Phenylthiocarbamide taste perception in type 2 diabetics and healthy subjects: A case-control study

Authors: Wajiha Hassan, Hina Hassan, Muhammad Usman Anwar, Muhammad Umar Kamal, Ehsan Ullah

ABSTRACT

Objectives:

We conducted this study to find out any epistatic relationship between expression of PTC gene and the genes controlling T2D development through comparing the relative frequency of PTC taste perception among T2D patients and healthy subjects.

Methods:

It was a case-control study conducted in diabetes clinics / centers located at various teaching hospitals in Lahore city. A total of 270 (135 diabetics and 135 healthy) subjects were tested for PTC taste perception by pouring a drop of PTC solutions of 0.0125%, 0.125% and 0.25% concentrations to determine super-tasters, tasters and non-tasters. The proportion of tasters and non-tasters was compared in two study groups with the help of Chi Square test and a p value of 0.05 or less was considered significant and to reject the null hypothesis.

Results:

Mean age of T2D patients and healthy subjects was 34.21±5.74 and 32.90±7.44 years respectively. Male to female ratio among T2D patients and healthy subjects was 1:14 and 1:1 respectively. Only 22 (16.29%) of T2D patients and 40 (30.37%) of healthy subjects were super-tasters which was significant difference (p = 0.009) and Odds ratio (OR) was 0.4624. A total of 39 (28.89%) of T2D patients and 25 (18.51%) of healthy controls were non-tasters which was also significant difference (p = 0.04513) and OR was 1.788.

Conclusions:

Supertasters and tasters of PTC have odds ratios of 0.4624 and 1.788 to have type 2 diabetes mellitus.

Key words:

Phenylthiocarbamide, taste perception, type 2 diabetes mellitus

Introduction:

Phenylthiocarbamide (PTC) taste perception is a genetically controlled trail.(1) Type 2 diabetes mellitus (T2D) is a widely occurring multifactorial disease with complex multigenic inheritance playing an important role in its pathogenesis.(21, 3) Interaction of genes conferring inheritance of T2D, pre-diabetes and obesity and those causing PTC taste perception has not been studied in detail though some investigators have highlighted that a possible link exists between the phenotypic expressions of these gene complexes.(4-6)

We conducted this study to find out any epistatic relationship between expression of PTC gene and the genes controlling T2D development through comparing the relative frequency of PTC taste perception among T2D patients and healthy subjects.

Methods:

It was a case-control study conducted in three diabetes clinics located at various teaching hospitals in Lahore city i.e. Jinnah A Diabetes and Endocrinology at Jinnah Hospital Lahore, Diabetes Management Center, Services Hospital Lahore and a diabetes clinic at Sheikh Zayed Hospital, Lahore. A sample of 270 (135 diabetics and 135 healthy) subjects was taken by simple random sampling technique with the help of lucky-draw method among the patients attending these clinics and their attendant/relatives who were non-diabetic. The confirmation of non-diabetic status of the control group participants was obtained by their random serum glucose < 140 mg/dl and by the fasting serum glucose <110 mg/dl if the random glucose was between 140 and 199 mg/dl. Informed consent was taken and participants were asked to spit the solution of PTC as soon as the taste perception was noticed. All participants were tested for PTC taste perception by pouring one drop of PTC solutions of 0.0125%, 0.125% and 0.25% concentrations to determine their taste perception as super-tasters, tasters and non-tasters for PTC compound. The proportion of tasters and non-tasters was compared in two study groups with the help of Chi Square test and Fisher Exact test.

P

value of 0.05 or less was considered significant and to reject the null hypothesis.

Results:

Mean age of T2D patients and healthy subjects was 34.21±5.74 and 32.90±7.44 years respectively and there was no significant difference of age distribution among two study groups as shown in Table 1.

Table 1. Age distribution of the study population

Age groups	Type-2 diabetics	Controls
18 – 25	14 (10.4%)	29 (21.5%)
26 – 35	33 (24.4%)	41 (30.4%)
36 – 45	27 (20%)	31 (23%)
46 – 55	36 (26.7%)	24 (17.8%)
56 and above	25 (18.5%)	10 (7.4%)
Mean and SD	34.21±5.74	32.90±7.44

Seventy (51.8%) of the T2D were males and 65 (48.2%) were females. Thus male to female ratio among T2D patients was near to 1:1. About half (n=67, 49.6%) of healthy subjects were males and 68 (50.4%) were females. Thus male to female ratio among healthy subjects was 1:1 as shown in Figure 1.

