End Homelessness Research Articles

Where’s the Housing? Housing and Income Outcomes of a Transitional Program to End Homelessness

ABSTRACTThis project examined the effectiveness of a transitional program in breaking the cycle of homelessness. Within a community-based research approach, the authors conducted a case study to describe the program and participants within a context in which housing is largely unavailable and unaffordable. Although most participants successfully transitioned to housing few transitioned from homelessness to economic self-sufficiency in market housing and participants remained in poverty. Evaluations of housing programs can “blame the victim” or “blame the program” when measures of success are not achieved. Interventions to address homelessness require attention to the system-level forces that create and sustain poverty and inequities.

Permanent Supportive Housing and Specialized Co-Occurring Disorders Wraparound Services for Homeless Individuals

Objective: Among individuals experiencing chronic homelessness, there is a high rate of co-occurring mental health and substance use, which has traditionally been addressed through the delivery of permanent supportive housing along with substance use and mental health services. However, this population often has difficulty engaging in treatment for co-occurring disorders, which can result in exacerbation of symptoms and housing loss. Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (MISSION) is a co-occurring mental health and substance use wraparound approach that was pilot-tested alongside Permanent Supportive Housing (PSH) to improve treatment access and engagement. This pilot was part of a state plan to end homelessness in the Boston metro area. Methods: This open pilot study enrolled 136 individuals who were chronically homeless and offered one year of MISSION along with PSH. Program participants also received baseline and 6- and 12-month follow-up assessments. Results: At one-year follow-up, 82.4% of the program participants were housed in PSH. However, due to limited affordable housing in the Boston metro area, it took on average 6.20 months to house the program participants. Furthermore, while MISSION was feasible to implement alongside PSH, fidelity to the MISSION model was lower than expected. This pilot also examined the role of housing status on clinical outcomes and found that the program participants who were housed at the time of discharge displayed a statistically significant improvement in emergency room visits for mental health complaints, the Psychosis subscale of the Behavior and Symptom Identification Scale (BASIS-32), illegal drug use, and pharmacotherapy treatment. Conclusions: This pilot study demonstrated that systematically integrating PSH and MISSION can improve access and engagement in care, housing retention, and mental health outcomes. Despite the preliminary success and while taking into account the limitations of the open single-group pre/post design, this study also identified the lack of affordable housing as a potential barrier to placement as well as the critical role of housing for improved clinical outcomes. Randomized controlled trials are needed to test MISSION with PSH as well as perhaps PSH with and without MISSION to tease apart the effects of integrating both approaches simultaneously.

Social support and housing transitions among homeless adults with serious mental illness and substance use disorders.

Research suggests that social supports are associated with housing retention among adults who have experienced homelessness. Yet, we know very little about the social support context in consumers find and retain housing. We examined the ways and identified the junctures in which consumers' skills and deficits in accessing and mobilizing social supports influenced their longitudinal housing status. We performed semi-structured qualitative interviews with VA Greater Los Angeles consumers (n = 19) with serious mental illness, substance use disorders, and a history of homelessness; interviews explored associations between longitudinal housing status (categorized as: stable, independent housing; sheltered housing, continually engaged in structured housing programs; and unstable housing) and social supports. We compared data from consumers in these 3 mutually exclusive categories. All participants described social support as important for finding and maintaining housing. However, participants used formal (provider/case managers) and informal (family/friends) supports in different ways. Participants in stable housing relied on formal and informal supports to obtain/maintain housing. Participants in sheltered housing primarily used formal supports, for example, case management staff. Unstably housed participants used formal and informal supports, but some of these relationships were superficial or of negative valence. Interpersonal problems were prevalent across longitudinal housing status categories. Social context, including patterns of formal and informal support, was associated with participants' longitudinal housing status. Within interventions to end homelessness, these findings suggest the value of future research to identify, tailor, and implement practices that can help consumers improve their social resources. (PsycINFO Database Record

Reliability and validity of the Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT) in real-world implementation

ABSTRACTThis study examined the reliability and validity of the Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT), a widely-used assessment of the health and social vulnerabilities and housing needs of individuals experiencing homelessness. Homeless Management Information System data were obtained for 1495 individuals who were administered the VI-SPDAT between 2014 and 2016. Subsamples were selected for reliability and validity assessments. Results suggest there are challenges to the reliability and validity of the VI-SPDAT in practical use. VI-SPDAT total scores did not significantly predict risk of return to homeless services, while type of housing was a significant predictor. Vulnerability assessment instruments have important implications for communities working to end homelessness by facilitating prioritization of scarce housing resources. Findings suggest that further testing and development of the VI-SPDAT is necessary.

