End Homelessness Research Articles

Review of Local Homeless Mortality Efforts: A Call for Standardized Data and Reporting.

There are currently no national estimates of how many people die while unhoused in the US. Local jurisdictions have developed their own approaches for estimating homeless mortality. We aimed to examine these local approaches, document what is known about homeless mortality, and summarize local methodologies. We reviewed 17 publicly available homeless mortality reports (ie, gray literature). Reports were sought from government, Health Care for the Homeless, coalition to end homelessness, and other advocacy and social service websites. From each report, we extracted the number of homeless deaths, dates of observation, data source(s) used, determination of homeless status, manners and causes of death, and decedent demographics. Data collection and reporting on homeless mortality varied greatly across reports. This variation limits aggregation across reports. Medical examiner data was the most used data source. Manner of death was the most consistently collected field, with accidental deaths reported as the most prevalent manner of homeless deaths. Not all reports listed specific causes of death, but those that did reported toxicity (eg, overdose) and cardiovascular causes as most prevalent. The most granular age category of most homeless decedents was 40 to 60years. On average, 80% of decedents were of male sex. While over half of reports included race and ethnicity information, disparities could not be estimated without suitable denominators. Standardized data collection and reporting guidance is needed for homeless mortality. Health departments can work with local Health Care for the Homeless programs and Continuums of Care to establish data sharing processes. Matching vital statistics with homeless service utilization records may be one opportunity to improve these efforts. Until there is federal or national guidance on these standards, localities can consider adding housing or homelessness variables as optional or mandatory fields in electronic death reporting systems.

The Problematisation of Young People Within Existing Housing-Related Policy in Queensland

AbstractMore young people are experiencing homelessness and housing stress in Australia than ever before, with policy responses failing to address a current housing and cost-of-living crisis. Of particular concern when considering increasing rates of youth homelessness and housing stress is the absence of research examining existing policy. This research was undertaken in the Australian state of Queensland and contributes to addressing this gap in knowledge by utilising Carol Bacchi’s (2009) ‘What’s the Problem Represented to be?’ approach to policy analysis to examine three state policies, namely Towards Ending Homelessness for Young Queenslanders 2022–2027, the Queensland Housing Strategy 2017–2027, and the Queensland Youth Strategy. A range of discourses were found which position young people as lacking knowledge and skills to obtain housing. Emphasis is also placed on education, training, and employment as solutions to youth housing issues rather than a genuine focus on empowering young people through policy and practice initiatives. The findings of this research mirror existing discourses found in global conversations about youth homelessness and housing stress and contribute to a growing knowledge base around the importance of engaging young people in decision making within public policy and social reform.

LEVERAGING RURAL AREAS & EMPLOYMENT IN AGRICULTURAL & NON AGRICULTURAL SECTORS TO ERADICATE HOMELESSNESS IN USA: A STUDY OF RURAL, SUBURBAN, AND URBAN CoCs INCLUDING A MAJOR CITY CoC

The study aims to explore the potential of using rural areas to develop strategies to end homelessness, including job creation initiatives, by examining the relationships between homelessness, urban and rural areas, and unemployment rates. Using descriptive analysis; histograms, summary tables, and regression analysis, the research finds a lower incidence of homelessness in rural areas. Regression results indicate that homelessness increases by 1294 individuals in urban areas but decreases by 402 individuals in rural areas per unit increase in the count of rural areas. Additionally, homelessness increases by 202 individuals for every unit increase in the unemployment rate. ANCOVA testing confirms the significant impact of Area Category (<0.001) on homelessness, with unemployment rates being lowest and highest in Largely Rural areas among the sampled locations.

The Implementation of Coordinated Access to End Homelessness in Ontario, Canada

To receive federal homelessness funding, cities in Canada must adhere to federal policy directives associated with the government of Canada’s Reaching Home program. These directives include the implementation of a homelessness management information system (HMIS) and a Coordinated Access process. In this article, we draw on 90 in-depth interviews and extensive policy and institutional analysis to assess the implementation of Coordinated Access in one Ontario city. Our findings suggest that none of the four pillars of Coordinated Access (access, assessment, prioritization, matching, and referral) work as intended. Structural and systemic challenges (e.g., related to housing stock, staff turnover, inaccessibility of shelters, criminalizing municipal bylaws, and the reliability of the assessment tool) undermine the efficacy of the process as a means of improving transparency, service coordination, and housing outcomes. Despite being an early adopter of the Coordinated Access process, this Ontario municipality continues to struggle with a growing housing affordability crisis and an unhoused population.

