Public Health Homelessness
by
Holly A. Holtzen
  • LAST REVIEWED: 05 May 2017
  • LAST MODIFIED: 21 November 2012
  • DOI: 10.1093/obo/9780199756797-0021

Introduction

Homelessness has existed throughout human history, and as far back as the 17th century in the United States. The causes of homelessness are complex and include both environmental and individual factors. External environmental factors include economic conditions, social policy changes, and demographic shifts. Individual vulnerabilities and circumstances also contribute to the risk of homelessness. Descriptions of homelessness as a social issue have shifted from the early “tramps,” to Skid Row with its extreme poverty and addiction, to the present-day view of invisible homelessness consisting of men and women, children, and veterans. Defining homelessness as a practical matter has proven difficult for policy makers and researchers. A decision about how to classify homeless people living in shelters, those receiving services, and those on the streets dramatically alters the count. Recent estimates suggest that 656,129 people were homeless at a single point in time (i.e., measured on one night in January annually) in the United States in 2009. Efforts to demonstrate the extent of homelessness guide social and housing policies. The varied counting methodologies influence the public policy response to homelessness differently, guiding housing policy and health and social services based on their inherent assumptions. Attempts to quantify homelessness as a social problem began with efforts by Peter H. Rossi in the Chicago studies and have continued with studies by the US Census Bureau, and most recently with biannual point-in-time counts conducted by the Continuum of Care. Providing homeless services and housing dramatically changed in the late 1980s with the passage of the Stewart B. McKinney Homeless Assistance Act (P.L. 100-77), which eventually created the Continuum of Care (CoC) system in the 1990s to provide coordinated outreach and assessment, prevention, permanent housing, and services. This legislation shifted the response to homelessness from a primarily grassroots effort to a national campaign to end homelessness. Under this act, funding and homeless services were consolidated to have a more regional approach to homeless services and housing. This coordinated approach was developed to address the diverse needs of the homeless, extending beyond providing shelter to addressing the causes of homelessness and the health-related risks. Homeless populations have a higher prevalence of infections and chronic diseases. Moreover, their mortality rate is four times higher than that of comparable housed populations. The homelessness literature is cross-disciplinary and reflects the diversity of homelessness, especially in the United States.

Introductory Works

Homelessness as a social issue has been described broadly in a variety of books. The introductory works Baumohl 1996, Blau 1992, Hopper 2003, and Robertson and Greenblatt 1992 provide a thorough collection of articles by leading experts covering public policy, research, and social issues related to homelessness in the United States. Levinson 2004 provides descriptions and suggestions for further reading on salient topics associated with homelessness. Since most of the introductory literature is somewhat dated, more recent publications (McNamara 2008; Barrett, et al. 2010) are useful because they describe current social policies and research on homelessness.

  • Baumohl, Jim, ed. 1996. Homelessness in America. Phoenix, AZ: Oryx.

    Save Citation »Export Citation »E-mail Citation »

    This book provides a broad overview of homelessness from a variety of perspectives. It is organized into three sections covering a range of topics from the causes of homelessness to prevention.

    Find this resource:

  • Blau, Joel. 1992. The visible poor: Homelessness in the United States. New York: Oxford Univ. Press.

    Save Citation »Export Citation »E-mail Citation »

    This is another book reviewing the basic issues of homelessness. It provides a synopsis of the key topics that describe homelessness, including causes, policy responses, needs, and misconceptions about the homeless.

    Find this resource:

  • Hopper, Kim. 2003. Reckoning with homelessness. 3d ed. Ithaca, NY: Cornell Univ. Press.

    Save Citation »Export Citation »E-mail Citation »

    This book is organized into three sections examining the history of homelessness and the evolution of homeless shelters, and it reviews early field work to examine homelessness and summarizes an ethnography of homeless men in New York. Finally, the author reviews the role of advocacy to legitimize the homeless and address their needs.

    Find this resource:

  • Lee, A. Barrett, Kimberly A. Tyler, and James D. Wright. 2010. The new homelessness revisited. Annual Review of Sociology 36:501–521.

    DOI: 10.1146/annurev-soc-070308-115940Save Citation »Export Citation »E-mail Citation »

    This is a review of research and public policies about homelessness from 1980 to present day. The purpose of this article was to highlight the most recent sociological literature that advanced knowledge of this social issue.

    Find this resource:

  • Levinson, David, ed. 2004. Encyclopedia of homelessness. Thousand Oaks, CA: SAGE.

    Save Citation »Export Citation »E-mail Citation »

    This is an introductory reference covering multiple topics associated with homelessness. This book provides the reader with basic information and suggestions for further reading on each subject.

    Find this resource:

  • McNamara, Robert, ed. 2008. Homelessness in America. 3 vols. Westport, CT: Praeger.

    Save Citation »Export Citation »E-mail Citation »

    Volume 1 focuses on demographics of the homeless population and covers topics such as homeless policies, homeless veterans, homeless women, and homeless families. Volume 2 discusses the causes of homelessness. The third volume focuses on solutions, discussing both old and new strategies, covering such topics as past attempts to solve homelessness, new shelter communities, criminalization of homelessness, and Homeless Management Information Systems.

    Find this resource:

  • Robertson, Marjorie J., and Milton Greenblatt, eds. 1992. Homelessness: A national perspective. New York: Plenum.

    Save Citation »Export Citation »E-mail Citation »

    This book is an overview of homelessness from a cross-disciplinary perspective. It provides a description of mental illness, health care for the homeless, substance abuse, veterans and elderly homeless, and homeless families and children.

    Find this resource:

Bibliographies

Scholars have compiled annotated bibliographies containing as many works relevant to homelessness as possible. Van Whitlock, et al. 1994 compiles works dating back to the late 19th century, and Henslin 1993 includes works dating as far back as the late 16th century. These are the most complete bibliographies on homelessness to date. Unfortunately, both are nearly twenty years old, but no recent works of this type exist.

  • Henslin, James M. 1993. Homelessness: An annotated bibliography. 2 vols. New York: Garland.

    Save Citation »Export Citation »E-mail Citation »

    This two-volume set includes an annotated list of literature about homelessness from 1592 through 1992. Books, journal articles, and popular media articles are included. Citations are organized alphabetically. Volume 2 lists all of the same books, journal articles, and popular media as Volume 1, but organizes them into forty-one different themes, unannotated.

    Find this resource:

  • Van Whitlock, Rod, Bernard Lubin, and Jean Sailors. 1994. Homelessness in America, 1893–1992: An annotated bibliography. Westport, CT: Greenwood.

    Save Citation »Export Citation »E-mail Citation »

    This is an annotated bibliography of homelessness with more than 1,700 citations, including books, dissertations, research articles, and book chapters published beginning in the 1930s. A wide range of topics is covered, from health and social issues to housing for the homeless.

    Find this resource:

Journals

Homelessness is covered in a wide variety of health-related journals. Public health and medical journals regularly feature articles about homelessness, including the American Journal of Public Health, the Journal of the American Medical Association, and the American Journal of Preventive Medicine. Mental health issues and homelessness are often featured in Psychiatric Services, Psychological Services, Journal of Nervous and Mental Disease, and Journal of Addictive Diseases.

Housing and Program Planning

Several journals specifically focus on housing and program planning, including Housing Policy Debate; Housing, Care, and Support; and Evaluation and Program Planning. These publications frequently report on issues related to homelessness. The Journal of Social Distress and Homelessness is one of the few journals specifically focused on homelessness issues.

