Predictors of homelessness among families in New York City: from shelter request to housing stability

Rural/urban differences in rates and predictors of intimate partner violence and abuse screening among pregnant and postpartum United States residents

OBJECTIVE

To describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth.

DATA SOURCES AND STUDY SETTING

This analysis utilized 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 45 states and three jurisdictions.

STUDY DESIGN

This is a retrospective, cross-sectional study using multistate survey data.

DATA COLLECTION/EXTRACTION METHODS

This analysis included 201,413 survey respondents who gave birth in 2016-2020 (n = 42,193 rural and 159,220 urban respondents). We used survey-weighted multivariable logistic regression models, stratified by rural/urban residence, to estimate adjusted predicted probabilities and 95% confidence intervals (CIs) for two outcomes: (1) self-reported experiences of IPV (physical violence by a current or former intimate partner) and (2) not receiving abuse screening at health care visits before, during, or after pregnancy.

PRINCIPAL FINDINGS

Rural residents had a higher prevalence of perinatal IPV (4.6%) than urban residents (3.2%). Rural respondents who were Medicaid beneficiaries, 18-35 years old, non-Hispanic white, Hispanic (English-speaking), or American Indian/Alaska Native had significantly higher predicted probabilities of experiencing perinatal IPV compared with their urban counterparts. Among respondents who experienced perinatal IPV, predicted probabilities of not receiving abuse screening were 21.3% for rural and 16.5% for urban residents. Predicted probabilities of not being screened for abuse were elevated for rural IPV victims who were Medicaid beneficiaries, 18-24 years old, or unmarried, compared to urban IPV victims with those same characteristics.

CONCLUSIONS

IPV is more common among rural birthing people, and rural IPV victims are at higher risk of not being screened for abuse compared with their urban peers. IPV prevention and support interventions are needed in rural communities and should focus on universal abuse screening during health care visits and targeted support for those at greatest risk of perinatal IPV.

The influence of sexual violence on suicide risk among runaway youth in South Korea: The multiple additive moderating effect of peer attachment and parental attachment

BACKGROUND

Runaway youth without an adequate and safe place are vulnerable to sexual violence. Sexual violence is strongly associated with suicide risk, but peers and family are important factors in attenuating the negative outcomes of sexual violence; however, research on this relationship is insufficient because previous studies have focused only on runaway youth's problematic behavior.

OBJECTIVE

This study's specific aims were as follows: 1) to verify the association between sexual violence and suicide risk among runaway youth, and 2) to assess whether peer and parental attachment moderated the association between sexual violence and suicide risk among runaway youth.

PARTICIPANTS AND SETTING

The participants comprised 232 runaway youth (51.3 % girls); more than half were aged 17-19 years and approximately two-thirds of them had experienced child abuse.

METHODS

Self-administered questionnaires were provided to the participating runaway youth in youth shelters in South Korea. The data were analyzed using a multiple additive moderating model that simultaneously included moderating and control variables.

RESULTS

In total, 18.5 % of runaway youth were exposed to sexual violence (10.6 % boys, 26.1 % girls). Sexual violence victimization affected suicide risk among runaway youth. Peer attachment alleviated the negative relationship between sexual violence and suicide risk, and acted as a protective factor. Although the moderating effect of parental attachment was not significant, it significantly influenced suicide risk.

CONCLUSION

Our findings demonstrate that runaway youth are vulnerable to sexual violence victimization, especially severe types of sexual violence. Our study verified the role of peer and parental attachment in the association between sexual violence and suicide risk among runaway youth. These findings suggest the need to improve positive peer and parent relationships to mitigate suicide risk among runaway youth.

Race matters in addressing homelessness: A scoping review and call for critical research

Structural racism contributes to homelessness in the United States, as evidenced by the stark racial disparities in who experiences it. This paper reviews research at the intersections of race and homelessness to advance efforts to understand and address racial inequities. Part 1 offers a synthesis of homelessness research from the 1980s to 2015, where several scholars examined the role of race and racism despite mainstream efforts to present the issue as race-neutral. Part 2 presents the results of a systematic scoping review of research at the intersections of race and homelessness from 2016 to 2021. The 90 articles included demonstrate a growing, multidisciplinary body of literature that documents how needs and trajectories of people experiencing homelessness differ by race, examines how the racialized structuring of society contributes to homelessness risk, and explores how programs, policies, and grassroots action can address inequities. In addition to charting findings and implications, included studies are appraised against research principles developed by Critical Race Theory scholars, mapping the potential of existing research on race and homelessness to challenge racism.

Temporary stays with housed family and friends among older adults experiencing homelessness: Qualitative findings from the HOPE HOME study

BACKGROUND

The proportion of adults age 50 and older experiencing homelessness is growing. People at risk for homelessness may stay with family and friends to prevent homelessness. Moving in with housed family and friends is a strategy used to exit homelessness. Little is known about these stays with family and friends. This study examined the motivations for and challenges of older adults experiencing homelessness staying with or moving in with family or friends.

