Severity of homelessness and adverse birth outcomes.

Predictors and the prevalence of adverse birth outcomes among 237 homeless women interviewed at 78 shelters and meal programs in Los Angeles in 1997 were assessed. It was hypothesized that they would report worse outcomes than national norms, that African Americans would report the worst outcomes because of their greater risk in the general population, and that homelessness severity would independently predict poorer outcomes beyond its association with other adverse conditions. Other predictors included reproductive history, behavioral and health-related variables, psychological trauma and distress, ethnicity, and income. African Americans and Hispanics reported worse outcomes than are found nationally, and African Americans reported the worst outcomes. In a predictive structural equation model, severity of homelessness significantly predicted low birth weight and preterm births beyond its relationship with prenatal care and other risk factors.     

Decreasing Psychiatric Symptoms by Increasing Choice in Services for Adults with Histories of Homelessness

Despite the increase in consumer-driven interventions for homeless and mentally ill individuals, there is little evidence that these programs enhance psychological outcomes. This study followed 197 homeless and mentally ill adults who were randomized into one of two conditions: a consumer-driven “Housing First” program or “treatment as usual” requiring psychiatric treatment and sobriety before housing. Proportion of time homeless, perceived choice, mastery, and psychiatric symptoms were measured at six time points. Results indicate a direct relationship between Housing First and decreased homelessness and increased perceived choice; the effect of choice on psychiatric symptoms was partially mediated by mastery. The strong and inverse relationship between perceived choice and psychiatric symptoms supports expansion of programs that increase consumer choice, thereby enhancing mastery and decreasing psychiatric symptoms.     

Homelessness, Mental Illness, and Criminal Activity: Examining Patterns Over Time

This study examined whether street homelessness, sheltered homelessness, and the severity of psychological symptoms predicted non-violent and violent crime among 207 mentally ill participants who were homeless at baseline. Participants were interviewed at 9 time points over 4 years. Hierarchical linear modeling (HLM) was used to examine whether changes in homelessness status and symptom severity predicted changes in criminal activity over time. Results indicated that homelessness both on the streets and in shelters and psychological symptom severity predicted increases in non-violent crime. Sheltered homelessness and symptom severity predicted increases in violent crime, although street homelessness did not. A separate mediational analysis with 181 participants showed that the relationship between diagnosis of a psychotic disorder and both non-violent and violent criminal activity was partially mediated through the severity of psychotic symptoms. Implications for research and intervention are discussed.     

Homeless women with children. The role of alcohol and other drug abuse.

For some women with children, alcohol and other drug use may be an important risk factor for homelessness because it may interfere with a woman's capacity to compete for scarce resources such as housing, employment, or services. The impact of various policy decisions on homeless women, their dependent children, and the family unit is considered, including women's right to privacy, criminalization of drug use, and scarcity of appropriate treatment programs for homeless women.     

How Does Homelessness Affect Parenting Behaviour? A Systematic Critical Review and Thematic Synthesis of Qualitative Research

The adverse social and physical conditions of homelessness pose significant developmental risks for children, which may be compounded or buffered by the quality of parenting behaviour they are exposed to. There is currently a limited understanding of how parents approach their care-giving role and responsibilities while adjusting to the experience of homelessness. Advancing knowledge in this area is essential for developing acceptable, appropriate and effective interventions to support highly marginalised and vulnerable homeless families. This review explored homeless parents’ perceptions of how homelessness affects their parenting behaviour and identified adaptive strategies that parents may use to mitigate the potentially negative impacts of homelessness on the quality of care-giving. A systematic search of four electronic databases (ASSIA, PsycINFO, Web of Science and MEDLINE) identified 13 published qualitative studies, all originating from the USA, which explored parenting behaviour in homeless contexts. The studies were critically appraised using the CASP qualitative assessment tool. Thematic synthesis identified the following determinants of parenting behaviour; negative self-concept in the parental role, parental mental health, material resources, challenges to autonomy and self-efficacy, daily hassles, physical environment and service context, stigma, child characteristics and lack of support. These were synthesised thematically using existing models of parenting determinants and positive parenting. Findings indicate substantive impacts of homelessness on parental mental health, parenting authority, material resources, parenting environments and social support. Parents developed a number of adaptive methods to negotiate the challenges of homeless parenting such as maintaining a positive mindset, cherishing the parental role and developing practical strategies. We conclude with recommendations that service providers should tailor parenting support to resource-constrained circumstances and that further research is required in order to better understand experiences of homeless parents in other international contexts.     

Homelessness in the mind

In this article, I am going to present several related, themes, based on data gathered from years of consulting to homelessness services, particularly staff and management working in the voluntary sector, who are responsible for the teams that deliver care to some of the most vulnerable and challenging individuals in society. The three concepts that I will put forward are as follows: firstly, the idea that there is a fundamental human concern, or state, regarding homelessness. What I will refer to as 'homelessness in the mind'. I will consider this from psychoanalytic and systems-psychodynamic viewpoints and explore the idea of an internalised homeless state and the structures which attempt to contain it. Second, is an almost universal hatred and repulsion of this state and a need for its expulsion and relocation, in phantasy, into individuals and services associated with the homeless population. Next, I will link the concept of homelessness in the mind with Bion’s idea of sophisticated/specialised basic assumption groups; groups, budded off from mainstream society to contain specific psychological aspects of the population. I will suggest that the associated psychological stressors and pressures of homelessness, and ‘homelessness in the mind’ and its subdivisions, dependency and shame, relate to aggressive and violent elements associated with the inability to correctly process, engage with, or contain, specific internal states related to homelessness. Throughout, I will refer to my practice as an organisational consultant, and my experience of working with managers and teams who work with the homeless population.     