Defining Homelessness

One of the biggest issues in homelessness is how to define it. This has been the subject of much debate, and many of the sources cited elsewhere in this bibliography touch on this topic (Hopper 1991b, cited under History; Wright and Devine 1992 and Wright and Devine 1995, both cited under Methodology; Lee, et al. 2010, cited under Introductory Works; Cohen 1999, cited under Aging). At the center of the debate is the decision about whom to count, which has both methodological and political implications. The US Department of Housing and Urban Development provides its definition of homelessness and chronic homelessness in the sources cited below. However, these definitions are the eligibility guidelines for qualifying for federal assistance rather than practical definitions of who is homeless or marginally housed.

History

The historical perspective on homelessness in the United States is described in the following books and articles. Although homelessness is frequently attributed to changes in economic conditions and social policies, these books add the historical context to describe the extent of the problem and solutions to it. Rossi 1990a focuses on homelessness in Chicago, while Caton 1990, Hopper 1990, Hopper 1991a, Hopper 1991b, and Peters 1990 primarily discuss homeless populations in New York City. The more inclusive history of US homelessness is explored by Kusmer 2002, Bassuk and Franklin 1992, and Rossi 1990b.

  • Bassuk, Ellen, and Deborah Franklin. 1992. Homelessness past and present: The case of the United States. In Homelessness: New England and beyond. Edited by Padraig O’Malley, 67–86. Amherst: Univ. of Massachusetts Press.

    Save Citation »Export Citation »E-mail Citation »

    Bassuk and Franklin compare and contrast the homeless population from the turn of the 20th century to that of the early 1990s. The authors find many similarities between the time periods with regard to demographic characteristics, mental and physical health factors, and the fact that both eras experienced increases in homelessness as a result of the overall economic and political environments.

    Find this resource:

  • Caton, Carol L. M. 1990. Homeless in America. New York: Oxford Univ. Press.

    Save Citation »Export Citation »E-mail Citation »

    Caton provides an overview of homelessness in America. The book begins by describing homelessness in the early colonial era of American history then moves through the early 19th century, post–Civil War period, early 20th century, post–World War II era, and finally the state of homelessness in the 1980s.

    Find this resource:

  • Hopper, Kim. 1990. Public shelter as “a hybrid institution”: Homeless men in historical perspective. Journal of Social Issues 46.4: 13–29.

    DOI: 10.1111/j.1540-4560.1990.tb01796.xSave Citation »Export Citation »E-mail Citation »

    This article presents a historical perspective on the establishment of public shelters. Hopper notes that negative perceptions of homelessness ultimately disguise the issues of labor reform and lack of employment opportunities, causing a haphazard treatment of the homeless.

    Find this resource:

  • Hopper, Kim. 1991a. A poor apart: The distancing of homeless men in New York’s history. Social Research 59.1: 107–132.

    Save Citation »Export Citation »E-mail Citation »

    Reflecting on the framing of the poor in New York’s history, Hopper discusses the historical perspective during the late 19th and early 20th centuries and social characterizations that shaped the public policy response to homelessness.

    Find this resource:

  • Hopper, Kim. 1991b. Homelessness old and new: The matter of definition. Housing Policy Debate 2.3: 755–813.

    DOI: 10.1080/10511482.1991.9521072Save Citation »Export Citation »E-mail Citation »

    This article reviews the social construction of homelessness and the influence on public policies from a historical perspective.

    Find this resource:

  • Kusmer, Kenneth L. 2002. Down and out, on the road: The homeless in American history. New York: Oxford Univ. Press.

    Save Citation »Export Citation »E-mail Citation »

    Kusmer offers a thorough depiction of homelessness throughout American history. The author examines the various economic and societal responses to homelessness.

    Find this resource:

  • Peters, Mark. 1990. Homelessness: A historical perspective on modern legislation. Michigan Law Review 88:1209–1242.

    DOI: 10.2307/1289121Save Citation »Export Citation »E-mail Citation »

    Basing arguments on New York City, the author asserts that modern legislative reforms are bound by 19th-century assumptions about homelessness. He points to modern New York legislation through 1990 and demonstrates parallels with the historical approaches to solving homelessness.

    Find this resource:

  • Rossi, Peter H. 1990a. Down and out in America. Chicago: Univ. of Chicago Press.

    Save Citation »Export Citation »E-mail Citation »

    Rossi provides a historical overview of homelessness with a particular focus on early studies conducted in Chicago. This book reviews various aspects of homelessness including causes, demographic characteristics of the homeless, estimation of the extent of homelessness, and solutions. This is a frequently cited, seminal book.

    Find this resource:

  • Rossi, Peter H. 1990b. The old homeless and the new homelessness in historical perspective. American Psychologist 45:954–959.

    DOI: 10.1037/0003-066X.45.8.954Save Citation »Export Citation »E-mail Citation »

    The author examines the changing US homeless population, from a largely older male population living in “Skid Row” neighborhoods in the 1950s to a more diversified homeless population, including women, families, and more minorities.

    Find this resource:

Methodology

Counting the number of homeless presents many methodological challenges. Hopper, et al. 2008 examines the use of estimation methods to count unsheltered homeless persons. Office of Community Planning and Development 2008 describes how Continuums of Care (CoC) should conduct point-in-time (PIT) counts. Wright and Devine 1992 and Wright and Devine 1995 describe the US Census Bureau’s count of homeless individuals, which was the precursor to the current PIT counts. Dennis, et al. 2007 provides a comprehensive assessment of homelessness policy and the use of systematic data collection efforts, including the use of Homeless Management Information Systems (HMIS). Culhane, et al. 2007 tests a typology of homeless to identify patterns of homelessness.

  • Culhane, Dennis P., Stephen Metraux, Jung Min Park, Maryanne Schretzman, and Jesse Valente. 2007. Testing a typology of family homelessness based on patterns of public shelter utilization in four US jurisdictions: Implications for policy and program planning departmental papers. Housing Policy Debates 18.1: 1–28.

    DOI: 10.1080/10511482.2007.9521591Save Citation »Export Citation »E-mail Citation »

    This study uses patterns of public shelter stays among homeless families to attempt to cluster these families into categories. The authors suggest that policy factors are more responsible for the length of shelter stays than are specific characteristics of families.

    Find this resource:

  • Dennis, Deborah, Gretchen Locke, and Jill Khadduri, eds. 2007. Toward understanding homelessness: The 2007 National Symposium on Homelessness Research. Washington, DC: US Department of Health and Human Services and US Department of Housing and Urban Development.

    Save Citation »Export Citation »E-mail Citation »

    This series of papers presented at the 2nd National Symposium on Homelessness Research provides an update on the status on homeless research and federal policy issues. These papers focus on data collection using the Homeless Management Information System (HMIS) and the development of more sophisticated research methodologies. The authors also discuss collaborative efforts between localities, states and the federal government.

    Find this resource:

  • Hopper, Kim, Marybeth Shinn, Eugene Laska, Morris Meisner, and Joseph Wanderling. 2008. Estimating numbers of unsheltered homeless people through plant-capture and postcount survey methods. American Journal of Public Health 98.8: 1438–1442.

    DOI: 10.2105/AJPH.2005.083600Save Citation »Export Citation »E-mail Citation »

    This article describes two methods for counting unsheltered homeless persons. Limitations of each method are described and the implications for statistically adjusting existing counts are discussed.

    Find this resource:

  • Office of Community Planning and Development. 2008. A guide to counting unsheltered homeless people. Washington, DC: US Department of Housing and Urban Development.

    Save Citation »Export Citation »E-mail Citation »

    The report provides guidance to the Continuums of Care (CoCs) for federal applications for homeless assistance on how to count unsheltered homeless people.

    Find this resource:

  • Wright, James D., and Joel A. Devine. 1992. Counting the homeless: The Census Bureau’s “S-night” in five US cities. Evaluation Review 16:355–364.