Housing Status Changes Are Associated With Cancer Outcomes Among US Veterans.

Cancer is a leading cause of death in older unhoused adults. We assessed whether being unhoused, gaining housing, or losing housing in the year after cancer diagnosis is associated with poorer survival compared with being continuously housed. We examined all-cause survival in more than 100,000 veterans diagnosed with lung, colorectal, and breast cancer during the period 2011-20. Five percent were unhoused at the time of diagnosis, of whom 21percent gained housing over the next year; 1percent of veterans housed at the time of diagnosis lost housing. Continuously unhoused veterans and veterans who lost their housing had poorer survival after lung and colorectal cancer diagnosis compared with those who were continuously housed. There was no survival difference between veterans who gained housing after diagnosis and veterans who were continuously housed. These findings support policies to prevent and end homelessness in people after cancer diagnosis, to improve health outcomes.

노숙인의 정신적 습관 형성에 영향을 미친 경험

Mental habits could be considered a major determinant not only of physical health behaviors and status but also of mental health. However, there has been limited research on the concept of mental habits in Korea and internationally. As homeless people experience mental health issues more frequently than the general population, early detection and management could be crucial for improving their mental health. Therefore, this study aims to conduct a phenomenological study to discover common experiences of the homeless, focusing on the formation process of mental habits. Through the analysis of in-depth interviews with 12 homeless people, 21 themes, 11 theme clusters, and 6 categories were derived. The results suggested that the mental habits of the homeless were formed through experiences including social disconnection, addiction, unethical behavior, economic difficulties, social exclusion, chronic problematic environments, and intrinsic motivations for life. From childhood to the current homeless status, various experiences have led to complicated interactions affecting the interviewees in multiple ways: a single event could lead to multiple mental habits, or a combination of experiences could develop a single mental habit. Therefore, policies for homeless people should not simply aim to provide shelter but should also aim to end homelessness through supports for sustainable living. This should be built on an understanding of their experiences including life before homelessness, the process of becoming homeless, and their experiences as homeless individuals. Based on this, the researchers' policy recommendations are as follows: First, programs for the homeless should proactively aim to eliminate discrimination. Second, interventions for mental habits should incorporate specific and non-specific interventions. Lastly, interventions for the mental health of homeless people should focus on creating intrinsic motivations.

Draining a flooded bathtub: a qualitative analysis of Built for Zero implementation during COVID-19

ABSTRACT Built for Zero (BFZ) is a data-driven approach being adopted by homeless systems in some Anglo countries to allocate permanent housing assistance. BFZ was created and promoted by Community Solutions – a nonprofit advocacy group based in the USA – as an evidence-based way to end homelessness. Despite its growing popularity amongst policymakers, few academic studies have analyzed BFZ implementation. This paper fills that knowledge gap with interviews conducted with 28 US homeless systems. My data analysis answers the following questions: What were the barriers to and enablers of BFZ implementation during the COVID-19 pandemic? How did managerial staff navigate these barriers and exploit these opportunities? What are the ethical implications of these strategies? I demonstrate government responses to COVID-19 facilitated entries into and hindered exits from homeless systems, BFZ communities experimented with risky interventions during the pandemic that have not been systematically tested, and homeless systems need additional resources to equitably implement BFZ.

Permanent Supportive Housing for Those Experiencing Chronic Homelessness with High Health or Social Support Needs: A Scoping Review.

Some populations have increased risks of experiencing chronic homelessness related to complex health and social needs combined with system failures. Permanent supportive housing (PSH) may improve housing and health outcomes for this population. To understand the scope of the literature on PSH, this scoping review uses Arksey and O'Malley's methodological framework enhanced by Levac and the Joanna Briggs Institute. A search was conducted across multiple databases for existing research on PSH. Forty-one studies were included, and five themes were generated: PSH sustains housing for most people; PSH is costly to implement, but costs can be recouped; PSH facilitates belonging and safety; single-site programs have social challenges but also provide efficiency and improve social networks; and visible on-site staff fundamentally helps those with highest support needs. Permanent supportive housing has been shown to be effective for those with the highest health and social support needs and is required to help prevent and end homelessness.

