Diverse Profiles of Homeless Young Adults: Implications for Tailored Prevention Strategies—Insights from Belgian Homelessness Counts

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The article you've provided on prevention strategies for homeless youth in Belgium is quite comprehensive and well-structured, with a robust data collection and thorough analysis of preventive interventions. However, there are certain aspects and additional recommendations you might consider to strengthen the submission before its publication in a high-impact scientific journal.

Recommendations for Revision:

1. Integration of Updated Readings: It would be beneficial to incorporate recent findings to enrich the theoretical framework and references of the article. Specifically, you could include the study by Rodilla, J.M.; Puchol, G.; Botija, M., which offers a systematic review of the evaluation methodologies for the impact of interventions aimed at homeless individuals in Europe. This reference can provide a broader view of the evaluation methodologies that could be applied or compared with your study.
2. Social Determinants of Health: I suggest adding a discussion on how social determinants affect the health of homeless youth, a dimension that can broaden the understanding of the necessary preventive interventions. Here, you could use the article by Botija et al., which examines homelessness as a determinant of health and its impact on quality of life, providing a link with night counts from other countries to highlight the relevance of social determinants in different contexts.
3. Inverse Care Law: Integrating an explanation and analysis of the inverse care law, which posits that the people who most need health services are often those who have the least access to them, would be crucial. This concept is especially relevant to addressing how to improve access to health and other critical services for homeless youth.

I can only congratulate you on the important work done and the transfer of results.

Author Response

Integration of Updated Readings: It would be beneficial to incorporate recent findings to enrich the theoretical framework and references of the article. Specifically, you could include the study by Rodilla, J.M.; Puchol, G.; Botija, M., which offers a systematic review of the evaluation methodologies for the impact of interventions aimed at homeless individuals in Europe. This reference can provide a broader view of the evaluation methodologies that could be applied or compared with your study.

A: We greatly appreciate this recommendation. We added a paragraph on the importance of evaluating intervention strategies in the discussion section (on page 6). 

Social Determinants of Health: I suggest adding a discussion on how social determinants affect the health of homeless youth, a dimension that can broaden the understanding of the necessary preventive interventions. Here, you could use the article by Botija et al., which examines homelessness as a determinant of health and its impact on quality of life, providing a link with night counts from other countries to highlight the relevance of social determinants in different contexts.

A: Thank you for your suggestion, we added the reference to the introduction where we briefly discuss the impact of (mental) health issues.

Inverse Care Law: Integrating an explanation and analysis of the inverse care law, which posits that the people who most need health services are often those who have the least access to them, would be crucial. This concept is especially relevant to addressing how to improve access to health and other critical services for homeless youth.

A: Thank you for this reflection, which helped us to argue more precisely how we believe that health and social issues are interconnected. We revised section 3.2 ‘access to rights (and hope)’.

 

Reviewer 2 Report

Comments and Suggestions for Authors

 

 

I’d like to thank the editors for the opportunity to review the article titled “Diverse Profiles of Homeless Young Adults: Implications for Tailored Prevention Strategies – Insights from Belgian Homelessness counts.”. The paper is present important empirical evidence regarding youth homelessness in Belgium and offer key insights for policymakers and academics alike. Overall, the paper is well written and constitutes a valuable contribution. I have some comments below that point to where the paper could be stronger and some additional development that might further support the clarity of contributions the authors seek to make.

 

Specific comments:

-              Some citations should be added to the second last sentence in the introduction (regarding the effects of loss of resources and support for youth) line 35-38.

-              The first sentence in the Youth Homelessness section reads a bit awkwardly (“The group of homeless young adults is a very heterogeneous one and entails a nuanced understanding of their experiences and life trajectories”)

o   I’d suggest changing it to something like: The homeless young adult population is very heterogenous and therefore requires an understanding of the diversity of experiences and life trajectories

§  The rest of the section could use a bit more editing for awkward wording and flow.

-              In the “homeless prevention” section, there are sources added to the approaches in Europe but none for the Australian or Canadian. These should also include some citations.

-              There seems to be a section missing that would introduce the Belgian case. The authors do a great job of talking about various strategies and types of efforts, but the reader is left wondering, “okay what happens in Belgium?”. The questions jump right to the implications for targeted prevention strategies but little is known what is currently being done and what current strategies look like (as well as their impacts).

o   Data on homelessness would also be helpful here for context as well as experiences of homelessness (from previous research or a discussion of what previous research has found that will set up the research questions presented). This would be helpful contextual information before the methodology is introduced.  

§  It seems to me that the authors are doing what might be the first of quant analyses of PIT counts in Belgium – this needs to be clearer! Is there a lack of data and research on homelessness in Belgium? More needs to be known here (to emphasize the contributions of this article as well as set the context).

-              Methodology: I would like to know more about how the sample of participants was recruited. It’s unclear whether or not the researchers worked with the PIT counts or separately. Where did social workers and volunteers approach participants? It seems later that the questionnaire was added to the counts but this needs to be clearer (particularly regarding recruitment).

o   How were the focus group members recruited? Was the group diverse in terms of providers and the services?

-              Results: prior to jumping into the different groups chosen it would be helpful to introduce why these three groups are the focus (this is introduced above somewhat but it would be helpful to repeat so the reader can follow why these three groups are being discussed).

o   It would be helpful if more was said regarding the groups. The results are presented, but a concluding (or introductory) sentence about the profile would be helpful – what do the quant results tell us in brief about the specific group (ie. A majority are… they live in … and have hardships like…).

o   The qualitative results are a bit disconnected from the quantitative. Were the participants shown the data and given the information regarding the three groups as were presented in the paper? Were they surprised? What did they think more broadly about the data presented? This might be a helpful way to then segway into the great solutions they offered. It would also be helpful if the authors included discussions that supported the quant findings and to show the important links between them (to show the supplementary nature of the data). For example, in the vulnerable family situation section there’s discussion of the fact that the group might be less known – so were they captured in the quant data or is this a group the participants argued was missing or needed further examination?