METHODS

We purposively sampled 46 participants from the HOPE HOME study, a cohort of 350 community-recruited adults experiencing homelessness age ≥50 in Oakland, CA. Inclusion criteria included having stayed with housed family/friends for ≥1 nights in the prior 6 months. We sampled 19 family/friends who had hosted participants experiencing homelessness. We conducted separate, semi-structured interviews, summarized, memoed and coded data consistent using a grounded theory approach.

RESULTS

Older adults experiencing homelessness reported primarily temporary stays. Motivations for stays on the part of participants included a need for environmental, physical, and emotional respite from homelessness. Both individuals experiencing homelessness and hosts cited the mutual benefits of stays. Barriers to stays included feelings of shame, concerns about burdening the hosts, and interpersonal conflicts between older adults experiencing homelessness and host participants.

CONCLUSIONS

There are potential opportunities and concerns surrounding temporary stays between older adults experiencing homelessness and their family or friends. Policy solutions should support the potential mutual benefits of temporary stays, while addressing interpersonal barriers to strengthen kinship and friendship networks and mediate the negative impacts of homelessness.

Using geographic information systems to assess community-level vulnerability to housing insecurity in rural areas

Research examining homelessness in rural areas has been sparse. The current study aims to expand conceptions of rural homelessness by mapping community-level risk factors related to housing insecurity. Geographic information systems (GIS) techniques were used to map the distribution of select community-level risk indicators in the State of Maine. Three methodological choices related to this process are demonstrated: (1) selection and distribution of housing insecurity risk indicators; (2) use of location quotients; and (3) use of spatial lags. After examining and mapping selected risk factors against the location of homeless service supports, four areas in Maine were identified as communities of concern for housing insecurity. Better understanding the extent and location of areas of high need that are resource poor can help service and funding agencies to plan for the more efficient and effective distribution of homeless prevention and mitigation services. Implications for research in rural areas are discussed.

Large socio-economic, geographic and demographic disparities exist in exposure to school closures

The coronovirus disease 2019 (COVID-19) pandemic has prompted many school districts to turn to distance or at-home learning. Studies are emerging on the negative effects of distance learning on educational performance, but less is known about the socio-economic, geographic and demographic characteristics of students exposed to distance learning. We introduce a U.S. School Closure and Distance Learning Database that tracks in-person visits across more than 100,000 schools throughout 2020. The database, which we make publicly accessible and update monthly, describes year-over-year change in in-person visits to each school throughout 2020 to estimate whether the school is engaged in distance learning. Our findings reveal that school closures from September to December 2020 were more common in schools with lower third-grade math scores and higher shares of students from racial/ethnic minorities, who experience homelessness, have limited English proficiency and are eligible for free/reduced-price school lunches. The findings portend rising inequalities in learning outcomes.

Large socio-economic, geographic and demographic disparities exist in exposure to school closures

The coronovirus disease 2019 (COVID-19) pandemic has prompted many school districts to turn to distance or at-home learning. Studies are emerging on the negative effects of distance learning on educational performance, but less is known about the socio-economic, geographic and demographic characteristics of students exposed to distance learning. We introduce a U.S. School Closure and Distance Learning Database that tracks in-person visits across more than 100,000 schools throughout 2020. The database, which we make publicly accessible and update monthly, describes year-over-year change in in-person visits to each school throughout 2020 to estimate whether the school is engaged in distance learning. Our findings reveal that school closures from September to December 2020 were more common in schools with lower third-grade math scores and higher shares of students from racial/ethnic minorities, who experience homelessness, have limited English proficiency and are eligible for free/reduced-price school lunches. The findings portend rising inequalities in learning outcomes.

Understanding Mechanisms Driving Family Homeless Shelter Use and Child Mental Health

Homeless shelters throughout the U.S. are overcrowded and under-resourced. Families with children face substantial barriers to timely, successful shelter exit, and prolonged shelter stays threaten child mental health. This community-based system dynamics study explored barriers to timely, successful shelter exit and feedback mechanisms driving length of stay and child mental health risk. Group model building - a participatory systems science tool - and key informant interviews were conducted with clients (N = 37) and staff (N = 6) in three family homeless shelters in a Midwestern region. Qualitative content analysis with emergent coding identified key themes feedback loops. Findings indicated overcrowding delayed successful shelter exit; longer stays exacerbated crowding and stress in a vicious cycle. Furthermore, longer stays exacerbated child risk for mental disorder both directly and indirectly via crowding and caregiver stress. Capacity constraints limited families served, while contributing to ongoing unmet need. Future research should investigate the roles of these dynamic feedback relationships in the persistent vulnerability of homeless families. Service design should prioritize interventions that alleviate crowding and subsequent threats to mental health such as private or scattered-site shelter accommodations, affordable child care, and homelessness prevention to facilitate successful shelter exit and mitigate child mental health risk.

When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers

People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases. In the year before shelter entry and the year following shelter exit, 39.3 percent and 43.3 percent, respectively, of first-time adult shelter users had an ED visit or hospitalization. Hospital visits-particularly ED visits-began to increase several months before shelter entry and declined over several months after shelter exit, with spikes in ED visits and hospitalizations in the days immediately before shelter entry and following shelter exit. We recommend cross-system collaborations to better understand and address the co-occurring health and housing needs of vulnerable populations.