Urban mental health: challenges and perspectives.

To provide an update on urban mental health and highlight the challenges that require urgent attention. The majority of the world's population live in towns and urbanization is expected to increase in all areas of the world. Challenges to mental health in urban areas include loneliness, violence, high crime rates, homelessness, noise and other pollutants, traffic accidents, drug abuse, and insufficiency of mental health services. Urbanization is a global and growing phenomenon that pose significant challenges to mental health and mental health services. Fast and unstructured urbanization, such as that seen in many developing countries, further exacerbates these challenges. There are promising initiatives emerging including initiatives to end homelessness, to improve access to green areas in urban environments, to provide emergency psychiatric services, and to develop new forms of mental health services adjusted to urban settings. Regrettably there are no universally accepted guidelines that would help governments in structuring health services for people with mental illness in towns and help to prevent mental health problems related to rapid urbanization.

Moving Beyond Housing: Service Implications for Veterans Entering Permanent Supportive Housing.

As a result of efforts to end homelessness among U.S. veterans, more former service members are entering permanent supportive housing (PSH). While PSH has been successfully used to house homeless veterans, more research is needed about services beyond housing placement and retention. This study uses the Gelberg-Andersen behavioral model for vulnerable populations to determine associations between predisposing, enabling, and need characteristics and recent service use (i.e., services to satisfy basic needs, occupational development, financial, healthcare, mental health) among unaccompanied homeless veterans (N=126) entering PSH in Los Angeles. Among the significant findings, as indicated using univariable logistic regression models, were veterans who had incarceration histories were more likely to utilize basic needs services, compared to those without incarceration histories. Veterans who received an honorable discharge were more likely to utilize occupational development services, compared to veterans with other discharge statuses. Veterans who had a case manager were more likely to utilize mental health services than those without a case manager, while those who received social security were less likely to utilize mental health services compared to veterans who did not receive social security. Veterans who met criteria for a psychological disability and veterans who met criteria for probable PTSD were more likely to use basic needs services and mental health services than veterans who fell below these thresholds. Clinical implications for social workers including "equal access to services," "enhancing economic stability," "providing safe and affordable housing with trauma-informed services," and "training service social workers to deliver well-informed linkages and services" are discussed.

Mental Illness, Healthcare, and Homelessness in Mississippi

Mental illness is prevalent among the homeless population and the rate of mentally ill homeless individuals has increased since deinstitutionalization. There is little information about homeless population mental health and access to mental healthcare. This study sought to describe the mental health status and utilization of mental healthcare services among homeless individuals in Mississippi. This is a cross-sectional study with 3,375 adults participants. There were 58% males, 42% females, 45% Caucasian, 54% African Americans, and 1% other minorities (Asian, Indian, and Pacific Islander) at intake into Mississippi United to End Homelessness' (MUTEH) Homeless Management Information System (HMIS) program. The data was collected during the initial screening of homeless individuals. The screening documented mental illness and utilization of healthcare. Frequency tables and Chi-SQ was used to test the relationship between mental illness and utilization of mental healthcare among the homeless in Mississippi. The result of the analysis revealed that 83% of the chronically homeless individual had a mental illness, and 78% of the chronically homeless participants were not receiving mental healthcare. Mental health services were successful in connecting mentally ill homeless individuals to mental healthcare in lieu of institutionalization. However, chronically homeless mentally ill individuals struggle with obtaining appropriate care.

Providing Solutions to LGBT Homeless Youth: Lessons From Baltimore’s Youth Empowered Society

In the United States, nearly 1.7 million youth under the age of 18 run away from home and often end up homeless each year. Reports estimate that between 20% and 40% of the runaway and homeless youth population identifies as lesbian, gay, bisexual, or transgender (LGBT) (Durso & Gates, 2012; Kaiser Family Foundation, 2014). This suggests that as many as 80,000 LGBT youth are homeless for over a week each year (National Alliance to End Homelessness, 2012). In addition, LGBT youth are more likely to suffer from poverty, substance abuse, violence, mental illness, and attempted suicide as a result of harassment and discrimination (Cray, Miller, & Durso, 2013; Kaiser Family Foundation, 2014; Swan, 2014). Grounded in social equity theory (Frederickson, 2010) and intersectionality (Crenshaw, 1991), this article argues that additional legal protections are necessary in order to ensure the constitutional rights of LGBT youth. A case study of the Youth Empowered Society (YES) in Baltimore City is provided as an example of a service-delivery model for this vulnerable population. Best practices are identified and anti-discrimination policies are recommended.

Pathways into homelessness among post-9/11-era veterans.

Despite the scale of veteran homelessness and government-community initiatives to end homelessness among veterans, few studies have featured individual veteran accounts of experiencing homelessness. Here we track veterans' trajectories from military service to homelessness through qualitative, semistructured interviews with 17 post-9/11-era veterans. Our objective was to examine how veterans become homeless-including the role of military and postmilitary experiences-and how they negotiate and attempt to resolve episodes of homelessness. We identify and report results in 5 key thematic areas: transitioning from military service to civilian life, relationships and employment, mental and behavioral health, lifetime poverty and adverse events, and use of veteran-specific services. We found that veterans predominantly see their homelessness as rooted in nonmilitary, situational factors such as unemployment and the breakup of relationships, despite very tangible ties between homelessness and combat sequelae that manifest themselves in clinical diagnoses such as posttraumatic stress disorder. Furthermore, although assistance provided by the U.S. Department of Veterans Affairs (VA) and community-based organizations offer a powerful means for getting veterans rehoused, veterans also recount numerous difficulties in accessing and obtaining VA services and assistance. Based on this, we offer specific recommendations for more systematic and efficient measures to help engage veterans with VA services that can prevent or attenuate their homelessness. (PsycINFO Database Record

Lifetime and 1-year prevalence of homelessness in the US population: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III.

Homelessness remains a major public health problem in the USA but there have been few recent epidemiological studies in the general population. Using data from structured interviews with a nationally representative sample of 36 299 US adults from the 2012-13 Wave 3 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), this study examined the lifetime and 1-year prevalence of homelessness, and its correlates. Lifetime and 1-year prevalence of homelessness in the US population was found to be 4.2 and 1.5%, respectively. Low income, debt, borderline personality disorder (PD), past-year tobacco use disorder, any history of suicidal attempts and being a victim of crime in the past year were all independently strongly associated with past-year homelessness (all OR > 1.5). Low income, debt, history of incarceration, antisocial PD and any history of suicidal attempts were all independently strongly associated with lifetime homelessness (all OR > 1.5). These findings provide an update to the original NESARC, suggesting a possible increase in lifetime homelessness (2.7-4.2%) in the past decade. Along with known economic and behavioral health conditions, special attention should be paid to PDs in efforts to prevent and end homelessness.

Prevalence of Homelessness in the Emergency Department Setting.

IntroductionAccording to the National Alliance to End Homelessness, the national rate of homelessness has been cited as 17.7 homeless people/10,000 people in the general population, and 24.8 homeless veterans/10,000 veterans in the general population. However, it is unknown what the prevalence of homelessness is in the emergency department (ED) setting. We set out to determine the prevalence of homelessness or at risk for homelessness in the ED setting.MethodsUsing a five-question screening tool derived from the U.S. Department of Housing and Urban Development, Health and Human Services and the Veterans Administration definition for homelessness, we surveyed all patients meeting inclusion/exclusion criteria on scheduled shifts in one of three EDs in Northeastern Pennsylvania. To participate, subjects had to be a registered patient in the ED, be 18 years or older, speak English, have the capacity to answer survey questions, not be critically ill, be willing to participate, and not have taken the survey before. We selected two survey periods to represent seasonal variations.ResultsWe included 4,395 subjects in the analysis. The mean age of those who screened positive for homelessness or at risk for homelessness was 43.1 (SD 16.6). Overall, 136 (3.1%) participants screened positive for at risk for homelessness and 309 (7.0%) screened positive for homelessness. A total of 103 subjects (9.8%) screened positive for homelessness or at risk for homelessness on weekends and 312 (10.3%) on weekdays (p=0.64). The proportion of those screening positive for homelessness or at risk for homelessness varied by site: 145 (7.5%) at the trauma center, 151(9.1%) at the suburban site, and 149 (18.7%) at the center city site, p<0.001.There was no statistical significance to the difference between the trauma center and the suburban site (p=.088), but there was statistical significance between both the suburban and the trauma center when compared to the center city site (both p<0.0001). The proportion of those screening positive for homelessness in the summer months (156, 7.5%) was similar to those in the winter months (153, 6.6%), p=0.23.,ConclusionIn our study, the overall prevalence of homelessness or at risk for homelessness was 10.1 percent. This prevalence did not seem to vary between weekdays and weekends. Additionally, summer months had a prevalence that was as concerning as winter months. The prevalence does, however, seem to vary by institutional characteristics even in the same geographic region. Understanding the patterns of prevalence of homelessness is a step toward considering possible interventions to assist this vulnerable population.

Do We Have the Knowledge to Address Homelessness?

AbstractVarious forms of housing exclusion are a reality for millions of people across the globe. For people who are homeless in advanced industrialized economies, housing exclusion often co-exists with social service engagement. This essay reviews three books about how homelessness is conceptualized and caused, and how we, as social service providers and social scientists, respond to homelessness: Housing First: Ending Homelessness, Transforming Systems, and Changing Lives, by Deborah Padgett, Benjamin Henwood, and Sam Tsemberis; Women Rough Sleepers in Europe: Homelessness and Victims of Domestic Abuse, by Kate Moss and Paramjit Singh; and The Value of Homelessness: Managing Surplus Life in the United States, by Craig Willse. It concludes that Housing First achieves justice for deeply marginalized individuals but that the effectiveness of Housing First represents a disturbing reminder of our failed welfare states and public institutions.

Housing First and the Reassembling of Permanent Supportive Housing: The Limits and Opportunities of Private Rental

Third sector agencies have played a central role in the social innovation of permanent supportive housing following deinstitutionalization and the emergence of a choice-based regime. This paper traces the reassembling and translation of permanent supportive housing that gained particular saliency through the globalised Housing First movement and the reassembling of private rental as a form of permanent supportive housing. Drawing on the concept of transformative social practices informed by resilience and assemblage thinking, we add new insights to existing literature by re-examining why agencies and models followed divergent paths and the resulting implications this has had in the quest to end homelessness. We argue that the failure to effectively implement such models according to a narrowly defined prescription of Housing First does not just stem from a lack of affordable housing but must be understood in the historically contested space of how affordable housing and support should be provided that is translated through the market, state and civil society relations assembled across time and place. Drawing on cases from Belgium, United States and Australia, it is concluded that evolutionary resilient social innovation in private rental PSH necessitate increased and ongoing engagement rather than a retreat of the State.

Discerning Functional and Absolute Zeroo: Defining and Measuring an End to Homelessness in Canada

Several cities and regions have announced that they have “ended homelessness,” as this goal has become a major part of policy and community-based responses to homelessness. Yet, there are different ways to define what “ending homelessness” actually means. It is almost never meant in its most literal form, which would mean having every resident in a community sleeping in his or her own, secure home, on any given night. While that is certainly the ideal, and the goal we can work towards, it is simply not realistic in practice. People may find themselves homeless, at least temporarily. We need a meaningful and useful definition of “ending homelessness” that recognizes that reality, while pushing us towards an ideal situation. This is the difference between a Functional Zero end to homelessness and an Absolute Zero end to homelessness. To the public, the words “ending homelessness” likely bring to mind a vision of someday when no person will ever experience homelessness, which is the ideal Absolute Zero concept, that is arguably unlikely to fully achieve. The goal of a Functional Zero end to homelessness, simplified, is to achieve a point where there are enough services, housing and shelter beds for everyone who needs them, and anyone who experiences homelessness does so only briefly, is rehoused successfully, and is unlikely to return to homelessness again.

Merging Institutional Logics and Negotiated Culture Perspectives to Help Cross‐Sector Partnerships Solve the World's Most Wicked Problems

Showcasing a sixteen‐month ethnographic study of a coalition to end homelessness in Western Canada, we show how the integration of two theoretical perspectives—institutional logics and negotiated culture—can be used as complementary, yet distinct lenses to better inform the practice of cross sector partnerships which tackle the world's wicked problems. In doing so, we highlight how we were able to holistically capture the meaning systems at work in such multi‐faceted partnerships resulting in a better understanding of how partnerships can work across difference to affect positive social change. In particular, we capture how multiple stakeholders make sense of a partnership's identity in a variety of different ways based upon meaning systems with which they identify at multiple levels as well as how they enact bridging skills across meaning‐related boundaries to promote more effective partner interface.

Opening More Doors to End Homelessness Through a Shared Housing Approach.

Opening More Doors to End Homelessness Through a Shared Housing Approach.

Examining the Effects of Scattered Site Supportive Housing on the Social and Economic Integration of Men Who Are Formerly Homeless and Primarily Black/African American

Housing dispersal strategies (scattered sites) have its roots in efforts to construct public housing in more ethnically diverse and affluent communities as a result of the overrepresentation of Blacks/African Americans living in public housing developments with concentrated poverty and racial segregation. Today, the use of scattered site housing is more indicative of nonprofit housing providers seeking to end homelessness. Comparable with the demographics of public housing residents, Blacks/African Americans are severely overrepresented in homeless populations across America. This study examined the impact of scattered site supportive housing, located in an affluent and predominately White/European American community to determine any reductions in social isolation and any levels of improved socio-economic status of men who were formerly homeless and primarily Black/African American. This study used five variables identified from earlier studies thought to influence socio-economic well-being: resident satisfaction, a sense of community, impact on income, neighbor opposition or not-in-my-own backyard (NIMBY) attitudes, and impact of scattered site housing on property values. The results showed that the respondents were, on average, more satisfied with the buildings where they lived than their landlord relations or external neighbors. Furthermore, the study found very little neighbor opposition based on race or class and no negative impact on property values from nearby scattered site developments. Based on these findings, recommendations to continue implementing housing dispersal strategies are offered. In addition, directions for future research are provided.

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.

Responding to the Grand Challenge to End Homelessness: The National Homelessness Social Work Initiative

The American Academy of Social Work and Social Welfare adopted ending homelessness as one of its 12 Grand Challenges for Social Work. The National Center for Excellence in Homeless Services supports this Grand Challenge through its National Homelessness Social Work Initiative. This initiative is being carried out through a consortium of schools of social work nationally, emphasizing workforce development and policy advocacy. This major, multiyear initiative applies innovative strategies to service and policy design and social work education. This article describes the overall mission of the Homelessness Initiative and key activities used to strengthen social work curriculum, expand homelessness-related field placement opportunities for students, and impact services through the policy advocacy and dissemination of best practices.

Does Race Matter in Addressing Homelessness? A Review of the Literature

Since the 1980s, black persons have been overrepresented in the United States homeless population. Given that morbidity and mortality is elevated among both the black population and the homeless population in comparison to the general U.S. population, this overrepresentation has important implications for health policy. However, the racial demographics of homelessness have received little attention from policymakers. This article reviews published social and behavioral science literature that addresses the relationship between race and contemporary homelessness in the United States. This literature points to substantial differences between racial subgroups of the U.S. homeless population in vulnerabilities, health risks, behaviors, and service outcomes. Such observed differences suggest that policies and programs to prevent and end homelessness must explicitly consider race as a factor in order to be of maximum effectiveness. The limited scope of these findings also suggests that more research is needed to better understand these differences and their implications.