{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:29:41Z","timestamp":1788791381134,"version":"build-2803163510"},"reference-count":80,"publisher":"Wiley","issue":"1-2","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["CIHR Foundation Grant Number 143259"],"award-info":[{"award-number":["CIHR Foundation Grant Number 143259"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J of Comm Psychol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>People experiencing homelessness are often described as having \u201ccomplex needs\u201d for whom various health and housing interventions have been developed. However, there is no consensus on how this and similar terms are defined or measured. A prospectively registered scoping review was conducted to examine how \u201ccomplexity\u201d is defined and measured with people experiencing homelessness. Six academic databases were searched, along with several techniques for identifying grey literature and articles in unindexed journals. A total of 224 academic articles were included in the review (35 grey literature articles were included in a supplemental review). There were 220 definitions of complexity provided in 203 academic articles, which most commonly included mental illness and\/or substance use problems. Physical health problems, multiple health conditions, justice system involvement and offending behaviours, health and social service use patterns, and type and characteristics of homelessness were also common. Three types of approaches for measuring complexity were identified in 29 articles: (1) instruments (primarily vulnerability indices and service prioritization tools), (2) risk adjustment\/health resource prediction indices, and (3) study\u2010specific algorithms and processes. Limited validation was common among the methodological approaches, with a few exceptions. Overall, the findings highlight how complexity is often underdefined, with limitations in its measurement.<\/jats:p>","DOI":"10.1002\/ajcp.70052","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T15:01:43Z","timestamp":1770908503000},"page":"19-36","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Complexity among people experiencing homelessness: A scoping review of definitions and measurement approaches"],"prefix":"10.1002","volume":"77","author":[{"given":"Nick","family":"Kerman","sequence":"first","affiliation":[{"name":"General Adult Psychiatry and Health Systems Division Centre for Addiction and Mental Health Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sena","family":"Gok","sequence":"additional","affiliation":[{"name":"General Adult Psychiatry and Health Systems Division Centre for Addiction and Mental Health Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Sylvestre","sequence":"additional","affiliation":[{"name":"School of Psychology University of Ottawa Ottawa Ontario Canada"},{"name":"Centre for Research on Educational and Community Services University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Ecker","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions Unity Health Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sihan","family":"Zhang","sequence":"additional","affiliation":[{"name":"General Adult Psychiatry and Health Systems Division Centre for Addiction and Mental Health Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W.","family":"Hwang","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions Unity Health Toronto Toronto Ontario Canada"},{"name":"Division of General Internal Medicine University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Kozloff","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Toronto Toronto Ontario Canada"},{"name":"Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health Centre for Addiction and Mental Health Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky","family":"Stergiopoulos","sequence":"additional","affiliation":[{"name":"General Adult Psychiatry and Health Systems Division Centre for Addiction and Mental Health Toronto Ontario Canada"},{"name":"Department of Psychiatry University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-022-00705-8"},{"key":"e_1_2_9_3_1","first-page":"189","article-title":"\u201cWe are not just rent receipts\u201d: Housing, neighbourhood, and community re\u2010imagined by formerly homeless people","volume":"22","author":"Anucha U.","year":"2005","journal-title":"Social Work Review"},{"key":"e_1_2_9_4_1","first-page":"62","article-title":"When a bed is home: The challenges and paradoxes of community development in a shared\u2010housing program for homeless people","volume":"58","author":"Anucha U.","year":"2006","journal-title":"Canadian Review of Social Policy"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1606\/1044-3894.3953"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/1364557032000119616"},{"key":"e_1_2_9_7_1","volume-title":"Screening for housing first","author":"Aubry T.","year":"2015"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10464-011-9444-z"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/10530789.2019.1622858"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/07370016.2018.1516422"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/10530789.2018.1482991"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10530789.2024.2426286"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/15504263.2017.1319586"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20295"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(20)30280-7"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/10530789.2020.1852502"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2013.0083"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192315928"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06815-4"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10935-020-00607-y"},{"key":"e_1_2_9_21_1","volume-title":"At home in Winnipeg: Localizing housing first as a culturally responsive approach to understanding and addressing urban Indigenous homelessness","author":"Distasio J.","year":"2018"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/02673037.2018.1556784"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-03727-7_14"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.3138\/cjpe.0019.009"},{"key":"e_1_2_9_25_1","volume-title":"European typology of homelessness and housing exclusion (ETHOS)","author":"FEANTSA","year":"2017"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/0042098012452329"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/2150131916656009"},{"key":"e_1_2_9_28_1","volume-title":"Canadian definition of homelessness","author":"Gaetz