conclusion homelessness research paper

• Open access
• Published: 22 August 2017

Social conditions of becoming homelessness: qualitative analysis of life stories of homeless peoples

• Mzwandile A. Mabhala   ORCID: orcid.org/0000-0003-1350-7065 1 , 3 ,
• Asmait Yohannes 2 &
• Mariska Griffith 1  

International Journal for Equity in Health volume  16 , Article number:  150 ( 2017 ) Cite this article

66k Accesses

50 Citations

23 Altmetric

Metrics details

It is increasingly acknowledged that homelessness is a more complex social and public health phenomenon than the absence of a place to live. This view signifies a paradigm shift, from the definition of homelessness in terms of the absence of permanent accommodation, with its focus on pathways out of homelessness through the acquisition and maintenance of permanent housing, to understanding the social context of homelessness and social interventions to prevent it.

However, despite evidence of the association between homelessness and social factors, there is very little research that examines the wider social context within which homelessness occurs from the perspective of homeless people themselves. This study aims to examine the stories of homeless people to gain understanding of the social conditions under which homelessness occurs, in order to propose a theoretical explanation for it.

Twenty-six semi-structured interviews were conducted with homeless people in three centres for homeless people in Cheshire North West of England.

The analysis revealed that becoming homeless is a process characterised by a progressive waning of resilience capacity to cope with life challenges created by series of adverse incidents in one’s life. The data show that final stage in the process of becoming homeless is complete collapse of relationships with those close to them. Most prominent pattern of behaviours participants often describe as main causes of breakdown of their relationships are:

engaging in maladaptive behavioural lifestyle including taking drugs and/or excessive alcohol drinking

Being in trouble with people in authorities.

Homeless people describe the immediate behavioural causes of homelessness, however, the analysis revealed the social and economic conditions within which homelessness occurred. The participants’ descriptions of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

It is increasingly acknowledged that homelessness is a more complex social and public health phenomenon than the absence of a place to live. This view signifies a paradigm shift, from the definition of homelessness in terms of the absence of permanent accommodation [ 1 , 2 , 3 , 4 , 5 ], with its focus on pathways out of homelessness through the acquisition and maintenance of permanent housing [ 6 ], to understanding the social context of homelessness and social interventions to prevent it [ 6 ].

Several studies explain the link between social factors and homelessness [ 6 , 7 , 8 , 9 , 10 ]. The most common social explanations centre on seven distinct domains of deprivation: income; employment; health and disability; education, skills and training; crime; barriers to housing and social support services; and living environment [ 11 ]. Of all forms, income deprivation has been reported as having the highest risk factors associated with homelessness [ 7 , 12 , 13 , 14 ]: studies indicate that people from the most deprived backgrounds are disproportionately represented amongst the homeless [ 7 , 13 ]. This population group experiences clusters of multiple adverse health, economic and social conditions such as alcohol and drug misuse, lack of affordable housing and crime [ 10 , 12 , 15 ]. Studies consistently show an association between risk of homelessness and clusters of poverty, low levels of education, unemployment or poor employment, and lack of social and community support [ 7 , 10 , 13 , 16 ].

Studies in different countries throughout the world have found that while the visible form of homelessness becomes evident when people reach adulthood, a large proportion of homeless people have had extreme social disadvantage and traumatic experiences in childhood including poverty, shortage of social housing stocks, disrupted schooling, lack of social and psychological support, physical, sexual, and emotional abuse, neglect, dysfunctional family environments, and unstable family structures, all of which increase the likelihood of homelessness [ 10 , 13 , 14 ].

Furthermore, a large body of evidence suggests that people exposed to diverse social disadvantages at an early age are less likely to adapt successfully compared to people without such exposure [ 9 , 10 , 13 , 17 ], being more susceptible to adopting maladaptive coping behaviours such as theft, trading sex for money, and selling or using drugs and alcohol [ 7 , 9 , 18 , 19 ]. Studies show that these adverse childhood experiences tend to cluster together, and that the number of adverse experiences may be more predictive of negative adult outcomes than particular categories of events [ 17 , 20 ]. The evidence suggests that some clusters are more predictive of homelessness than others [ 7 , 12 ]: a cluster of childhood problems including mental health and behavioural disorders, poor school performance, a history of foster care, and disrupted family structure was most associated with adult criminal activities, adult substance use, unemployment and subsequent homelessness [ 12 , 17 , 21 ]. However, despite evidence of the association between homelessness and social factors, there is very little research that examines the wider social context within which homelessness occurs from the perspective of homeless people themselves.

This paper adopted Anderson and Christian’s [ 18 ] definition, which sees homelessness as a ‘function of gaining access to adequate, affordable housing, and any necessary social support needed to ensure the success of the tenancy’. Based on our synthesis of the evidence, this paper proposes that homelessness is a progressive process that begins at childhood and manifests itself at adulthood, one characterised by loss of the personal resources essential for successful adaptation. We adopted the definition of personal resources used by DeForge et al. ([ 7 ], p. 223), which is ‘those entities that either are centrally valued in their own right (e.g. self-esteem, close attachment, health and inner peace) or act as a means to obtain centrally valued ends (e.g. money, social support and credit)’. We propose that the new paradigm focusing on social explanations of homelessness has the potential to inform social interventions to reduce it.

In this study, we examine the stories of homeless people to gain understanding of the conditions under which homelessness occurs, in order to propose a theoretical explanation for it.

The design of this study was philosophically influenced by constructivist grounded theory (CGT). The aspect of CGT that made it appropriate for this study is its fundamental ontological belief in multiple realities constructed through the experience and understanding of different participants’ perspectives, and generated from their different demographic, social, cultural and political backgrounds [ 22 ]. The researchers’ resulting theoretical explanation constitutes their interpretation of the meanings that participants ascribe to their own situations and actions in their contexts [ 22 ].

The stages of data collection and analysis drew heavily on other variants of grounded theory, including those of Glaser [ 23 ] and Corbin and Strauss [ 24 ].

Setting and sampling strategy

The settings for this study were three centres for homeless people in two cities (Chester and Crewe) in Cheshire, UK. Two sampling strategies were used in this study: purposive and theoretical. The study started with purposive sampling and in-depth one-to-one semi-structured interviews with eight homeless people to generate themes for further exploration.

One of the main considerations for the recruitment strategy was to ensure that the process complies with the ethical principles of voluntary participation and equal opportunity to participate. To achieve this, an email was sent to all the known homeless centres in the Cheshire and Merseyside region, inviting them to participate. Three centres agreed to participate, all of them in Cheshire – two in Chester and one in Crewe.

Chester is the most affluent city in Cheshire and Merseyside, and therefore might not be expected to be considered for a homelessness project. The reasons for including it were: first, it was a natural choice, since the organisations that funded the project and the one that led the research project were based in Chester; second, despite its affluence, there is visible evidence of homelessness in the streets of Chester; and third, it has several local authority and charity-funded facilities for homeless people.

The principal investigator spent 1 day a week for 2 months in three participating centres, during that time oral presentation of study was given to all users of the centre and invited all the participants to participate and written participants information sheet was provided to those who wished to participate. During that time the principal investigator learned that the majority of homeless people that we were working with in Chester were not local. They told us that they came to Chester because there was no provision for homeless people in their former towns.

To help potential participants make a self-assessment of their suitability to participate without unfairly depriving others of the opportunity, participants information sheet outline criteria that potential participants had to meet: consistent with Economic and Social Research Council’s Research Ethics Guidebook [ 25 ], at the time of consenting to and commencing the interview, the participant must appear to be under no influence of alcohol or drugs, have a capacity to consent as stipulated in England and Wales Mental Capacity Act 2005 [ 26 ], be able to speak English, and be free from physical pain or discomfort.

As categories emerged from the data analysis, theoretical sampling was used to refine undeveloped categories in accordance with Strauss and Corbin’s [ 27 ] recommendations. In total 26 semi-structured interviews were carried out. Theoretical sampling involved review of memos or raw data, looking for data that might have been overlooked [ 27 , 28 ], and returning to key participants asking them to give more information on categories that seemed central to the emerging theory [ 27 , 28 ].

The sample comprised of 22 male and 4 female, the youndgest participant was 18 the eldest was 74 years, the mean age was 38.6 years. Table 1 illustrates participant’s education history, childhood living arrangements, brief participants family and social history, emotional and physical health, the onset of and trigger for homelessness.

Ethical approval

Ethical approval was obtained from the Research Ethics Committee of the University of Chester. The centre managers granted access once ethical approval had been obtained, and after their review of the study design and other research material, and of the participant information sheet which included a letter of invitation highlighting that participation was voluntary.

Data analysis

In this study data collection and analysis occurred simultaneously. Analysis drew on Glaser’s [ 23 ] grounded theory processes of open coding, use of the constant comparative method, and the iterative process of data collection and data analysis to develop theoretical explanation of homelessness.

The process began by reading the text line-by-line identifying and open coding the significant incidents in the data that required further investigation. The findings from the initial stage of analysis are published in Mabhala [ 29 ]. The the second stage the data were organised into three themes that were considered significant in becoming homeless (see Fig. 1 ):

Engaging in maladaptive behaviour

Being in trouble with the authorities.

Being in abusive environments.

Social explanation of becoming homeless. Legend: Fig. 1 illustrates the process of becoming homeless

The key questions that we asked as we continued to interrogate the data were: What category does this incident indicate? What is actually happening in the data? What is the main concern being faced by the participants? Interrogation of the data revealed that participants were describing the process of becoming homeless.

The comparative analysis involved three processes described by Glaser ([ 23 ], p. 58–60): each incident in the data was compared with incidents from both the same participant and other participants, looking for similarities and differences. Significant incidents were coded or given labels that represented what they stood for, and similarly coded or labeled when they were judged to be about the same topic, theme or concept.

After a period of interrogation of the data, it was decided that the two categories - destabilising behaviour, and waning ofcapacity for resilience were sufficiently conceptual to be used as theoretical categories around which subcategories could be grouped (Fig. 1 ).

Once the major categories had been developed, the next step consisted of a combination of theoretical comparison and theoretical sampling. The emerging categories were theoretically compared with the existing literature. Once this was achieved, the next step was filling in and refining the poorly defined categories. The process continued until theoretical sufficiency was achieved.

Figure 1 illustrates the process of becoming homeless. The analysis revealed that becoming homeless is a process characterised by a progressive waning of resilience created by a series of adverse incidents in one’s life. Amongst the frequently cited incidents were being in an abusive environment and losing a significant person in one’s life. However, being in an abusive environment emerged from this and previously published studies as a major theme; therefore, we decided to analyse it in more detail.

The data further show that the final stage in the process of becoming homeless is a complete collapse of relationships with those with whom they live. The most prominent behaviours described by the participants as being a main cause of breakdown are:

Engaging in maladaptive behaviour: substance misuse, alcoholism, self-harm and disruptive behaviours

Being in trouble with the authorities: theft, burglary, arson, criminal offenses and convictions

The interrogation of data in relation to the conditions within which these behaviours occurred revealed that participants believed that their social contexts influenced their life chance, their engagement with social institution such as education and social services and in turn their ability to acquire and maintain home. Our experiences have also shown that homeless people readily express the view that behavioural lifestyle factors such as substance misuse and engaging in criminal activities are the causes of becoming homeless. However, when we spent time talking about their lives within the context of their status as homeless people, we began to uncover incidents in their lives that appeared to have weakened their capacity to constructively engage in relationships, engage with social institutions to make use of social goods [ 29 , 30 , 31 ] and maturely deal with societal demands.

Being in abusive environments

Several participants explicitly stated that their childhood experiences and damage that occurred to them as children had major influences on their ability to negotiate their way through the education system, gain and sustain employment, make appropriate choices of social networks, and form and maintain healthy relationships as adults.

It appears that childhood experiences remain resonant in the minds of homeless participants, who perceive that these have had bearing on their homelessness. Their influence is best articulated in the extracts below. When participants were asked to tell their stories of what led to them becoming homeless, some of their opening lines were:

What basically happened, is that I had a childhood of so much persistent, consistent abuse from my mother and what was my stepfather. Literally consistent, we went around with my mother one Sunday where a friend had asked us to stay for dinner and mother took the invitation up because it saved her from getting off her ass basically and do anything. I came away from that dinner genuinely believing that the children in that house weren’t loved and cared for, because they were not being hit, there was no shouting, no door slamming. [Marco]

It appears that Marco internalised the incidents of abuse, characterised by shouting, door slamming and beating as normal behaviour. He goes on to intimate how the internalised abusive behaviour affected his interaction with his employers.

‘…but consistently being put down, consistently being told I was thick, I started taking jobs and having employers effing and blinding at me. One employer actually used a “c” word ending in “t” at me quite frequently and I thought it was acceptable, which obviously now I know it’s not. So I am taking on one job after another that, how can I put it? That no one else would do basically. I was so desperate to work and earn my own money. [Marco]

Similarly, David makes a connection between his childhood experience and his homelessness. When he was asked to tell his life story leading to becoming homeless, his opening line was:

I think it [homelessness] started off when I was a child. I was neglected by my mum. I was physically and mentally abused by my mum. I got put into foster care, when I left foster care I was put in the hostel, from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel. [David]

David and Marco’s experiences are similar to those of many participants. The youngest participant in this study, Clarke, had fresh memories of his abusive environment under his stepdad:

I wouldn't want to go back home if I had a choice to, because before I got kicked out me stepdad was like hitting me. I wouldn't want to go back to put up with that again. [I didn't tell anyone] because I was scared of telling someone and that someone telling me stepdad that I've told other people. ‘[Be] cause he might have just started doing again because I told people. It might have gotten him into trouble. [Clarke]

In some cases, participants expressed the beliefs that their abusive experience not only deprived them life opportunities but also opportunities to have families of their own. As Tom and Marie explain:

We were getting done for child neglect because one of our child has a disorder that means she bruise very easily. They all our four kids into care, social workers said because we had a bad childhood ourselves because I was abused by my father as well, they felt that we will fail our children because we were failed by our parents. We weren’t given any chance [Tom and Marie]

Norma, described the removal of her child to care and her maladaptive behaviour of excessive alcohol use in the same context as her experience of sexual abuse by her father.

I had two little boys with me and got took off from me and put into care. I got sexually abused by my father when I was six. So we were put into care. He abused me when I was five and raped me when I was six. Then we went into care all of us I have four brothers and four sisters. My dad did eighteen months for sexually abusing me and my sister. I thought it was normal as well I thought that is what dads do [Norma]

The analysis of participants in this study appears to suggest that social condition one is raised influence the choice of social connections and life partner. Some participants who have had experience of abuse as children had partner who had similar experience as children Tom and Marie, Lee, David and his partners all had partners who experienced child abuse as children.

Tom and Marie is a couple we interviewed together. They met in hostel for homeless people they have got four children. All four children have been removed from them and placed into care. They sleep rough along the canal. They explained:

We have been together for seven years we had a house and children social services removed children from us, we fell within bedroom tax. …we received an eviction order …on the 26th and the eviction date was the 27th while we were in family court fighting for our children. …because of my mental health …they were refusing to help us.

Our children have been adopted now. The adoption was done without our permission we didn’t agree to it because we wanted our children home because we felt we were unfairly treated and I [Marie] was left out in all this and they pin it all on you [Tom] didn’t they yeah, my [Tom] history that I was in care didn’t help.

Tom went on to talk about the condition under which he was raised:

I was abandoned by my mother when I was 12 I was then put into care; I was placed with my dad when I was 13 who physically abused me then sent back to care. [Tom].

David’s story provides another example of how social condition one is raised influence the choice of social connections and life partner. David has two children from two different women, both women grew up in care. Lisa one of David’s child mother is a second generation of children in care, her mother was raised in care too.

I drink to deal with problems. As I say I’ve got two kids with my girlfriend Kyleigh, but I got another lad with Lisa, he was taken off me by social services and put on for adoption ten years ago and that really what started it; to deal with that. Basically, because I was young, and I had been in care and the way I had been treated by my mum. Basically laid on me in the same score as my mum and because his mum [Lisa] was in care as well. So they treated us like that, which was just wrong. [David]

In this study, most participants identified alcohol or drugs and crime as the cause of relationships breakdown. However, the language they used indicates that these were secondary reasons rather than primary reasons for their homelessness. The typical question that MA and MG asked the interview participants was “tell us how did you become homeless”? Typically, participants cited different maladaptive behaviours to explain how they became homeless.

