Homelessness Prevention Research Articles

Reassessing measures of risk for homelessness among families with children in New York City

This study reassessed risks that researchers have identified as predicting homelessness among families in New York City. These risks form the basis of a screening tool called the Risk Assessment Questionnaire (RAQ). It is used by NYC's homelessness prevention program, Homebase, to determine services to provide families. An RAQ score of 7 or above, on a 25-point scale, indicates high risk and greater service needs. This study's logistic regression model identified five indicators that increased odds of shelter entry among 9630 Homebase family clients from 2016 to 2019 (12 % entered shelters): having a child less than two years old; discord with one's landlords; being in an institution, or shelter, recently; and having been in a shelter as an adult; or as a child. This study also identified combinations of client risks, using Latent Class Analysis. Two groups most likely to enter shelters (7.5 % of the sample) also had the highest rates of experiences in institutions or shelters and moving frequently, with one of these registering the highest rate of childhood trauma. This study recommends implementing a state program that covers childcare costs for vulnerable families, which could address risks that children of single mothers face to future instability.

Community- and data-driven homelessness prevention and service delivery: optimizing for equity.

The study tests a community- and data-driven approach to homelessness prevention. Federal policies call for efficient and equitable local responses to homelessness. However, the overwhelming demand for limited homeless assistance is challenging without empirically supported decision-making tools and raises questions of whom to serve with scarce resources. System-wide administrative records capture the delivery of an array of homeless services (prevention, shelter, short-term housing, supportive housing) and whether households reenter the system within 2 years. Counterfactual machine learning identifies which service most likely prevents reentry for each household. Based on community input, predictions are aggregated for subpopulations of interest (race/ethnicity, gender, families, youth, and health conditions) to generate transparent prioritization rules for whom to serve first. Simulations of households entering the system during the study period evaluate whether reallocating services based on prioritization rules compared with services-as-usual. Homelessness prevention benefited households who could access it, while differential effects exist for homeless households that partially align with community interests. Households with comorbid health conditions avoid homelessness most when provided longer-term supportive housing, and families with children fare best in short-term rentals. No additional differential effects existed for intersectional subgroups. Prioritization rules reduce community-wide homelessness in simulations. Moreover, prioritization mitigated observed reentry disparities for female and unaccompanied youth without excluding Black and families with children. Leveraging administrative records with machine learning supplements local decision-making and enables ongoing evaluation of data- and equity-driven homeless services. Community- and data-driven prioritization rules more equitably target scarce homeless resources.

Incidence of SARS-CoV-2 Infection Among People Experiencing Homelessness in Toronto, Canada

People experiencing homelessness are at high risk of SARS-CoV-2 infection. Incident infection rates have yet to be established in these communities and are needed to inform infection prevention guidance and related interventions. To quantify the SARS-CoV-2 incident infection rate among people experiencing homelessness in Toronto, Canada, in 2021 and 2022 and to assess factors associated with incident infection. This prospective cohort study was conducted among individuals aged 16 years and older who were randomly selected between June and September 2021 from 61 homeless shelters, temporary distancing hotels, and encampments in Toronto, Canada. Self-reported housing characteristics, such as number sharing living space. Prevalence of prior SARS-CoV-2 infection in summer 2021, defined as self-reported or polymerase chain reaction (PCR)- or serology-confirmed evidence of infection at or before the baseline interview, and SARS-CoV-2 incident infection, defined as self-reported or PCR- or serology-confirmed infection among participants without history of infection at baseline. Factors associated with infection were assessed using modified Poisson regression with generalized estimating equations. The 736 participants (415 of whom did not have SARS-CoV-2 infection at baseline and were included in the primary analysis) had a mean (SD) age of 46.1 (14.6) years; 486 (66.0%) self-identified as male. Of these, 224 (30.4% [95% CI, 27.4%-34.0%]) had a history of SARS-CoV-2 infection by summer 2021. Of the remaining 415 participants with follow-up, 124 experienced infection within 6 months, representing an incident infection rate of 29.9% (95% CI, 25.7%-34.4%), or 5.8% (95% CI, 4.8%-6.8%) per person-month. Report after onset of the SARS-CoV-2 Omicron variant was associated with incident infection, with an adjusted rate ratio (aRR) of 6.28 (95% CI, 3.94-9.99). Other factors associated with incident infection included recent immigration to Canada (aRR, 2.74 [95% CI, 1.64-4.58]) and alcohol consumption over the past interval (aRR, 1.67 [95% CI, 1.12-2.48]). Self-reported housing characteristics were not significantly associated with incident infection. In this longitudinal study of people experiencing homelessness in Toronto, SARS-CoV-2 incident infection rates were high in 2021 and 2022, particularly once the Omicron variant became dominant in the region. Increased focus on homelessness prevention is needed to more effectively and equitably protect these communities.

