Homelessness Prevention Research Articles

Housing rights, homelessness prevention and a paradox of bureaucracy?

In most nations homelessness remains a major injustice. A key response in Wales has been the introduction of a pioneering justiciable right to homelessness prevention and relief assistance. This paper explores the complexities of the new welfare bureaucracy this has created. We explore whether these housing rights invoke a paradox, whereby the positive impacts for citizens are accompanied by distancing and exclusion. The study reveals both a faceless bureaucracy characterised by processes of silencing and subordination propped up by tools of exclusion, particularly impenetrable paperwork, but also a system that can work to grant housing rights to those in need of support. There is no evidence for an utterly ‘faceless tyrant’ of a bureaucratic system, due to the often-inclusive ways that frontline staff operate, frequently at the margins of the law (Arendt 1970). Thus, this paper draws attention to the complexities inherent in a rights-based homelessness system and the paradoxical nature of attempting to grant housing rights.

Associations of intimate partner violence and financial adversity with familial homelessness in pregnant and postpartum women: A 7-year prospective study of the ALSPAC cohort.

To determine whether emotional and physical intimate partner violence (IPV) and financial adversity increase risk of incident homelessness in pregnancy and the post-partum period. Data were drawn from the Avon Longitudinal Study of Parents and Children, which starting in 1990 mailed questionnaires to 14,735 mothers in the UK, over 7 years from pregnancy onwards. Marginal structural models and multiple imputation were used to address time-varying confounding of the primary variables, testing for interaction between concurrent emotional/physical IPV and financial adversity, and adjusted for baseline age, ethnicity, education, partner's alcohol use, parity, depression, and social class. Emotional IPV (HR 1.44 (1.13,1.84)), physical IPV (HR 2.05 (1.21,3.49)), and financial adversity (HR 1.59 (1.44,1.77)) each predicted a multiplicative increase in the discrete-time hazard of incident homelessness. We identified joint effects for concurrent emotional IPV and financial adversity (HR 2.09 (1.35,3.22)) and concurrent physical IPV and financial adversity (HR 2.79 (1.21,6.44)). We further identified a temporary decline in self-reported physical IPV among mothers during pregnancy and up to 8 months post-partum. Emotional and physical IPV and financial adversity independently and jointly increase the risk of incident homelessness. The effects of emotional and physical IPV are comparable to or greater than the risk of financial adversity. Homelessness prevention policies should consider IPV victims as high-risk, regardless of financial status. Furthermore, self-reported physical IPV declines temporarily during pregnancy and up to 8 months post-partum. Screening for IPV in this period may miss high-risk individuals.

How to Address Homelessness: Reflections from Research

This commentary considers policy implications of research in this volume and elsewhere, and we emphasize the benefits of policy approaches that move “upstream,” to the prevention of homelessness. Policies that address the structural causes of homelessness, described by numerous articles in this ANNALS volume, are the furthest upstream and may be the most important in eradicating homelessness, and policies aimed at prevention are next. We point out that effective prevention requires targeting those most at risk, and we call for creative use of data and better coordination with institutions and systems that may be able to identify the antecedents to homelessness. We note that currently, the homelessness shelter system is strained, so we argue for a radical rethinking of its role, with a shift of resources to efforts further upstream. The existing racial disparities in both pathways to and incidence of homelessness bring urgency to making more than marginal policy changes.

Public Assistance and Homeless Shelter Trajectories

We study public assistance participation among homeless shelter users, characterizing the trajectories of public assistance receipt for individuals before and after they enter shelters and analyzing the influence of public assistance participation on subsequent shelter use. Our analysis identifies three distinct groups of shelter users based on personal characteristics and prior patterns of public assistance use. These groups are differentiated by their patterns of no use, increasing use, and high use of public assistance. For all three groups, increased participation in public assistance programs following the first observed homeless shelter entry reduces subsequent shelter use. The analysis draws attention to the potential role of public assistance programs and strengthened coordination of services for the prevention of homelessness.