Alvin’s story is typical of:

Basically I started off as a bricklayer, … when the recession hit, there was an abundance of bricklayers so the prices went down in the bricklaying so basically with me having two young children and the only breadwinner in the family... so I had to kinda look for factory work and so I managed to get a job… somewhere else…. It was shift work like four 12 hour days, four 12 hour nights and six [days] off and stuff like that, you know, real hard shifts. My shift was starting Friday night and I’ll do Friday night, Saturday night to Monday night and then I was off Tuesday, Wednesday and Thursday, but I’d treat that like me weekend you know because I’ve worked all weekend. Then… so I’d have a drink then and stuff like that, you know. 7 o’ clock on a Monday morning not really the time to be drinking, but I used to treat it like me weekend. So we argued, me and my ex-missus [wife], a little bit and in the end we split up so moved back to me mum's, but kept on with me job, I was at me mum’s for possibly about five years and but gradually the drinking got worse and worse, really bad. I was diagnosed with depression and anxiety. … I used to drink to get rid of the anxiety and also to numb the pain of the breakup of me marriage really, you know it wasn’t good, you know. One thing led to another and I just couldn’t stop me alcohol. I mean I’ve done drugs you know, I was into the rave scene and I’ve never done hard drugs like heroin or... I smoke cannabis and I use cocaine, and I used to go for a pint with me mates and that. It all came to a head about November/December time, you know it was like I either stop drinking or I had to move out of me mum's. I lost me job in the January through being over the limit in work from the night before uum so one thing led to another and I just had to leave. [Alvin]

Similarly, Gary identified alcohol as the main cause of his relationship breakdown. However, when one listens to the full story alcohol appears to be a manifestation of other issues, including financial insecurities and insecure attachment etc.

It [the process of becoming homeless] mainly started with the breakdown of the relationship with me partner. I was with her for 15 years and we always had somewhere to live but we didn't have kids till about 13 years into the relationship. The last two years when the kids come along, I had an injury to me ankle which stopped me from working. I was at home all day everyday. …I was drinking because I was bored. I started drinking a lot ‘cause I couldn't move bout the house. It was a really bad injury I had to me ankle. Um, and one day me and me partner were having this argument and I turned round and saw my little boy just stood there stiff as a board just staring, looking at us. And from that day on I just said to me partner that I'll move out, ‘cause I didn't want me little boy to be seeing this all the time. [Gary]

In both cases Gary and Alvin indicate that changes in their employment status created conditions that promoted alcohol dependency, though both explained that they drank alcohol before the changes in their employment status occurred and the breakdown of relationships. Both intimated that that their job commitment limited the amount of time available to drink alcohol. As Gary explained, it is the frequency and amount of alcohol drinking that changed as a result of change in their employment status:

I used to have a bit of a drink, but it wasn’t a problem because I used to get up in the morning and go out to work and enjoy a couple of beers every evening after a day’s work. Um, but then when I wasn't working I was drinking, and it just snowballed out, you know snowball effect, having four cans every evening and then it went from there. I was drinking more ‘cause I was depressed. I was very active before and then I became like non-active, not being able to do anything and in a lot of pain as well. [Gary]

Furthermore, although the participants claim that drinking alcohol was not a problem until their employment circumstances changed, one gets a sense that alcohol was partly responsible for creating conditions that resulted in the loss of their jobs. In Gary’s case, for example, alcohol increased his vulnerability to the assault and injuries that cost him his job:

I got assaulted, kicked down a flight of stairs. I landed on me back on the bottom of the stairs, but me heel hit the stairs as it was still going up if you know what I mean. Smashed me heel, fractured me heel… So, by the time I got to the hospital and they x-rayed it they wasn't even able to operate ‘cause it was in that many pieces, they weren't even able to pin it if you know what I mean. [Gary]

Alvin, of the other hand, explained that:

I lost my job in the January through being over the limit in work from the night before, uum so one thing led to another and I just had to leave. [Alvin]

In all cases participants appear to construct marriage breakdown as an exacerbating factor for their alcohol dependence. Danny, for example, constructed marriage breakdown as a condition that created his alcohol dependence and alcohol dependence as a cause of breakdown of his relationship with his parents. He explains:

I left school when I was 16. Straight away I got married, had children. I have three children and marriage was fine. Umm, I was married for 17 years. As the marriage broke up I turned to alcohol and it really, really got out of control. I moved in with my parents... It was unfair for them to put up with me; you know um in which I became... I ended up on the streets, this was about when I was 30, 31, something like that and ever since it's just been a real struggle to get some permanent accommodation. [Danny]

Danny goes on to explain:

Yes [I drank alcohol before marriage broke down but] not very heavily, just like a sociable drink after work. I'd call into like the local pub and have a few pints and it was controlled. My drinking habit was controlled then. I did go back to my parents after my marriage break up, yes. I was drinking quite heavily then. I suppose it was a form of release, you know, in terms of the alcohol which I wish I'd never had now. When I did start drinking heavy at me parents’ house, I was getting in trouble with the police being drunk and disorderly. That was unfair on them. [Danny]

The data in this study indicate that homelessness occurs when the relationships collapse, irrespective of the nature of the relationship. There were several cases where lifestyle behaviour led to a relationship collapse between child and parents or legal guardians.

In the next excerpt, Emily outlines the incidents: smoking weed, doing crack and heroin, and drinking alcohol. She also uses the words ‘because’, ‘when’ and ‘obviously’, which provide clues about the precipitating condition for her behaviours “spending long time with people who take drugs”.

I've got ADHD like, so obviously my mum kicked me out when I was 17 and then like I went to **Beswick** and stuff like that. My mum in the end just let me do what I wanted to do, ‘cause she couldn't cope anymore. …I mean I tried to run away from home before that, but she'd always like come after me in like her nightie and pyjamas and all that. But in the end she just washed her hands of me . [Emily]

Emily presented a complex factors that made it difficult for her mother to live with her. These included her mother struggle with raising four kids as a single parent, Emily’s mental health (ADHD], alcohol and drug use. She goes on to explain that:

Ummm, well the reason I got kicked out of my hostel was ‘cause of me drinking, so I'd get notice to quit every month, then I’d have a meeting with the main boss and then they'd overturn it and this went on every month for about six months. Also, it was me behaviour as well, but obviously drink makes you do stuff you don't normally do and all that shit. I lived here for six months, got kicked out because I jumped out the window and broke me foot. I was on the streets for six months and then they gave me a second chance and I've been here a year now. So that's it basically. [Emily]

There were several stories of being evicted from accommodation due to excessive use of alcohol. One of those is David:

I got put into foster care. When I left foster care I was put in the hostel, from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel. It’s been going on now for about… I was thirty-one on Wednesday, so it’s been going on for about thirteen years, homeless on and off. Otherwise if not having shoplifted for food and then go to jail, and when I don’t drink I have lot of seizures and I end up in the hospital. Every time I end up on the street. I trained as a chef, I have not qualified yet, because of alcohol addiction, it didn’t go very well. I did couple of jobs in restaurants and diners, I got caught taking a drink. [David]

Contrary to the other incidents where alcohol was a factor that led to homelessness, Barry’s description of his story appears to suggest that the reason he had to leave his parents’ home was his parents’ perception that his sexuality brought shame to the family:

When I came out they I’m gay, my mum and dad said you can’t live here anymore. I lived in a wonderful place called Nordic... but fortunately, mum and dad ran a pub called […] [and] one of the next door neighbours lived in a mansion. His name was [….] [and] when I came out, he came out as in he said “I'm a gay guy”, but he took me into Liverpool and housed me because I had nowhere to live. My mum and dad said you can't live here anymore. And unfortunately, we get to the present day. I got attacked. I got mugged... only walked away with a £5 note, it’s all they could get off me. They nearly kicked me to death so I was in hospital for three weeks. By the time I came out, I got evicted from my flat. I was made homeless. [Barry]

We used the phrase “engaging in maladaptive behaviour” to conceptualise the behaviours that led to the loss of accommodation because our analysis appear to suggest that these behaviours were strategies to cope with the conditions they found themselves in. For example, all participants in this category explained that they drank alcohol to cope with multiple health (mental health) and social challenges.

In the UK adulthood homelessness is more visible than childhood homelessness. However, most participants in this research reveal that the process of becoming homeless begins at their childhood, but becomes visible after the legal age of consent (16). Participants described long history of trouble with people in authority including parents, legal guardians and teachers. However, at the age of 16 they gain legal powers to leave children homes, foster homes, parental homes and schools, and move outside some of the childhood legal protections. Their act of defiance becomes subject to interdiction by the criminal justice system. This is reflected in number of convictions for criminal offenses some of the participants in this study had.

Participants Ruddle, David, Lee, Emily, Pat, Marco, Henry and many other participants in this study (see Table 1 ) clearly traced the beginning of their troubles with authority back at school. They all expressed the belief that had their schooling experience been more supportive, their lives would have been different. Lee explains that being in trouble with the authorities began while he was at school:

‘The school I came from a rough school, it was a main school, it consisted of A, B, C, D and The school I came from [was] a rough school, it was a main school, it consisted of A, B, C, D and E. I was in the lowest set, I was in E because of my English and maths. I was not interested, I was more interested in going outside with big lads smoking weed, bunking school. I used to bunk school inside school. I used to bunk where all cameras can catch me. They caught me and reported me back to my parents. My mum had a phone call from school asking where your son is. My mum grounded me. While my mum grounded me I had a drain pipe outside my house, I climbed down the drain pipe outside my bedroom window. I used to climb back inside. [Lee]

Lee’s stories constructed his poor education experiences as a prime mover towards the process of becoming homeless. It could be noted in Table 1 that most participants who described poor education experiences came from institutions such as foster care, children home and special school for maladjusted children. These participants made a clear connection between their experiences of poor education characterised by defiance of authorities and poor life outcomes as manifested through homelessness.

Patrick made a distinct link between his school experience and his homelessness, for example, when asked to tell his story leading up to becoming homeless, Patrick’s response was:

I did not go to school because I kept on bunking. When I was fifteen I left school because I was caught robbing. The police took me home and my mum told me you’re not going back to school again, you are now off for good. Because if you go back to school you keep on thieving, she said I keep away from them lads. I said fair enough. When I was seventeen I got run over by a car. [Patrick]

Henry traces the beginning of his troubles with authorities back at school:

[My schooling experience]… was good, I got good, well average grades, until I got myself into [a] few fights mainly for self-defence. In primary schools, I had a pretty... I had a good report card. In the start of high school, it was good and then when the fights started that gave me sort of like a... bad reputation. I remember my principal one time made me cry. Actually made me cry, but eh... I don't know how, but I remember sitting there in the office and I was crying. My sister also stuck up for me when she found out what had happened, she was on my side; but I can’t remember exactly what happened at that time. [Henry]

Emily’s story provides some clues about the series of incidents - including, delay in diagnosing her health condition, being labelled as a naughty child at school, being regularly suspended from school and consequently poor educational attainment.

Obviously, I wasn't diagnosed with ADHD till I was like 13, so like in school they used to say that's just a naughty child. … So it was like always getting suspended, excluded and all that sort of stuff. And in the end [I] went to college and the same happened there. [Emily]

The excerpt above provides intimations of what she considers to be the underlying cause of her behaviour towards the authorities. Emily suggests that had the authorities taken appropriate intervention to address her condition, her life outcomes would have been different.

Although the next participant did not construct school as being a prime mover of their trouble with authorities, their serious encounters with the criminal justice system occurred shortly after leaving school:

Well I did a bit of time at a very early age, I was only 16… I did some remand there, but then when I went to court ‘cause I'd done enough remand, I got let out and went to YMCA in Runcorn. Well, that was when I was a kid. When I was a bit older, ‘cause it was the years 2000 that I was in jail, I was just trying to get by really. I wasn’t with Karen at the time. I was living in Crewe and at the time I was taking a lot of amphetamines and was selling amphetamines as well, and I got caught and got a custodial sentence for it. But I've never been back to jail since. I came out in the year 2000 so it's like 16 years I've kept meself away from jail and I don't have any intentions of going back. [Gary]

The move from school and children social care system to criminal justice was a common pathways for many participants in this study. Some including Lee, Crewe, David, Patrick spent multiple prison sentences (see Table 1 ). Although Crewe did not make connection between his schooling experiences and his trouble with law, it could be noted that his serious encounter with criminal justice system started shortly after leaving foster care and schooling systems. As he explains:

I was put into prison at age of 17 for arson that was a cry for help to get away from the family, I came out after nine months. I have been in prison four times in my life, its not very nice, when I came out I made a promise to myself that I’m never going to go back to prison again. [Crewe]

Lee recalls his education experience. He explained:

I left school when I was fifteen… then I went off the rails. I got kidnapped for three and half months. When I came back I was just more interested in crime. When I left school I was supposed to go to college, but I went with travellers. I was just more interested in getting arrested every weekend, until my mum say right I have enough of you. I was only seventeen. I went through the hostels when I was seventeen. [Lee]

None describe the educational experience with a similar profundity to Marco:

On few occasions I came out on the corridors I would be getting battered on to my hands and knees and teachers walk pass me. There was quite often blood on the floor from my nose, would be punched on my face and be thrown on the floor. …. It was hard school, pernicious. I would go as far as saying I never felt welcome in that school, I felt like a fish out of the water, being persistently bullied did my head in. Eventually I started striking back, when I started striking back suddenly I was a bad one. My mother decided to put me in … school for maladjusted boys, everyone who been there including myself have spent time in prison. [Marco]

The trouble with authorities that was observes in participants stories in this category appear to be part of the wider adverse social challenges that the participants in this study were facing. Crewe’s description of arson as a cry for help appears to be an appropriate summation of all participants in this category.

The participants’ description of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

The key feature that distinguish this study from comparable previous studies is that it openly acknowledges that data collection and analysis were influenced by the principles of social justice [ 28 , 30 , 31 ]. The resulting theoretical explanation therefore constitutes our interpretation of the meanings that participants ascribe to their own situations and actions in their contexts. In this study, defining homelessness within the wider socioeconomic context seemed to fit the data, and offered one interpretation of the process of becoming homeless.

While the participants’ experiences leading to becoming homeless may sound trite. What is pertinent in this study is understanding the conditions within which their behaviours occurred. The data were examined through the lens of social justice and socio-economic inequalities: we analysed the social context within which these behaviours occurred. We listened to accounts of their schooling experiences, how they were raised and their social network. The intention was not to propose a cause-and-effect association, but to suggest that interventions to mitigate homelessness should consider the social conditions within which it occurred.

Participants in this study identified substance misuse and alcohol dependency as a main cause of their homelessness. These findings are consistent with several epidemiological studies that reported a prevalence of substance misuse amongst the homeless people [ 32 , 33 , 34 , 35 , 36 ]. However, most these studies are epidemiological; and by nature epidemiological studies are the ‘gold standard’ in determining causes and effects, but do not always examine the context within which the cause and effect occur. One qualitative study that explored homelessness was a Canadian study by Watson, Crawley and Cane [ 37 ]. Participants in the Watson, et al. described ‘lack of quality social interactions and pain of addition. However, Watson et al. focus on the experiences of being homeless, rather than the life experiences leading to becoming homeless. To our knowledge the current study is one of very few that specifically examine the conditions within which homelessness occurs, looking beyond the behavioural factors. Based on the synthesis of data from previous studies, it makes sense that many interventions to mitigate homelessness focus more on tackling behavioural causes of homelessness rather than fundamental determinants of it [ 38 ]. From the public health intervention’ point of view, however, understanding the conditions within which homelessness occurs is essential, as it will encourage policymakers and providers of the services for homelessness people to devote equal attention to tackling the fundamental determinants of homelessness as is granted in dealing behavioural causes.

Participants in this study reported that they have been defiant toward people in positions of authority. For most of them this trouble began when they were at school, and came to the attention of the criminal justice system as soon as they left school at the age of 16. These findings are similar to these in the survey conducted by Williams, Poyser, and Hopkins [ 39 ] which was commissioned by the UK Ministry of Justice. This survey found that 15 % of prisoners in the sample reported being homeless before custody [ 39 ]; while three and a half percent of the general population reported having ever been homeless [ 39 ]. As the current study reveals there are three possible explanations for the increased population of homeless young people in the criminal justice system: first, at the age of 16 they gain legal powers to leave their foster homes, parents homes, and schools and move beyond some of the childhood legal protections; second, prior to the age of 16 their defiant behaviours were controlled and contained by schools and parents/legal guardians; and third, after the age of 16 their acts of defiant behaviour become subject to interdiction by the criminal justice system.

The conditions in which they were born and raised were described by some participants in this study as ‘chaotic’, abusive’, ‘neglect’, ‘pernicious’ ‘familial instability’, ‘foster care’, ‘care home’, etc. Taking these conditions, and the fact that all but one participants in this left school at or before the age of 16 signifies the importance of living conditions in educational achievement. It has been reported in previous studies that children growing up in such conditions struggle to adjust in school and present with behavioural problems, and thus, poor academic performance [ 40 ]. It has also been reported that despite these families often being known to social services, criminal justice systems and education providers, the interventions in place do little to prevent homelessness [ 40 ].

Analysis of the conditions within which participants’ homelessness occurred reveals the adverse social conditions within which they were born and raised. The conditions they described included being in an abusive environment, poor education, poor employment or unemployment, poor social connections and low social cohesion. These conditions are consistent with high index of poverty [ 37 , 41 , 42 ]. And several other studies found similar associations between poverty and homelessness [ 42 ]. For example, the study by Watson, Crowley et al. [ 37 ] found that there were extreme levels of poverty and social exclusion amongst homeless people. Contrary to previous studies that appear to construct homelessness as a major form of social exclusion, the analysis of participants’ stories in this current study revealed that the conditions they were raised under limited their capacity to engage in meaningful social interactions, thus creating social exclusion.

