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A reference colleague related the following anecdote. In the course of teaching a reference workshop she would hold up photos of users, and the attendees would provide a background profile [...]

The course of homelessness was examined among adults entering treatment in the Chicago Target Cities sample, which was aimed at improving the service delivery system in large metropolitan areas across the U.S. The objectives of the present study were: (1) Examine transitions in and out of homelessness over 3 years post entry into treatment; and (2) Determine the treatment and non-treatment factors that predict achieving and sustaining residential stability. Sixty-one percent of initially homeless participants were stably housed at 36 months. By contrast, only 14% of initially housed participants were homeless at 36 months. Sample-wide, homelessness was reduced by 43% over 3 years. In conditional logistic regression models, the most consistent and persistent predictors were crack as the primary problem substance, which appears to be a risk factor for becoming and remaining homeless, and whether or not others were dependent on the participant for food/ shelter, which appears to be a protective factor for achieving housing and preventing homelessness. In general, specific treatment factors did not predict outcomes. Limitations and implications for treatment are discussed. Keywords: Substance abuse; Addiction; Homelessness; Treatment; Predictors

When large numbers of homeless people began appearing on the streets of American cities in the late 1970s, a sense of crisis galvanized advocates, the media, and policymakers. (1) Now, [...]

A secondary syringe exchange program can be effective in reducing the risk of HIV infection in homeless drug addicts. These programs recruit drug addicts to collect used syringes from homeless addicts, exchange them for clean syringes at a needle exchange program, and distribute the clean syringes to the homeless addicts.

An evaluation is presented on a collaboration between health care providers and university researchers to treat homeless persons for substance abuse. Components include abstinent-contingent housing and work therapy and links between community and project services.

This study used a non-equivalent control group design to investigate the effect of consumer choice of treatment on both process and outcome variables. All study participants suffered from severe mental illness, were homeless at baseline, and were enrolled in a modified Assertive Community Treatment (ACT) program. Consumers in the choice condition had selected the ACT program from a menu of five treatment programs; clients in the no-choice condition were simply assigned to the ACT program by an intake worker. Results found that consumers in the choice condition visited the ACT staff at their offices more than consumers in the no-choice condition, but there were no significant differences between groups on the other treatment process variables. Although consumers in the choice condition increased their income more than consumers in the no-choice condition, there were no significant differences between groups on the other outcome variables (stable housing, psychotic symptoms, depression, and substance abuse).

A study of group membership in relation to service use by homeless people is discussed. The groups are based on the streets or based on service systems; variables include the service types of case management, group or subsistence services; and current behaviors including substance use, illegal market involvement, current housing and employment status.

The Families in Transition program (FIT), in collaboration with the University of Maryland School of Medicine, designed and implemented a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) homeless outreach project. Staff scheduled regular outreach visits to shelters and soup kitchens to ensure that eligible participants were certified for the WIC program and families were closely followed. Two hundred fourteen homeless clients were certified for the WIC program during a 1-year period. A nutritional analysis of foods provided by shelters and soup kitchens revealed that participants' daily dietary intakes would be deficient in key nutrients for pregnant and breastfeeding women and children under age 5. This analysis was based on the assumptions that participants at any given shelter or soup kitchen had access to no food other than that provided by the shelter or kitchen and that participants consumed all foods available at the shelter or soup kitchen. Providing intensive nutrition and health education played a key role in ensuring proper use of the WIC food packages. Outreach services are fundamental to effectively serving homeless families through the WIC program.

A study found that the homeless are able to receive health care services through Medicaid. It was noted, however, that it brings little impact on their access and use of emergency rooms. Some of them were able to get cash benefits from Medicaid, and this group availed more of the outpatient medical services. Meanwhile, the group of indigents who have access to both Medicaid and direct service tend to have better access to medical care.

The US still has a long way to go before it can solve its homelessness problem. Homelessness should be seen as a manifestation of the failure of the social service system. American society itself should be blamed for the problem which can only be solved through fundamental social change., The past decade has made clear that homelessness is not simply a passing phenomenon requiring heroic volunteer efforts on the part of a few until the temporary crisis passes. Yet [...]

