Geography Homelessness
by
Lois M. Takahashi
  • LAST REVIEWED: 03 July 2017
  • LAST MODIFIED: 27 September 2017
  • DOI: 10.1093/obo/9780199874002-0108

Introduction

Homelessness has been defined along a spectrum of insufficient and inadequate shelter, from literal street sleeping to sleeping in temporary shelters to overcrowded housing circumstances; along a spectrum of time, from continuous to sporadic homeless episodes; and along a spectrum of space, from limited mobility to movement within and across geographic areas. In the United States and the Western industrialized world, homelessness was often framed as a crisis in the 1980s but has since become part of a larger narrative concerning entrenched poverty and income inequality. Research in the 1980s, primarily in sociology, psychology, social work, public policy, urban planning, public health, and geography, focused on defining homelessness, identifying the multiple and intersecting causes of homelessness, clarifying mental health issues faced by homeless persons, and recommending strategies, including emergency shelters, transitional housing, permanent housing with and without social services, and housing with and without prerequisites. Early-21st-century research on homelessness has deepened scholarly and policy understanding of the variety of homeless subpopulations and their specific needs and survival strategies and increasingly has framed homelessness as a particular aspect of the larger structural issues defining poverty and inequality in industrialized countries. Geographers in particular have emphasized the spatial dimensions of homelessness and have provided a countervailing explanation (usually based in social structures such as poverty and social exclusion) to the popular notion that homelessness is the result of individual counterproductive behavior or vulnerabilities. This review article includes both conceptual and empirical research, endeavoring to cover the myriad of conceptual frameworks explaining homelessness and the varied approaches researchers have tested to ameliorate homelessness. The article also summarizes resistant threads of scholarship on homelessness, from theories of revanchism to feminism, and includes both work in the United States and other industrialized countries (in particular, Canada and the United Kingdom). The article is organized into the following sections, which highlight in particular the contributions made by geographers and those with spatial lenses. First, two overview sections summarize publications that have led the field in conceptualizing homelessness for scholars and policymakers; one of the sections highlights specific geographical contributions. A section on reference resources, especially online, follows that and focuses on advocacy organizations. The next few sections shows how scholars have described the needs and challenges faced by varying groups of homeless persons, centering on health, mental health, and substance abuse. Geographers and others have worked to reconceptualize homelessness, from descriptions of need and individual deficits to a focus on systems and politics; one section highlights these innovative works. The final four sections summarize alternatives to the population descriptions that comprise the mainstay of homelessness research to focus on stigma and identity, revanchism and resistance, and conceptual and empirical discussions of policies and programs that should be, and have been, developed and delivered to address homelessness. I thank Nathaniel Barlow for expert research assistance, and the editorial team and two anonymous reviewers for their very helpful comments. All errors or omissions remain my responsibility.

General Overviews

The 1980s and 1990s saw a burst of research on homelessness. Much of the early research focused on methods to estimate the size and location of the homeless population and risk factors for homelessness (e.g., Caton, et al. 2005; Lee and Price-Spratlen 2004; Link, et al. 1994; Susser, et al. 1993). Alternative rubrics were put forth to explain the rapid rise in homelessness across North American cities in the 1980s. Many researchers focused on mental disability/illness and deinstitutionalization, where the closure of large mental health institutions in the United States and the lack of creation of community-based mental health-care settings (which were argued to be superior to large institutional settings but were not sufficiently provided) led to former patients being released into communities with little or no services and housing. Bachrach 1992 explains, in an accessible piece, how mental disability/illness and homelessness are linked. Some researchers focused on individual vulnerabilities, even framing them as deficits, such as substance abuse and mental health issues (stemming from child abuse, domestic violence, military experience, and other sources). Baum and Burnes 1993 and Jencks 1995 in particular argue that substance abuse along with other factors resulted in individual homelessness. O’Flaherty 1995 provides a rare housing-markets-centered economic explanation of homelessness. Outside the United States, Fitzpatrick 2005 offers an alternative explanation of homelessness in the United Kingdom, on the basis of a realist philosophical perspective.

  • Bachrach, Leona L. “What We Know about Homelessness among Mentally Ill Persons: An Analytical Review and Commentary.” Hospital & Community Psychiatry 43.5 (1992): 453–464.

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    Accessible review of the literature on homelessness, focused on mental disability. The article highlights how homeless populations are counted, the variations within and between homeless subpopulations (including mobility and migration patterns), whether and how deinstitutionalization is linked to the expansion of homeless populations, and recommendations about planning services to meet the needs of homeless persons with mental health-care needs.

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  • Baum, Alice S., and Donald W. Burnes. A Nation in Denial: The Truth about Homelessness. Boulder, CO: Westview, 1993.

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    Argues that the rise in homelessness was due primarily to individual deficits and vulnerabilities, especially substance abuse and mental disability, along with the failure of public policies directed toward homelessness, including deinstitutionalization, decriminalizing alcohol abuse, and gentrification of central-city skid row areas. Controversial in its focus on individual deficits for explaining homelessness.

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  • Caton, Carol L. M., Boanerges Dominguez, Bella Schanzer, et al. “Risk Factors for Long-Term Homelessness: Findings from a Longitudinal Study of First-Time Homeless Single Adults.” American Journal of Public Health 95.10 (2005): 1753–1759.

    DOI: 10.2105/AJPH.2005.063321Save Citation »Export Citation »E-mail Citation »

    Longitudinal interview study of 377 newly homeless single adults who entered New York City homeless shelters in 2001 and 2002, who were reinterviewed every six months for eighteen months. The most commonly reported reason for homelessness was “interpersonal problems.” Longer duration of homelessness was associated with less family support, less coping capacity, a history of substance abuse treatment, and arrest histories.

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  • Fitzpatrick, Suzanne. “Explaining Homelessness: A Critical Realist Perspective.” Housing, Theory and Society 22.1 (2005): 1–17.

    DOI: 10.1080/14036090510034563Save Citation »Export Citation »E-mail Citation »

    Challenges structural and individual conceptualizations of homelessness, advocating instead a realist-based explanation of homelessness in the United Kingdom.

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  • Jencks, Christopher. The Homeless. Cambridge, MA: Harvard University Press, 1995.

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    Attributes the rise in homelessness in the United States to crack cocaine, male unemployment, lower marriage rates, deinstitutionalization, reductions in welfare benefits, and redevelopment of skid rows. Argues that housing-market changes were not at the core of expanding homelessness in the 1980s. Controversial in its focus on individual deficits and vulnerabilities.

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  • Lee, Barrett A., and Townsand Price-Spratlen. “The Geography of Homelessness in American Communities: Concentration or Dispersion?” City & Community 3.1 (2004): 3–27.

    DOI: 10.1111/j.1535-6841.2004.00064.xSave Citation »Export Citation »E-mail Citation »

    Accessible overview of arguments on dispersion and concentration, and a detailed critique of the United States (US) Census S-night data collection. Analyzes 1990 US Census S-night and 2000 US Census data. The “visible” homeless population (living in shelters and on the streets) is most numerous in urban metropolitan areas. See also “Determinants of Homelessness in Metropolitan Areas,” by Lee, Price-Spratlen, and James W. Kanan, in Journal of Urban Affairs 25.3 (2003): 335–356.

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  • Link, Bruce G., Ezra Susser, Ann Stueve, Joe Phelan, Robert E. Moore, and Elmer Struening. “Lifetime and Five-Year Prevalence of Homelessness in the United States.” American Journal of Public Health 84.12 (1994): 1907–1912.

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

    Though dated, provides a useful examination of the challenges of estimating the size of the homeless population in the United States.

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  • O’Flaherty, Brendan. “An Economic Theory of Homelessness and Housing.” Journal of Housing Economics 4.1 (1995): 13–49.

    DOI: 10.1006/jhec.1995.1002Save Citation »Export Citation »E-mail Citation »

    Theory of homelessness based on the notion that housing “filters,” or that lower-income households (with homeless persons having the lowest incomes) are able to purchase (buy or rent) housing as housing quality deteriorates over time. Focuses solely on housing-market dynamics and not on individual vulnerabilities for explaining homelessness. Also see O’Flaherty’s 1998 book, Making Room: The Economics of Homelessness (Cambridge, MA: Harvard University Press).

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  • Susser, Ezra, Robert Moore, and Bruce Link. “Risk Factors for Homelessness.” American Journal of Epidemiology 15.2 (1993): 546–556.

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    Critical analysis of definitions of homelessness. Compares studies in Chicago, New York, and Los Angeles. Homeless populations are mostly men and mostly persons of color, although with more women and more individuals younger than sixty-five years of age than in the 1960s. Presents a developmental model of homelessness that includes demographic characteristics, childhood experiences, assets and challenges during young adulthood, and structural and individual factors during later adulthood.

