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date: 25 November 2017

Homelessness

Abstract and Keywords

This entry provides an overview of contemporary homelessness as a major social problem in the United States, focusing on the definition of homelessness and its prevalence, as well as on the composition and characteristics of the homeless population. It then discusses the dynamics and causes of homelessness and examines policy responses toward homelessness since the McKinney–Vento Homeless Assistance Act of 1987. The entry points to the multifaceted nature of homelessness and highlights promising interventions that have shown to be effective in addressing homelessness among members of special needs populations.

Keywords: behavioral health, chronic homelessness, continuum of care, co-occurring disorder, criminal justice, critical time intervention, domestic violence, foster care, homeless families, homelessness, homelessness prevention, housing, housing first model, individual-vulnerability perspective on homelessness, intensive case management, management information system, McKinney–Vento Homeless Assistance Act, patterns of homelessness, physical health, physical and sexual abuse, poverty, runaways, throwaways and homeless youths, service coordination and integration, shelter and street homeless, structural perspective on homelessness

Although concern over homelessness has long been documented in American history, the nature of homelessness has changed considerably over time, reflecting different economic and social contexts and the public's perception of problems faced by members of society who endure the severest form of housing deprivation. Up until the late 1970s, homelessness was understood as affecting primarily a small and homogeneous segment of the population, including itinerant workers and “sturdy beggars” in Colonial America, unemployed working men during the preindustrial era, “hobos” during the post–Civil War period, and the “skid row” men in the post–World War II years (Anderson, 1923; Bahr & Caplow, 1973; Rossi, 1989). Homelessness during these time periods was associated with transiency, vagrancy, vagabond, and disaffiliation from the mainstream society. Comprehensive public efforts were scantily made in response to the needs of homeless people, with the exception of the Great Depression in the 1930s when the failing economy expanded vulnerability toward homelessness among massive number of single men and women, youths, and families (Crouse, 1986).

Definition of Homelessness

In the late 1970s, homelessness became increasingly visible in the urban landscape, and since then, has persisted as a social problem in the public policy arena. The official U.S. policy, as stipulated in the McKinney–Vento Homeless Assistance Act of 1987, defines persons as homeless if they lacked a fixed, regular, and adequate nighttime residence, and if they sleep in a shelter designated for temporary living accommodations or in places not designated for human habilitation (42 U.S.C. § 11301). This definition of homelessness precludes persons who are precariously housed, including the “hidden homeless” who double up with relatives and friends, as well as those who are at an imminent risk of becoming homeless. Because of geographic remoteness and service inaccessibility, persons experiencing homelessness in rural areas are less likely to use shelters or live on the streets, and are more likely to live with relatives or friends in overcrowded or substandard housing (Aron & Fitchen, 1996).

The literal definition of homelessness does not convey a moral connotation that exists in previous definitions, which consider homelessness as a life style preferred by an individual or a condition of profound alienation from the mainstream society.

However, this literal definition of homelessness is considered inadequate for understanding the prevalence and distribution of rural homelessness.

Prevalence of Homelessness

In the 1980s estimates of the size of the homeless population were a subject of heated debate, with estimates varying widely from 250,000 to 3 million people. In 1990, the U.S. Census Bureau obtained a count of 178,828 people in shelters and 49,793 people on the streets during a designated 24-hr period (U.S. Department of Commerce, 1991). This count was much disputed because of its failure to identify homeless persons in unconventional sites including abandoned buildings and parked vehicles. Recently, there has been more agreement over the prevalence of homelessness, with the most cited estimates derived from two studies conducted by Martha Burt and her colleagues. Based on two national probability surveys of users of programs for homeless individuals, the point-in-time estimates of homeless adults and children were, respectively, 567,000–600,000 in 1987 (Burt & Cohen, 1989) and 444,000–842,000 in 1996 (Burt, Aron, & Lee, 2001). Using the higher estimates in these two time periods, the rate of homelessness increased from 24.3 per 10,000 in 1987 to 38.0 per 10,000 in 1996. A recent study conducted by the National Alliance to End Homelessness reported a point-in-time estimate of 744,313 people experiencing homelessness in January 2005. This estimate was based on tabulation of data from 463 Continuum-of-Care point-in-time studies (National Alliance to End Homelessness, 2007).