The activities of public organizations in overcoming the child homelessness and neglect in the Ukrainian SSR in the 1920s

The article describes the activities of public organizations in overcoming child homelessness and neglect of the USSR in the 1920s, showing their mechanism of functioning. It has been proven that public organizations were actively involved in the protection of children and the fight against homelessness, neglect and juvenile delinquency. They provided individual assistance to orphans and half-orphans and were engaged in the prevention of homelessness. These organizations also organized patronage, assisted in the maintenance of childcare establishments, participated actively in the creation of institutions for children of the unemployed, and provided protection of minors’ labor rights.

Homelessness prevention and determinants of housing among first-time and recurrent emergency shelter users in Canada

Primary and secondary prevention initiatives stop people from becoming homeless and help them exit quickly when they do. This study uses administrative data from emergency shelters in Canada from 2010–2016 to compare homelessness pathways and housing outcomes between first-time and recurrent shelter users. It uses a multinomial logit model to identify factors that influence the likelihood of exiting into housing following a shelter stay. The findings demonstrate that first-time users are over two times more likely to exit into newly acquired housing than recurrent users, and that the pathways into and out of homelessness vary significantly between the two groups. The findings suggest that the composition of existing prevention strategies do not sufficiently meet the needs of first-time users experiencing financial and substance use challenges. For recurrent users, federal policies that promote Housing First initiatives increase exits into housing. However, duration of previous homelessness negatively influences housing outcomes, reinforcing the need for early intervention prevention initiatives.

Nothing about us without us: Centering lived experience and revolutionary care in efforts to end and prevent homelessness in Canada

Following the efforts of Disability-Justice advocates who have fought for decades for the representation of people with disabilities in matters that impact them, this paper considers the importance of centering people with lived experience of homelessness and housing insecurity in efforts to end and prevent homelessness. This paper has three interrelated goals: situating the work being done by activists with lived experience of homelessness within broader homelessness prevention and housing rights advocacy in Canada; outlining the importance of centering voices of lived experience in research and advocacy contexts, focusing on both ‘naming’ power and privilege in advocacy work, and navigating embodied knowledge and epistemic authority; and highlighting the ethics of ‘care’ (as theorized by disability and feminist scholars) as fundamental to the process of doing radical and justice-oriented work. To accomplish this, this paper examines two oppositional faces of ‘care’–anonymous care, structured by the demands of neoliberal capitalism, and a potential antidote, revolutionary care. The paper draws on ethnographic fieldwork conducted in 2017 in Whitehorse, Yukon Territory to contextualize lived experience self-advocacy. Additional examples are drawn from the new Canadian Lived Experience Leadership Network, as well as the author’s lived experience of homelessness and activist work in the context of homelessness prevention. Ultimately, this paper offers a critique of efforts to include lived experts in the fight to end and prevent homelessness that, despite good intentions, often reproduce power imbalances–suggesting mutual, reciprocal, revolutionary care as one possible path forward. Power operates in subtle ways in advocacy contexts as an unintended driver of exclusion and discrimination: recognizing and disrupting this dynamic is integral to the goals of ending and preventing homelessness and achieving housing justice in Canada.

Designing tools for ‘joined up’ homelessness prevention: Insights from one case study

AbstractHomelessness is a complex social problem with significant health and economic consequences. Prevention‐based responses seek to reduce the number of people who go on to experience homelessness, but effective homelessness prevention is challenging to implement and can require service integration across mainstream referral organisations and specialist homelessness service agencies. The ‘At‐Risk Screening Tool’ was piloted over August 2018 to March 2019 to enable such mainstream and specialist organisations to coordinate their screening and referral process in the context of homelessness prevention. The tool was used by mainstream referral agencies to assess a client's risk of homelessness, and a tailored referral pathway to a specialist homelessness agency was produced based on this assessment. This article discusses the evaluation of the pilot, exploring three key insights around service integration in a community service context. These insights emphasise the importance of embedding an awareness of staff needs and organisational constraints into the design and application of similar tools.