    DOI: 10.1177/0193841X9201600401Save Citation »Export Citation »E-mail Citation »

    This article is the introduction to a series of papers in this journal issue describing the US Census Bureau’s “S-Night” count, which was the precursor to current enumeration methods. A brief background on counting homeless populations is provided and limitations of the S-Night count are discussed.

    Find this resource:

  • Wright, James D., and Joel A. Devine. 1995. Housing dynamics of the homeless: Implications for a count. American Journal of Orthopsychiatry 65:320–333.

    DOI: 10.1037/h0085062Save Citation »Export Citation »E-mail Citation »

    This article attempts to reconcile the number of homeless people counted on the US Census Bureau’s “S-Night” with the “best guess” estimates of experts and the actual number of homeless. It finds that there are large numbers of homeless individuals who were either uncounted or uncountable on “S-Night,” causing only one-third to one-fifth of homeless individuals to have been counted.

    Find this resource:

Prevalence

Quantifying the problem of homelessness in the United States is difficult because the problem is often hidden. Consequently, methods to enumerate homelessness are relatively recent. The US Department of Housing and Urban Development’s 2009 Annual Homeless Assessment Report to Congress releases the point-in-time counts, measuring the number of homeless on one night in January, gathered by each Continuum of Care (CoC) annually since 2005. While it provides a count of homelessness on one day in January every year, inconsistent methods limit the accuracy of the counts. Although the count has several limitations, Henry and Sermons 2010 uses 2009 counts to describe the geography of homelessness. Link, et al. 1994 and Link, et al. 1995 represent limited attempts to estimate actual lifetime prevalence of homelessness in the United States. These studies confirm that this social problem appears to be more widespread that what is illustrated using other counting methods. Others have focused on national estimates; Shinn, et al. 1998; Ringwalt, et al. 1998; and Sermons and Witte 2011 describe US homelessness among families, youth, and seniors, respectively.

  • Henry, Meghan, and M. William Sermons. 2010. Geography of homelessness. Washington, DC: National Alliance to End Homelessness.

    Save Citation »Export Citation »E-mail Citation »

    The report provides an overview of the geographic distribution of homelessness. Comparisons are made between urban and rural regions, with further distinctions made within urban regions. Included in this report are the prevalence of homelessness and the distribution of the housing inventory by geographic categories.

    Find this resource:

  • Link, Bruce G., J. Phelan, M. Bresnahan, A. Stueve, R. Moore, and Ezra Susser. 1995. Lifetime and five-year prevalence of homelessness in the United States: New evidence on an old debate. American Journal of Orthopsychiatry 65:347–354.

    DOI: 10.1037/h0079653Save Citation »Export Citation »E-mail Citation »

    This is a follow-up to the study published in Link, et al. 1994. The authors reinterviewed subjects from the first study to confirm the earlier findings with more specific definitions of literal homelessness and duration of homelessness. The findings were surprisingly similar to the earlier study, confirming the high lifetime prevalence of ever being homeless in the United States.

    Find this resource:

  • Link, Bruce G., Ezra Susser, A. Stueve, J. Phelan, R. E. Moore, and E. Struening. 1994. Lifetime and five-year prevalence of homelessness in the United States. American Journal of Public Health 94:1907–1912.

    DOI: 10.2105/AJPH.84.12.1907Save Citation »Export Citation »E-mail Citation »

    Link and colleagues review lifetime and five-year (1985–1990) prevalence of homelessness, using a national telephone survey in the United States. In the sample of adults aged eighteen and older, the authors report a lifetime and five-year prevalence of homelessness as 14 percent and 4.6 percent, respectively.

    Find this resource:

  • Office of Community Planning and Development. 2010. 2009 Annual Homeless Assessment Report to Congress. Washington, DC: US Department of Housing and Urban Development.

    Save Citation »Export Citation »E-mail Citation »

    This report is the most recent of a series of reports published by the US Department of Housing and Urban Development for Congress. The estimates provided in this report are derived from point-in-time (PIT) counts of homeless and data from the Homeless Management Information Systems (HMIS). This annual report provides national counts of homeless people and describes shelter use.

    Find this resource:

  • Ringwalt, Christopher L., Jody M. Greene, Marjorie Robertson, and Melissa McPheeters. 1998. The prevalence of homelessness among adolescents in the United States. American Journal of Public Health 88:1325–1329.

    DOI: 10.2105/AJPH.88.9.1325Save Citation »Export Citation »E-mail Citation »

    The authors used the 1992 Youth Risk Behavior Survey to estimate the national prevalence of youth (ages twelve to seventeen years) homelessness. Findings suggest the prevalence of youth homelessness in this sample is similar to previous studies and remarkably high.

    Find this resource:

  • Sermons, M. William, and Peter Witte. 2011. State of homelessness in America. Washington, DC: National Alliance to End Homelessness.

    Save Citation »Export Citation »E-mail Citation »

    This report provides an overview of homelessness using the most recent point-in-time (PIT) counts and other risk indicators such as economic conditions and demographic factors associated with homelessness.

    Find this resource:

  • Shinn, Marybeth, Beth C. Weitzman, Daniela Stojanovic, et al. 1998. Predictors of homelessness among families in New York City: From shelter request to housing stability. American Journal of Public Health 88.11: 1651–1657.

    DOI: 10.2105/AJPH.88.11.1651Save Citation »Export Citation »E-mail Citation »

    The purpose of this study was to determine the effect of housing subsidies on homeless families who requested entry into a shelter. The results suggest that families who receive housing subsidies are much more likely to have stable housing situations than families receiving no public support.

    Find this resource:

Veterans

Homelessness affects many different subgroups. One subgroup, veterans, is covered in several published works. These chapters and articles address the unique programs for and prevalence of homeless veterans. Rosenheck, et al. 1996 provides an overview of homelessness among veterans. O’Toole, et al. 2003 and Roth 1992 review the physical and mental health of homeless veterans and compare this with nonveterans. McGuire, et al. 2010 and Kasprow, et al. 2000 explore housing outcomes of veterans involved in supportive housing and a US Department of Veterans’ Affairs treatment program for homeless veterans with either substance abuse or psychiatric problems, respectively. Benda 2005 focuses on gender-specific treatment programs for homeless veterans to inform specialized services directed to homeless female veterans.

  • Benda, Brent B. 2005. A study of substance abuse, traumata, and social support systems among homeless veterans. Journal of Human Behavior in the Social Environment 12.1: 59–82.

    DOI: 10.1300/J137v12n01_04Save Citation »Export Citation »E-mail Citation »

    This study examined the effects of trauma, combat duty, gender, and social support systems on readmission rates of homeless veterans to drug treatment programs. This is the first study to have specifically examined gender differences among homeless veterans, with the intent of providing a potential framework for Veterans’ Affairs hospitals to provide better and more specialized services for women veterans.

    Find this resource:

  • Kasprow, Wesley J., Robert A. Rosenheck, Linda Frisman, and Diane DiLella. 2000. Referral and housing processes in a long-term supported housing program for homeless veterans. Psychiatric Services 51.8: 1017–1023.

    DOI: 10.1176/appi.ps.51.8.1017Save Citation »Export Citation »E-mail Citation »

    This article examines the short-term success of a supported housing program for veterans. The study found that, while only about half of homeless veterans were eligible for the program and fewer than 10 percent of those eligible were referred to the program, the program was very successful. Many of them gained housing, and almost all were still housed a year later.

    Find this resource:

  • McGuire, James, Robert A. Rosenheck, and Wesley J. Kasprow. 2011. Patient and program predictors of 12-month outcomes for homeless veterans following discharge from time-limited residential treatment. Administration and Policy in Mental Health 38.3: 142–154.