Given the turnover of the homeless population and its seasonal variation, point-in-time prevalence represents an underestimation of the size of the homeless population. This is because counts taken at a snapshot miss people who experience relatively brief episodes of homelessness. The Philadelphia and New York City homeless management information systems revealed that 4–6 times the number of people homeless on a given day passed through the shelter systems of the two cities in the course of a year (Culhane, Dejowski, Ibañez, Needham, & Macchia, 1994). In addition to undercounting, relying on information from point-in-time studies results in misrepresentation of the nature of homelessness by overestimating the proportion of people who experience chronic homelessness. This has led to an undue focus on personal deficits as antecedents of homelessness. Using a method to make projections from point-in-time estimates, Burt and colleagues found that between 2.3 million and 3.5 million people experienced homelessness in 1 year nationwide. Moreover, based on data from a random-digit dialing telephone sample of 1,507 adults living in 48 contiguous states, Link and his colleagues estimated a lifetime homelessness prevalence rate of 7.4%, or 13.5 million people (Link et al., 1994).

Characteristics

The homeless population constitutes a diverse group in reference to age, gender, race or ethnicity, living units (single individuals and families), location (urban versus rural), health status (medical, psychiatric, addictive disorders, HIV/AIDS), and social status (veterans and criminal offenders). Three key subgroups in the overall homeless population have been distinguished for research and service planning purposes: homeless single adults, homeless families, and unaccompanied homeless youth (Toro, 2007).

Distributions and characteristics of these three subgroups vary across studies due to differences in study sites and study methods. The 1996 National Survey of Homeless Assistance Providers and Clients (NSHAPC), based on a large probability sample of 76 metropolitan and nonmetropolitan areas (including small cities and rural areas), provides a comprehensive socio-demographic profile of service-using homeless single adults and homeless families (Burt et al., 1999). About one-third of homeless service users in NSHAPC were members of families, with 11% being parents and 23% minor children. Homeless families constituted 15% of all homeless households.

Data from NSHAPC indicate that homeless clients differ considerably from the U.S. adult population, and that parents in homeless families differ from single homeless clients in some demographic characteristics. Men dominate the homeless population (68%), with about three-quarters of all single homeless clients being male. The sex ratio for parents in homeless families is reverse—only 16% are men. The racial/ethnic makeup of the homeless population does not differ by family status, with homeless clients about equally divided between non-Hispanic Whites and non-Hispanic Blacks (41% and 40%). Compared with the general population, homeless clients are disproportionately non-Hispanic Blacks (11% versus 40%) and Native American (1% versus 8%). The service-using homeless population is younger than the general population, less likely to be currently married (9% versus 60%), and less likely to report some education beyond high school (28% versus 45%). About one-quarter of single homeless adults are veterans, twice the rate of the general population.

Using multiple indicators of behavioral health status, NSHAPC found that two-thirds of homeless clients experienced at least one alcohol, drug, or mental health problem during the past month. The 1-year and lifetime prevalence of at least one mental health, alcohol, and drug problem is 74% and 86%, respectively. These findings are consistent with many studies that found high levels of behavioral health problems among homeless populations. In addition, NSHAPC estimated that 3% have HIV/AIDS, 26% have other acute infectious conditions, and 46% have chronic health conditions. The lifetime incarceration rate of homeless clients in jail, prison, or juvenile detention center is 54%.

Service-using homeless persons in NSHAPC reported extremely low average income, at 50% of the federal poverty level. More than one-quarter (28%) of all homeless clients received some type of means-tested government assistance besides food stamps, and 45% reported some health insurance benefits from Medicaid.

Unaccompanied homeless youth constitute a distinct group from homeless adults and families. It is estimated that between 1.6 million and 1.7 million youth experience runaway or homelessness each year (Hammer, Finkelhor, & Sedlak, 2002; Ringwalt, Greene, Robertson, & McPheeters, 1998). According to the Runaway and Homeless Youth Act (JJDPA, P.L. 93–415), “homeless youth” refers to an individual who is not more than 21 years of age for whom it is not possible to live in a safe environment with a relative, and who has no other safe alternative living arrangement. Four types of homeless youth are identified (a) runaways, who have left home without parental permission; (b) throwaways, who have been forced to leave home by their parents; (c) street youth, who spend a significant amount of time on the streets that increase their risk of sexual abuse, sexual exploitation, prostitution, or drug abuse; and (d) system youth, who become homeless after aging out of foster care or discharging from the juvenile justice system.