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Overviews by Geographers

Dear and Wolch 1987 provides one of the first geographical analyses of homelessness and deinstitutionalization, and this work remains an excellent overview of the history of deinstitutionalization and its spatial fallout in cities. Geographers in the 1980s and 1990s provided insight into the ways that place played a critical role in the identification of particular areas with homelessness (e.g., skid rows of central cities; see Takahashi 1996), and in the first decade of the 21st century and beyond, they demonstrated how policies and places interacted to marginalize homeless populations (e.g., DeVerteuil, et al. 2009).

  • Dear, Michael J., and Jennifer R. Wolch. Landscapes of Despair: From Deinstitutionalization to Homelessness. Princeton, NJ: Princeton University Press, 1987.

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    Eloquent arguments, using a geographic perspective, that the intertwined roles of the state, professional service providers, and civil society resulted in constructing, dismantling, and relocating places and individuals reliant on social services. The authors highlight the ways in which the distribution of social services and affordable housing has long been the result of and representative of uneven power relations among government, capital, and society.

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  • DeVerteuil, Geoffrey, Jon May, and Jürgen von Mahs. “Complexity Not Collapse: Recasting the Geographies of Homelessness in a ‘Punitive’ Age.” Progress in Human Geography 33.5 (2009): 646–666.

    DOI: 10.1177/0309132508104995Save Citation »Export Citation »E-mail Citation »

    Building on Takahashi 1996, summarizes important spatial theories on urban homelessness. Existing theories do not easily fit how homeless people move through cities and towns, so the authors offer alternatives: a theory of poverty management (or systems and agencies that are meant both to punish but also to care for homeless populations), studies outside the United States, and a focus on intersections of race, gender, and homelessness.

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  • Takahashi, Lois M. “A Decade of Understanding Homelessness in the USA: From Characterization to Representation.” Progress in Human Geography 20.3 (1996): 291–310.

    DOI: 10.1177/030913259602000301Save Citation »Export Citation »E-mail Citation »

    Summarizes alternative explanations for the causes of homelessness, including structural explanations (economic marginalization, shrinking affordability in housing markets, welfare state reorganization) and explanations pertaining to individual/personal vulnerabilities and deficits (substance abuse, family instability, criminal history, domestic violence). Overview of research on coping and social-service delivery; argues that socio-spatial stigma explains why communities actively resist or reject homeless persons and organizations that serve homeless populations.

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Reference Resources

There are several governmental and nongovernmental agencies that act as clearinghouses for research and information about homelessness in the United States and Europe. In the United States, at the national level, the United States Interagency Council on Homelessness and the National Alliance to End Homelessness are useful sites that bring together information and analyses. In Europe, the European Federation of National Organisations Working with the Homeless (FEANTSA) provides a similar function, acting as a coordinating body and clearinghouse for information and service models. FEANTSA founded an open-edition journal that highlights research on homelessness in Europe (European Journal of Homelessness).

Health

As homelessness has been discussed less as a crisis and more as a facet of 21st-century urbanization, research has expanded on the varied health issues faced by homeless populations. Many researchers, especially those in public health, nursing, and allied health sciences, have focused on the lack of access to health care (primary, dental/oral, mental health), and some have estimated the cost of hospitalization for homeless populations. Nyamathi 1992 provides an early examination of the link between homelessness and HIV risk for African American women. De Rosa, et al. 1999 describes the services used by homeless and runaway youth in Los Angeles. Salit, et al. 1998 is a careful empirical study of hospitalization costs associated with homelessness, finding higher costs for homeless admissions because of diagnoses of substance abuse or mental disorders. Research on mortality, health needs, and access to care for homeless populations substantially expanded in the late 1990s and the first decade of the 21st century. Gelberg, et al. 2000 adapts a widely used access-to-medical-care model in public health to examine access to medical care for homeless persons. Kushel, et al. 2001, which presents secondary analysis of the National Survey of Homeless Assistance Providers and Clients (which includes 2,974 homeless respondents) to examine use of ambulatory case services, emergency room visits, and inpatient hospital care, finds a lack of access to health care for homeless persons in the United States. Hwang 2001 examines homelessness and health in Canadian cities and finds similarities and differences from the United States context, and, further, Hwang, et al. 2010 argues that even with universal health coverage, homeless persons experience barriers to medical care in Canada. Several researchers have estimated rates of death for homeless populations (Barrow, et al. 1999; Hwang, et al. 1997).

  • Barrow, Susan M., Daniel B. Herman, Pilar Córdova, and Elmer L. Struening. “Mortality among Homeless Shelter Residents in New York City.” American Journal of Public Health 89.4 (1999): 529–534.

    DOI: 10.2105/AJPH.89.4.529Save Citation »Export Citation »E-mail Citation »

    Data from a survey of shelter residents in 1987 were compared to national mortality data from 1987 to 1994. Homeless men and women in shelters had death rates four times higher than the United States population and two to three times higher than the general New York City population.

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  • De Rosa, Christine J., Susanne B. Montgomery, Michele D. Kipke, Ellen Iverson, Joanne L. Ma, and Jennifer B. Unger. “Service Utilization among Homeless and Runaway Youth in Los Angeles, California: Rates and Reasons.” Journal of Adolescent Health 24.3 (1999): 190–200.

    DOI: 10.1016/S1054-139X(98)00081-0Save Citation »Export Citation »E-mail Citation »

    Qualitative (N=46) and survey data (N=296) were collected from homeless youth thirteen to twenty-three years of age to measure service use in Los Angeles. Most respondents reported using drop-in centers and shelters, with much-lower proportions using medical care, mental health services, and substance abuse treatment.

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  • Gelberg, Lillian, Ronald M. Andersen, and Barbara D. Leake. “The Behavioral Model for Vulnerable Populations: Application to Medical Care Use and Outcomes for Homeless People.” Health Services Research 34.6 (2000): 1273–1302.

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    Andersen’s widely cited access-to-care model is adapted to homelessness. A regular source of care nearby improves health outcomes for homeless individuals, but health outcomes are not affected by service use. Also see “Competing Priorities as a Barrier to Medical Care among Homeless Adults in Los Angeles,” by Gelberg, Teresa C. Gallagher, Andersen, and Paul Koegel, in American Journal of Public Health 87.2 (1997): 217–220.

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  • Hwang, Stephen W. “Homelessness and Health.” Canadian Medical Association Journal 164.2 (2001): 229–233.

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    Discusses “absolute homelessness” (individuals without physical shelter) and “relative homelessness” (individuals who have inadequate shelter). Chronic disease rates are higher in homeless persons at younger ages than in domiciled adults. Homeless individuals experience problems with oral/dental health, skin and foot issues, and infections of the respiratory tract. Also see Hwang’s “Mortality among Men Using Homeless Shelters in Toronto, Ontario,” in Journal of the American Medical Association 283.16 (2000): 2152–2157.

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  • Hwang, Stephen W., E. John Orav, James J. O’Connell, Joan M. Lebow, and Troyen A. Brennan. “Causes of Death in Homeless Adults in Boston.” Annals of Internal Medicine 126.8 (1997): 625–628.

    DOI: 10.7326/0003-4819-126-8-199704150-00007Save Citation »Export Citation »E-mail Citation »

    Estimates causes of death for 17,292 adults served by the Boston Health Care for the Homeless Program from 1988 to 1993. For young men (eighteen to twenty-four years), homicide is the leading cause of death; for male and female younger adults (twenty-five to forty-four years), AIDS is the leading cause of death; and for adults forty-five to sixty-four years of age, heart disease and cancer are the leading causes of death.

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  • Hwang, Stephen W., Joanna J. M. Ueng, Shirley Chiu, et al. “Universal Health Insurance and Health Care Access for Homeless Persons.” American Journal of Public Health 100.8 (2010): 1454–1461.

    DOI: 10.2105/AJPH.2009.182022Save Citation »Export Citation »E-mail Citation »

    Analyzes data from a survey of a representative sample of 1,129 homeless persons in Toronto, Ontario, Canada, to assess access to health care. Even with universal health care, compared to the general population, homeless persons (especially homeless women with children) experience more barriers to health care.

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  • Kushel, Margot B., Eric Vittinghoff, and Jennifer S. Haas. “Factors Associated with the Health Care Utilization of Homeless Persons.” Journal of the American Medical Association 285.2 (2001): 200–206.