Instytucje i organizacje w Monachium na rzecz uchodźców – wybrane aspekty

Russia’s war in Ukraine has been ongoing since 2014, but initially Russian actions took the form of a hybrid war. Ukraine was in peaceful relations with the rest of the world when Russia seized Ukraine’s Crimea without a declaration of war and waged war in Donbass. Its full-scale scope, launched on February 24, 2022, was unprecedented in post-war Europe and caused several million people living in the invaded country to leave Ukrainian territory. The purpose of this article is to show how organizations and institutions in Munich are addressing the influx of refugees into the city, including refugees from Ukraine. As a research hypothesis, it was assumed that in Germany, including Munich, the German experience of 2015 and subsequent years in accepting newcomers from the Middle East played a huge role in solving the problems of refugees from Ukraine after February 24, 2022. The basic research problems are contained in questions such as: what changes in asylum law have been made in Germany by the federal government; who in the city of Munich is entitled to assistance and what benefits does it cover?; what is the assistance to refugees provided by the Office for Housing and Migration in Munich?; what does the Office for the Prevention of Homelessness do?; what are the tasks of the Local Mediation Office?; what are the competencies of the so-called Social Service for the Deaf?; what is the scope of activities of the Office of Return Assistance?; what are the return offices in Bavaria?; what are the activities of the Office for Intercultural Work?; what is the scope of activities of the Foreign Qualification Development Service Center? The leading research method used in the research conducted is institutionallegal analysis.

Predictors of homeless service utilization and stable housing status among Veterans receiving services from a nationwide homelessness prevention and rapid rehousing program

Homelessness prevention and rapid rehousing (RRH) programs are increasingly important components of the homeless assistance system in the United States. Yet, there are key gaps in knowledge about the dynamics of the utilization of these programs, with scant attention paid to examining the duration of homelessness prevention and RRH service episodes or to patterns of repeated use of these programs over time. To address these gaps, we use data from the U.S. Department of Veterans Affairs’ (VA) Supportive Services for Veteran Families (SSVF) program—the largest program in the country providing homelessness prevention and RRH services—to assess the relationship between individual and program-level factors and exits to stable housing, length of service episodes, and patterns of repeated service use over time. We analyze data for a primary cohort of 570,798 of Veterans who received SSVF services during Fiscal Years (FY) 2012–2021, and for separate cohorts of Veterans who received SSVF prevention and RRH services, respectively, during FY 2016–2021. We find that participants’ income, indicators of their health status, their use of other VA homeless programs, and rurality are consistent predictors of our outcomes. These findings have implications for how to allocate homelessness prevention and RRH resources in the most efficient manner to help households maintain or obtain stable housing.

ED-Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use.