Figure 1. Gender ratio among study groups

Only 22 (16.29%) of T2D patients and 40 (30.37%) of healthy subjects were super-tasters which was significant difference (p = 0.009) and Odds ratio (OR) was 0.4624. Seventy-one (52.6%) of T2D and 73 (54.1%) of healthy controls were tasters which was not significantly different (p=0.141) and calculated OR for tasters as compared to non-tasters was 1.556. A total of 39 (28.89%) of T2D patients and 25 (18.51%) of healthy controls were non-tasters which was also significant difference (p = 0.04513) and OR was 1.788 as shown in Figure 2.

Figure 2. Frequency of super-tasters, tasters and non-tasters in T2D and controls

Discussion:

Perception of bitter taste is a variable trait both within the same population and between different human populations.(7) Bitter taste perception is encoded by a family of 25 TAS2R taste receptors.(8) Whereas, the two most studied genes are TAS2R38, the one associated with the ability to taste PTC (phenylthiocarbamide) and PROP (6-n-propylthiouracil).(9) Approximately 75% of the world’s population are considered ‘‘tasters’’, and perceive these substances as moderately to intensely bitter. These compounds are weak or tasteless for the remaining 25% of the population, who are considered ‘‘non tasters’’.(10) Another study revealed that tasters can be further divided into two sub-groups: “ tasters”, who perceived moderate intensity from PTC/PROP, and “supertasters” who perceived these compounds as extremely bitter. Thus, the population distribution of non tasters, tasters and super tasters is nearly 25%, 50% and 25% respectively.(11)

In current study, the distribution of PTC taste perception for non-tasters, tasters and super-tasters was 25 (18.5%), 71(52.6%), 39 (28.9%) among the healthy controls which is quite comparable to the findings of Bartoshuk et al.(11) A study from American population showed that 71.2% of their study population was taster and 28.8% was nontaster.(12) A study from a neighboring Asian country reported that taste perception to PTC compounds was present (tasters) in 67% and absent (non-tasters) in 33%.(13) Another study from same Asian country reported that 66.38% of the study population was taster and 33.62% was non-taster to PTC.(14) However, a study from a Pakistani population of young healthy adults revealed the distribution of PTC tasters and non-tasters as 73.75% and 26.25% respectively.(15) Similarly, another group of investigators from Pakistan reported that 81.33% of the healthy adults were tasters and 18.6% were non-tasters.(16) Our observations are comparable to both the studies especially prevalence of non-tasters in our study is approximately the same as reported by Iqbal et al.(16)

The second point of discussion in current study is the phenotypic association between the genes encoding for PTC taste perception and diabetes which has been studied by the procedures and methods mentioned earlier. Why the authors did conduct this study? A simple answer is the compelling and enormous links between diabetes and taste perception proposed in the recent literature.(17-19) A study has revealed that increased serum glucose levels induce a concentration-dependent impairment of taste perception in T2D patients as the result of an adaptation of the sensory cell to elevated circulating concentrations of glucose.(5) A study from an Asian population revealed a significant difference in taste sensitivity to PTC between the diabetics and non-diabetics, the former being less sensitive than the latter (16.7 vs. 6.8%).(20) A decrease in palatability of the glucose solutions induced by the glucose load (negative alliaesthesia) has been reported between PTC tasters and non-tasters where tasters showed higher hedonic ratings (Mean 4-25), as compared to non-tasters (Mean 3-70) and this difference was more evident after the glucose load in non-tasters.(21) More recently, genetic analysis of bitter tasters and non-tasters have shown that a polymorphism in TAS2R38 is associated with differences in ingestive behavior of the two groups, which may in turn be linked to the development of pre-diabetes and T2D.(22) However, by far the most delectable observations have been reported by Wang et al., who observed significant differences in plasma levels of leptin, tumor necrosis factor-alpha and insulin-like growth factors-1 between tasters and non-tasters to PTC.(4) They also found a positive correlation between plasma levels of glucose and body mass index (BMI) exclusively in non-tasters which indicate that besides the regulation of food consumption, taste perception also appears to be snugly linked to the circulating metabolic hormones.

It is proposed by the previous investigators and supported by the authors of current study that people with different taste sensitivity may respond differently to the nutrient stimulation. More robust investigations probing into the link between taste perception and peripheral metabolic control could potentially lead to the development of novel therapies for obesity or Type 2 diabetes.