Trauma Among Unaccompanied Homeless Youth: The Integration of Street Culture into a Model of Intervention

Homeless adolescents comprise a population particularly vulnerable to developing symptoms of post-traumatic stress. Research has shown that prevalence of trauma-related symptoms among homeless youth living in shelters and on the streets without families is approximately 18%. The detrimental effects of traumatic experiences often inhibit homeless youths' ability to employ the psychosocial skills necessary to a transition out of homelessness. Consequently, interventions targeting the mitigation of post-traumatic stress symptoms among this population are crucial. This article aims to address the symptoms and needs of unaccompanied homeless youth who experience post-traumatic stress disorder symptomatology and offers a strength-based intervention framework for understanding, identifying, and beginning to address trauma-related mental health needs within the cultural context and experience of youth homelessness.     

Utilizing Participatory Mapping and GIS to Examine the Activity Spaces of Homeless Youth

Although previous studies have informed our understanding of certain aspects of youth homelessness, few studies have critically examined the spatial and social environments utilized by youth as they navigate life on the streets. This study employed participatory mapping and Geographic Information Systems (GIS) to examine the activity spaces of homeless youth as they relate to sense of community and psychological well‐being. Participants were 28 youth experiencing homelessness in Portland, Oregon, USA. Results suggest that youth engage most frequently in service‐related activities, and their activity participation is significantly associated with sense of community and psychological well‐being. The utility of innovative participatory methods for better understanding the diverse experiences of homeless youth is discussed alongside examination of their practical implications.     

Homelessness Among Families, Children, and Adolescents: An Ecological–Developmental Perspective

This paper reviews and evaluates the literatures on children in families that are homeless and on adolescents who are homeless on their own. After presenting several emerging theoretical approaches, we propose a broad ecological-developmental perspective that recognizes that, although persons in these groups often lack resources and experience negative events that can amplify the risk for poor outcomes, they also have resources and adaptive potential. The perspective also recognizes that homelessness may have different meanings and outcomes at different points in development and that we need to consider interactions between individual development and multiple levels of social organization in order to foster new solutions to homelessness. On the basis of this perspective, we discuss directions for treatment and preventive interventions as well as social policy.     

The epidemiology of alcohol, drug, and mental disorders among homeless persons.

This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.     

Homelessness and the problem of containment

Homelessness is a problem that is hardly spared to any society in our modern world. Usually discussed by people concerned with social policy, sociology, public health and politics, homelessness has only quite recently begun to command the attention of professionals concerned with psychological and psychotherapeutic processes. Following from the author's experience of working therapeutically with homeless people, as well as in discussions with homeless services, the paper follows a line of thinking around homelessness that is explicitly psychodynamic in orientation. The central argument here is that homelessness is an experience that is, so to speak, waiting to happen. Homelessness is portrayed as a natural extension of an underlying experience of the sister states of uncontainment and alienation. I argue that the homeless person not only experienced a lack of containment in his earliest interactions, but has grown through life with significant difficulties in this area. Homelessness then is an extreme response to a deeper psychological reality that projects into a part of the person's life the agonies associated with uncontainment. Homelessness is the realization of an internal situation –a shifting of a personal struggle into a new and more visible stage. This view of homelessness is designed to provide an amendment to current views that privilege the roles of poverty and social exclusion in the origins of homelessness rather than as an alternative account of the origins of homelessness.     

Peer Substance Use and Homelessness Predicting Substance Abuse from Adolescence Through Early Adulthood

Adolescents who experience homelessness are at higher risk for abusing substances, and for being exposed to substance-using peers. The current study used a longitudinal design to track substance abuse, affiliation with substance-using peers, and episodes of homelessness among a sample of 223 adolescents who were housed at the baseline data collection and 148 adolescents who were housed at baseline. Participants were interviewed at six waves over 6.5 years, covering an age range from 13 to 25. Many participants experienced a recurrence of homelessness during follow-up, with 64.6 % of the baseline homeless group and 22.6 % of the baseline housed group reporting an additional episode of homelessness. Both alcohol abuse and other drug abuse symptoms showed an increase in adolescence followed by slowing in early adulthood. Recent homelessness and friend alcohol use predicted alcohol abuse symptoms, and the strength of the influence of friend use decreased over time. Recent homelessness and friend drug use predicted other drug abuse symptoms. Duration of the initial episode of adolescent homelessness showed no influence on substance abuse over time, or the effects of other predictors, highlighting the importance of conceptualizing the experience of homelessness as a recent stressor rather than an enduring personal characteristic.     

