ArticlePDF Available

"Homelessness and Social Support Systems: Planning Effective Interventions"

Authors:

Abstract and Figures

Homelessness persists as a social problem that affects the populace due to economic fluctuations, housing accessibility, and discrimination. This paper aims to discuss the role of social support systems for the homeless with a focus on interventions and their results. The paper uses questionnaires, interviews, and case studies to analyze the demographic characteristics of the homeless population, the reasons for homelessness, and the effectiveness of current interventions. Research shows that economic fluctuation is the leading cause, further worsened by issues in housing costs and racism. The comparative evaluation also shows that Housing First interventions are more effective in providing lasting housing for homeless people than the shelter-first model. While there were improvements in the areas of providing shelters and healthcare, there are still issues regarding the lack of proper linkages between services and lack of adequate employment that continue to trap people into homelessness. Policy implications suggest that more funding should be allocated to affordable housing, higher levels of support services, and better collaboration between agencies to address these issues. In this way, the identified problems can be solved more effectively, and the necessary interventions can be made for the improvement of the situation with homeless people.
Content may be subject to copyright.
JOURNAL OF APPLIED BIOANALYSIS, August 2024, p. 234-242.
http://doi.org/10.53555/jab.v10i2.178 (ISSN 2405-710X)
Vol. 10, No. 2
234
"Homelessness and Social Support Systems: Planning
Effective Interventions"
Mrs K.Sri Durga1, Dr. A.V.N. Murty2*, Dr Abhilasha Singh Raghav3, Dr. Prity
Purushottam Patil4, Chandan Kumar Mohapatra5
1research Scholar, Department Of Management Studies, Kl University, Reg No : 183510026
Durga_Sree2@Yahoo.Co.In
2professor, K.L.E.F Deemed University, Email - Dravnmurty@Kluniversity.In
3asso. Professor & Hod Deptt. Of Business Management, Himcs (Sharda Group Of Institutions) Farah, Nh -2,
Mathurau.P.,Aniruddhraghavagra@Gmail.Com
4assistant Professor , Department Of Sociology, - Pgtd Department Of Sociology, Gondwana University,
Gadchirolipin-442650,Pritykalepatil@Gmail.Com
5faculty Associate, Kiit University, Bhubaneswar, Odisha, Chandan.Mohapatrafyo@Kiit.Ac.In
Homelessness persists as a social problem that affects the populace due to economic
fluctuations, housing accessibility, and discrimination. This paper aims to discuss the role
of social support systems for the homeless with a focus on interventions and their results.
The paper uses questionnaires, interviews, and case studies to analyze the demographic
characteristics of the homeless population, the reasons for homelessness, and the
effectiveness of current interventions. Research shows that economic fluctuation is the
leading cause, further worsened by issues in housing costs and racism. The comparative
evaluation also shows that Housing First interventions are more effective in providing lasting
housing for homeless people than the shelter-first model. While there were improvements in
the areas of providing shelters and healthcare, there are still issues regarding the lack of
proper linkages between services and lack of adequate employment that continue to trap
people into homelessness. Policy implications suggest that more funding should be allocated
to affordable housing, higher levels of support services, and better collaboration between
agencies to address these issues. In this way, the identified problems can be solved more
effectively, and the necessary interventions can be made for the improvement of the situation
with homeless people.
Keywords: homelessness, social support systems, Housing First, intervention effectiveness, affordable housing
1. Introduction
Homelessness is a major and multifaceted problem
that impacts millions of people worldwide. It
includes the absence of secure, safe, and suitable
homes, which is frequently accompanied by low
income, marginalization, and health risks. Various
factors lead to homelessness; these are, among
others, lack of employment, low wages, inadequate
housing, family problems, mental health disorders,
and substance abuse (Culhane et al., 2013).
Homelessness can be defined in different ways;
people can be living on the street, in a shed, in a car,
with friends or relatives, or in a house that does not
meet the minimum standards of shelter.
Homelessness is not a one-size-fits-all concept, and
it is possible to observe differences in the experience
of homeless people depending on their age, gender,
ethnicity, and the region they live in. For example,
women, especially those with children, are homeless
differently than single men, and they have different
risks and challenges (Baptista et al., 2017).
Homelessness is not only the absence of a home; it
is a state that influences a person’s well-being in
terms of health, employment, social interactions, and
overall well-being. It also has social costs that affect
society such as higher health care costs, involvement
with the criminal justice system, and need for social
services (Shinn, 2010).
1.1 Current Statistics and Trends in
Homelessness
Internationally, homelessness is still a major problem
and according to recent statistics, more than 150
million people are homeless all over the world, and
*Corresponding Author: Dr. A.V.N. Murty
*Email - Dravnmurty@Kluniversity.In
MURTY et al. J. APPL. BIOANAL
235
approximately 1. According to the United Nations,
by 2020, more than 6 billion people do not have
proper shelter. According to HUD in the United
States, about 580,000 people were homeless on a
single night in January 2020. This figure comprises
the homeless people who are in shelters, temporary
housing, or those who are homeless and have no
shelter (HUD, 2020).