    DOI: 10.1001/jama.285.2.200Save Citation »Export Citation »E-mail Citation »

    One-quarter of homeless people did not access necessary medical care in the preceding year; 40 percent had been prescribed medication in the previous year, but one-third were not compliant in their prescription regimes. See also “Emergency Department Use among the Homeless and Marginally Housed: Results from a Community-Based Study,” by Kushel, Sharon Perry, David Bangsberg, Richard Clark, and Andrew R. Moss, in American Journal of Public Health 92.5 (2002): 778–784.

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  • Nyamathi, Adeline. “Comparative Study of Factors Relating to HIV Risk Level of Black Homeless Women.” Journal of Acquired Immune Deficiency Syndromes 5.3 (1992): 222–228.

    DOI: 10.1097/00126334-199203000-00002Save Citation »Export Citation »E-mail Citation »

    Important role of coping, depression, and self-esteem for African American homeless women in preventing HIV transmission. See also “Psychosocial Predictors of AIDS Risk Behavior and Drug Use Behavior in Homeless and Drug Addicted Women of Color,” by Nyamathi, Judith A. Stein, and Mary-Lynn Brecht, in Health Psychology 14.3 (1995): 265–273.

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  • Salit, Sharon A., Evelyn M. Kuhn, Arthur J. Hartz, Jade M. Vu, and Andrew L. Mosso. “Hospitalization Costs Associated with Homelessness in New York City.” New England Journal of Medicine 338.24 (1998): 1734–1740.

    DOI: 10.1056/NEJM199806113382406Save Citation »Export Citation »E-mail Citation »

    Hospital discharge data of homeless adults and nonmaternity admissions for low-income adults in New York City from 1992 to 1993 show that over half the admissions for homeless adults were for substance abuse or mental illness treatment, compared to one-quarter for low-income adults, resulting in an average of four days longer in the hospital (ranging in cost per day from about $2,400 to about $4,100).

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Geographies of Homelessness and Health

Geographers have long worked to highlight the spatial dimensions of homelessness and mental health across urban/rural places. Research has identified how geography helped or hindered people’s ability to seek help or housing, analyzing how culture and identity influenced understanding of home and health (Arcury, et al. 2005; Kearns and Smith 1994).

  • Arcury, Thomas A., Wilbert M. Gesler, John S. Preisser, Jill Sherman, John Spencer, and Jamie Perin. “The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region.” Health Services Research 40.1 (2005): 135–156.

    DOI: 10.1111/j.1475-6773.2005.00346.xSave Citation »Export Citation »E-mail Citation »

    Analyzed data from a survey of 1,059 adults in rural North Carolina to measure use of medical care for regular medical checkups and care. Distance from medical providers was more important in terms of regular checkups and care for chronic conditions than for medical emergencies.

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  • Kearns, Robin A., and Christopher J. Smith. “Housing, Homelessness, and Mental Health: Mapping an Agenda for Geographical Inquiry.” Professional Geographer 46.4 (1994): 418–424.

    DOI: 10.1111/j.0033-0124.1994.00418.xSave Citation »Export Citation »E-mail Citation »

    Offers a conceptual framework to examine the intersections of housing, homelessness, and mental disability across two dimensions: orientation (individual versus population) and type of homelessness (literal, incipient, and metaphorical).

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Population Characteristics and Needs

Researchers in the 1980s began to examine the particular characteristics of homelessness and identified subgroups experiencing distinct challenges (Burt 2001; Culhane, et al. 1996). In this section, existing research is organized into three subsections. The first subsection (Domiciled and Homeless Comparisons) highlights work that has compared similar domiciled and homeless populations to ascertain their differences. The second subsection focuses on research on Mental Health, Substance Abuse, and Childhood Abuse as key factors related to homelessness. The third subsection summarizes scholarship on important Subgroups within the larger homeless population.

  • Burt, Martha R. “Homeless Families, Singles, and Others: Findings from the 1996 National Survey of Homeless Assistance Providers and Clients.” Housing Policy Debate 12.4 (2001): 737–780.

    DOI: 10.1080/10511482.2001.9521428Save Citation »Export Citation »E-mail Citation »

    Analysis of data from a national representative sample of individuals using homeless assistance programs in the United States. Though severe poverty is common across homeless subgroups, most other characteristics associated with homelessness are present in only a quarter of the national sample, suggesting that the homeless population is quite diverse.

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  • Culhane, Dennis P., Chang-Moo Lee, and Susan M. Wachter. “Where the Homeless Come From: A Study of the Prior Address Distribution of Families Admitted to Public Shelters in New York City and Philadelphia.” Housing Policy Debate 7.2 (1996): 327–365.

    DOI: 10.1080/10511482.1996.9521224Save Citation »Export Citation »E-mail Citation »

    Careful empirical analysis of the prior residence addresses of families living in public shelters in New York City and Philadelphia. High rates of poverty are associated with family homelessness. In other words, the places where families living in public shelters reported that they previously lived are closer to one another than is seen in more-general patterns of poverty.

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Domiciled and Homeless Comparisons

Researchers have also examined, especially since the 1980s, whether homelessness is substantially distinct from severe poverty. Wood, et al. 1990 compares the characteristics of homeless and homed families in Los Angeles. Bassuk, et al. 1998 and Shinn, et al. 1991 compare mothers living in shelters with low-income mothers, whereas Caton, et al. 1995 compares homeless and domiciled women with schizophrenia in New York City, and Lee and Farrell 2003 compares homeless panhandlers and non-panhandlers.

  • Bassuk, Ellen L., John C. Buckner, Jennifer N. Perloff, and Shari S. Bassuk. “Prevalence of Mental Health and Substance Use Disorders among Homeless and Low-Income Housed Mothers.” American Journal of Psychiatry 155.11 (1998): 1561–1564.

    DOI: 10.1176/ajp.155.11.1561Save Citation »Export Citation »E-mail Citation »

    Study of 220 homeless and 215 housed mothers who were receiving public assistance. Low-income and homeless mothers have higher rates of substance abuse and post-traumatic stress disorders than do women in the general population. See also “Homelessness in Female-Headed Families: Childhood and Adult Risk and Protective Factors,” by E. Bassuk, Buckner, Linda F. Weinreb, et al., in American Journal of Public Health 87.2 (1997): 241–248.

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  • Caton, Carol L. M., Patrick E. Shrout, Boanerges Dominguez, Paula F. Eagle, Lewis A. Opler, and Francine Cournos. “Risk Factors for Homelessness among Women with Schizophrenia.” American Journal of Public Health 85.8 (1995): 1153–1156.

    DOI: 10.2105/AJPH.85.8_Pt_1.1153Save Citation »Export Citation »E-mail Citation »

    Compares one hundred homeless and one hundred domiciled (never homeless) women with schizophrenia in New York City in social functioning, positive and negative aspects of schizophrenia, current/lifetime substance abuse, family disorganization, service use, adherence to medications, and patterns of outpatient treatment. Homeless women have less social support and more alcohol/drug use than do domiciled women with schizophrenia.

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  • Lee, Barrett A., and Chad R. Farrell. “Buddy, Can You Spare a Dime? Homelessness, Panhandling, and the Public.” Urban Affairs Review 38.3 (2003): 299–324.

    DOI: 10.1177/1078087402238804Save Citation »Export Citation »E-mail Citation »

    Analysis of data from the National Survey of Homeless Assistance Providers and Clients conducted in 1996 and a survey of 700 clients of 5,700 homeless programs. Contrary to popular belief, small proportions of homeless persons panhandle, young people do not make up a large proportion of homeless panhandlers, and homeless panhandlers do not generally have histories of violence and are not largely in poor physical health.

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  • Shinn, Marybeth, James R. Knickman, and Beth C. Weitzman. “Social Relationships and Vulnerability to Becoming Homeless among Poor Families.” American Psychologist 46.11 (1991): 1180–1187.

    DOI: 10.1037/0003-066X.46.11.1180Save Citation »Export Citation »E-mail Citation »

    Compares 677 homeless and 495 low-income domiciled mothers in New York City. Unlike most studies, the results indicate that the homeless mothers are more often in contact with family members and friends than are the domiciled mothers, but that they had already stayed with these family members when they requested shelter, suggesting that they had used up available family resources before turning to the public shelter system.

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  • Wood, David, Robert Burciaga Valdez, Toshi Hayashi, and Albert Shen. “Homeless and Housed Families in Los Angeles: A Study Comparing Demographic, Economic, and Family Function Characteristics.” American Journal of Public Health 80.9 (1990): 1049–1052.

    DOI: 10.2105/AJPH.80.9.1049Save Citation »Export Citation »E-mail Citation »

    Examines the characteristics of homeless and very low-income homed families in Los Angeles and finds that cost of housing is the major cause of homelessness, but that vulnerabilities such as child abuse, parental substance abuse, and weak social support are also important.