Conclusions:

Supertasters are less whereas tasters and non-tasters are more likely to have type 2 diabetes mellitus. Further work is encouraged to unveil the link between taste perception to PTC and T2D.

Acknowledgements

We acknowledge the participating institutions, their staff members, patients and healthy volunteers for their cooperation. We are thankful to Prof. Dr. Tehseen Iqbal, Professor of Physiology at Dera Ghazi Khan Medical College, DG Khan, Pakistan for his critical, analytic and logistic help without that this research would have never been completed.

References:

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4.Wang R, van Keeken NM, Siddiqui S, Dijksman LM, Maudsley S, Derval D, et al. Higher TNF-alpha, IGF-1, and Leptin Levels are Found in Tasters than Non-Tasters. Front Endocrinol (Lausanne). 2014;5:125.

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9.Behrens M, Bartelt J, Reichling C, Winnig M, Kuhn C, Meyerhof W. Members of RTP and REEP gene families influence functional bitter taste receptor expression. J Biol Chem. 2006 Jul 21;281(29):20650-9.

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Mrs Cheng has a 2 years history of bowel cancer recently being complicated by liver metastases. Doctors had given her a prognosis of about one month left to live. She is admitted to the medical ward for palliative care.

Social

Mrs Cheng is the sole survivor of the Boxing Day Tsunami in her family. She has thus no viable support system to speak of.

Ethical

From a palliative care perspective, it may seem appropriate to assist the patient in meeting her special needs during the final days of her life.

Legal

The hospital prohibits smoking by law. Thus Mrs Cheng is allowed smoking only at a garden outside of the hospital.

2. Get the facts

Pathophysiology

Bowel cancer is presented with a growth of a malignant tumor in the colon or rectum (Realtime Health, 2010). It is currently the third most commonly diagnosed cancer in Australia (Cancer Council Australia, 2010).

The final stage of the bowel cancer often denotes that the cancer has spread to other organs, for example the liver. Currently, there is no known effective treatment available for stage 4 bowel cancer (Cancer Council Australia, 2010).

In Mrs Cheng’s case, her bowel cancer has been further complicated by liver metastases. This is unfortunate but typical in patients with end-stage bowel cancer.

Palliative care

As defined by World Health Organization (WHO) (2010), Palliative care is an approach that improves the quality of life of terminally-ill patients and their families by recognizing the needs of a terminally-ill patient, and focusing on making them comfortable (Palliative Care Victoria, 2007).

It is important for nurses to understand that patient care must continue until the end of life and that everything within the means of the healthcare team be done to ensure that the patient’s death will be peaceful and dignified (Cancer.Net, 2010).

Palliative Care Australia recognizes the importance of palliative care, and affirms that it should be considered a core competency for all health care professionals (Palliative Care Australia, 2008).

Patient’s understanding

It is important to ascertain Mrs Cheng’s level of understanding towards the ‘no-smoking policy’, the manpower situation and unhappiness of the staff. Without proper clarification, being a patient, Mrs Cheng may be ignorant of the issues which had arisen. It is thus the responsibility of the team to ensure that she fully understands the inconveniences imposed.

Patient advocacy

Patient advocacy, as stated in the Australian Nursing and Midwifery Council (ANMC) Code of Ethics for Nurses in Australia, is the obligation of the nurses to question nursing care which they may regard as potentially unethical or illegal (ANMC, 2008).

Ironically, due to the presence of manpower shortage, nurses advocating in the interest of Mrs Cheng may experience an ethical dilemma as they may find difficulty distributing equal amount of attention and nursing care to the rest of the patients. Likewise, the opposite would be true if advocacy is to be in the interest of the other patients.

Patient’s support

Being the sole survivor of the Boxing Day tsunami in her family, Mrs Cheng has inordinately poor social support. It is not known if Mrs Cheng has any extended family members.

The presence of a kin is most favorable in palliative care. A family member may be able to render a higher level of emotional support to Mrs Cheng, and also provide her some positive and healthy distraction away from her smoking habit.

Thus, the aid of social workers should be enlisted in tracing possible extended family members of Mrs Cheng.

Staff disagreement

Some of the staff had demonstrated dissatisfaction by threatening resignation. To mitigate the matter, the nursing unit manager needs to interview the affected staff, to gain a clearer understanding of the problem and any other precipitating factors that might have led the staff to the point of threatening resignation.

Manpower

As Mrs Cheng smokes about 25 cigarettes daily, and each smoking trip would take up 12 minutes of the accompanying staff’s working time. As such, approximately 300 minutes of manpower would be taken up daily, to see to this particular need of Mrs Cheng.

