Contexts of Mother–Child Separations in Homeless Families

Families that contend with the losses, disruptions, and hardships occasioned by homelessness often experience dispersal of children as well. Although a federal initiative on homeless families identified family preservation as a focus of intervention development, there is little research to guide service efforts. This qualitative study of mother–child separations in homeless families with maternal mental health and/or substance use problems identifies precursors of separations (precarious housing, turbulent relationships, substance abuse by mothers and others, institutional confinement, and children's needs) and examines how mothers' responses to these events and conditions interact with social and institutional contexts to shape variations in the course and outcome of separations. Implications for research, services, and policies affecting homeless families are discussed.     

A 12-Month Follow-Up Evaluation of Integrated Treatment for Homeless Individuals With Co-Occurring Disorders

ABSTRACT

This study examined the effectiveness of the Comprehensive, Continuous, Integrated System of Care (CCISC) model in addressing co-occurring mental health and substance use disorders. Clients were eligible for participation if they had co-occurring disorders and were homeless or at risk of homelessness. Forty-eight clients received a comprehensive array of services consistent with the CCISC model. Measures assessing housing, employment, mental health, and substance use were completed at baseline, 6-month, and 12-month follow-up. Results demonstrated significant improvements in housing, employment, mental health, and substance use at 12-month follow-up. These results underscore the effectiveness of implementing evidence-based care.     

Assessing Health Care Needs Among Street Homeless and Transitionally Housed Adults

ABSTRACT

This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral health care services. Nearly a third of participants reported current unaddressed health problem(s); an inability to obtain needed health care; and feelings of unaddressed mental health issue(s) as well as substance abuse problem(s) in the past year. Future research on homelessness and health should focus on identifying different pathways to health and mental health services for this vulnerable population and the outcomes of these interventions.     

An Ecological Systems Comparison Between Homeless Sexual Minority Youths and Homeless Heterosexual Youths

ABSTRACT

This study examined risk and protective outcomes by comparing homeless sexual minority youths to heterosexual homeless youths regarding family, peer behaviors, school, mental health, stigma, discrimination, substance use, and sexual risk behaviors. Structured interviews (N = 147) were conducted with individuals aged 16 to 24 years old in Toronto. Bivariate analyses indicated statistically significant differences between homeless sexual minorities (n = 66) and their heterosexual counterparts (n = 81) regarding all variables: family, peer behaviors, stigma, discrimination, mental health, substance use, and sexual risk behaviors, with the exception of school belonging. Implications for future research are suggested.     

A family support service for homeless children and parents: user and staff perspectives

Children and their parents who become homeless constitute a group of families with a complex range of social care and health needs, including mental health difficulties. In response to this, a local authority housing department established a family support team (FST) that provides assessment and detection of a range of problems, support to parents and children, parenting interventions for child behavioural problems, liaison with other agencies, and referral to specialist services when appropriate. The aim of this study was to establish the perceptions of parents and staff on their experience of the service, and ways of improving it in the future. The study adopted a developmental evaluation approach and used multiple methods, including in‐depth interviews with families; diaries; reflective activities; participatory learning and action; and observation of the FST. The study mapped the innovative service and captured the range of skills in the team and the complexity of agencies the team interacted with. It also identified areas for further development in terms of the mental health needs of children and parents who have become homeless.     

Youth Experiences Survey (YES): Exploring the Scope and Complexity of Sex Trafficking in a Sample of Youth Experiencing Homelessness

