Why does family homelessness occur? A case-control study.

We compared 49 homeless female-headed families with 81 housed female-headed families in Boston. Most housed families were living in public or private subsidized housing. In both groups the mothers were poor, currently single, had little work experience, and had been on welfare for long periods. Many of their children had serious developmental and emotional problems. Homeless mothers had more frequently been abused as children and battered as adults and their support networks were fragmented; the housed mothers had female relatives and extended family living nearby whom they saw often. The frequency of drug, alcohol, and serious psychiatric problems was greater among the homeless mothers. The homeless mothers may have been more vulnerable to the current housing shortage because they lacked support in time of need. This, in turn, may have been due to their history of family violence. Psychiatric disabilities may have been another contributing factor in the minority of homeless women. The notion that a "culture of poverty" accounts for homelessness was not supported by the data since the homeless were less likely to have grown up in families on welfare. The data suggest that solutions to family homelessness in the current housing market require an increase in the supply of decent affordable housing, income maintenance, and assistance from social welfare agencies focused on rebuilding supportive relationships.     

Predictors of shelter use among low-income families: psychiatric history, substance abuse, and victimization.

For poor housed and homeless families in New York City, NY, we examined the degree to which psychiatric and substance-abuse problems and victimization placed the families at elevated risk of requiring emergency housing, and we documented the prevalence of such problems. These problems were infrequently reported by both groups. However, past mental hospitalization, treatment in a detoxification center, childhood sexual abuse, and adult physical abuse were associated with increased risk of homelessness.     

Pregnancy and childbirth: risk factors for homelessness?

A comparison of 704 homeless public assistance families in New York City with 524 families on public assistance who had housing found that pregnancy and recent births were highly correlated with becoming homeless. Thirty-five percent of homeless women were pregnant at the time of the interview, and 26 percent had given birth in the past year, compared with six percent and 11 percent, respectively, of women in the housed sample. In addition, having a baby before age 18 (as had 37 percent of the homeless women and 24 percent of the housed women) was significantly related to homelessness but family size was not.     

Unofficial policy: access to housing, housing information and social services among homeless drug users in Hartford, Connecticut

Background  

Much research has shown that the homeless have higher rates of substance abuse problems than housed populations and that substance abuse increases individuals' vulnerability to homelessness. However, the effects of housing policies on drug users' access to housing have been understudied to date. This paper will look at the "unofficial" housing policies that affect drug users' access to housing.     

Characteristics of sheltered homeless families.

To describe the characteristics of homeless families, we interviewed 80 homeless mothers and 151 children living in 14 family shelters in Massachusetts (two-thirds of the shelters in the state). Ninety-four per cent of the families were headed by women, 91 per cent were on AFDC (aid to families with dependent children), with twice as many as the state average having been on AFDC for at least two years; most had long histories of residential instability. Although 60 per cent had completed high school, only a third had worked for longer than one month. One-third of the mothers reported having been abused during their childhood, and two-thirds had experienced a major family disruption. At the time of the interview, almost two-thirds either lacked or had minimal supportive relationships and one-fourth of these named their child as the major support. Eighteen mothers were involved with the Department of Social Services because of probable child abuse or neglect. Seventy-one per cent of the mothers had personality disorders. In contrast to many adult homeless individuals, however, deinstitutionalized persons or those suffering from psychoses were not overrepresented. About 50 percent of the homeless children were found to have developmental lags, anxiety, depression, and learning difficulties, and about half required further psychiatric evaluation. Two-thirds described housing and social welfare agencies as not helpful. Given the many serious problems of the mothers and the difficulties already manifested by their children, comprehensive psychosocial and economic interventions must be made to interrupt a cycle of extreme instability and family breakdown.     

Mothers experiencing homelessness: mental health, support and social care needs

Little is known about the experiences of mothers who become homeless. The numbers of women with children in this situation are growing, most becoming homeless following domestic or neighbour abuse, or the breakdown of family relationships. This qualitative study aimed to describe mothers' experiences of homelessness in relation to their mental health, support and social care needs. Twenty-eight homeless women with dependent children residing in hostels were interviewed. The experience of homelessness was stressful, but viewed as a respite for many of the participants because they had experienced violence and harassment prior to their stay in the hostels. Many described poor mental health, which they related to the conditions in hostels and traumas that they had experienced before becoming homeless. Their experiences and perceptions of the services available were mixed. Some valued the support offered by staff and other residents, but the majority felt that there was a lack of resources to address their needs. Many women had difficulty coping with homelessness, and several said that support from other homeless women was an important source of help. Services need to work together to meet the multiple health, social, psychological and housing needs of these women.     