The majority of homeless youth are aged 13 years or older, with the distribution of male and female varying by age groups and whether the sample is recruited from the streets or the shelters (Toro, Dworsky, & Fowler, 2007). Although evidence on the racial or ethnic distribution of homeless youth is mixed, prior research suggests that gay, lesbian, bisexual, and transgender youth leave home more frequently than heterosexual homeless youth and are exposed to greater victimization (Cochran, Stewart, Ginzler, & Cauce, 2002). Homeless youth are also more likely to have ever been pregnant or impregnated by someone other than housed youth (Greene & Ringwalt, 1998). Compared to housed youth, homeless youth tend to come from low-income communities, are more likely to have a history of academic and school behavior problems, report more family conflict or child abuse and neglect, and are at an elevated risk for mental health problems (McCaskill, Toro, & Wolfe, 1998; Thompson, Kost, & Pollio, 2003; Votta & Manion, 2004; Wolfe, Toro, & McCaskill, 1999).

Dynamics of Homelessness

Three patterns of homelessness have been identified in studies using the longitudinal design to track homeless persons (including nonshelter users) and those based on shelter administrative records. These include groups now divided into (a) transitionally (or short-term) homeless; (b) episodically (or intermittently) homeless; and (c) chronically (or long-term) homeless (Arce & Vergare, 1984). Distributions of these three patterns vary across studies because of different sample designs and different definitions of exits from and returns to homelessness. A study using public shelter records in New York City and Philadelphia over a 7-year period found the majority (80%) of the shelter users to be transitionally homeless, while persons experiencing chronic and episodic homelessness each constituted 10% of all shelter users (Kuhn & Culhane, 1998). The same study also found that despite their relatively small number, persons who were chronically homeless used half of all shelter days during the study period.

There is evidence that homeless families and unaccompanied homeless youths tend to experience brief episodes of homelessness and to remain in housing once they left the homeless state (Shinn et al., 1998; Toro et al., 2007). A study in the Alameda County, California, found that women, especially those with children, exited homelessness more rapidly than single homeless men. The ability of women with children to leave homelessness at a faster rate was related to their greater access to institutional resources, rather than lower incidence of personal problems and difficulties (Wong & Piliavin, 1997). The gap in accessing housing subsidy among sample members was striking: 55% of women with children and 24% of single women, compared to only 13% of men, reported access to subsidized housing. A New York City family shelter study similarly found procurement of subsidized housing as the most robust predictor of a lower risk of shelter reentry among homeless families (Wong, Culhane, & Kuhn, 1997). A recent review of research on supportive housing affirms the findings already mentioned by highlighting the potency of affordable housing in facilitating positive residential outcomes for persons with serious mental illness, including those who are formerly homeless (Rog, 2004).

Causes of Homelessness

The public discourse on the causes of homelessness has centered on two contrasting perspectives. The structural perspective focuses on understanding factors and forces that have associated with the rise in homelessness since the 1970s and intercity variation in homelessness rates. The individual-vulnerability perspective focuses on personal characteristics and circumstances that affect the differential risks of homelessness among people who are precariously or marginally housed.

Structural explanations posit the emergence and growth of homelessness from the vantage of changes in societal forces that are beyond the control of individuals. Structural forces that are associated with the growth of homelessness and its spatial distribution include: (a) the shortage of affordable rental housing, including the demise of single room occupancy due to gentrification and abandonment (Hoch & Slayton, 1989); (b) demographic trend in the increased number of single-parent and single-person households (Burt, 1992); (c) increase in joblessness and decline in marriage (Jencks, 1994); (d) decline in real income due to the shift from an industry-based to a service-based economy (Belcher & BiBlasio, 1990; Blau, 1992); (e) the unintended effect of deinstitutionalization in terms of inadequate community care for persons with psychiatric disabilities (Lamb, 1984); and (f) the erosion of public assistance benefits since the 1970s (Hopper & Hamberg, 1986).

The individual-vulnerability perspective focuses on identifying person-level and household-level characteristics that differentiate both homeless families and homeless single adults from their housed counterparts. Using multivariate analyses that control for socio-demographic differences between homeless and poor, housed individuals or households, the most commonly cited individual factors that are associated with vulnerability toward homelessness include psychiatric disabilities, addiction to drugs and alcohol, physical and sexual abuse, domestic violence, and experience of foster care and other traumatic events during childhood (Goodman, 1991; Grigsby, Baumann, Gregorich, & Roberts-Gray, 1990; Piliavin, Sosin, Westerfelt, & Matsueda, 1993; Simons & Whitbeck, 1991; Susser, Struening, & Conover, 1987).