The patterns of homelessness can be different
depending on the area and period. In many high-
income countries, homelessness, particularly in
urban areas, has been on the rise especially due to
high costs of housing and economic marginalization.
For example, Los Angeles, New York, and San
Francisco have experienced significant growth in
homeless populations within the last decade
(National Alliance to End Homelessness, 2021). On
the other hand, some areas have been able to
eliminate homelessness through policy initiatives and
efficient intervention mechanisms. For instance, the
Housing First approach has been adopted in Finland
and has led to a drastic reduction in homelessness
since the government offers homeless people
permanent homes (Pleace, 2017).
Figure 1. Trends in homelessness in the United States. (“State of Homelessness: 2023 Edition -
endhomelessness.org,” 2024)
1.2 Importance of Addressing Homelessness
Through Social Support Systems
The problem of homelessness can be solved with
the help of complex intervention strategies that
include not only the provision of housing but also
the use of effective social support. Sheltering is one
of the main services that homeless people need, and
social support systems are very important in
providing this service to homeless people. These
systems include emergency shelters, transitional
housing programs, mental health and substance
abuse treatment, employment assistance, and social
integration programs.
The role of social support in the case of
homelessness is to reduce the negative impacts of
homelessness by offering the first response,
connecting the homeless to the services they require,
and promoting stability and self-sufficiency. For
instance, complex case management that involves
linking the clients to housing, healthcare, and
employment services has been found to enhance
housing stability and health (Henwood et al., 2011).
In addition, the social support systems that focus on
the reintegration of homeless people and the creation
of social networks can assist them with the
restoration of their social roles and feelings of worth.
1.3 Challenges Faced by Homeless Populations
The homeless populations experience various
barriers that make it difficult for them to attain
stability and independence. Another major problem
is sheltering poverty, which is one of the main
obstacles to exiting homelessness. Many cities and
regions are experiencing a dire shortage of affordable
rental housing, and the competition and prices for
housing that are beyond the reach of the low-income
population are only growing (National Low-Income
Housing Coalition, 2020).
Besides shelter, homeless individuals have other
challenges such as poor health, which may comprise
diseases, mental disorders, and substance use
disorders. These health conditions are both a cause
and a result of homelessness, which puts the
individuals in a cycle that is hard to escape (Baggett
MURTY et al. J. APPL. BIOANAL
236
et al., 2013). These problems are worsened by the
fact that homeless people cannot easily access
healthcare services because they cannot afford to pay
for their treatment, they do not have health
insurance, or they cannot easily get to a health
facility.
The other effects of homelessness on the homeless
include social isolation and stigmatization which
results in hopelessness and powerlessness.
Homelessness also results in social isolation and
disconnection from friends and family, which
complicates the process of getting help and
establishing connections that can help in the healing
process and reintegration into society (Hwang et al.,
2009).
1.4 Gaps in Existing Social Support Systems
There are still many gaps in addressing homelessness
even if there are numerous types of social support
services. Among these gaps, there is a major one
the lack of integration and poor organization of
service providers. Homeless people receive services
in a fragmented and uncoordinated manner, and this
results in fragmentation of services, duplication, and
gaps in service delivery (Burt, 2007). This can lead to
gaps where some people do not get all the help they
require, and this is due to fragmentation. The other
gap is that homeless services receive insufficient
funding and resources. The programs are quite often
underfunded, and the number of people in need of
help keeps rising. This lack of resources hampers the
ability of shelters, transitional housing programs, and
supportive services to meet the needs of homeless
people (Shinn et al., 2001). In addition, there is
usually inadequate emphasis on follow-up and
preventive measures. Most interventions focus on
temporary solutions like the provision of emergency
shelters, while the root causes of homelessness are
not addressed or housing solutions are not offered as
a long-term solution (Culhane et al., 2011). This is
why it is necessary to adopt a comprehensive strategy
that would involve the prevention of homelessness,
timely intervention, and effective support for
individuals and families who have become homeless.
1.5 Significance of the Study
Policy Implications
Considering the above findings, it can be deduced
that this research has policy implications. In this way,
this study can help policymakers identify the best
practices and estimate the impact of social support
systems to improve the efficiency of policies
addressing homelessness. This means demanding
more money and attention to homeless services,
encouraging cooperation and integration of services,
and focusing on permanent solutions and
prevention.
In addition, the research can help in the formulation
of policies that are informed by the realities of
homeless people and their requirements. Thus, this
study can contribute to the development of such
policies that will be sensitive to the needs of the
homeless and their families and will address the
issues that lead to homelessness and advocate for
social justice.
Contributions to Urban Planning and Social
Work Practices
Besides the policy implications, this research has
implications for urban planning and social work
practices. The findings can be useful for urban
planners to design and introduce housing policies
and programs that focus on the provision of
affordable housing and social inclusion. This
includes supporting mixed-income housing,
increasing the availability of affordable rental
housing, and providing services within housing.
For social work practitioners, the research can be
useful in identifying the best practices that can be
used to help the homeless. This includes issues such
as case management, social networks, community
integration, trauma-informed care, and person-
centeredness. It is possible to state that applying
these findings in practice will help social workers
improve their performance and the outcomes for
homeless people who need assistance in finding a
permanent home and becoming financially
independent.
