Mixed-methods study of the feasibility and acceptability of ecological momentary assessment with young adults who are currently or formerly homeless (Preprint)

BACKGROUND The use of ecological momentary assessment (EMA) has been utilized with young people experiencing homelessness to gather information on contexts associated with homelessness and risk behavior in real time and has proven feasible with this population. However, the extent to which EMA may impact attitudes or behaviors of currently homeless and formerly young adults residing in supportive housing has not been well investigated. OBJECTIVE This study describes feedback regarding EMA study participation from currently and formerly homeless young adults and examines reactivity to EMA participation and compliance. METHODS This mixed-methods study uses cross-sectional data collected pre- and post-EMA, intensive longitudinal data from a seven-day EMA prompting period and focus groups with currently and formerly homeless young adults in Los Angeles, California between 2017 and 2019. RESULTS Qualitative data confirmed quantitative findings. Differences in the experience of EMA between currently and formerly homeless young adults were found related to stress/anxiety, interference with daily life, difficulty charging, behavior change, and honesty in response. Anxiety and depression symptomatology decreased from pre- to post-EMA, but compliance was not significantly associated with the decrease. CONCLUSIONS Results point to special considerations when administering EMA with currently and formerly homeless young adults. EMA appears to be slightly more burdensome for currently homeless young adults, compared to those residing in supportive housing; nuances to consider in study design. The lack of relationship between study compliance and symptomatology suggests low levels of reactivity.

Transforming Worker–Client Identities: From Shelters to Housing First

The Housing First (HF) approach to counteracting homelessness, stemming from the USA, is advocated as a blueprint for homelessness policy change in Europe, including the Nordic countries. In contrast to traditional homelessness policies based on shelters as the first step towards ending homelessness, the HF policy discourse regards access to one’s own housing as a basic human right that should not be conditional upon good or acceptable behaviour. Building on ethnographic research in a Swedish HF unit striving to implement the HF approach ‘by the book,’ which includes both focus group interviews with workers and observations of worker–client interactions during home visits, we show how the new HF policy challenges both workers and clients, who used to encounter each other in shelters but now meet in clients’ own homes, transforming their identities. We demonstrate how workers account for transformations in worker–client identities by referring to how they and their clients used to think, talk and act, thus contrasting their new identities with their former selves. Moreover, in their efforts to accomplish their actual work tasks within the framework of the new HF policy discourse in the homes of formerly homeless clients, we show how workers struggle with their identities when they encounter clients in practice. In their accounts of policy change, the workers embraced their new identities with pleasure, but in practice, they were hesitant when dealing with issues of concern, such as their clients’ use of tobacco, alcohol and drugs. In sum, it becomes complicated in practice.

Examining HIV Risk and Exchange Sex Among Current and Formerly Homeless Young Adults

This study investigated HIV risk among homeless and formerly homeless young adults by examining risky sex behaviors (e.g., condomless sex, exchange sex, and sex with multiple persons) using 90-day and daily recall methods. Data came from a sample of young adults (aged 18–27) with current (n = 101) or past (n = 109) homelessness experience in Los Angeles, California, recruited between 2017 and 2019. Baseline surveys queried demographics and sexual history. Daily retrospective surveys queried sexual events. Multiple logistic regressions were used to test the effects of demographic characteristics including homelessness history, relationship status, substance use, and sexual history on risky sex outcomes. In this sample, 26% reported never using a condom during anal or vaginal sex in the past 90 days, 5% reported testing positive for HIV, 82% had limited to no knowledge of preexposure prophylaxis, and 8% reported having had exchange sex during a 7-day measurement period, with those experiencing homelessness more likely to report. The study suggests supportive housing can reduce the occurrence of exchange sex but that HIV prevention services are still needed in homeless and housing programs to promote safe sexual practices.

Subalternity as displacement: Memoirs of homelessness and the struggle to be heard

Building on the writings of homeless and formerly homeless memoirists from the United States and United Kingdom, this paper examines how the voices and ideas of those who experience homelessness are consistently removed from public debate and historical memory. While people without homes are discussed at length in journalistic and academic texts, their own voices are rarely at the center of such conversations. Memoirists argue that this exclusion is not passive or benign. They attest to persistent efforts to make their voices heard, even as newspapers, television stations, and other institutions of knowledge obstruct their efforts. In this way, homeless voices are actively and repeatedly displaced by the commentary of elite experts. Based on these insights, I engage with literature in geography and subaltern studies to advance a new understanding of subalternity as a process of epistemic displacement. Moving beyond deconstructive approaches to representation, I argue that challenging subalternity involves disseminating subaltern scholarship, journalism, and expertise to confront society's failure to listen.