§  A small comment: there is a spelling error in the first quote (finnish instead of finish) on line 317.

§  This section could use additional revision (some tense and flow issues).

-              Discussion: I’d like to applaud the authors for the discussion and for offering important insights into strategies for youth homelessness. The discussion is great and might benefit from just a bit more development and tying together of specific elements.

o   the discussion of the rights-based approach (in the paragraph on line 441) might benefit from an introduction of the approach and the key tenets.

o   The discussion turns to the need for specific and targeted interventions, and this was introduced as the focus of the focus groups – did participants offer some recommendations themselves that the authors may want to add to the results? This might better tie the results and discussion together better.

-              A last (small) comment: The page numbering seems to be off

Comments on the Quality of English Language

As my specific comments indicate there are sections of the paper that could benefit from revision (mainly related to tense and flow).

Author Response

The paper presents important empirical evidence regarding youth homelessness in Belgium and offers key insights for policymakers and academics alike. Overall, the paper is well written and constitutes a valuable contribution. I have some comments below that point to where the paper could be stronger and some additional development that might further support the clarity of contributions the authors seek to make.

Authors: Thank you very much for your kind words regarding our paper. We value your feedback and hope that our responses have addressed your comments satisfactorily.

Some citations should be added to the second last sentence in the introduction (regarding the effects of loss of resources and support for youth) line 35-38.

A: We revised this section for better readability and added citations.

The first sentence in the Youth Homelessness section reads a bit awkwardly (“The group of homeless young adults is a very heterogeneous one and entails a nuanced understanding of their experiences and life trajectories”). I’d suggest changing it to something like: The homeless young adult population is very heterogenous and therefore requires an understanding of the diversity of experiences and life trajectories. The rest of the section could use a bit more editing for awkward wording and flow.

A: Thank you, we revised this section for better readability.

In the “homeless prevention” section, there are sources added to the approaches in Europe but none for the Australian or Canadian. These should also include some citations.

A: Thank you, sources for the Canadian and Australian approach were added

There seems to be a section missing that would introduce the Belgian case. The authors do a great job of talking about various strategies and types of efforts, but the reader is left wondering, “okay what happens in Belgium?”. The questions jump right to the implications for targeted prevention strategies but little is known what is currently being done and what current strategies look like (as well as their impacts). Data on homelessness would also be helpful here for context as well as experiences of homelessness (from previous research or a discussion of what previous research has found that will set up the research questions presented). This would be helpful contextual information before the methodology is introduced. 

A: Thank you for this addition. We are now providing a paragraph to explain the Belgian situation in more detail. (line 102-113)

It seems to me that the authors are doing what might be the first of quant. analyses of PIT counts in Belgium – this needs to be clearer! Is there a lack of data and research on homelessness in Belgium? More needs to be known here (to emphasize the contributions of this article as well as set the context).

A: to make this clearer we added this information (line 155-158)

Methodology: I would like to know more about how the sample of participants was recruited. It’s unclear whether or not the researchers worked with the PIT counts or separately. Where did social workers and volunteers approach participants? It seems later that the questionnaire was added to the counts but this needs to be clearer (particularly regarding recruitment). How were the focus group members recruited? Was the group diverse in terms of providers and the services?

A: thank you, information is added (line 182-185)

Results: prior to jumping into the different groups chosen it would be helpful to introduce why these three groups are the focus (this is introduced above somewhat but it would be helpful to repeat so the reader can follow why these three groups are being discussed). It would be helpful if more was said regarding the groups. The results are presented, but a concluding (or introductory) sentence about the profile would be helpful – what do the quant results tell us in brief about the specific group (ie. A majority are… they live in … and have hardships like…).

A: thank you, additional information was added to make this more clear

The qualitative results are a bit disconnected from the quantitative. Were the participants shown the data and given the information regarding the three groups as were presented in the paper? Were they surprised? What did they think more broadly about the data presented? This might be a helpful way to then segway into the great solutions they offered. It would also be helpful if the authors included discussions that supported the quant findings and to show the important links between them (to show the supplementary nature of the data). For example, in the vulnerable family situation section there’s discussion of the fact that the group might be less known – so were they captured in the quant data or is this a group the participants argued was missing or needed further examination?

A: thank you, extra information on the focus group was added

A small comment: there is a spelling error in the first quote (finnish instead of finish) on line 317. This section could use additional revision (some tense and flow issues).

A: Thank you, we revised this section to improve its readability.

Discussion: I’d like to applaud the authors for the discussion and for offering important insights into strategies for youth homelessness. The discussion is great and might benefit from just a bit more development and tying together of specific elements.

 

o   the discussion of the rights-based approach (in the paragraph on line 441) might benefit from an introduction of the approach and the key tenets.

A: thank you, we added a short introduction on the rights-based approach

o   The discussion turns to the need for specific and targeted interventions, and this was introduced as the focus of the focus groups – did participants offer some recommendations themselves that the authors may want to add to the results? This might better tie the results and discussion together better.

A: thank you, we made additional reference to recommendations by the focus group members

A last (small) comment: The page numbering seems to be off

Info for editor?