Thus, one can conclude that homelessness is a
multifaceted social problem that can be solved only
with the help of complex and integrated strategies
and measures. This study’s goal is to advance the
understanding of how to prevent homelessness by
exploring the difficulties experienced by homeless
individuals, the shortcomings of current social
support, and proven interventions. The implications
of the findings are relevant to policy and can enhance
the understanding of urban planning and social work
for homeless people, thus enhancing social justice
for the homeless.
1.6 Research Aim
The purpose of this study is to determine the
evidence-based practices in the prevention of
homelessness and to assess the function and
efficiency of social support services in enhancing the
quality of life of homeless people. Thus, the research
aims to contribute to the identification of effective
practices and evaluation of the existing support
services to advance the understanding of the causes
and effective prevention of homelessness and
improve the quality of life of homeless people.
1.7 Objectives
1. To establish best practices for preventing
homelessness by identifying and discussing effective
strategies, case studies, and approaches that have
successfully ended homelessness.
MURTY et al. J. APPL. BIOANAL
237
2. To assess the effectiveness of social support
systems in the lives of homeless individuals,
evaluating their performance, identifying
shortcomings, and providing recommendations for
improvement.
2. Methodology
2.1 Research Design
This research is a mixed-methods study, which
combines qualitative and quantitative data collection
and analysis techniques. The use of mixed-methods
design is useful in the study of homelessness and the
existing social support structures because it provides
both the depth of qualitative data and the width of
quantitative data. This approach helps to gain a
comprehensive understanding of the problem,
including the qualitative aspects of the homeless
people’s lives and the quantitative evaluation of the
effectiveness of the interventions.
2.2 Data Collection
Primary Data
Interviews: Face-to-face, semi-structured interviews
conducted with homeless people to get detailed
information about their experiences, difficulties, and
contacts with support services. These interviews
involved service providers who directly work with
the homeless populace. The interview questions
aimed at assessing the efficacy of the current
interventions, discovering the lack of services, and
getting ideas for improvement.
Surveys: Quantitative data was collected using
structured questionnaires to a larger population of
homeless people and service givers. The surveys
gathered quantitative data on demographic data, the
use of social support services, satisfaction with these
services, and perceived hindrances to support.
Case Studies: The actual homeless people and service
providers are described in detail to show successful
approaches and practices. These case studies gave an
account of the actual application of some of these
strategies and their effects on homeless people.
Secondary Data
Literature Review: The literature review involves an
analysis of previous research on homelessness and
social support structures. This review used peer-
reviewed articles, books, reports from governmental
and non-governmental organizations, and statistical
data from the leading databases. The literature review
assisted in situating the primary data and offered a
theoretical background for the research.
Reports and Statistical Data: Secondary data is also
collected from reports and statistical databases
available in the literature. This data comprised of the
current statistics of homelessness, the changes in the
statistics over time, and the details about the
efficiency of the social support measures.
2.3 Sampling
Criteria for Selecting Participants:
The participants were chosen in such a way that they
meet certain criteria that make them represent the
population. For homeless individuals, criteria
included being currently homeless or having been
homeless within the last year. This is because service
providers were chosen according to their functions
in organizations that directly engage with homeless
people.
Sample Size and Demographic Information
The sample size is around 100 homeless people and
50 service providers. The demographic data gathered
are age, gender, ethnicity, length of homelessness,
and the kind of services that they use. Such a diverse
sample will ensure that a wide range of experiences
and perspectives are included in the study.
2.4 Data Analysis
Qualitative Analysis
The information collected from interviews and case
studies will be analyzed using thematic coding and
content analysis. The common experiences and
issues that homeless people encounter will be
analyzed using themes and patterns. The data will be
coded and sorted into relevant themes that will
illustrate the efficiency of social support services and
the identified gaps.
Quantitative Analysis
The survey quantitative data will be analyzed by
employing statistical techniques. The demographic
data of the sample will be presented using descriptive
statistics while inferential statistics will be used to
determine the relationship or differences between
variables. For instance, descriptive analysis will be
useful in establishing the relationship between the
extent of use of certain support services and the
quality of life as perceived by homeless people.
2.5 Ethical Considerations
Informed Consent: Before the study, all the participants
were informed about the purpose of the study, the
procedures that would be followed, and the possible
risks and benefits that may accrue from the study.
They were given consent forms, and they were given
a chance to ask questions and drop out of the study
at any time without any repercussions.
Confidentiality and Anonymity: Participant identification
was avoided in the study and all the information
collected was kept confidential to protect the
participant’s identity. The data was kept only with the
research team, and participants’ names were changed
to pseudonyms in the reports and publications.
Addressing Potential Biases: The following measures
were put in place by the research team to minimize
bias. This involved the use of purposive sampling to
ensure that different views were included, the use of
MURTY et al. J. APPL. BIOANAL
238
structured data collection tools, and data collection
from different sources. About the issue of reflexivity,
care was taken throughout the research process to
declare and manage any bias that might distort the
study.