In the early debate on the causes of homelessness, the structural and individual-vulnerability perspectives were often framed as diametrically opposing positions. As understanding of homelessness increases over the years, there is growing recognition that both perspectives need to be taken into account because of the complex nature of homelessness (Burt, 1992). Although the shortage of affordable rental housing and increase in poverty have been seen as the two major trends primarily responsible for increasing the pool of low-income households at risk of homelessness, policy responses toward homelessness have primarily followed a social service strategy that focuses on the treatment needs of homeless persons and promotes their self-sufficiency. However, the social service strategy that intends to address the multiple and complex needs of homeless persons has faced major challenges. These include neighborhood resistance in siting of homeless service facilities (not-in-my-backyard or NIMBY-ism); inadequate supply of residential slots resulting from no legal guarantee for a right to shelter; and inadequacy of mainstream social service systems (such as mental health, substance treatment, and child welfare) in enabling the reintegration of homeless persons into society (Blasi & Preis, 1992; Oakley, 2002; Stoner, 1995).

Recently, the federal government has also endorsed the goal of ending chronic homelessness for persons with serious mental illnesses and co-occurring substance disorders (Caton, Wilkins, & Anderson, 2007).

Policy Trends

The evolution of public policy response represents an increasing acknowledgment of the multifarious nature of homelessness. The earliest response to homelessness was ad hoc and crisis oriented, and took the form of emergency shelters and emergency food programs. In 1987, Congress passed the McKinney–Vento Act, providing federal support for a variety of homeless service programs at the local level. In the mid-1990s, local multitier homeless assistance systems, referred to as the Continuums of Care, were introduced to augment service coordination and integration so that homeless clients may move from one tier of service to another in their transition from homelessness to stable housing.

There is a broad array of programs in the McKinney–Vento Act and non-McKinney–Vento Act ranging from education for homeless children to drug prevention for unaccompanied homeless youths. In addition, there are three major programmatic responses to address the housing and service needs of the homeless population: (a) emergency shelters; (b) transitional housing; and (c) permanent supportive housing. Although emergency shelter beds increased about a fifth from 1988 to their 1996 level, the primary focus of housing and service development since the late 1980s has been transitional housing and permanent supportive housing. In particular, the remarkable growth of permanent supportive housing programs has been informed by research findings that consistently demonstrated the effectiveness, including cost-effectiveness, of long-term housing interventions in reducing the residential instability of previously homeless persons with special needs (Culhane, Metraux, & Hadley, 2002; Nelson, Aubry, & Lafrance, 2007).

One promising intervention is the “housing first” model, which is a housing and service approach that places homeless tenants directly into affordable housing without requiring “housing readiness” prior to entry (Substance Abuse and Mental Health Services Administration, 2005). Housing readiness admission criteria in permanent supportive housing typically include mandated sobriety for an extended period of time, compliance with mental health and substance abuse treatment, and demonstration of basic living skills (Caton et al., 2007). Without requiring housing readiness, the housing first approach has shown to be applicable for persons experiencing chronic homelessness, as these individuals often find it difficult to meet the admission criteria of conventional supportive housing programs (Padgett, Gulcur, & Tsemberis, 2006; Tsemberis & Eisenberg, 2000). Other intervention approaches that have shown to be effective for homeless persons with behavioral health problems include shelter-based community outreach, assertive community treatment (ACT), intensive case management, and critical time intervention (Bradford, Gaynes, Kim, Kaffman, & Weinberger, 2005; Dixon, Krauss, Kernan, Lehman, & Deforge, 1995; Nelson et al., 2007; Susser et al., 1997). Intervention approaches that are in the process of development include homelessness prevention efforts among high-risk populations such as those discharged from the criminal justice system and aging out of the foster care system.

Social workers are at the forefront of homeless service delivery. Utilizing evidence-based practices and best practices cited earlier, social workers have the potential for effecting significant social change through assuming a range of professional roles including those of clinician, advocate, administrator, planner, and researcher, as well as through participating in a multidisciplinary service team to address the complex needs of persons experiencing homelessness.

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