Homeless people describe the immediate behavioural causes of homelessness; however, this analysis revealed the social and economic conditions within which homelessness occurred. The participants’ descriptions of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

Limitations

The conclusions drawn relate only to the social and economic context of the participants in this study, and therefore may not be generalised to the wider population; nor can they be immediately applied in a different context. It has to be acknowledged that the method of recruitment of the 26 participants generates a bias in favour of those willing to talk. The methodology used in this study (constructivist grounded theory) advocates mutual construction of knowledge, which means that the researchers’ understanding and interpretations may have had some influence on the research process as the researchers are an integral part of the data collection and analysis

Department for Communities and Local Government. Statutory homelessness: October to December quarter 2015, in 26 homelessness statistical release 2016. London: Stationery Office; 2015.

Google Scholar  

HM Government. Homelessness act 2002. London: UK Government; 2002.

HM Government. Homelessness reduction act 2017. London: UK government; 2017.

MH Government. Housing (Homeless Persons) act 1977. London: UK Government; 1977.

Department for Communities and Local Government. Statutory homelessness: October to December quarter 2015, in 26 homelessness statistical release 2016. London: Stationery Office; 2016.

Christian J, Abrams D, Clapham D, Nayyar D, Cotler J. Intentions to move from homelessness to social inclusion: the role of participation beliefs, attitudes and prior behaviour. Soc Incl. 2016;4643(4):16–27.

Article   Google Scholar  

Deforge BR, Belcher J, O’rourke M, Lindsey MA. Personal resources and homelessness in early life: predictors of depression in consumers of homeless multiservice centres. J Loss Trauma. 2008;13:222–42.

Barman-Adhikari A, Petering R, Lengnick-Hall R, Rice E, Rhoades H, McCune S. Social context of service use among homeless youth in Los Angeles, California. J Soc Serv Res. 2016;42(4):501–15.

Barman-Adhikari A, Bowen E, Bender K, Brown S, Rice E. A social capital approach to identifying correlates of perceived social support among homeless youth. Child Youth Care Forum. 2016;45(5):691–708.

Keane CA, Magee CA, Kelly PJ. Is there a complex trauma experience typology for Australians experiencing extreme social disadvantage and low housing stability? Child Abuse Negl. 2016;61:43–54.

Article   PubMed   Google Scholar  

Department for Communities and Local Government. The English indices of deprivation 2015. London: Stationery Office; 2016.

Patterson ML, Moniruzzaman A, Somers JM. History of foster care among homeless adults with mental illness in Vancouver, British Columbia: a precursor to trajectories of risk. BMC Psychiatry. 2015;15(1):32.

Article   PubMed   PubMed Central   Google Scholar  

Fry C, Langley K, Shelton K. A systematic review of cognitive functioning among young people who have experienced homelessness, foster care and of poverty. Child Neuropsychol. 2016; doi.10.1080/09297049.2016.1207758 .

Reeve K. Welfare conditionality, benefit sanctions and homelessness in the UK: ending the ‘something for nothing culture’ or punishing the poor? J Poverty Soc Justice. 2017;25(1):65–78.

Somers J, Patterson M, Moniruzzaman A, Currie L, Rezansoff S, Palepu A. Vancouver at home: pragmatic randomized trials investigating housing first for homeless and mentally ill adults. Trials. 2013. doi: 10.1186/1745-6215-14-365 .

Watson J, Crawley J, Kane D. Social exclusion, health and hidden homelessness. Public Health. 2016;139:96–102.

Article   CAS   PubMed   Google Scholar  

Roos LE, Distasio J, Bolton S-L, Katz LY, Afifi TO, Isaak C, Goering P, Bruce L, Sareen J. A history in-care predicts unique characteristics in a homeless population with mental illness. Child Abuse Negl. 2014;38(10):1618–27.

Anderson I, Christian J. Causes of homelessness in the UK: a dynamic analysis. J Community Appl Soc Psychol. 2003;13:105–18.

Anderson I. Synthesizing homelessness research: trends, lessons and prospects. J Community Appl Soc Psychol. 2003;13:197–205.

Tsai J, Edens EL, Rosenheck RA. A typology of childhood problems among chronically homeless adults and its association with housing and clinical outcomes. J Health Care Poor Underserved. 2011;22(3):853–70.

Haskett ME, Armstrong MJ, Tinsdale J. Developmental status and social-emotional functioning of young children experiencing homelessness. Early Childhood Educ J. 2016;44:119–25.

Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. London: SAGE Publications; 2006.

Glaser BG. Remodelling grounded theory. Hist Soc Res. 2007;Supplement 19:47–68.

Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. Los Angeles: Sage Publications; 2008.

Book   Google Scholar  

Economic and Social Research Council: The research ethics guidebook a resource for social scientists. 2017. http://www.ethicsguidebook.ac.uk/ . Accessed 6 June 2017.

HM Government: Mental capacity act 2005.2005. http://www.legislation.gov.uk/ukpga/2005/9/pdfs/ukpga_20050009_en.pdf . Accessed 5 June 2017.

Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. 2nd ed. London: Sage Publication; 1998.

Mabhala M. Public health nurse educators’ conceptualisation of public health as a strategy to reduce health inequalities: a qualitative study. Int J Equity Health. 2015;14:14.

Mabhala MA, Massey A, Ellahi B, Kingston P. Understanding the determinants of homelessness through examining the life stories of homeless people and those who work with them: a qualitative research protocol. Diversity Equality Health Care. 2016;13(4):284–9.

Mabhala M. Social justice and global perspectives on health improvement in health improvement and wellbeing strategies and actions. Maidenhead: McGrow Hill and Open University Press; 2014.

Mabhala MA. Health inequalities as a foundation for embodying knowledge within public health teaching: a qualitative study. Int J Equity Health. 2013;12:46.

North CS, Eyrich-Garg KM, Pollio DE, Thirthalli J. A prospective study of substance use and housing stability in a homeless population. Soc Psychiatric Epidemiol. 2010;45:1055–62.

Kushel M, Vittinghoff E, Haas J. Factors associated with the health care utilization of homeless persons. J Am Med Assoc. 2001;285:200–6.

Article   CAS   Google Scholar  

Orwin RG, Scott CK, Arieira C. Transitions through homelessness and factors that predict them: three-year treatment outcomes. J Subst Abus Treat. 2005;28:S23–39.

Grinman MN, Chiu S, Redelmeier DA, Levinson W, Kiss A, Tolomiczenko G, Cowan L, Hwang SW. Drug problems among homeless individuals in Toronto, Canada: prevalence, drugs of choice, and relation to health status. BMC Public Health. 2010;10:94.

Linton SL, Celentano DD, Kirk GD, Mehta SH. The longitudinal association between homelessness, injection drug use, and injection-related risk behaviour among persons with a history of injection drug use in Baltimore, MD. Drug Alcohol Depend. 2013;132:457–65.

Crawley J, Kane D, Atkinson-Plato L, Hamilton M, Dobson K, Watson J. Needs of the hidden homeless – no longer hidden: a pilot study. Public Health. 2013;27(7): 674–80.

Office of the Deputy Prime Minister: Housing, planning, and local government and the regions committee: homelessness: third report of session 2004–05. 2005. https://www.publications.parliament.uk/pa/cm200405/cmselect/cmodpm/61/61i.pdf . Accessed 24 Oct 2016.

Williams K, Poyser J, Hopkins K. Accommodation, homelessness and reoffending of prisoners: results from the surveying prisoner crime reduction (SPCR) survey. London: Ministry of Justice; 2012.

Kennedy S. It should not be a pit stop: voices and perspectives of homeless youth on labeling and placement in special education. J Ment Health Res Intellect Disabil. 2017;10:1–19.

Lugo MA. Oxford Poverty & Human Development Initiative (OPHI): employment, in Oxford Poverty & Human Development Initiative (OPHI). Oxford: Oxford University; 2007.

Shinn M. Homelessness, poverty and social exclusion in the United States and Europe. Eur J Homelessness. 2010;4:19–43.

Download references

Acknowledgements

The authors wish to thank all participants in this study; without their contribution it would not have been possible to undertake the research. The authors acknowledge the contribution of Professor Paul Kingston and Professor Basma Ellahi at the proposal stage of this project. A very special thanks to Robert Whitehall, John and all the staff at the centres for homeless people for their help in creating a conducive environment for this study to take place; and to Roger Whiteley for editorial support. A very special gratitude goes to the reviewers of this paper, who will have expended considerable effort on our behalf. 

This research was funded by quality-related research (QR) funding allocation for the University of Chester.

Availability of data and materials

The datasets generated during and/or analysed during the current study are not publicly available due to ethical restriction and privacy of participant data but are available from the corresponding author on reasonable request.

Author information

Authors and affiliations.

Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of Chester, Riverside Campus, Chester, CH1 1SL, UK

Mzwandile A. Mabhala & Mariska Griffith

Mount Sinai, Department of Surgery, Ambulatory Surgery Centre, 5 East 98th Street, 14th Floor, Box 1259, New York, NY, 10029-6574, USA

Asmait Yohannes

Department of Public health and Wellbeing, University of Chester, Riverside Campus, Chester, CH1 1SF, UK

Mzwandile A. Mabhala

You can also search for this author in PubMed   Google Scholar

Contributions

MM wrote the entire manuscript, designed the study, collected data, analysed and interpreted data, and presented the findings. AY contributed to transcribing data and manuscript editing. MG contributed to data collection, and transcribed the majority of data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mzwandile A. Mabhala .

Ethics declarations

Ethics approval and consent to participate.

Ethical approval to conduct the study was provided by the Faculty of Health and Social Care Research Ethics Subcommittee of the University of Chester.

Consent for publication

All participants have given consent to publish.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Mabhala, M.A., Yohannes, A. & Griffith, M. Social conditions of becoming homelessness: qualitative analysis of life stories of homeless peoples. Int J Equity Health 16 , 150 (2017). https://doi.org/10.1186/s12939-017-0646-3

Download citation

Received : 24 March 2017

Accepted : 10 August 2017

Published : 22 August 2017

DOI : https://doi.org/10.1186/s12939-017-0646-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Homeless People
• Poor Educational Attainment
• Public Health Phenomenon
• Permanent Accommodation
• Behavioral Causes

International Journal for Equity in Health

ISSN: 1475-9276

• General enquiries: [email protected]

Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness (2018)

Chapter: 9 conclusions and recommendations, 9 conclusions and recommendations.

Homelessness, and especially chronic homelessness, is a highly complex problem that communities across the country are struggling to address. Despite the diligent efforts of federal agencies and nonprofit and philanthropic organizations to develop and implement programs to address the challenges of homelessness, the large number of Americans who continue to experience homelessness makes clear that much remains to be done to solve this pressing societal problem.

Permanent supportive housing (PSH) is a housing model designed to primarily serve individuals and families experiencing chronic homelessness, a population having different needs from those individuals and families who experience acute episodic or temporary homelessness. This committee was charged to examine the connection between PSH and improved health outcomes, addressing the primary question, “To what extent have permanent supportive housing programs improved health outcomes and affected health care costs in people experiencing chronic homelessness?” This chapter offers the committee’s overall conclusions about the evidence on the effect of PSH on health outcomes, as well as research and policy recommendations.

CONCLUSIONS

Evaluating the impact of psh on health: assessment and limitations of the evidence.

During the course of the study, the committee examined the published and unpublished literature and conducted a variety of other data-gathering efforts, including site visits. The committee found that interpreting the research relevant to PSH and health outcomes was challenging because, as discussed in the report, common terms have different meanings within and between homelessness lexicons used by various agencies, nongovernmental organizations, researchers, and advocates ( USICH, 2011 ). The lack of precise definitions of the housing models

reported upon and the paucity of detail about the exact nature and extent of supportive services provided in different housing models and in control or comparison groups further complicated the interpretation of reported findings.

In addition, data about PSH programs are generally siloed, uncoordinated, and fragmented. There are multiple barriers to collecting and sharing these data across agencies or programs, and there is a need for much greater interoperability of the data. The paucity of comparable data available across agencies makes it difficult to assess a variety of outcomes, and complicates efforts to provide the array of housing and social services that may be needed by individuals experiencing homelessness ( Culhane, 2016 ). See Chapter 8 for an in-depth discussion of related research gaps.

On the basis of currently available studies, the committee found no substantial evidence that PSH contributes to improved health outcomes, notwithstanding the intuitive logic that it should do so and limited data showing that it does do so for persons with HIV/AIDS. There are significant limitations in the current research and evidentiary base on this topic. Most studies did not explicitly include people with serious health problems, who are the most likely to benefit from housing. Of the studies that were more rigorous, the committee found that, in general, housing increases the well-being of persons experiencing homelessness.

The committee found no substantial published evidence that PSH improves health; however, PSH increases an individual’s ability to remain housed and plausibly alleviates a number of conditions that negatively impact health. However, few randomized controlled trials or other methodologically rigorous studies have evaluated the role of PSH in producing improved health outcomes. Consistent data in this regard are presently lacking. While the committee recognizes that there are moral and ethical reasons that make it problematic to carry out randomized controlled trials with this population, an overarching finding of this study is that more rigorous research is needed to determine how health outcomes per se are influenced by PSH. Different types of studies might pose fewer ethical concerns, such as stepped-wedge study designs, which are increasingly being used in the evaluation of health care research ( Simmons et al., 2017 ).

Housing has long been acknowledged as a key social determinant of health, and extensive literature has accumulated over the past two centuries showing that housing is foundational for good health. The United Nations adopted the Universal Declaration of Human Rights in Paris in 1948 in response to the devastation of World War II, declaring that the right to housing was among the rights to which all humans should be entitled. The United States was among the 48 signatories of this declaration. More recently, safe housing was noted as fundamental to the health of populations by the World Health Organization’s Commission on Social Determinants of Health ( CSDH, 2008 ).

While safe, secure, and stable housing contributes to good health, there is extensive literature also showing it is not sufficient. The quality and location of housing make a difference. Robust public health studies have shown the untoward health consequences of inadequate housing, including asthma, the spread of communicable diseases, exposure to toxins such as lead and radon, injuries, childhood

malnutrition, mental health conditions, violence, and the harmful effects of air pollution. Population studies have also shown that a person’s neighborhood matters a great deal with regard to health outcomes, with safe streets, safe schools, and economic opportunity essential for good health and well-being.

The committee acknowledges the importance of housing in improving health in general, but it also believes that some persons experiencing homelessness have health conditions for which failure to provide housing would result in a significant worsening of their health. Said differently, notwithstanding that housing is good for health in general, the committee believes that stable housing has an especially important impact on the course and ability to care for certain specific conditions and, therefore, the health outcomes of persons with those conditions. The committee refers to these conditions as “housing-sensitive” conditions and recommends that high priority be given to conducting research to further explore whether there are health conditions that fall into this category and, if so, what those specific conditions are. The evidence of the impact of housing on HIV/AIDS in individuals experiencing chronic homelessness may serve as a basis for more fully examining this concept. Chapter 3 describes the current research and the concept of housing-sensitive conditions in more detail.

Scaling Up PSH: Policy and Program Barriers

As part of its charge, the committee was asked to identify the “key policy barriers and research gaps associated with developing programs to address the housing and health needs of homeless populations.” While the committee found no substantial published evidence that PSH improves health, the intervention increases an individual’s ability to remain housed and that plausibly alleviates a number of conditions that negatively impact health. Based on its position that PSH holds potential for reducing the number of persons experiencing chronic homelessness and for improving their health outcomes, the committee describes the key policy and program barriers to bringing PSH and other housing models to scale to meet the needs of those experiencing chronic homelessness (discussed in greater detail in Chapter 7 ).

There are many barriers to bringing PSH to scale to meet the current level of need. As is often the case with housing and social service providers generally, PSH programs operate in an environment of scarcity with often inadequate and unreliable funding. The siloed nature of the programs and funding streams for PSH is an important barrier to scaling up. PSH providers working at the ground level to fulfill an already challenging mission are further challenged by the need to pool or braid together funding from multiple agencies and levels of government, each with its own requirements.

Multiple barriers also exist at the local level in meeting the need for PSH. As highlighted in the committee’s site visits in Denver and San Jose (see Appendix D ), operationalizing PSH programs is a very complicated and lengthy process, often taking many years to complete single-site projects. The high capital costs

and long development process are a substantive barrier to the replicability of successful programs. In the case of single-site PSH developments, myriad local land-use, permitting, and other regulatory barriers, which may be undergirded by prejudicial stereotypes and neighborhood opposition, makes land unavailable, leads to protracted delays, drives up development costs by as much as 20-35 percent, and generally impairs the efficiency of government assistance programs (see, e.g., van den Berk-Clark, 2016 ). Experts and government officials across the political spectrum have long recognized these barriers, but few of the many recommendations over the years for eliminating unnecessary regulatory barriers, streamlining processes, and more vigorously enforcing anti-discrimination laws have been implemented. Until such recommendations are effectively implemented, single-site PSH will not be a sufficient answer to address the need.