    DOI: 10.1007/s10488-010-0309-9Save Citation »Export Citation »E-mail Citation »

    This study compares three types of residential treatment programs offered by the US Department of Veterans’ Affairs. The results suggest that there were no differences between program outcomes at a one-year follow-up, and the strongest predictor of positive outcomes was length of stay.

    Find this resource:

  • O’Toole, Thomas P., Alicia C. Conde-Martel, Jeanette L. Gibbon, Barbara H. Hanusa, and Michael J. Fine. 2003. Health care of homeless veterans: Why are some individuals falling through the safety net? Journal of General Internal Medicine 18:929–933.

    DOI: 10.1046/j.1525-1497.2003.21209.xSave Citation »Export Citation »E-mail Citation »

    O’Toole and colleagues discuss a community-based study on homeless veterans in Pittsburgh and Philadelphia.

    Find this resource:

  • Rosenheck, Robert, Catherine A. Leda, Linda K. Frisman, J. Lam, and Ah-me Chung. 1996. Homeless veterans. In Homelessness in America. Edited by James Baumohl, 97–108. Phoenix, AZ: Oryx.

    Save Citation »Export Citation »E-mail Citation »

    This chapter reviews homelessness among veterans. Rosenheck and colleagues conclude that military service in and of itself does not cause homelessness, but homeless services providers should recognize the role of posttraumatic stress disorder. Past military service is an important consideration for treatment and rehabilitation programs.

    Find this resource:

  • Roth, D. 1992. Homeless veterans: Comparisons with other homeless men. In Homelessness: A national perspective. Edited by M. J. Robertson and M. Greenblatt, 213–219. New York: Plenum.

    Save Citation »Export Citation »E-mail Citation »

    This chapter reviews a National Institute of Mental Health study of homeless veterans in Ohio. The findings suggest that homeless veterans are not significantly different from homeless nonveterans.

    Find this resource:

Youth

There are many potential causes of youth homelessness, such as being born to homeless parents, running away from home, and aging out of the foster care and child welfare system (Toro, et al. 2007; Whitbeck and Hoyt 1999). Culhane and Park 2007 found that entry into the child welfare system can increase the likelihood of a child’s becoming homeless, and Zlotnick 2009 found similar results with foster care. Buckner 2008 and Baron 2003 examine the negative effects associated with youth homelessness, including criminal behavior, poor development, and poor academic performance.

  • Baron, Stephen. 2003. Self-control, social consequences, and criminal behavior: Street youth and the general theory of crime. Journal of Research in Crime and Delinquency 40.4: 403–425.

    DOI: 10.1177/0022427803256071Save Citation »Export Citation »E-mail Citation »

    The author examines the association between self-control and criminal behavior among homeless youth. This article is frequently cited in the criminology literature.

    Find this resource:

  • Buckner, John C. 2008. Understanding the impact of homelessness on children: Challenges and future research directions. American Behavioral Scientist 51.6: 721–736.

    DOI: 10.1177/0002764207311984Save Citation »Export Citation »E-mail Citation »

    Buckner provides a review of the relationship between youth homelessness and mental health, development, and academic performance.

    Find this resource:

  • Culhane, Dennis P., and Jung Min Park. 2007. Homelessness and child welfare services in New York City: Exploring trends and opportunities for improvement of outcomes for children and youths. New York: Administration for Children’s Services.

    Save Citation »Export Citation »E-mail Citation »

    This report written for New York City’s Administration for Children’s Services synthesizes the findings of three previous studies. The goal of this paper was to discover the extent to which children and families who have experience with the child welfare system also have experienced homelessness.

    Find this resource:

  • Toro, Paul A., Amy Dworsky, and Patrick J. Fowler. 2007. Homeless youth in the United States: Recent research findings and intervention approaches. In Toward understanding homelessness: The 2007 National Symposium on Homelessness Research. Edited by Deborah Dennis, Gretchen Locke, and Jill Khadduri. Washington, DC: US Department of Health and Human Services and US Department of Housing and Urban Development.

    Save Citation »Export Citation »E-mail Citation »

    This paper reviews youth homelessness, including prevalence, demographic characteristics, and health issues. The authors include a review of the research published since 1998.

    Find this resource:

  • Whitbeck, Les B., and Dan R. Hoyt. 1999. Nowhere to grow: Homeless and runaway adolescents and their families. New York: Aldine de Gruyter.

    Save Citation »Export Citation »E-mail Citation »

    This book provides a comprehensive review of youth homelessness. The authors address the risk factors for homelessness and provide a theoretical framework to discuss the issue of youth homelessness.

    Find this resource:

  • Zlotnick, Cheryl. 2009. What research tells us about the intersecting streams of homelessness and foster care. American Journal of Orthopsychiatry 79.3: 319–325.

    DOI: 10.1037/a0017218Save Citation »Export Citation »E-mail Citation »

    This review provides evidence suggesting a link between homelessness and foster care. Also addressed is the role of supportive services and interventions for foster children and families.

    Find this resource:

Aging

The average age of the homeless population has historically been in the mid-thirties; however, Sermons and Henry 2010; Hahn, et al. 2004; and Crane and Warnes 2010 show that the homeless population has been growing older in the past few decades, mostly because of the aging of the chronically homeless. This fact, combined with the discussion in Rich, et al. 1995 about the overlapping risk factors of being older and homeless, makes the subject of older homeless people more important than ever. Like homeless youths and veterans, older homeless people have specific problems and needs, many of which are pointed out in Crane 1999. Ladner 1992 offers several policy suggestions that could help to end the growing problem of elderly homeless people. Cohen 1999 reviews the research and provides a model to explain homelessness among older adults.

  • Cohen, Carl I. 1999. Aging and homelessness. The Gerontologist 39.1: 5–14.

    DOI: 10.1093/geront/39.1.5Save Citation »Export Citation »E-mail Citation »

    This review presents a broad overview of homelessness among older populations. A model to explain homelessness in this population is also presented. Risk factors for homelessness among those aged fifty and older are described, which include both individual and structural causes.

    Find this resource:

  • Crane, Maureen. 1999. Understanding older homeless people: Their circumstances, problems, and needs. Buckingham, UK: Open Univ. Press.

    Save Citation »Export Citation »E-mail Citation »

    This book focuses on many aspects of the lives of older homeless people, from the circumstances that led to their homelessness to the problems they face while living in homelessness. Written in England, the book mostly discusses the plight of homeless elderly people in the United Kingdom.

    Find this resource:

  • Crane, Maureen, and Anthony M. Warnes. 2010. Homelessness among older people and service responses. Reviews in Clinical Gerontology 20:354–363.

    DOI: 10.1017/S0959259810000225Save Citation »Export Citation »E-mail Citation »

    Crane and Warnes provide a review of homelessness in older populations. This article focuses on older adults in the United Kingdom; however, the authors also illustrate some of the US issues among this subgroup of homeless adults. This article provides an introduction to these issues, including the reasons for homelessness and potential policy solutions.

    Find this resource:

  • Hahn, Judith A., Margot B. Kushel, David R. Bangsberg, Elise Riley, and Andrew R. Moss. 2004. The aging of the homeless population: Fourteen-year trends in San Francisco. Journal of General Internal Medicine 21.7: 775–778.

    DOI: 10.1111/j.1525-1497.2006.00493.xSave Citation »Export Citation »E-mail Citation »

    This is one of the few longitudinal studies of adult homelessness. This article describes the fourteen-year trend of the homeless in San Francisco. The authors report a consistent aging of the homeless population, suggesting that many are older chronically homeless adults. The authors found few newly homeless contributing to the aging of the homeless population.

    Find this resource:

  • Ladner, Susan. 1992. The elderly homeless. In Homelessness: A national perspective. Edited by M. Robertson and M. Greenblatt, 221–226. New York: Plenum.

