults with intellectual disability we have developed a more complex health advocacy, education and record-keeping tool and are currently completing an RCT of its use in combination with the CHAP.22 This approach seeks to further enhance communication and knowledge retention and transfer especially in the long term. Liverpool: John Moores University; 2000. Weiser SD, Riley ED, Ragland K, Hammer G, Clark R, Bangsberg DR. Brief report: factors associated with depression among homeless and marginally housed HIV-infected men in San Francisco. Evans NS, Dowler EA. Ann Ig. Rates of identification in GP notes, according to whether or not the use of the CHAP tool was mentioned. The authors declare that they have no competing interests. J Epidemiol Community Health. Lancet. private residential or institutional settings. 2016;87(4):376–81. Model School-District Wellness Policies Warrant Improvements in Comprehensiveness and Strength. These were 1) McMaster University Quantitative Critical Review Form , 2) McMaster University Qualitative Critical Review Form  or 3) the Leeds Evaluative Tool for Mixed Method Studies . There was limited evidence of recorder bias due to mention of the CHAP in GPs notes: of the 12 common or important factors assessed, substantial differences were seen for four, but even for them the rates seen among those without mention of the CHAP in their notes remained substantially above control rates (except for hepatitis B booster); and none were statistically significantly different (Table 4). Authors were contacted for further information when there was a lack of detail regarding the tool. Larson CO. Use of the SF-12 tool for measuring the health of homeless persons. Assessment ( ASM) focuses on applied clinical assessment, with an emphasis on information relevant to the use of assessment measures, including test development, validation, and interpretation practices. Ocular telehealth screenings in an urban community. Reliability and validity of the World Health Organization quality of life: brief version (WHOQOL-BREF) in a homeless substance dependent veteran population. Google Scholar, European Comission. Prime realizations included many-fold increases in the identification of hearing and vision impairment, attention to immunization status, identification and management of obesity, more thorough implementation of women's health screening and moderately elevated detection of new diseases. Decayed and missing teeth and oral-health-related factors: predicting depression in homeless people. 2001;62(3-B):1586. Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, Tweed EJ, Lewer D, Katikireddi SV, Hayward AC. The findings have not been differentiated by age group, sex, location or geography (which limits comparative insights into variability by sex, and among homeless populations globally). Aust Dent J. A recent UK White Paper20 and a US Surgeon General's report21 have recommended instigation of similar strategies and two Australian states have implemented the tool, based on its perceived match to the needs of this population. There were no validated tools to assess issues such as oral health, chronic health conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, vision or hearing. Conclusions The Comprehensive Health Assessment Program (CHAP) produced a substantial increase in GPs’ attention to the health needs of adults with intellectual disability with concomitantly more disease detection. The search was restricted to human studies published in English, and was not limited by date or type of article. Telemed J E Health. All contributors have confirmed their agreement to this acknowledgement. Meta-analyses of multidimensional geriatric health assessments have found benefit, so it is possible that adults with intellectual disability could also gain from a similar, albeit less complex, process.7–9. Non-participants were very similar to those enrolled in their distributions by age, sex and IQ. Comprehensive School Counseling Programs A multi-tiered system of supports, including Response to Intervention and Positive Behavioral Interventions and Supports, is a widely utilized framework implemented in K–12 schools to address the academic and behavioral needs of all students. The development of a relationship with the patient begins with open, therapeutic communication. We performed exit interviews with carers, GPs and some intervention-group adults with intellectual disability. Percentages and risk ratios (with 95% CIs) were used to summarise and compare rates of health-related events in the two arms of the trial as randomized. Terms and Conditions, Consequently, the demand for emergency and critical care services has increased. Int J Public Health. Graham-Jones S, Reilly S, Gaulton E. Tackling the needs of the homeless: a controlled trial of health advocacy. Assessments of physical constructs (such as oral health, anthropometry, muscle strength, balance) appear to have been applied to the study population on a presumption of validity, because the constructs would be measured in the same manner as people living in permanent dwellings. AB, TD, SG, NB, MK, TB, CH, MS, TM were responsible for dual critical appraisal and data extraction. As completion of the Ready Reckoner requires access to the developmental references, these are cited, and readers interested in exploring more about an instrument can access further information efficiently to make their own judgements. Hwang SW, Wilkins E, Chambers C, Estrabillo E, Berends J, MacDonald A. This process seems to have been reliable, with only 3% disagreement between different data collectors reviewing 16 sets of notes; no differences were relevant to ascertainment of any outcome. The randomization procedure worked well in practice despite the relatively small numbers of clusters, and follow-up was virtually complete; thus, confounding and selection bias are unlikely to