Housing insecurity is prevalent among emergency department (ED) patients. Despite a surge of interest in screening for patients' social needs including housing insecurity, little research has examined ED social needs interventions. We worked together with government and community partners to develop and pilot test a homelessness prevention intervention targeted to ED patients with drug or unhealthy alcohol use. We approached randomly sampled patients at an urban public hospital ED, May to August 2019. Adult patients were eligible if they were medically stable, not incarcerated, spoke English, had unhealthy alcohol or any drug use, and were not currently homeless but screened positive for risk of future homelessness using a previously developed risk screening tool. Participants received a three-part intervention: (1) brief counseling and referral to treatment for substance use delivered through a preexisting ED program; (2) referral to Homebase, an evidence-based community homelessness prevention program; and (3) up to three troubleshooting phone calls by study staff. Participants completed surveys at baseline and 6 months. Of 2183 patients screened, 51 were eligible and 40 (78.4%) participated; one later withdrew, leaving 39 participants. Participants were diverse in age, gender, race, and ethnicity. Of the 32 participants reached at 6 months, most said it was very or extremely helpful to talk to someone about their housing situation (n=23, 71.9%) at the baseline ED visit. Thirteen (40.6%) said their housing situation had improved in the past 6 months and 16 (50.0%) said it had not changed. Twenty participants (62.5%) had made contact with a Homebase office. Participants shared ideas of how to improve the intervention. This pilot intervention was feasible and well received by participants though it required a large amount of screening to identify potentially eligible patients. Our findings will inform a larger future trial and may be informative for others seeking to develop similar interventions.

Determinants of Causal Attributions of Homelessness in Croatia

Homelessness is one of the most difficult social issues, and people who have experienced homelessness are often exposed to stigmatisation and negative public perception. Public perception of homeless people also depends on how citizens interpret and what they attribute the causes of homelessness to. Therefore, this paper is aimed at verifying the causal attributions of homelessness based on Weiner’s three-dimensional attribution model. The aim of the research was to examine the determinants of causal attributions of homelessness regarding certain sociodemographic and socioeconomic characteristics and attitudes towards homeless people. The research was conducted on a representative sample of citizens of the Republic of Croatia (n=1 010). The results showed that, on average, the citizens mostly attribute the causes of homelessness to factors related to the circumstances of a person’s life and the broader social context. Differences were found in certain sociodemographic characteristics, whereby women attribute the causes of homelessness more often to the circumstances of a person’s life and the broader social context, while participants with lower socioeconomic status attribute the causes of homelessness more often to structural factors. The results also point out regional differences in attributing the causes of homelessness to different factors. With regard to the attitude towards homeless people, it was found that participants who attribute the causes of homelessness to factors within the broader social context more also perceive homeless people more positively, considering that the state should take greater responsibility in caring for homeless people, and expressing more willingness to help homeless people. The results can contribute to a more effective development and implementation of intervention and policies aimed at sensitising the public regarding the issue and prevention of homelessness. Key words: attribution theory, homelessness, causal attributions, public opinion.

A Network Analysis of the Relationship Between Mental and Physical Health in Unsheltered Homeless Persons in Los Angeles County.

Homelessness is a public health crisis both nationally, in the United States, and internationally. Nevertheless, due to the hidden vulnerabilities of persons who are without shelter, little is known about their experiences during periods of homelessness. The present research adopts a network approach that conceptualizes how the major risk factors of homelessness interact, namely substance abuse problems, poor mental health, disability, and exposure to physical or sexual violence by an intimate partner. Our analysis draws on a large demographic survey of over 5,000 unsheltered homeless persons conducted in 2017 by the Los Angeles Homeless Services Authority. We estimated a network structure for 12 survey items tapping individual risk using the graphical least absolute shrinkage and selection operator algorithm. We then examined network centrality metrics and implemented a community detection algorithm to detect communities in the network. Our results indicated that mental illness and intimate partner violence (IPV) are central measures that connect all other mental and physical health variables together and that post-traumatic stress disorder and IPV are both highly affected by changes in any part of the network and, in turn, affect changes in other parts of the network. A community detection analysis derived four communities characterized by disability, sexual victimization and health, substance use, and mental health issues. Finally, a directed acyclic graph revealed that drug abuse and physical disability were key drivers of the overall system. We conclude with a discussion of the major implications of our findings and suggest how our results might inform programs aimed at homelessness prevention and intervention.

