“I’m not homeless,I’m houseless”: identifying as homeless and associations with service utilization among Los Angeles homeless young people

Little is known about homeless young people’s identification of being homeless and how that identity may or may not be associated with service utilization. This study of 444 homeless young people attending Los Angeles area drop-in centers explores the associations of demographic characteristics, homelessness characteristics, negative lifetime experiences, mental health symptoms, technology use, and past month service utilization with identifying as homeless. Fifty-two percent of the sample identified as being homeless. Being Black, a current traveler, and history of injection drug use were all significantly associated with a decreased likelihood in identifying as homeless. However, having fair/poor health, accessing shelter services, and reporting one’s own substance use as a reason for homelessness were all significantly associated with identifying as homeless. There are important service implications for reaching young people who are in need of services but may not identify with the target population label of homeless.     

Prevalence and correlates of diabetes mellitus among homeless veterans nationally in the Veterans Health Administration

Abstract

Background: Homeless people are at high risk for many chronic medical conditions although their risk of diabetes has not been well studied. Current epidemiological studies of diabetes prevalence among homeless adults have been based mostly on self-report data not supported by clinical assessments.

Objectives: To determine the prevalence and risk factors for diabetes mellitus (DM) among homeless veterans in the Veteran Health Administration (VHA).

Methods: The sample included 3?464?364 veterans with documented body mass indexes (BMI), 137?720 (4%) of whom had been homeless. Logistic regression models were used to determine the odds of having DM among homeless veterans compared to non-homeless veterans. Bivariate and multi-variate analyses were then used to identify potential risk factors for DM among homeless veterans.

Results: The prevalence of DM in homeless veterans was 19%. Homeless veterans with DM, compared to those without it were older, more likely to have a BMI?>?40 and more likely to have DM-related co-morbidities.

Conclusions: There is a high prevalence of DM among homeless veterans in the VHA compared to previous reports for homeless adults (8%). Tailored approaches to improve access to DM screening, prevention, and treatment could benefit homeless veterans.     

Overcoming Barriers to Homeless Delivery Services: A Community Response

Homelessness is one of the most pressing social problems today. The Institute of Medicine defines the problem as a failure in the support systems created to prevent the problem and a tighter housing market. The assumption is that the support system should help to prevent the occurrence of homelessness. The Eastern Fairfield County area performed a study to look at the relationship between those services serving people who are homeless and near homeless to determine the availability, accessibility, and adequacy of services for homeless people. The study identified several barriers in the service delivery system. A strategy was then developed to address these barriers. This paper shows how a research process can facilitate a community response to a social problem. The paper presents the steps that were taken so other communities may replicate the process.     

Overcoming Barriers to Homeless Delivery Services: A Community Response

Homelessness is one of the most pressing social problems today. The.lnstitute of Medicine defines the problem as a failure in the support systems created to prevent the problem and a tighter housing market. The assumption is that the support system should help to prevent the occurrence of homelessness. The Eastern Fairfield County area peiformed a study to look at the relationship between those services serving people who are homeless and near homeless to determine the availability, accessibility, and adequacy of services for homeless people. The study identified several barriers in the service delivery system. A strategy was then developed to address these barriers. This paper shows how a research process can facilitate a community response to a social problem. The paper presents the steps that were taken so other communities may replicate the process.     

Barriers and facilitators to shelter utilization among homeless young adults

Rates of shelter use among homeless youth are low compared to use of other supportive services, yet research on barriers to shelter use has been conducted in limited regions, specifically in West Coast or Midwest cities. Additionally, while studies have generally focused on barriers to shelter use, studies on what might facilitate shelter use are lacking. This study explores barriers and facilitators to shelter use among homeless young adults from a large city in the Southwest region. Focus groups were conducted with a diverse sample of 49 homeless young adults ages 18–24. Drawing on models of health service use, findings were categorized into two domains – attitudinal and access. Themes related to attitudinal barriers include stigma/shame and self-reliance/pride. Attitudinal facilitators include the desire to extricate themselves from street life and turn their lives in a new direction. Access-related themes include barriers such as a lack of shelters and services available to meet the needs of youth, adverse shelter conditions, staff attitudes that are not acceptable to youth, restrictive shelter rules, restrictive definitions of homelessness, and a desire to differentiate themselves from older homeless individuals. Certain characteristics or circumstances (e.g., being pregnant), having supportive others, and shelters’ ability to connect them to other services emerged as access facilitators to shelter use. Implications for policymakers, service providers, and future research are discussed.     