3. Results and Discussion
3.1 Demographic Profile of Homeless
Individuals
Demographic characteristics of homeless people
interviewed in this study reveal the various aspects of
the homeless population, which is a cross-section of
society.
Table 1. Demographic Characteristics of Homeless Individuals
Characteristic
Percentage
Gender
- Male
65%
- Female
35%
Age Group
- 18-24 years
15%
- 25-54 years
75%
- 55+ years
10%
Ethnicity/Race
- African American
30%
- Hispanic/Latino
20%
- White
40%
- Other
10%
Duration of Homelessness
- <6 months
40%
- 6 months - 1 year
30%
- >1 year (chronic)
30%
Gender and Age Distribution
: The sample was
slightly skewed towards the male gender where they
constituted 65% of the sample size among the
population that was surveyed. The rest 35%
comprised females. The age distribution showed that
the majority of the respondents fell within the age of
25 to 54 years, which constituted approximately 75%
of the sample.
Ethnicity and Racial Composition:
Many of the
surveyed population reported that they belonged to
the racial minority, which is also characteristic of the
homeless population. More specifically, African
American and Hispanic participants accounted for
about half of the participants.
Duration of Homelessness:
The time that the
respondents had been homeless ranged from a few
months to many years. Of these, 60 percent said they
had been homeless for less than six months with the
remaining 40 percent indicating that they had been
homeless for more than one year and/or
continuously.
3.2 Common Causes of Homelessness Identified
from Interviews and Surveys
Participants’ interviews and survey data revealed the
diverse and complex antecedents to homelessness
which were grouped under economic, individual, and
systemic causes.
Economic Factors:
The findings showed that
economic insecurity was the leading cause of
homelessness among the respondents. Issues like
unemployment, low wages, and homelessness were
mentioned as the common causes for people to
become homeless and have no permanent place to
live.
Personal Circumstances
: Personal factors that
were influential in homelessness included family
breakdown, domestic violence, and mental health
problems. This study also highlighted some of the
family conflicts such as eviction due to disputes or
abandonment that pushed the respondents into
unstable housing. Moreover, respondents pointed
out the effect of mental health issues, specifically
untreated psychiatric disorders that caused problems
with housing stability.
Structural Issues
: Stigma and discrimination in
access to housing and employment opportunities
were also blamed for homelessness, especially among
minorities. Exclusion in housing, prejudice in renting
and selling houses, and racism in housing, all led to
restricted access to affordable and decent homes for
blacks. Likewise, employment discrimination and
differences in wages created economic instability
among the minorities which in turn exposed them to
homelessness.
MURTY et al. J. APPL. BIOANAL
239
Analysis
The demographic characteristics and reasons for
homelessness indicate that homelessness is not just a
personal issue but a result of various factors that
affect society. The fact that most of them were male
and within the age of 25-54 years is not out of place
with the general population of homeless people who
are characterized by unstable employment, poverty,
and other structural vulnerabilities.
It is therefore important to understand the
demographic characteristics and risk factors
associated with homelessness to design appropriate
prevention and support strategies for housing
insecurity. Thus, by understanding these outcomes,
policymakers and service providers will be able to
offer solutions that will meet the needs of homeless
individuals and families in the short term and address
the root causes of homelessness in the long term.
3.3 Effectiveness of Existing Social Support
Systems
The quality of social support for homelessness
differs, which affects the homeless persons’ chances
of obtaining a permanent home, accessing medical
care, and finding a job.
Shelter and Housing Programs
: Most of the
participants had a positive perception towards
emergency shelters in as much as they are concerned
with the provision of temporary relief from
homelessness. However, they reported major
barriers to moving to permanent housing because of
long waiting lists and scarcity of affordable housing.
Some people were forced to live in temporary
shelters for a long time, which limited their chances
of returning to a normal life and finding a home
(Culhane et al., 2017).
Healthcare and Mental Health Services
:
Healthcare services for homeless people were
irregular and, in many cases, insufficient. Some had
challenges in accessing regular follow-up care for
chronic diseases and mental health disorders because
of the absence of insurance, scarcity of specialized
services, and system-related issues. This lack of
healthcare access maintained health inequalities and
intensified the difficulties of dealing with long-term
diseases while homeless (Baggett et al., 2013).
Employment and Skills Training: The vocational
training programs were received positively by the
participants with most of them for the opportunities
to gain new skills and enhance their chances of
getting a job. Nevertheless, homeless people remain
challenged when it comes to finding decent and
stable jobs. Some of the problems highlighted were
inadequate transport means, poor marketability of
the acquired skills due to inadequate job vacancies,
and discrimination in employment. These barriers
tended to keep people homeless for longer because
they restricted the options for gaining employment
and becoming financially self-sufficient (Fargo et al.,
2013).
3.4 Case Studies of Successful Interventions
Several case examples demonstrate successful
interventions in homelessness and positive changes
for homeless populations based on best practices.