The City Government's Role In Begging

The purpose of this study is to ascertain how the Bandung municipal government interacts with homeless persons and to pinpoint the factors that support and impediment this interaction. This study employs a descriptive methodology and is qualitative in nature. The research subjects include the Mayor of Bandung, the Director of the Bandung City Social Service, and the sprawl of the City of Bandung. Based on the results of the data analysis, it is feasible to draw the following conclusion: The 2019 Bandung City Regional Regulation Concerning the Treatment of Vagabonds and the Homeless regulates how the municipal government is to handle gepeng. Social services aid in efforts to rehabilitate society. According to Article 16 of the 2019 Bandung City Regional Regulation, efforts to end homelessness are conducted in four different ways: prevention, repression, social rehabilitation, and reintegration activities. The central government's support, the 2019 Regional Regulation, the existence of non-governmental groups, and community support all contribute to the Bandung City Government's attempts to manage sprawl. Two barriers are the sluggish homeless culture and the cash-on-hand culture.

Preparing Allied Health Students to Address Social Work’s Grand Challenge to End Homelessness

ABSTRACT Meeting Social Work’s Grand Challenge to end homelessness requires skills in collaborating across professions and the ability to actively engage marginalized people who may have physical, mental, and social challenges. We present our experience building an interprofessional community service and training Center in a neighborhood with high numbers of people experiencing homelessness. The Center provides services to people unhoused while simultaneously providing practicum education to Health Science and Human Services students. The knowledge gained from our Center’s experience can assist Social Work educators with identifying strategies for increasing collaboration among university departments and community-based organizations while simultaneously targeting the professional training of students to combat homelessness. Allied health professionals’ collaboration is essential to systematically ending homelessness.

The POP (Permanent Supportive Housing Overdose Prevention) Study: protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial

BackgroundPermanent supportive housing (PSH)—subsidized housing paired with support services such as case management—is a key part of national strategic plans to end homelessness. PSH tenants face high overdose risk due to a confluence of individual and environmental risk factors, yet little research has examined overdose prevention in PSH.MethodsWe describe the protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial (RCT) of overdose prevention practice implementation in PSH. We adapted evidence-based overdose prevention practices and implementation strategies for PSH using input from stakeholder focus groups. The trial will include 20 PSH buildings (with building size ranging from 20 to over 150 tenants) across New York City and New York’s Capital Region. Buildings will be randomized to one of four 6-month intervention waves during which they will receive a package of implementation support including training in using a PSH Overdose Prevention (POP) Toolkit, time-limited practice facilitation, and learning collaboratives delivered to staff and tenant implementation champions appointed by each building. The primary outcome is building-level fidelity to a defined list of overdose prevention practices. Secondary and exploratory implementation and effectiveness outcomes will be examined using PSH staff and tenant survey questionnaires, and analysis of tenant Medicaid data. We will explore factors related to implementation success, including barriers and facilitators, using qualitative interviews with key stakeholders. The project is being conducted through an academic-community partnership, and an Advisory Board including PSH tenants and other key stakeholders will be engaged in all stages of the project.DiscussionWe describe the protocol for a hybrid type 3 stepped-wedge cluster RCT of overdose prevention practice implementation in PSH. This study will be the first controlled trial of overdose prevention implementation in PSH settings. The research will make a significant impact by testing and informing future implementation strategies to prevent overdose for a population at particularly high risk for overdose mortality. Findings from this PSH-focused research are expected to be broadly applicable to other housing settings and settings serving people experiencing homelessness.Trial registrationClinicalTrials.gov, NCT05786222, registered 27 March 2023.

Ending Homelessness in Canada: Reflections from Researchers in the Field

Ten-year plans to end homelessness have become common in communities across Canada, yet homelessness persists. This study brings together experts in the field of homelessness to gain insight into whether homelessness can be ended and what steps need to be taken to accomplish this. Twenty-six Canadian homelessness researchers participated in video-recorded structured interviews in the summer of 2021. They were asked whether, and how, homelessness could be ended in Canada. Interviews were transcribed and analyzed for recurring themes. There was widespread agreement across the participants that homelessness could be ended in Canada by focusing on four distinct yet related areas. First, all levels of government must be held accountable for policy decisions they make, and they must learn from other countries, such as Finland, where social welfare policies are more robustly integrated. Second, Canada must continue to implement policies and laws that prioritize housing as a human right rather than a commodity. Third, there is a need for individualized choice-based supports, following the principles of Housing First, which emphasize community integration. Finally, preventive measures must be prioritized with a focus on improved systems alignment and discharge planning between institutions. This paper does not offer a blueprint for change, recognizing the extent of public and social policies, tax restructuring, and ideological shifts that will need to occur. Rather, it provides a thoughtful reflection from researchers on where we as a nation should focus our attention if we want to end homelessness in Canada.