“The least loved, that’s what I was”: A qualitative analysis of the pathways to homelessness by LGBTQ+youth

Little information is available regarding how young lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals enter homelessness. This qualitative study documents the variations in LGBTQ + youth’s pathways to homelessness via 16 interviews with youths aged 17–25 years. All LGBTQ + youths reported having lived in a family environment marked by neglect, which had led to the loss of self-confidence and trust in their families. These experiences of family neglect constitute the starting point of three different trajectories toward homelessness: (1) being evicted by families that perpetuate heterocisnormative victimization; (2) aging out of youth protection services without a safety net upon exiting; and (3) fleeing from bullying at school in search of freedom and support. Results show the importance of developing homelessness prevention strategies for LGBTQ + youth that consider the heterocisnormativity experienced in their different life environments.

Evolution of the Regulation and Character of Municipal Programmes for the Care of Homeless Animals and Animal Homelessness Prevention in Poland

One of the legal forms of action to be applied by a commune for the care of homeless animals is to develop and implement homeless animal care programmes and prevent animal homelessness. The whole regulations examined below clearly demonstrate that the commune carries out its duties as mentioned above, cooperating with registered and legally operating animal shelters. Derogations from this principle may be regarded as the unlawful fulfilment of commune's own tasks, which is the subject of an audit by the State Veterinary Inspectorate or the voivodeship governor. However, it may be difficult to make a clear identification of the legal nature of homeless animal care programmes and animal homelessness prevention as acts of local law or planning acts as internal law acts. The views of scholars and case-law on this issue are not uniform.

Understanding Mechanisms Driving Family Homeless Shelter Use and Child Mental Health

Homeless shelters throughout the U.S. are overcrowded and under-resourced. Families with children face substantial barriers to timely, successful shelter exit, and prolonged shelter stays threaten child mental health. This community-based system dynamics study explored barriers to timely, successful shelter exit and feedback mechanisms driving length of stay and child mental health risk. Group model building – a participatory systems science tool – and key informant interviews were conducted with clients (N = 37) and staff (N = 6) in three family homeless shelters in a Midwestern region. Qualitative content analysis with emergent coding identified key themes feedback loops. Findings indicated overcrowding delayed successful shelter exit; longer stays exacerbated crowding and stress in a vicious cycle. Furthermore, longer stays exacerbated child risk for mental disorder both directly and indirectly via crowding and caregiver stress. Capacity constraints limited families served, while contributing to ongoing unmet need. Future research should investigate the roles of these dynamic feedback relationships in the persistent vulnerability of homeless families. Service design should prioritize interventions that alleviate crowding and subsequent threats to mental health such as private or scattered-site shelter accommodations, affordable child care, and homelessness prevention to facilitate successful shelter exit and mitigate child mental health risk.

Mortality Outcomes in People Experiencing Homelessness Across England: a population-based study

Abstract Introduction The number of people experiencing homelessness in England has increased since 2010 and a recent systematic review and meta-analysis demonstrated high levels of mortality in this group across high-income countries. In this study we examine the death rates in people experiencing homelessness after discharge from hospital. Methods This is a study of linked hospital admission records and mortality data for two groups. First, a “Homeless group”: people seen by 17 specialist homeless discharge schemes between 1 November 2013 and 30 November 2016. Second, an “IMD5 group”: A matched group of patients who live in deprived areas and have the same age and sex, and were discharged from the same hospital in the same year as the homeless patient. Our analysis entailed calculating mortality rates across each group and by the number of comorbidities. Results The mortality rate for the IMD5 group was 1,935 deaths per 100,000 person years, compared with 5,691 for the homeless group, giving a rate ratio of 2.9 (95% CI 2.5-3.5). The mortality risk increased with the number of comorbidities. Individuals in the IMD5 group with zero comorbidities had a death rate of 831 per 100,000 person-years, compared with the homeless group for which the corresponding figure was 2,598 and or those with 4+ comorbidities were 7,324 (IMD5) and 12,714 (homeless). This suggests a 'super-additive' interaction in which the effect of morbidity on mortality risk after discharge is greater for homeless patients. Survival at 5 years for the homelessness group was for men 80% (95% CI 77-85) and women 85 (95% CI 81-87). Conclusions This study shows that the well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population. Key messages The well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population.