Housing First Approach:
Housing First has been
widely acclaimed for its effectiveness in ending
homelessness by focusing on housing as the first
stage and not insisting on the people change their
behavior or go through treatment before they are
given a place to live. This approach has proved to
enhance housing stability and the general welfare of
CH individuals since it offers direct access to
permanent housing accompanied by case
management and healthcare services (Tsemberis,
2010).
Community Integration Programs:
Some of the
interventions that have been found effective include
those that target building social support and social
relations among the homeless. Such programs may
include community intervention, support groups,
and other activities that would enable the individuals
to assimilate into the community. Thus, through
enhancing social connectedness and support, these
interventions have helped enhance mental health and
enhance the chances of housing stability in the long
run.
Analysis
The response to homelessness by social support
systems depends on how well it meets the needs of
the homeless in terms of the type and extent of
support offered, as well as the extent to which it
tackles the root causes of homelessness. The
problem with emergency shelters is that the focus is
to provide temporary shelter and the issue becomes
to transition the occupants to more permanent
housing solutions. Homeless people require more
healthcare services that are convenient and
responsive to their multifaceted health requirements
such as mental illness and chronic diseases.
Vocational training programs offer the potential to
prepare people for the type of employment that can
be considered sustainable. However, other system
factors, for example, transportation to and from
work and employment discrimination, need to be
tackled to improve employment opportunities for
homeless persons.
It is important to comprehend the differential
efficacy of social support systems and effective
intervention strategies to guide policy and practice to
prevent homelessness. Through the implementation
MURTY et al. J. APPL. BIOANAL
240
of such approaches as Housing First and community
integration programs, policymakers and service
providers can address the complex needs of the
homeless population and facilitate the process of
reaching stability. Further research and assessment
of these interventions are required to improve the
methods that are most effective in helping homeless
individuals attain stable housing and overall health.
3.5 Discussion
Interpretation of Findings in the Context of
Existing Literature
The findings of this research are in harmony with the
prior research findings and depict that homelessness
is not a simple issue, but it is intertwined with
economic, social, and health problems. In the case of
the causes of homelessness, economic insecurity due
to factors such as unemployment and low income
was cited as the main reason as it has been in other
studies (Fitzpatrick-Lewis et al., 2011). Another issue
that arose in the case of housing stability was the
question of homelessness and the fact that even
when homeless people can secure a job, they cannot
easily secure permanent housing since the rents are
rising and there is a shortage of affordable housing.
Comparison of Different Types of Interventions
and Their Outcomes
A comparison of the interventions established that
Housing First methods were superior to the
conventional shelter-based ones. The Housing First
model which does not compel the clients to undergo
treatment, attend AA meetings, or abstain from
substances before they can be housed has been seen
to produce better results concerning housing stability
(Tsemberis, 2010). This is backed by elaborate case
management that involves the provision of other
services that are unique to the needs of the targeted
homeless persons; thus, dealing with the complex
problems that affect the targeted group (Henwood et
al., 2015).
Role of Social Support Systems in Preventing
and Addressing Homelessness
Social support systems are thus very crucial in the
provision of the required care and the determination
of the causes of homelessness. Yet, the study found
that there were some problems concerning the
organization and accessibility of services that
hindered efficiency. For instance, the demand for
health and mental health was recognized, but there
was insufficient and uneven distribution of such
services, and no access to a specialist, which were
identified as significant concerns (Tsai & Rosenheck,
2015). Enhancing the integration of these services
with other support systems may be useful for
homeless people because it would enable meeting
their present needs and health issues.
Challenges and Barriers to Implementing
Effective Interventions
Some of the main challenges that were observed by
(MuntheKaas et al., 2018)) as contributing to the
failure of implementing the interventions include
Lack of funds, restricted access to services due to
administrative procedures, and social prejudice
towards homeless people. There is limited funding
for the expansion and the number and variety of
supportive housing programs and services; program
prerequisites can also delay access to needed services.
Also, prejudice towards homeless people in society
can enhance their marginalization and hinder their
potential to be reintegrated into society.
3.6 Policy Recommendations Based on Findings
Based on the identified challenges of the present
study and reviews following policies are
recommended to help solve the problems
highlighted in the study:
1.
Increase Affordable Housing Stock:
More
should be done to generate more space for the
construction of cheap houses and reduce the barriers
to construction. This includes promoting private
actors to engage in the construction of affordable
homes (Fitzpatrick-Lewis et al., 2011).
2.
Enhance Supportive Services:
Provide primary
care and specialty services, mental health, and SUD
treatment for homeless populations. This implies
increasing funding for the programs that assist
homeless persons to receive medical and social
services (Tsai & Rosenheck, 2015).
3.
Promote Employment Opportunities:
Implement partnerships between government, non-
profit, and private organizations to provide
vocational education, employment, and training.
This can entail offering employers some incentives
for offering employment to persons from the
homeless category (Tsemberis, 2010).
4.
Strengthen Coordination of Services:
Involve
the social services, healthcare, and housing
departments so that the services being offered to the
homeless are well coordinated and easily available.
This can be done through common information
technologies like case management systems and
MoUs between the agencies (Henwood et al., 2015).
By these policy recommendations, the policymakers
and service providers can attempt at least to
intervene on the factors that cause homelessness,
improve the systems of help, and thus, attempt to
make some positive change in the lives of homeless
people who are seeking housing and belonging in
society.