COVID-19 prevalence and infection control measures at homeless shelters and hostels in high-income countries: a scoping review

BackgroundThe COVID-19 pandemic has disproportionately impacted homeless populations and service workers, especially within homeless shelter/hostel settings. To date, there have been few evidence syntheses examining outbreaks of COVID-19 among both homeless shelter residents and service workers and no critical review of infection control and prevention (IPAC) measures. This scoping review offers a much-needed synthesis of COVID-19 prevalence within homeless shelters and a review of pertinent IPAC measures. MethodsWe conducted a scoping review that aimed to synthesize academic and gray literature published from March 2020 to July 2021 pertaining to (1) the prevalence of COVID-19 among both residents and staff in homeless shelters and hostels in high-income countries and (2) COVID-19 IPAC strategies applied in these settings. Two reviewers independently screened the literature from several databases that included MEDLINE, PsycInfo, and the WHO’s COVID-19 Global Health Portal. The extracted data was mapped, categorized, and thematically discussed.ResultsThematic analysis of 77 academic and gray literature documents revealed four key themes: (1) the demographics of COVID-19 in homeless shelters, (2) asymptomatic spread, (3) pre-existing vulnerability of people experiencing homelessness and shelters, and (4) the inconsistency and ineffectiveness of IPAC implementation.ConclusionThis review offers a useful glimpse into the landscape of COVID-19 outbreaks in homeless shelters/hostels and the major contributing factors to these events. This review revealed that there is no clear indication of generally accepted IPAC standards for shelter residents and workers. This review also illustrated a great need for future research to establish IPAC best practices specifically for homeless shelter/hostel contexts. Finally, the findings from this review reaffirm that homelessness prevention is key to limiting disease outbreaks and the associated negative health outcomes in shelter populations. Limitations of this review included the temporal and database constraints of the search strategy, the exclusion of quality assessments of the literature, and the absence of investigation on the influence of emerging variants on public health policy.Systematic review registrationThis scoping review has not been registered on any database; the protocol is available on York University’s Institutional Repository https://dx.doi.org/10.25071/10315/38513.

“Systems trauma”: A qualitative study of work-related distress among service providers to people experiencing homelessness in Canada

Service provision to people experiencing homelessness is challenging and stressful work. Yet, there is a dearth of evidence on how the work experiences of service providers contribute to mental health distress and wellness. This qualitative study examined the contributing factors to workplace mental health among service providers to people experiencing homelessness in Canada, with the aim of establishing a causal theory for how work-related challenges cause distress. In-depth interviews were conducted with 40 service providers working in the homeless service, supportive housing, and harm reduction sectors across Canada. Data were analyzed using a grounded theory-informed approach. The workplace mental health of service providers was centred on the concept of “systems trauma,” which refers to the structural and systemic factors that exacerbate the difficulty of service providers’ work, putting them at-risk of work-related mental health distress. “Systems trauma” had multifaceted causes and consequences, as did the organizational- and individual-level factors that protected service providers against its impacts. Overall, the findings highlight how the same sociopolitical context that negatively affects people experiencing homelessness also shapes the workplace mental health of service providers. Supports for managing moral distress, policy and public initiatives to improve the valuation of work with people experiencing homelessness, dedicated funding for workforce development, and further investment in primary and secondary prevention of homelessness are recommended to promote workplace mental health.

Housing trajectories and the risk of homelessness among new mental health service users: Protocol for the AMONT study.