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Mental Health, Substance Abuse, and Childhood Abuse

Much of the published research on homelessness has focused on describing the characteristics of homeless persons and families, to outline their needs for income, health, and mental health services. Researchers since the 1980s have assessed the prevalence of mental disability/illness, substance abuse/use, and dual diagnosis (mental disorders and substance abuse disorders) among homeless populations (e.g., Bassuk, et al. 1996; Drake, et al. 1991; Folsom, et al. 2005), in part because of the popularized framing of homelessness as being caused by these two conditions and in part because of efforts to identify high-priority challenges and needs faced by homeless populations. Some have examined childhood abuse and family disruption as causal factors for adult homelessness (Herman, et al. 1997; Koegel, et al. 1995; Stein, et al. 2002).

  • Bassuk, Ellen L., Linda F. Weinreb, John C. Buckner, Angela Browne, Amy Salomon, and Shari S. Bassuk. “The Characteristics and Needs of Sheltered Homeless and Low-Income Housed Mothers.” Journal of the American Medical Association 276.8 (1996): 640–646.

    DOI: 10.1001/jama.1996.03540080062031Save Citation »Export Citation »E-mail Citation »

    Case control study of 220 mothers living in homeless shelters and 216 low-income housed mothers who have never been homeless but are receiving income benefits in Worcester, Massachusetts. Mothers living in shelters reported higher rates of abuse and assault and less available financial and social support than did comparable low-income housed mothers.

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  • Drake, Robert E., Fred C. Osher, and Michael A. Wallach. “Homelessness and Dual Diagnosis.” American Psychologist 46.11 (1991): 1149–1158.

    DOI: 10.1037/0003-066X.46.11.1149Save Citation »Export Citation »E-mail Citation »

    Early review of research on dual diagnosis and homelessness. Dual diagnosis, which generally is defined as diagnosis both of several mental disabilities/disorders and substance abuse, affects about ten to twenty percent of homeless individuals. Available online.

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  • Folsom, David P., William Hawthorne, Laurie Lindamer, et al. “Prevalence and Risk Factors for Homelessness and Utilization of Mental Health Services among 10,340 Patients with Serious Mental Illness in a Large Public Mental Health System.” American Journal of Psychiatry 162.2 (2005): 370–376.

    DOI: 10.1176/appi.ajp.162.2.370Save Citation »Export Citation »E-mail Citation »

    Data drawn from the adult mental health services system in San Diego, California, from 1999 to 2000. About fifteen percent of the 10,340 individuals treated for mental disorders were homeless. Homeless individuals tended to be male, African American substance users, not to have Medicaid (public medical coverage for impoverished individuals), and to be diagnosed with schizophrenia or bipolar disorder.

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  • Herman, Daniel B., Ezra S. Susser, Elmer L. Struening, and Bruce L. Link. “Adverse Childhood Experiences: Are They Risk Factors for Adult Homelessness?” American Journal of Public Health 87.2 (1997): 249–255.

    DOI: 10.2105/AJPH.87.2.249Save Citation »Export Citation »E-mail Citation »

    Analysis of data drawn from the Comprehensive Nationwide Study of Knowledge, Attitudes and Beliefs about Homelessness, which consisted of a national, random-digit-dial phone survey of 1,507 adults in fall 1990. About seven percent of respondents reported that they had been homeless at some point in their lives. Results indicate that parental lack of care and childhood sexual/physical abuse are associated with a much-higher rate of adult homelessness.

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  • Koegel, Paul, Elan Melamid, and M. Audrey Burnam. “Childhood Risk Factors for Homelessness among Homeless Adults.” American Journal of Public Health 85.12 (1995): 1642–1649.

    DOI: 10.2105/AJPH.85.12.1642Save Citation »Export Citation »E-mail Citation »

    Analyzes interview data from the Course of Homelessness Study, which included 1,563 homeless adults in Los Angeles. Highlights the “bundling” of challenges faced before individuals become homeless, especially disruptive experiences as children.

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  • Stein, Judith A., Michelle B. Leslie, and Adeline Nyamathi. “Relative Contributions of Parent Substance Use and Childhood Maltreatment to Chronic Homelessness, Depression, and Substance Abuse Problems among Homeless Women: Mediating Roles of Self-Esteem and Abuse in Adulthood.” Child Abuse & Neglect 26.10 (2002): 1011–1027.

    DOI: 10.1016/S0145-2134(02)00382-4Save Citation »Export Citation »E-mail Citation »

    Analysis of a survey of 581 homeless women living in Los Angeles homeless shelters or sober-living centers. Argues that child abuse and parental substance abuse have long-lasting effects, whereas childhood abuse has direct effects on homelessness in adulthood.

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Subgroups

In the 1990s and the first decade of the 21st century, researchers examined the challenges faced by particular homeless subgroups (e.g., families, single women, adolescents, mentally disabled, formerly incarcerated, and veterans; see Burt 2001, cited under Population Characteristics and Needs), and more often these researchers argued for a global or international perspective on homelessness. McChesney 1995 is an early but still-useful review on urban homeless families. In terms of homeless youth and adolescents, Kipke, et al. 1997 highlights the high degree of violence experienced by homeless youth; Ennett, et al. 1999 analyzes social networks among homeless youth in Washington, DC; Cauce, et al. 2000 highlights mental health issues for homeless adolescents; and Cochran, et al. 2002 discusses challenges for homeless adolescents who are also sexual minorities. In terms of elderly populations, Stergiopoulos and Herrmann 2003 describes the service needs for homeless adults sixty-five years and older in Toronto, Canada. In terms of homeless women, Cheung and Hwang 2004 estimates the risk of death for homeless women in Toronto, and Metraux and Culhane 1999 analyzes characteristics of women living in shelters in New York City. Metraux and Culhane 2006 analyzes homeless shelter use by formerly incarcerated individuals in New York City. In terms of veterans, there have been a number of studies analyzing risk factors and effectiveness of US Department of Veterans Affairs (VA) homeless services; Tsai, et al. 2016 argues that low use of VA homeless services is a barrier to prevention; Tsai, et al. 2017 highlights demographic and substance use characteristics associated with homelessness for veterans referred to VA specialty mental health clinics; and Malte, et al. 2017 shows improvements in number of days housed for homeless veterans in VA programs with either an intensive substance use treatment program or a housing support group.

  • Cauce, Ana Mari, Matthew Paradise, Joshua A. Ginzler, et al. “The Characteristics and Mental Health of Homeless Adolescents: Age and Gender Differences.” Journal of Emotional and Behavioral Disorders 8.4 (2000): 230–239.

    DOI: 10.1177/106342660000800403Save Citation »Export Citation »E-mail Citation »

    Highlights the particular challenges faced by homeless youth, including high levels of mental disorders. Male and female adolescents are similar in their reports of abuse during childhood and of violence encountered on the streets; however, males reported physical assault while females reported sexual assault and victimization.

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  • Cheung, Angela M., and Stephen W. Hwang. “Risk of Death among Homeless Women: A Cohort Study and Review of the Literature.” Canadian Medical Association Journal 170.8 (2004): 1243–1247.

    DOI: 10.1503/cmaj.1031167Save Citation »Export Citation »E-mail Citation »

    Observational study of women using homeless shelters in 1995 over an average of 2.6 years in Toronto, Canada. Homeless women are much more likely to die compared to the general population of women, but younger homeless women experience the highest rates of death. Comparisons made to death rates for homeless women and men in cities in Canada, the United States, and Europe.

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  • Cochran, Bryan N., Angela J. Stewart, Joshua A. Ginzler, and Ana Mari Cauce. “Challenges Faced by Homeless Sexual Minorities: Comparison of Gay, Lesbian, Bisexual, and Transgender Homeless Adolescents with Their Heterosexual Counterparts.” American Journal of Public Health 92.5 (2002): 773–777.

    DOI: 10.2105/AJPH.92.5.773Save Citation »Export Citation »E-mail Citation »

    Compares gay, lesbian, bisexual, and transgender (GLBT) homeless adolescents with heterosexual homeless adolescents to assess psychosocial similarities and differences. The GLBT homeless adolescents are victimized more, use addictive substances more, and have more sexual partners. The authors conclude that sexual minority groups who are homeless are more at risk of negative physical and mental health outcomes than are their heterosexual counterparts.

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  • Ennett, Susan T., Susan L. Bailey, and E. Belle Federman. “Social Network Characteristics Associated with Risky Behaviors among Runaway and Homeless Youth.” Journal of Health and Social Behavior 40.1 (1999): 63–78.