4. Conclusion
Homelessness is still a multifaceted and widespread
social phenomenon that depends on the economic
MURTY et al. J. APPL. BIOANAL
241
crisis, availability of affordable housing, and other
factors that contribute to the formation of vulnerable
populations’ poverty. From this study, it has been
evident that social support systems play a very crucial
role in the fight against homelessness, and despite
the successes made in the delivery of services and
effectiveness of interventions, there are still some
hurdles that need to be overcome.
The results of this study are consistent with previous
studies, stressing the complexity of the homeless
issue and the relationships between the economic,
social, and health factors. Unemployment and low
wages were identified as the main causes of
homelessness due to economic volatility. Access to
housing remains a major problem, as homeless
persons must spend long periods in emergency
shelters because of the shortage of affordable
housing.
The comparison of the interventions indicated that
Housing First approaches, which involve providing
permanent housing with services to clients
immediately, have demonstrated positive results in
terms of housing tenure. These approaches are vastly
different from the conventional shelter-based
approaches, which are a clear indication that the best
way to address homelessness is to recognize the
person. Hence, proper social support structures were
deemed necessary in the provision of holistic care
that meets the needs of the patients while there are
still deficiencies in service integration and availability.
Mental health and medical care, which are essential
to meet the multifaceted health requirements of
homeless people, are still inadequate and sporadic.
Likewise, challenges to attaining and maintaining
sustainable employment and the continued social
marginalization of homeless people add layers to the
process of helping them gain stability in their lives.
Based on the findings of this study, policy
implications focus on the necessity of more funding
for affordable housing programs, better support
services, and better collaboration among service
suppliers. Employment and training with employers
and the expansion of job training programs are
important strategies in the process of the economic
independence of homeless people. Furthermore, it is
crucial to eliminate the administrative obstacles and
fight against the social stigmas that hinder the
process of homeless people’s reintegration into
society. Therefore, it can be concluded that the
problem of homelessness can be solved only with the
help of an integrated approach that implies providing
housing and necessary services for each person. By
supporting such evidenced-based practices as
Housing First and promoting policy changes that
would improve the delivery of services and funding
for such services, politicians and practitioners can go
a long way toward addressing the issue of
homelessness and improving the quality of life of the
most vulnerable populations. Further research,
assessment of interventions, and intersectoral
cooperation can help move towards a culture in
which homelessness is not only treated but also
prevented by efficient planning and humane social
policies.
References:
1. State of Homelessness: 2023 Edition -
endhomelessness.org. (2024, January 6).
Retrieved from
https://endhomelessness.org/homelessness-
in-america/homelessness-statistics/state-of-
homelessness/
2. Baggett, T. P., Hwang, S. W., O'Connell, J. J.,
Porneala, B. C., Stringfellow, E. J., Orav, E. J.,
Singer, D. E., & Rigotti, N. A. (2013). Mortality
among homeless adults in Boston: shifts in
causes of death over 15 years. JAMA Internal
Medicine, 173(3), 189–195.
https://doi.org/10.1001/jamainternmed.2013.
1604
3. Baptista, I., Benjaminsen, L., Busch-Geertsema,
V., & Pleace, N. (2017). Family homelessness in
Europe. In M. Amore & M. Allen (Eds.),
Homelessness and Housing Insecurity in
Europe (pp. 171-190). Bristol University Press.
4. Burt, M. R. (2007). System change efforts and
their results: Los Angeles, St. Louis, and
Worcester. Housing Policy Debate, 18(3), 613-646.
5. Culhane, D. P., Metraux, S., Byrne, T., Stino,
M., & Bainbridge, J. (2013). The Age Structure
of Contemporary Homelessness: Evidence and
Implications For Public Policy. Analyses of Social
Issues and Public Policy, 13(1), 228–244.
https://doi.org/10.1111/asap.12004
6. Culhane, D. P., Metraux, S., & Byrne, T. (2011).
A prevention-centered approach to
homelessness assistance: A paradigm shift?
Housing Policy Debate, 21(2), 295-315.
7. Henwood, B. F., Stanhope, V., & Padgett, D. K.
(2011). The role of housing: a comparison of
front-line provider views in housing first and
traditional programs. Administration and policy in
mental health, 38(2), 77–85.
https://doi.org/10.1007/s10488-010-0303-2
8. Hwang, S. W., Kirst, M. J., Chiu, S.,
Tolomiczenko, G., Kiss, A., Cowan, L., &
Levinson, W. (2009). Multidimensional social
support and the health of homeless individuals.
Journal of urban health: bulletin of the New York
Academy of Medicine, 86(5), 791–803.
https://doi.org/10.1007/s11524-009-9388-x
9. National Alliance to End Homelessness. (2021).
State of homelessness: 2021 edition. Retrieved
from
https://endhomelessness.org/homelessness-
in-america/homelessness-statistics/state-of-
homelessness-2021/
MURTY et al. J. APPL. BIOANAL
242
10. National Low Income Housing Coalition.
(2020). Out of reach 2020: The high cost of
housing. Retrieved from
https://reports.nlihc.org/oor
11. Pleace, N. (2017). The action plan for
preventing and tackling homelessness in
Finland. Retrieved from
https://www.feantsa.org/download/y-
foundation-housing-first-
finland14459515471234474184.pdf
12. Shinn, M. (2010). Homelessness, poverty, and
social exclusion in the United States and
Europe. European Journal of Homelessness, 4(1), 19-
44.
