Characteristics of homeless alcohol and drug abusers identified through an assertive outreach program

Differences between substance abusers and non-abusers, and among abmers of alcohol, drugs, or both substances, were investigated for 1166 persons identified as homeless or at risk of homelessness by an assertive outreach program in a moderate size city. The 603 self-reported substance abusers included disproportionate numbers of male, Black, unmarried, and currently homeless persons with a history or symptoms of mental illness, who expressed a primary need for assistance dealing with the social service system. Type of abuse was associated with demographic characteristics, length of homelessness, mental illness status, and primary expressed needs. An accurate picture of subgroup differences can aid design and delivery of services for the homeless.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco account for the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco accountfor the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.     

Factors in the Transition to Homelessness in the Chronically Mentally III

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for the previous year were significantly correlated with TBH Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

The variation in family background amongst young homeless shelter users in Denmark

This article analyses variation in the family background of young homeless people in a cohort of young Danes. The study is based on administrative data for individuals who were 18 years old in 2007 and their parents. Homelessness is measured by shelter use over a five-year period. Data also cover education, employment, mental illness, substance abuse problems and placement outside home in childhood for the young persons, and education, employment, civil status, mental illness and substance abuse problems for their parents. A cluster analysis identifies two groups, each comprising half of the young shelter users. In the first group, social marginalisation is transmitted between generations, as most parents have low education and mental illness or substance abuse problems, and are unemployed. In contrast, the young people in the second group come from wider socioeconomic backgrounds, with few of their parents having mental illness or substance abuse problems. These young people develop psychosocial problems and become homeless without strong predictors from their family background. Amongst the young shelter users from families with severe social problems a higher share are in the Not in Education, Employment or Training group. They also have more shelter stays, compared to young shelter users from families with fewer social problems.     

Life Experiences and Vulnerabilities of Homeless Women: A Comparison of Women Unaccompanied Versus Accompanied by Minor Children, and Correlates with Children's Emotional Distress

The histories and service needs of 2 groups of homeless women, those unaccompanied by minor children (n = 46) and those accompanied by minor children (n = 22), were compared, on the basis of their responses to a biennial survey of homeless people in a midsize city in the southeast United States. Mothers of children aged 2–10 also completed a measure of stress symptoms for their children (n = 20). Irrespective of family status group, problems such as substance abuse, history of mental illness, health problems, chronicity of homelessness, and crime victimization tended to cluster together. The findings also suggest that declining and/or inadequate levels of public benefits, Temporary Assistance to Needy Families, and Medicaid-funded health care in particular, have adversely affected the 2 groups, particularly families with children. The young children in this sample experienced elevated levels of stress, and significant associations were found between children's stress levels and certain risk factors of their mothers. Implications for service delivery are discussed.     

Factors in the transition to homelessness in the chronically mentally Ill

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for theprevious year were significantly correlated with TBH. Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

Attitude Shifts: A Qualitative Analysis of Students' Awareness and Reaction to the Homeless

Abstract

Perceptions toward homelessness among 23 undergraduates were explored through individual, semi-structured interviews. Several higher-education institutions have incorporated non-traditional learning components to promote altruism and empathy among students toward the poor and homeless. We focused on one Midwestern university's experiential approach that had a “poverty-immersion” experience within a selected course. We explored how the poverty-immersion weekend altered undergraduates' perceptions of the poor and persons in homeless milieu. Students evidenced marked alterations in their understandings of the homeless: dispelling assumptions to consider individuals in light of personal and circumstantial situations that led to their states of homelessness, and the holistic nature of their needs. Students were challenged to reconsider the attitudes towards the homeless as expressed by those in the middle-class socioeconomic status.     

Social control correlates of arrest behavior among homeless youth in five U.S. cities

This study identified homelessness, substance use, employment, and mental health correlates of homeless youths' arrest activity in 5 cities. Two hundred thirty-eight street youth from Los Angeles, Austin, Denver, New Orleans, and St. Louis were recruited using comparable sampling strategies. Ordinary least squares (OLS) regression results reveal that being arrested for criminal activity is associated with length of homelessness, history of juvenile detention and incarceration, receiving income from theft, substance abuse, and mental illness. Arrests are also associated with interactions between lack of formal employment income and receiving income from theft and between drug and alcohol abuse/ dependency. Understanding the health and situational factors associated with homeless youths' delinquent activity has implications for providing more comprehensive health, mental health, and substance abuse services.     