    Save Citation »Export Citation »E-mail Citation »

    This chapter touches on one of the few studies of elderly homeless conducted in a New York shelter. The authors describe the demographic characteristics of the elderly homeless in New York and also propose policy suggestions to ameliorate this social problem. The data used in this study are not current; however, the implications are pertinent to today’s homeless issues.

    Find this resource:

  • Rich, Diane Wiatt, Thomas A. Rich, and Larry C. Mullins. 1995. Old and homeless—double-jeopardy: An overview of current practice and policies. Westport, CT: Greenwood.

    Save Citation »Export Citation »E-mail Citation »

    This book examines several issues pertaining particularly to homeless individuals over the age of fifty. These issues apply to both the old and the homeless, but they all seem to be magnified for those who are both. Topics covered include characteristics and needs, mental and physical health, medication and substance abuse, and housing policy.

    Find this resource:

  • Sermons, M. William., and Meghan Henry. 2010. Demographics of homelessness series: The rising elderly population. Washington, DC: National Alliance to End Homelessness.

    Save Citation »Export Citation »E-mail Citation »

    In this report, Sermons and Henry review demographic shifts in the homeless population and illustrate the changes in the elderly population of homeless. The cause of this moderate increase in older homeless individuals is considered to be the general aging of the chronically homeless and new elderly homeless affected by financial, health, and work problems.

    Find this resource:

Mortality

There is limited literature on the mortality rates of homeless populations. What is known, however, is summarized in O’Connell 2005, in which US and international mortality rates are reviewed. Barrow, et al. 1999 provides a glimpse into the mortality rates of homeless in New York.

Health

The health status of the homeless and the challenges of providing health care to homeless populations are addressed in various articles and book chapters. The US Department of Health and Human Services website provides a wealth of information about health issues and programs for the homeless. More recent articles, such as Schanzer, et al. 2007 and Baggett, et al. 2010, provide data on the health needs and utilization of health services among the homeless. Wright 1990 and Brickner, et al. 1990 present findings from a large national data collection effort in 1985, the National Health Care for the Homeless program, assessing the health needs of the homeless receiving care from health clinics in nineteen US cities. Dennis, et al. 1991 provides a more dated review of the literature exploring the physical and mental health status of homeless populations, while Stark 1992 describes barriers to receiving health care. Hwang, et al. 2005 reports a systematic review of treatment and intervention programs for homeless adults with mental illness.

  • Baggett, Travis P., James J. O’Connell, Daniel E. Singer, and Nancy A. Rigotti. 2010. The unmet healthcare needs of homeless adults: A national study. American Journal of Public Health 100.7: 1326–1333.

    DOI: 10.2105/AJPH.2009.180109Save Citation »Export Citation »E-mail Citation »

    This article describes a recent national study on health care for the homeless. Data from the Health Care for the Homeless User Survey were used to explore unmet health needs in a representative sample of homeless persons.

    Find this resource:

  • Brickner, Philip W., Linda K. Scharer, Barbara Conanan, Marianne Savarese, and Brian C. Scanlan, eds. 1990. Under the safety net: The health and social welfare of the homeless in the United States. New York: W. W. Norton.

    Save Citation »Export Citation »E-mail Citation »

    This book is a compilation of papers about a national Health Care for the Homeless demonstration program implemented in 1985. Topics ranged from descriptions of health status to programmatic issues that arose during the implementation of the program.

    Find this resource:

  • Dennis, Deborah L., Irene S. Levine, and Fred C. Osher. 1991. The physical and mental health status of homeless adults. Housing Policy Debate 2.3: 815–835.

    DOI: 10.1080/10511482.1991.9521073Save Citation »Export Citation »E-mail Citation »

    This paper is a review of mental and physical health among homeless populations.

    Find this resource:

  • Hwang, Stephen W., George Tolomiczenko, Fiona Kouyoumdjian, and Rochelle E. Garner. 2005. Interventions to improve the health of the homeless: A systematic review. American Journal of Preventive Medicine 29.4: 311–311.

    DOI: 10.1016/j.amepre.2005.06.017Save Citation »Export Citation »E-mail Citation »

    Hwang and colleagues conduct a systematic review of treatment and intervention research for homeless adults identified as having mental illness or substance abuse problems.

    Find this resource:

  • Schanzer, Bella, Boanerges Dominguez, Patrick E. Shrout, and Carol L. M. Caton. 2007. Homelessness, health status, and health care use. American Journal of Public Health 97.3: 464–469.

    DOI: 10.2105/AJPH.2005.076190Save Citation »Export Citation »E-mail Citation »

    This article presents the results of a study on the health status and use of health care among newly homeless individuals in the New York City shelter system. The study found that, while the newly homeless have a higher prevalence of disease and mental illness, many experienced improvements in health status and access to health care while in the shelter system.

    Find this resource:

  • Stark, Louisa R. 1992. Barriers to health care for homeless people. In Homelessness: A prevention oriented approach. Edited by René I. Jahiel, 151–165. Baltimore: Johns Hopkins Univ. Press.

    Save Citation »Export Citation »E-mail Citation »

    This chapter is part of a larger collection of works on homelessness. The chapter focuses on barriers to health care for homeless individuals from two perspectives: that of the providers and that of the homeless.

    Find this resource:

  • US Department of Health and Human Services.

    Save Citation »Export Citation »E-mail Citation »

    This website provides health-related information on homelessness. Links to grant announcements, recent publications, and other resources are provided.

    Find this resource:

  • Wright, James D. 1990. Poor people, poor health: The health status of the homeless. Journal of Social Issues 46:49–64.

    DOI: 10.1111/j.1540-4560.1990.tb01798.xSave Citation »Export Citation »E-mail Citation »

    In this article, Wright addresses the fact that poor physical or mental health can be both a cause of homelessness and an effect of it. He uses data from the National Health Care for the Homeless program to show that homeless individuals have higher prevalence of very many health issues.

    Find this resource:

Tuberculosis

Tuberculosis is prevalent among the homeless. Outbreaks of tuberculosis in homeless shelters were documented in an early study, Nardell, et al. 1986. The prevalence of tuberculosis is examined by Haddad, et al. 2005. More recent articles (Khan, et al. 2011; Barnes, et al. 2011; Barnes and El-Hajj 1996) explore trends in tuberculosis infection. Treatment noncompliance is examined by Brudney and Dobkin 1992.

  • Barnes, Peter F., Hiyam El-Hajj, Susan Preston-Martin, et al. 1996. Transmission of tuberculosis among the urban homeless. Journal of the American Medical Association 275.4: 305–307.

    DOI: 10.1001/jama.1996.03530280057037Save Citation »Export Citation »E-mail Citation »

    The authors evaluated the frequency of tuberculosis in homeless populations in Los Angeles, California. Of the thirty-four patients included in this study, twenty-four cases were due to primary tuberculosis. The implication of this research informs the identification and treatment of homeless populations diagnosed with tuberculosis.

    Find this resource:

  • Barnes, Richard F.W., Maria Luisa Moore, Richard S. Garfein, Stephanie Brodine, Steffanie A. Strathdee, and Timothy C. Rodwell. 2011. Trends in mortality of tuberculosis patients in the United States: The long-term perspective. Annals of Epidemiology 21.10: 791–795.

    DOI: 10.1016/j.annepidem.2011.07.002Save Citation »Export Citation »E-mail Citation »

    While not addressing homelessness specifically, the authors compare mortality trends between death records and the National Tuberculosis Surveillance System. These findings are important for surveillance and tuberculosis control in all populations.

    Find this resource:

  • Brudney, Karen, and Jay Dobkin. 1992. Resurgent tuberculosis in New York City: Human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs. Journal of Public Health Policy 13.4: 435–451.