Forty Years of Research on Predictors of Homelessness

Homelessness is a chronic public health issue in the U.S. This paper reviews the endurance and evolution of individual, youth, and family homelessness over the past 40-plus years. Thematic findings detail research on predictors of homelessness among adolescents, runaway youth, veterans, older adults, sheltered families, and female-headed families. Results provide a summary of contributors to homelessness, including issues related to family instability, unemployment and poverty, mental illness, substance use, unstable living arrangements, child maltreatment, social support, crime, and violence. Findings highlight key and persistent predictors of homelessness found across decades, as well as more recently identified and nuanced precursors to individual or family displacement. The goal of this work was to summarize what is known about predictors of homelessness to inform targeted research, practice, and policies.

Why Do Homeless Families Exit and Return the Homeless Shelter? Factors Affecting the Risk of Family Homelessness in Salt Lake County (Utah, United States) as a Case Study

Previous quantitative research on family homelessness has addressed a question of why some households become homeless. However, why some homeless families return the shelter to repeat their homelessness has not been explored well. This study aims at providing a comprehensive insight into the dynamics of homeless families by identifying the physical, social, and economic characteristics of a homeless family affecting the likelihood of their decision to stay, exit, and return the shelter. The relationships of factors with shelter exit and return were examined using Kaplan-Meier estimates of survival times and Cox Proportional Hazard regression analysis. This study employs a sample of 2348 historical records for 1462 homeless families registered to the Homeless Management Information System (HMIS) database between January 1, 2015 and December 31, 2017. The results indicate that structural factors such as subsidized housing program enrollment during a homeless episode and prior income play a significant role in reducing the risks of shelter exit and return rather than physical characteristics of a homeless family. Additionally, results show that variations in prior residence and exit destination of homeless families serve as factors determining the length of their shelter stay and the likelihood to return to the shelter. Integration of both shelter exit and return analysis results make policymakers and urban planners think about developing policies for coordination of housing and economic stability to address family homelessness.

"It Wasn't Just One Thing": A Qualitative Study of Newly Homeless Emergency Department Patients

OBJECTIVES

Emergency departments (EDs) frequently care for patients who are homeless or unstably housed. One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions.

METHODS

We conducted in-depth, one-on-one qualitative interviews with ED patients who had become homeless within the past 6 months. Using a semistructured interview guide, we asked patients about their pathways into homelessness and what might have prevented them from becoming homeless. Interviews were digitally recorded and professionally transcribed. Transcripts were coded line by line by multiple investigators who then met as a group to discuss and refine codes in an iterative fashion.

RESULTS

Interviews were completed with 31 patients. Mean interview length was 42 minutes. Four main themes emerged: 1) unique stories yet common social and health contributors to homelessness, 2) personal agency versus larger structural forces, 3) limitations in help from family or friends, and 4) homelessness was not expected.

CONCLUSIONS

These findings demonstrate gaps in current homeless prevention services and can help inform future interventions for unstably housed and homeless ED patients. More immediately, the findings provide rich, unique context to the lives of a vulnerable patient population commonly seen in EDs.

Solving Homelessness from a Complex Systems Perspective: Insights for Prevention Responses

Homelessness represents an enduring public health threat facing communities across the developed world. Children, families, and marginalized adults face life course implications of housing insecurity, while communities struggle to address the extensive array of needs within heterogeneous homeless populations. Trends in homelessness remain stubbornly high despite policy initiatives to end homelessness. A complex systems perspective provides insights into the dynamics underlying coordinated responses to homelessness. A constant demand for housing assistance strains service delivery, while prevention efforts remain inconsistently implemented in most countries. Feedback processes challenge efficient service delivery. A system dynamics model tests assumptions of policy interventions for ending homelessness. Simulations suggest that prevention provides a leverage point within the system; small efficiencies in keeping people housed yield disproportionately large reductions in homelessness. A need exists for policies that ensure reliable delivery of coordinated prevention efforts. A complex systems approach identifies capacities and constraints for sustainably solving homelessness.

Stressful life events among homeless people in León (Nicaragua): Quantity, types, timing, and perceived causality

Nicaragua is one of Latin America's least developed countries and has a lack of data on homeless people, a stigmatized group living in extreme poverty. We conducted structured interviews with homeless people living in the city of León (Nicaragua; n = 41) to obtain data on the quantity, types, timing, and perceived causality of stressful life events (SLEs) experienced during their childhood and adolescence as well as throughout their adult lives. The findings showed that our participants had experienced a high number of extremely severe SLEs at very early ages and most of these SLEs occurred before they first became homeless. In terms of the perceived causal relationship between SLEs and homelessness, the interviewees mainly attributed being homeless to material, affective, or relationship factors, or an excessive consumption of alcohol and/or drugs. Suffering from multiple and serious SLEs, largely due to living in socioeconomically disadvantaged environments, appears to be an important vulnerability factor in both becoming homeless and chronic homelessness.