A life course approach to understanding homelessness of shelter residents

ABSTRACT

Using in-depth interviews of 40 residents from a homeless shelter in El Paso, Texas in the United States, this study examines the etiology, processes, and patterns of homelessness by assessing those confronting homeless spells at different time points and for varying reasons. Our study is guided by the research questions: How did residents of homeless shelters experience transitions and turning points of homelessness? What were the coping resources that homeless people drew on to overcome life adversities? Overall, we found that risk accumulation as a result of different traumatic events, such as death of a family member, marital or relationship breakdown, victimization, unemployment, substance addiction, poor mental health, or discrimination confronted in varied contexts, could serve as precursors or consequences that exacerbated the housing crisis over the course of a life. We recommend that efforts geared toward remediating, alleviating, or preventing homelessness be life course driven. It is only through compassion and empathy rather than criminalizing and stigmatizing that we can help stop the triggers and spread of the downward spiral of homelessness.     

An Exploration of Family Violence Among the Homeless

Abstract

This research found a high incidence of family violence among homeless people. The most common form of violence was physical; the least common was sexual abuse. The data also reported a high percentage of violence among homeless people confronted with mental illness. The policy and practice implications for these findings are discussed.     

Homelessness in Ottawa County Michigan: The “Gap” Population

Abstract

Homelessness has gained increasing attention since the 1980s in the United States. And the numbers of individuals and families experiencing homelessness are growing, with a 20,000 person, or 3% increase, from 2008 through 2009 (“State of Homelessness,” 2011). In spite of persistent investigation and activism on how to prevent and end homelessness, there is not agreement on what causes homelessness or how to stop it (McNamara, 2009). What is apparent, however, is that the homeless population is not homogenous. Therefore, the standard models of service, whether from governmental or non-governmental organizations (NGOs), end up neglecting the needs of portions of the population of people who face homelessness. Governmental and non-governmental service providers have recognized the existence of the unique sub-populations of people who are homeless and are attempting to understand and meet the needs of people outside the prevailing understanding of homelessness. This project works with a collaborative of such service providers through a multiple methodological approach to generate better understanding on the two key areas necessary to create models of service for people who are in the “gap” subsector of the homeless population. First, investigation was undertake to learn systematically who is included in the “gap” population among the homeless community, or, in other words, what traits those who continue to cycle in and out of homelessness, and thus are part of this “gap” population, share. Secondly, the project explores what organizations are currently serving these people, and how are they doing so. In other words, this project also ask what are the trends or practices that exist nationally and locally for serving people who fall into this category of homelessness? Findings suggest central traits including mental illness, substance abuse and a history of incarceration as factors spanning members of the “gap” population. Though there are caveats and practices to be avoided, these people are surviving or even thriving through the service primarily of faith-based non-governmental organizations, unfettered by the policy and funding constraints of governmental entities.     

Risk Factors for Homelessness Among Lesbian, Gay, and Bisexual Youths: A Developmental Milestone Approach

Lesbian, gay, and bisexual (LGB) youths are over-represented in the homeless population. To examine why some LGB youths become homeless, this report compares homeless and non-homeless LGB youths. Of the 156 LGB youths, 48% reported ever being homeless (i.e., running away or being evicted from home). Results indicate that sexual orientation awareness and the initiation of sexual behavior occurred earlier in homeless than in non-homeless LGB youths and predated the first homeless episode. Substance use was more frequent and first occurred at an earlier age in homeless as compared to non-homeless LGB youths; however, substance use occurred subsequent to first homelessness. Childhood sexual abuse was associated with homelessness; and, early sexual orientation development was related to homelessness among youths without a history of sexual abuse. Findings suggest that interventions should help youths cope with their unfolding sexual orientation and work to prevent or address the consequences of sexual abuse.     