A Retrospective Examination of Child Protection Involvement Among Young Adults Accessing Homelessness Services

Childhood maltreatment is associated with a variety of young adult adversities including homelessness. This study used linked administrative records to develop a population‐level, epidemiological characterization of the child protection histories of young adults accessing homelessness services. The records of all 17‐ to 24‐year‐olds receiving homeless services between 2011 and 2014 in San Francisco County, California (n = 2241) were probabilistically linked to statewide child protective service (CPS) records. Findings document that 50.0% of young adults had been reported for maltreatment at least once during childhood, yet the prevalence of past CPS involvement varied across demographic and child welfare characteristics. Homeless female youth were significantly more likely to have a CPS history than male youth (58.1% vs. 41.5%). Nearly twice as many Black clients accessing homelessness services had a CPS history as did White clients (59.8% vs. 31.8%). Roughly half (47.3%) of those with a childhood history of reported maltreatment had been last reported for maltreatment in another California county. Targeting services that address past trauma and instability among homeless young adults may be justified given the prevalence of CPS history in this population.     

Homelessness and strategies of identity maintenance: a participant observation study

In order to investigate identity maintenance strategies used by a low status group, a covert participant observation study was conducted in a shelter for the homeless. From Social Identity Theory and previous research on the homeless, it was hypothesized that the identity maintenance strategies used would differ as a function of longevity of homelessness: the short‐term homeless (<2 years) would be less likely to identify themselves as homeless (social mobility), while the longer‐term homeless (>2 years) would identify themselves as homeless but engage in various types of social creativity to mitigate their situation. In addition to the strategies described in SIT, it was conjectured that some of the longest‐term homeless would have given up making any intergroup or other social comparisons. Of the various strategies found, some were beyond SIT. The pattern of strategy use was best interpreted mainly as a function of longevity of homelessness, but this was moderated by both experience and personality. A trajectory of change in identity strategies with longevity of homelessness was offered as a plausible frame of reference for further research. Methodological limitations, implications for Social Identity Theory and recommendations for improving the situation of the homeless were discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

Mother-child separations among homeless and housed families receiving public assistance in New York City

We examined the incidence, characteristics, and predictors of separations of children from mothers in 543 poor families receiving public assistance, 251 of whom had experienced homelessness during the previous 5 years. Forty-four percent of the homeless mothers and 8% of housed mothers were separated from one or more children. A total of 249 children were separated from 110 homeless families and 34 children from 23 housed families. Children were placed with relatives and in foster care but were rarely returned to their mothers. Maternal drug dependence, domestic violence, and institutionalization predicted separations, but homelessness was the most important predictor, equivalent in size to 1.9 other risk factors. We infer that policies regarding child welfare and substance abuse treatment should be changed to reduce unnecessary placements. Studies of homeless children who remain with families may be biased if separated children are excluded.     

Cognitive-affective preparation for homelessness: quantitative and qualitative analyses of childhood out-of-home placement and child abuse in a sample of homeless men

Patterns of homelessness were examined against histories of childhood out-of-home placement and abuse in a sample of 146 homeless men. It was speculated that out-of-home placement and abuse influenced needs for love and belonging and were related to preparation for adult homelessness. Main effects of a 2 x 2 (placement by abuse) multivariate analysis of variance were significant with longer periods of time since first homeless and greater lengths of a current episode of homelessness associated with childhood out-of-home placement. Homeless men who had experienced abuse as a child had more episodes of homelessness than those who had not experienced abuse. Mean Brief Index of Self-actualization scores were not different for those with out-of-home placement or abuse; however, self-actualization scores were minimally lower with greater number of homeless episodes but not with total time homeless. Case histories supported the quantitative findings that loss of feelings of belonging in childhood were preparatory for chronic homelessness.     

Effects of psychosocial and situational variables on substance abuse among homeless adults

Finding direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people was used to explore predictive relationships in a sample of homeless adults (N = 664) among (a) psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, (b) situational variables of homelessness history and quality of recent housing, and (c) outcomes of alcohol use, injection drug use (IDU), and non-IDU. Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors, including encouraging provision of permanent supportive housing.     

Changes in Public Attitudes and Perceptions about Homelessness Between 1990 and 2016

Public attitudes on homelessness can and has influenced policies and services for homeless populations. This study surveyed national public attitudes about homelessness in the 21st century and examined changes in attitudes in the past two decades. An online survey of public attitudes about homelessness was conducted with 541 U.S. adults across 47 states in November 2016 using Amazon Mechanical Turk. Survey results were compared to two public surveys conducted in 1990. Compared to previous surveys, the current sample endorsed more compassion, government support, and liberal attitudes about homelessness. The largest changes were related to increased support for homeless individuals to use public spaces for sleeping and panhandling. When asked about the demographic composition of the homeless population, the contemporary sample tended to overestimate the proportions who were young and racial/ethnic minorities, while underestimating the proportions who were married, or had mental health or substance abuse problems. Together, the findings suggest there has been an increase in compassion and liberal attitudes toward homelessness in the past two decades. Greater support for homeless individuals during an era of economic recessions and governmental homeless initiatives presents opportunities for new public health approaches to address homelessness.