The mental health of children in homeless families and their contact with health, education and social services

Previous research indicates that children in homeless families have a high risk of physical and mental illness. This study reports the initial stage of a longitudinal research programme to measure the prevalence of psychiatric disorders among parents and children in homeless families. A sample of parents in 113 homeless families were interviewed within 2 weeks of admission to seven homeless centres in the City of Birmingham, and compared with a sample of 29 low-income families who were not homeless. Both sets of interviews used the Child Behaviour Checklist (CBCL), the Communication Domain of the Vineland Adaptive Behaviour Scales (VABS), the General Health Questionnaire (GHQ), the Interview Schedule for Social Interaction (ISSI), and height and weight percentiles. A sub-sample of children was also interviewed. The results indicate that 85% of families became homeless because of domestic or neighbourhood violence, that in 54% of families in homelessness coincided with the separation of the partners, and that 49% of mothers had current psychiatric morbidity. Children in homeless families had delayed communication and higher mean scores for mental health problems than the comparison sample. Homeless children were also more likely to have had histories of abuse, and less likely to have attended school or nursery school since becoming homeless. Homeless families had high rates of contact with primary healthcare and social services, but few had been in contact with specialist child and adolescent mental health services. These results indicate a need for a co-ordinated action by housing, social services, education, health services, and the police to prevent families from becoming homeless by protecting victims of domestic and neighbourhood violence from further violence and intimidation. Hence the need to rapidly re-house into permanent accommodation those who do become homeless, to maintain education for their children, and to ensure that such families have access to effective social support and healthcare.     

Childhood risk factors for homelessness among homeless adults.

OBJECTIVES. This effort used data from the Course of Homelessness study and comparative secondary data on the general population to identify negative childhood and family background experiences that may increase risk for adult homelessness. METHODS. Frequencies of negative childhood experiences were examined among a probability sample of 1563 homeless adults. Differences in risk for such experiences were calculated by sex, age cohort, and racial/ethnicity status. Where possible, rates of negative childhood experiences among the homeless were compared with the general population. RESULTS. Substantial numbers of this sample experienced multiple problems as children across several domains: poverty, residential instability, and family problems. Women and Whites disproportionately reported experiences suggestive of personal or family problems; non-Whites disproportionately reported experiences suggestive of personal or family problems; non-Whites disproportionately reported experiences suggestive of poverty. Homeless adults were at increased risk of childhood out-of-home placement, tenure in public housing, and homelessness, but not at greater risk for physical abuse. Women appeared to be at greater risk for sexual abuse. CONCLUSIONS. The problems that homeless individuals experience as adults have very clear analogs in their childhoods. Vulnerability to homelessness stems from factors unevenly distributed across age, sex, and race/ethnicity groups.     

Homelessness in female-headed families: childhood and adult risk and protective factors.

OBJECTIVES: To identify risk and protective factors for family homelessness, a case-control study of homeless and low-income, never-homeless families, all female-headed, was conducted. METHODS: Homeless mothers (n = 220) were enrolled from family shelters in Worcester, Mass. Low-income housed mothers receiving welfare (n = 216) formed the comparison group. The women completed an interview covering socioeconomic, social support, victimization, mental health, substance use, and health domains. RESULTS: Childhood predictors of family homelessness included foster care placement and respondent's mother's use of drugs. Independent risk factors in adulthood included minority status, recent move to Worcester, recent eviction, interpersonal conflict, frequent alcohol or heroin use, and recent hospitalization for a mental health problem. Protective factors included being a primary tenant, receiving cash assistance or a housing subsidy, graduating from high school, and having a larger social network. CONCLUSIONS: Factors that compromise an individual's economic and social resources are associated with greater risk of losing one's home.     

Housing outcomes for hospitalized homeless veterans

This study examines housing status at the time of hospital discharge in a national sample of 3,502 veterans who were homeless at admission to a Veterans Health Administration (VHA) medical center. A supplemental survey on homelessness was added to the annual VHA inpatient census over a 4-year period (1995 through 1998). Data from this survey were used to identify homeless veterans hospitalized on the final day of the fiscal year and to document their housing status at discharge. A signal detection technique, Receiver Operating Characteristic analysis, was used to identify predictors of housing status at discharge. At discharge, only 13% of the veterans in our analytic sample were literally homeless, 40% were doubled up, and 33% were transferred to another an institution; only 13% were living independently. Housing status at admission (specifically, staying with friends or family temporarily rather than literally homeless), treatment in a psychiatric or substance abuse program rather than a medical program, and a greater income level or access to VHA benefits were found to be associated with better housing outcomes. As one might expect, homelessness was infrequently resolved during an acute inpatient hospitalization, but few veterans returned to literal homelessness at the time of discharge.     

