Characteristics of Homeless Alcohol and Drug Abusers Identified Through an Assertive Outreach Program

Differences between substance abusers and non-abusers, and among abusers 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, unmam'ed, and currently homeless persons with a history or symptoms of mental illness, who expressed a primary need for assistance dealing with the social seIVice system. Type of abuse was associated with demographic charaeten'stics, 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 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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Policy Implications from the Study of the Homeless

The article presents contemporary research results, reviews the case histories of selected homeless, discusses inferences deduced from participant observation, and delineates conclusions drawn from an analysis of intake data in facilities for the homeless. Although the problems described by individuals served by the three agencies have different manifestations, the root causes are similar. The data supports the conclusion that although substance abuse and mental illness are often associated with being homeless, they are not usually the principal cause. Clearly the root cause of homelessness is the critical lack of low-cost housing compounded by the inability to find a job. Several complicating factors that contribute to the growing problem of homelessness are also discussed within the context of the increasing importance of the effects of concentrated poverty and the social isolation of the poor. Policy options are outlined that are critical to developing an intelligent response to the problems of homelessness.     

Depression among the homeless

Very little is known about one of the most common mental health problems facing the homeless: high levels of depressive symptomatology. This paper explains variation in the prevalence of depressive symptoms (CES-D) for a random sample of 150 shelter- and street-based homeless persons in the Birmingham metropolitan area. Fifty-nine percent of the sample show the signs of "probable clinical caseness"; yet there is significant variation in the level of symptomatology. A modified version of the social resources model explains 31 percent of the variation in CES-D scores. Although psychological resources play an important role in the distress outcome, as predicted, social supports are found to have limited impact on depression. Life circumstances have significant direct effects on depression. Persons with previous histories of mental illness and with extensive life event histories are more susceptible to distress. Younger persons, the chronically homeless, the street-based homeless, the sick, and the less educated are also more likely to experience depression. This study suggests the importance of understanding homelessness both as a psychological condition and as a complex set of life circumstances and physical deprivations.     

“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.     

Does a Baby Help Young Women Transition Out of Homelessness? Motivation,Coping, and Parenting

Homeless young women experience high levels of stress, challenges to mental health, substance use and abuse, and a lack of housing or of secure housing. This article explores one of the findings from a longitudinal qualitative study designed to follow homeless young women for a 2-year period as they make efforts to transition out of homelessness. Our objective was to determine the assets used by these young women as they survived on the street and to transition out of homelessness. The authors found that one of the primary reasons discussed for leaving homelessness was becoming pregnant and having a baby. However, most of the mothers reported increasing levels of stress as the baby became a toddler. They described themselves as using “soft drugs” as a mode of coping with this stress.     

Psychosocial Problems Associated With Homelessness in Sexual Minority Youths

Sexual minorities are overrepresented among homeless youths, and this is often related to reactions to their status as sexual minorities. While on the streets, they are at increased risk for victimization, substance and alcohol use, sexual risk behaviors, and mental health issues compared to homeless heterosexual youths. This article uses ecological systems theory to examine psychosocial problems associated with homelessness among sexual minority youths and reviews empirical literature examining outcomes related to homeless sexual minority youths including mental health, substance use, and sexual risk behavior. Implications for social work are discussed including practice, policy, and suggestions for future studies.