Staffing is a factor which often inhibits the quality of care, and limits the time available for nursing care delivery to each patient (Irurita, 1999). The issue of both the manpower wastage and shortage needs to be address.

Disruption of care

Mrs Cheng’s smoking habit requires extended periods of attention from the healthcare professionals. It is thus inevitable that attention is being deprived from the rest of the patients in the ward. This needs to be looked into, as negligence may result from such disruption of care.

Passive smoking

By accompanying Mrs Cheng to the garden for cigarette smoking, it is inevitable for the accompanying nurse to be exposed to harmful passive smoking. As Mrs Cheng smokes heavily, the exposure of the nursing staff to the harmful fumes, are relatively immerse. Thus, measures should be taken to safeguard the well-being of the staff.

3. Consider the four principles

Autonomy

Autonomy is referred to as the exercise of one’s free will, which should be deemed as acceptable, as long as it does not affect the rights of others adversely (Staunton & Chiarella, 2008, p. 31). Being mentally competent, Mrs Cheng should possess the free will to smoke cigarettes for as much as she wishes.

Beneficence

Beneficence is often described as the principle of ‘above all, do good’ (Staunton & Chiarella, 2008, p. 32). It affirms that the healthcare professional should always act, with the best interest of the patient in mind (Dominick, 1999). Thus, advocating Mrs Cheng to quit smoking may be an act of ‘beneficence’, as smoking is an unhealthy habit and induces undesirable health outcomes.

Non-maleficence

Non-maleficence is the principle of ‘above all, do no harm’ (Staunton & Chiarella, 2008, p. 32). Thus from the ‘non-maleficence’ perspective, one should not forbid Mrs Cheng from indulging in cigarette smoking as it may affect her negatively, with regards to her emotional health and stability.

Justice

Justice refers to the obligation of the healthcare professionals to treat all patients with equality and fairness (eNotes.com, 2006). An example of justice, particularly in countries where racism is evident in many aspects of life, is when nurses demonstrate equal and unbiased care and treatment towards all patients, regardless of age, sex, and ethnicity.

Value statement 3 of the Australian Nursing and Midwifery Council (ANMC) Code of Ethics for Nurses in Australia states that nurses should value and respect the diversity of people (ANMC, 2008). While conduct statement 4 of the ANMC Code of Professional Conduct for Nurses in Australia states to respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment (ANMC, 2008).

As a palliative patient in the ward, it is perchance that Mrs Cheng’s special needs are more so taken care of than the rest of the patients in the unit. One could argue that, in spite of Mrs Cheng’s plight, it is equitable that equal attention and care should be rendered to all the patients in the unit.

4. Identify ethical conflicts

Beneficence versus Non-maleficence

Beneficence versus Non-maleficence is one of the most apparent ethical dilemmas which are pertinent to Mrs Cheng’s smoking habit. Beneficence, here, may refer to protecting Mrs Cheng from the ill effects of smoking by advocating her to lead a smoke-free life; while non-maleficence, may refer to respecting Mrs Cheng’s wishes by approving her requests to smoke.

The healthcare team needs to weigh the benefits and losses of adopting either principle. Being a medical ward, it is dubious if all the nurses on the unit understand the crux of palliative nursing. It is therefore of eminent importance that the entire team gain a better understanding of palliative care. As such, a higher level of empathy and a more humanitarian approach may be invoked in the nurses caring for Mrs Cheng.

In spite of being one of the most preventable causes of ill health and death (HealthInsite, 2010), it is somewhat irrelevant to discuss about the issues of health awareness with a dying patient. It is also uncompassionate to have a terminally-ill patient cut down on or to quit smoking during the final days of her life, as withdrawal symptoms may result from abstinence from smoking, causing more discomfort to Mrs Cheng, and in turn, further compromises her quality of life.

Autonomy versus Beneficence

Despite being a terminally-ill patient, Mrs Cheng is mentally able and competent. Thus her autonomy as an individual should be respected. Mrs Cheng indulges in, and draws enjoyment from smoking cigarettes. An ethical conflict arises when Mrs Cheng’s autonomy disharmonizes with the healthcare professional’s principle of beneficence.

An effort to preserve Mrs Cheng’s autonomy would mean assisting her in meeting her needs of getting her cigarette smokes; while on the contrary, one with the principle of beneficence in mind would discredit such an act.