ABSTRACT

In the United States, sex trafficking victims have been identified at ages across the lifespan but young persons (under age 25) have been found to have unique vulnerabilities. At-risk youth, such as those who run away from home or those experiencing homelessness, are also at an increased risk of sexual exploitation. To better understand the scope and complexity of sex trafficking among these at-risk youth, a convenience sample of 131 homeless youth aged 12 to 25 years old experiencing homelessness recruited from Kentuckiana youth service providers completed an enhanced version of the Youth Experiences Survey (YES). Univariate and bivariate analyses were conducted. Results indicated that 41.2% of the homeless youth were victims of sex trafficking. The sex trafficked youth were more likely to report previous self-harm behaviors, suicide attempts, and substance use. This study not only provides support for improved service delivery, but also provides essential statistics that should inform internal policy and procedures for youth serving agencies in Kentucky and Indiana. Findings highlight a need for trauma-informed interventions designed to treat not only females but also males and LGBTQ youth. Additionally, service providers should consider partnering with victim providers and clinicians to offer therapeutic groups, individual therapy, and supportive services that increase prevention, education, and wraparound care for clients. In regards to future research, findings point towards a need to better understand the role that trauma and adverse childhood experiences may play in making young people vulnerable to sex trafficking, and encourage the need for testing prevention and early intervention practices among vulnerable youth.     

The Prevention of Homelessness Revisited

Conceptual and methodological problems plague efforts to prevent homelessness. Attempts to identify individuals at risk are inefficient, targeting many people who will not become homeless for each person who will. Such interventions may do useful things for needy people, but evidence that they prevent homelessness is scant. Subsidized housing, with or without supportive services, has ended homelessness for families and played a key role in ending it for people with serious mental illnesses. Other risk factors may be less important once housing is secured. But programs that allocate scarce housing may simply reallocate homelessness, determining who goes to the head of the line for housing, not shortening the line itself. We recommend reorienting homelessness prevention from work with identified at-risk persons to efforts to increase the supply of affordable housing and sustainable sources of livelihood nationwide or in targeted communities.     

Living on the margins: older homeless adults in Toronto

A handful of scholars have acknowledged that, along side the traditional homeless, there are now older people who become homeless for the first time in old age. Few researchers, however, have systematically compared the recent older homeless with the chronic or traditional homeless. In the research presented here, we compare recent older homeless with long-term older homeless adults in Toronto according to their health and wealth, their housing history, and their use of health and social services. Findings indicate that people who become homeless for the first time at older ages have needs that are different from the lifetime elderly homeless and require different approaches to intervention.     

'Don't Leave Me Hanging': Homeless Mothers' Perceptions of Service Providers

Few interventions have been developed for substance-abusing homeless mothers. Among those interventions, high dropout rates (up to 85%) are consistently reported. Understanding homeless mothers' experiences with service providers may be an important first step to understanding ways to increase treatment engagement. Therefore, the current study used qualitative methods to gain a better understanding of homeless mothers' perceptions of service providers. A total of 28 mothers who were currently residing at a homeless shelter in a Midwestern city participated in three focus groups. Overall, mothers held negative perceptions of service providers related to understanding, support, and fear. Based upon this study's findings, recommendations are offered to improve service delivery and guide future research.     

Sexual Health Services for Homeless Youth: A Qualitative Analysis of their Experiences

The sexual health problems experienced by homeless youth bring into question their use of available sexual health services. Using a qualitative typological analysis, this study aims to identify sexual health services utilization profiles for homeless youth, and to understand the role of the homeless experience on the utilization of sexual health services. Individual interviews were conducted with 33 homeless youth (17 men, 16 women) between 18 and 25?years of age. Typological analysis identified four profiles: (1) a targeted use of sexual health services to determine one’s serological status following a relational change during the homeless experience; (2) a limited use of sexual health services to manage sexual emergencies that arise during the homeless experience; (3) a regular use of sexual health services to avoid the risks associated with the homeless experience; (4) a frequent use of sexual health services to obtain support when engaging in prostitution during the homeless experience. This study shows that the precarious and unstable conditions within the homeless experience incite youth to utilize sexual health services in different ways. These findings point to the importance of rethinking sexual health services to better adapt them to the different utilization profiles of homeless youth.     

“Don't Leave Me Hanging”: Homeless Mothers’ Perceptions of Service Providers

ABSTRACT

Few interventions have been developed for substance-abusing homeless mothers. Among those interventions, high dropout rates (up to 85%) are consistently reported. Understanding homeless mothers’ experiences with service providers may be an important first step to understanding ways to increase treatment engagement. Therefore, the current study used qualitative methods to gain a better understanding of homeless mothers’ perceptions of service providers. A total of 28 mothers who were currently residing at a homeless shelter in a Midwestern city participated in three focus groups. Overall, mothers held negative perceptions of service providers related to understanding, support, and fear. Based upon this study's findings, recommendations are offered to improve service delivery and guide future research.     