13. Shinn, M., Baumohl, J., & Hopper, K. (2001).
The prevention of homelessness revisited.
Analyses of Social Issues and Public Policy, 1(1), 95-
127.
14. United Nations. (2020). SDG 11 synthesis
report: Tracking progress towards inclusive,
safe, resilient, and sustainable cities and human
settlements. Retrieved from
https://unhabitat.org/sdg-11-synthesis-report
15. Fargo, J. D., Munley, E. A., Byrne, T. H.,
Montgomery, A. E., & Culhane, D. P. (2013).
Community-Level Characteristics Associated
With Variation in Rates of Homelessness
Among Families and Single Adults. American
Journal of Public Health, 103(S2), S340–S347.
https://doi.org/10.2105/ajph.2013.301619
16. Tsemberis, S. (2010) Housing First. The
Pathways Model to End Homelessness for
People with Mental Illness and Addiction.
Hazelden, Center City. - References - Scientific
Research Publishing. (n.d.). Retrieved from
https://www.scirp.org/reference/referencespa
pers?referenceid=2499611
17. Tsai, J., & Rosenheck, R. A. (2015). Risk factors
for homelessness among US veterans.
Epidemiologic reviews, 37, 177–195.
https://doi.org/10.1093/epirev/mxu004
18. Fitzpatrick-Lewis, D., Ganann, R.,
Krishnaratne, S., Ciliska, D., Kouyoumdjian, F.,
& Hwang, S. W. (2011). Effectiveness of
interventions to improve the health and
housing status of homeless people: a rapid
systematic review. BMC Public Health, 11(1).
https://doi.org/10.1186/1471-2458-11-638
19. MuntheKaas, H. M., Berg, R. C., & Blaasvær,
N. (2018). Effectiveness of interventions to
reduce homelessness: a systematic review and
metaanalysis. Campbell Systematic Reviews,
14(1), 1–281.
https://doi.org/10.4073/csr.2018.3
20. Evidence reviews for the effectiveness of
approaches to improve access to and
engagement with health and social care and
joined-up approaches. (2022, March 1).
Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK5
79615/
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Prevention has long been cited as an important part of any strategy to end homelessness. Nonetheless, effective prevention initiatives have proven difficult to implement in practice. The lack of a prevention-oriented policy framework has resulted in responses to homelessness that focus primarily on assisting those who have already lost their housing and, consequently, to the institutionalization of homelessness. Recent Federal legislation, however, signals an emergent paradigm shift towards prevention-based approaches to homelessness. This paper explores the conceptual underpinnings of successful prevention initiatives and reviews practice-based evidence from several successful prevention-oriented approaches to homelessness in the United States and Europe. We then outline a conceptual framework for a transformation of homeless assistance towards prevention-oriented approaches, with a discussion of relevant issues of program design and practice, data collection standards, and program performance monitoring and evaluation.
Article
Full-text available
Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations. These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless populations with HIV.
Article
Full-text available
This step-by-step manual provides a solid foundation for introducing the evidence-based Housing First approach--provide housing first, followed by supportive treatment services--into new locations, and evolving existing programs into those based on the ideals of the Pathways Model to End Homelessness. It guides you in structuring policies and programs that respect and respond to the voices of men, women, and families in your community, and provides easy-to-follow tools and tips for implementation.
Article
Full-text available
Homeless individuals often suffer from serious health problems. It has been argued that the homeless are socially isolated, with low levels of social support and social functioning, and that this lack of social resources contributes to their ill health. These observations suggest the need to further explore the relationship between social networks, social support, and health among persons who are homeless. The purpose of this study was to examine the association between multidimensional (cognitive/perceived and behavioral/received) social support and health outcomes, including physical health status, mental health status, and recent victimization, among a representative sample of homeless individuals in Toronto, Canada. Multivariate regression analyses were performed on social support and health outcome data from a subsample of 544 homeless adults, recruited from shelters and meal programs through multistage cluster sampling procedures. Results indicated that participants perceived moderately high levels of access to financial, emotional, and instrumental social support in their social networks. These types of perceived social supports were related to better physical and mental health status and lower likelihood of victimization. These findings highlight a need for more services that encourage the integration of homeless individuals into social networks and the building of specific types of social support within networks, in addition to more research into social support and other social contextual factors (e.g., social capital) and their influence on the health of homeless individuals.