The writer feels that the principle of beneficence should not overwrite that of the patient’s autonomy. Value statement 2 of the Singapore Nursing Board code of ethics and professional conduct, states to respect and promote the patient’s autonomy and rights for self-determination (SNB, 2006). Thus restricting Mrs Cheng from smoking should be deemed as unethical and unprofessional.

Nevertheless, any concerned nurse may educate Mrs Cheng on the adverse effects of smoking and advice her on the option of Nicotine Replacement Therapy (NRT), by doing so ensures that she is fully aware of the undesirable health outcomes of smoking and the options available.

However, it is also important to ensure that this is not done in a domineering manner. Clause 2.1 of the Australian Nursing and Midwifery Council (ANMC) national competency standards for the registered nurse, states to ensure that personal values and attitudes are not imposed on others (ANMC, 2006).

Should Mrs Cheng choose to continue smoking, her autonomy should be respected and preserved, for as long as she is mentally competent of making her own decisions.

5. Consider the Law

Smoking is prohibited by law in the hospital. Nonetheless, being mentally able, Mrs Cheng should retain the autonomy of making her own decisions. In this instance, carrying out the act of cigarette smoking, so long she does not do it within the hospital.

It is not said if Mrs Cheng possesses the physical abilities to maneuver herself about in a wheelchair. Nonetheless, should she require any assistance, it is the duty of the nurse to assist her in the aspect of her mobility. Clause 1.2 of the ANMC National Competency Standards for the Registered Nurse states to fulfill the duty of care towards patients (ANMC, 2006). In Mrs Cheng’s case, a duty of care would involve accompanying her to the garden for cigarette smoking.

There is no clear ethical or legal bill that protects the interest of the nurses. However, in Australia, the importance of nurses protecting themselves was discussed in a guideline titled ‘The Responsibilities of Nurses and Midwives in the Event of a Declared National Emergency’.

Owing to the duty of care, it may be the liability of the nurses to escort Mrs Cheng for cigarette smoking. Nevertheless, nurses should not be oblivious to the fact that they are being exposed to passive smoking in the process, and take protective measures, such as donning a face mask to prevent unnecessary and excessive inhalation of harmful fumes (ANMC, 2008).

6. Making the ethical decision

The writer believes that Mrs Cheng should retain her right to smoke cigarettes. As a palliative patient, Mrs Cheng’s needs should not be compromised.

It is perhaps lucid that the nurses in the medical unit feels frustrated over caring for Mrs Cheng. Apart from manpower shortage, they also lack specialized knowledge and hence may find difficulty in empathizing with Mrs Cheng’s needs. Thus, it is perchance that majority of the nurses would be inclined to caring more for the medical patients, for whom they are able to render nursing care more confidently.

The manager should enquire with the palliative unit of the hospital regarding the possibility of transferring Mrs Cheng to a palliative ward, where she may receive more individualized nursing care from trained palliative nurses. By doing so, would concurringly, solve the issue of the manpower shortage, and also the dissatisfaction amongst the affected nurses.

In the event that a transfer is not possible, the manager may explore the possibility of enlisting the help of a palliative volunteer, to tend to this special need of Mrs Cheng. This would alleviate the burden on the healthcare team. There are several palliative volunteer programmes in Australia, one of which is Victoria’s Palliative Care Program (Victorian Government Department of Human Services, 2007).

7. Document the decision

Documentation is essentially an integral element in nursing care, as it serves as an important tool for communication between members of the healthcare team. Nurses need also be aware that the patient’s progress notes could be commanded as legal documents in the event of a legal prosecution, thus it is important that entries are concise and factual (Hansebo, Kihlegren, and Ljunggren, 1999).

Clause 10.2 of the ANMC National Competency Standards for the Registered Nurse states the importance of nurses to documents all forms of communication, nursing interventions and individual/group responses, precisely and as soon as possible (ANMC, 2006).

The manager should assume the responsibility of documenting the complaints of the nurses, so as to better facilitate an analysis of the possible root causes of the problem. Upon arriving at the ethical decision, points agreed upon by the team needs to be clearly recorded, to ensure that everyone on the unit is aware of the decision.

Nurses should educate Mrs Cheng on the harmful effects of smoking, and have it documented in the notes. Mrs Cheng’s requests to proceed to the garden to smoke should also be recorded, likewise for each and every journey made.

It is also important for the nurse to state that Mrs Cheng has been accompanied by a nurse or certified volunteer throughout her journey to the garden; this is particularly true if Mrs Cheng is physically frail and requires assistance with mobility.