Socially excluding housing support to homeless substance misusers: two Swedish case studies of special category housing

This article discusses special category housing for homeless addicts, based on case studies of two different housing programmes and using both qualitative and quantitative data. The staff and residents were interviewed about their experiences of the programmes. Longitudinal data were collected on various indicators of substance misuse and the frequency of contact with the social services at different levels. Our findings show that special category housing has positive direct effects on the housing stability of the residents and their feelings regarding their quality of life, but not on their substance misuse. However, the increased housing stability seems to be more a direct effect of their staying on the programme, rather than a long-term effect. Furthermore, although their quality of life improves, the residents still experience a lack of belonging and feel that their lives lack meaningful content. The choice of special category housing as an intervention model thus seems to perpetuate rather than prevent social exclusion and can possibly be described as an expression of 'institutionalised resignation'.     

Homeless young people,families and change: family support as a facilitator to exiting homelessness

The families of homeless young people are most often portrayed as a precipitating factor in their homelessness. However, recent studies, particularly those taking a longitudinal approach, have drawn attention to the enabling role of family members and their positive influence on the housing trajectories of homeless youth. Drawing on selected findings from an ongoing longitudinal qualitative study of homeless young people in Dublin, Ireland, this paper aims to build on this relatively fertile area of research. We demonstrate the supportive role of the families of young people who experience homelessness (often as a consequence of difficult family environments) and specifically examine how family re‐engagement is negotiated and achieved. The findings highlight a number of dimensions of transition and change. Prominent among these is the importance of renewed trust and communication. Young people and their parents also had to accept responsibility for areas of life that previously served to undermine their relationships and were implicated in the circumstances surrounding a young person's premature home‐leaving. Tensions and resistances on the part of young people are highlighted, demonstrating the adaptive mechanisms at work as they attempt to re‐engage with family members. The implications of the findings for social work intervention with homeless youth are discussed.     

Understanding lifetime homeless duration: investigating wave 1 findings from the Journeys Home project

The variation in the amount of time people remain homeless has important policy implications with respect to reducing long‐term homelessness and designing more effective early intervention approaches. This paper examines the factors that influence lifetime homeless duration in Australia using data from the first wave of Journeys Home, a new national survey of individuals exposed to high levels of housing insecurity that employs more rigorous sampling methods than previously used. Those at increased risk of long durations of homelessness over their lifetimes include people who had less family support in childhood, shorter work histories and lower education levels. We also find evidence supporting the idea that people who first experience homelessness at a young age are more likely to experience persistent homelessness.     

Perceptions of Students about Younger and Older Men and Women who May Be Homeless

ABSTRACT

Future human service providers will interact with homeless persons in health, mental health, and social service practice contexts. This study investigated the perceptions of students enrolled in social work courses who are pursuing degrees in human service programs toward older and younger female and male homeless individuals. Respondents (N = 207) were given one of four vignettes in which a character was identified as an older male, a younger male, an older female, or a younger female who was frequently seen near an interstate highway, talking to him/herself and appearing unkempt, thin, and frail. Most respondents perceived the vignette character as mentally ill, neglectful of health, likely to have HIV, tuberculosis, hepatitis A and/or hepatitis B and/or hepatitis C, likely to experience suicidal thoughts/ideation, and to have head lice/scabies/body lice. Older men were more likely to be perceived as military veterans with a history of mental illness and substance abuse. Older women were least likely to be perceived as having a history of substance abuse or using a handout to purchase ethanol. Older women were perceived to be homeless because they could not afford other living accommodations. A general linear model revealed significant differences in 7 of 41 items that respondents answered based on the gender and age of the vignette characters. These perceptual differences between male and female homeless persons will require additional investigation.     