What Interventions Work Best for Families Who Experience Homelessness? Impact Estimates from the Family Options Study

What housing and service interventions work best to reduce homelessness for families in the United States? The Family Options Study randomly assigned 2,282 families recruited in homeless shelters across 12 sites to priority access to one of three active interventions or to usual care in their communities. The interventions were long-term rent subsidies, short-term rent subsidies, and transitional housing in supervised programs with intensive psychosocial services. In two waves of follow-up data collected 20and 37 months later, priority access to long-term rent subsidies reduced homelessness sand food insecurity and improved other aspects of adult and child well-being relative to usual care, at a cost 9 percent higher. The other interventions had little effect. The study provides support for the view that homelessness for most families is an economic problem that long-term rent subsidies resolve and does not support the view that families must address psychosocial problems to succeed in housing. It has implications for focusing government resources on this important social problem.

The Impact of Housing Instability on Child Maltreatment: A Causal Investigation

More than a half million children are confirmed as victims of maltreatment by the child welfare system each year. Children from unstably housed families are over-represented in child mal-treatment reports, and a growing body of evidence links housing problems to maltreatment and Child Protective Services (CPS); investigation. The present study applies two propensity score analysis approaches-greedy matching and propensity score weighting-to data from the Fragile Families and Child Well-being Study to move toward a causal explanation of child mal-treatment behaviors among mothers in low-income households. Utilizing two separate methods to correct for overt selection bias, the present study finds that housing instability leads to a small increase in maltreatment behaviors, yet this small positive net impact on child maltreatment does not fully explain the over-representation of unstably housed families in the child welfare system. Families experiencing housing problems likely have a range of needs that require earlier, targeted intervention to mitigate consequences of poverty, domestic violence, and maternal depression. Child welfare services should invest resources in housing assistance programs in-house as well as through partnerships with local public housing authorities to stabilize families, reduce housing-related strain on caregivers, and promote family preservation.

Can Housing and Service Interventions Reduce Family Separations for Families Who Experience Homelessness?

Family break-up is common in families experiencing homelessness. This paper examines the extent of separations of children from parents and of partners from each other and whether housing and service interventions reduced separations and their precursors among 1,857 families across 12 sites who participated in the Family Options Study. Families in shelters were randomized to offers of one of three interventions: permanent housing subsidies that reduce expenditures for rent to 30% of families' income, temporary rapid re-housing subsidies with some services directed at housing and employment, and transitional housing in supervised facilities with extensive psychosocial services. Each group was compared to usual care families who were eligible for that intervention but received no special offer. Twenty months later, permanent housing subsidies almost halved rates of child separation and more than halved rates of foster care placements; the other interventions did not affect separations significantly. Predictors of separation were primarily homelessness and drug abuse (all comparisons), and alcohol dependence (one comparison). Although housing subsidies reduced homelessness, alcohol dependence, intimate partner violence, and economic stressors, the last three variables had no association with child separations in the subsidy comparison; thus subsidies had indirect effects via reductions in homelessness. No intervention reduced partner separations.

A Theory of Mental Health and Optimal Service Delivery for Homeless Children

Homeless children are a vulnerable group with high risk for developing mental health disorders. The pathways to disorders among homeless children have not been fully elucidated, with significant logistical and measurement issues challenging accurate and thorough assessment of need. The environments of homeless children are uniquely chaotic, marked by frequent moves, family structure changes, household and neighborhood disorder, parenting distress, and lack of continuous services. Despite high rates of service use, mental health outcomes remain poor. This paper reviews the literature on homeless children's mental health, as well as prior theoretical explorations. Finally, the paper proposes a theoretical model that explains elevated rates of mental health problems among homeless children as consequences of harmful stress reactions triggered by chronic household instability along with repeated service disruptions. This model draws upon existing conceptual frameworks of child development, family poverty, health services utilization, and the biology of stress to clarify the role of environmental chaos in the development of child emotional and behavioral problems. Potential strategies to mitigate the risk for mental health disorders among homeless children and future research directions are discussed.

Describing Trajectories of Homeless Service Use in Hawai'i Using Latent Class Growth Analysis

The State of Hawai'i, like many other areas across the United States, has large numbers of individuals and families experiencing homelessness, many of whom seek support through statewide shelters and services. This study explored the diversity of ways in which individuals and families moved through Hawai'i's homeless service system. Using administrative data, a cohort of new service users was tracked across time to trace the developmental trajectories of their homeless service use. The sample consisted of adults who had entered the service system for the first time in the fiscal year (FY) of 2010 (N = 4655). These individuals were then tracked through the end of FY 2014, as they used emergency shelter, transitional shelter, and outreach services. A latent class growth analysis was conducted and identified four distinct patterns of service use: low service use (n = 3966, 85.2%); typical transitional shelter use (n = 452, 9.7%); atypical transitional use (n = 127, 2.7%), and potential chronic service use (n = 110, 2.4%). Multinomial logistic regression models were then used to determine if select demographic, family, background experience (e.g., education, employment), or health variables were associated with class membership. The distinct profiles for class membership are discussed.