8. Evaluation the decision

Clauses 4.1, 7.6, and 8.1 of the ANMC National Competency Standards for the Registered Nurse state the importance of nursing care evaluation.

The manager needs to review and assess staff satisfaction on a regular basis, to minimize any amassment of discord or unhappiness amongst the members of the healthcare team. This would also provide chance for ventilation and early intervention, and in turn prevent issues from escalating to an immitigable state.

Nurses on the ward should review the safety and comfort of Mrs Cheng with the palliative volunteer, if any. While it is advantageous to have a volunteer to see to the needs of Mrs Cheng, her safety and wellbeing must not be compromised.

Introduction

Homelessness is a social welfare issue that is predominant around the globe, and it has existed for quite some time. Over the most recent two centuries homelessness has increased, and has affected people all over. Scientists who have conducted research on homelessness all have their own interpretation of the meaning of homelessness. They also have perspectives on how people become homeless, and the population that is most affected by the issue today. This paper will go into depth about homelessness – the population that is most affected the theoretical framework-perspective, practice methods, service effectiveness, etc.

One of the most significant components to think about when trying to understand homelessness as a social welfare issue is how to define homelessness. The definition of homeless is individuals who do not have permanent housing. In an article written by Anne Rufa, she believes that the social welfare issue can be characterized into three general areas. The first area are those who have absolutely no living space, and who consequently wind up dozing in their own vehicles, or open areas like the woods or under bridges. Secondly, individuals who live in shelters that are funded by their state or local government. Lastly, many are considered homeless if they are doubled up, meaning they are staying with multiple family members or friends, and don’t have much stability.

Historical Background

Homelessness has been around for years, but the most significant time in American history where many people where homeless was during the Great Depression. The Great Depression was an economic crisis that started in 1929 and ended in 1939. The crisis started with Black Tuesday which started on October 28, 1929. This led to major chaos on Wall Street as stock shares became no good and investors were dropped which eventually caused a sequence of incidents to occur as consumers reduced their spending, and many stopped investing. Many employed Americans lost their jobs and suffered a major crisis. In the midst of this major crisis, Franklin Delano Roosevelt became president and under his presidency he put many policies in place to help the American political structure. The aftermath of the Great Depression had long lasting consequence.

Identify the Most Affected Population

Homelessness is known all over the world and it has been linked to lack of employment – housing, violence- incarceration, mental health, teen pregnancy, substance-drug abuse, etc. The social welfare issue does not discriminate; it affects people all over from older people to young people. In fact, homeless youth have been known as one of the fastest growing vulnerable groups (Coates, J, & Mckinzie- Mohr , S. (2010 ).Daily children are born into poverty and it carries on to their teen and adult years. Youth who are homeless have a hard time coping in life, many feel unsafe and not wanted, many are not mentally stable, and they lack self-confidence. Many suffer with dramatic loss of early development and learning; are held back from grade to grade; constantly absent from school, and have multiple disciplinary referrals which leads to them dropping out of high school; and enter the juvenile justice system. This issue remains largely invisible in most communities especially in smaller cities. In an article written by Mary Cunningham she believes that urban development increases the likelihood of people being homeless. She also believes that the homeless population is easier to pick out today. In areas where there is not much development, there is a decrease in homelessness , and it is very hard to pick out, but areas that are more developed – major cities homelessness increases and it is very easy to label and pick those who are homeless out.

Prisoners are vulnerable groups that are likely to become homeless. Statistics have shown that the conditions that prisoners go through while serving their sentences plays a major apart of their mental health and once they are released from prison, many have a hard time coping with life. As a result of not being able to cope many become homeless. The recidivism rate of homeless individuals who spent time in prison is very high due to non-violent and violent criminal activity (Fischer et al. 2008). The connection between poverty and non-violent criminal activity has been analyzed being that many ex-prisoners who have become homeless are at a greater risk at being apprehended for less serious crimes than homeless people who challenge with serious mental illnesses (Fischer et al. 2008)., but those who are homeless that suffer from mental health are more likely to commit a crime compared to the general public. Homeless people who challenge with mental health are more likely to commit violent crimes because they feel like they are not receiving the adequate support from society to be able to meet their basic needs. Homeless people who live in shelters are less likely to participate in crimes because their needs are being met.