Senior Services that Support Housing First in Metro Vancouver

Housing First is a model and philosophy for housing homeless people in immediate and permanent housing. In order to implement and deliver Housing First, research is essential to understand the system of support services as they currently exist. Guided by principles of community-based participatory research, this paper presents the findings from a senior-focused deliberative dialogue workshop in Metro Vancouver, Canada. Participants (16 service providers and 1 service recipient) identified services and resources available to support seniors in maintaining housing and barriers and facilitators for accessing services. Broadly, data were organized into seven themes: (1) Housing; (2) Home support; (3) Transportation; (4) Information availability, accessibility, and navigation; (5) Cultural diversity; (6) Discrimination; and (7) Funding and financial support. Results found that affordable housing that adapts to changing health conditions, income supports, health services, homecare, transportation, and culturally appropriate and nondiscriminatory informational resources are among the supports most needed for persons as young as 50 years old to succeed under the Housing First model in Metro Vancouver. Barriers to Housing First service provision, including rigid eligibility criteria for chronically and episodically homeless, should be revised to better support the growing number of older adults who are newly entering homelessness in Metro Vancouver.     

Ability of the Behavioral Model to Predict Utilization of Five Services by Individuals Suffering from Severe Mental Illness and Homelessness

Abstract

This study examined the ability of the behavioral model to predict utilization of five specific services in a sample of individuals who suffered from severe mental illness and who were homeless at baseline. Nearly 4000 individuals from 18 sites provided data at baseline and 12 months later for this study. Hierarchical logistic regression was used to analyze the data. The behavioral model did not explain much of the variance of utilization of medical services, housing services, and public support. The behavioral model did explain a moderate amount of the variance of utilization of psychiatric services and substance abuse services. Enabling variables explained more of the variance of psychiatric services than either predisposing or need variables. In contrast, predisposing and need variables explained more of the variance of utilization of substance abuse services than enabling variables. Social support from professionals and self-perceived need for service were the most consistent predictors of all of the service utilization variables.     

Part III: A student learns casework

Abstract

When homeless and severely mentally ill individuals leave housing programs designed to help them achieve stability, their very lives become at risk. Despite the prevalence of this problem and its potentially life-threatening consequences, there is a complete dearth of case studies examining why clients in programs for the homeless and mentally ill suddenly depart from those programs, and how paranoid and other seemingly unreachable clients can significantly improve the quality of their lives. This single case study, utilizing a naturalistic methodology, provides a before and after picture of a client who precipitously left a housing program, then returned two years later in a state of severe physical and mental decompensation. The study focuses on understanding why the client left the program the first time and what could be done to prevent another premature discharge. The findings point to a lack of coordination of care and problems with stable human interaction on the part of those caring for Charles, and are critical to understanding how to engage successfully with homeless and severely mentally ill clients.     

Adverse Childhood Experiences and Substance Use History among Vulnerable Older Adults Living in Public Housing

ABSTRACT

Previous research shows strong correlations between adverse childhood experiences (ACE) and later life health. The current study examines the relationship between ACEs and substance use among older adults living in public housing. Results show that about one-third of participants had four or more ACEs, and ACE score predicted likelihood of substance use history. Over half of older adults with four or more ACEs experienced substance abuse in their lifetime compared to one out of ten older adults with less than four ACEs. Findings shed light on a vulnerable group and point to next steps in research and practice.     

Paternal Risk Factors for Child Maltreatment and Father's Participation in a Primary Prevention Program in Germany

ABSTRACT

Across the globe, the research into the influence of paternal risk and protective factors on the family, as well as on the involvement of fathers in family-related interventions, is lacking. This study utilized 506 families and examined the characteristics of fathers in psychosocially stressed families and associations between paternal risk factors (PRFs: mental health disorder, physical health disorder, young paternity, unemployment, absence of father) and family risk factors (FRFs: problematic financial situation, problematic housing situation, social isolation) for child maltreatment. The identification of PRFs and FRFs was carried out using information from consultations with social education workers and from a risk inventory completed by the mothers. The data analysis revealed an increased incidence of economic problems found in families with fathers having mental health issues, fathers under the age of 22, and unemployed fathers or single mothers. Other factors such as social isolation occurred more often in families with a single mother. The present study underlines the importance of a father's involvement for young families. Future research and program recommendations should always systematically include the father's role in family-related interventions.