As the population of the United States continues to age, providing this ever-growing group of individuals with end of life care is becoming an increasingly important issue. Quality end of life care begins with understanding the distinct needs and desires of each individual, and the best way to ensure that their wishes are followed is through the completion of advance directives. Although many Americans understand the importance of completing advance directives, the most vulnerable members of our society, the homeless, are often not given the opportunity to document their end of life wishes. In addition to dealing with the demands of everyday life on the street, homeless individuals are often disconnected from the healthcare system, and therefore they frequently miss out on the opportunity to partake in advance care planning. As this population ages, their end of life care is becoming ever more important. Studies have shown that homeless individuals are willing and able to fill out advance directives when they are given the opportunity, but in today’s busy healthcare system medical providers often do not have the time to assist each of their patients with completing an advance directive. Fortunately, nursing and medical students have proven that they can successfully assist homeless individuals in filling out advance directives, although the success of physician assistant students in providing this intervention has yet to be studied. This thesis will propose a new educational intervention designed to teach physician assistant students about advance care planning as well as giving them the opportunity to assist homeless individuals in completing advance directives. The curriculum will provide an innovative way of fulfilling educational standards set forth by the Accreditation Review Commission on Education for the Physician Assistant, and it can be adapted for physician assistant programs throughout the nation. As a result, physician assistant students will graduate with the confidence and skills necessary to provide advance care planning to all of their patients.

Doctor of Philosophy / Curriculum and Instruction Programs / Kakali Bhattacharya / Sally J. Yahnke / Over the past five years, alone, in the rural state of West Virginia, the number of identified homeless students has increased 315%— from 2,000 students to 8,300 students— which is assumed to be a conservative estimate by local and state education officials (Mays, 2014). Homelessness is often identified as an urban problem, as the most visible forms occur among street dwellers in urban settings (Joyce-Beaulieu & Sulkowski, 2014). Within rural locations, however, homelessness predominately remains a concealed issue requiring extensive collaboration to combat issues of geographic isolation and lack of support, infrastructure, and public services. This study will demonstrate how community school programming offers considerable potential to provide direct support and services within the school setting for rural homeless youth.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Anne E. Beamish / One of the most important aspects of a public space is its accessibility and inclusivity for all people. In urban parks, this often means that a wide variety of users must be considered during the design process. Denver Civic Center Park is a historic urban park in the heart of Denver’s downtown. The park caters to a variety of people ranging from tourist, who briefly visit the park, to people who are experiencing homelessness, and call the park home. Ensuring that the needs of people varying in age, culture, and economic background is key to any urban park’s success. Semi-structured interviews, site observations, site inventory and analysis, and critical mapping helped assess Denver’s Civic Center Park’s inclusivity and accessibility. Through a combination of improved infrastructure and additional amenities, a thoughtful redesign of the historic park addressed today’s challenges with homelessness and created a more inclusive environment. Because of the historic nature of the park only specific modifications to the southern ares were made. There are two reasons to create inclusive public spaces. The first is the social mixing that comes from people of different backgrounds and cultures sharing a safe environment. Social mixing connects groups of people through passive and active interactions that are built on seeing someone or overhearing their conversations. Social interactions, that take place in a safe environment, can trigger empathy within the community and start to build relationships between people of different socioeconomic groups. The second reason focuses on the ethics of designing public space. The infrastructure and policy of a public space should not be exclusive to a “desirable” demographic, but should include all existing users and the surrounding community. Because a large portion of users in Denver’s Civic Center Park are people experiencing homelessness, the design and programmatic amenities should consider their needs and desires. Landscape architects can influence the public’s views and the way people interact with each other by designing safe and active urban public spaces. In this project I asked, what design policies and strategies could be implemented to make Denver’s Civic Center Park more inclusive and secure for all park users, including those experiencing homelessness?

This study compared homeless shelters, one was a structured homeless shelter and the other a non-structured homeless shelter, evaluating the residents' level of social functioning and level of self-sufficiency at both shelters. A structured shelter may offer counseling, parenting classes, money management, nutrition classes, a 12-step program and support groups, and after school and summer programs for youths. Whereas a non-structured shelter is one that only offers a place to sleep and some food.

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Homelessness is a serious national and international issue, with significant implications for societal health. It is such a complicated and multifaceted issue to address, and it needs much more attention than it has currently. Alongside discussions on how to house homeless individuals, it is important to discuss how to help increase this populations overall health. The homeless population is one of the most medically at-risk patient populations. Existing research has shown that homeless individuals are at a higher risk for developing ill health and disease. They face numerous barriers to obtaining health care, and have many competing priorities. As a result, they are more likely to present to hospitals and clinics with advanced stages of disease that could have been prevented, or treated more easily earlier. Overall, the homeless population is at such a high risk of developing disease due to a variety of factors. Some of which are, their chronic exposure to the elements and other ill people, a lack of access to hygiene facilities or healthy food, and certain advantageous preventative resources. Past research has focused on interventions such as housing first over healthcare, and mobile clinical services, but they take a great deal of time and money to be fully realized. It is important to expand resources to include smaller, more feasible, preventative provisions for conditions that homeless individuals are more susceptible to such as skin cancer, tooth decay and loss, and others. More research into practical interventions, which can help improve the health and hygiene of homeless population, will close a gap in the current medical literature. This thesis focuses on practical prevention efforts for the homeless in the form of, SPF 70 spray sunscreen, hard bristled toothbrushes, sugarless gum, body wipes, dry shampoo, hand sanitizer, and more. These scientifically backed interventions can be immediately incorporated into the resources that community healthcare centers, shelters, or any other related homeless care facilities, provide. These supplies should improve homeless individuals’ health and quality of life while waiting for larger interventions such as housing, or free clinics, to be implemented. Importantly, these resources can help to bring an end to this current period in time in which homeless individuals are left to wait for any form of preventative or curative health care. As Ben Carson recently said, “Leaving [the] homeless unsheltered, unhealthy, and unsafe is a human tragedy and unacceptable.”

Abstract BACKGROUND: The number of homeless pregnant women is continuing to increase around the world. Homeless women are experiencing difficulties with their pregnancy that others may not face, including birth abnormalities and not seeking appropriate care due to cost and stigmatization. Nurses need to educate homeless pregnant women on what is needed for a healthy pregnancy and childbirth. OBJECTIVE: This exploratory research describes the needs for advocacy in women who are experiencing homelessness while pregnant and how homelessness affects pregnancy, childbirth, and postpartum care. LITERATURE REVIEW: The search methods used was CINAHL and ETSU Library. Keywords: homelessness, childbirth, homeless women, nursing. There were ten studies established all together. FINDINGS: Homeless pregnant women are not educated on contraceptives and what they need to do to have a healthy pregnancy. For example, they don’t know that being homeless and absence of proper care results in abnormalities such as low birth weights, longer NICU stays, and premature childbirths. CONCLUSION: We conclude that homeless pregnant women should be advocated for in hopes they will feel comfortable and seek proper care for a safe pregnancy. Keywords: homelessness, childbirth, homeless women, nursing

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