Mental health in the United States is a topic that has been talked about for many years. The illness when intertwined with little to no opportunities can easily lead to homelessness. The topic was openly and often discussed during the 19th century and, many state governments controlled mental health facilities that housed mentally ill individuals. Like today, during this time mental health was looked at negatively and many places that were open to help this population were shut down and no longer in place. Many people who suffer with mental health have a very hard time gaining employment and seeking help for their mental health diagnosis which eventually leads them to being homeless.

Veterans also experience homelessness, specifically men over the age of 50. In 2016 about 9 in 10 veterans that were homeless were men. Women made up about 9 percent, and this has been the same since 2009 even with the number of Veteran women increasing. Veteran women are twice more likely to experience homelessness versus non- veteran women. A third of Veteran women, who have experienced homelessness, are usually a result of military sexual abuse. African Americans Veterans are 3 percent more likely to experience homelessness than all US Veterans. (Homelessness in America: Focus on Veterans. (2012). About 16 percent of Veterans that experience homelessness lived in rural areas while receiving services from the VA.

Theoretical Framework

Conflict theory can be used in understanding why homelessness happens. Conflict theory was created by Karl Max and it states that the world is constantly changing as a result to conflict. It looks at social life as being competitive. Based on this theory, society is made up of individuals competing for limited resources such as money and free time. Competition over limited resources is major part of all social relationships. Competition, rather than consensus, is characteristic of human relationships (The Conflict Perspective. (2019). Other social structures and organizations such as religions and the government imitate the competition for resources and the inherent inequality competition entails; some people and organizations have more resources and power and use it as a way to keep their positions and stay in power. Sociologists usually use this theory as a way to research the distribution of resources, power, and inequality, and they ask the question who benefits from this?

Another theory by Karl Max can be used in trying to understand homelessness. This theory is Marxism. Marxism states that capitalism is a class system in which confrontation is unavoidable because it is in the interests of the ruling class to exploit the working class and to try to resolve this exploitation in the interests of the workers”(The Conflict Perspective. (2019). Homelessness therefore involves capitalism and competition to economic resources and power, according to Marx. This literally divides people into two categories in a capitalist society: those with money and power (capitalists) and those without money and power (workers). The theory of conflict recognizes homelessness as an issue because of bourgeois motivations arising from social inequalities and social stratification.

Social inequality is affected by social stratification; people who live in poverty are at the bottom and people with money are at the top. As a result, homeless people face many social inequalities and social conflicts because they have no power and are struggling to make progress in life. This theory also states that because of the constant resentment of capitalist towards workers, capitalism is the reason for homelessness. Capitalist dominate social institutions in favor of their prosperity, while workers are outstripped without the ability to advance their status in life and run counter to the interests of homeless people (The Conflict Perspective. (2019). It assumes that homeless people do not realize their subordination and assumes that all aspects of social life are based on capital and profit in society. Capitalism is therefore responsible under Marx’s theory for indicating certain social conditions that have led to homelessness.

Practice Methods

There are many ways to solve and help with homelessness today, many people just don’t want to take the time to do it. As stated earlier, homelessness is often misinterpreted, and stereotypes make it extremely hard to help those who are in need. We can help this social issue by learning the various paths leading to homelessness. Each individual on the street has a story of their own. Some people struggle with addiction. Others lost everything due to finances; some are suffering from mental illness. It is important that we educate ourselves on these challenges and spread the word so that others will understand.

It is also important that we as people not only take the step, but the community, and groups also take the needed steps. Whether if it is church, school, NGO- Nonprofit organizations, etc the community plays a major role in helping with homelessness. Volunteers of America is a group of people who come together to help stop homelessness. They meet homeless people through street outreach and mobile outreach programs and once they connect with homeless people, teenagers and families with children, they provide assistance such as paying a first month’s rent to providing permanent supportive housing so that people with disabilities can become safe and productive members of their communities (Volunteer of America .(2019). The group supported more than 10,000 homeless in 2017 by finding them homeless shelters in their area, drop in centers, permanent supportive housing, and transitional housing. Volunteers of America are similar to United Way and the Salvation Army. They all work together to help individuals and families who are in need.

Another community agency that helps assist homeless people is Family Promise. They help homeless and low income families achieve stability. Family Promise is a home that holds up to three families depending on the county you live in. A family can stay in the home for up to 6 months. There are staff members there that help care givers or parents find employment, and also home that they can transition into. In many areas they offer trainings for parents and caregivers that could possibly help them gain employment. I was able to attend Effingham Family Promise Shelter during my internship. While there, I was able to meet a lady who was getting ready to move out and into her new place. She expressed that she enjoyed her time at Family Promise and was a little sad to leave because she developed such a wonderful relationship with the staff members and the other family members there. She stated that it felt like a family. Everyone in the house would look out for one another.