Turning Off the Tap: A Typology for Homelessness Prevention.

As states move beyond simply managing their homelessness crises to looking for ways to reduce and ultimately end homelessness, broad-scale efforts to prevent homelessness are lacking. Experiences of homelessness are often harmful, traumatic, and costly, making a compelling case for why homelessness prevention should be prioritized. In recent years, countries such as Australia, Finland, and Wales have shifted their focus to prevention, but there remains a conceptual and systematic gap in our collective knowledge about what precisely homelessness prevention is, what policies, programs, and interventions are captured in a homelessness prevention strategy, and how to build a framework for orienting our response to homelessness towards prevention. This article begins to fill that gap by providing a definition and typology of homelessness prevention (THP). Our definition offers a schema to clarify the nature of homelessness prevention and to develop a collective response between various policies and practices that can and should be framed as homelessness prevention. Building off of the public health model of prevention and pre-existing homelessness prevention classification systems, our THP complements the definition by specifying the pragmatic nature of prevention initiatives and the range of sectors, stakeholders, and levels of government required to respond to the causes of homelessness. Our typology is made up of five interrelated elements: structural, systems, early intervention, evictions prevention, and housing stabilization. Each of these elements contains actionable strategies that cut across primary, secondary, and tertiary prevention to ensure that people at various levels of risk have access to the tools and resources necessary to find and maintain safe, appropriate, and suitable housing. Together the definition and THP are useful tools to envision a new way forward in how we respond to homelessness.

Reflexive mapping exercise of services to support people experiencing or at risk of homelessness: a framework to promote health and social care integration

ABSTRACT This article describes the process to create a framework to map services for people experiencing and/or at risk of becoming homeless. Using a participative and multi-agency approach the Reflexive Mapping Exercise (RME) was proposed to increase knowledge on what is available to address the health and social care needs of those experiencing homelessness and to encourage synergies between sectors addressing prevention and management of homelessness. Applied in the Scottish context of design and implementation of national and local policies, this framework identify gaps in service provision and can be a tool to improve integration and communication between services to support vulnerable groups. The RME results provided information of the current status of services in eight areas of care, combined with their spatial distribution. The analysis revealed an unequal distribution of services, with major focus on services addressing crisis periods of homelessness and less on prevention and sustainability out of homelessness. The REM has been informing the redesign of services of a local five years homelessness strategic plan (2016–2021) in a Scottish city, with high levels of deprivation, and can be used to create more integrated pathways to health and social care for people experiencing extreme social exclusion.

A psychosocial mediational model of homelessness among U.S. male and female veterans who served in Iraq and Afghanistan.

Few studies have focused on homelessness among Operations Iraqi Freedom, Enduring Freedom and New Dawn (OEF/OIF/OND) veterans, especially female veterans. An explanatory model of homelessness was constructed and tested for each gender. Data collected in the United States from 833 OEF/OIF/OND veterans (41.5% female; Mage =35.22, SD=8.86) who completed the baseline assessment of the Survey of the Experiences of Returning Veterans between September 2011 and July 2014 were analysed. Path analysis was used to examine associations between risk factors and any lifetime homelessness, stratified by gender. Adverse childhood events (ACEs) and low social support were significantly associated with lifetime homelessness for both genders. Social support mediated associations between ACEs and homelessness, after controlling for sociodemographic factors. While sociodemographic risk factors are often considered in homeless prevention, these findings highlight the importance of social support among male and female OEF/OIF/OND veterans, underscoring the need to target this life domain in preventing homelessness.

Clergy Attitudes About Ways to Support the Mental Health of Sexual and Gender Minorities.

This pilot study explored clergy members' attitudes about ways to support the mental health needs of sexual and gender minorities (SGM; e.g., lesbian, gay, bisexual, and transgender people). Participants (N = 86, 46% female, 26% SGMs) were US clergy members from a variety of religious faiths but mostly were leaders in Christian faith communities in the greater Chicago area. Clergy participants completed quantitative and qualitative items asking what types of resources (e.g., workshops, websites, consultations, or testimonies) and delivery format (online or in-person) they perceived as most helpful in supporting the mental health of SGM members in their faith communities. The results demonstrated that clergy members found all listed resources to be helpful to varying degrees, although suicide and homelessness prevention were prioritized above other resources. Clergy members also prioritized resources related to supporting gender minorities to be more informative, relative to resources for supporting sexual minorities. Finally, clergy member preferred information to be delivered in-person instead of online. The degree of openness to LGBTQ health promotion resources did not vary by clergy religious denomination.