The key elements of a systems integration approach to delivery of human services are reviewed in terms of their application to services for mentally ill homeless persons. The example of a mental health outreach project illustrates the service- and systems-integrating influences of clinical case management with this population, and the ability of a 'bottom-up' street-level approach to improve coordination and service accessibility for clients in general is discussed.

In the United States, those street-dwelling homeless persons who suffer from serious psychiatric disabilities often reject the dependency generated by treatment modalities. Psychiatric and/or psychosocial rehabilitation, which emphasizes client choice, resonates with recent empowerment perspectives in community psychology, consumer-ran mental health alternatives, and nontraditional homelessness programs. However, few of these approaches have been analyzed. This article examines critically how client choice, as a driving principle and idiographic concept, was constructed in a program for street-dwelling homeless persons labeled mentally ill by service providers. The cultural underpinnings of individualist choice are traced. This article analyzes the paradoxes of applying an idiographic framework, which favors case-by-case approaches over universally applicable rules, in a larger context of normatively oriented service organizations upon which the program depended for desired resources. Finally, it demonstrates how the emergence of a collectivity within the program redefined the outer limits of individual choice. Key words: homelessness, mental illness, psychiatric rehabilitation, empowerment, social construction; US, New York City

We studied a modified therapeutic community designed for the treatment of patients with combined substance abuse and psychiatric disorders. This model has been ap 117117plied on a limited basis in clinical practice, and little is known about the characteristics of patients who are likely to complete the prescribed stay in such a program. In this report, we present characteristics of 189 homeless dually diagnosed men who entered a shelter-based, modified therapeutic community with a prescribed 6-month stay. Thirty-four percent of admissions completed the prescribed stay. These patients were more likely to have fewer inpatient psychiatric admissions and more job experience than those who did not complete their stay. Findings are discussed in terms of their similarities and differences to findings from traditional therapeutic communities for the singly diagnosed. Keywords-addiction; therapeutic community; dual diagnosis; homelessness; retention rate.

The Homeless Employment and Related Training (HEART) Project is aimed at helping the homeless and their families establish themselves into the mainstream by providing them with job skills training and job search assistance. Results show that 87% of participants graduated from the program while 81% successfully found employment during the course of the program. About 65% also moved from shelters to permanent homes after graduating.

Employing data from a 1987 shelter survey of 1260 homeless adults in New York City, multivariate models of emergency room (ER) use are developed which include an array of risk factors for visiting a hospital ER including health and mental health problems, victimization and injuries. The study's primary goal is to identify factors that predict ER use in this population. Multivariate logistic and linear regression models were tested separately for men and women predicting three outcomes: any use of the ER during the past 6 months, use of the ER for injuries vs all other reasons (given any ER use), and the number of ER visits (given any ER use). Lower alcohol dependence, health symptoms and injuries were strong predictors for both men and women; other significant predictors differed markedly by gender. Both models were highly significant and produced strikingly high risk profiles. A high prevalence of victimization and injuries underlies ER use among the homeless. Based upon the findings, we recommend expanded health and victim services as well as preventive measures. Until primary care becomes available for this population, we advise against policies that discourage ER use by the homeless. Key words - emergency room services, homelessness, service utilization, victimization, injuries

Two residential programs for dually diagnosed (severely mentally ill and substance-abusing) homeless individuals in Philadelphia were compared in a quasi-experimental field study. Findings indicate that the experimental model, a hybrid psychosocial and drug rehabilitation program, did significantly better in maintaining clients in care and in successful rehabilitation than did the comparison model, a modified therapeutic community program. However, the overall rate of success in both programs was quite modest. We found Emile Durkheim's concepts of organic and mechanical solidarity to be useful in comparing the structure of the two programs. Because of the small number of clients treated by these programs and the unique characteristics (predominately young, black, and male) of this urban population, findings are not conclusive but clarify direction for further practice and study.