S.","year":"2012"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.2196\/46690"},{"key":"e_1_2_9_30_1","volume-title":"Downtown Emergency Service Center's vulnerability assessment tool for individuals coping with chronic homelessness: A psychometric analysis","author":"Ginzler J. A.","year":"2010"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-015-0125-0"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2011-000323"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1080\/10530789.2021.1906475"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1080\/14036096.2023.2254770"},{"key":"e_1_2_9_35_1","first-page":"203","article-title":"The importance of first\u2010hand experience in homelessness research, policy and implementation","volume":"15","author":"Green H.","year":"2021","journal-title":"European Journal of Homelessness"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1080\/02673030500213953"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003750"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.5770\/cgj.19.253"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.4337\/9781800883413"},{"key":"e_1_2_9_40_1","first-page":"31","article-title":"How do we measure success in homelessness services? Critically assessing the rise of the homelessness outcomes star","volume":"10","author":"Johnson G.","year":"2016","journal-title":"European Journal of Homelessness"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/s44220-024-00218-0"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001548"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1037\/ort0000335"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.17645\/si.v4i4.596"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1108\/JICA-02-2018-0017"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmed.2023-0074"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1080\/19460171.2019.1598881"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2018.01.034"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/0891241617753289"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.5888\/pcd13.150567"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.13000"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.36251\/josi.136"},{"key":"e_1_2_9_53_1","first-page":"153","article-title":"Local representations of homelessness in Copenhagen, Glasgow and Gothenburg: A cross\u2010city policy analysis","volume":"11","author":"Petersson F.","year":"2021","journal-title":"European Journal of Homelessness"},{"key":"e_1_2_9_54_1","first-page":"293","article-title":"Associations between the vulnerability index\u2010service prioritization decision assistance tool and returns to homelessness among single adults in the United States","volume":"23","author":"Petry L.","year":"2021","journal-title":"Cityspace"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0230896"},{"key":"e_1_2_9_56_1","volume-title":"Everyone counts 2020\u20102022\u2014Results from the third nationally coordinated point\u2010in\u2010time counts of homelessness in Canada","author":"Quayum S.","year":"2024"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1080\/10875549.2015.1094774"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1108\/14608790200400016"},{"key":"e_1_2_9_59_1","volume-title":"The TAY triage tool: A tool to identify homeless transition age youth most in need of permanent supportive housing","author":"Rice E.","year":"2013"},{"key":"e_1_2_9_60_1","volume-title":"TAY triage tool pilots report","author":"Rice E.","year":"2015"},{"key":"e_1_2_9_61_1","volume-title":"Mental health & addictions interventions for youth experiencing homelessness: Practical strategies for front\u2010line providers","author":"Rice E.","year":"2018"},{"key":"e_1_2_9_62_1","doi-asserted-by":"publisher","DOI":"10.1037\/14954-012"},{"key":"e_1_2_9_63_1","volume-title":"A literature review on multiple and complex needs","author":"Rosengard A.","year":"2007"},{"key":"e_1_2_9_64_1","doi-asserted-by":"publisher","DOI":"10.18865\/ed.30.3.501"},{"key":"e_1_2_9_65_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2021.306628"},{"key":"e_1_2_9_66_1","volume-title":"The 2024 annual homelessness assessment report (AHAR) to Congress\u2014Part 1: Point\u2010in\u2010time estimates of homelessness","author":"Sousa T.","year":"2024"},{"key":"e_1_2_9_67_1","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igz049"},{"key":"e_1_2_9_68_1","doi-asserted-by":"publisher","DOI":"10.1080\/10530789.2017.1328007"},{"key":"e_1_2_9_69_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.0.0334"},{"key":"e_1_2_9_70_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-12-345"},{"key":"e_1_2_9_71_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11414-016-9527-6"},{"key":"e_1_2_9_72_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-14-309"},{"key":"e_1_2_9_73_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0850"},{"key":"e_1_2_9_74_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-6629(199903)27:2<225::AID-JCOP9>3.0.CO;2-Y"},{"key":"e_1_2_9_75_1","volume-title":"Final report of the vulnerability assessment tool evaluation: Narrative summary of quantitative results and qualitative findings","author":"Tsemberis S.","year":"2017"},{"key":"e_1_2_9_76_1","doi-asserted-by":"publisher","DOI":"10.1002\/cl2.1329"},{"key":"e_1_2_9_77_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajcp.12237"},{"key":"e_1_2_9_78_1","doi-asserted-by":"publisher","DOI":"10.1037\/ser0000561"},{"key":"e_1_2_9_79_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753-6405.13175"},{"key":"e_1_2_9_80_1","doi-asserted-by":"publisher","DOI":"10.1108\/HCS-09-2018-0023"},{"key":"e_1_2_9_81_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.0393"}],"container-title":["American Journal of Community Psychology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajcp.70052","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ajcp.70052","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajcp.70052","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T14:47:32Z","timestamp":1774277252000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajcp.70052"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":80,"journal-issue":{"issue":"1-2","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/ajcp.70052"],"URL":"https:\/\/doi.org\/10.1002\/ajcp.70052","archive":["Portico"],"relation":{},"ISSN":["0091-0562","1573-2770"],"issn-type":[{"value":"0091-0562","type":"print"},{"value":"1573-2770","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"assertion":[{"value":"2024-05-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}