Scattered-site approaches, which generally make use of Housing Choice Vouchers (HCV) to lease existing housing stock, avoid some of the barriers relevant to single-site PSH and appear to offer promise for scaling up PSH in a shorter time. But scattered-site programs also face challenges when operating in high-priced housing markets and markets where state and local laws allow property owners to refuse to accept vouchers. It also can be more difficult for residents to access supportive services when not directly available on-site. Moreover, federal funding for the HCV program has been at best stable and at worse declining, forcing PSH providers and clients to compete with others on long waiting lists for vouchers.

RECOMMENDATIONS

The committee developed the following recommendations based on its assessment of the evidence that it hopes will guide research and federal action on this issue. The recommendations flow from the specific questions posed to the committee in the statement of task, including research needs related to assessing PSH and health outcomes, the cost-effectiveness of PSH, and key policy and program barriers to bringing PSH and other housing models to scale to meet the needs of those experiencing chronic homelessness.

Recommendation 3-1: Research should be conducted to assess whether there are health conditions whose course and medical management are more significantly influenced than others by having safe and stable housing (i.e., housing-sensitive conditions ). This research should include prospective longitudinal studies, beyond 2 years in duration, to examine health and housing data that could inform which health conditions, or combinations of conditions, should be considered especially housing sensitive. Studies also should be undertaken to clarify linkages between the provision of both permanent housing and supportive services and specific health outcomes. (See Chapter 3 .)

Recommendation 3-2 : The Department of Health and Human Services, in collaboration with the Department of Housing and Urban Development, should call

for and support a convening of subject matter experts to assess how research and policy could be used to facilitate access to permanent supportive housing and ensure the availability of needed support services, as well as facilitate access to health care services. (See Chapter 3 .)

Recommendation 4-1: Incorporating current recommendations on cost-effectiveness analysis in health and medicine ( Sanders et al., 2016 ), standardized approaches should be developed to conduct financial analyses of the cost-effectiveness of permanent supportive housing in improving health outcomes. Such analyses should account for the broad range of societal benefits achieved for the costs, as is customarily done when evaluating other health interventions. (See Chapter 4 .)

Recommendation 4-2: Additional research should be undertaken to address current research gaps in cost-effectiveness analysis and the health benefits of permanent supportive housing. (See Chapter 4 .)

Recommendation 5-1: Agencies, organizations, and researchers who conduct research and evaluation on permanent supportive housing should clearly specify and delineate: (1) the characteristics of supportive services, (2) what exactly constitutes “usual services” (when “usual services” is the comparator), (3) which range of services is provided for which groups of individuals experiencing homelessness, and (4) the costs associated with those supportive services. Whenever possible, studies should include an examination of different models of permanent supportive housing, which could be used to elucidate important elements of the intervention. (See Chapter 5 .)

Recommendation 5-2: Based on what is currently known about services and housing approaches in permanent supportive housing (PSH), federal agencies, in particular the Department of Housing and Urban Development, should develop and adopt standards related to best practices in implementing PSH. These standards can be used to improve practice at the program level and guide funding decisions. (See Chapter 5 .)

Recommendation 7-1: The Department of Housing and Urban Development and the Department of Health and Human Services should undertake a review of their programs and policies for funding permanent supportive housing with the goal of maximizing flexibility and the coordinated use of funding streams for supportive services, health-related care, housing-related services, the capital costs of housing, and operating funds such as Housing Choice Vouchers. (See Chapter 7 .)

Recommendation 7-2: The Centers for Medicare & Medicaid Services should clarify the policies and procedures for states to use to request reimbursement for allowable housing-related services, and states should pursue opportunities to ex-

pand the use of Medicaid reimbursement for housing-related services to beneficiaries whose medical care cannot be well provided without safe, secure, and stable housing. (See Chapter 7 .)

Recommendation 7-3: The Department of Health and Human Services and the Department of Housing and Urban Development, working with other concerned entities (e.g., nonprofit and philanthropic organizations and state and local governments) should make concerted efforts to increase the supply of PSH for the purpose of addressing both chronic homelessness and the complex health needs of this population. These efforts should include an assessment of the need for new resources for the components of PSH, such as health care, supportive services, housing-related services, vouchers, and capital for construction. (See Chapter 7 .)

Chronic homelessness and related health conditions are problems that require an appropriate multidimensional strategy and an ample menu of targeted interventions that are premised on a resolute commitment of resources. More precisely defined and focused research to refine the menu of needed interventions, and a materially increased supply of PSH are part of the multidimensional strategy. The committee hopes that this report will help to stimulate research and federal action to move the field forward and further efforts to address chronic homelessness and improved health in this country.

Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed.

Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.

READ FREE ONLINE

Welcome to OpenBook!

You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

Do you want to take a quick tour of the OpenBook's features?

Show this book's table of contents , where you can jump to any chapter by name.

...or use these buttons to go back to the previous chapter or skip to the next one.

Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

Switch between the Original Pages , where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

To search the entire text of this book, type in your search term here and press Enter .

Share a link to this book page on your preferred social network or via email.

View our suggested citation for this chapter.

Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

Get Email Updates

Do you enjoy reading reports from the Academies online for free ? Sign up for email notifications and we'll let you know about new publications in your areas of interest when they're released.

• Open access
• Published: 25 April 2022

A qualitative systematic review on the experiences of homelessness among older adults

• Phuntsho Om 1 , 2 ,
• Lisa Whitehead 1 , 3 ,
• Caroline Vafeas 1 &
• Amanda Towell-Barnard 1  

BMC Geriatrics volume  22 , Article number:  363 ( 2022 ) Cite this article

6670 Accesses

2 Citations

13 Altmetric

Metrics details

Adults who experience homelessness for an extended period of time also experience accelerated ageing and other negative impacts on their general health and wellbeing. Homelessness amongst older adults is on the rise, yet there are few systematic reviews investigating their experiences. Thus, this review classifies and synthesises qualitative research findings of studies published between 1990 to 2020 that have examined the needs and challenges of homeless older adults to elucidate their journey of homelessness. Seven papers met the requirements for inclusion. Three main themes were identified in the review: - (1) Pathways to homelessness, (2) Impact of homelessness, and (3) Outcomes and resolutions. This review collates current evidence on what is known about the experience of homelessness among older adults. In this study, homeless older adults identified a wide range of challenges associated with the experience of homelessness.

Peer Review reports

The population globally is ageing. Although, ageing is truly a triumph of development, this demographic change presents both advantages and challenges. The concept of successful ageing is to “add life to years” rather than adding days to life and is about maximizing wellbeing and happiness for the older adult [ 1 ]. The risk of developing physical and mental health issues among older adults along with associated costs are linked to a higher demand for health and social care [ 2 ].

Theories on ageing have been developed with the goal of understanding the ageing process and how best to support “healthy ageing at home” and “ageing-in-place” [ 3 ] however these do not consider older adults who do not live in a supportive environment or adults who are homeless. The home setting can be a place associated with poor subjective well-being and some older adults may feel compelled to leave the home setting as a result [ 4 ].

There is no consistent definition of homelessness, rather it has been confined to socio-historical, geographical, and cultural contexts from which the term is drawn [ 5 ]. Homelessness can be defined by a range of categories: absolute and or hidden with homelessness defined as sleeping in parked cars or parks, in emergency shelters, or in temporary shelters (couch surfing) with no or minimal health and safety requirement standards, and risk to personal safety [ 6 , 7 , 8 ]. This includes people residing in sub-standard housing such, as single-room occupancy hotels, or cheap boarding houses, as well as low-cost tiny, lodgings with minimal amenities [ 9 , 10 ].

There is an increasing rise in homelessness among older adults and older homeless adults have been identified as the “new homeless”, a “forgotten group” and a “hidden group” [ 9 , 11 , 12 ].

The reasons for homelessness amongst older adults are diverse. These can include: the impact of natural disasters; the availability of affordable housing, including rising rental costs, a decline in social welfare and support programs; financial insecurity; a lack of social amenities; and increasing rates of mental health issues, combined with various addictions, including gambling [ 2 , 9 , 11 , 12 , 13 , 14 , 15 , 16 ]. In addition to this, family relationship breakdowns, or the death of loved ones, can cut people’s social connections, resulting in older adults experiencing homelessness for the first time. This displacement of older more vulnerable adults can lead to deprivation including the basic need for a place they can relate to as home, subsequently leaving them homeless [ 3 , 7 , 15 , 17 ].

Molinari, Brown and Frahm et al. (2013) found homelessness was unanimously perceived as a humiliating experience by homeless older adults [ 13 ]. According to a survey conducted by the United States Department of Housing and Urban Development, over 15% of 634,000 homeless individuals were 50 years or older, where the number of homeless people aged over 65 has been projected to double by 2050 [ 13 ]. The same survey reported that in the United States alone, adults as young as 50 years of age were facing challenges of homelessness, effectively accelerating ageing processes. Further to this, homeless older adults face a greater threat of age-related disease burden, where they are more likely to experience: functional, auditory, visual, and neurological impairments, frailty, emotional distress, and urinary incontinence, at higher rates than in the general community [ 18 ].

Similarly, van Dongen et al. have reported within a longitudinal cohort study, that older homeless adults, unlike their younger counterparts, reported a higher incidence of cardiovascular disease and visual problems, as well as reporting limited social support from family and friends or acquaintances, and limited medical or hospital care use in the past [ 19 ].

However, there is limited published research identifying the distinct needs of homeless older adults. This is a critical gap in the literature, where a deeper understanding of the experiences of older adults who have been or are currently homeless is required.

The main aim of this qualitative systematic review is to synthesise the evidence on the experience of homelessness of older adults.

Using Joanna Briggs Institute (JBI) guidelines, a meta-synthesis of global qualitative evidence was undertaken. Studies with titles and abstracts that met the analysis goals were retrieved and chosen, based on inclusion and exclusion criteria. These studies were further appraised to evaluate methodological validity by analysing evidence relevant to viability, appropriateness, meaningfulness, and effectiveness [ 20 ]. Qualitative and mixed-method studies with ample qualitative data in their results sections to allow secondary data analysis met the inclusion criteria. The sample comprised of older adults aged between 45 and 80 years that had experienced homelessness for at least one period. The search was restricted to studies that were published in English and available in full-text form, where studies with participants below 45 years, older adults in housing facilities, and aged care residents were excluded.

Search methods

This analysis followed the Joanna Briggs Institute (JBI) method for systematic reviews [ 20 ]. A qualitative assessment and review instrument (JBI-QARI 10 item tool) [ 20 ] was used to facilitate the meta-synthesis. Results from the studies were extracted, categorised, and synthesised. Searches were conducted in PsycINFO, Web of Science, Google Scholar, Medline, PubMed, and CINAHL using appropriate search terms. Additionally, important citations were searched from reference lists of relevant articles. Searches were limited to published studies from 1990 to 2020 (see Fig.  1 ).

PRISMA flowchart

Quality appraisal

Two reviewers independently assessed 21 articles for methodological quality in their design, conduct and analysis using the JBI-QARI 10 item tool [ 20 ]. Any discrepancies were discussed within the team. Out of the 21 articles, seven were included in the synthesis. Each selected study was re-read several times, discussed within the review team and data were abstracted for interpretation.

Data abstraction

Findings relating to both current and past experiences of homelessness among older adults were extracted from the seven selected studies. A total of 56 findings were extracted. Each finding was reviewed and further compared and manually coded to identify themes. Table  1 lists the author and year, sample size, design, setting, and participant characteristics of the selected studies.

Analysis of the seven reviewed articles was carried out using the qualitative evidence synthesis method [ 20 ] developed by JBI (2014). Qualitative findings from each study were first read and reread, followed by an identification of common themes. Recurring themes across studies were then grouped together in a meta-synthesis of the findings. This process comprised critical appraisal, data extraction, analysis, and a meta synthesis involving organisation and categorisation through decoding and encoding of the extracted data to produce a final summation of the findings. The qualitative evidence summation and synthesis were deliberated, cross-checked, and then reviewed by all the authors.

Of the seven studies identified for review (see Table 1 above), four studies directly explored pathways to homelessness amongst older adults. Individual study sample sizes ranged from 14 in Reynolds, et al. (2016) [ 21 ] to 60 in Viwatpanich (2015) [ 24 ]. Three studies applied in-depth face to face interviews, with three studies using semi-structured interviews, and one study conducting focus groups to collect data. The studies were conducted in three countries: Canada, USA, and Thailand.

Data synthesis commenced using open descriptive coding to search and identify concepts and finding relationship between them. Next using an interpretive process, the meaning units were categorised within each domain using labels close to the original language of the participants. The categorization of the data for each case was then followed by a cross-case analysis that examined the similarities and differences. Following categorisation, themes were conceptualised for each category. An overarching theme was identified: ‘the journey of homelessness’. Within this context, three core themes were identified: 1) Pathways to homelessness; 2) impact of homelessness; and 3) outcomes and resolutions, where each of these 3 themes had relevant sub-themes. (see Fig.  2 ).

The Journey of Homelessness Model

The conceptual model depicted in Fig. 2 represents the overarching theme of the ‘journey to homelessness,” and key concepts and relationships between variables from the synthesis of the literature. Unlike other conceptual models that involve causal and directional relationships, this model is both directional and non-hierarchical. The model illustrates the pathways to homelessness, the associated impacts of homelessness and the outcomes of homelessness. The following section explores the three themes and sub-themes in more detail.

Theme 1. Pathways to homelessness

The causes of homelessness were shown to be multifaceted, where pathways to homelessness revolved around a combination of individual, social, and structural factors. The reviewed data suggested that becoming homeless involved two distinct pathways: one that was gradual and one that was rapid.

Sub-theme 1.1: gradual pathway to homelessness

Findings from six studies contributed to this subtheme. This sub-theme captured the factors contributing to gradual pathways into homelessness amongst older people. These factors were identified as accelerated ageing, poverty, rising housing costs, failing and uncommitted social security systems, a lack of social programs and services, social distress, rural-urban migration, substance abuse and addiction, as well as estrangement from family or lack of living relatives [ 13 , 14 , 21 , 22 , 23 , 24 , 25 , 26 ].

The following quotations from these studies illustrate both estrangement from family and the impact of a lack of support from social services:

Many conflicts we had at that time, we never talked … never talked in normal way … nothing clear between us, emotion never came clear...they did not want to talk to me, not even to look at my face … I could not stand it, I surrendered. Beating and scolding by descendants is not in our tradition, no respect, if they did not want me to stay with them, I moved out [ 24 ] .

I submitted applications for low-income housing, I’ve been on the waiting list, seven years is a long time, especially at my age [ 22 ] .

Personal vulnerability to difficult familial relationships, neglected needs and unstable housing were the most cited causes of homelessness amongst these older adults [ 3 , 9 , 14 , 25 ].

Two studies [ 15 , 21 ] described a pathway to homelessness as related to alcoholism and drug abuse, as highlighted in the following quotation:

I got into crack cocaine, I got into hooking, I got into anything you could think of I guess . . . So it was my addictions that brought me down, and unhealthy relationships [ 25 ] .

Feeling ‘homeless at home’ [ 27 ] due to loneliness was noted by some older adults as their reason for ‘living on the streets’. For example, homeless older adults that experienced social rejection and conflicts with housing management, neighbours, and roommates, noted this to ultimately lead them to homelessness. For example, one participant stated, “I have lived alone and never really felt at home, because to me home is a place that includes other people, your family” [ 23 ].

Sub-theme 1.2: rapid pathway to homelessness

Some older adults described the process of homelessness as ‘rapid’. A rapid pathway to homelessness was associated with abrupt life changes such as losing a loved one, divorce, and the impact of these losses on their lives. The two quotes below highlight rapid pathway process:

Losing them, let’s just say it evaporates over time. It’s the fact that I wake up like I am here that I can’t accept … homeless … in the street. I sold everything, every single thing! I never thought I’d end up like this. It’s like starting from zero [ 23 ].

I had a wife, then she died, I did not know where to go, what to do, I turned homeless [ 24 ] .

Older adults that faced a series of losses and a rapid deprivation of social support systems noted the experience of disrupted circumstances. Accordingly, they noted their fear of losing their independence and ‘sense of self’ resulted in their resistance to any help that was offered, in turn contributing to their homelessness.

Theme 2. Impact of homelessness

Findings from five studies contributed to this subtheme. Homelessness and ageing were presented to form a ‘double jeopardy’ where homelessness aggravated the challenges of old age [ 15 , 21 , 22 , 23 , 24 ].

This theme included the subthemes of: unmet needs, coping strategies, and the realities of housing availability.

Sub-theme 2.1: unmet needs

‘Unmet needs’ amongst older homeless adults were categorised as involving physical, emotional and social needs leading to despair and destitution. As this quote below highlights:

I’m supposed to get a pneumoscopy, but where am I, where do I stay? How can they get a hold of me? I don’t have money to get around [ 15 ] .

Sub-theme 2.1.1: lack of physical wellbeing

Findings from six studies [ 14 , 15 , 18 , 21 , 22 , 24 ] contributed to this subtheme. Physical decline and physical disability were described as exacerbated by the experience of being homeless. Participants described a relationship between age and frailty, fatigue, poor physical health, and impaired mobility while homeless, as these quotes demonstrate:

Ah! Walking all day, for me, it’s very hard on the body, ok. Sleeping outside on a park bench, that’s very, very hard on the body. The bones, the humidity. Just leaving in the morning and then not going to work. … You’re always faced with the outdoors, and always faced with walking, walking. It’s not easy walking from downtown [ 15 ] .

