Homelessness In The United States Research Articles

The Use of Mobile Medical Units for Populations Experiencing Homelessness in the United States: A Scoping Review.

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness.

Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States.

Louse-borne Bartonella quintana infection and flea-borne murine typhus are two potentially serious vector-borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse- and flea-borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases. Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared. Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse- and flea-borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing.

Gentrification Beliefs and Attitudes Towards Park and Recreation Agency Actions Intended to Support People Experiencing Homelessness

After declining from historically high levels following the Great Recession, homelessness in the United States is again on the rise due to an increase in the prevalence of unsheltered homelessness, and homeless encampments in public spaces such as parks. As such, there is significant interest in understanding opinion regarding community park agency activities intended to support unhoused users. Unfortunately, these actions and investments may also contribute to the process of environmental gentrification. In this note we use structural equation modeling of survey responses to examine how beliefs about the gentrification process influence public attitudes toward park and recreation agency activities intended to support people experiencing homelessness. Gentrification beliefs were significantly related to attitudes toward both housing-related and service-related agency activities. Managers and other decision makers should consider the potential impact of agency activities on the gentrification process, and seek to understand stakeholder attitudes toward gentrification as a phenomenon.

Community-level predictors of doubled-up homelessness

ABSTRACT Existing research has examined the community-level factors associated with sheltered and unsheltered homelessness in the United States, generally finding that housing, labor market, and social safety net factors have significant associations with geographic variation in homelessness. Some definitions of homelessness include doubling up, defined as staying with others because of housing loss or economic hardship. We examine the community correlates of doubled-up homelessness across metropolitan areas using a measure that draws on American Community Survey microdata. We present evidence that area median rent and unemployment are positively associated with rates of doubling up among the population in or near poverty, and that income inequality and unemployment are positively associated with rates of doubling up in the total population. In contrast to recent studies of sheltered and unsheltered homelessness, we find a negative relationship between access to cash public assistance and doubling up rates within both the total population and those who are low income.

Homelessness And Health: Factors, Evidence, Innovations That Work, And Policy Recommendations.

On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, we highlight structural and individual risk factors that can lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations. Health system efforts to address homelessness and improve the health of homeless populations have included interventions such as screening for social needs and medical respite programs. Initiatives using the Housing First approach to permanent supportive housing have a strong track record of success. Health care financing innovations using Medicaid Section 1115 waivers offer promising new approaches to improving health and housing for people experiencing homelessness. To substantially reduce homelessness and its many adverse health impacts, changes are needed to increase the supply of affordable housing for households with very low incomes. Health care providers and systems should leverage their political power to advocate for policies that scale durable, evidence-based solutions to reduce homelessness, including increased funding to expand housing choice vouchers and greater investment in the creation and preservation of affordable housing.

A Qualitative Exploration of People Who Have Left Housing First and Returned to Homelessness

This article offers a thick, rich, multidimensional, and situational look into a Housing First (HF) program in Charlotte, North Carolina, called HousingWorks. This study focuses on individuals who have experienced chronic homelessness and who exited permanent supportive housing (PSH) programs that employ a HF model and return to homelessness. In January 2022, there were 582,500 people experiencing homelessness in the United States (The U.S Department of Housing and Urban Development [HUD], 2023). One-third of these individuals had patterns of chronic homelessness, which has doubled since 2016 (HUD, 2023). Additionally, one-third of unsheltered individuals are at a high risk of being unsheltered again. To address issues of chronic homelessness, emphasis has been placed on increasing supportive housing, which combines permanent affordable housing with supportive services (permanent supportive housing), commonly called a housing first, or the rapid rehousing approach. Participants exited HousingWorks for multiple individual and programmatic reasons. All exits in this study were tied to relationships individuals had with friends, family (of choice and biological), romantic partners, case managers, and neighbors. Consumers, providers, and former residents describe their experiences and offer insights for improving housing retention in PSH programs. Implications for implementation and housing first fidelity criteria are also discussed.

Association between psychosocial factors and co-morbid cigarette smoking and alcohol use in a population experiencing homelessness

The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years (SD = 11.6). Bivariate analyses show that heaviness of smoking was positively correlated with social network size (r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score (r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness.