    DOI: 10.2307/2676379Save Citation »Export Citation »E-mail Citation »

    Analysis of survey of 327 youth living in Washington, DC. Youth reporting that they did not have social networks more often report substance use, multiple sex partners, and survival sex. See also “Substance Use and Risky Sexual Behavior among Homeless and Runaway Youth,” by Bailey, Carol S. Camlin, and Ennett, in Journal of Adolescent Health 23.6 (1998): 378–388.

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  • Kipke, Michele D., Thomas R. Simon, Susanne B. Montgomery, Jennifer B. Unger, and Ellen F. Iversen. “Homeless Youth and Their Exposure to and Involvement in Violence While Living on the Streets.” Journal of Adolescent Health 20.5 (1997): 360–367.

    DOI: 10.1016/S1054-139X(97)00037-2Save Citation »Export Citation »E-mail Citation »

    Survey of 432 youth in Hollywood, California, in 1994–1995. Homeless youth are exposed to high rates of violence, regardless of ethnicity. See also “Homeless Youths and Young Adults in Los Angeles: Prevalence of Mental Health Problems and the Relationship between Mental Health and Substance Abuse Disorders,” by Unger, Kipke, Simon, Montgomery, and Christine J. Johnson, in American Journal of Community Psychology 25.3 (1997): 371–394.

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  • Malte, Carol A., Koriann Cox, and Andrew J. Saxon. “Providing Intensive Addiction/Housing Case Management to Homeless Veterans Enrolled in Addictions Treatment: A Randomized Controlled Trial.” Psychology of Addictive Behaviors 31.3 (2017): 231–241.

    DOI: 10.1037/adb0000273Save Citation »Export Citation »E-mail Citation »

    Using a randomized controlled trial of 181 homeless veterans entering outpatient VA substance treatment program, study finds improvement in number of days housed for both types of programs: (1) intensive addiction/housing case management and (2) housing support group.

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  • McChesney, Kay Young. “A Review of the Empirical Literature on Contemporary Urban Homeless Families.” Social Service Review 69.3 (1995): 429–460.

    DOI: 10.1086/604134Save Citation »Export Citation »E-mail Citation »

    An early overview of the empirical literature on homeless families. Argues for a three-level conceptual framework for understanding homelessness: societal (lack of affordable housing), community and neighborhood (concentration of poverty and racial segregation), and family characteristics.

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  • Metraux, Stephen, and Dennis P. Culhane. “Family Dynamics, Housing, and Recurring Homelessness among Women in New York City Homeless Shelters.” Journal of Family Issues 20.3 (1999): 371–396.

    DOI: 10.1177/019251399020003004Save Citation »Export Citation »E-mail Citation »

    Using administrative data on women who left homeless shelters in 1992 in New York City, the authors compare two groups: women who stayed with their families in family shelters, and women who stayed in single-adult shelters. Highest risk of recurring homelessness is associated with younger age and recent birth, history of domestic violence, and children leaving the mother’s household (for foster care or joining other family members).

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  • Metraux, Stephen, and Dennis P. Culhane. “Recent Incarceration History among a Sheltered Homeless Population.” Crime & Delinquency 52.3 (2006): 504–517.

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

    Analyzes administrative data in New York City and finds that about one-quarter of individuals staying in New York City homeless shelters had been jailed or imprisoned in the previous two years. See also Metraux and Culhane’s “Homeless Shelter Use and Reincarceration following Prison Release” in Criminology & Public Policy 3.2 (2004): 139–160.

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  • Stergiopoulos, Vicky, and Nathan Herrmann. “Old and Homeless: A Review and Survey of Older Adults Who Use Shelters in an Urban Setting.” Canadian Journal of Psychiatry 48.6 (2003): 374–380.

    DOI: 10.1177/070674370304800603Save Citation »Export Citation »E-mail Citation »

    Provides useful review of literature on homelessness among elderly populations. Compiles data from the Toronto Community and Neighborhood Services Department to estimate the number of adults sixty-five years or older who were using shelters.

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  • Tsai, Jack, Rani A. Hoff, and Ilan Harpaz-Rotem. “One-Year Incidence and Predictors of Homelessness among 300,000 U.S. Veterans seen in Specialty Mental Health Care.” Psychological Services 14.2 (2017): 203–207.

    DOI: 10.1037/ser0000083Save Citation »Export Citation »E-mail Citation »

    Retroactive cohort study design using VA medical records of 306,351 patients across 130 VA specialty mental health clinics from 2008 to 2012. Results show that 5.6 percent of the total sample experienced homelessness within twelve months of referral to the VA clinic, with higher proportions for women compared to men, and higher likelihood of homelessness for those unmarried, diagnosed with a drug disorder, being black, and with annual incomes less than $25,000.

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  • Tsai, Jack, Bruce Link, Robert A. Rosenheck, and Robert H. Pietrzak. “Homelessness among a Nationally Representative Sample of US Veterans: Prevalence, Service Utilization, and Correlates.” Social Psychiatry and Psychiatric Epidemiology 51.6 (2016): 907–916.

    DOI: 10.1007/s00127-016-1210-ySave Citation »Export Citation »E-mail Citation »

    Analyzes a survey of a nationally representative sample of 1,533 US veterans, and finds that 8.5 percent of the sample reported being homeless as an adult at any time, and that 17.2 percent of the sample reported ever using VA homeless services. Lower usage of VA homeless services was associated with being white and living in a rural area.

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Reconceptualizing Geographies of Need

Geographers have been at the forefront in challenging conventional views on homelessness and providing reconceptualizations of the needs of homeless persons, and the strengths and vitality inherent within homeless families and groups. Veness 1993 provides an early, and excellent, example of a countervailing explanation of homelessness that is based on the perceptions of low-income individuals in Delaware. Rowe and Wolch 1990 reconceptualizes homelessness as “time-space discontinuity” and provides a geographical and anthropological analysis of the social-support networks and daily paths/routines of homeless women in Los Angeles. Ruddick 1996 provides a geography lens on youth homelessness and space in Los Angeles. May, et al. 2007 provides a qualitative study of homeless women in Britain. Other researchers beyond geography have also worked to reframe the homelessness debate. Draine, et al. 2002 tries to move the debate beyond a causal explanation of mental illness/disability by arguing that poverty is the fundamental determinant of social problems, and Galea and Vlahov 2002 takes this argument further by arguing for a social-determinants conceptual framing of substance abuse as the result of poverty, homelessness, and incarceration. Toro 2007 provides a comparison between homelessness in the United States and other industrialized countries, as part of a special issue on homelessness in the Journal of Social Issues.

  • Draine, Jeffrey, Mark S. Salzer, Dennis P. Culhane, and Trevor R. Hadley. “Role of Social Disadvantage in Crime, Joblessness, and Homelessness among Persons with Serious Mental Illness.” Psychiatric Services 53.5 (2002): 565–573.

    DOI: 10.1176/appi.ps.53.5.565Save Citation »Export Citation »E-mail Citation »

    Instead of conventional thinking in psychology that posits mental illness as directly linked to incarceration, unemployment, and homelessness, the authors argue that poverty acts as a critical moderator. In other words, they argue that the social disadvantage that constitutes and is constituted by poverty leads to social problems, rather than mental illness itself leading to social problems.

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  • Galea, Sandro, and David Vlahov. “Social Determinants and the Health of Drug Users: Socioeconomic Status, Homelessness, and Incarceration.” Public Health Reports 117.S1 (2002): S135–S145.

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    Social determinants approach to explaining homelessness. Social determinants of health comprise social and economic factors that result in health disparities, such as substance abuse. The health of substance users is directly affected by lack of access to resources and social services, by homelessness, and by incarceration.

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  • May, Jon, Paul Cloke, and Sarah Johnsen. “Alternative Cartographies of Homelessness: Rendering Visible British Women’s Experiences of ‘Visible’ Homelessness.” Gender, Place & Culture 14.2 (2007): 121–140.

    DOI: 10.1080/09663690701213677Save Citation »Export Citation »E-mail Citation »

    Compelling depiction of coping in urban space. Interviews with nineteen “visibly homeless” women in Britain to describe the variety of ways in which these women cope with social exclusion.

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  • Rowe, Stacy, and Jennifer Wolch. “Social Networks in Time and Space: Homeless Women in Skid Row, Los Angeles.” Annals of the Association of American Geographers 80.2 (1990): 184–204.

    DOI: 10.1111/j.1467-8306.1990.tb00287.xSave Citation »Export Citation »E-mail Citation »

    Nuanced qualitative examination of the survival strategies of homeless women in Skid Row, Los Angeles. Offers new concept of homelessness defined as “time-space discontinuity” that interferes with the ability of homeless women to effectively address barriers and challenges that they face daily. Argues that social networks (peer and homed) are used to reestablish time-space continuity.