Evolving an evidence-based model for homelessness prevention.

While some progress has been made in addressing chronic homelessness through supportive models, a comprehensive solution for housing loss must include prevention. The purpose of this article is twofold: to conduct a review of the literature on the domains of the Framework for Homelessness Prevention; and to use literature on the concept of quaternary prevention, preventing the harms of service provision, to theorise an additional domain. The Framework for Homelessness Prevention draws upon theory from public health exploring primary, secondary and tertiary prevention, and also integrates primordial prevention. This leads to a typology of homelessness prevention that incorporates the following five domains: (a) Structural prevention; (b) Systems prevention; (c) Early intervention; (d) Eviction prevention; and (e) Housing stability. By systematically reviewing the literature we build out the evidence-base supporting these domains. The team used research databases, internet searches and retrospective reference list reviews to identify high-quality journal articles on prevention, which were then sorted by level of prevention. Through this process, we evolved our thinking on the Framework in considering that quaternary prevention was not initially included. Therefore, we explored the literature related to quaternary prevention in the context of homelessness and offer a sixth domain for the Framework: Empowerment. Ultimately, a comprehensive Framework for Homelessness Prevention will support communities and governments to more effectively prevent homelessness through upstream approaches.

Homeless Shelter Entry in the Year After an Emergency Department Visit: Results From a Linked Data Analysis

Housing instability is prevalent among emergency department (ED) patients and is known to adversely affect health. We aim to determine the incidence and timing of homeless shelter entry after an ED visit among patients who are not currently homeless. We conducted a random-sample survey of ED patients at an urban public hospital from November 2016 to September 2017. Patients provided identifying information and gave informed consent for us to link their survey data with the New York City Department of Homeless Services shelter database. Shelter use was followed prospectively for 12 months after the baseline ED visit. We examined timing of shelter entry in the 12 months after the ED visit, excluding patients who were homeless at baseline. Of 1,929 unique study participants who were not currently homeless, 96 (5.0%) entered a shelter within 12 months of their baseline ED visit. Much of the shelter entry occurred in the first month after the ED visit, with continued yet slower rates of entry in subsequent months. Patients in our sample who entered a shelter were predominantly men and non-Hispanic black, and commonly had past shelter and frequent ED use. In this single-center study, 5.0% of urban ED patients who were not currently homeless entered a homeless shelter within the year after their ED visit. Particularly if replicated elsewhere, this finding suggests that ED patients may benefit from efforts to identify housing instability and direct them to homelessness prevention programs.

“I WILL STAY AT MCDONALD'S FOR THE NIGHT. IT'S MY RIGHT TO BE HOMELESS.”; CHALLENGES IN TREATING AN ELDERLY HOMELESS MALE WITH BIPOLAR DISORDER AND MILD INTELLECTUAL DISABILITY AND MULTIPLE MEDICAL ISSUES