Presents 12-month follow-up results from an outreach/linkage intervention with persons who are homeless and mentally ill, contrasting these with results obtained at 4 months. Both sets reflect the success of the program in placing individuals in independent housing. However, longer term data provide useful information regarding client movement patterns and increased tenure in nonhomeless living arrangements beyond the termination of specialized services. Analyses of 12-month residential outcomes identified four variables as significant predictors: recruitment source, project service duration, CMH service duration, and client age. In contrast to 4-month predictors, variables reflecting baseline client functioning were no longer significantly related to outcome, suggesting that the positive effects of the intervention may take longer to achieve with some clients. Discussion focuses on the implications of these effectiveness results for future research designs and measures as well as the utility and limitations of preexperimental approaches for evaluating innovative service models when implementation and efficacy experiences are lacking.

The number of homeless people is increasing, and the percentage of that number that are families is also increasing. The transitory state caused by homelessness creates special educational problems for the children of those families.

There is no single, simple solution to the problems of homelessness among the severely mentally ill population across our nation. Any successful effort to end their homelessness must be a […]

The extent and nature of homelessness is discussed. Only after understanding these parameters was the federal government able to develop an appropriate homelessness policy, including an explicit goal to help end, rather than simply address, the problem. The article describes how, with increased information, federal programs for the homeless have evolved, beginning with emergency remedies and shifting to more permanent solutions. Significantly increased cooperation at federal, state, and local levels is called for to effectively address this multifaceted problem. In the long term, we must wage a broad attack on poverty if we are to eradicate the root problems that force people into homelessness.

This article reviews the problem of homelessness from the perspective of an advocate who has been working to change national policy. The Stewart B. McKinney Homeless Assistance Act, an important initial step supported by advocates and (now) political leaders, is described as providing too few resources and limited programs. An agenda for policy change is proposed to deal with the dual problems of rapidly dwindling low-cost housing and inadequate income among the poor and homeless. It is hoped that psychologists and other professionals will get actively involved in creating such policy change.

Public policy issues related to homelessness and their priorities are reviewed. It is argued that the three most important policy issues are housing, income, and health. Cutting across these priority areas are the special problems of homeless children and youth, both in families and alone. Alcohol, drug abuse, and mental health services, although needed and effective, will neither stop nor slow the rate of increase in homelessness experienced in recent years. Psychologists, in emphasizing aspects of homelessness that they are expect in, are deflected from variables determining the prevalence and incidence of homelessness. The latter variables must be regarded as the priority policy issues in homelessness.

This article describes a public policy agenda developed for the American Psychological Association (APA) by the APA Ad Hoc Advisory Panel on Homelessness, which met May 31-June 1, 1991. The agenda is intended to inform APA staff in their legislative and policy work with Congress and Executive Branch agencies on issues relevant to homelessness.

This study compares social relationships of 677 mothers in families requesting shelter with those of 495 mothers in housed families, randomly selected from the public assistance caseload in New York City. As hypothesized, women seeking shelter had experienced higher levels of a variety of childhood and adult events indicative of disruptions in social relationships. Contrary to our hypothesis, they were more likely than were housed mothers to have had recent contact with parents, other relatives, and friends, although they felt less able to draw on these resources for help with their current housing needs. More than three fourths of families seeking shelter had already stayed with members of their social network in the past year. The data suggest that they had used up potential sources of support before turning to public shelter.

Credible estimates of the prevalence of alcohol and drug abuse suggest that alcohol abuse affects 30% to 40% and drug abuse 10% to 15% of homeless persons. A review of policies that address substance abuse among the homeless finds that interventions alternate between control and rehabilitation. However, the unique needs of a changing homeless population require an integration of alcoholism and drug abuse recovery services with programs for women, adolescents, and the mentally ill. Alcohol- and drug-free housing is essential to support and maintain recovery. Psychology can contribute in the development of effective programs for homeless individuals struggling with addiction and alcoholism.

Over the past decade, researchers have documented the range of needs and devised new methods for increasing our understanding of the homeless severely mentally ill population. Clinicians have developed an appreciation of the difficulty and complexity of effectively treating this population, and policymakers have become increasingly aware of the barriers to developing services and housing. In this article, the progress-to-date in research, the evolution of new service approaches, and the development of federal, state, and local policies to meet the needs of homeless mentally ill individuals are assessed. The many challenges that remain are also considered.