My health was very poor. I was very prone to pneumonia. I was taken out of the shelter in the ambulance and it was later determined that I had actually contracted tuberculosis [ 22 ] .

At that time, I got Psoriasis, I knew that it was disgusting … . It looked scary. I am much too old. It is so difficult to find a job … nobody needed me … so I decided to stay and sleep here [ 24 ] .

Homelessness in later life was shown to often be linked to a multitude of health problems. Most studies described older homeless people as living with physical health problems including chronic diseases such as hypertension, diabetes, bone and joint diseases, respiratory illness, and skin diseases [ 14 , 21 , 22 ]..

Sub-theme 2.1.2: lack of emotional wellbeing

Findings from five studies contributed to this subtheme. Accordingly, homelessness was described as contributing to poor emotional health related to social exclusion and isolation amongst older adults. Further, homelessness was associated with cognitive impairment, stigma, shame, stress and anxiety, as well as depression amongst homeless older adults [ 15 , 21 , 24 , 25 ]. Homelessness was described as a humiliating and degrading experience, as evident in these quotes:

At my age, I don’t see life ahead of me anymore. You see, I don’t know, I don’t see the end of the tunnel, … … It’s as if I wanted to erase myself [ 15 ] .

All I could think about was suicide. How did I end up here? When I think a lot to myself, what the hell am I doing? [ 23 ] .

Feelings such as shame, demoralisation, and loss of dignity were described and these impacted on emotional health.

Opportunities to improve emotional wellbeing were rarely described, however one example stood out as an exception and this was related to volunteering:

One thing I didn’t expect was when I helped people with whatever issues they were having on their bicycle, I really enjoyed that. It gave me a chance to teach someone [ 25 ] .

Examples such as these were rare, with social exclusion and the lack of opportunity to contribute and connect with others more commonly described.

Sub-theme 2.1.3: lack of social relationships

Findings from four studies contributed to this subtheme. Social relationships were described as central to creating a life that had meaning and familial interactions. Disconnection from loved ones was associated with feelings of unhappiness [ 13 , 15 , 27 ], while companionship was shown to improve wellbeing [ 25 ]. Social relationships were shown to decline, leading to the experience of social exclusion and isolation.

I am a walking dying woman. I walk until I can’t walk anymore, and then I sit. The busses pass me by. We are untouchables and I do not think anybody’s going to do anything about it [ 25 ] .

At my age, I don’t see life ahead of me anymore. Because everywhere I go: “Ah! He’s homeless.” It is as if I wanted to erase myself. I think that it’s more “society,” as such, that rejects homeless people [ 15 ] .

I think that living homeless, you exclude yourself, and a lot of other people exclude you. I was on the other side before becoming homeless. So, you know, the perception that people have, it plays a big part. … So that together makes it so that, if you don’t have family either, let’s say, you don’t have … close friends or a strong social network. Well, you experience all that, you live with loneliness and isolation [ 15 ] .

Sub-theme 2.2: impaired coping strategies

Findings from four studies contributed to this subtheme. Older homeless adults described a range of factors as impacting their ability to cope. These included moving to shelters, challenges to adapt to their unique requirements, limited housing options, limited income supports, social exclusion, isolation, and a lack of coordination and access to community health and support services [ 13 , 15 , 23 , 25 ].

As the quote below shows, there were expressions about the fear of homelessness and how long it will last:

Struggling to get your basic needs met, scrounging, just trying to get by as best I can, and feeling desperation, humiliation, despair, a shocking feeling, full of fear, and turmoil. What’s tomorrow gonna bring? Why am I in this situation? How do I get out of it? [ 13 ]

Coping with the harsh realities of homelessness in later life was described as being increasingly challenging for most older adults because older homeless individuals experience mental health disorders and acute or chronic physical illnesses.

Sub-theme 2.3: realities of housing availability

Findings from three studies [ 13 , 15 , 23 ] described the challenges experienced in accessing housing services and fulfilling requirements for safe, secure, and affordable housing. This theme captured impacts of poor coordination and communication between homeless veterans and housing intervention providers in regard to information for service availability, gaining access to homeless shelters and a lack of training and education by some housing providers especially with regard to homelessness.

He … got this rule book and threw it at me. Find a place! [ 13 ]

You know, I’m 60, I’m not 20 anymore. So that’s what makes you tired, you get stressed. So, after that, they give you pills as a solution. I told the doctor, sorry I didn’t come here for pills, I came for housing [ 23 ] .

I submitted applications for low-income housing, I’ve been on the waiting list, seven years is a long time, especially at my age [ 23 ] .

I want a space where I can be well. I wasn’t well when I was young. I’ve never been well anywhere. I need a simple place … where I can have peace, and quiet … but not be all alone [ 15 ] .

Older homeless adults described a need to create stability and escape homelessness through the provision of services, and in particular, housing. Older adults described how oscillating in and out of shelters prevented senses of safety, stability, or autonomy.

Theme 3. Outcomes and resolutions

In four studies [ 13 , 15 , 21 , 24 ] homeless older adults described how the outcomes and resolutions of homelessness involved overcoming both complex challenges and habituations. This theme encompassed the finding of directions and strengths to improve difficult situations and overcome challenges that occurred at the intersection of homelessness and ageing.

Three subthemes were identified within this theme: building resilience, strength, and hope; seeking spiritual meaning; and exiting the cycle of homelessness.

Sub-theme 3.1: exiting the cycle of homelessness

Some older adults moved out of the phase of homelessness and described facilitators and barriers to this transition whilst other described choosing to stay homeless until the end of their lives.

Sub-theme 3.1.1: factors facilitating the exit

Two studies [ 13 , 15 ] contributed to this sub-theme, where older adults described means of overcoming challenges and establishing priorities in order to exit homelessness in later life. The results suggested that the creation of autonomy, flexibility, and privacy helped people feel belonging and often this meant living in a place where they could continue to drink and/or occasionally use drugs, have access to a health system to manage health problems; and have access to food and shelter facilitated exits.

They listen to you and they help you with . . . your transition, your program. You sit down and you work the program out with them;” “If you have a question, you can walk in anytime and ask them what’s going on [ 13 ] .

In the next couple years, I hope to find myself an apartment for the few good years I have left, before the big pains of “aging” come [ 15 ] .

Fulfilling financial support, housing and health care services was identified facilitate older adults exiting homelessness.

Sub-theme 3.2: remaining homeless

Some older adults experienced homelessness at a younger age and described continuing to be homeless in older age, where they oscillated between living in shelters and on the streets.

I am used to being in this way, moved from place to place … me alone, without father and mother since childhood … it become normal and I feel happier, than to stay with others [ 24 ] .

It’s just a continual cycle. I just got sucked down into it, you know. It’s hard to describe because when I found myself there, I was just like, wow. How did I get here? [ 21 ]

Participants described the chronic nature of homelessness as involving a challenge of disentangling themselves from the cycle of homelessness. A lack of tailored intervention programs to respond to homelessness in later life also prevented older adults from exiting homelessness.

Sub-theme 3.2.1: perceived barriers to exiting homelessness

In two studies [ 21 , 24 ], older adults described experiences of vulnerabilities and challenges to exiting homelessness. Shelters were described as constraining and not being able to adapt to the unique needs of older adults. Where limited housing options were seen as available, income supports were described as limited, with a lack of coordinated and, accessible community health and social support services, impacting on participants’ ability to ‘feel in place’.

My health pretty much stayed the same as when I was homeless. The conditions I have aren't gonna improve [ 22 ] .

It’s harder to keep a place, especially when you keep falling back in the same circle and you’re in the same crowd. I am finding out today, you keep falling back in the same circle, the same circle is not gonna change [ 21 ] .

One participant described the difficulty of obtaining employment as a barrier to exiting homelessness:

You know being 50 years old, it’s going to be really difficult to be able to reintegrate into the workforce [ 21 ] .

Housing facilities and transition to housing shelters were shown to present challenges for homeless older adults. A lack of privacy, autonomy, rigid rules, and challenging interpersonal relationships within housing and shelter programs were identified as leading older adults to feel homeless at home.

Sub-theme 3.3: building resilience and strength

This sub-theme captured the life lessons, resilience, strength, and hope of older homeless adults, described as having formed through experiences and skills developed whilst living on the streets. This theme also suggests how individuals cope with difficult symptoms related to social support and, addiction, relying on positive things learned while living with other homeless people on the streets. Some older adults chose to stay homeless accepting homelessness as their fate.

In the next couple years, I hope to find myself an apartment for the few good years I have left, before the big pains of “aging” come. I really want a normal life, get up in the morning, go to work, think about vacation. Hang out with other people … I don’t have a girlfriend but would like to start a life with someone else [ 15 ] .

What does ageing mean to you, getting older on the streets? A: Experience. Q: Ok. A: Wisdom. Q: Getting older on the streets, that’s how you see it, it’s the wisdom that you have gained. A: Yeah, that’s where I learned to be wise. Because there are several people who told me I am wise [ 15 ] .

I think because of karma … I accept it as punishment from bad deeds in my former life, but only in this life okay! Next life I am looking forward for a normal life, like others [ 24 ] .

Most studies [ 3 , 8 , 13 , 17 ] cited that wisdom, experience, and optimism were necessary in order to help older adults exit homelessness. Optimism instilled future hope and self-worth back into the self-esteem of homeless older adults.

Sub-theme 3.3.1: seeking spiritual meaning

In two studies [ 24 , 25 ], older adults described finding meaning in life through adopting and accepting religious faith with a belief to achieve higher self-actualisation.

I want to be closer to Dhamma (Buddhist teaching), I want to be a monk till I die [ 24 ] .

Meditate, just being by myself. Living the night, just being alone and listening to my music, that makes [my pain] feel better. I like jazz but I just listen to my music, just go away to myself. That makes me feel - I like being alone. I love being alone [ 25 ] .

When I feel [anger over my situation] I go to the water and I pray hard. I just start praising God until I can feel the spirit come over me to comfort me. I pray until He comes and allows his spirit to wrap his arm around me; I feel a lot better. A psychiatrist can’t tell me what’s wrong with me. For someone to try to help would mean a lot. I do not have nobody but to trust God. He’s my only psychiatrist [ 25 ] .

Homeless older adults recognised and confirmed that psychosocial and existential symptoms caused as much distress as physical symptoms triggering negative changes in personality, energy, and motivation. Some homeless older adults viewed their age as a source of strength, wisdom, and experience in learning to manage their symptoms, describing themselves as survivors who had overcome significant hardships. Higher levels of wellbeing were likely to be achieved when older people sought spiritual meaning through religion, socialising, reading, meditating, volunteering, and introspection practices.

This review synthesised evidence generated from qualitative studies to provide a glimpse into the experiences of homeless older adults. The review has shown that while drivers related to entry into homelessness were diverse, two distinct trajectories underpinned the experience of becoming homeless amongst older adults. Older people that faced a sudden series of losses that completely overturned their circumstances fell into the ‘rapid pathway’ to homelessness. Participants on a ‘gradual pathway’ were shown to become homeless due to a range of factors, for example - addiction problems, physical and mental health issues, relationship break-ups, foster care, poverty, unemployment, and greater housing instability [ 13 , 24 ]. Further to this, homeless older adults were shown to include a significant percentage of separated, divorced, or single individuals [ 28 ]. Likewise becoming single in later life was shown to be associated with homelessness amongst older people. Other studies found that ageing, its associated factors and a lack of stable housing were prominent reasons for homelessness [ 15 , 22 , 23 ].

Housing was perceived to offer a sense of security and a stable environment conducive for safe ageing. Further, housing was identified as offering protection from harsh weather and other dangers. Similar accounts relaying how the health of homeless older adults declined during episodes of homelessness was also reported [ 9 ]. Stable housing played an influencing role in physical health and general wellbeing. Although homeless older adults expressed satisfaction with life, they linked secure housing with healthy dietary habits, proper sleep patterns, enhanced self-care and reduced feelings of stress and anxiety [ 22 ]. In addition, this review found that most homeless older adults were more able to prioritise their health care needs when other necessities such as food and shelter were met. However, research has also suggested that living in scattered-site apartments can reinforce the process of social exclusion, and thus they are not appropriate for older adults living alone, with regard to their additional health and social needs [ 3 , 10 , 28 ].

Ageing intensified the adversities of homelessness experiences and presented a twofold risk where homelessness aggravated the challenges of old age and vice versa [ 15 ]. Old age and its associated conditions intensified older adults’ perceptions of homelessness later in life, including feelings of shame, anxiety, and worry. Studies by Cohen [ 9 ], Kwan, Lau and Cheung [ 29 ], and Molinari et al. [ 13 ], have unanimously shown older adults to perceive homelessness as a dehumanising experience. Homelessness was described as: struggling “to get your basic needs met,” “scrounging, just trying to get by as best I can,” and feeling “desperation,” “humiliation,” “despair,” “a shocking feeling,” “full of dread, turmoil,” “what will tomorrow bring? why am I in this predicament and how can I get over it?” [ 13 ]. For most participants, homelessness was not a preferred option.

The limitations of this review include the predominance of data collected in North America which may reduce the generalisability of the findings. Another drawback is that it presents only a cursory review of issues related to gender, race, and ethnicity. Finally, the qualitative data analysis applied by the majority of studies here is subjective, where outcomes could be affected by authors’ personal biases.

Despite these limitations, the review has conceptualised two divergent pathways into homelessness in later life, as well as the impacts of homelessness, drawing attention to a greater understanding of homelessness experienced by older adults.

The review sought to provide insight into the needs of homeless older adults. Awareness of the complexities faced by homeless older adults need to be acknowledged if policy and research are to support the population and improve access to resources and support. The review has highlighted areas for future research to expand knowledge and understanding of the unique needs and challenges of homeless older adults.

Synthesis of seven studies resulted in the identification of an overarching theme relating to the ‘journey of homelessness’ and three major themes, each with subthemes, to describe older adults’ experiences of homelessness. A broad range of diverse settings, cultures, and countries with a particular focus on homelessness in later life were included. The review has revealed homogeneity of experiences amongst homeless older adults, with the need for access to appropriate and affordable housing and adequate support systems.

The findings have identified pathways to homelessness require different prevention and support measures. People in the study who described a gradual pathway needed social support to address distress, which might have helped them avoid losing their homes. Those individuals with rapid pathways unanimously concluded that homelessness could have been avoided if independence and self-sufficiency were less regarded as a norm by society.

Availability of data and materials

The authors declare that all data generated or analysed during this study are included in this published article.

Bowling A, Dieppe P. What is successful ageing and who should define it? Bmj. 2005;331(7531):1548–51.

Article   Google Scholar  

Beard HPJR, Bloom DE. Towards a comprehensive public health response to population ageing. Lancet (London, England). 2015;385(9968):658.

Woolrych R, Gibson N, Sixsmith J, Sixsmith A. “No home, no place”: addressing the complexity of homelessness in old age through community dialogue. J Hous Elder. 2015;29(3):233–58.

Diener E, Chan MY. Happy people live longer: subjective well-being contributes to health and longevity. Appl Psychol. 2011;3(1):1–43.

Google Scholar  

Zufferey C, Yu N. The many faces of homelessness: a critical introduction. Faces of homelessness in the. Asia Pacific: Routledge; 2017. p. 1–8.

Book   Google Scholar  

Ploeg J, Hayward L, Woodward C, Johnston R. A case study of a Canadian homelessness intervention programme for elderly people. Health Soc Care Community. 2008;16(6):593–605.

Tutty LM, Bradshaw C, Schiff JW. Risks and assets for homelessness prevention: A literature review for the Calgary Homeless Foundation. Calgary: Calgary Homeless Foundation; 2009.

Echenberg H, Jensen H. Defining and enumerating homelessness in Canada. Publication No. PRB 08-30E 29. Social affairs division parliamentary information and research service; 2008.

Cohen CI. Aging and homelessness. The Gerontologist. 1999;39(1):5–15.

Article   CAS   Google Scholar  

Canham SL, Walsh CA, Sussman T, Humphries J, Nixon L, Burns VF. Identifying shelter and housing models for older people experiencing homelessness. J Aging Environ. 2021:1–22.

Lipmann B. Elderly homeless men and women: aged care's forgotten people. Aust Soc Work. 2009;62(2):272–86.

Quine S, Kendig H, Russell C, Touchard D. Health promotion for socially disadvantaged groups: the case of homeless older men in Australia. Health Promot Int. 2004;19(2):157–65.

Molinari VA, Brown LM, Frahm KA, Schinka JA, Casey R. Perceptions of homelessness in older homeless veterans, VA homeless program staff liaisons, and housing intervention providers. J Health Care Poor Underserved. 2013;24(2):487–98.

Crane M, Warnes AM. Homelessness among older people and service responses. Rev Clin Gerontol. 2010;20(4):354–63.

Grenier A, Sussman T, Barken R, Bourgeois-Guérin V, Rothwell D. ‘Growing old’in shelters and ‘on the street’: experiences of older homeless people. J Gerontol Soc Work. 2016;59(6):458–77.