Estimating long-term K-12 student homelessness after a catastrophic flood disaster

Despite efforts to end homelessness in the United States, student homelessness is gradually growing over the past decade. Homelessness creates physical and psychological disadvantages for students and often disrupts school access. Research suggests that students who experience prolonged dislocation and school disruption after a disaster are primarily from low-income households and under-resourced areas. This study develops a framework to predict post-disaster trajectories for kindergarten through high school (K-12) students faced with a major disaster; the framework includes an estimation on the households with children who recover and those who experience long-term homelessness. Using the National Center for Education Statistics school attendance boundaries, residential housing inventory, and U.S. Census data, the framework first identifies students within school boundaries and links schools to students to housing. The framework then estimates dislocation induced by the disaster scenario and tracks the stage of post-disaster housing for each dislocated student. The recovery of dislocated students is predicted using a multi-state Markov chain model, which captures the sequences that households transition through the four stages of post-disaster housing (i.e., emergency shelter, temporary shelter, temporary housing, and permanent housing) based on the social vulnerability of the household. Finally, the framework predicts the number of students experiencing long-term homelessness and maps the students back to their pre-disaster school. The proposed framework is exemplified for the case of Hurricane Matthew-induced flooding in Lumberton, North Carolina. Findings highlight the disparate outcomes households with children face after major disasters and can be used to aid decision-making to reduce future disaster impacts on students.

What tradeoffs are made on the path to functional zero chronic homelessness?

Built for Zero (BFZ) is a resource allocation method for homeless systems that has gained popularity in North America. Community Solutions, the organization that created/promotes BFZ, argues system managers can end homelessness by using business management techniques to flexibly allocate housing assistance and achieve systemwide benchmarks like functional zero chronic homelessness. Little research has analyzed how BFZ strategies are applied to homeless systems. This is a notable blind spot because homeless systems confront different barriers/enablers that facilitate/constrain BFZ integration. I extend housing scholarship by using ethnographic data of referral meetings in a large U.S. County to analyze managerial use of BFZ strategies promoted by Community Solutions. I show political economic constraints force macro-micro tradeoffs on the path to functional zero that marginalize the wants/needs of some clients by referring them to suboptimal housing. My findings show equitable progress to functional zero requires adequate housing resources so the wants/needs of service recipients are not sidelined.

A feeling for the data: How government and nonprofit stakeholders negotiate value conflicts in data science approaches to ending homelessness

AbstractGovernmental and organizational policy increasingly claims to be data‐driven, data‐informed, or knowledge‐driven. We explore the data practices of local governments and nonprofits a seeking to end homelessness in the City of Austin. Drawing on 31 interviews with stakeholders, alongside the reflections and experiences of our interdisciplinary, cross‐sector collaborative team, we consider the role of data in guiding and informing interventions and policy regarding homelessness. Ending homelessness is a particularly challenging scenario for intervention, with increasing politicization, changing circumstances, and needing rapid intervention to reduce harm. In exploring some implications of data science “in the wild” as it is deployed, understood, and supported within the Travis County Continuum of Care (CoC), we analyze how data‐intensive work connects and engages across disciplinary boundaries. Furthermore, we consider how data science and the iField can collaborate in addressing complex, social problems as advisors and partners with invested organizations.

From Communities of Practice to Smart and Connected Communities: Information Sharing Practices Among Social Service Providers

ABSTRACTTo be a smart and connected community is an aspiration and orientation. A goal of smart and connected communities is to make more effective and consistent use of data, information, and technology, and in many ways to operate at a critical junction between community members and an imagined future structured around a particular vision of the role of government, the role of participation, and often‐conflicting visions of what these might become. This paper reports findings from 32 semi‐structured interviews with stakeholders in the City of Austin Continuum of Care (CoC), a collaborative group of organizations working to end homelessness in the Austin/Travis County region, as well as critical analysis of their collaborative and siloed data resources. The key themes that emerged in this case study include the continual process of “becoming” a smart and connected community, focusing on the development and “accretion” of data and informational infrastructure, and its impact on the communities of practice related to providing services to people experiencing homelessness. The information behaviors of the stakeholders of the CoC demonstrates ongoing movement towards more collaborative resolutions of issues of data quality and interoperability, alongside a negotiation of the role of data‐intensive structuring of collaborations and work.