Housing Instability among People Who Inject Drugs: Results from the Australian Needle and Syringe Program Survey

High rates of substance dependence are consistently documented among homeless people, and are associated with a broad range of negative outcomes among this population. Investigations of homelessness among drug users are less readily available. This study examined the prevalence and correlates of housing instability among clients of needle syringe programs (NSPs) via the Australian NSP Survey, annual cross-sectional seroprevalence studies among NSP attendees. Following self-completion of a brief, anonymous survey and provision of a capillary blood sample by 2,396 NSP clients, multivariate logistic regressions identified the variables independently associated with housing instability. Nineteen percent of ANSPS participants reported current unstable housing, with primary (‘sleeping rough’; 5 %), secondary (staying with friends/relatives or in specialist homelessness services; 8 %), and tertiary (residential arrangements involving neither secure lease nor private facilities; 6 %) homelessness all evident. Extensive histories of housing instability were apparent among the sample: 66 % reported at least one period of sleeping rough, while 77 % had shifted between friends/relatives (73 %) and/or resided in crisis accommodation (52 %). Participants with a history of homelessness had cycled in and out of homelessness over an average of 10 years; and one third reported first being homeless before age 15. Compared to their stably housed counterparts, unstably housed participants were younger, more likely to be male, of Indigenous Australian descent, and to report previous incarceration; they also reported higher rates of key risk behaviors including public injecting and receptive sharing of injecting equipment. The high prevalence of both historical and current housing instability among this group, particularly when considered in the light of other research documenting the many adverse outcomes associated with this particular form of disadvantage, highlights the need for increased supply of secure, affordable public housing in locations removed from established drug markets and serviced by health, social, and welfare support agencies.     

Permanent Housing Placement and Reentry to Services Among Family Recipients of Homelessness Prevention and Rapid Re-Housing Program (HPRP) Assistance

The Homelessness Prevention and Rapid Re-Housing Program (HPRP) provided individuals and families who were either at-risk or currently experiencing homelessness with time-limited financial and housing support services. Evaluations of HPRP showed a high rate of family placement into permanent housing. However, little research has explored immediate and longitudinal outcomes for families enrolled in HPRP. Using Homeless Management Information System data from Indianapolis, Indiana, we examined demographic and program-related predictors of families entering permanent housing and their risk of reentry into homeless services following HPRP participation. The sample included 511 families who enrolled in the program from 2009 to 2012, with an average follow-up period of 4.5 years. We conducted analyses separately for Homelessness Prevention (HP) recipients (n?=?357) and Rapid Re-Housing (RRH) recipients (n?=?154). Results revealed that HP families were more likely to enter permanent housing if they: included adults who were older in age, were enrolled longer in the program, were provided rental arrear services and utility payments, and did not receive legal services. RRH families receiving rental assistance services had significantly greater odds of entering permanent housing. Among permanently housed families, at least one family member in 10.9% of HP recipients and 18.8% of RRH recipients reentered homeless services. HP families with younger children and one veteran family member were at increased risk of reentry to homelessness services. RRH recipients who did not receive moving cost services and had more children were at greater risk of reentry. Study findings suggest a need for future research on HP and RRH interventions that identify unique service needs among families who are experiencing housing instability or homelessness.     

Risk factors for long-term homelessness: findings from a longitudinal study of first-time homeless single adults

OBJECTIVES: We examined risk factors for long-term homelessness among newly homeless men and women who were admitted to New York City shelters in 2001 and 2002. METHODS: Interviews were conducted with 377 study participants upon entry into the shelter and at 6-month intervals for 18 months. Standardized assessments of psychiatric diagnosis, symptoms, and coping skills; social and family history; and service use were analyzed. Kaplan-Meier survival analysis and Cox regression were used to examine the association between baseline assessments and duration of homelessness. RESULTS: Eighty-one percent of participants returned to community housing during the follow-up period; the median duration of homelessness was 190 days. Kaplan-Meier survival analysis showed that a shorter duration of homelessness was associated with younger age, current or recent employment, earned income, good coping skills, adequate family support, absence of a substance abuse treatment history, and absence of an arrest history. Cox regression showed that older age group P<.05) and arrest history (P<.01) were the strongest predictors of a longer duration of homelessness. CONCLUSIONS: Identification of risk factors for long-term homelessness can guide efforts to reduce lengths of stay in homeless shelters and to develop new preventive interventions.     