Kushel M. Older homeless adults: can we do more? J Gen Intern Med. 2012;27(1):5–6.

McDonald L, Dergal J, Cleghorn L. Living on the margins: older homeless adults in Toronto. J Gerontol Soc Work. 2007;49(1–2):19–46.

Brown RT, Kiely DK, Bharel M, Mitchell SL. Geriatric syndromes in older homeless adults. J Gen Intern Med. 2012;27(1):16–22.

van Dongen SI, van Straaten B, Wolf JR, Onwuteaka-Philipsen BD, van der Heide A, Rietjens JA, et al. Self-reported health, healthcare service use and health-related needs: a comparison of older and younger homeless people. Health Soc Care Community. 2019;27(4):e379–e88.

PubMed   PubMed Central   Google Scholar  

Joanna Briggs Institute. Joanna briggs institute critical appraisal tools for use in JBI systematic review. Checklist for qualitative researcher’s manual 2017 edition. Adelaide: JBI; 2017.

Reynolds KA, Isaak CA, DeBoer T, Medved M, Distasio J, Katz LY, et al. Aging and homelessness in a Canadian context. Can J Community Mental Health. 2016;34:1–13.

Waldbrook N. Exploring opportunities for healthy aging among older persons with a history of homelessness in Toronto. Can Soc Sci Med. 2015;128:126–33.

Burns VF, Sussman T. Homeless for the first time in later life: uncovering more than one pathway. Gerontologist. 2019;59(2):251–9.

Viwatpanich K. Homelessness among the elderly in Bangkok metropolitan. J Med Assoc Thail. 2015;98:S118–30.

Bazari A, Patanwala M, Kaplan LM, Auerswald CL, Kushel MB. ‘The thing that really gets me is the future’: symptomatology in older homeless adults in the HOPE HOME study. J Pain Symptom Manag. 2018;56(2):195–204.

Bennett K. Homeless at home in East Durham. Antipode. 2011;43(4):960–85.

Saarnio L, Boström AM, Gustavsson P, Öhlén J. Meanings of at-homeness at end-of-life among older people. Scand J Caring Sci. 2016;30(2):312–9.

Nelson G, Patterson M, Kirst M, Macnaughton E, Isaak CA, Nolin D, et al. Life changes among homeless persons with mental illness: a longitudinal study of housing first and usual treatment. Psychiatr Serv. 2015;66(6):592–7.

Kwan JSK, Lau BHP, Cheung KSL. Toward a comprehensive model of frailty: an emerging concept from the Hong Kong centenarian study. J Am Med Dir Assoc. 2015;16(6):536. e1–7.

Download references

Acknowledgements

We would like to acknowledge Lisa Webb, Librarian, Edith Cowan University Library for her support in the literature search and Dr. Michael Stein, HDR Communication Advisor, Edith Cowan University for editing.

There are no separate funding source for this review as it is part of my full-time PhD study with the School of Nursing Midwifery, Edith Cowan University.

Author information

Authors and affiliations.

School of Nursing and Midwifery, Edith Cowan University, Building 21, Level 4, PhD room, Joondalup Campus, Joondalup, Western Australia, Australia

Phuntsho Om, Lisa Whitehead, Caroline Vafeas & Amanda Towell-Barnard

Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Science of Bhutan, Thimphu, Bhutan

Phuntsho Om

The Centre for Evidence-Informed Nursing, Midwifery and Healthcare Practice, a JBI Affiliated Group, Joondalup, Australia

Lisa Whitehead

You can also search for this author in PubMed   Google Scholar

Contributions

PO, LW, CV, and ATB substantially contributed to the conception and design of the article. All authors critically appraised the searched literature, discussed each item in the appraisal instrument for each study included in the review and interpreting the relevant findings. The primary author PO drafted the article and LW, CV and ATB revised it critically for important intellectual content. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Phuntsho Om .

Ethics declarations

Ethical approval and consent to participate.

The study was classified as exempt from ethical review approved by the Human Research Ethics Committee of Edith Cowan University. All material included in this review are in the public domain and not applicable as it is a review article. Accordance: We declare that this systematic review was conducted in accordance with Joanna Briggs Institute (JBI) method for systematic reviews using the qualitative assessment and review instrument (QARIs) to facilitate the meta-synthesis. This review was followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (2009).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests. We know of no conflicts of interest associated with this publication, and as corresponding author, I confirm that the manuscript has been read and approved for submission by all the named authors.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Om, P., Whitehead, L., Vafeas, C. et al. A qualitative systematic review on the experiences of homelessness among older adults. BMC Geriatr 22 , 363 (2022). https://doi.org/10.1186/s12877-022-02978-9

Download citation

Received : 06 July 2021

Accepted : 25 March 2022

Published : 25 April 2022

DOI : https://doi.org/10.1186/s12877-022-02978-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Homelessness
• Older adults
• Health and wellbeing
• Qualitative
• Systematic review

BMC Geriatrics

ISSN: 1471-2318

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Advertisement

Bringing Lived Experience to Research on Health and Homelessness: Perspectives of Researchers and Lived Experience Partners

• Fresh Focus
• Published: 19 May 2023
• Volume 59 , pages 1235–1242, ( 2023 )

Cite this article

• Howard Padwa   ORCID: orcid.org/0000-0002-1428-9277 1 ,
• Benjamin F. Henwood 2 ,
• Roya Ijadi-Maghsoodi 1 , 3 ,
• Bikki Tran-Smith 4 ,
• Anna Darby 5 ,
• Ricky Bluthenthal 6 ,
• Melissa Chinchilla 3 ,
• Katherine Diaz Vickery 7 ,
• Randall Kuhn 8 ,
• Alexander Lawton 8 ,
• Ena Fenderson 9 ,
• Elvin Galarza 10 ,
• Anthony Haynes 9 , 11 ,
• Dennis King 9 , 11 ,
• Emily Martiniuk 11 ,
• Pamela Marshall 10 ,
• Sonny Mendoza 10 ,
• Theodore Patton 11 ,
• Suzette Shaw 12 , 13 ,
• Reba Stevens 13 , 14 &
• Lillian Gelberg 3 , 15  

4233 Accesses

9 Altmetric

Explore all metrics

Improving health and healthcare for people experiencing homelessness (PEH) has become a national research priority. It is critical for research related to homelessness to be guided by input from PEH themselves. We are a group of researchers and individuals who have personally experienced homelessness collaborating on a study focused on homelessness and housing. In this Fresh Focus , we describe our partnership, lessons learned from our work together, what we have gained from our collaboration, and considerations for future homelessness research-lived experience partnerships.

Avoid common mistakes on your manuscript.

Homelessness is a growing social and public health crisis in the United States (U.S.), as approximately 580,000 individuals experienced homelessness on a given night in 2020 (U.S. Department of Housing and Urban Development, 2021 ). Compared to their housed counterparts, people experiencing homelessness (PEH) have elevated risk for serious health problems such as infectious disease (National Health Care for the Homeless Council – NHCH, 2019 ; Zlotnick,& Zerger. 2009 ; Zlotnick et al., 2013 ), behavioral health disorders (Fazel et al., 2008 ; Greenberg & Rosenheck, 2010 ; Zlotnick & Zerger, 2009 ), and multimorbidities (Vickery et al., 2021 ). Furthermore, the material hardships of homelessness accelerate aging, leading to the onset of geriatric conditions and medical conditions more typical of individuals 10–20 years older (Adams et al., 2007 ; Brown et al., 2012 ; Gelberg et al., 1990 ).

These issues are compounded by the fact that homelessness brings about significant barriers to consistent quality healthcare (Baggett et al., 2010 ; Zlotnick et al., 2013 ). Most PEH lack access to routine basic medical and behavioral services, and stigma and discrimination decrease treatment quality on the rare occasions they receive care (Baggett et al., 2010 ; Gilmer & Buccieri 2020 ; Jones et al., 2017 ; Jones et al., 2018 ; Mejia-Lancheros et al., 2020 ). The combination of increased risk, low access to services, and poor care quality has dire consequences. On average, individuals experiencing homelessness die 12 years younger than the rest of the U.S. population (NHCH, 2019 ).

The crisis of homelessness and health has spurred action, with the U.S. National Institutes of Health ( 2022 ) reporting that it is currently spending over $195 million to support 191 research projects related to homelessness as of August 2022, and other funders investing significantly in research on healthcare and homelessness. For this research to be impactful, it needs to be rooted in a solid understanding of the practical challenges homelessness brings. Basic necessities that are often taken for granted in the industrialized world—physical safety, private restrooms, and access to hygienic supplies, medication, food, and water—are rare luxuries when experiencing homelessness. Public responses to homelessness exacerbate these challenges. Ordinances prohibiting sleeping, resting, eating, panhandling, or sitting in public places lead to a de-facto criminalization of homelessness, causing constant stress and dislocation for PEH (Robinson, 2019 ; Tars, 2021 ). Forced evictions and law enforcement sweeps of encampments and tent communities frequently result in the loss or destruction of the few possessions PEH own (Tars, 2021 ). The impacts that these harsh realities have on well-being and ability to access services need to be incorporated into research on health and healthcare for populations experiencing homelessness.

Research on homelessness also needs to account for contextual factors that may inhibit participation in studies. Increasingly research utilizes digital platforms to collect data, but many PEH lack reliable access to the equipment or data plans needed to engage consistently as research participants (Humphry, 2019 ). Individuals living in encampments, shelters, and other congregate settings also lack privacy or quiet spaces needed to complete surveys and interviews. These factors are exacerbated by the fact that many studies do not recruit PEH directly, instead partnering with other homeless-interfacing institutions (e.g. housing programs, social service programs) to find and engage participants (Gordon, Baker, & Steffens, 2022 ). Many of these institutions have failed individuals experiencing homelessness in the past (Hoolachan, 2016 ; Woodhall-Melnik et al., 2018 ; Woodhall-Melnik et al., 2022 ), and studies’ association with them may compromise their trustworthiness in the eyes of potential participants, causing downstream problems for study recruitment, retention, and data quality.

In sum, research on homelessness and health is complex and nuanced, and researchers need to consider the aforementioned issues in all phases of study design and implementation. One way to do this is to engage people who have lived experience with homelessness as research partners (Franco et al., 2021 ; Kiser & Hulton 2018 ; Fletcher et al., 2022 ). Across healthcare and health services research, partnership with people with lived experience can contribute to the development of questions and outcomes that are more meaningful to patients and caregivers, and it is associated with higher levels of study enrollment and participant retention (Forsythe et al., 2019 ). With growing awareness of the importance of stakeholder partnership in research studies, funding agencies such as the National Institutes of Health and the Patient-Centered Outcomes Research Institute (PCORI) are increasingly providing research support to studies that rigorously incorporate stakeholder partnerships (Baker, 2022 ; Selby et al., 2012 ). In this paper, we—a group of homelessness researchers and individuals who have personally experienced homelessness—describe early phases of a study on homelessness and housing has brought us together. We share perspectives on what we have learned from our collaboration, what we have gained from our partnership, and lay out considerations for future efforts to integrate lived experience into research on homelessness.

Lived Experience and the Person-Centered Housing Options, Outcomes, Services, & Environment (PCHOOSE) Study

We formed our partnership to guide the Person-Centered Housing Options, Outcomes, Services, & Environment (PCHOOSE) study, a mixed-methods project examining the comparative effectiveness of different permanent supportive housing (PSH) configurations in improving housing, health, well-being, mental health, substance use, and healthcare utilization during the COVID-19 pandemic. The two models being studied are place-based PSH, which houses individuals in congregate settings where most residents are transitioning out of homelessness and supportive services are delivered onsite, and scattered-site PSH, which houses participants in apartments rented from private landlords and provides mobile case management services.

Our core investigative team consists of ten researchers from multiple disciplines, none of whom have personally experienced homelessness. To bring perspectives of individuals who have experienced homelessness and received housing services such as PSH to the project, the researchers organized a Lived Experience Group (LEG), consisting of eleven individuals with homelessness histories who have gone through the process of attaining and maintaining housing. LEG members were identified and recruited through pre-existing relationships that study investigators had with them from other projects and collaborations. Approximately half of LEG members (6/11) identify as male, and the majority of them (8/11) identify as Black or African American. The mean age of LEG members is 49 years old (SD = 15), and on average, they experienced 13.6 years of homelessness (SD = 11.9). LEG members are compensated for their time and expertise at the same rate as other project advisors and stakeholders (e.g. homelessness service advocates, policymakers, subject matter experts) who have been hired as study consultants.

We convene in meetings that bring together our core investigative team and our LEG roughly five times per year. LEG meetings occur on Zoom and generally last between 90 and 120 min. There have been twelve LEG meetings since July 2021. A member of the investigative team facilitates LEG meetings with support from other members of the research team. We organize LEG meetings around several principles of Community-Based Participatory Research (CBPR), including openness to influence from LEG members who do not have formal research training and recognition that LEG members’ strengths, resources, and experiences are invaluable assets for the research team (Israel et al., 2017 ; Wells et al., 2006 ). As described below, researchers made many decisions concerning study design and implementation based on recommendations from LEG members given their intimate, real-world knowledge of homelessness, the housing process, and mistrust PEH may have of researchers and the research process Acknowledging the structural disparities and inequalities between professional researchers and LEG members, the facilitator explicitly focuses on emphasizing and empowering the knowledge and expertise of LEG members, and making them equal partners in group discussions. Issues of race, ethnicity, and class often emerge during meetings, and both researchers and LEG members all discuss their own experiences, prejudices, and assumptions during meetings (Israel et al., 2017 ). To encourage honesty and trust, the group facilitator checks in with LEG members between meetings through surveys and one-to-one correspondence, eliciting feedback on how they feel about group meetings and ways that they could be improved.

The results presented below are a summary of how we have experienced this collaboration. The lead author—who is also the LEG group facilitator—wrote an outline of this summary based on detailed notes other team members took during LEG meetings, his own recollections of LEG discussions, and input he received from LEG members themselves. He then verified the trustworthiness of the notes and his interpretation of them through member-checking, having other investigators and LEG members review findings, and discuss them during a LEG meeting (Candela, 2019 ; Thomas, 2017 ). Next, LEG members shared their perspectives on the study and their experience with the lead author over email. The lead author analyzed respondent emails using content analysis (Hseih & Shannon, 2005), produced an outline summary of key themes and results that used direct quotes from LEG participants’ emails, and verified them through member-checking. All members of the core investigative team and the LEG are co-authors on this paper, and we all agree that the summary below is an accurate reflection of our experience and perspectives.

What We Have Learned So Far

We have learned that partnering with individuals who have personally experienced homelessness can enhance many phases of the research process, particularly ones that are challenging for scholars. For example, developing and implementing effective recruitment and retention strategies has historically been difficult in research on homelessness (Becker et al., 2014 ; North et al., 2012 ; Strehlau et al., 2017 ) When the researchers in our group asked LEG members how to address recruitment challenges, LEG members suggested that the study could be made more appealing if individuals who have personally experienced homelessness introduce the research and explain why it is important to potential participants. To do this, we created informational videos where LEG members introduced themselves, discussed their personal histories of homelessness, presented an overview of the study, explained why they believe the study is important, and emphasized that joining the study was a way for participants to make their voices heard. These videos were posted on the study’s webpage to help publicize the project. To help boost retention, LEG members provided the investigative team with input on how to use study funds to compensate participants after they took monthly surveys, and project researchers used these insights to design an incentive schedule that helped the study reach target follow-up rates.

LEG members have also contributed key insights that have helped the investigative team consider new perspectives when interpreting data and adjust its qualitative data collection and analysis plans accordingly. For example, when early quantitative data showed lower-than-expected rates of substance use among the study sample, LEG members suggested that study participants—all of whom had recently received PSH placements—could be underreporting substance use because they feared that if they disclosed alcohol or drug use the information could be used as “evidence” that could jeopardize their newly-secured housing. Based on this input, the study is emphasizing the confidentiality of all study data when asking participants about substance use, and considering the possibility that fear of disclosing substance use could be influencing the trends observed in quantitative and qualitative data When investigators shared early data about health service utilization, LEG members helped contextualize findings by highlighting that many respondents may have reported about mental health and substance use services—not primary care—in response to this question. The LEG members in our group explained that this is because for many PEH, the first thing that comes to mind when asked about “healthcare” is behavioral healthcare, since they see mental health and substance use service providers for groups, counseling, and medication regularly, but they only see physical healthcare providers when they are sick or injured. Based on these insights, the investigative team has supplemented qualitative semi-structured interview scripts and the accompanying analytic plan to be mindful that participants may define “healthcare” differently from the research team.

In one case, our LEG member insights contributed to the addition of new methodological approaches to the project. When the investigative team presented initial quantitative findings concerning social activity, it shared the information by highlighting differences and similarities among participants in different types of housing programs (place-based, scattered-site) since that was the focus of the original study. After hearing this analysis, LEG members highlighted that for many individuals in PSH, the perceived safety of the neighborhood and attractiveness of amenities available to them (e.g. shopping, parks)—not just the type of housing itself—could account for observed differences in social activity. Based largely on this insight, study investigators adjusted the qualitative data collection and analysis plans, supplementing traditional semi-structured interviews with recently-housed participants with photo-elicitation interviews (PEIs - Clark-Ibanez, 2004 ; Padgett, Smith, Derejko, Henwood, & Tiderington, 2013 ). In our PEIs, participants are asked take photos that they believe capture the essence of their daily lives on study-issued cell phones (which they already had been issued to take surveys) and share them with qualitative interviewers, who then use them as prompts to start conversations about participants’ neighborhood and day-to-day activities In addition to using PEI to facilitate interviews, the investigative team will also use the images themselves as a form of data (Richard & Lahman, 2015 ) that it will analyze, interpret, and integrate with other quantitative and qualitative data.