Intersection of homelessness and mental health: A mixed methods study of young adults who accessed psychiatric emergency services

Young adults who experience homelessness have high rates of mental disorders, yet low rates of outpatient mental health service use. This mixed methods study examined the intersection of homelessness and mental health in a sample of 54 young adults (ages 18–25) who were hospitalized on a short-term, inpatient psychiatric unit. Nearly half (n = 26) reported being homeless in the prior year and more than a quarter were homeless at the time of admission (n = 15). Qualitative analyses identified key factors that contributed to both mental health problems and homelessness including disrupted support networks, fragile family relationships, foster care involvement, substance use and traumatic events. Homelessness was both a facilitator and a barrier to successfully accessing mental health services to manage mental health symptoms. Findings highlight the interconnection of homelessness and mental health and their common relationship with additional underlying risk factors. Providers across service settings need to recognize the overlap of client populations and provide integrated, trauma informed care to address housing instability, mental health, and substance use together.     

Perceptions of and Reactions to the Homeless: A Survey of Fourth-Grade,High School,and College Students in a Small Midwestern Community

A total of 459 fourth-graders, high school students, and undergraduates completed a Homelessness Questionnaire developed for use in this study. Although participants generally expressed positive and supportive attitudes toward the homeless, attributing homelessness to either social maladjustment (e.g., drug problem) or negative characteristics (e.g., laziness) within the homeless was positively associated with “fear of and anger toward the homeless” for all groups of participants. In addition, perceptions of and reactions to the homeless were influenced by both the participants’ gender and age group. Although high school and college students’ interest in helping the homeless was associated with various attitudes and reactions (e.g., feelings of sympathy/support), their indication that they had ever helped homeless people (either directly or indirectly) was consistently associated only with the acknowledgment that their mother and father had ever helped homeless people (either directly or indirectly). Among these older participants, homelessness in the United States was rated as a more serious problem at the end of the questionnaire than at the beginning.     

Successfully exiting homelessness: experiences of formerly homeless mentally ill individuals

This study aims to identify and describe processes of change enabling achievement of stable housing among homeless individuals. Twelve previously homeless individuals who had maintained stable housing for a period of at least 24 consecutive months provided information through semi-structured interviews on the following topics: (1) the personal experience of homelessness, (2) the process of becoming housed, and (3) the role of significant life relationships. Only the second and third topic areas were included in this discussion. Eight categories were developed and analyzed from the qualitative interviews, including: work/employment difficulties, substance use and/or mental illness, cyclical nature of homelessness, personal motivation, housing-related issues, lessons learned, relationships with family/friends and relationships with service providers. The participants highlighted relationships with family, friends and service providers as central in the processes of achieving stable housing.     

Trauma and health risk behaviors in people with severe mental illness

The current study tests the association between a composite measure of unsafe sex and sharing syringes for drug use with six of the more common lifetime traumatic/stressful events in 421 community mental health clients with severe mental illness (SMI) while controlling for psychiatric symptoms and related problems. A small but significant proportion of respondents said they had injected drugs with a shared needle in their lifetime (30, 7.2%), and a much larger proportion of respondents had engaged in unprotected sex (165, 39.2%). Unprotected sex and needle sharing were significantly correlated (Spearman’s rho = .20, p < .01). Frequency of lifetime traumatic events that occurred at least once was reported by one third to three quarters of clients depending on type of trauma. Regression analysis revealed that substance abuse and lifetime homelessness were significantly correlated with health risk behaviors. Practitioners need to be continuously vigilant to comorbid substance use and the housing needs of people with SMI. Limitations of the study include its cross-sectional design.     

Developmental Outcomes of Children of Homeless Substance-Abusing Mothers

Abstract

This study evaluated the impact ofan extended shelter-based child development/family therapy intervention, called Building Blocks, on the development of children of substance- abusing homeless mothers. The homeless children had greater than expected percentages ofdevelopmental deficits in a number of the developmental domains. Those children who participated in the extended child development/family therapy services were one fourth as likely to have a developmental deficit at 12 months compared to children who did not receive these services. Interventions must be intensive and long-term to improve the developmental outcomes of children with multiple risks ofpoverty, homelessness, and family substance abuse.