Angela Woods

Purpose: This paper - the final paper of a series of three - aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic. Design/methodology/approach: Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS. Findings: Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society. Research limitations/implications: Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach. Practical implications: This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population. Social implications: This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems. Originality/value: The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

Purpose – The purpose of this paper – the second of three – is to report the findings from a service user needs assessment in those who have contact with a local homelessness service in the North-West of England.
Design/methodology/approach – Data were collected using a semi-structured questionnaire that included a section exploring Adverse Childhood Experiences. Aggregated data from a total of 100 completed questionnaires were analysed to understand the nature and scope of those accessing the Homelessness and Vulnerable Adults Service (HVAS).
Findings – Homeless people accessing HVAS face a number of challenges, which reflect their upbringing and chaotic and complex lifestyles. Reports of multiple disadvantage, social isolation, physical and mental health problems were common among the cohort.
Research limitations/implications – This was a small cohort study, and the authors accept that this may potentially limit the scope of the findings. Themes identified are, however, reflected in wider research and official data collection sources. Future research may seek to widen the data collection methods to offer a more representative cohort.
Practical implications – The provision of co-ordinated multi-agency support is essential to tackle health inequalities experienced by those who are homeless.
Social implications – The complex issues often experienced by those who are homeless can further compound the impact of social exclusion on health and well-being. The reduction of statutory support and increased emphasis on self-reliance can further impact those people on the margins of society.
Originality/value – This study identifies how multiple deprivations and social isolation impacts upon health and well-being, further compounding a person’s ability and willingness to engage with services. It raises the question of the systems failure to respond effectively

Purpose – This opinion piece documents the experience of losing an adult sibling to suicide and explores the experience of personal and family grief.
Design/methodology/approach – The narrative is written from an autoethnographic perspective and utilises the current evidence base to support a personal reflection.
Findings – The paper identifies the complex nature of bereavement following death from suicide and considers those factors which support more positive outcomes for those grieving.
Research limitations/implications – The piece focuses on autoethnographic data but is supported by findings from the wider evidence base.
Practical implications – The importance of seeking positives as part of the healing process when processing complex grief.
Social implications – Disclosure has been identified as an important part of processing complex grief associated with suicide bereavement and yet suicide remains a taboo subject for many.
Originality/value – This autoethnographic piece details the experience of dealing with a sibling suicide and the importance of creating the opportunity for positive reflection to process complex grief.

Purpose – This paper – the first of three – aims to explore some of the complex physical and mental health needs of those experiencing homelessness. It will act as a leader to the other articles by establishing the nature of the problem and offer a rationale for carrying out a service user needs assessment as part of a review of local service provision in the North West of England against the backdrop of the current COVID-19 epidemic.
Design/methodology/approach – There are a number of complex social and health inequalities often experienced by those who are homeless. Effectively tackling these requires a co-ordinated multi-agency response to both prevent and tackle the harms associated with being and becoming homeless.
Findings – Partnership working offers the best opportunity to meet the complex needs of those experiencing homelessness. The current delivery model being actioned in the North West of England highlights the importance of the links between statutory and non-statutory services. An ongoing service user needs assessment will further help to highlight contemporary issues faced by those experiencing homelessness and those providing services in the context of the COVID-19 epidemic.
Social implications – Future papers as part of this series of three will consider the implications of social exclusion and barriers to accessing services faced on a day-to-day basis by those experiencing homelessness.
Originality/value – The opportunity to reflect on established views in relation to the nature and scope of homelessness. It will consider the implications exclusion from society and service provision that this group face on a day-to-day basis. The paper will describe a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 epidemic

Health promotion is a relatively new concept that is grounded in the definition of health proposed in 1946 by the World Health Organization. The thinking behind health promotion departs from the biomedical model of health and considers how biological, psychological and social factors interact to affect the health and health outcomes of individuals, communities and population groups. An accurate and in-depth understanding of what health means to people and how health is experienced enables healthcare professionals, planners and policymakers to develop and deliver health promotion interventions that prevent suboptimal health and address health inequalities. This article describes the concepts, frameworks and models that underpin health promotion and discusses the different types of health promotion interventions that can be applied in nursing practice.