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  • Ruddick, Susan M. Young and Homeless in Hollywood: Mapping Social Identities. New York: Routledge, 1996.

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    Elegant conceptual treatment of youth homelessness in Los Angeles. Discusses youth subculture, and the ways that space and place influence and are influenced by social identity, through social history and qualitative research.

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  • Toro, Paul A. “Toward an International Understanding of Homelessness.” Journal of Social Issues 63.3 (2007): 461–481.

    DOI: 10.1111/j.1540-4560.2007.00519.xSave Citation »Export Citation »E-mail Citation »

    Introduction to a special issue on homelessness outside the United States. See also, in the same issue, “Homelessness in Europe and the United States: A Comparison of Prevalence and Public Opinion,” by Toro, Carolyn J. Tompsett, Sylvie Lombardo, et al. (pp. 505–524), as well as “International Homelessness: Policy, Socio-cultural, and Individual Perspectives,” by Marybeth Shinn (pp. 657–677).

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  • Veness, April R. “Neither Homed nor Homeless: Contested Definitions and the Personal Worlds of the Poor.” Political Geography 12.4 (1993): 319–340.

    DOI: 10.1016/0962-6298(93)90044-8Save Citation »Export Citation »E-mail Citation »

    Excellent discussion of the normative definitions of “homed” and “homeless” as they relate to individuals living in poverty. Early, more countervailing explanation of homelessness than in most of the rapidly expanding literature in the 1980s and 1990s.

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Ethnographies

Anthropologists and other researchers have long provided in-depth portraits of homelessness, through detailed and often-poignant ethnographies of the lives and places associated with homelessness. Wolch and Rowe 1992 conducted ethnographic research at homeless shelters in Los Angeles to explore homeless mobility. Snow and Anderson 1993, an ethnography of homeless men in Texas, provides an alternative narrative to homelessness in large cities in the United States on the West and East Coasts. Desjarlais 1997 highlights the ways that mental disability frames and is framed by life in a homeless shelter in Boston. Duneier 1999 illuminates the interaction of homeless individuals and other inhabitants and participants in life on a street in Greenwich Village in New York City. Gowan’s award-winning book (2010) and articles focus on homelessness in San Francisco and Seattle and highlight how social representation (“sick talk” and “sin talk”) drives public understanding about the nature of homelessness.

Stigma and Identity

Erving Goffman in 1963 posited that stigma, or a “deeply discrediting” attribute, involved negative perceptions of individuals but also rejection of such marked persons. Researchers have investigated how homelessness is stigmatized and what effects such stigma might have on societal acceptance of homeless persons and services providing care and treatment. Snow and Anderson 1987 studies personal identities of homeless individuals to ascertain how they maintain dignity and self-worth, while Phelan, et al. 1997 highlights the importance of labels, and Takahashi 1997 provides a geographical conceptual argument of person-place stigma associated with homelessness. Kidd 2007 uses a measure of stigma to study how stigma affects homeless youth and adolescents and their ability to cope with challenges and danger.

  • Kidd, Sean A. “Youth Homelessness and Social Stigma.” Journal of Youth and Adolescence 36.3 (2007): 291–299.

    DOI: 10.1007/s10964-006-9100-3Save Citation »Export Citation »E-mail Citation »

    Analysis of agency and street survey conducted with 208 youth in New York City and Toronto. Questions on social stigma adapted from research on HIV. Also measured self-esteem (Rosenberg scale), loneliness (UCLA Loneliness Scale), and hopelessness (Beck’s Hopelessness Scale). Results suggest that stigma is associated with “feeling trapped” (hopelessness and helplessness).

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  • Phelan, Jo C., Bruce G. Link, Robert E. Moore, and Ann Stueve. “The Stigma of Homelessness: The Impact of the Label ‘Homeless’ on Attitudes toward Poor Persons.” Social Psychology Quarterly 60.4 (1997): 323–337.

    DOI: 10.2307/2787093Save Citation »Export Citation »E-mail Citation »

    Provides brief overview of research from the 1970s, showing that the public in the United States and the United Kingdom evaluates the causes of poverty as emanating from individual deficiencies. Examines link of homelessness to mental disability as a possible explanation for stigma. Discusses results of a telephone survey that asked respondents questions about a vignette that inserted different labels describing a single male.

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  • Snow, David A., and Leon Anderson. “Identity Work among the Homeless: The Verbal Construction and Avowal of Personal Identities.” American Journal of Sociology 92.6 (1987): 1336–1371.

    DOI: 10.1086/228668Save Citation »Export Citation »E-mail Citation »

    Elegant discussion of identity, stigma, and self-worth for homeless street people. One-year ethnographic study of homeless individuals in Austin, Texas, from 1984 to 1985 highlighted three types of “identity talk”: “distancing,” “embracement,” and “fictive storytelling.” Available for free online through registration. See also “The Outcomes of Homeless Mobilization: The Influence of Organization, Disruption, Political Mediation, and Framing,” by Daniel M. Cress and David Snow, in American Journal of Sociology 105.4 (2000): 1063–1104, which is available for free online through registration.

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  • Takahashi, Lois M. “The Socio-spatial Stigmatization of Homelessness and HIV/AIDS: Toward an Explanation of the NIMBY Syndrome.” Social Science & Medicine 45.6 (1997): 903–914.

    DOI: 10.1016/S0277-9536(96)00432-7Save Citation »Export Citation »E-mail Citation »

    Builds on Goffman’s classic concept to argue that the stigma of homeless persons and places leads to community rejection. Person-place stigma is comprised of three elements: importance of productivity and labor market participation, degree of danger associated with homelessness, and perceived personal culpability. See also Takahashi’s Homelessness, AIDS, and Stigmatization: The NIMBY Syndrome in the United States at the End of the Twentieth Century (New York: Oxford University Press, 1998).

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Revanchism and Resistance

The 1990s and the first decade of the 21st century saw the emergence of studies that focused on rethinking homelessness, from estimating rates and describing characteristics to a reflection on broader relations of economy and polity. Such work began a stronger focus on social justice and resistance, clarifying the controlling and helping aspects of government and the service sector. Mitchell 1995 uses the case of People’s Park in Berkeley, California, to highlight the ways in which public spaces have become private, with more surveillance and the removal of homeless persons and other socially disruptive individuals. DeVerteuil 2006 and Cloke, et al. 2010 challenge such dystopian analyses of homeless cities, and especially the concept of revanchism, to argue instead that there is both exclusion and compassion in relation to homeless populations. In a rare study on indigenous populations in Western industrialized countries, Peters and Robillard 2009 examines how indigeneity, regulation, and mobility intersect in a study of First Nations peoples in Saskatchewan, Canada.

  • Cloke, Paul, Jon May, and Sarah Johnsen. Swept Up Lives? Re-envisioning the Homeless City. RGS-IBG Book. Chichester, UK: Wiley, 2010.

    DOI: 10.1002/9781444324655Save Citation »Export Citation »E-mail Citation »

    Insightful and thought-provoking book on homelessness in the United Kingdom. Challenges widespread conceptualizations of the “homeless city” as solely or primarily dystopian, instead offering a discussion that includes “compassion and care” in addition to “containment and control.” See also “Day Centres for Homeless People: Spaces of Care or Fear?,” by Johnsen, Cloke, and May, in Social & Cultural Geography 6.6 (2005): 787–811.

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  • DeVerteuil, Geoffrey. “The Local State and Homeless Shelters: Beyond Revanchism?” Cities 23.2 (2006): 109–120.

    DOI: 10.1016/j.cities.2005.08.004Save Citation »Export Citation »E-mail Citation »

    Concise review of literature on revanchism (as conceptualized by Neil Smith in The New Urban Frontier: Gentrification and the Revanchist City, New York: Routledge, 1996). Qualitative analysis of shelter system in Los Angeles, describing both controlling and caring dimensions. See also “Any Space Left? Homeless Resistance by Place-Type in Los Angeles County,” by DeVerteuil, Matthew Marr, and David Snow, in Urban Geography 30.6 (2009): 633–651.

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  • Mitchell, Don. “The End of Public Space? People’s Park, Definitions of the Public, and Democracy.” Annals of the Association of American Geographers 85.1 (1995): 108–133.

    DOI: 10.1111/j.1467-8306.1995.tb01797.xaSave Citation »Export Citation »E-mail Citation »

    Excellent analysis of how public places have become more “private,” meaning that socially disruptive populations, such as homeless persons, are forcibly removed. See also Mitchell’s The Right to the City: Social Justice and the Fight for Public Space (New York: Guilford, 2003) and “The Annihilation of Space by Law: The Roots and Implications of Anti-homeless Laws in the United States,” in Antipode 29.3 (1997): 303–335.