To address the problems of homeless people, emergency-oriented services were increased during the 1980s. However, too little progress has been made in solving a principal cause of homelessness: the expanding gap between supply and demand for low-income housing. This article analyzes arguments for strengthening the roles os the federal government, states and localities, and the private sector in funding low-income housing. Recommendations include targetting funds to enhance the effectiveness of existing monetary support and using community loan funds and pension plan assets as additional resources.

This article reports the findings of a National Institute of Mental Health (NIHM) services demonstration project that used a mobile case management team to serve homeless mentally ill clients. The projects examined three issues: (1) factors associated with client engagement in case management, (2) clients' perceptions of how case management affected their quality of life, and (3) significant differences between clients who remained engaged in case management services and those who discontinued involvement. The results indicated that clients who received more frequent case management contact, had higher assessed independent living skills, were older, were less likely to be substance abusers, and had experienced fewer periods of homelessness and fewer prior psychiatric hospitalizations were more likely to remain engaged in case management services. After six months of case management, clients perceived significant improvement in their global well-being, living situation, use of leisure time, finances, and physical health. Implications for providing case management services to homeless mentally ill people are presented.

In this article the authors report on the self-perceived needs of 40 homeless people who are coping with psychiatric problems. These people were among 207 with psychiatric problems participating in an innovative advocacy project based outside the formal mental health system. Compared with domiciled participants, the homeless participants had more accentuated and somewhat different major daily living needs in the areas of income and benefits, housing, legal services, employment, and health care. On the basis of these findings, the authors draw implications for social work practice with homeless people coping with psychiatric problems.

To correct previous researchers' almost exclusive emphasis on describing the size and personal characteristics of homeless individuals, this article reports on an empirical evaluation of the influence of several structural conditions on rates of homelessness in U.S. metropolitan areas. It is hypothesized that unavailability of low-cost housing, high poverty, poor economic conditions, concentrations of minorities and female-headed families, and insufficient mental health care for the indigent are determinants of high levels of homelessness. The results of a multivariate analysis show that the availability of low income housing and of mental health care are the strongest predictors. Relatively modest investments in improving availability of these services would provide considerable payoff in reducing homelessness.

This study assessed costs, quality of life, services, length of stay, and clienteles in 9 nonprofit shelters for families in New York City. It compared different types of nonprofit shelters and used published data to compare the nonprofits as a class to welfare hotels and city-operated congregate shelters. The nonprofit models provided a reasonable quality of life, and both more and better coordinated services than the welfare hotels at a slightly lower cost. Projected costs for expanding these models were slightly higher than costs projected by the city for welfare hotels, but substantially lower than for the congregate shelters. The average length of stay in particular shelters was affected by family size, advocacy efforts, and regulations, but only an increase in the stock of permanent housing was judged likely to change the average length of stay in the full shelter system.

The histories of public shelter in Chicago and New York show that homelessness among single men has typically been viewed as a problem of troubled--and troublesome--individuals. In this viewpoint, the link between the labor market and emergency shelter use, so obvious during times of economic depression, has been lost. Shelters historically have been 'hybrid institutions,' plugging gaps in the formal institutional array of supports, while at the same time serving as dwellings of last resort for usually-working men who have exhausted informal resources of assistance. This double burden has made program design incoherent, barriers to access commonplace, and mystification of shelter functions the rule. Today, families continue to play the largest role in avoiding homelessness among single men, with shelters serving as intermittent, stopgap accessories. A coherent unemployment relief policy is still lacking, despite the centrality of labor market dynamics in the homelessness of these men.

This study gathered descriptive data on 163 individuals who applied by telephone to a residential rehabilitation program for homeless veterans and compared these data with general veteran and homeless populations. Ss were a young (M = 40.82 years) and educated (M = 13.34 years of schooling) subgroup of homeless men (98.16%) with histories of relatively high, stable functioning (e.g., previous successful employment) and high rates of medical (47.47%), substance abuse (67.1%), psychiatric (41.93%; primarily nonpsychotic), and legal (71.15%) problems. Thes characteristics appear to be different from those of other sugroups of homeless (e.g., homeless chronically mentally ill, skid-row alcoholics), and they provide a basis for beginning to develop distinct remedial strategies that are specific to this subpopulation. The advantages of studying subgroups of homeless and the utility of the telephone interview data collection methodology are discussed.