Article
Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Article
Amidst concern about the implications of an aging U.S. population, recent evidence suggests that there is a unique aging trend among the homeless population. Building on this, we use data from New York City and from the last three decennial Census enumerations to assess how the age composition of the homeless population—both single adults and adults in families—has changed over time. Findings show diverging trends in aging patterns for single adults and adults in families over the past 20 years. Among single adults, the bulk of the sheltered population is comprised of persons born during the latter part of the baby boom era whose high risk for homelessness has continued as they have aged. Specifically, the age group in this population facing the highest risk for homelessness was 34–36 (born 1954–1956) in 1990; 37–42 (born 1958–1963) in 2000; and 49–51 (born 1959–1961) in 2010. In contrast, among adults in sheltered families, there is no indication of any progressive aging of the family household heads. The modal age across the study period remains at 21–23 years of age. We consider implications for the health care and social welfare systems, and policy responses to homelessness.
Article
Objectives: We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic, and safety net characteristics. Methods: We entered community-level characteristics and US Department of Housing and Urban Development point-in-time counts for a single night in January 2009 into separate mixed-effects statistical analyses that modeled homelessness rates for 4 subpopulations: families and single adults in metropolitan and nonmetropolitan regions. Results: Community-level factors accounted for 25% to 50% of the variance in homelessness rates across models. In metropolitan regions, alcohol consumption, social support, and several economic indicators were uniquely associated with family homelessness, and drug use and homicide were uniquely associated with single-adult homelessness. In nonmetropolitan regions, life expectancy, religious adherence, unemployment, and rent burden were uniquely associated with family homelessness, and health care access, crime, several economic indicators, and receipt of Supplemental Security Income were uniquely associated with single-adult homelessness. Conclusions: Considering homeless families and single adults separately enabled more precise modeling of associations between homelessness rates and community-level characteristics, indicating targets for interventions to reduce homelessness among these subpopulations.
Article
Background: Homeless persons experience excess mortality, but US-based studies on this topic are outdated or lack information about causes of death. To our knowledge, no studies have examined shifts in causes of death for this population over time. Methods: We assessed all-cause and cause-specific mortality rates in a cohort of 28 033 adults 18 years or older who were seen at Boston Health Care for the Homeless Program from January 1, 2003, through December 31, 2008. Deaths were identified through probabilistic linkage to the Massachusetts death occurrence files. We compared mortality rates in this cohort with rates in the 2003-2008 Massachusetts population and a 1988-1993 cohort of homeless adults in Boston using standardized rate ratios with 95% confidence intervals. Results: A total of 1302 deaths occurred during 90 450 person-years of observation. Drug overdose (n = 219), cancer (n = 206), and heart disease (n = 203) were the major causes of death. Drug overdose accounted for one-third of deaths among adults younger than 45 years. Opioids were implicated in 81% of overdose deaths. Mortality rates were higher among whites than nonwhites. Compared with Massachusetts adults, mortality disparities were most pronounced among younger individuals, with rates about 9-fold higher in 25- to 44-year-olds and 4.5-fold higher in 45- to 64-year-olds. In comparison with 1988-1993 rates, reductions in deaths from human immunodeficiency virus (HIV) were offset by 3- and 2-fold increases in deaths owing to drug overdose and psychoactive substance use disorders, resulting in no significant difference in overall mortality. Conclusions: The all-cause mortality rate among homeless adults in Boston remains high and unchanged since 1988 to 1993 despite a major interim expansion in clinical services. Drug overdose has replaced HIV as the emerging epidemic. Interventions to reduce mortality in this population should include behavioral health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness.
Article
Conceptual and methodological problems plague efforts to prevent homelessness. Attempts to identify individuals at risk are inefficient, targeting many people who will not become homeless for each person who will. Such interventions may do useful things for needy people, but evidence that they prevent homelessness is scant. Subsidized housing, with or without supportive services, has ended homelessness for families and played a key role in ending it for people with serious mental illnesses. Other risk factors may be less important once housing is secured. But programs that allocate scarce housing may simply reallocate homelessness, determining who goes to the head of the line for housing, not shortening the line itself. We recommend reorienting homelessness prevention from work with identified at-risk persons to efforts to increase the supply of affordable housing and sustainable sources of livelihood nationwide or in targeted communities.
Article
Within the mental health system, there are two distinct service models for adults who have severe mental illness and are homeless: one prioritizes treatment before accessing permanent housing (Treatment First) while the other provides permanent housing upfront followed by clinical support (Housing First). Investigating front-line providers working within these two models affords an opportunity to learn more about their implementation from an insider perspective, thus shedding light on whether actual practice is consistent with or contrary to these program models' contrasting philosophical values. Forty-one providers were recruited from four agencies as part of a NIMH funded qualitative study. Multiple, in-depth interviews lasting 30-45 min were conducted with providers that explored working within these agencies. Thematic analysis was utilized to compare the views of 20 providers working in Housing First versus the 21 providers working in Treatment First programs. Providers viewed housing as a priority but differences emerged between Treatment First and Housing First providers along three major themes: the centrality of housing, engaging consumers through housing, and (limits to...) a right to housing. Ironically, this study revealed that providers working within Treatment First programs were consumed with the pursuit of housing, whereas Housing First providers focused more on clinical concerns since consumers already had housing. Clearly, how programs position permanent housing has very different implications for how providers understand their work, the pressures they encounter, and how they prioritize client goals.