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  • Peters, Evelyn J., and Vince Robillard. “‘Everything You Want Is There’: The Place of the Reserve in First Nations’ Homeless Mobility.” In Special Issue: Rights, Space, and Homelessness: Part I. Urban Geography 30.6 (2009): 652–680.

    DOI: 10.2747/0272-3638.30.6.652Save Citation »Export Citation »E-mail Citation »

    Useful overview of geography literature on homelessness and mobility. Rare qualitative study of rural areas and indigenous/First Nations populations in Canada. Results indicate high levels of mobility through urban and rural areas, including reserves. See also Peters’s “‘I Like to Let Them Have Their Time’: Hidden Homeless First Nations People in the City and Their Management of Household Relationships,” in Social & Cultural Geography 13.4 (2012): 321–338.

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Policies and Programs

There have been a myriad of strategies used to address the rise and increasing diversity in homelessness in industrialized countries. This section summarizes existing research on explanations of current policy and institutional approaches and provides an overview of evaluations of Housing First and supportive housing programs.

Politics, Institutions, and Programs

Political debate about homelessness has raged, in part, because constituents have differing definitions and understanding of homelessness (Toro and Warren 1999). Some have argued that residential instability or shelter insecurity is the challenge that needs to be addressed by policy and programs for effective homelessness solutions (Hoch 2000). Some have argued that it is the “institutional circuit” or the circulation of individuals through varying institutional placements that leads to residential instability (Shinn, et al. 2001). Some have argued that the lack of political will and the larger political-economic system contribute to the seeming intractability of homelessness in the United States (Wolch and Dear 1993). In contrast to the conventional focus on deficits, feminist scholars have argued that program design should start with homeless women’s strengths and building attachment with other women (Boes and van Wormer 1997, Brown and Ziefert 1990). Other researchers have deepened conceptualizations of the faith-based sector, which has constituted a substantial provider of services targeting homeless persons. Allahyari 2000 examines the complex role of volunteers in faith-based organizations, and Cloke and Beaumont 2013 offers a theory of postsecular spaces. Outside the United States, Lancione 2014 examines Catholic-based services in Turin, Italy.

  • Allahyari, Rebecca Anne. Visions of Charity: Volunteer Workers and Moral Community. Berkeley and Los Angeles: University of California Press, 2000.

    DOI: 10.1525/california/9780520221444.001.0001Save Citation »Export Citation »E-mail Citation »

    Insightful analysis of moral rhetoric and volunteerism within two religious charitable organizations serving homeless populations in Sacramento, California. Offers concepts such as “moral selving” (p. 4) or how volunteers seek to improve their moral or spiritual centers through their work with homeless persons.

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  • Boes, Mary, and Katherine van Wormer. “Social Work with Homeless Women in Emergency Rooms: A Strengths-Feminist Perspective.” Affilia 12.4 (1997): 408–426.

    DOI: 10.1177/088610999701200404Save Citation »Export Citation »E-mail Citation »

    Advocates for using a strengths perspective to develop programs that target and serve homeless women.

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  • Brown, Kaaren Strauch, and Marjorie Ziefert. “A Feminist Approach to Working with Homeless Women.” Affilia 5.1 (1990): 6–20.

    DOI: 10.1177/088610999000500101Save Citation »Export Citation »E-mail Citation »

    Provides a developmental model for designing programs for homeless women.

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  • Cloke, Paul, and Justin Beaumont. “Geographies of Postsecular Rapprochement in the City.” Progress in Human Geography 37.1 (2013): 27–51.

    DOI: 10.1177/0309132512440208Save Citation »Export Citation »E-mail Citation »

    Interesting reconceptualization of the interaction between faith-based and secular agency in urban space. Useful review of literature that summarizes faith scholarship and research on the city.

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  • Hoch, Charles. “Sheltering the Homeless in the US: Social Improvement and the Continuum of Care.” Housing Studies 15.6 (2000): 865–876.

    DOI: 10.1080/02673030020002582Save Citation »Export Citation »E-mail Citation »

    Develops an innovative argument that most homelessness programs begin with the fundamental assumption of a “continuum of care” (p. 865) from social dependence to independence. Argues instead that homeless programs should promote “shelter security” and should operate from a fundamental assumption that homelessness constitutes “shelter insecurity” rather than “social dependence.”

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  • Lancione, Michele. “Entanglements of Faith: Discourses, Practices of Care and Homeless People in an Italian City of Saints.” Urban Studies (2014).

    DOI: 10.1177/0042098013514620Save Citation »Export Citation »E-mail Citation »

    Provides useful insights from a study of faith-based organizations in Turin, Italy, that challenges monolithic representations of religious institutions (as agents of social control).

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  • Shinn, Marybeth, Jim Baumohl, and Kim Hopper. “The Prevention of Homelessness Revisited.” Analyses of Social Issues and Public Policy 1.1 (2001): 95–127.

    DOI: 10.1111/1530-2415.00006Save Citation »Export Citation »E-mail Citation »

    Programs that aim to prevent homelessness (universal, selected, or indicated) are inefficient, but subsidized housing has been effective for families and mentally disabled homeless populations. Also see “Homelessness, Severe Mental Illness, and the Institutional Circuit,” by Hopper, John Jost, Terri Hay, Susan Welber, and Gary Haugland, in Psychiatric Services 48.5 (1997): 659–665, which also discusses “institutional circuits” that include shelters, jails, and prisons.

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  • Toro, Paul A., and Melissa G. Warren. “Homelessness in the United States: Policy Considerations.” In Special Issue: Homelessness. Journal of Community Psychology 27.2 (1999): 119–136.

    DOI: 10.1002/(SICI)1520-6629(199903)27:2<119::AID-JCOP2>3.0.CO;2-ISave Citation »Export Citation »E-mail Citation »

    Concise overview of varying definitions and statistics that guide public discourse and debate about homelessness in the United States. The lack of consensus on definitions, estimates, and causes of homelessness leads to counterproductive debates and lack of action. See also “Let’s Ask the Homeless People Themselves: A Needs Assessment Based on a Probability Sample of Adults,” by Olga Acosta and Toro, in American Journal of Community Psychology 28.3 (2000): 343–366.

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  • Wolch, Jennifer R., and Michael J. Dear. Malign Neglect: Homelessness in an American City. Jossey-Bass Public Administration. San Francisco: Jossey-Bass, 1993.

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    Critique of policies at various scales that have contributed to the ongoing crisis of homelessness.

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Housing First and Supportive Housing

Since the late 1990s, there have been rigorous evaluations conducted of programs, especially supportive housing/integrated treatment and the Housing First strategy, to ascertain potential effects of interventions on health and housing outcomes for homeless populations. Tsemberis, et al. 2004 defines Housing First as the provision of housing without prerequisites or conditions for treatment usually required by supportive housing programs (for example, sober-living homes or many homeless shelters), while harm reduction centers on the choices by individuals to use substances or to follow treatment and take medications depending on their own process of recovery. Drake, et al. 1997 evaluates integrated treatment (mental health, substance abuse treatment, and housing) for homeless persons with severe mental disability/illness and substance abuse. Lehman, et al. 1997 evaluates assertive community treatment (ACT) for homeless persons in Baltimore. Padgett, et al. 2006 evaluates a Housing First compared to treatment-first strategy in New York City. Culhane, et al. 2002 finds in New York City that for severely mentally disabled persons, placement in supportive housing reduced use of other public services (e.g., public shelters, hospitals, jails), a finding that is echoed in Rosenheck, et al. 2003, which compares regular care at the United States Veterans Administration with case management and with case management and housing vouchers for mentally disabled/ill veterans. Hurlburt, et al. 1996 finds that Section 8 housing vouchers lead to more-stable housing and more-regular contact with case managers. Tsemberis, et al. 2004 compares Housing First with harm reduction and finds that Housing First (housing without substance use or mental health treatment conditions) for homeless and mentally disabled/ill individuals did not negatively affect their mental health or substance use symptoms. Culhane and Metraux 2008 argues that resources should be allocated that efficiently match homeless subpopulation needs with shelter/housing/service types. Kertesz, et al. 2009 argues that more caution and care is needed to determine when Housing First and more-linear substance abuse treatment programs are appropriate for specific groups of homeless persons, and further, that there are not sufficient data to show that Housing First as currently conceived is effective for homeless persons with severe substance abuse addiction.

  • Culhane, Dennis P., and Stephen Metraux. “Rearranging the Deck Chairs or Reallocating the Life Boats? Homelessness Assistance and Its Alternatives.” Journal of the American Planning Association 74.1 (2008): 111–121.