Housing Assistance and Housing Insecurity: A Study of Renters in Southeastern Michigan in the Wake of the Great Recession

This article examines the factors shaping longitudinal patterns of housing insecurity in the wake of the Great Recession, with a focus on whether housing assistance helped renters who received it. We use data from the first two waves (2009-10 and 2011) of the Michigan Recession and Recovery Study, a population-representative sample of working-aged adults from Southeast Michigan. We use detailed reports from renters and other non-homeowners to construct measures of instability and cost-related housing problems at both waves, and we compare the changes in these over follow-up between housing assistance recipients and their income-eligible but non-recipient counterparts. Our findings suggest that receiving housing assistance reduced the chance of experiencing housing insecurity problems over follow-up regardless of baseline housing insecurity.

Risk Models for Returns to Housing Instability Among Families Experiencing Homelessness

This study developed risk models for returns to housing instability (that is, homelessness and unstable doubling-up situations) among families exiting emergency shelter. Participants included 446 families randomly assigned to receive priority offers of long-term housing subsidies and 578 families randomly assigned to usual care in the Family Options Study, a multisite experiment designed to test the impact of various housing and service interventions for homeless families. Relationships between family features recorded at shelter entry and returns to housing instability 20 months later were examined empirically. Correlation, hierarchical logistic regression, and receiver operating characteristic curves were used to combine family features into predictive risk models. Results indicated that few observable family features beyond previous housing instability offered predictive utility. Access to long-term housing subsidies appears to reduce housing instability. Further research should examine whether disability benefits, reliable employment, or effective substance dependence treatment reduce housing instability.

Mismatch Between Homeless Families and the Homelessness Service System

The enrollment phase of the Family Options Study provides information about the mismatch of the homeless service system and the needs and desires of families experiencing homelessness in 12 communities. One-fourth (25.8 percent) of the 2,490 families screened for the study after shelter stays of a week were deemed ineligible for one or more of the interventions at initial screening, with ineligibility highest for those screened for transitional housing programs (28.9 percent) and lower for short- and long-term rental subsidies (9.2 and 4.1 percent). Families given priority offers of housing and service interventions for which they appeared eligible faced additional screening by programs and made decisions about whether to enroll. Considering all stages of this process, families were least likely to be eligible for and subsequently choose to enroll (within 9 months) in transitional housing programs (32.5 percent of those initially screened) and most likely to be eligible for and subsequently lease up with long-term subsidies (73.4 percent) with short-term subsidies in between (51.0 percent). Homeless system interventions systematically screen out families with housing and employment barriers, despite the presumption that these families are the families who need interventions in order to achieve housing and economic stability.

Commentary on the Future of Community Psychology: Perspective of a Research Community Psychologist

Community psychology is commented upon from the perspective of a community psychologist who was trained in the Community Psychology Program at the University of Michigan in Ann Arbor. Her background and training are reviewed. A brief survey of research on homelessness as a frame for community psychology research is presented. Concluding remarks are provided on the future of research in community psychology.

Methods for Influencing Social Policy: The Role of Social Experiments

Research methods in community psychology have grown more diverse since the Swampscott conference, but rigorous social experiments maintain a place among the multiplicity of methods that can promote community psychology values. They are particularly influential in policy circles. Two examples of social experiments to end homelessness for different populations illustrate their role. Both studies show that offering extremely poor and disenfranchised people autonomy and the resources they seek works better than "helping" them to overcome deficits in ways designed by well-meaning service providers. Experiments are neither the first nor the last method community psychologists should employ, but are a critical part of the field's armamentarium for systems change.

Predictors of homelessness among vulnerably housed adults in 3 Canadian cities: a prospective cohort study

Background

Homelessness is a major concern in many urban communities across North America. Since vulnerably housed individuals are at risk of experiencing homelessness, it is important to identify predictive factors linked to subsequent homelessness in this population. The objectives of this study were to determine the probability of experiencing homelessness among vulnerably housed adults over three years and factors associated with higher risk of homelessness.

Methods

Vulnerably housed adults were recruited in three Canadian cities. Data on demographic characteristics, chronic health conditions, and drug use problems were collected through structured interviews. Housing history was obtained at baseline and annual follow-up interviews. Generalized estimating equations were used to characterize associations between candidate predictors and subsequent experiences of homelessness during each follow-up year.

Results

Among 561 participants, the prevalence of homelessness was 29.2 % over three years. Male gender (AOR = 1.59, 95 % CI: 1.14–2.21) and severe drug use problems (AOR = 1.98, 95 % CI: 1.22–3.20) were independently associated with experiencing homelessness during the follow-up period. Having ≥3 chronic conditions (AOR = 0.55, 95 % CI: 0.33–0.94) and reporting higher housing quality (AOR = 0.99, 95 % CI: 0.97–1.00) were protective against homelessness.

Conclusions

Vulnerably housed individuals are at high risk for experiencing homelessness. The study has public health implications, highlighting the need for enhanced access to addiction treatment and improved housing quality for this population.