While helping the study add new dimensions to the study, LEG input has also kept the research team from pursuing activities that could have potentially undermined project success. When thinking about how to better capture information about how PSH spend their time, the investigative team considered adding a supplement to the study where a subset of participants would be given an option to have their study-issued phones’ geolocation data tracking activated and share location information with the project. When presented with this idea, LEG members strongly opposed it for several reasons. First, they expressed concern that for individuals who were survivors of abuse, the idea of geographic tracking could trigger a post-traumatic stress response or cause serious emotional distress. Second, LEG members highlighted that many PEH and recently housed individuals are highly concerned about surveillance and tracking, so the collection of such data could be seen as an inappropriate and suspicious invasion of privacy. When researchers on the team explained that they would inform participants that this information would be secure and used only by the study team, LEG members maintained that even so, proposing the idea could have negative impacts on the study. Many LEG members cautioned that PEH often feel “misled” by researchers after they complete studies because they are told that their participation will lead to improved services, but they rarely see substantive change. By adding a potentially troubling “ask” to the research project after initially enrolling participants only to collect information about health and quality of life information, LEG members felt that the study could come across as doing a “bait and switch” with participants, thus irrevocably compromising their trust in the study and potentially jeopardizing retention. Based on this input, the research team opted not to go back to participants to obtain additional consent to add the geo-tracking component to data collection after the study had already started.

What We Have Gained from Our Partnership

The researchers among us, while we had been highly cognizant of the challenges PEH face before, have gained a deeper understanding of what our LEG members term “the realism of homelessness, from real people” and the perspectives of “front-line soldiers who’ve lived and survived in that world (of homelessness)” though our collaboration. Getting to know the stories of misery, hardship, resilience, and recovery from LEG members with whom we have developed strong working relationships has added emotional depth and nuance to our understandings of individuals’ journeys through homelessness. Moreover, partnering with people with lived experience—and not just collecting data from them—has forced us to consider the perspectives of our participants first and foremost as we have designed and implemented the study. Consequently, we have taken information that is, as one LEG member writes, “very often overlooked or not seen as valid” seriously, and proactively tailored the study to be as cognizant of and responsive to the realities of homelessness as possible.

For the LEG members among us, collaborating with researchers has been an avenue for healing and empowerment. While LEG meetings are not specifically designed to be therapeutic, having a forum where we get to discuss some of our darkest and most vulnerable experiences from the past in a safe space bring us senses of emotional wellness and belonging. Using our past pain to help improve knowledge about homelessness and alleviate the suffering of our unsheltered and recently-housed neighbors makes us feel good, and that we are making a difference. For some of us, this research is one of the first opportunities we have had to contribute to something positive by making our voices heard. We also recognize that through this collaboration, we speak not only for ourselves, but for all of the people who are still suffering on the streets. We are empowered by the fact that when we contribute to this group and to research, and we are speaking for all of those who are suffering, but who have not yet found their voices or had a chance to be heard.

Considerations for Future Collaboration

Though our collaboration has been highly beneficial, we also recognize ways that future researcher-lived experience collaborative studies on homelessness and housing could be improved. First, the main question of our study—what is the comparative effectiveness of place-based and scattered-site housing—was generated by researchers based largely on a literature review. All of the LEG contributions discussed above occurred within the confines of a study that was already conceptualized by researchers who have not personally experienced homelessness, and chosen for funding by a scientific review committee that was likely mostly composed of individuals who had not experienced homelessness. If individuals with lived experience had played a more substantive role in conceptualizing our study, we may have designed it to better capture issues that LEG members believe are crucially important (such as the neighborhoods of PSH placements, and not just their configurations) from its outset. However, there are significant barriers—lack of resources to support the time of LEG members for conceptualizing studies that are not yet funded, not having the training and experience needed to design robust research projects, and unfamiliarity with the peer-review process among them—that make it difficult to meaningfully involve PEH in the development of research ideas. There are ways that future projects can address this issue. CBPR provides a roadmap that researchers can use to partner with community members—including those who have experienced homelessness—to develop research questions that address the community’s priorities, and not just those of researchers and scientific review boards (Fletcher et al., 2022 ; Forsythe et al., 2019 ; Franco et al., 2021 ; Israel et al., 2017 ; Kiser & Hulton 2018 ; Selby et al., 2012 ; Wells et al., 2006 ; Woodhall-Melnik et al., 2018 ; Woodhall-Melnik et al., 2022 ). The LEG group facilitator recently received funding to implement the Stakeholder Engagement in question Development and prioritization (SEED) method—an approach that combines CBPR principles with scientific reviews of available evidence to develop rigorous, community-driven ideas for research (Rafie et al., 2019 ; Zimmerman 2017 ; Zimmerman & Cook, 2017 ; Zimmerman et al., 2020 )—in collaboration with the LEG. Our hope is that this new project will continue bringing the benefits of CBPR to research on homelessness in the community, similar to how the U.S. Department of Veterans Affairs (VA) health system has been implementing CBPR with veterans who have experienced homelessness (Fletcher et al., 2022 ).

A second consideration for future collaboration is that our lived experience partners likely differ from much of the population experiencing homelessness in significant ways. In large part, this is because our LEG was formed by researchers who recruited members through pre-existing networks they had. Consequently, most LEG members have previously been involved in activities—such as volunteering for research projects, speaking at conferences, or working as peer advocates in PSH programs—that are not typically pursued by most people who experience homelessness. Many individuals exiting homelessness continue to experience a lack of meaningful activity and social integration, (Harris et al., 2019 ; Hawkins & Abrams, 2007 ; Pilla & Park-Taylor, 2022 ), and it is likely that that our LEG members are more active and engaged in their community than most people who are experiencing homelessness or transitioning to housing. Furthermore, in our study, lived experience contributions were confined to the perspectives of people who had previously experienced homelessness. No LEG members are currently unhoused, so their lived experience contributions of the LEG are based on retrospection—memory of the experience of homelessness in the past. The homelessness experience of LEG members is somewhat distal, with some individuals having been housed for over five years, so their understanding of homelessness could differ substantively from homelessness as it is today due to changes in the economy, society, and housing policy. If the LEG included people who are currently experiencing homelessness and/or received housing placements more recently, it could have potentially offered a different perspective to the project.

However, it is not clear if advising a research group would be a priority, or feasible, for people currently experiencing homelessness or who have been recently housed. The instability of being unhoused and logistical issues that often intersect with homelessness (e.g. lack of communication devices, transportation challenges, participation in residential behavioral health programs) make it difficult for PEH to engage with research teams and sustain these relationships (Fletcher et al., 2022 ). The same material and contextual factors that can affect their health and research participation also inhibit participation in academic-community collaborations. Furthermore, for most PEH, exiting homelessness and meeting basic needs for survival are pressing priorities, leaving them with little time or mental energy to dedicate to research (Fletcher et al., 2022 ). Even when partnering with people who had experienced homelessness but are currently housed this is an issue since individuals exiting homelessness tend to be under-employed and still struggle financially (Poremski et al., 2016 ). Several ongoing initiatives, including efforts being spearheaded by the National Health Care for the Homeless Council (National Health Care for the Homeless Council, 2022 ) and the VA (Fletcher et al., 2022 ), include individuals who are currently unhoused as research stakeholders. However, some of these efforts have encountered significant obstacles sustaining partnerships (Fletcher et al., 2022 ). Further research is needed to identify effective strategies and best practices not only for bringing people currently experiencing homelessness into research partnerships, but also to sustain these relationships.

It is notable that beyond improving the study, the LEG members among us have found partnership with researchers to be healing and empowering on a personal level. Homelessness can lead to experiences of trauma, marginalization, dehumanization, and exclusion (Hamilton et al., 2011 ; Magwood et al., 2019 ; Tsai et al., 2020 ), and activities that support empowerment, resilience, and a sense of personal mastery help facilitate the process of healing and recovery during the transition out of homelessness (Magwood et al., 2019 ; Manning & Greenwood 2019 ). The personal fulfillment and sense of meaning LEG members are deriving from this research partnership highlights how having individuals with lived experience join research teams can advance not only research, but also the process of healing and growth for PEH themselves. Finding purpose (conducting meaningful daily activities) and community (having relationships and social networks that provide support, friendship, love, and hope) are key dimensions of recovery (SAMHSA, 2023 ), and based on our experience, it seems that research partnerships can foster both. Future documentation of PEH’s experience in research partnerships, and its contributions to their senses of purpose and fulfillment, can help develop understanding of the role that partnering in research on homelessness can have for individuals who have experienced homelessness as they proceed on their own recovery journeys. At the same time, the limitations of research collaborations also need to be considered and better understood.

The Person-Centered Housing Options, Outcomes, Services, & Environment (PCHOOSE) study has benefited tremendously from the input of individuals who have lived experience with homelessness, underscoring the importance of bringing their voices to research. Our experience has shown how partnering with PEH can help investigators conduct research that is better informed by and aligned with the real-world experience of homelessness. At the same time, partnering with researchers seems to provide individuals with lived experience with opportunities for healing and empowerment, furthering their recovery from homelessness. Though these partnerships require a significant investment of time and resources, they can be critical to ensuring that research generates knowledge that improves clinical practice and policy, and contributes to the broader goal of improving the lives of individuals impacted by our nation’s homelessness crisis.

Adams, J., Rosenheck, R., Gee, L., Seibyl, C. L., & Kushel, M. (2007). Hospitalized younger: A comparison of a national sample of homeless and housed inpatient veterans. Journal of Heatlh Care for the Poor and Underserved , 21 (4), 1234–1249.

Google Scholar  

Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: A national study. American Journal of Public Health , 100 (7), 1326–1333. https://doi.org/10.2105/AJPH.2009.180109

Article   PubMed   PubMed Central   Google Scholar  

Baker, R. G. (2022). Welcoming Patients’ Lived Experience Into the Lab: A Message from Rebecca G. Baker, Ph.D., Director of the NIH HEAL Initiative. Retrieved from https://heal.nih.gov/about/director/patient-engagement . Accessed March 10, 2023.

Becker, K., Berry, S., Orr, N., & Perlman, J. (2014). Finding the hard to reach and keeping them engaged in research. In R. Tourangeau, B. Edwards, T. Johnson, K. Wolter, & N. Bates (Eds.), Hard-to-survey populations (pp. 619–641). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9781139381635.036 [Crossref], [Google Scholar].

Chapter   Google Scholar  

Brown, R. T., Kiely, D. K., Bharel, M., & Mitchell, S. L. (2012). Geriatric syndromes in older homeless adults. Journal of General Internal Medicine , 27 (1), 16–22. https://doi.org/10.1007/s11606-011-1848-9

Article   PubMed   Google Scholar  

Candela, A. G. (2019). Exploring the function of member checking. The Qualitative Report , 24 (3), 619–628.

Clark-Ibáñez, M. (2004). Framing the social world with photo-elicitation interviews. American Behavioral Scientist , 47 (12), 1507–1527. https://doi.org/10.1177/0002764204266236

Article   Google Scholar  

Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS Medicine , 5 (12), e225. https://doi.org/10.1371/journal.pmed.0050225

Fletcher, E. H., Gabriellan, S., Brown, L., Gough, J. C., Ijadi-Maghsoodi, R., Kolofonos, I., Nazinyan, M., Orellana, E., & Wells, K. (2022). Lessons learned by collaborating with structurally vulnerable veterans via a Veterans Engagement Group. Journal of General Internal Medicine , 37 (S1), 109–112. https://doi.org/10.1007/s11606-021-07075-y

Forsythe, L. P., Carman, K. L., Szydlowski, V., Fayish, L., Davidson, L., Hickam, D. H., Hall, C., Bhat, G., Neu, D., Stewart, L., Jalowsky, M., Aronson, N., & Ayanwu, C. U. (2019). Patient engagement in research: Early findings from the patient-centered outcomes Research Institute. Health Affairs (Millwood) , 38 (3), 359–367. https://doi.org/10.1377/hlthaff.2018.05067

Franco, A., Meldrum, J., & Ngairuiya, C. (2021). Identifying homeless population needs in the emergency department using community-based participatory research. BMC Health Research , 21 (428), https://doi.org/10.1186/s12913-021-06426-z

Gelberg, L., Linn, L. S., & Mayer-Oakes, A. (1990). Differences in health status between older and younger homeless adults. Journal of the American Geriatrics Society , 38 (11), 1220–1229. https://doi.org/10.1111/j.1532-5415.1990.tb01503.x

Article   CAS   PubMed   Google Scholar  

Buccieri, K. (2020). Homeless patients associate clinician bias with suboptimal care for mental illness, addictions, and chronic pain. Journal of Primary Care and Community Health , 11 , 1–7. https://doi.org/10.1177/2150132720910289

Gordon, S.J., Baker, N., & Steffens, M. (2022). Appropriate and acceptable health assessments for people experiencing homelessness. BMC Public Health , 22 :1289. https://doi.org/10.1186/s12889-022-13723-7

Greenberg, G. A., & Rosenheck, R. A. (2010). Mental health correlates of past homelessness in the National Comborbidity Study Replication. Journal of Health Care for the Poor and Undeserved , 21 (4), 1234–1249.

Hamilton, A. B., Poza, I., & Washington, D. L. (2011). Homelessness and trauma go hand-in-hand”: Pathways to homelessness among women Veterans. Women’s Health Issues , 21 (4), S203–S209. https://doi.org/10.1016/j.whi.2011.04.005

Harris, T., Rhoades, H., Duan, L., & Wenzel, S. L. (2019). Mental health change in the transition to permanent supportive housing: The role of housing and social networks. Journal of Community Psychology , 47 (8), 1834–1849. https://doi.org/10.1002/jcop.22230

Hawkins, R., & Abrams, C. (2007). Disappearing acts: The social networks of formerly homeless individuals with co-occurring disorders. Social Science & Medicine , 65 (10), 2031–2042. https://doi.org/10.1016/j.socscimed.2007.06.019

Hoolachan, J. E. (2016). Ethnography and homelessness research. International Journal of Housing Policy, 16 (1), 31–49. https://doi.org/10.1080/14616718.2015.1076625 Hsieh, H.F., & Shannon, S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15 (9), 1277–1288. https://doi.org/10.1177/1049732305276687

Humphry, J. (2019). Digital First”: Homelessness and data use in an online service environment. Communication Research and Practice , 5 (2), 172–187. https://doi.org/10.1080/22041451.2019.1601418

Israel, B. A., Schulz, A. J., Parker, E. A., Becker, A. B., Allen, A. J., Guzman, J. R., & Lichtenstein, R. (2017). Critical issues in developing and following CBPR Principles. In N. Wallerstein, B. Duran, J. Oetzel, & M. Minkler (Eds.), Community-based Participatory Research for Health: Advancing Social and Health Equity (3rd edition., pp. 31–45). San Francisco: John Wiley & Sons, Inc.

Jones, A. L., Haussman, L. R., Haas, G. L., Mor, M. K., Cashy, J. P., Schaefer, J. H., & Gordon, A. J. (2017). A national evaluation of homeless and nonhomeless veterans’ experiences with primary care. Psychological Services , 14 (2), 174–183. https://doi.org/10.1037/ser0000116

Jones, A. L., Haussman, L. R., Kertesz, S., Ying, S., Cashy, J. P., Mor, M. K., Schaefer, J. H., Gundlapalli, A. V., & Gordon, A. J. (2018). Difference in experiences with care between homeless and nonhomeless patients in Veterans Affairs facilities with tailored and non-tailored primary care teams. Medical Care , 56 (7), 610–618. https://doi.org/10.1097/MLR.0000000000000926

Hulton, L. (2018). Addressing health care needs in the homeless population: A new approach using participatory action research. SAGE Open , 8 (3), https://doi.org/10.1177/215824401878975

Magwood, O., Leki, V.Y., Kpade, V., Saad, A., Alkhateeb, Q., Gebremeskel, A… Pottie,K. (2019). Common trust and personal safety issues: a systematic review on the acceptability of health and social interventions for persons with lived experience of homelessness. PLoS One, 14 (12), e0226306. https://doi.org/10.1371/journal. pone.0226306

Manning, R. M., & Greenwood, R. M. (2019). Recovery in homelessness: The influence of choice and mastery on physical health, psychiatric symptoms, alcohol and drug use, and community integration. Psychiatric Rehabilitation Journal , 42 (2), 147–157. https://doi.org/10.1037/prj0000350

Mejia-Lancheros, C., Lachaud, J., O’Campo, P., Wiens, K., Nisenbaum, R., Wang, R., Hwang, S. W., & Stergiopoulos, V. (2020). Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PloS One , 15 (2), e0229385. https://doi.org/10.1371/journal.pone.0229385

Article   CAS   PubMed   PubMed Central   Google Scholar  

National Health Care for the Homeless Council. Homelessness & Health: What’s the Connection? National Health Care for the Homeless Council (2019).; Retrieved from https://nhchc.org/wp-content/uploads/2019/08/homelessness-and-health.pdf . Accessed May 27, 2022.