    DOI: 10.2307/3342533Save Citation »Export Citation »E-mail Citation »

    This frequently cited prospective study examined tuberculosis treatment compliance. The findings show that homelessness was significantly associated with noncompliance with tuberculosis treatment after discharge from the hospital.

    Find this resource:

  • Haddad, Maryam B., Todd W. Wilson, Kashef Ijaz, Suzanne M. Marks, and Marisa Moore. 2005. Tuberculosis and homelessness in the United States, 1994–2003. Journal of the American Medical Association 293:2762–2766.

    DOI: 10.1001/jama.293.22.2762Save Citation »Export Citation »E-mail Citation »

    This study compared risk factors and disease characteristics of homeless people with tuberculosis to those of nonhomeless people with the disease. The authors found that the higher prevalence of tuberculosis in homeless individuals is likely due to overlapping risk factors, but good case management allowed homeless individuals with tuberculosis to achieve the same level of treatment outcomes as housed patients.

    Find this resource:

  • Khan, Kamran, Elizabeth Rea, Cameron McDermaid, et al. 2011. Active tuberculosis among homeless persons, Toronto, Ontario, Canada, 1998–2007. Emerging Infectious Diseases 17.3: 357–365.

    DOI: 10.3201/eid1703.100833Save Citation »Export Citation »E-mail Citation »

    This study evaluated trends of tuberculosis infection among Canadian-born and foreign-born homeless adults.

    Find this resource:

  • Nardell, Edward, B. Mclinnis, B. Thomas, and S. Weidhass. 1986. Exogenous reinfection with tuberculosis in a shelter for the homeless. New England Journal of Medicine 315:1570–1575.

    DOI: 10.1056/NEJM198612183152502Save Citation »Export Citation »E-mail Citation »

    The authors examined a tuberculosis outbreak among homeless adults living in a shelter setting. This study is frequently cited in the homelessness and tuberculosis literature.

    Find this resource:

HIV/AIDS

A large portion of adults who are homeless or at risk of being homeless have HIV/AIDS. Douaihy, et al. 2005; Wolitski, et al. 2007; and Aidala and Sumartojo 2007 review the public health issue of HIV/AIDS in homeless populations. The prevalence of HIV/AIDS is documented by Culhane, et al. 2001, which is one of many studies reporting higher estimates of HIV/AIDS than in housed populations. There is a plethora of research evaluating treatment and housing assistance programs, including Wolitski 2010; Kidder, et al. 2007; Aidala, et al. 2007; and Naranbhai, et al. 2011.

  • Aidala, Angela A., Gunjeong Lee, David M. Abramson, Peter Messeri, and Anne Siegler. 2007. Housing need, housing assistance, and connection to medical care. AIDS and Behavior 11, suppl. 2: S101–S115.

    Save Citation »Export Citation »E-mail Citation »

    This study compares housing status and health care outcomes using the 1994–2006 cohorts of the Community Health Advisory & Information Network (CHAIN) study, which includes a representative sample of HIV-positive adults aged twenty and older. Findings suggest that housing is associated with better health outcomes.

    Find this resource:

  • Aidala, Angela A., and Esther Sumartojo. 2007. Why housing? AIDS and Behavior 11:S1–S6.

    Save Citation »Export Citation »E-mail Citation »

    This article is an introduction to a special issue of AIDS and Behavior exploring homelessness and HIV/AIDS. The author provides an overview of the association between housing and health outcomes of persons with HIV/AIDS or those at risk of exposure.

    Find this resource:

  • Culhane, Dennis P., Erica Gollub, Randall R. Kuhn, and Mark Shpaner. 2001. The co-occurrence of AIDS and homelessness: Results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia. Journal of Epidemiology and Community Health 55:515–520.

    DOI: 10.1136/jech.55.7.515Save Citation »Export Citation »E-mail Citation »

    The authors estimate the co-occurrence of AIDS and homelessness from public shelter users in Philadelphia. Findings suggest that homeless persons are at high risk for AIDS. Estimates indicated that subjects had nine times the risk of having AIDS.

    Find this resource:

  • Douaihy, Antoine B., Keith R. Stowell, Thuy Bui, Dennis Daley, and Ihsan Salloum. 2005. HIV/AIDS and homelessness, part I: Background and barriers to care. AIDS Reader 15.10: 516–520, 527.

    Save Citation »Export Citation »E-mail Citation »

    Douaihy and colleagues provide a comprehensive review of HIV/AIDS and homelessness in the United States.

    Find this resource:

  • Kidder, Daniel P., Richard J. Wolitski, M. L. Campsmith, and G. V. Nakamura. 2007. Health status, health care use, medication use, and medication adherence in homeless and housed people living with HIV/AIDS. American Journal of Public Health 97.12: 2238–2245.

    DOI: 10.2105/AJPH.2006.090209Save Citation »Export Citation »E-mail Citation »

    The authors examined the Centers for Disease Control and Prevention’s Supplement to HIV/AIDS Surveillance project in multiple US cities. This study compared health care use between HIV-positive housed and homeless populations.

    Find this resource:

  • Naranbhai, Vivek, Q. Abdool Karim, and Anna Meyer-Weitz. 2011. Interventions to modify sexual risk behaviours for preventing HIV in homeless youth. Cochrane Database of Systematic Reviews 1: CD007501.

    DOI: 10.1002/14651858.CD007501.pub2Save Citation »Export Citation »E-mail Citation »

    This recent review examines behavioral interventions to prevent HIV in homeless youth. The final analysis includes three randomized control trials conducted in the United States.

    Find this resource:

  • Wolitski, Richard J., Daniel P. Kidder, and Kevin A. Fenton. 2007. HIV, homelessness, and public health: Critical issues and a call for increased action. AIDS and Behavior 11:S167–S171.

    Save Citation »Export Citation »E-mail Citation »

    This introduces articles published in this special issue of AIDS and Behavior describing homelessness or unstable housing and the associated health issues, including HIV/AIDS.

    Find this resource:

  • Wolitski, Richard J., Daniel P. Kidder, Sherri L. Pals, et al. 2010. Randomized trial of the effects of housing assistance on the health and risk behaviors of the homeless and unstably housed people living with HIV. AIDS and Behavior 14:493–503.

    DOI: 10.1007/s10461-009-9643-xSave Citation »Export Citation »E-mail Citation »

    This article presents the results from a randomized control trial assessing the impact of housing assistance for homeless or those at risk of homelessness with HIV. The data was from the Housing and Health Study sponsored by the CDC and HUD.

    Find this resource:

Mental Health and Substance Abuse

Substance abuse and mental illness are often co-occurring issues for the homeless. Both are known to be causes of homelessness, and homelessness can exacerbate mental illness and substance abuse. Bassuk, et al. 1984; Martens 2001; Scott 1993; Dennis, et al. 1999; and Fischer and Breakey 1991 assess the prevalence of mental illness among homeless populations. Many publications have addressed these relationships. Greenberg and Rosenheck 2010 examines correlates of past homelessness and mental health status and substance abuse. Gillig and McQuistion 2006 published a well-known clinical guide for treating homeless persons with mental illness. Hoch, et al. 2008 reviews the cost of addiction services for homeless adults in the United States and Canada.

  • Bassuk, Ellen L., Lenore Rubin, and Alison Lauriat. 1984. Is homelessness a mental health problem? American Journal of Psychiatry 141.12: 1546–1550.

    Save Citation »Export Citation »E-mail Citation »

    This frequently cited article examines the prevalence of psychiatric diagnoses of homeless adults and children living in emergency shelters.

