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

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.     

Longitudinal cost of services in a homeless sample with cocaine use disorder

ABSTRACT

Homeless people with cocaine use disorder have multiple comorbidities and costly service needs. This study examined service costs associated with cocaine use and substance service use in substance, psychiatric, and medical service sectors. 127 homeless participants with cocaine use disorder were interviewed annually. Self-report and agency-report service use and cost data were combined. Pairwise comparisons were made with cocaine abstinence and substance service use in relation to mean and yearly proportional service costs in 3 service sectors. Among substance service users, the achievement of abstinence was not associated with decreased substance service costs. Cocaine abstinence was associated with proportional reduction of substance service costs over time. Substance service use was associated with proportional reduction of psychiatric service costs over time among the abstinent subgroup. Conversely, substance service use was associated with continuing higher medical service expenditures in the abstinent subgroup and higher psychiatric service expenditures in those not abstinent. Homeless individuals who achieved cocaine abstinence after using substance services had decreased substance service expenditures. Individuals with continued substance service use had greater medical and psychiatric service costs. Policy-based on maximizing benefits while minimizing costs appears insufficiently complex to incorporate the multiple needs and associated with the costs of treating homeless populations.     

“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.     

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.     

Forms of advocacy in social welfare work with homeless women

The article examines the practices of social welfare work with homeless women. The question asked is, what forms of advocacy can be identified in these practices, especially from the perspective of welfare rights? The research is conducted in a support point open to all homeless women, located in a large Finnish city. The data consist of a diary kept mainly by three practitioners between 21 August 2000 and 21 September 2001. The analysis, which focuses on 359 entries, shows that the diary contains elements of four different forms of advocacy: best interest advocacy; self- and consumer-controlled advocacy; partnership and personal advocacy; and citizen advocacy. The conclusions from the research have relevance to work with the most vulnerable groups in general and are of three kinds. Firstly, all forms of advocacy are significant, for they complement each other and make up for the deficiencies in other forms. Secondly, the support point functions as a refuge for the homeless women, from which contacts with other service systems are organised and negotiated. Thirdly, this kind of advocacy is needed, because vulnerable groups have the greatest risk of being excluded or mistreated in different service systems.     

Policing the homeless: An ethical dilemma

The homeless challenge police to reconsider their social role, the constituency they serve, the alliances they should form, and the activities they should engage in. This paper considers three conceptions of the police role — law enforcement, order maintenance, and social peacekeeping — and indicates how they impinge on treatment of the homeless. The moral challenge posed by the homeless favors the peacekeeping conception, but the inadequate resources available to police make it essential that they consider alliances with social service organizations, and even some form of collective lobbying or public conscientization.     

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.     

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.     

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.     

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.     

A social comparison perspective of treatment seeking by the homeless

The homeless will readily list ailments they claim to have, yet they will also claim that such ailments are not a problem and do not warrant treatment. In an attempt to understand this apparentparadox, data from a sample of homeless individuals were re-analyzed from a social comparison perspective. It was hypothesized that increased entrenchment in homelessness (increased isolation from nonhomeless environments and further involvement in the homeless environment)—operationalized by longer time spent on the street and a greater number of street friends—would lead homeless individuals to alter their perceptions of what constitutes a problem worthy of treatment. Results supported this hypothesis, in direction, and in almost all tests conducted. The involvement of adaptation level theory in such a social comparison process and the implications for intervention and treatment are discussed.     

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.     

What is mixed in welfare mix? Welfare ideologies at stake in the Lithuanian case of social service delivery

The article deals with the development of social welfare and social services in Lithuania by describing cultural contexts and disclosing evaluations of social service providers and recipients and needs of social service delivery. The authors of the article discuss the changing role of the state, pose a question as to what the institutions and the actors are and to what extent should they participate in the creation of social welfare. One of the aims of this paper is to describe the development of the welfare mix in Lithuania, by showing that welfare is inevitably woven into the historical, economic, political and social context; the distinctive cultural configuration of the welfare mix in social services delivery in Lithuania is revealed. Empirical research (survey of social services recipients and providers) presented in the article discloses that actors of social services delivery experience tension and ambiguity between the demand of neoliberal policy to choose and be responsible and the expectation that the state will participate in the social service market. At the same time social services recipients and providers express a need for different actors to take an active part in the welfare system.     

HIV seroprevalence and clinical characteristics of severe inpatient mentally Ill homeless

Two related studies were carried out at a state psychiatric center unit designed for the long-term hospitalization of homeless mentally ill people removed from the streets of New York City and taken to hospitals for psychiatric treatment. The first study, a chart review of 102 patients, documented high rates of severe psychiatric illness, alcohol and other substance use, and untreated medical problems. Patient histories showed significant social disadvantages, including high rates of criminal activity and inability to complete high school or establish long-term relationships. Our second study anonymously tested 87 patients between the ages of 18 and 59 for the presence of HIV antibodies. An overall seroprevalence rate of 5.8% is reported. Men and women in this population are likely to have similar rates of HIV infection. Being young, and Black, or Hispanic appears to be associated with increased risk. This disenfranchised population urgently needs a broad array of social, medical, and psychiatric services. Assertive community outreach programs are necessary to assure delivery of services to this population.     

Social support among homeless and housed mothers: an integrative review

Homelessness has been associated with levels of stress beyond the normal strain of living in poverty. For mothers who are homeless, support from their social networks may provide a buffer from some of the stresses associated with being homeless. To better understand the relationship between social support and female-headed homeless families, an integrative review was conducted of 12 research articles that compare social support among low-income housed mothers and homeless mothers, using guidelines set forth by Ganong. The included studies revealed four significant attributes of social support among housed and homeless mothers: size of the social support network; composition of the social support network; contacts with members of the social support network; and perceived support from members of the social support network. Nurses who work with homeless families are in a position to help develop ways for these families to cultivate and maintain their social support networks while homeless. Nurses can be available to offer support, including the necessary mental health services or referrals.     

Genealogy and Ideology of Taiwan Homeless Delivery Services

Abstract

Since the mid-1990s, the number of homeless in Taiwan has been increasing. Politicians, policy makers, and service providers frequently debate whether the government should provide services for the homeless. Democracy and economic change have increased the number of homeless in Taiwan. However, the current homeless problem is also a product of a conservative welfare ideology based on family values and moral judgments. This study has implications for social workers and policy makers. (1) A universal principle for nationwide homeless delivery systems is required. (2) Restrictions that prohibit adults and youths with families providing little support from entering shelters should be eliminated. (3) Employment consultation and housing compensation should be provided to assist street people in re-entering mainstream society. (4) Supportive relationships with mainstream- based outreach services should be developed.     

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.     

The need for safe spaces: Exploring the experiences of homeless LGBTQ youth in shelters

Studies indicate LGBTQ youth are at higher risk of homelessness (2–13 times) than their heterosexual cisgender counterparts and that they represent a substantial portion of youth utilizing housing and shelter services. Some authors have provided anecdotal (rather than empirical) examples of LGBTQ youth experiencing abuse or mistreatment in shelters; most studies focusing on LGBTQ homeless youth have been conducted in large cities and have rarely collected data from both youth and providers. Using an exploratory, grounded theory approach, this study utilized data from interviews with LGBTQ youth with a history of homelessness as well as service providers working with this population in a mid-sized Northeastern city. Findings suggest youth experience multiple challenges, barriers, and mistreatment in the shelters; further, data suggests several ideas about how to transform shelters to better meet the needs of LGBTQ youth.