Service providers to the homeless mentally Ill: Their thoughts,perceptions, and recommendations for the homeless

A qualitative research study was conducted to obtain an understanding of the people who provide services to persons who are homeless and mentally ill. Service providers were asked about the kinds of services they provide, what they consider beneficial to this population, the kinds of services they would like to provide, and what is needed to alleviate the homeless problem. Services found in the study included, those that meet basic needs, psychiatric/medical services, social services, and activities. Service providers indicated the major service priority is housing and the necessity of: (a) a safe environment, (b) additional psychiatric/social services, (c) day programs, and (d) health care. It is recommended that service providers advocate for the necessary improvements in services including, collaborative workshops and training sessions to the public and to each other.     

Suicidality among homeless people: Testing the mediating effects of self-efficacy and depression

ABSTRACT

This cross-sectional study examined the mediating effect of PTSD on suicide ideation and suicide attempt through two mediators, self-efficacy and depression, among homeless adults. We recruited a non-random, purposive sample of 156 homeless adults from seven homeless people shelters in Kansas. SEM results suggest that self-efficacy and depression were significant mediators between PTSD and suicide ideation, but not between PTSD and suicide attempt. This study’s findings can be used to identify risk factors associated with suicidal behaviors that can be used to design service programs aimed at preventing suicidal ideation and attempt among people who are homeless.     

The system-of-care for homeless youth: perceptions of service providers

Service providers' perceptions of the system of care for homeless youth are described. Face-to-face structured interviews were conducted with staff at homeless youth agencies in Los Angeles County (L.A. County) regarding organizational and staff characteristics, issues affecting youth, types of available services, gaps in services, and barriers to service delivery.Overall, agencies were large, well established, and provided multiple services. Most agencies (62%) were concentrated in Hollywood, a cruise area of L.A. County. Clear distinctions emerged between large and small agencies; large agencies had more resources, more professional staff, were established longer, and were policy advocates. Typical of other US metropolitan areas, services for homeless youth in L.A. County are located in cruise areas, and are not as readily available in other geographic areas. Such geographic barriers to providing a comprehensive and coordinated system of care can affect youth's pathways out of homelessness.     

Challenges in evaluating programs serving homeless families

Homeless families, usually headed by single mothers, are the fastest growing segment of the homeless population. Although families with children make up a large percentage of those experiencing homelessness, there have been few studies on the effectiveness of services for homeless families offered by shelters transitional housing programs, and other agencies. This article summarizes the research that has been conducted on families that are homeless and the limitations of this research for program evaluation. Challenges to program evaluation are identified: the lack of published studies in the area; the fact that program evaluation is rarely built into programs or funded; the methodological issues in tracking families; the difficulty in assessing the impact on families; implementation issues; the range of barriers to housing stability faced by homeless families; and changes in society at large that influence the results of evaluation. Six recommendations are made for meeting these challenges: evaluation from a coherent theory of change; setting reasonable and differential expectations for clients; strengthening linkages with other agencies that serve the same client population; increasing the emphasis on follow-up; utilizing prevention efforts to reduce the number of families that become homeless; and working for expanded low-income housing and expanded subsidies.     

Using WhatsApp for a homeless count

The study analyses how the use of instant messaging (WhatsApp) alongside other ICT tools is adequate to complement the count of homeless people in an area. In particular, it describes the methodology used in order to organize the first official count of homeless people in Girona (Catalonia, Spain). Given that this is the first count of individuals experiencing homelessness in the city, it is difficult to say that it is an improvement, but it could be suggested that the app might make the future counts more efficient. Both professional and volunteers and homeless people used WhatsApp to send information. A total of 283 homeless people were detected. Results show that the usage of this application optimized the results of the count. 36.1% of the data were obtained online. Homeless people, who were reluctant to contact directly with the professional team, used WhatsApp to communicate with them, adding up to 19.4% of the data obtained. Results show how communication between homeless people and health and mental health services can be potentially improved with this type of application.     

“If you’re gonna help me,help me”: Barriers to housing among unsheltered homeless adults

Despite a legally-mandated right to shelter and extensive outreach efforts, an estimated 3,675 homeless individuals were living on the streets of New York City in 2018. Through interviews with 43 unsheltered homeless individuals in the borough of Manhattan (age range 21–74 years), this qualitative study examined barriers they face in accessing housing and other services as well as experiences surviving on the street. Through thematic analysis of the interview data, the most common barriers found were obtaining required identification documents, lack of accessibility of shelters amid complex healthcare needs, waiting as part of the process, and exclusion of pets from shelters and housing options. Themes capturing survival on the street included sleeping safe, avoiding shelters, and meeting daily needs. Virtually all barriers street homeless New Yorkers face stem from bureaucratic policies that, however well-intentioned, do not address their diverse needs. Thus, long delays and poor communication, combined with crowded, unsafe shelters, lead to frustration and alienation. While homelessness is ultimately the result of a severe and chronic shortage of affordable housing, creating accessible, safe, pet-friendly shelter and safe haven options and instituting a smoother, more transparent process for moving from the streets could substantially reduce street homelessness.     

Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective

This article reports on results of a one-day public health survey conducted in six states by homeless youth providers to measure and compare risk factors between lesbian, gay, and bisexual (LGB) homeless youth and non-LGB homeless youth. This article intends to inform the child welfare field on existing gaps in services and areas where more training and technical support is necessary in providing services to homeless LGB youth. The findings point to substantial differences within the homeless youth sample and demonstrate that in addition to the public health risks young people face merely by being homeless, the risks are exacerbated for those who self-identify as lesbian, gay, or bisexual. The article informs child welfare providers and policymakers about the substantial vulnerability of LGB youth beyond that of non-LGB homeless youth and the need to fund programming, training, technical assistance and further research to specifically respond to the complex needs of this population.     

When homeless people are allowed to decide by themselves. Rehousing homeless people in Germany

Several surveys on homeless people in Germany and evaluation results of studies in other European countries show that a majority of homeless people want to live in mainstream, self-contained housing. Research in the UK and in Germany also proves that most homeless single people with special difficulties and rough sleepers, who are often stigmatized as 'unable to live on their own', manage to sustain a normal tenancy, when additional social support is provided for those in need of it. This article presents the results of a long-term evaluation of two projects in Germany, which aimed at the reintegration of single homeless people into normal, permanent housing and were evaluated for a longer period of time. Both projects were part of a research scheme funded by the German Government.     

The invisibility of disability for homeless youth

A largely unexplored complexity in the lives of youth who have experienced homeless is the presence of intellectual, developmental and/or learning disabilities. Although emerging research shows that youth with cognitive disabilities are more likely to become homeless and that rates of cognitive disabilities are higher among the homeless population than the population in general, exploring the intersection of disability and homelessness for youth has not been a priority. In this study, a critical disability and systems failure lens is brought to bear on the vulnerability of youth who experience this intersection. Based on interviews with key informants in the disability, homelessness, education, employment and child welfare sectors in three sites in Ontario, Canada, the invisibility of disability among homeless youth is brought to light. We explore the ways youth with a disability in the homelessness sector are made vulnerable, the insurmountable barriers to getting access to the requisite assessment for disability services and the siloed nature of the homelessness and disability service sectors. An argument is made that “working outside the box” to assist youth to navigate significant system disjunctures is insufficient.     

A portrait of older homeless men: Identifying hopelessness and adaptation

Using participant observation as a homeless shelter volunteer and through face-to-face long interviews with four homeless elders (50+) and six service providers throughout the Greater Cincinnati Metropolitan area, data revealed unique coping strategies and patterns of service use of older homeless people. A state of hopelessness characterized many older homeless people who adapted and functioned in their culture of poverty. Sources of hopelessness were identified. Unique adaptations were noted for certain individuals who either learned to use the services opportunities provided or learned to exploit/abuse the service network. This group of people have found a social niche in which they can function and meet basic survival needs.     