    Find this resource:

  • Dennis, Michael L., Robert M. Bray, Ronaldo Iachan, and Jutta Thornberry. 1999. Drug use and homelessness. In Drug use in metropolitan America. Edited by R. M. Bray and M. E. Marsden, 79–123. Thousand Oaks, CA: SAGE.

    Save Citation »Export Citation »E-mail Citation »

    As part of a book about drug use, this chapter addresses drug use among homeless individuals in metropolitan areas, and Washington, DC, in particular. In addition to researching the prevalence of drug use in the homeless population, the study used for this chapter also investigated the relationship between drug use and other problems (e.g. criminal activity, mental illness, sexually transmitted diseases).

    Find this resource:

  • Fischer, Pamela J., and William R. Breakey. 1991. The epidemiology of alcohol, drug, and mental disorders among homeless persons. American Psychologist 46.11: 1115–1128.

    DOI: 10.1037/0003-066X.46.11.1115Save Citation »Export Citation »E-mail Citation »

    Fischer and Breakey examine the prevalence of mental illness and alcohol and drug use among homeless populations.

    Find this resource:

  • Gillig, Paulette M., and Hunter L. McQuistion, eds. 2006. Clinical guide to the treatment of the mentally ill homeless person. Arlington, VA: American Psychiatric Association.

    Save Citation »Export Citation »E-mail Citation »

    This book is a clinical guide for treating mentally ill homeless persons. The authors review the process of outreach and engagement, and the specific concerns for single adults, families, and children. Topics include housing, health care settings, and incarceration.

    Find this resource:

  • Greenberg, Greg A., and Robert A. Rosenheck. 2010. Mental health correlates of past homelessness in the National Comorbidity Study Replication. Journal of Health Care for the Poor and Underserved 21:1234–1249.

    Save Citation »Export Citation »E-mail Citation »

    This study investigated the relationship between mental health and substance abuse. The authors found that past incarceration and substance abuse problems are both more closely associated with homelessness than are non-substance-abuse psychiatric disorders.

    Find this resource:

  • Hoch, Jeffrey S., Carolyn S. Dewa, Stephen W. Hwang, and Paula Goering. 2008. Health care cost matters for homeless people: An example of costing mental health and addiction services in homeless shelters in Canada. International Journal of Mental Health and Addiction 6:476–483.

    DOI: 10.1007/s11469-008-9156-2Save Citation »Export Citation »E-mail Citation »

    Hoch and colleagues enumerate the average health care costs provided in homeless shelters in Toronto.

    Find this resource:

  • Martens, Willem H. 2001. A review of physical and mental health in homeless persons. Public Health Reviews 29.1: 13–33.

    Save Citation »Export Citation »E-mail Citation »

    This review explores the prevalence of mental illness among the homeless in the United States, Australia, and Canada.

    Find this resource:

  • Scott, J. 1993. Homelessness and mental illness. British Journal of Psychiatry 162:314–324.

    DOI: 10.1192/bjp.162.3.314Save Citation »Export Citation »E-mail Citation »

    The author reviews the literature to assess the prevalence of mental illness among homeless populations.

    Find this resource:

Shelter and Housing

Perhaps the most prominent policy response to homelessness has been the homeless shelter system, transitional housing, and permanent supportive housing models. General literature on housing and the policy response to homelessness is provided by the US Department of Housing and Urban Development’s 2009 report to Congress (Steffen, et al. 2011) and Rosenthal and Foscarinis 2006. Additional information about local, state, and federal responses to homelessness is available through multiple outlets, including the US Department of Housing and Urban Development, the National Low Income Housing Coalition, the US Interagency Council on Homelessness, and the National Alliance to End Homelessness. Burt 2010 examines transitional housing in five US communities, describing residents and services and the resulting outcomes of this housing model.

Supportive Housing

An increasingly popular option to help the homeless is to provide longer-term housing options with supportive services. The supportive housing movement has resulted in several housing models, which are described by Wong, et al. 2006; Culhane, et al. 2002; and Flaming, et al. 2009. Other studies (Herman, et al. 2007; Hickert and Taylor 2011; Foster, et al. 2009) have examined supportive housing interventions that do not neatly fall within the Housing First or Assertive Community Treatment models. Although not frequently discussed in the literature, family supportive housing has started to gain importance and is described by Nolan, et al. 2005. Lipton, et al. 2000 evaluates different intensities of supportive services within this housing model. Additionally, the Corporation for Supportive Housing is a leader in this field and a valuable resource for research and technical assistance on supportive housing models.

Housing First

The Housing First model was introduced by Sam Tsemberis in the early 1990s to provide access to housing and supportive services for persons with mental illness or substance abuse problems. This model removes barriers that would otherwise prevent access to subsidized housing, such as active substance use. The Pathways to Housing website and Tsemberis 2010 provide an overview of and relevant research on this model. Recent research evaluating the Housing First model are presented in Tsemberis, et al. 2004; Tsemberis and Eisenberg 2000; Kertesz, et al. 2009; and Pearson, et al. 2009.

  • Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, Robert E. Cusimano, and Joseph E. Schumacher. 2009. Housing First for homeless persons with active addiction: Are we overreaching? Milbank Quarterly 87.2: 495–534.

    DOI: 10.1111/j.1468-0009.2009.00565.xSave Citation »Export Citation »E-mail Citation »

    This article reviews several studies of Housing First programs in comparison to linear interventions such as the Continuum of Care model. This review suggests that Housing First programs are very successful at helping clients to maintain housing in both the short and long terms. The authors warn about generalizing this conclusion, though, because the available data are limited.

    Find this resource:

  • Pathways to Housing.

    Save Citation »Export Citation »E-mail Citation »

    This website provides information on the Housing First model and an extensive list of applicable research.

    Find this resource:

  • Pearson, Carol, Ann Elizabeth Montgomery, Gretchen Locke. 2009. Housing stability among homeless individuals with serious mental illness participating in Housing First programs. Journal of Community Psychology 37.3: 404–417.

    DOI: 10.1002/jcop.20303Save Citation »Export Citation »E-mail Citation »

    This study is an exploratory comparison of three Housing First programs: DESC, Pathways to Housing, and REACH. While each had its unique differences, of eighty individuals tracked in the three programs combined, 84 percent remained in housing for a year after entry into a program.

    Find this resource:

  • Tsemberis, Sam. 2010. Housing First: Ending homelessness, promoting recovery, and reducing costs. In How to house the homeless. Edited by Ingrid Gould Ellen and Brendan O’Flaherty, 37–56. New York: Russell Sage Foundation.

    Save Citation »Export Citation »E-mail Citation »

    The author reviews the Housing First program for persons with mental illness.

    Find this resource:

  • Tsemberis, Sam, and Ronda F. Eisenberg. 2000. Pathways to Housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services 51.4: 487–493.

    DOI: 10.1176/appi.ps.51.4.487Save Citation »Export Citation »E-mail Citation »

    This study evaluated the feasibility of moving individuals with psychiatric disabilities or substance addictions directly from the street into housing. Looking at Linear Residential Treatments and Pathways to Supported Housing, the study found 84.2 percent of tenants could go from streets to apartments without any additional transitional housing.

    Find this resource:

  • Tsemberis, Sam, Leyla Gulcur, and Maria Nakae. 2004. Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health 94.4: 651–656.

    DOI: 10.2105/AJPH.94.4.651Save Citation »Export Citation »E-mail Citation »

    This study explored the effectiveness of Housing First versus Continuum of Care by using interviews and analyzing results to measure differences between the experimental (Housing First) group and control (CoC) group.

    Find this resource:

Assertive Community Treatment Models

Assertive Community Treatment (ACT) is one type of supportive housing program designed to provide community-based psychiatric treatment in a team setting. Rosenheck and Dennis 2001 explore the outcomes eighteen months after discharge from an ACT program. Tsemberis 1999 found that ACT was often more successful than previously used methods of supportive housing. Carton, et al. 2010 found that ACT was also successful in helping clients to build personal relationships.