There are many programs state and federal such as Medicaid, food stamps, free and reduced lunch, and the McKinney Vento Act that also help assists youth and families that may be in need. The McKinney-Vento Act is a federal law that ensures the right of students to go to school even when they are homeless or don’t have a permanent address. The Act aims to decrease barriers that stop homeless youth from enrolling, attending, and succeeding in school, including transportation; residency requirements; and documentation requirements, such as birth certificates and medical records. All homeless young people can get assistance under the McKinney Vento Program including those young people who are not in the custody of their parents, but these youth must be living in emergency shelters, doubled up with family or friends, or staying in motels, campgrounds, or cars (McKinney Vento Program. (2012).

Medicaid is an assistance program to help low income individuals despite their age. Many who have Medicaid pay little to no cost for medical expenses. Medicaid like the McKinney Vento program is a federal state program that is ran by local and state governments within federal guidelines. Free and Reduce lunch is another program that is beneficial, children can be eligible for free lunch if they live in households that participate in Temporary Assistance for Needy Families, runaway youth, youth who are homeless, or youth who have participated in Head Start.

Ethical Framework Philosophy

There are many values that I would use within the NASW Code of Ethics, but the two that are most significant when working with the homeless population are

service

and

dignity of a person

. Based on the NASW of Code of Ethics, social workers elevate service to others above their self-interest. Social workers draw on knowledges, values, and skills to help people in need and to address social problems. Social workers are encouraged to volunteer some portion of their professional skills with no exception of significant financial strain (Workers, N. A. (2008). Providing services can include helping individuals find resources in the community that may beneficial. The next is Dignity and Worth of the Person. Social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity.

Social workers promote clients socially responsible self -determination. Social workers seek to enhance clients and capacity and opportunity to change and to address their own needs. They are cognizant of their dual responsibility to client and to the broader society (Workers, N. A. (2008). They seek to resolve conflicts between client’s interest and the broader society’s interests in a socially responsible manner consistent with the values, ethical principles, and ethical standards of the profession. With that being said, it is important to treat everyone with respect and in a caring despite their social class. Many people find themselves dismissing the homeless population because of the stigma that many just beg for money simply to get drugs or for their own personal gain. It is important that social workers continue to advocate for this population as many continue to dismiss them. It is important to remember that despite their social class/ position they are human beings first and should be treated as such.

Justification

I chose these two values because I believe they both are very significant and they will help me to become a better social worker when working with this population. Many people who are homeless often feel worthless, hopeless, and as if no one is there for them or no one really truly understands them or their story. As a future social worker, it is my duty to advocate and speak up for vulnerable populations such as the homeless population because many of them feel like they don’t have a voice and that they are alone. It is my job to let them know that there is hope and that they will be able to make it through their current situation. As a future social worker it is also important that I do my own individual research and connect individuals and families to the appropriate resources in the community that may be beneficial to them. The ultimate goal should be to help them become stable whether if that is finding them a home or helping them find employment or trainings that may be useful. The NASW value

social justice

is also significant when working with the homeless population especially in big cities. Many feel invisible and as though no one really truly notices or sees the challenges that many of them face. Many want to reach out for help, but just don’t how or who to reach out to. The NASW Code of Ethics states that it is our job as social workers to pursue and focus on social change on the behalf of vulnerable individuals and population. Social workers primary change focus mainly on issues such as poverty, unemployment, and discrimination which all could lead to homelessness. As social workers it is our job to push ourselves to research needed information, services, and resources, and meaningful participation in decision making for all people. We want people to make the right decision and we do this by making sure they have enough information and understand the information that is given to them (Workers, N. A. (2008).

Recommendation

I believe it is important that the community and groups continue to come together to bring awareness of homelessness, and also educate those who may not really truly understand how homelessness can start. A person losing their job is at risk of being homeless especially if they have little to no support. I use this example because some situations are simply out of people’s control, and many outsiders don’t think like this . We have to stop the stigma of homelessness and educate others. I believe if many are educated the more likely they will be willing to help. I also believe in the importance of the community collaborating with one another. Schools, churches, nonprofit organizations coming together as one to help a social issue such as homelessness will definitely be beneficial. The collaborations will promote, restore, maintain, and enhance the overall wellbeing of individuals and families.

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