Welfare Reform and Housing: Assessing the Impact to Substance Abusers

The addiction disability (Supplemental Security Income and Social Security Disability Income program for drug abuse and alcoholism) was terminated by Congress in December 1996 as part of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). Discussions about welfare reform policies in the latter 20th century have centered on Aid to Families with Dependent Children (AFDC) receipt by the general population. Far less attention has been paid to programs such as the addiction disability that were also affected by the PRWORA. Our purpose is to study the effect of this policy change on the housing status of former addiction disability recipients and to also explore whether and how disruptions in living situations increased risks for drug and alcohol use, criminal participation and victimization. We utilize insights from two major sociological theories of housing or homelessness, i.e., individualistic and structural, to guide our exploration of the policy's impact on housing. A qualitative analysis, featuring in-depth interviews with 101, nonrandomly selected former recipients revealed that disability benefits promoted housing autonomy, successful cohabitation, and overall housing stability. The termination of benefits, at a time of diminishing social services (e.g., cash and housing assistance) and a housing market explosion, increased various types of homelessness for respondents and dependency on family and friends. Such negative living outcomes, in turn, further escalated the risk of drug and alcohol use, criminal participation, and victimization. Individual-level factors also complicated the matter. Implications for research and policy are discussed.

“I Couldn’t go Anywhere”

The authors examine the narratives of 24 substance-addicted welfare recipients to understand how their neighborhoods provide a particular context for substance abuse, violence, and social isolation. The authors also examine the relationships among substance abuse, violence, and social isolation. Overall, these narratives indicate that place of residence influences one’s social networks and exposure to drugs, which subsequently influence women’s experiences with substance abuse and domestic violence. The authors suggest a cohesive framework for understanding women’s experiences, that of structural violence as experienced through neighborhood living conditions, which fosters social isolation and vulnerability to long-term drug use and domestic violence.

Housing and Service Interventions for Families Experiencing Homelessness in the United States: An Experimental Evaluation

This paper examines the housing and service interventions that work best to end family homelessness and to promote housing stability, adult and child well-being, family and self-sufficiency in the United States. It is based on the short-term (20-month) results of the Family Options Study, which recruited 2,282 families in emergency homeless shelters across 12 sites and randomized them to one of three housing and service interventions or to usual care in their communities. The approaches test both theoretical propositions about the nature of family homelessness and practical efforts to end it. Permanent housing subsidies were most successful at ending homelessness and promoting housing stability and had radiating impacts on all the other domains, suggesting that homelessness among families in the United States is centrally a problem of housing affordability. Project-based transitional housing, which attempts to address families' psychosocial needs in supervised settings, and temporary 'rapid re-housing' subsidies had little effect.

Homelessness prevention in New York City: On average, it works

This study evaluates the community impact of the first four years of Homebase, a homelessness prevention program in New York City. Family shelter entries decreased on average in the neighborhoods in which Homebase was operating. Homebase effects appear to be heterogeneous, and so different kinds of averages imply different-sized effects. The (geometric) average decrease in shelter entries was about 5% when census tracts are weighted equally, and 11% when community districts (which are much larger) are weighted equally. This study also examines the effect of foreclosures. Foreclosures are associated with more shelter entries in neighborhoods that usually do not send large numbers of families to the shelter system.

Longitudinal Impact of a Family Critical Time Intervention on Children in High-Risk Families Experiencing Homelessness: A Randomized Trial

A randomized trial compared effects of a Family Critical Time Intervention (FCTI) to usual care for children in 200 newly homeless families in which mothers had diagnosable mental illness or substance problems. Adapted from an evidence-based practice to prevent chronic homelessness for adults with mental illnesses, FCTI combines housing and structured, time-limited case management to connect families leaving shelter with community services. Families were followed at five time points over 24 months. Data on 311 children-99 ages 1.5-5 years, 113 ages 6-10 years, and 99 ages 11-16 years-included mother-, teacher-, and child-reports of mental health, school experiences, and psychosocial well-being. Analyses used hierarchical linear modeling to investigate intervention effects and changes in child functioning over time. Referral to FCTI reduced internalizing and externalizing problems in preschool-aged children and externalizing for adolescents 11-16. The intervention led to declines in self-reported school troubles for children 6-10 and 11-16. Both experimental and control children in all age groups showed reductions in symptoms over time. Although experimental results were scattered, they suggest that FCTI has the potential to improve mental health and school outcomes for children experiencing homelessness.

Personal, dyadic, and contextual resilience in parents experiencing homelessness

Adopting a developmental psychopathology (DP) perspective, the present study systematically reviewed the quantitative literature on positive functioning and outcomes in parents experiencing homelessness. Studies were identified from PubMed, PsycInfo, and Web of Science using an exhaustive list of key terms. Of 3443 total studies screened, 219 were inspected, 176 were excluded, and 43 were included. Included studies fell into three outcome categories: the ability to function well personally (cope effectively, meet basic family needs, experience reduced psychopathology); dyadically (demonstrate positive parenting practices and promote child adjustment); and contextually (exit episodes of homelessness and avoid shelter re-entry). Results also reflected personal, dyadic, and contextual independent variables associated with each positive outcome category. Many parents experiencing homelessness display positive outcomes, and many factors support positive functioning. Future research should replicate these findings and examine multilevel parental functioning to help bridge the gap between the DP theoretical perspective and the quantitative evidence for parental resilience as a process.

