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Objective: The associations between adverse childhood experiences (ACEs) and psychopathology have been well-established in the general population. Research on ACEs in the homeless population has been limited. This study examined whether ACE exposure is associated with specific mental health outcomes among a national sample of homeless adults with mental illness and whether this association varies according to ACE dimension and gender. Methods: This cross-sectional study utilized data from a national sample of 2,235 homeless adults with mental illness in Canada to evaluate their sociodemographic characteristics, exposure to ACEs, and mental health outcomes. Exploratory and confirmatory factor analyses were conducted to identify and confirm ACE dimensions (maltreatment, sexual abuse, neglect, divorce, and household dysfunction) from individual ACE items. Multivariable logistic regression was used to examine the associations between total ACE score and ACE dimensions with mental illness diagnoses and psychopathology severity. Results: The mean total ACE score among all study participants was 4.44 (standard deviation [ SD]: 2.99). Total ACE score was positively associated with several mental illness diagnoses and psychopathology severity. Unique associations were found between specific ACE dimensions and poor mental health outcomes. The prevalence of almost all ACEs was significantly higher among women. Yet, associations between several ACE dimensions and poor mental health outcomes existed uniquely among men. Conclusions: There are unique and gender-specific associations between specific ACE dimensions and mental health outcomes among homeless adults. Better understanding of the mechanisms underlying these associations is needed to inform screening, prevention, and treatment efforts, particularly given the very high prevalence of ACEs among this vulnerable and marginalized population.

This study identifies time-patterned trajectories of housing stability among homeless and vulnerably housed individuals who participated in a multisite four-year longitudinal study in Canada. Findings show four distinct trajectories for the homeless and vulnerably housed: high levels of sustained housing stability, improving levels over time leading to high levels of housing stability, decreasing levels of housing stability over time, and low levels of housing stability over time. The presence of resources rather than risk factors differentiated the trajectories of participants who achieved housing stability from those who had low levels of housing stability. Participants who had better housing stability were more likely to live in subsidized housing. Findings highlight the need for programs and policies directed at addressing the housing affordability problem through income support strategies and the creation of affordable housing.

High level of mental health problems are a critical concern among youth experiencing or at-risk of homelessness. Using data from a randomized controlled trial on Housing First in Canada, this study examined the risk factors and protective resources associated with mental health recovery among 215 homeless youth with mental illness at baseline and at a 24-month follow-up. At study entry, higher levels of recovery were associated with a lower number of adverse childhood experiences, less frequent presence of mental health symptoms, higher level of satisfaction with social relationships, and a higher level of psychological integration at baseline. At 24-months, a lower frequency of experiencing mental health symptoms and a higher level of psychological integration were associated with a higher level of recovery. The study’s findings highlight the importance of protective resources, notably having supportive social relationships and a sense of belonging in the community as contributors to mental health recovery

Objectives: Exposure to adverse childhood experiences (ACEs) is associated with increased risk of criminal justice involvement and repeated victimization among homeless individuals. This study aimed to (1) examine whether the relationship between cumulative ACE score and odds of experiencing criminal justice involvement and victimization remains significant over time after receiving the Housing First (HF) intervention and (2) investigate the moderating effect of cumulative ACE score on the effectiveness of the HF intervention on the likelihood of experiencing these outcomes among homeless individuals with mental illnesses. Methods: We used longitudinal data over the 2-year follow-up period from the At Home/ Chez Soi demonstration project that provided HF versus treatment as usual (TAU) to homeless adults with mental illness in five Canadian cities (N = 1,888). Results: In all 4 follow-up time points, the relationship between cumulative ACE score and both outcomes remained significant, regardless of study arm (HF vs. TAU) and other confounding factors. However, cumulative ACE score did not moderate intervention effects on odds of experiencing either outcome, suggesting that the effectiveness of HF versus TAU, with regard to the odds of being victimized or criminal justice involvement, did not differ by cumulative ACE scores over the course of study. Conclusions: Findings suggest that providing services for homeless individuals with mental illness should be trauma informed and include specialized treatment strategies targeting the experience of ACEs and trauma to improve their treatment outcomes. An intensive approach is required to directly address the problem of criminal justice involvement and victimization in these individuals.

Homelessness has consequences for families, including risk of deterioration in the health of their members, disruption of family dynamics, and separation of parents and children. This study used qualitative interviews to explore pathways into and perceived consequences of homelessness among 18 families living in an emergency family shelter system in Canada. Findings showed that families’ experiences prior to their homelessness were characterized by vulnerability, instability, and isolation. In the emergency shelter system, families faced new challenges in environments that were restrictive, noisy, chaotic, and afforded little privacy. Participants described a further disruption of relationships and described having to change their family practices and routines. Despite the challenges that families encountered, some participants felt optimistic and hopeful about the future. Future research is needed on ways in which shelters can be more hospitable, supportive, and helpful for parents and their families to minimize negative impacts and facilitate timely rehousing of families.

Purpose:Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless adults with mental illness. However, little is known about patterns of change and characteristics that predict different outcome trajectories over time. This article reports on latent trajectories of housing stability among 2140 participants (84% followed 24 months) of a multisite randomised controlled trial of HF.Methods:Data were analyzed using generalised growth mixture modeling for the total cohort. Predictor variables were chosen based on the original program logic model and detailed reviews of other qualitative and quantitative findings. Treatment group assignment and level of need at baseline were included in the model.Results:In total, 73% of HF participants and 43% of treatment-as-usual (TAU) participants were in stable housing after 24 months of follow-up. Six trajectories of housing stability were identified for each of the HF and TAU groups. Variables that distinguished different trajectories included gender, age, prior month income, Aboriginal status, total time homeless, previous hospitalizations, overall health, psychiatric symptoms, and comorbidity, while others such as education, diagnosis, and substance use problems did not.Conclusion:While the observed patterns and their predictors are of interest for further research and general service planning, no set of variables is yet known that can accurately predict the likelihood of particular individuals benefiting from HF programs at the outset.

This study examined the relationship between victimization and mental health functioning in homeless individuals. Homeless populations experience higher levels of victimization than the general population, which in turn have a detrimental effect on their mental health. A sample of 304 homeless adults and youth completed one-on-one interviews, answering questions on mental health, past victimization, and recent victimization experiences. A hierarchical linear regression showed that experiences of childhood sexual abuse predicted lower mental health functioning after controlling for the sex and age of individuals. The study findings are applicable to current support programs for victims in the homeless population and are relevant to future research on homelessness and victimization.

Disrupted high school experiences, including dropout, are educational consequences for many youth with histories of homelessness. Using an ecological resilience prediction model (ERPM) based on the literature on resilience in at-risk youth, the study followed 82 youth who were initially homeless for a 2-year period, to identify predictors of participating in school. Female sex and increased duration of rehousing at Time 2 significantly predicted being in school at follow-up. Youth who were not in school reported a greater increase in satisfaction with social support compared to youth who were participating in school at follow-up. The study adds to what is understood regarding the longitudinal consequences of housing instability and discontinuity in school participation in youth by examining ecological predictors of resilience. Implications of findings for policy and program development targeting education and housing for youth are discussed.