  • Carton, Adam D., M. Scott Young, and Kristine M. Kelly. 2010. Changes in sources and perceived quality of social supports among formerly homeless persons receiving Assertive Community Treatment services. Community Mental Health Journal 46:156–163.

    DOI: 10.1007/s10597-009-9185-8Save Citation »Export Citation »E-mail Citation »

    This article reports on a study of the quality and size of support systems of formerly homeless individuals who participated in Assertive Community Treatment services.

    Find this resource:

  • Rosenheck, Robert A., and Deborah Dennis. 2001. Time-limited Assertive Community Treatment (ACT) for homeless persons with severe mental illness. Archives of General Psychiatry 58:1073–1080.

    DOI: 10.1001/archpsyc.58.11.1073Save Citation »Export Citation »E-mail Citation »

    In this article, Rosenheck and Dennis assess the effects of follow-up treatments to extensive Assertive Community Treatment programs for homeless people with severe mental illnesses.

    Find this resource:

  • Tsemberis, Sam. 1999. From streets to homes: An innovative approach to supported housing for homeless adults with psychiatric disabilities. Journal of Community Psychology 27.2: 225–241.

    DOI: 10.1002/(SICI)1520-6629(199903)27:2%3C225::AID-JCOP9%3E3.0.CO;2-YSave Citation »Export Citation »E-mail Citation »

    Tsemeris compares two supportive housing models, the Assertive Community Treatment (ACT) and a linear residential treatment model for homeless with severe mental illness. Findings suggest the ACT model of providing housing without requirements for sobriety reported better retention rates than linear residential treatment with sobriety requirements.

    Find this resource:

Incarceration

Homelessness and incarceration are inextricable linked (Metraux, et al. 2007; Metraux and Culhane 2006). Hopper, et al. 1997 describes the use of homeless shelters as an expansion of institutional services such as prisons and hospitals. Roman and Travis 2006 provides an overview of the housing policy implications of prisoner reentry. Greenberg and Rosenheck 2008 and Kushel, et al. 2005 show that incarceration and homelessness both cause many other physical and mental health problems, with the effects being even greater for people who have been both homeless and incarcerated. Further, the health effects of homelessness differ between genders. These issues are documented by Weiser, et al. 2009.

  • Greenberg, Greg A., and Robert A. Rosenheck. 2008. Jail incarceration, homelessness, and mental health: A national study. Psychiatric Services 59.2: 170–177.

    DOI: 10.1176/appi.ps.59.2.170Save Citation »Export Citation »E-mail Citation »

    This article presents the results of a study that found that incarcerated individuals are more likely to have been homeless at some point in the year before incarceration than is true of the general population of the United States. The research also touched on mental illness and substance abuse, showing that incarcerated individuals and homeless individuals have a higher prevalence of both.

    Find this resource:

  • Hopper, Kim, John Jost, Terri Hay, Susan Welber, and Gary Haugland. 1997. Homelessness, severe mental illness, and the institutional circuit. Psychiatric Services 48.5: 659–664.

    Save Citation »Export Citation »E-mail Citation »

    Hopper and colleagues describe the use homeless shelters in four different ways, the most prevalent of which is as a part of a larger, extended institutional circuit that includes prisons, psychiatric hospitals, and rehabilitation clinics.

    Find this resource:

  • Kushel, Margot B., Judith A. Hahn, Jennifer L. Evans, David R. Bangsberg, and Andrew R. Moss. 2005. Revolving doors: Imprisonment among the homeless and marginally housed population. American Journal of Public Health 95.10: 1747–1752.

    DOI: 10.2105/AJPH.2005.065094Save Citation »Export Citation »E-mail Citation »

    This article examined the effects of imprisonment on mental and physical health, drug use, and sexual behavior among homeless individuals.

    Find this resource:

  • Metraux, Stephen, and Dennis P. Culhane. 2006. Recent incarceration history among a sheltered homeless population. Crime and Delinquency 52.3: 504–517.

    DOI: 10.1177/0011128705283565Save Citation »Export Citation »E-mail Citation »

    Metraux and Culhane examined the prevalence of past incarceration among the sheltered homeless population in New York. The results of the research show that homeless people are much more likely to have a history of incarceration than is true of the general population.

    Find this resource:

  • Metraux, Stephen, Caterina  G. Roman, and Richard  S. Cho. 2007. Incarceration and homelessness. In Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research. Edited by Deborah Dennis, Gretchen Locke, and Jill Khadduri. Washington, DC: US Department of Health and Human Services and US Department of Housing and Urban Development.

    Save Citation »Export Citation »E-mail Citation »

    The paper provides a review of the literature about the association between homelessness and incarceration in the United States, including barriers to housing, reentry issues, and the evaluation of interventions. The authors also discuss policy implications and areas for future research.

    Find this resource:

  • Roman, Caterina G., and Jeremy Travis. 2006. Where will I sleep tomorrow? Housing, homelessness, and the returning prisoner. Housing Policy Debate 17.2: 389–418.

    DOI: 10.1080/10511482.2006.9521574Save Citation »Export Citation »E-mail Citation »

    This article describes the scope of the issue, barriers to securing appropriate housing, and the public policies and funding to address prisoner reentry.

    Find this resource:

  • Weiser, Sheri D., Torsten B. Neilands, Megan L. Comfort, et al. 2009. Gender-specific correlates of incarceration among marginally housed individuals in San Francisco. American Journal of Public Health 99.8: 1459–1463.

    DOI: 10.2105/AJPH.2008.141655Save Citation »Export Citation »E-mail Citation »

    This article compares the effects of homelessness on incarceration of men and women. The authors conclude that almost all forms of homelessness increase the likelihood of incarceration, and incarceration increases the likelihood of homelessness for both men and women.

    Find this resource:

Prevention

If the homelessness problem is ever to be resolved, then one of the major aspects of the cure will be preventing people from becoming newly homeless. Jahiel 1992 provides an overview of homelessness prevention strategies through a thorough compilation of articles. Lindblom 1991 argues that efforts to prevent homelessness will not only be more effective than traditional methods of aiding people once they have already become homeless, but that they can also be less expensive.

  • Jahiel, René I., ed. 1992. Homelessness: A prevention-oriented approach. Baltimore: Johns Hopkins Univ. Press.

    Save Citation »Export Citation »E-mail Citation »

    This book provides an overview of homeless prevention. This compilation of papers reviews the historical context, causes, and responses to homelessness in an effort to understand effective prevention strategies.

    Find this resource:

  • Lindblom, Eric N. 1991. Toward a comprehensive homelessness-prevention strategy. Housing Policy Debate 2.3: 957–1025.

    DOI: 10.1080/10511482.1991.9521079Save Citation »Export Citation »E-mail Citation »

    This article advocates prevention strategies designed for those at risk of becoming homeless, rather than focusing on helping only those people who are already homeless. Lindblom suggests that it costs less per person to provide assistance to people before they become homeless, and more people could be helped with the same amount of money if preventive strategies are adopted.

    Find this resource:

International Homelessness

Homelessness is an international issue (Philippot, et al. 2007; Glasser 1994). A more recent review of the literature about international homelessness is provided in a special issue of the Journal of Social Issues. Several papers in this issue provide a thorough overview of the issue (Toro 2007; Shinn 2007; Toro, et al. 2007). Beier and Ocobock 2008 offers a historical perspective on homelessness on a global scale. Unlike the previously described research in developed countries, Tipple and Speak 2009 reviews the issue of homelessness in developing counties.

back to top

Article

Up

Down