Marlee Bower

People experiencing homelessness can often have small and fragmented social networks, due to the loss and absence of critical connections, leaving them particularly susceptible to loneliness. During the course of homelessness, some people experience a changing profile of networks, transitioning away from family and some friends and forming new/substitute networks, such as service providers or pets. The resulting loneliness can have profound impacts on this group, threatening their physical and mental health and their ability to exit homelessness successfully. This study aimed to understand the social network characteristics and support associated with loneliness. MOS Social Support and social network questionnaire data from 124 participants (either currently or formerly homeless) were used in three hierarchical regression models to predict romantic, social, and family loneliness (SELSA-S), respectively. Findings suggested the more supportive, important, and (often) more satisfying that participants deemed current relationships to be, the lonelier they tended to feel. This occurred even if they were no longer homeless. These findings suggest that loneliness can operate differently in the context of poverty and homelessness. Whilst experiencing homelessness, people may prioritise relationships that provide resources and safety over those that assuage loneliness. Service providers can support people exiting homelessness to (re)connect with important and valued networks to reduce loneliness.

Issues addressed People experiencing homelessness and/or complex needs often require targeted health services to address unique vulnerabilities. COVID‐19 restrictions acted as a barrier for this group accessing health and alcohol and other drug (AOD) treatment services. The Haymarket Foundation, an accommodation and health facility in Australia, transitioned from in‐person AOD‐counselling services to online consultations. Clients accessing these services were tracked, from March 2019 to November 2020, to assess the impact of the switch to telehealth on client retention. Methods Qualitative analysis of Haymarket clients' service experience surveys and quantitative descriptives of “no‐show” (nonattended sessions) rates and survival analysis of client treatment separations were completed to assess the impact of transitioning to telehealth on client retention. Results Although the initial transition to telehealth in March 2020 minimally impacted client no‐show rates, reinstated government restrictions in June/July 2020 coincided with increasing no‐shows and a substantial increase in treatment exits without notice, especially amongst males. Qualitative analysis showed clients had mixed feelings towards telehealth: some attributed their dissatisfaction to the inability to build rapport with their counsellor online, or with COVID‐19 in general. Others appreciated the availability and genuine care of their counsellors through either setting. Conclusions Telehealth may be a feasible replacement for face‐to‐face AOD counselling for people experiencing homelessness, however further investigation needs to be conducted to understand factors associated with improved client retention. So what? This pilot demonstrates telehealth may be a feasible ongoing feature of health promotion for vulnerable high‐needs populations, including people experiencing homelessness who use substances.