A Gap Analysis Evaluating Project Homekey’s Time-effectiveness in Housing Homeless in Los Angeles

California has been long burdened with the highest rate of homelessness in the United States. However, in recent years, a new housing initiative, Project Homekey, has begun converting city-purchased hotel and motel properties into individual units to temporarily house California’s financially insecure individuals. The nascent program has shown promise, however, due to its recent creation, much of the research surrounding the program focuses on its cost-effectiveness rather than its time-effectiveness in reducing homeless numbers within Los Angeles. Using a gap analysis approach, this study aimed to fill this gap while focusing on 9 recently bought properties within the city of Los Angeles. Publicly accessible city files were used to find and calculate the average rate of stay for Project Homekey inhabitants, and with knowledge of the amount of converted units per property as well as the current homeless population – unsheltered and total – within each city council district of Los Angeles, it was estimated how many years it would take to house each city district’s homeless population. Finally, a gap analysis SWOT tool was employed to study the overall soundness of the program in relation to its time effectiveness, and to point out areas of improvement and areas of success. Ultimately, it was concluded that Project Homekey, although estimated to take decades to resolve Los Angeles’s Homeless population, was a viable solution to the arduous issue. Nonetheless, due to the constraint of available resources, there are several limitations as to the extent of the conclusion’s applicability.

The Cost of Living Index as a Primary Driver of Homelessness in the United States: A Cross-State Analysis.

Homelessness persists as a critical global issue despite myriad interventions. This study analyzed state-level differences in homelessness rates across the United States to identify influential societal factors to help guide resource prioritization. Homelessness rates for 50 states and Washington, DC, were compared using the most recent data from 2020 to 2023. Twenty-five variables representing potential socioeconomic and health contributors were examined. The correlation between these variables and the homelessness rate was calculated. Decision trees and regression models were also utilized to identify the most significant factors contributing to homelessness. Homelessness rates were strongly correlated with the cost of living index (COLI), housing costs, transportation costs, grocery costs, and the cigarette excise tax rate (all: P < 0.001). An inverse relationship was observed between opioid prescription rates and homelessness, with increased opioid prescribing associated with decreased homelessness (P < 0.001). Due to collinearity, the combined cost of living index was used for modeling instead of its individual components. Decision tree and regression models identified the cost of living index as the strongest contributor to homelessness, with unemployment, taxes, binge drinking rates, and opioid prescription rates emerging as important factors. This state-level analysis revealed the cost of living index as the primary driver of homelessness rates. Unemployment, poverty, and binge drinking were also contributing factors. An unexpected negative correlation was found between opioid prescription rates and homelessness. These findings can help guide resource allocation to address homelessness through targeted interventions.

Identifying Novel Motivation Phase-Specific Cessation Targets for Youth Experiencing Homelessness in the United States.

Of youth experiencing homelessness (YEH; 14-24 years old), 70%+ smoke combustible, commercial tobacco. Though many have tried to quit, most use ineffective methods. Drop-in centers for YEH are opportune places to link YEH to evidence-based treatment. Using the Phase-Based Model (PBM) for Cessation Research, the aim of this study was to identify "Motivation" phase-specific challenges impacting YEH's willingness to make a quit attempt-the goal of this cessation phase. Surveys were interview administered with 96 past-week combusted tobacco users accessing drop-in services. Regression models were fit to confirm hypothesized challenges impacting YEH's willingness to quit. Moderate nicotine dependence was noted-a key Motivation phase cessation mechanism targeted-and was associated with population challenges including, but not limited to, replacing food with tobacco, accidental oxygen-deprivation events, and smoking to socialize. While 67.1% of participants made a past-year quit attempt, 45.8% expressed 30-day quit interest. Dimensions of coping with housing were associated with quit attempts and quit interest. Quit attempts were also associated with nicotine dependence, working, and smoking to socialize. Whereas, quit interest was associated with less endorsement of smoking to regulate affect and more endorsement to avoid danger. Though common challenges targeted in Motivation phase cessation exist among YEH, other challenges may also need to be addressed to promote quitting. Future research in optimizing evidence-based cessation access for YEH through drop-in centers may consider addressing the challenges of housing, food security, social context, violence, and neurotrauma sequela to bolster YEH willingness to make a quit attempt.

“Being homeless can burn you out”: a qualitative study of individuals’ experience of administrative burden when accessing homeless services

ABSTRACT Despite significant efforts to address the homelessness in the United States, on any given night more than 500,000 individuals lack shelter/place to call home. This persistent and high rate of homelessness can be attributed to the shortage of affordable housing options, the eviction crisis, and unmet need for rental assistance. Administrative burdens tied to homeless services may also create barriers to housing for individuals experiencing homelessness, and to date have been under-explored in the literature. Our study explores administrative burden by examining 28 individuals’ experiences navigating homeless services in New Haven, Connecticut. Our analysis describes the learning, compliance and psychological costs individuals face. Our findings suggest that administrative burdens may lead to underutilization of services and prolonged homelessness. Further, they may promote new forms of inequities. We conclude with recommendations to reduce administrative burden and increase investments in homeless services and housing resources nationwide.