Factors Associated With Mortality Among Homeless Older Adults in California

The population of homeless older adults is growing and experiences premature mortality. Little is known about factors associated with mortality among homeless older adults. To identify the prevalence and factors associated with mortality in a cohort of homeless adults 50 years and older. In this prospective cohort study (Health Outcomes in People Experiencing Homelessness in Older Middle Age [HOPE HOME]), 450 adults 50 years and older who were homeless at baseline were recruited via venue-based sampling in Oakland, California. Enrollment occurred in 2 phases, from July 2013 to June 2014 and from August 2017 to July 2018, and participants were interviewed at 6-month intervals. Baseline and time-varying characteristics, including sociodemographic factors, social support, housing status, incarceration history, chronic medical conditions, substance use, and mental health problems. Mortality through December 31, 2021, based on state and local vital records information from contacts and death certificates. All-cause mortality rates were compared with those in the general population from 2014 to 2019 using age-specific standardized mortality ratios with 95% CIs. Of the 450 included participants, median (IQR) age at baseline was 58.1 (54.5-61.6) years, 107 (24%) were women, and 360 (80%) were Black. Over a median (IQR) follow-up of 55 (38-93) months, 117 (26%) participants died. Median (IQR) age at death was 64.6 (60.3-67.5) years. In multivariable analyses, characteristics associated with mortality included a first episode of homelessness at 50 years and older (adjusted hazard ratio [aHR], 1.62; 95% CI, 1.13-2.32), homelessness (aHR, 1.82; 95% CI, 1.23-2.68) or institutionalization (aHR, 6.36; 95% CI, 3.42-11.82) at any follow-up compared with being housed, fair or poor self-rated health (aHR, 1.64; 95% CI, 1.13-2.40), and diabetes (aHR, 1.55; 95% CI, 1.06-2.26). Demographic characteristics, substance use problems, and mental health problems were not independently associated. All-cause standardized mortality was 3.5 times higher (95% CI, 2.5-4.4) compared with adults in Oakland. The most common causes of death were heart disease (n = 17 [14.5%]), cancer (n = 17 [14.5%]), and drug overdose (n = 14 [12.0%]). The cohort study found that premature mortality was common among homeless older adults and associated factors included late-life homelessness and ongoing homelessness. There is an urgent need for policy approaches to prevent and end homelessness among older adults in the US.

A Turning Point? Responses to COVID-19 Within the Homelessness Industrial Complex

The coronavirus disease 2019 (COVID-19) pandemic affected the homeless serving sector in significant ways, including impacts on service users and service providers. In this qualitative case study from Ottawa, Canada, we conducted 28 semi-structured interviews with service providers and key informants from the homeless serving sector to learn more about responses to the pandemic. We argue that, as it is currently designed, the homeless serving sector had limited opportunity to respond to the combined crises in housing, overdose, and COVID-19 with a transformative agenda. The article draws on Dej’s (2020) concept of the homelessness industrial complex, which argues that current systems manage and sustain rather than end homelessness. And we use Lipsky’s (1969; 1980) notion of street-level bureaucracy to explore the role of service providers as they translated shifting public health guidelines into action on the ground within contexts of ambiguity and constraint. Service providers were tasked with keeping people safe from COVID-19 while managing broader social issues such as homelessness, food insecurity, mental health challenges, and an increasingly poisoned illicit drug supply. They described challenges such as narrowly directed funding and short-term and temporary solutions to homelessness. Staff faced significant occupational stress and burnout within demoralizing contexts (Kerman & Kidd, 2021; Kerman et al., 2022). Despite new partnerships and innovative approaches that emerged, responses to the pandemic in Ottawa were shaped by the homelessness industrial complex and did not significantly contribute to ending homelessness. Even so, public health measures were able to disrupt business as usual in the sector, sparking the question: what might be possible if homelessness comes to be understood as a public health crisis?

How COVID-19 has impacted access to healthcare and social resources among individuals experiencing homelessness in Canada: a scoping review

ObjectivesIn Canada, individuals experiencing homelessness (IEH) rely on public health and social services for healthcare, food and basic necessities. The COVID-19 pandemic has disproportionately affected marginalised populations, in part by...

A Proactive Approach to End Homelessness

This study examines the evolution of the homeless serving system of care (HSSC) in Calgary, Alberta, and explores related successes, challenges, and lessons learned from a governance lens. The study relies on an inductive approach and qualitative methods, including a literature review, document reviews, and nine key informant interviews. Findings suggest that Calgary’s HSSC is a key governance structure for policy alignment and coordination and that it has facilitated system changes that promote more integration between homelessness, housing, health, and justice systems. The significance of this research is to document any notable components and best practices in Calgary’s HSSC that are relevant to stakeholders (e.g., community entities, government funders, policymakers, and academic researchers) looking to improve their systems.