High rates of mental illness among individuals experiencing homelessness, as well as documented contacts with psychiatric services prior to episodes of homelessness, indicate that early intervention could play a key role in homelessness prevention. Decision-makers and clinical teams need longitudinal data on housing trajectories following initial contact with psychiatric services, as well as on predictors of risk of housing instability and homelessness. This paper describes the AMONT study, a mixed-methods naturalistic longitudinal cohort study of individuals identified as new psychiatric service users in seven clinical sites across the province of Québec (Canada). The goal of AMONT is to examine the housing situations of individuals over 36 months after their initial contact with psychiatric services, and to identify environmental and individual correlates and predictors of housing outcomes. Participants complete a broad battery of instruments at baseline and follow-up assessments after 24 and 36 months. We explore housing stability following an initial episode of psychiatric service use from the perspective of service users, family members, and service providers, through qualitative interviews. The findings from the AMONT study will yield a better understanding of the residential pathways of individuals with mental illness, from their first contact with psychiatric services and for 3 years subsequently. This will inform service providers, decision-makers and managers on the specific housing concerns and issues that affect first-time mental health service users. This in turn can lead to the development and implementation of evidence-informed practices and policies that aim to prevent instability and homelessness.

Preventing homelessness: Exploring the role of clinical psychology in adult mental health services

This paper is based on the first author’s doctoral thesis, which explored the role of clinical psychology in the prevention of homelessness from the perspective of clinical psychologists working in adult mental health services. It includes consideration of current practice and the ways that the profession could contribute to the prevention of homelessness in the future.

The Everyday of Future-Avoiding: Administering the Data-Driven Smart City

Drawing on a two-year ethnographic study of data-driven governance in Los Angeles, this study shows that while much is made of using smart, data-driven approaches to make better, more sustainable, and more connected city futures, the everyday practices of data-driven governance are instead wrapped around efforts to prevent unwanted futures. Put another way, while the rhetoric of the smart city promises a utopia of transparency, efficiency, and well-being, the practical application of smart city tools is cast through their opposites: preventing waste, crime, disaster, and so on. Detailing two administrative projects that aim to prevent through prediction—crime prevention and homelessness prevention—this study asks, What does the coupling of prevention logics and predictive analytics do? I suggest that rendering preferable futures by avoiding unwanted ones expands the epistemic infrastructure of the smart city and, with it, reliance on surveillance.

Evidence-Based Analysis of Social Impact Bonds for Homelessness: A Scoping Review.

Social impact bonds (SIBs) have emerged as an innovative financial instrument designed to support the social service sector in delivering innovative social programs. In particular, SIBs can be used to finance prevention of homelessness among those regarded as vulnerable. There is little evidence that outcomes from SIB-funded programs are significantly different compared to more traditional programs. This is the first scoping review of academic and gray literature that explores the main features and outcomes from all SIBs for homelessness based on evidence, addressing an important gap in the literature. The scoping review provides a transparent and comprehensive approach for mapping areas of this research. A total of 73 studies and articles were found eligible for inclusion. These concerned 32 SIBs for homelessness implemented in the United Kingdom, the United States, Australia, and Belgium. The review found that academic papers on SIBs for homelessness lack evidence-based analysis, while gray literature lacks transparency, especially in evaluation method and outcome. We found that fourteen projects met their target outcomes. The common features of these SIBs were a navigator intervention model, effective partnership working, and use of Special Purpose Vehicles. Our findings show that it is necessary for the managers of SIBs to improve outcome metrics and evaluation methods, support target groups fairly, and attract more private investors to finance SIBs for better addressing homelessness.

Can Emergency Rental Assistance Be Designed to Prevent Homelessness? Learning from Emergency Rental Assistance Programs

Homelessness prevention efforts face an overarching challenge: how to target limited resources far enough downstream to capture those at greatest risk of homelessness, but far enough upstream to stabilize households before they experience a cascade of negative outcomes. How did the COVID-19 emergency rental assistance programs launched in hundreds of localities across the United States respond to this challenge? This paper draws on two waves of a national survey of emergency rental assistance program administrators, as well as in-depth interviews with 15 administrators, to answer this question. Results show that although the vast majority of program administrators considered homelessness prevention to be a key program goal, their programs tended to target rental assistance far upstream of tenants at immediate risk.