Pathways of Individuals Experiencing Serious Illness While Homeless: An Exploratory 4-Point Typology from the RASCAL-UP Study

The shifting age demographics of those experiencing homelessness in the United States expose shortcomings and barriers within homelessness response services and safety-net healthcare to address serious illness. The purpose of this study is to describe the common trajectories of patients concurrently experiencing homelessness and serious illness. As a part of the Research, Action, and Supportive Care at Later-life for Unhoused People (RASCAL-UP) study, the study uses patient charts (n = 75) from the only specialty palliative care program in the U.S. specifically for people experiencing homelessness. Through a thematic mixed-method analysis, a four-point typology of care pathways taken by people experiencing homelessness while seriously ill is introduced: (1) aging and dying-in-place within the housing care system; (2) frequent transitions during serious illness; (3) healthcare institutions as housing; and (4) housing as palliation. Implications of this exploratory typology include targeted, site-specific interventions for supporting goal-concordant patient care and assisting researchers and policy makers in appreciating heterogeneity in experience and need among older and chronically ill people experiencing homelessness and housing precarity.

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.

Analyzing U.S. tweets for stigma against people experiencing homelessness.

Author(s): Kim, NJ; Lin, J; Hiller, C; Hildebrand, C; Auerswald, C | Abstract: Rising homelessness in the United States has been a considerable source of concern, with policymakers and community members calling for “solutions.” Stigma, as a societal barrier to addressing inequity, is a significant cause of morbidity and mortality for people experiencing homelessness (PEH) and presents a barrier to the proposed solutions. Given that using surveys to study stigma against PEH carries potential social desirability bias, our research team used Twitter, a microblogging platform comprised of 140-character messages (aka, tweets), to get a snapshot of how American Twitter users stigmatize PEH. We conducted a content analysis of 6,400 tweets regarding homelessness collected over 3 months. Our analysis was informed by Erving Goffman’s theoretical framework regarding stigma. Consistent with Goffman’s work, we illustrate the ways that Twitter users rationalized the situation of PEH by creating a “stigma theory,” in which they attribute undesirable characteristics to PEH, highlight the multiple ways in which they “deserve” to be homeless because of their character flaws, and emphasize their devalued “bottom of the heap” status. We describe the ways that this stigma theory of homelessness is expressed in tweets regarding interactions between PEH and housed individuals. Complementing Goffman’s work as applied to PEH, we also describe the ways in which Twitter users impute additional stigmatized identities onto PEH and the role that disgust plays in stigma against PEH. Our findings suggest the need for a multi-level response to stigma, including addressing stigma at the individual and structural levels and providing housing to PEH across communities. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

The structural nature of family homelessness: a critical analysis of the intersection of unaffordable housing, housing insecurity, non-livable wages, and eviction

ABSTRACT Family homelessness is a pervasive and persistent problem in the United States. The complexity of family homelessness and interrelated structural issues combine to negatively impact the quality of life and upward mobility of those experiencing homelessness. This conceptual article proposes a critical analysis of factors contributing to family homelessness to illustrate how multiple forces act in concert to perpetuate the issue. Most current interventions to ameliorate family homelessness in the United States are uninformed by critical theory and do not address the root causes of the issue and therefore have proven to be only marginally effective. The authors assert that social work practices that are critical theory informed and empowerment based will lead to effective interventions with families experiencing homelessness.

A socioecological perspective to contraceptive access for women experiencing homelessness in the United States