EXPLORING MULTIPLE LEVELS of ACCESS to RENTAL SUBSIDIES and SUPPORTIVE HOUSING

Despite the well-documented benefits of stable housing, there are myriad barriers that preclude low-income and homeless individuals from accessing housing support. This paper examines which individual characteristics predict greater or more limited access to supportive housing and rental subsidy programs in Hartford, Connecticut. Although individuals with HIV/AIDS are most likely to access housing, limited options remain for other vulnerable populations, including those with substance use disorders and mental illness.

Family Unification Program: Housing Services for Homeless Child Welfare-Involved Families

The Family Unification Program-a U.S. Department of Housing and Urban Development initiative to facilitate interagency collaboration between the child welfare and public housing service systems-aims to stabilize families at risk for parent-child separation by addressing housing needs. Findings from a randomized controlled trial suggest that families referred to the program experienced lower risk for homelessness and out-of-home placement compared with child welfare services as usual. The findings suggest that housing services offer an effective alternative to foster care.

Leaving Homelessness Behind: Housing Decisions among Families Exiting Shelter1

Because homelessness assistance programs are designed to help families, it is important for policymakers and practitioners to understand how families experiencing homelessness make housing decisions, particularly when they decide not to use available services. This study explores those decisions using in-depth qualitative interviews with 80 families recruited in shelters across four sites approximately six months after they were assigned to one of four conditions (permanent housing subsidies, project-based transitional housing, community-based rapid re-housing, and usual care). Familiar neighborhoods near children's schools, transportation, family and friends, and stability were important to families across conditions. Program restrictions on eligibility constrained family choices. Subsidized housing was the most desired intervention and families leased up at higher rates than in other studies of poor families. Respondents were least comfortable in and most likely to leave transitional housing. Uncertainty associated with community-based rapid re-housing generated considerable anxiety. Across interventions, many families had to make unhappy compromises, often leading to further moves. Policy recommendations are offered.

Community-level characteristics associated with variation in rates of homelessness among families and single adults

OBJECTIVES

We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic, and safety net characteristics.

METHODS

We entered community-level characteristics and US Department of Housing and Urban Development point-in-time counts for a single night in January 2009 into separate mixed-effects statistical analyses that modeled homelessness rates for 4 subpopulations: families and single adults in metropolitan and nonmetropolitan regions.

RESULTS

Community-level factors accounted for 25% to 50% of the variance in homelessness rates across models. In metropolitan regions, alcohol consumption, social support, and several economic indicators were uniquely associated with family homelessness, and drug use and homicide were uniquely associated with single-adult homelessness. In nonmetropolitan regions, life expectancy, religious adherence, unemployment, and rent burden were uniquely associated with family homelessness, and health care access, crime, several economic indicators, and receipt of Supplemental Security Income were uniquely associated with single-adult homelessness.

CONCLUSIONS

Considering homeless families and single adults separately enabled more precise modeling of associations between homelessness rates and community-level characteristics, indicating targets for interventions to reduce homelessness among these subpopulations.

Relationship among adverse childhood experiences, history of active military service, and adult outcomes: homelessness, mental health, and physical health

OBJECTIVES

We determined whether a report of adverse childhood experiences predicts adult outcomes related to homelessness, mental health, and physical health and whether participation in active military service influences the relationship between childhood and adult adversity.

METHODS

Using data from the 2010 Washington State Behavioral Risk Factor Surveillance System, we tested by means of logistic regression the relationship between adverse childhood experiences and 3 adult outcomes--homelessness, mental health, and physical health--as well as differences among those with a history of active military service.

RESULTS

Adverse childhood experiences separately predicted increased odds of experiencing homelessness as an adult and mental health and physical health problems. Childhood adversity increased the likelihood of adult homelessness and poor physical health among individuals with no history of active military service and the likelihood of mental health problems among individuals with a history of active military service.

CONCLUSIONS

The relationship between childhood adversity and adult adversity changes in degree when history of active military service is controlled, which has implications for Armed Forces recruitment strategies and postmilitary service risk assessment.

Efficient targeting of homelessness prevention services for families

OBJECTIVES

We developed and evaluated a model to target homelessness prevention services to families more efficiently.

METHODS

We followed 11,105 families who applied for community-based services to prevent homelessness in New York City from October 1, 2004, to June 30, 2008, through administrative records, using Cox regression to predict shelter entry.

RESULTS

Over 3 years, 12.8% of applicants entered shelter. Both the complete Cox regression and a short screening model based on 15 risk factors derived from it were superior to worker judgments, with substantially higher hit rates at the same level of false alarms. We found no evidence that some families were too risky to be helped or that specific risk factors were particularly amenable to amelioration.

CONCLUSIONS

Despite some limitations, an empirical risk model can increase the efficiency of homelessness prevention services. Serving the same proportion of applicants but selecting those at highest risk according to the model would have increased correct targeting of families entering shelter by 26% and reduced misses by almost two thirds. Parallel models could be developed elsewhere.

Twenty-five years of child and family homelessness: where are we now?

Family homelessness emerged as a major social and public health problem in the United States during the 1980s. We reviewed the literature, including journal articles, news stories, and government reports, that described conditions associated with family homelessness, the scope of the problem, and the health and mental health of homeless children and families. Much of this literature was published during the 1980s and 1990s. This raises questions about its continued applicability for the public health community. We concluded that descriptions of the economic conditions and public policies associated with family homelessness are still relevant; however, the homeless family population has changed over time. Family homelessness has become more prevalent and pervasive among poor and low-income families. We provide public health recommendations for these homeless families.