Periodic Evaluations of Risk Assessments: Identifying Families for Homelessness Prevention Services

The New York City Homebase program is one of only a few comprehensive U.S. homelessness prevention programs. To ensure that in-depth services are provided to families most at risk of homelessness, Homebase utilizes a structured assessment, the Risk Assessment Questionnaire (RAQ), developed using 2004–2008 data. We evaluated the RAQ’s performance in a more recent cohort of 48,450 families with children applying for Homebase services from 2013 to 2016, testing the predictive power of the current assessment, as well as the power of existing and potential new individual items, using Cox survival models to predict homeless shelter application. The RAQ threshold for in-depth services still effectively identifies shelter risk (13.7%, vs. 5.9% for those below the threshold), suggesting that services are being directed to the highest-risk families. Simulations of a modified RAQ reflecting regression results and program leadership input present assessment adjustments to consider to improve its efficiency and predictive power.

Out of the trenches; prevalence of Australian veterans among the homeless population and the implications for public health

ObjectivesTo examine the prevalence of Australian Defence Force veterans among people sleeping rough and explore their health and social needs relative to non‐veteran rough sleepers. MethodAnalysis of responses to the Vulnerability Index – Service Prioritisation Decision Assistance Tool (VI‐SPDAT) collected from 8,027 rough sleepers across five Australian States from 2010‐2017. ResultsVeterans were found to comprise 5.6% of people sleeping rough in Australia, with veterans reporting having spent an average of 6.3 years on the street or in emergency accommodation (compared with an average of five years for their non‐veterans counterparts). Veterans had a higher prevalence of self‐reported physical health, mental health and social issues compared with non‐veteran rough sleepers. ConclusionsThis is the first study of its kind to elucidate the presence of Australian veterans among people sleeping rough. That they are likely to have spent more years on the street, and have a higher prevalence of health and social issues, highlights the imperative for earlier intervention and prevention of veteran homelessness itself, and its health impacts. Implications for public healthVeteran homelessness has been comparatively hidden in Australia compared to other countries, and consequently the myriad of health, psychosocial and adjustment issues faced by homeless veterans has also been hidden. With heightened attention on veteran suicide and self‐harm, earlier intervention to prevent veterans becoming homeless constitutes sound public health prevention and mental health policy.

The effect of emergency financial assistance on healthcare use

Does providing financial assistance to people who have just experienced an income shock affect their healthcare use? To address this question, we examine healthcare outcomes in a setting where people at risk of homelessness due to an income shock were offered or denied referral to financial assistance quasi-randomly. Among callers who have been screened as eligible for assistance at Chicago’s Homelessness Prevention Call Center (HPCC), some are denied assistance because the availability of funding varies. Conditional on some observable characteristics, funding availability is as-good-as-randomly assigned to callers. We link callers to healthcare utilization records and observe their inpatient hospital stays and emergency department visits. We find that referral to financial assistance has little effect on overall healthcare use–we can reject increases in total utilization greater than 7% of the base rate and decreases of more than 4%. This null effect can be explained, in part, by the fact that the income shock does not significantly change overall healthcare use among those not receiving assistance, suggesting that these individuals can insure health and healthcare demand against these shocks in other ways.

The Homelessness Reduction Act 2017: furthering not fracturing marginalisation of those experiencing homelessness

AbstractThe Homelessness Reduction Act 2017 represents the most significant change to the rights of homeless people in England for decades. Through an analysis of the history of homelessness legislation in England, but focusing on the ‘ground-breaking’ 2017 Act, this paper explores how the homeless population is represented and ‘constructed’ in this new legislation and what this tells us about the place of homeless people in our society. In so doing, this paper exposes how the 2017 Act – a state instrument of apparent homelessness prevention – can be read and understood as contributing to rather than obviating the marginalisation and social exclusion of homeless people.

Establishing a Research Agenda for Suicide Prevention Among Veterans Experiencing Homelessness

Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors (e.g., clinical complexity including multimorbidity, difficulty monitoring risk across systems). To address this challenge, the United States Department of Veterans Affairs (VA) convened the Health Services Research and Development (HSR&D) Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from within and outside of VA. During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness.