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.     

An autopsy-based evaluation of deaths of homeless unknown persons (HUPs)

Background: India is a significant host to homeless unknown persons (HUPs) and subsequently to their untimely deaths due to various reasons. The autopsy-based evaluation has been always important in knowing the exact reasons behind it. Objective: To know about the epidemiological mortality profile such as magnitude, cause and manner of death, seasonality, and year-wise distribution of their untimely and unattended deaths. Materials and Methods: A retrospective autopsy-based evaluation of unnatural deaths among HUPs was done at LHMC, New Delhi for a total duration of 5 years (January 2006 to December 2010). Results: Out of 749 cases in the study group in this duration, 536 deaths have been caused due to some natural events and 213 due to some unnatural events. Among the natural deaths, the pulmonary pathology did contribute for 509 cases. Conclusion: The study population is a vulnerable segment of the society which often suffers the extreme adversity of natural and unnatural events in the form of their deaths. It is a significant host to the pulmonary infections that often spread to the other segments of the society at the point of contact. Thereby it deserves an urgent public health intervention and a policy response for the same for the well-being of HUPs and the general public at large.     

Changing the method of working with homeless people: a photovoice project in Italy

In Italy, many organizations are experimenting with the Housing First (HF) model to promote a change in how they work with homeless people. This change creates some difficulties, especially in promoting freedom of choice in people involved in the HF programs. This study explored the definition of “home” in homeless people’s points of view. The study participants were 5 homeless men involved in a HF program called “The Road Home” implemented in the city of Padua. Data were collected using Photovoice, a photographic method based on participatory action research. During the project, the participants took photographs to illustrate their definitions of “home” and then engaged in a critical dialogue about the images represented in the photographs. The results of the study showed that occupants identified the home as being related to family, friendship, cohabitation, and hope for the future. The Photovoice project provided an opportunity to promote discussions that revealed the true needs of the people involved, and in the meantime, it brought a change to the program and to the community, in addition to promoting the HF model in the community.     

Rolling forward: addressing needs in the homeless community

ABSTRACT

The purpose of this pilot study was to use a bottom up, or grounded, approach to understand, from the perspective of the individuals living in the homeless community, what they feel would enable them to become housed and stay permanently housed. Organizations which serve homeless individuals often use a top down approach and implement programs without asking the homeless what they most need to find permanent housing. This project used intensive interviews to determine the needs of unhoused individuals in a mid-sized city with a tourist-centered economy in the south eastern United States. Working local homeless shelters, and various other intermediaries we collected data from 102 homeless individuals and 11 service providers. The major theme that emerged in our research is that the homeless individuals we interviewed were, for the most part, they were able to meet many of their basic needs, such as securing food, clothing, a place to bathe and wash their clothes, as well as obtain physical and mental care. However, they perceived lack of reliable and affordable transportation to be a significant barrier to obtaining and maintaining employment, making and keeping appointments, and maintaining their social support network.     

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.     

How to integrate digital media into a drop-in for homeless young people for deepening relationships between youth and adults

This paper reports on a curriculum called New Tech for Youth Sessions, designed for homeless young people, aged 13-25. Motivated by the ordinariness of digital media and its importance in communicating with society's institutions, the primary goal of the curriculum was to develop students' life skills for information technology and digital media. A crucial secondary goal was to position students to recognize their self-worth, through meeting challenges, positive communication with adults, and reciprocal peer support. The paper describes how these goals were addressed by incorporating a community technology center into a multi-purpose drop-in for homeless young people and by a curriculum that guides students through an integrated series of activities related to finding employment. The paper discusses the principles underlying the curriculum, the class processes, and the social structure that supports the learning environment. A far-reaching result, based on offering 13 classes to over 75 youth over 16 months, is the hypothesis that instruction in digital media can create visceral, life-affirming experiences of challenges overcome, which can help strengthen relationships between the youth and the drop-in staff. The paper concludes with a discussion of lessons learned for incorporating digital media into drop-ins for enabling access and for improving life skills.     

Validation of interaction-based egocentric elicitation using ecological momentary assessment with young adults currently or formerly homeless

IntroductionSocial network changes are common as individuals transition from homeless to Supportive Housing. Egocentric approaches to elicit network members have been utilized with young adults experiencing homelessness to better understand such socio-environmental contexts; however, such approaches are subject to recall bias. Momentary measurements of one’s social network via Ecological Momentary Assessment (EMA) can support in understanding the accuracy of egocentric elicitation methods.ObjectiveTo examine who is elicited using an interaction-based approach in egocentric social network analysis among currently homeless and formerly homeless young adults residing in Supportive Housing and explore which alters are reported in interactions and how often are they reported when egocentric network analysis is embedded in EMA.MethodsThe present study utilizes interaction-based elicitation embedded within Ecological Momentary Assessment (EMA) in two sub-samples: currently homeless young adults (n = 72) and formerly homeless young adults residing in Supportive Housing (n = 118).ResultsMost egos interacted with three of their top five alters, while only 8.9% interacted with all five. Conversely, only 2% of egos reported that they did not interact with any of their top five. Several differences in alter characteristics were identified by housing status. Alters indicated as being more supportive are elicited first and alters elicited first are interacted with the most.ConclusionsEMA findings suggest that a cross-sectional social network survey of top five alters will results in an ordered list, with the most important/frequent alter being named first and trend downward. Results have implications for future study design involving egocentric network analyses. Present findings indicate qualities of alters present and thus, offer plausible “best practices” when utilizing network elicitation methods, particularly interaction-based methods.     

A follow-up study of homeless women

This article presents an in-depth analysis of the changes observed in 25 homeless women with drug and alcohol abuse problems participating in a case management program. Participation in the program ranged from 6 to 44 months. Thirty-two percent of all participants' situations were considered to have improved, while 20% remained stable. Less improvement was noted in the situations of women followed for 3 years or more (14.3% improved, 28.6% stable). Domains showing the most improvement were housing, financial situation, and substance abuse. Deterioration was primarily attributable to physical and mental health problems. These findings could indicate that although a case management program can initially contribute to improving the living conditions of its clients, acquisitions are difficult to maintain over an extended period. Health and substance abuse play a crucial role in the deterioration process.     

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.     

The experiences of “aging” among formerly homeless adults with chronic mental illness: A qualitative study

Little is known about the life course of older adults with serious mental illness who have also been homeless. Using 44 life history interviews with 25 study participants ages 40 to 62, this study used case study and thematic analysis to examine the lived experience of such individuals as they enter their mid- and later-life years. Participants, whose lives were marred by early-onset substance abuse, symptoms of mental illness and a descent into homelessness, spoke of an awareness of aging and premature mortality. Major themes that emerged were: (1) reflecting on losses, (2) growing older and wiser, (3) struggling with normality, (4) having space and time to reevaluate, and (5) awareness of the future and “time left.” Life histories which focus on the person-in-context and their subjective experiences provide a viable research method to further the understanding of one of the most underserved and hardest-to-reach populations.     

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.     

A community of singers: employing exploratory cluster analysis to reveal profiles of psychosocial characteristics among members of a street choir for homeless and formerly homeless individuals

This exploratory study employed cluster analysis to identify profiles of resilience, social support, stress, and mental health among members of a homeless and formerly homeless street choir; we examined the association between choir attendance and cluster membership, and the interaction of cluster membership and race. Respondents (N?=?111, 66% African American, 84% homeless) had participated in the choir for an average of 12 months (SD?=?12.02). We stratified the analysis according to homelessness status. Among those housed, k-means cluster analysis revealed two profiles: (1) relatively resourced but lower resilience, and (2) high resilience. Three profiles emerged among the homeless: (1) psychologically vulnerable, high stress and mental health concerns; (2) relatively resourced, showing average levels of mental health concerns and social support, minimally elevated stress, and higher resilience; and (3) low resilience. Examining the interaction, non-African American, housed participants in the high resilience cluster reported the most frequent choir attendance (M?=?4.00, SD?=?0.00); among the homeless, non-African Americans in the psychologically vulnerable cluster reported the most frequent attendance (M?=?3.88, SD?=?1.25). Results support the need for programs that address higher order needs concurrently with housing; they also highlight the ongoing need to provide particular outreach to minority populations.     

A qualitative analysis of suicide risk factors,preferred means,and means restriction feasibility within a homeless shelter environment

Suicide completion rates among homeless individuals are approximately nine times higher than the general population. The purpose of this study was to capture the state of social support among homeless individuals, understand how homeless community members support peers in crisis, examine the awareness of suicidal ideation, identify common methods for suicide, and generate strategies for means restriction within a shelter. Twenty individuals residing at an emergency shelter were interviewed. Participants were of diverse cultural identities overrepresented in the sample relative to the general population. Interviews revealed that 40% of participants lacked social support. However, the majority indicated that if they encountered someone at risk for suicide, they would provide support and encouragement to the at-risk individual. Almost half of participants reported knowing of an individual in the shelter who had previously attempted suicide and/or was currently or previously feeling suicidal. Overdose was identified as a primary method for suicide; however, the majority of participants were unable to generate strategies for means restriction. The present study offers a glimpse into the experience of homeless individuals and provides valuable information regarding risk factors for suicide within this highly marginalized and underserved population.     

Home for now: A mixed-methods evaluation of a short-term housing support program for homeless families

The use of short-term rental subsidy vouchers offers a new approach to addressing the housing needs of families facing homelessness. In Massachusetts, the Family Home pilot program placed homeless families in housing instead of shelter, providing two years of rental subsidy plus support services with the goal of enabling families to maintain market rate housing. This mixed-method case study complements staff and participant interview data with participant survey and administrative data to evaluate the implementation and short-term outcomes of Family Home in one region. Data point to improved family well-being in housing but also persistent barriers to achieving longer-term housing and economic stability. Of the families who had exited the program at the end of the study, one quarter were able to retain their housing at market rate, only 9% returned to shelter, and one in five moved in with families/friends. Lack of affordable housing in a high rental cost region and jobs that pay living wages were among the major reasons that families struggled to maintain housing. This research points to the need for integrating supportive services from the program's start, including targeted workforce development, to plan for the end of the short-term rental subsidy.     

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.     

Everyday discrimination among formerly homeless persons in permanent supportive housing

ABSTRACT

Experiences of discrimination are associated with poor health and are particularly common among persons experiencing homelessness. Permanent supportive housing (PSH) provides a foundation for improved well-being among persons with homelessness histories, but research on discrimination among this population is limited. We examined changes in experiences of, and perceived reasons for, everyday discrimination when persons moved into PSH. 421 adults in Los Angeles County completed baseline (pre-housing), 3-, 6- or 12-month post-housing structured interviews. Generalized linear mixed models (GLMM) examined change in discrimination outcomes, controlling for demographic characteristics. Everyday discrimination experiences decreased significantly when persons moved from homelessness into PSH, and remained consistently lower across the first year in PSH. Reports of homelessness/poverty, race/ethnicity, and neighborhood as reasons for discrimination also decreased from baseline levels. PSH may offer respite from everyday discrimination, but the persistence of discrimination and particularly racism in society requires structural solutions addressing implicit bias and systemic inequities.     

Modeling the dynamism of HIV information diffusion in multiplex networks of homeless youth

Cascade and threshold models are widely used to predict information diffusion in social networks, yet their characterization of networks as static and monoplex limit their ability to accurately predict how information propagates in dynamic, multiplex social environments. Using data from a peer-led HIV prevention intervention for homeless youth, we determine whether manipulating the baseline social network by (1) adding ties observed at later time points, and (2) accounting for alternative relational contexts improves each model’s predictive accuracy. Results show that the addition of new ties improves the performance of both models, while substituting the context of interaction yields only minor improvements.     

Moving On From Supportive Housing (MOSH): Development and evaluation of a transitional skill-building curriculum for providers helping residents exit homeless services

This article describes the development and evaluation of MOSH (Moving On From Supportive Housing), a transitional skill-building curriculum for providers helping residents exit homeless services to mainstream housing without embedded supports. In this evaluation, we assess the feasibility, acceptability, fit, and potential efficacy of the MOSH curriculum to improve proximal provider-level outcomes, including self-efficacy to provide MOSH-related independent living skills and supports. Homeless-services providers (N = 49) from a range of programs and settings participated in the training. Findings from focus groups and pre- and posttest surveys indicate high levels of overall satisfaction with the training. The majority of trainees perceived the training to be useful to their work and potentially useful for service recipients, felt the training would fit well within their existing day-to-day work, and said they were very likely to use MOSH skills in such work. Statistically significant improvements in self-efficacy regarding all skills but one were also found. MOSH holds promise as an intervention that can enhance provider practice and promotion of independent living skills in homeless services. Although these initial findings on MOSH are encouraging, further research will be needed to evaluate provider knowledge gains and effective use of these skills in practice.     

Factors preventing the social reintegration of homeless persons: A comparison between residents of long-stay hostels and individuals living on the street

Homelessness is a major social issue in all Western countries. In France, many homeless persons do not have access to the accommodation and help with social reintegration provided in long-stay hostels, and remain on the streets or in other forms of emergency shelter. The objective of the present study is to identify the variables preventing access to these hostels and, more generally, to a process of social reintegration. We compared a group of 10 individuals housed in long-stay hostels with a group of 16 who were still living in the streets. All participants were assessed on the Hospital Anxiety and Depression Scale and underwent a semi-structured interview. Results showed that individuals who had not been admitted to a hostel were characterized by high levels of depression and anxiety, the attribution of responsibility to external factors, a vagrant lifestyle, a lack of social support, a negative approach to reintegration, and an inability to look to the future. This study highlights various factors explaining the reintegration difficulties encountered by a proportion of the homeless population. It suggests new ways of improving support for the homeless.