Agency in advanced liberal services: grounding sociological knowledge in homeless people's accounts

This paper aims to understand how people who are homeless respond to advanced liberal social services that endeavour to promote their autonomy and responsible actions. We prioritize the experiences and positions of people who are homeless, and what agentic action means to them. Sociological literature is selective about what accounts are deemed agentic. Agency is associated with accounts that resist or subvert dominant neoliberal framings of homelessness as failure of individuals. When people experiencing homelessness or poverty themselves foreground autonomy or responsibility, sociologists treat them as cultural dopes who have internalized neoliberal discourse. Our analysis is driven by an ethnographic study in an Australian homelessness shelter. We demonstrate how people who are homeless neither outright reject nor completely embrace advanced liberal practices to influence their actions and promote autonomy. People engaged in relational reasoning. Paternalist and advanced liberal social services were both lauded and rejected for their capacities and limitations to realize a good life. We contribute to the discussion for sociology to value people's accounts and experiences, rather than broader social process explaining their accounts. From the perspectives of people who are homeless, we show that just because something appears neoliberal does not mean it should be automatically rejected.     

A qualitative study of smoking cessation experiences and perceptions among homeless young adults

Up to 70% of homeless youth smoke, but there is little information available on their smoking cessation experiences and perceptions to guide cessation intervention efforts. This study examined reasons for quitting smoking, previous experiences quitting smoking, and preferences for smoking cessation programs among homeless young adults. Four focus groups (N?=?27) were conducted in centers serving homeless 18–25 year olds in Los Angeles. Sessions were audio recorded, transcribed, and analyzed by a systematic procedure for qualitative analysis to identify key themes on the topics of interest. The short-term health-related consequences of smoking and high cost of cigarettes were the main reasons participants indicated for quitting or wanting to quit. In terms of barriers to quitting, exposure to peers who smoke and smoking to cope with the daily stressors of homelessness were the two most salient themes. Suggested features of a smoking cessation program for homeless youth included having a group-based component to provide support, offering incentives to attend, and using “scare tactics” as a tool to increase motivation to quit. To increase acceptability and uptake, smoking cessation programs for homeless youth need to focus on the short-term consequences of smoking and harness of the power of peer influences.     

The periphery of care: Emergency services for homeless people in rural areas

Until recently, homelessness in rural areas has received little recognition because of overwhelming assumptions about the urban-centredness of homeless people and their needs. This paper seeks to build on recent research that has begun to uncover some of the problems and characteristics of rural homelessness, by suggesting two significant dynamics which together can shape the experience of different groups of homeless people in rural environments. First, rural places reflect particular local qualities which contextualise both the circumstances of homelessness and the provision of services in response to those circumstances. Secondly, the contemporary governance of homelessness unfolds rather unevenly in different rural areas, producing distinct local service environments with varying degrees of ‘insider’ and ‘outsider’ status in relation to joined-up responses to the needs of homeless people. These dynamics are articulated through three case studies: a remote friary in a deep rural area of southern England; a small hostel run by a vibrant non-statutory organisation in a small town in the west of England, and two advice centres in a coastal resort in the north-east of England. Through these case studies we highlight the importance of both local reactions to the homeless other, and local relations between central government funding, local authority initiatives and charitable organisations, in the production and consumption of spaces of care in settings set in, or serving, rural environments.     

Characteristics of homeless jail inmates: Implications for social work

This study set out to validate the hypothesis (belief) that homeless people were likely to commit minor offenses as solutions to their conditions. Jails, and maybe prisons, would provide three meals a day, a place to sleep, and minimal health care-especially during the winter months. Instead, the data did not support the hypothesis. Contrary to the reported practices of some homeless people in Colorado who are described as committing non-serious but timed offenses to go to jail, it found a homeless population in jail who give a literal interpretation to the political phrase the invisible people. They were not in jail because they were homeless, but instead they were in jail for serious crimes (murder, rape, drugs, robbery) and their homelessness was a side fact. Since it was not likely that this group would seek to address or resolve their homelessness, it was recommended that jail social workers identify their needs to them, track them into social welfare networks, with a designated contact person, prior to their release.