Inadequate housing among families under investigation for child abuse and neglect: prevalence from a national probability sample

This study aimed to estimate the prevalence of inadequate housing that threaten out-of-home placement among families under investigation by child welfare. Data came from the National Survey of Child and Adolescent Well-Being, a nationally representative longitudinal survey of child welfare-involved families. Child protective services caseworkers as well as caregivers provided information on families whose child remained in the home after initial investigation (N = 3,867). Multilevel latent class analyses tested the presence of inadequately housed subgroups using 4 housing problem indicators at baseline. Logistic regressions assessed convergent and predictive validity. A two class latent solution best fit the data. Findings indicated that inadequate housing contributed to risk for out-of-home placement in approximately 16 % of intact families under investigation by child protective services. These families were 4 times more likely to need housing services 12 months later. Federal legislation emphasizes integration of social services as necessary to end homelessness. This study demonstrates overlap across public agencies. Enhanced coordination of child welfare and housing services facilitates interventions to prevent and mitigate homelessness.

Leaving ≠ moving: housing patterns of women who have left an abusive partner

Access to safe and affordable housing is a key concern for women leaving abusive partners. Yet little is known about women's housing patterns around leaving. In this community sample, approximately equal numbers of women did not move, moved once, and moved two or more times during the transition period around leaving. Overall, moving patterns were associated with housing type and suitability, economic circumstances, and severity of violence. This study calls into question the tendency to equate leaving with moving, draws attention to the different housing patterns after leaving, and highlights the need to tailor housing supports to diverse women.

Comparing the housing trajectories of different classes within a diverse homeless population

The paper presents findings from a longitudinal study identifying different classes of homeless individuals in a mid-size Canadian city based on health-related characteristics and comparing the housing trajectories of these classes 2 years later. Using data collected through in-person interviews with a sample of 329 single persons who have experienced homelessness, the paper presents results of a latent class analysis. Results found four distinct latent classes characterized by different levels of severity of health problems--i.e., a class of individuals who are "Higher Functioning" (28.7%), a second class with "Substance Abuse Problems" (27.1%), a third class with "Mental Health Substance Abuse Problems" (22.6%), and a fourth class with "Complex Physical and Mental Health Problems" (21.6%) that included having diminished physical functioning, multiple chronic physical health conditions, mental health difficulties, and in some cases substance abuse problems. Follow-up interviews with 197 of these individuals (59.9%) 2 years later showed the class of individuals with substance abuse problems experiencing the greatest difficulty in exiting homelessness and achieving housing stability. Implications of these findings for social policy development and program planning are discussed.

Physical and mental health, cognitive development, and health care use by housing status of low-income young children in 20 American cities: a prospective cohort study

OBJECTIVES

We assessed the independent effect of homeless and doubled-up episodes on physical and mental health, cognitive development, and health care use among children.

METHODS

We used data from 4 waves of the Fragile Families and Child Wellbeing Study, involving a sample of 2631 low-income children in 20 large US cities who have been followed since birth. Multivariate analyses involved logistic regression using the hybrid method to include both fixed and random effects.

RESULTS

Of the sample, 9.8% experienced homelessness and an additional 23.6% had a doubled-up episode. Housing status had little significant adverse effect on child physical or mental health, cognitive development, or health care use.

CONCLUSIONS

Family and environmental stressors common to many children in poverty, rather than just homeless and doubled-up episodes, were associated with young children's poor health and cognitive development and high health care use. Practitioners need to identify and respond to parental and family needs for support services in addition to housing assistance to effectively improve the health and development of young children who experience residential instability, particularly those in homeless families.

A population-based assessment of the health of homeless families in New York City, 2001-2003

OBJECTIVES

We compared estimated population-based health outcomes for New York City (NYC) homeless families with NYC residents overall and in low-income neighborhoods.

METHODS

We matched a NYC family shelter user registry to mortality, tuberculosis, HIV/AIDS, and blood lead test registries maintained by the NYC Department of Health and Mental Hygiene (2001-2003).

RESULTS

Overall adult age-adjusted death rates were similar among the 3 populations. HIV/AIDS and substance-use deaths were 3 and 5 times higher for homeless adults than for the general population; only substance-use deaths were higher than for low-income adults. Children who experienced homelessness appeared to be at an elevated risk of mortality (41.3 vs 22.5 per 100,000; P < .05). Seven in 10 adult and child deaths occurred outside shelter. Adult HIV/AIDS diagnosis rates were more than twice citywide rates but comparable with low-income rates, whereas tuberculosis rates were 3 times higher than in both populations. Homeless children had lower blood lead testing rates and a higher proportion of lead levels over 10 micrograms per deciliter than did both comparison populations.

CONCLUSIONS

Morbidity and mortality levels were comparable between homeless and low-income adults; homeless children's slightly higher risk on some measures possibly reflects the impact of poverty and poor-quality, unstable housing.