Introduction Frequent emergency department (ED) users make up nearly 30% of ED visits nationwide. Although there is no established definition of frequent ED utilization, the following classification was most commonly employed in recent literature: frequent users 4-9?visits/?year, super-users ≥ 10?visits/?year. Homelessness is strongly associated with frequent use of the emergency department services. According to the US department of Housing and Urban Development, the elderly homeless population has increased from 2.9 percent to 4.7 percent over the past 12?years. In addition to an increased risk of recidivism, homelessness is also associated with poor socioeconomic status, psychosocial issues, limited resources, and high incidences of mental health and substance abuse problems. However little research has been done towards identifying and characterizing subgroups within this population. Further classification of this vulnerable population might lead to the development of targeted interventions varying in intensity and composition with the goal of decreasing rates of recidivism. The objective of this case report is to discuss the challenges behind managing a homeless geriatric patient with complex comorbid medical and psychiatric conditions who qualifies as a super-utilizer with greater than 230 ED visits over 4?years who despite engagement is rejecting help and prefers to be homeless. This case also highlights the importance to continuously engage the patient and realizing that acceptance of “help” may not be instantaneous but requires a great deal of patience and trust acquisition. Methods This specific case was reviewed and compared to relevant literature for further discussion. Results Case Report Information: 62 year old Caucasian man, divorced and homeless, with a previous psychiatric history of Schizoaffective Disorder and mild Intellectual Disability and past medical history of hypertension, hyperlipidemia, coronary artery disease s/p stent placement, atrial fibrillation s/p ablation, AICD placement with pacemaker,heart failure, multiple strokes, and COPD presented to the emergency room under police custody after breaking a bus window with his cane and attempting to assault police officers. Review of records indicated approximately 40 inpatient medical admissions, the majority of which were exacerbations of existing chronic medical conditions due to non compliance and 4 psychiatric admissions over 4?years. On initial evaluation, the patient appeared disorganized and irritable with pressured and illogical speech, elevated mood, and paranoia associated with persecutory ideation. He displayed poor insight and judgement but consented to treatment with all prescribed medications and medical consultations. The patient began to improve with a regimen of Aripiprazole and Sodium Valproate over the course of his hospitalization. He became less disorganized and paranoid with speech that was more comprehensible. He was evaluated by the medical and cardiology consult service and recommended cardiology follow up and his pacemaker was interrogated ??? while on the unit. Pt was assisted in contacting his family in Mississippi from whom he was estranged. He was offered placement in supportive housing and case management services. He refused all shelter and housing services stating “I am a free man. I'm at the Mcdonald's nearby and I know the manager who allows me to sit there at night. I prefer to stay on the streets”. He displayed sufficient capacity to refuse offered resources. Although he agreed to follow up with both psychiatric and medical care once discharged, he did not show up for his scheduled appointments. Conclusions Frequent ED users are the focus of much research given the cost burden on healthcare systems. Moulin et al. analyzed the relationship between mental illness and frequent ED visits and found a strong association between homelessness and patients with Medicaid coverage with higher ED visit rates. homeless patients had higher rates of ED visits and hospitalizations and have higher morbidity and mortality when compared to non-homeless patients. Homeless patients with co-occurring medical problems have difficulty in keeping up with follow up and having adequate primary care follow up. Addressing barriers to outpatient care and providing supportive housing were among the most successful interventions found to positively improve healthcare utilization and expenditures. Other research corroborates intensive case management as the most successful intervention for recidivism prevention. Further research should focus on the need for collaborative care models targeting the complexities associated with geriatric psychiatric patients with co-occurring medical conditions as this could lead to improved care for this vulnerable patient population. It is important to analyze cases such as these to identify homelessness risk factors and associated characteristics that might indicate trends for the development of targeted prevention and early intervention strategies towards recidivism reduction and homelessness prevention. This research was funded by: Not applicable

Making the Prevention of Homelessness a Priority: The Role of Social Innovation

AbstractMass homelessness emerged in Canada in the wake of neoliberal policies that reduced government production of housing and other supportive measures. Efforts to reduce homelessness have occurred in three stages: 1) an emergency response in the 1990s that consisted mostly of investment in shelters, soup kitchens, and day programs, 2) the implementation of community plans to end homelessness, combined with the adoption of Housing First as a strategy that seeks to provide reliable shelter as a first step to anyone without it, followed by other remedial services, and 3) the recent development in Canada of early intervention strategies to prevent homelessness from its inception. The second stage was highly successful in dealing with the situation of chronically homeless adults, and many communities have begun to see reductions in homelessness. However effective, this approach does not break the cycle by intercepting potentially homeless individuals in their youth, which is when it begins for many people. Canada is at the beginning stages of the move towards a stronger focus on prevention, aided by a social innovation agenda to identify, design, test, and evaluate preventive interventions to determine which ones will be most strategically effective, setting the stage for implementation and going to scale.