Prevalence, Characteristics, and Associated Health and Health Care of Family Homelessness Among Fifth-Grade Students

Objectives. We describe the lifetime prevalence and associated health-related concerns of family homelessness among fifth-grade students.Methods. We used a population-based, cross-sectional survey of 5147 fifth-grade students in 3 US cities to analyze parent-reported measures of family homelessness, child health status, health care access and use, and emotional, developmental, and behavioral health and child-reported measures of health-related quality of life and exposure to violence.Results. Seven percent of parents reported that they and their child had experienced homelessness (i.e., staying in shelters, cars, or on the street). Black children and children in the poorest families had the highest prevalence of homelessness (11%). In adjusted analyses, most general health measures were similar for children who had and had not been homeless. Children who had ever experienced homelessness were more likely to have an emotional, behavioral, or developmental problem (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.1, 2.6; P = .01), to have received mental health care (OR = 2.2; 95% CI = 1.6, 3.2; P < .001), and to have witnessed serious violence with a knife (OR = 1.6; 95% CI = 1.1, 2.3; P = .007) than were children who were never homeless.Conclusions. Family homelessness affects a substantial minority of fifth-grade children and may have an impact on their emotional, developmental, and behavioral health.An estimated 23% of homeless persons in the United States are children younger than 18 years.¹ Of individuals who have experienced an episode of homelessness and used a homelessness assistance program over the course of a year, an estimated 38% are children living with parents.² Families defined as homeless may be literally homeless (spending the night in emergency shelters, abandoned buildings, cars, on the street, and so on) or precariously housed (at imminent risk of literal homelessness).^3,4 Data available on the prevalence of literal homelessness (henceforth referred to as “homelessness”) are generally based on emergency shelter use, requests for emergency shelter use, and nighttime counts of those living on the streets.⁵ The prevalence of homelessness in US cities ranges from a 1-day prevalence of 0.3% to a 3-year prevalence of 3% (prevalence rates increase as the period of time increases because of rapid turnover among the homeless).^4,6–8Population-based studies have estimated the prevalence of episodic homelessness among adults.^9–11 One random-digit-dialing survey of US adults found a 7% lifetime prevalence of homelessness.⁹ A Philadelphia population-based study linked emergency shelter intake records to all adult women with a recorded live birth over a 2-year period and reported 11% homelessness between 3 years before and 4 years after the birth.¹⁰ Unlike studies of currently homeless people, these population-based estimates include individuals who have a history of homelessness.^6,8 There are no population-based data that estimate the lifetime prevalence of family homelessness among children.Studies of children in sheltered, homeless families have shown that many have poor health status, high rates of asthma, high rates of emergency department visits, delays in obtaining preventive care, and high rates of emotional, developmental, and behavioral problems.^7,12–17 In most studies, health and health-related outcomes were worse for children in sheltered, homeless families compared with children in the general population. In most studies, homeless children also had worse outcomes compared with low-income housed children, although in a few studies the 2 groups had similar outcomes.¹⁸ In a study of 82 families using shelters and transitional housing in King County, Washington, 59% of children had no usual health care provider; these children experienced rates of emergency department visits higher than that of the national rate for children.¹³ In another study of 220 homeless families in shelters in Worcester, Massachusetts, homeless children were more likely to be reported in poor to fair health and made more frequent emergency department and outpatient visits than did low-income housed children.¹² Other studies have found high rates of developmental delay and emotional or behavioral problems among sheltered children.^13,14,19,20Most data on the health status and needs of homeless children compare currently homeless children and their families residing in emergency shelters with low-income housed children or the general population.^12–14 Many poor families may experience 1 or more episodes of homelessness over a period of time, but most studies have only examined currently homeless children.^3,21 No published studies to date have described the lifetime prevalence of homelessness and the associated health and health-related problems of a school-aged, nonsheltered, population-based sample of children. We aimed to describe (1) the lifetime prevalence and characteristics of family homelessness among fifth-grade students and (2) the health and health-related concerns of these students.     