ObjectiveAlthough persons who are pregnancy-capable and experiencing homelessness may have a strong desire to avoid pregnancy, they face unique barriers to contraception. This multimethod qualitative study aimed to identify preferences for, barriers to, and facilitators of contraceptive access and use among women experiencing homelessness in the United States using a systems perspective. Study designWe conducted semistructured interviews with women experiencing homelessness (n = 19), healthcare providers (n = 6), and social service providers (n = 6). We recruited participants from community-based, housing, and medical organizations in North Texas in the United States. Two coders conducted thematic analysis and reached consensus for codes. ResultsWomen participants were in emergency shelter, unsheltered, or transitional/rapid rehousing. We stratified themes using the Socioecological Framework to illustrate factors affecting contraception access at individual, interpersonal, organizational and community, and societal levels. Notable results include women’s preferences for long-acting reversible contraception, difficulties healthcare providers face in initiating contraceptive counseling, and the underutilized role of social service providers in reproductive healthcare. Insurance policies, connections between health clinics and community organizations, and organizational priorities both facilitated and hindered women experiencing homelessness’s access to women’s healthcare services. ConclusionThis study identified opportunities throughout the healthcare and social service systems to support contraceptive access for women experiencing homelessness. Future interventions should strengthen and leverage these connections to promote access among this vulnerable population with the goal of supporting reproductive autonomy. ImplicationsThis study explored the reproductive health needs of women experiencing homelessness. Multilevel interventions, such as interdisciplinary care, patient-centered approaches, and an emphasis on health literacy, are needed to adequately provide the preferred methods of contraception for women experiencing homelessness, thus enabling reproductive autonomy for this population.

Detection of Bartonella quintana (Hyphomicrobiales: Bartonellaceae) Among Day Laborers in Osaka, Japan, 2009-2010.

Bartonella quintana is a gram-negative bacterium causing trench fever, an illness historically acquired by soldiers during World War I. More recently, outbreaks of trench fever have been reported in those experiencing homelessness in the United States, France, Russia, and Tokyo, as well as in children in Nepal and persons in Ethiopia. Reports of B. quintana infection outside of Tokyo are rare in Japan. The aim of this study was to examine body lice and blood obtained from people staying in shelters in Osaka (2009-2010) for B. quintana via polymerase chain reaction and enzyme-linked immunosorbent assays. Day laborers were defined as homeless individuals and shelter residents in this study. We detected genes of B. quintana in body lice by PCR and antibodies against B. quintana. The positive rate of B. quintana genes was 6/10 (60%) in body lice and the seroprevalence (IgG) of B. quintana was 4/10 (40%). This demonstrates that trench fever was endemic in people staying in shelters in Osaka in 2009-2010.

Diagnosis, Treatment, and Prevention of Tuberculosis Among People Experiencing Homelessness in the United States: Current Recommendations.

Tuberculosis (TB) is a public health problem, especially among people experiencing homelessness (PEH). The Advisory Council for the Elimination of Tuberculosis issued recommendations in 1992 for TB prevention and control among PEH. Our goal was to provide current guidelines and information in one place to inform medical and public health providers and TB programs on TB incidence, diagnosis, and treatment among PEH. We reviewed and synthesized diagnostic and treatment recommendations for TB disease and latent TB infection (LTBI) as of 2022 and information after 1992 on the magnitude of homelessness in the United States, the incidence of TB among PEH, the role of public health departments in TB case management among PEH, and recently published evidence. In 2018, there were 1.45 million estimated PEH in the United States. During the past 2 decades, the incidence of TB was >10 times higher and the prevalence of LTBI was 7 to 20 times higher among PEH than among people not experiencing homelessness. TB outbreaks were common in overnight shelters. Permanent housing for PEH and the use of rapid TB diagnostic tests, along with isolation and treatment, reduced TB exposure among PEH. The use of direct observation enhanced treatment adherence among PEH, as did involvement of social workers to help secure shelter, food, safety, and treatment for comorbidities, especially HIV and substance use disorders. Testing and treatment for LTBI prevented progression to TB disease, and shorter LTBI regimens helped improve adherence. Federal agencies and the National Health Care for the Homeless Council have helpful resources. Improvements in TB diagnosis, treatment, and prevention among PEH are possible by following existing recommendations and using client-centered approaches.

3.106 Amplifying a Crisis: The COVID-19 Pandemic's Impact on Families Experiencing Homelessness

Families experiencing homelessness face significant mental health and social inequities that increase their vulnerability to the COVID-19 pandemic. Despite the burden of family homelessness in the United States, little is known about their pandemic experience. We sought to understand how the pandemic impacted homeless-experienced families across multiple sectors of their lives.

&lt;i&gt;Land of Stark Contrasts. Faith-Based Responses to Homelessness in the United States&lt;/i&gt;, edited by Manuel Mejido Costoya

Land of Stark Contrasts. Faith-Based Responses to Homelessness in the United States, edited by Manuel Mejido Costoya. Fordham University Press, 2021. 384pp., 7 b/w illustrations. Pb. US$35.00. ISBN-13: 9780823293964.