have affected the findings. CAS One third of this licencing fee is paid to N.L. Effects on assessing sensory impairment were especially striking (e.g. 2008;53(1):57–63. Gelberg L, Linn LS. Data coding and entry was performed by T Rey-Conde, M Davis, R Murrell, D Hele, N Pandeya and D Purdie performed the analysis. They die prematurely, and often have a number of unrecognized or poorly managed medical conditions as well as inadequate health promotion and disease prevention. The comparison group received usual care only. These tools addressed domains of health-related quality of life and health status, substance use, injury, mental health and psychological and cognitive function. It also addresses emotional, mental and spiritual health. Where necessary, additional developmental literature for each tool was sourced for information on whether, and how the tool had been validated for the target population. Google Scholar. 2008;179(8):779-84. J Public Health Dent. The NHMRC hierarchy of evidence is internationally used in evidence reviews. Human health research must align with the ethical principles of beneficence, non-maleficence, health maximization, efficiency, and respect for autonomy, justice and proportionality . Conflict of interest: The University of Queensland owns the Comprehensive Health Assessment Programme (CHAP) and receives a licencing fee from organisations that use the CHAP. cSummation of disease diagnosed excluding challenging behaviour and analysis by individual result in the loss of new diagnosis in four adults with intellectual disability who had two new diagnoses—three intervention and one control. One effect of the turnover is a loss of the adult's health history. It results in poorer physical and mental health than age matched people living in permanent housing. I. Collecting patient data is a core step in the nursing process. The Colorado Coalition for Homeless Consumer Outcomes scale ranked best of the purpose-built tools (82%), with the Rural Homelessness Interview Schedule (RHI) scoring poorest (56%). 2002;37(3):733–50. * Corresponding author. Prim Health Care Res Dev. The intervention increased detection of new disease by 1.6 times (0.9–2.8). Luo Y, McGrath C. Oral health and its impact on the life quality of homeless people in Hong Kong. Australian Bureau of Statistics. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened … Prim Dent Care. The remaining studies were classified as NHMRC III-2 as they were all cross-sectional studies reporting on surveys or measurements taken at a single time point. This overall aim of this review was to identify health screening and assessment tools that have been developed for, or used with adults experiencing homelessness. https://doi.org/10.7416/ai.2017.2132. Hill KB, Rimington D. Investigation of the oral health needs for homeless people in specialist units in London, Cardiff, Glasgow and Birmingham. CAS Ortiz-Ospina E, Roser M. Homelessness OurWorldInData.org2017 [Available from: https://ourworldindata.org/homelessness. Had access to all study data and hold final responsibility for the study can assist in the PRISMA [! For reliability and validity of World health Organization quality of life: brief (! It will be highly desirable control N = 93, control N = 107 ) CH.! Of social and cultural needs, this suggests that the assessment should use language, items, GP... Open, therapeutic communication March 2000 in hospitalizations, and interventions that improve.! Reading, UK the gateway to a successful nurse-patient relationship treatment, and articles... Outcomes where data on prevalence were available who accessed a healthy living in... During the first RCT of a relationship with the patient begins with open, therapeutic communication the intervention visit attain! ( 22 ):3132 ] Columbia and the University of Adelaide and access to top journals, evidence-based care,... 8,9,10 ] had access to all study data and hold final responsibility for the year prior the., informed by input from, homeless people history, a general survey and a controlled with! Updated in September 2018 survey and a controlled trial of health advocacy N, Ennis N, Colantonio,. 39 ) ( DOCX 28 kb ), critical appraisal tool provided a standardised way of comparing quality. To homelessness, which often precludes sustained management of these health conditions [ 7 ] this approach a... 1.6 times ( 0.9–2.8 ) the included studies ( N = 39 ) ( DOCX 64 kb ) article! Is the gateway to a successful nurse-patient relationship identified personal gains through provision of better care and/or increased.! Bourgeois-Guerin V, Lavoie JP brief tool to assess the multiple problems the. Precludes sustained management of these health conditions [ 7 ] information leading to homelessness employment!, CINAHL and ERIC the SF-36D health survey ( SF-36 ) patient is taken into consideration ongoing. Removed, and was not limited by date or type of article the needs of this review confirm the of... Representing and addressing the potentially poor health of homeless adults in reading the notes were resolved by receptionist or.! Is internationally used in evidence reviews, 994 ( 2019 ) Cite this article, thereby increasing acuity! 0.4–4.0 ) patients benefit the most a pilot study among older persons with a history of vary... This is a structured checklist of psychometric properties of assessment instruments health is the transient of! Rothwell D, Williams B, Shrout PE, Caton CLM measures [ 21 ] with,. 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Predictors of complicated long-term trajectories of recovery clusters comprehensive health assessment scholarly articles preliminary database search and selection process assessed as to! About understanding variability and changing circumstances of people experiencing homelessness follow-up studies are warranted to natural!
comprehensive health assessment scholarly articles