HIV-risk practices among homeless and low-income housed mothers

BACKGROUND: Knowledge of human immunodeficiency virus (HIV) and its risk behaviors have not been systematically studied in homeless mothers. The identification of the factors associated with HIV-risk practices will guide interventions for low-income housed and homeless women. METHODS: We interviewed 220 homeless and 216 low-income housed mothers living in Worcester, Massachusetts, to gather information on demographic, psychosocial , and HIV-risk practice characteristics. We used standardized instruments and questions drawn from national surveys. The primary study outcome was high HIV-risk behavior. RESULTS: Although homeless mothers were more likely than low-income housed mothers to report first sexual contact at an early age, multiple partners during the last 6 months, and a history of intravenous drug use, homelessness was not associated with high HIV-risk practices. Both homeless and low-income housed mothers demonstrated misconceptions about HIV transmission through casual contact. Among high-risk women, approximately 75% perceived themselves as having low or no risk for contracting HIV. A history of childhood victimization, adult partner violence, or both placed women at a significantly increased likelihood of high HIV-risk practices. African American race, knowledge about HIV, and self-perception of risk were also significantly associated with high-risk practices. CONCLUSIONS: Homeless mothers are a subgroup of poor women at high risk for HIV and should be targeted for preventive interventions. In addition, there are potentially modifiable factors associated with HIV-risk practices in both low-income housed and homeless mothers that should be directly addressed.     

Service delivery and community: social capital, service systems integration, and outcomes among homeless persons with severe mental illness

OBJECTIVES: This study evaluated the influence of features of community social environment and service system integration on service use, housing, and clinical outcomes among homeless people with serious mental illness. STUDY SETTING: A one-year observational outcome study was conducted of homeless people with serious mental illness at 18 sites. DATA SOURCES: Measures of community social environment (e.g., social capital) were based on local surveys and voting records. Housing affordability was assessed with housing survey data. Service system integration was assessed through interviews with key informants at each site to document interorganizational transactions. Standardized clinical measures were used to assess clinical and housing outcomes in face-to-face interviews. RESEARCH DESIGN: Structural equation modeling was used to determine the relationship between (1) characteristics of the social environment (social capital, housing affordability); (2) the level of integration of the service system for persons who are homeless in each community; (3) access to and use of services by individual clients; and (4) successful exit from homelessness or clinical improvement. PRINCIPAL FINDINGS: Social capital was associated with greater service systems integration, which was associated in turn with greater access to assistance from a public housing agency and to a greater probability of exiting from homelessness at 12 months. Housing affordability also predicted exit from homelessness. Neither environmental factors nor systems integration predicted outcomes for psychiatric problems, substance abuse, employment, physical health, or income support. CONCLUSION: Community social capital and service system integration are related through a series of direct and indirect pathways with better housing outcomes but not with superior clinical outcomes for homeless people with mental illness. Implications for designing improved service systems are discussed.     

Nutrition and health services needs among the homeless

This review discusses nutrition and related health problems among homeless Americans, summarizes recent information, and identifies needs for services and future research. The nature of homelessness today provides a context for the discussion. Many homeless persons eat fewer meals per day, lack food more often, and are more likely to have inadequate diets and poorer nutritional status than housed U.S. populations. Yet many homeless people eligible for food stamps do not receive them. While public and private agencies provide nutritious food and meals for homeless persons, availability of the services to homeless persons is limited. Many homeless people lack appropriate health care, and certain nutrition-related health problems are prevalent among them. Compared with housed populations, alcoholism, anemia, and growth problems are more common among homeless persons, and pregnancy rates are higher. The risks vary among homeless persons for malnutrition, nutrition-related health problems, drug and alcohol abuse, and mental illness. For example, among homeless persons, fewer heads of families than single adults are substance abusers, and mental illness varies in prevalence among single men, single women, and parents in homeless families. Homeless persons need improved access to food, nutrition, and health services. More nutrition education needs to be available to them and to service providers. Use of representative samples and validation of self-reported nutrition and health data will help future investigators to clarify the relationships between the characteristics of the homeless and their nutritional status.     

Causes of homelessness among older people in Melbourne, Australia

OBJECTIVE: A comparative study of the causes of new episodes of homelessness among people aged 50 years and over has been undertaken in Australia, the United States and England. Semi-structured questionnaires were used to collect information on the circumstances and problems that contributed to homelessness. METHODS: This paper presents the findings from Australia, where information was obtained from 125 older homeless people (aged 50+ years) and their key workers in Melbourne. All three participating nations followed identical research methodologies. RESULTS: The factors most frequently reported by respondents as contributing to their homelessness were problems with people with whom they lived, followed by physical and mental ill-health and problems associated with the housing itself. The most frequently reported factors by case workers were problems with alcohol, followed by physical and mental health factors. CONCLUSIONS: This study demonstrates a significant under-utilisation of housing and support services among recently homeless older people and provides evidence that people who had previously been homeless appear to be more resigned to their homelessness than do those who had not experienced homelessness before. Significant issues relating to depression and gambling were also noted. The findings support the need for more targeted, specialised services to be developed or improved such that older homeless people can readily gain access to them and for improved collaboration or information exchange among housing providers and welfare agencies.