    DOI: 10.1080/01944360701821618Save Citation »Export Citation »E-mail Citation »

    Advocates an efficiency (volume-by-cost) approach to allocating resources that better match housing and services with specific needs of subpopulations living in homeless shelters.

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  • Culhane, Dennis P., Stephen Metraux, and Trevor Hadley. “Public Service Reductions Associated with Placement of Homeless Persons with Severe Mental Illness in Supportive Housing.” Housing Policy Debate 13.1 (2002): 107–163.

    DOI: 10.1080/10511482.2002.9521437Save Citation »Export Citation »E-mail Citation »

    Analyzes data from 1989 to 1997 in New York City of 4,679 severely mentally disabled individuals placed in supportive housing and of their use of public shelters and hospitals. For persons in supportive housing, there are lower rates of shelter use and hospitalizations, and shorter times incarcerated, than for homeless individuals not placed in supportive housing. Available online.

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  • Drake, Robert E., Nancy A. Yovetich, Richard R. Bebout, Maxine Harris, and Gregory J. McHugo. “Integrated Treatment for Dually Diagnosed Homeless Adults.” Journal of Nervous & Mental Disease 185.5 (1997): 298–305.

    DOI: 10.1097/00005053-199705000-00003Save Citation »Export Citation »E-mail Citation »

    Compares two programs over eighteen months in Washington, DC: integrated treatment (mental health, substance abuse, and housing) and standard treatment (nonintegrated treatment) for 217 dually diagnosed (substance abuse and mental disorders) individuals who are homeless. The integrated treatment group (N=158) showed better housing and substance abuse outcomes than did the standard treatment group (N=59).

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  • Hurlburt, Michael S., Patricia A. Wood, and Richard L. Hough. “Providing Independent Housing for the Homeless Mentally Ill: A Novel Approach to Evaluating Long-Term Longitudinal Housing Patterns.” Journal of Community Psychology 24.3 (1996): 291–310.

    DOI: 10.1002/(SICI)1520-6629(199607)24:3<291::AID-JCOP8>3.0.CO;2-#Save Citation »Export Citation »E-mail Citation »

    Early comparison of supportive case management and independent housing (through Section 8 housing vouchers in the United States). Results indicate that availability of Section 8 housing vouchers led to more-stable housing and more-stable and regular contact with case managers. See also “Effects of Substance Abuse on Housing Stability of Homeless Mentally Ill Persons in Supported Housing,” by Hurlburt, Hough, and Wood, in Psychiatric Services 47.7 (1996): 731–736.

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  • Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, Robert E. Cusimano, and Joseph E. Schumacher. “Housing First for Homeless Persons with Active Addiction: Are We Overreaching?” Milbank Quarterly 87.2 (2009): 495–534.

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

    Useful updated review of the literature on Housing First and more-“linear” traditional programs that seek to make residents “housing ready” before placement in permanent housing. Argues that linear approaches may work well for specific subgroups in the homeless population, especially individuals with severe addictions. Also argues that more data are needed to identify the groups for which Housing First may be most effective.

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  • Lehman, Anthony F., Lisa B. Dixon, Eimer Kernan, Bruce R. DeForge, and Leticia T. Postrado. “A Randomized Trial of Assertive Community Treatment for Homeless Persons with Severe Mental Illness.” Archives of General Psychiatry 54.11 (1997): 1038–1043.

    DOI: 10.1001/archpsyc.1997.01830230076011Save Citation »Export Citation »E-mail Citation »

    Describes the results of a randomized study in Baltimore, Maryland, evaluating the effectiveness of an intensive program combining community-based clinical treatment and case management (termed assertive community treatment, or ACT) for individuals diagnosed with severe mental disorders. Individuals receiving ACT services experienced fewer in-patient psychiatric days and were more stably housed.

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  • Padgett, Deborah K., Leyla Gulcur, and Sam Tsemberis. “Housing First Services for People Who Are Homeless with Co-occurring Serious Mental Illness and Substance Abuse.” Research on Social Work Practice 16.1 (2006): 74–83.

    DOI: 10.1177/1049731505282593Save Citation »Export Citation »E-mail Citation »

    Assesses a Housing First program in New York City (Pathways to Housing, or PTH) and shows no differences in substance use for PTH and treatment-first services. Also see “Housing, Hospitalization, and Cost Outcomes for Homeless Individuals with Psychiatric Disabilities Participating in Continuum of Care and Housing First Programmes,” by Gulcur, Ana Stefancic, Marybeth Shinn, Tsemberis, and Sean N. Fischer, in Journal of Community & Applied Social Psychology 13.2 (2003): 171–186.

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  • Rosenheck, Robert, Wesley Kasprow, Linda Frisman, and Wen Liu-Mares. “Cost-Effectiveness of Supported Housing for Homeless Persons with Mental Illness.” Archives of General Psychiatry 60.9 (2003): 940–951.

    DOI: 10.1001/archpsyc.60.9.940Save Citation »Export Citation »E-mail Citation »

    Randomized study of three types of care for mentally disabled/ill homeless veterans over a three-year period: intensive case management and subsidized housing vouchers, case management only (without vouchers), and usual care provided by the United States Veterans Administration (VA). Costs for vouchers and case management are higher than standard VA care; however, these costs are modest, and benefits outweigh the costs especially as housing costs per day rise.

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  • Tsemberis, Sam, Leyla Bulcur, and Maria Nakae. “Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals with a Dual Diagnosis.” American Journal of Public Health 94.4 (2004): 651–656.

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

    Analyzes data on randomly assigned homeless and mentally disabled/ill participants in supportive housing (N=126) and in Housing First (N=99) programs. Housing First participants show 80 percent retention in housing, and supportive housing participants show more use of substance abuse treatment services. See also Tsemberis’s “From Streets to Homes: An Innovative Approach to Supported Housing for Homeless Adults with Psychiatric Disabilities” in Journal of Community Psychology 27.2 (1999): 225–241.

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Delivering Programs to Youth: Mobile Devices, Computers, and Technology

Homeless populations remain difficult to reach irrespective of their demographic characteristics, location, or needs. The familiarity with cell/smart phones and the frequent use of social media platforms across most homeless subgroups, especially youth and adolescents, make cell/smart phones an important potential conduit for communciation and program/service delivery. While this area of study is still emerging, studies have shown interesting and promising results. Tyler and Schmitz 2017 shows that providing cellphones to homeless youth may be an important way to disseminate information; Jennings, et al. 2016 finds that finances and conflict impede homeless youth use of mobile phone use; Harpin, et al. 2016 reports half of a sample of homeless youth (N=181) in Denver owned a mobile phone but 72 percent reported regularly using Facebook.

  • Harpin, Scott, Jillian Davis, Hana Low, and Christine Gilroy. “Mobile Phone and Social Media Use of Homeless Youth in Denver, Colorado.” Journal of Community Health Nursing 33.2 (2016): 90–97.

    DOI: 10.1080/07370016.2016.1159440Save Citation »Export Citation »E-mail Citation »

    Analysis of survey of convenience sample of 181 homeless youth in shelters or drop-in centers in Denver, Colorado, 44 percent were African American and 21 percent were Latino/Hispanic. Survey was administered using iPads and desktop computers. About 47 percent of respondents reported owning a mobile phone, with 65 percent of those reporting that their mobile devices were smart phones, but about 72 percent reported regularly using social media with Facebook, the most common social media platform reported.

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  • Jennings, Larissa, Nicole Lee, Deborah Shore, et al. “US Minority Homeless Youth’s Access to and Use of Mobile Phones: Implications for mHealth Intervention Design.” Journal of Health Communication 21.7 (2016): 725–733.

    DOI: 10.1080/10810730.2015.1103331Save Citation »Export Citation »E-mail Citation »

    The study analyzes focus groups and interviews with homeless youth in Baltimore and Washington DC (nine focus groups with fifty-two total participants, and interviews with forty-one, about 82 percent of whom were African American). Literature review indicates that mobile phone use/ownership is comparable between homeless and homed youth in the United States. Study results indicated that about 78 percent of participants in focus groups and interviews owned a mobile phone, with 50 percent receiving the phone as a gift.

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  • Tyler, Kimberly A., and Rachel M. Schmitz. “Using Cell Phones for Data Collection: Benefits, Outcomes, and Intervention Possibilities with Homeless Youth.” Children and Youth Services Review 76 (2017): 59–64.

    DOI: 10.1016/j.childyouth.2017.02.031Save Citation »Export Citation »E-mail Citation »

    This study provided cell phones to 150 homeless youth for thirty days in two Midwestern cities to assess homeless youth perceptions of participating in a research study, and gathered information using survey questions via short message service (SMS) or “texting” and semi-structured interviews. Useful literature review on consistent and regular cell phone access and usage for homeless youth.

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