National Health Care for the Homeless Council (2022). National Consumer Advisory Board. https://nhchc.org/consumers/ncab/ Accessed August 2, 2022.

North, C., Black, M., & Pollio, D. (2012). Predictors of successful tracking over time in a homeless population. Social Work Research , 36 , 153–159. https://doi.org/10.1093/swr/svs005

Padgett, D. K., Smith, B. T., Derejko, K. S., Henwood, B. F., & Tiderington, E. (2013). A picture is worth… Photo elicitation interviewing with formerly homeless adults. Qualitative Health Research , 23 (11), 1435–1444. https://doi.org/10.1177/1049732313507752

Pilla, D., & Park-Taylor, J. (2022). Halfway Independent”: Experiences of formerly homeless adults living in permanent supportive housing. Journal of Community Psychology , 50 (3), 1411–1429. https://doi.org/10.1002/jcop.22724

Poremski, D., Stergiopoulos, V., Braithwaite, E., Distasio, J., Nisenbaum, R., & Latimer, E. (2016). Effects of Housing First on Employment and Income of Homeless individuals: Results of a Randomized Trail. Psychiatric Services , 67 (6), 603–609. https://doi.org/10.1176/appi.ps.201500002

Rafie, C. L., Zimmerman, E. B., Moser, D. E., Cook, S., & Zarghami, F. (2019). A lung cancer research agenda that reflects the diverse perspectives of community stakeholders: Process and outcomes of the SEED method. Research Involvement and Engagement , 5 , 3. https://doi.org/10.1186/s40900-018-0134-y

Richard, V. M., & Lahman, M. K. (2015). Photo-elicitation: Reflexivity on method, analysis, and graphic portraits. International Journal of Research & Method in Education , 38 (1), 3–22. https://doi.org/10.1080/1743727X.2013.843073

Robinson, R. (2019). No right to rest: Policy enforcement and quality of life consequences of the criminalization of homelessness. Urban Affairs Review , 55 (1), 41–73. https://doi.org/10.1177/1078087417690833

Selby, J. V., Beal, A. C., & Frank, L. (2012). The patient-centered outcomes Research Institute (PCORI) national priorities for research and initial research agenda. Journal of the American Medical Association , 307 (15), 1583–1584. https://doi.org/10.1001/jama.2012.500

Strehlau, V., Torchalla, I., Patterson, M., Moniruzzaman, A., Liang, A., Addorisio, S., Frankish, J., Krausz, M., & Somers, J. (2017). Recruitment and retention fo homeless individuals with mental illness in a housing first intervention study. Contemporary Clinical Trials Communications , 7 , 48–57. https://doi.org/10.1016/j.conctc.2017.05.001

Substance Use and Mental Health Services Administration (SAMHSA) (2023). Recovery and Recovery Support Retrieved from https://www.samhsa.gov/find-help/recovery . Accessed February 24, 2023.

Tars, E. S. (2021). Criminalization of Homelessness National Low Income Housing Coalition. Retrieved from https://nlihc.org/sites/default/files/AG-2021/06-08_Criminalization-of-Homelessness.pdf . Accessed May 23, 2022.

Thomas, D. R. (2017). Feedback from research participants: Are member checks useful in qualitative research? Qualitative Research in Psychology , 14 (1), 23–41. https://doi.org/10.1080/14780887.2016.1219435

Tsai, J., Schick, V., Hernandez, B., & Pietrzak, R. H. (2020). Is homelessness a traumatic event? Results from the 2019–2020 National Health and Resilience in Veterans Study. Depression and Anxiety , 37 (11), 1137–1145. https://doi.org/10.1002/da.23098

U.S. Department of Housing and Urban Development (2021). The 2020 Annual Homeless Assessment Report (AHAR) Assessment Report to Congress U.S. Department of Housing and Urban Development, Office of Community Planning and Development. Retrieved from https://www.huduser.gov/portal/sites/default/files/pdf/2021-AHAR-Part-1 .pdf Accessed May 27, 2021.

U.S. National Institutes of Health (2022). NIH RePORTER. Retrieved from https://reporter.nih.gov/ Accessed August 1, 2022.

Vickery, K. D., Winkelman, T., Ford, B. R., Busch, A., Robertshaw, D., Pittman, B., & Gelberg, L. (2021). Trends in trimorbidity among adults experiencing homelessness in Minnesota, 2000–2018. Medical Care , 59 (S2), S220–S227. https://doi.org/10.1097/MLR.0000000000001435

Wells, K. B., Staunton, A., Norris, K. C., Bluthenthal, R., Chung, B., Gelberg, L., Jones, L., Kataoka, S., Koegel, P., Miranda, J., Mangione, C. M., Patel, K., Rodriguez, M., Shapiro, M., & Wong, M. (2006). Building an academic-community partnered network for clinical services research: The Community Health Improvement Collaborative (CHIC). Ethnicity & Disease , 16 (Supp 1), S3–17.

Woodhall-Melnik, J., Dunn, J. R., Svenson, S., Patterson, C., & Matheson, F. I. (2018). Men’s experiences of early life trauma and pathways into long-term homelessness. Child Abuse & Neglect , 80 , 216–225. https://doi.org/10.1016/j.chiabu.2018.03.027

Woodhall-Melnik, J., Hamilton-Wright, S., Hamilton-Wright, E., Guilcher, S. J. T., & Matheson, F. I. (2022). Getting help: Findings from two World cafes with youth who experience homelessness. Canadian Journal of Family and Youth , 14 (3), 52–77. https://doi.org/10.29173/cjfy29797

Zimmerman, E. B., & Cook, S. K. (2017). SEED Method Toolkit for Stakeholder Engagement in Question Development and Prioritization . Virginia Commonwealth University Center on Society and Health. Richmond, VA.

Zimmerman, E. B., Cook, S. K., Haley, A. D., Woolf, S. H., Prince, S. K., & Engaging Richmond Team. (2017). A patient and provider research agenda on diabetes and hypertension management. American Journal of Preventive Medicine , 53 (1), 123–129. https://doi.org/10.1016/j.amepre.2017.01.034

Zimmerman, E. B., Rafie, C. L., Moser, D. E., Hargrove, A., Noew, T., & Mills, C. A. (2020). Participatory action planning ot the address the opioid crisis in a rural Virginia community using the SEED method. Journal of Participatory Research Methods , 1 (1), https://doi.org/10.35844/001c.13182

Zlotnick, C., & Zerger, S. (2009). Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs. Health & Social Care in the Community , 17 (1), 18–26. https://doi.org/10.1111/j.1365-2524.2008.00793.x

Zlotnick, C., Zerger, S., & Wolfe, P. B. (2013). Health care for the homeless: What have we learned in the past 30 years and what’s next. American Journal of Public Health , 100 (7), 1326–1333. https://doi.org/10.2105/AJPH.2013.301586

Download references

Acknowledgements

The work reported in this article was funded through Patient-Centered Outcomes Research Institute Contract COVID-2020C2-10933. The views and opinions in this article are solely the responsibility of the authors, and do not necessarily represent the views of are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.

Author information

Authors and affiliations.

Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA, 90024, USA

Howard Padwa & Roya Ijadi-Maghsoodi

Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA

Benjamin F. Henwood

Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA

Roya Ijadi-Maghsoodi, Melissa Chinchilla & Lillian Gelberg

Department of Biomedical & Health Sciences, University of Vermont, 149 Beaumont Avenue, Burlington, VT, 05405, USA

Bikki Tran-Smith

Department of Emergency Medicine, University of California, Los Angeles, 924 Westwood Blvd, Los Angeles, CA, 90024, USA

Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA

Ricky Bluthenthal

Health, Homelessness, & Criminal Justice Lab, Hennepin Healthcare Research Institute, 825 8th St S., Minneapolis, MN, 55404, USA

Katherine Diaz Vickery

Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA

Randall Kuhn & Alexander Lawton

Skid Row Housing Trust, Los Angeles, CA, USA

Ena Fenderson, Anthony Haynes & Dennis King

Homelessness Advocate, Los Angeles, CA, USA

Elvin Galarza, Pamela Marshall & Sonny Mendoza

Corporation for Supportive Housing, Los Angeles, CA, USA

Anthony Haynes, Dennis King, Emily Martiniuk & Theodore Patton

National Alliance to End Homelessness, Los Angeles, CA, USA

Suzette Shaw

Los Angeles County Continuum of Care Board, Los Angeles, CA, USA

Suzette Shaw & Reba Stevens

Los Angeles County Mental Health Commission, Los Angeles, CA, USA

Reba Stevens

Department of Family Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA

Lillian Gelberg

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Howard Padwa .

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Padwa, H., Henwood, B.F., Ijadi-Maghsoodi, R. et al. Bringing Lived Experience to Research on Health and Homelessness: Perspectives of Researchers and Lived Experience Partners. Community Ment Health J 59 , 1235–1242 (2023). https://doi.org/10.1007/s10597-023-01138-6

Download citation

Received : 02 November 2022

Accepted : 10 May 2023

Published : 19 May 2023

Issue Date : October 2023

DOI : https://doi.org/10.1007/s10597-023-01138-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Homelessness
• Patient engagement
• Patient-centered research
• Research methods
• Find a journal
• Publish with us
• Track your research

What can social workers do to help the growing number of people experiencing homelessness? The view from an urban hospital Emergency Department

Article sidebar.

Main Article Content

Homelessness is a growing problem nationwide. According to the U.S. Department of Housing and Urban Development (HUD), the number of people experiencing homelessness rose 12% from 2022 to 2023 (HUD Exchange, 2024b). Low vacancy rates, increased rent costs, and income inequality all comprise difficult structural factors locking people out of the housing market. Those who most harshly bear the brunt of this crisis are people with social vulnerabilities. This paper analyzes the social problem of homelessness from the perspective of an urban hospital Emergency Department (ED), Yale New Haven Hospital (YNHH) in New Haven, Connecticut. Social workers in these settings have a dual role: working directly with individuals and families to connect them with available services and resources and advocating for structural interventions that can ultimately ease this problem. Social workers are also at the forefront of combating any stigma unhoused persons face by both approaching patients experiencing homelessness with dignity and respect while educating others that this problem is not one of the individual, but is rather a consequence of multiple other social problems we have collectively failed to address.

Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License .

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• BMC Med Inform Decis Mak

Analyzing the impact of social factors on homelessness: a Fuzzy Cognitive Map approach

Vijay k mago.

1 The Modelling of Complex Social Systems (MoCSSy) Program, The IRMACS Centre, Simon Fraser University, Burnaby, Canada

Hilary K Morden

2 Department of Criminology, Simon Fraser University, Burnaby, Canada

Charles Fritz

3 Department of Geography, Simon Fraser University, Burnaby, Canada

Tiankuang Wu

4 Department of Mathematics, Simon Fraser University, Burnaby, Canada

Sara Namazi

5 School of Computing Science, Simon Fraser University, Burnaby, Canada

Parastoo Geranmayeh

Rakhi chattopadhyay, vahid dabbaghian.

The forces which affect homelessness are complex and often interactive in nature. Social forces such as addictions, family breakdown, and mental illness are compounded by structural forces such as lack of available low-cost housing, poor economic conditions, and insufficient mental health services. Together these factors impact levels of homelessness through their dynamic relations. Historic models, which are static in nature, have only been marginally successful in capturing these relationships.

Fuzzy Logic (FL) and fuzzy cognitive maps (FCMs) are particularly suited to the modeling of complex social problems, such as homelessness, due to their inherent ability to model intricate, interactive systems often described in vague conceptual terms and then organize them into a specific, concrete form (i.e., the FCM) which can be readily understood by social scientists and others. Using FL we converted information, taken from recently published, peer reviewed articles, for a select group of factors related to homelessness and then calculated the strength of influence (weights) for pairs of factors. We then used these weighted relationships in a FCM to test the effects of increasing or decreasing individual or groups of factors. Results of these trials were explainable according to current empirical knowledge related to homelessness.

Prior graphic maps of homelessness have been of limited use due to the dynamic nature of the concepts related to homelessness. The FCM technique captures greater degrees of dynamism and complexity than static models, allowing relevant concepts to be manipulated and interacted. This, in turn, allows for a much more realistic picture of homelessness. Through network analysis of the FCM we determined that Education exerts the greatest force in the model and hence impacts the dynamism and complexity of a social problem such as homelessness.

Conclusions

The FCM built to model the complex social system of homelessness reasonably represented reality for the sample scenarios created. This confirmed that the model worked and that a search of peer reviewed, academic literature is a reasonable foundation upon which to build the model. Further, it was determined that the direction and strengths of relationships between concepts included in this map are a reasonable approximation of their action in reality. However, dynamic models are not without their limitations and must be acknowledged as inherently exploratory.

Homelessness

Homelessness is a complex social problem with a variety of underlying economic and social factors such as poverty, lack of affordable housing, uncertain physical and mental health, addictions, and community and family breakdown. These factors, in varying combinations, contribute to duration, frequency, and type of homelessness. To be fully homeless is to live without shelter; however, many experience partial homelessness that can include uncertain, temporary, or sub-standard shelter. Homelessness is difficult to define, thus governments struggle with uncertainty when creating and implementing policies they hope will effectively manage or eradicate this problem.

Levels of government, in countries like Canada, add to the complexity of dealing with homelessness. Being governed at three different levels, federal, provincial, and municipal, requires high levels of agreement to effectively create and administer policies. In Canada, each level of government is responsible for different facets of homelessness. The federal government, responsible for the whole of Canada, creates and administers policies and funding for aboriginal peoples (a segment of Canada’s population over-represented in homeless counts), seniors, and social housing, as well as transfers funds to the provinces to help pay for their social programs. The provincial government, responsible for needs of the provinces and territories, creates and administers policies regarding mental illness, addictions, welfare, minimum wage laws, landlord and tenant acts, and child protection services and shares responsibility with the federal government for seniors and social housing. The municipal governments, are seen as the hands or arms of the provincial government, and are technically not responsible for homelessness; however are often involved in choosing sites for social housing, supporting emergency shelters and hospital emergency wards, as well as providing support, in a variety of ways, to facilitate these initiatives. The fact that there is no comprehensive national housing strategy to co-ordinate these levels of government often leads to inadequate policies and funding that fall far short of meeting the country’s housing needs [ 1 ]. This lack of coordination towards policy and funding for homelessness has recently come to the attention of courts in Canada who have begun to make decisions which support shelter as an essential right for Canadians [ 2 ]. The UN Special Rapporteur on adequate housing in Canada has also strongly urged the federal government to commit sufficient funding to create a national housing strategy by working with the provinces and territories [ 3 ].

Metro Vancouver is one city in Canada which conducts a comprehensive homeless count every three years [ 4 ]. Counters make every effort to include in the count those considered sheltered homeless (individuals who spend nights in shelters, safe houses, transition houses, hospitals, jails, remand centres, and detox/recovery facilities) and those who are unsheltered homeless (individuals who spend their nights unsheltered on streets, in parks, or at drop-in programs). Counts are shown in Figure ​ Figure1 1 .

Homeless count in Metro Vancouver.

It becomes apparent that if the complex and oft-times chaotic experiences such as job loss that lead to family breakdown, mental illness, and drug/alcohol addiction, which may lead to homelessness, were better understood then social policies and procedures which constitute “best practices” would be more effective in reducing and preventing homelessness [ 5 ]. Fuzzy logic and fuzzy cognitive maps are especially useful for modelling complex social problems due to their inherent ability to capture and model vague concepts and values [ 6 ]. In relationship to homelessness, syllogisms such as, “if there is a lack of affordable housing, then there will be a significant increase in homelessness” can be accurately modelled by assigning a value to the parameter based on the retrieved linguistic terms taken from existing empirical literature. In this way greater meaning, which captures and aggregates the nuances of the stressors and protective factors, is given to the existing empirical literature related to homelessness. This also allows the complex social issue to be graphically described in a manner which may be more readily understood. This, in turn, may then help social policy-makers to refine their decision-making, leading to effective changes in social policies with the goal of reducing homelessness.

Fuzzy logic (FL) is a mutli-valued logic technique that is approximate. Rather than using traditional logic theory where binary sets have a two-valued logic (i.e., true, 1, and false, 0), fuzzy variables have a truth-value between 0 and 1, allowing them to be valued between absolutely true and absolutely false. Using linguistic variables, taken from empirical literature that describes the effect each factor in a knowledge system has on the others, FL can be used to convert the effects into values between 0 and 1. Once determined, these values can then be input into a graphical representation of the system containing all factors with directed lines (edges) showing the calculated strength of the causal relationship between them. This graphical representation is known as a fuzzy cognitive map (FCM). A brief description of the techniques, with an example is presented in the subsequent subsection.

Fuzzy Cognitive Map (FCM)

The FCM is a framework used for modelling interdependence between concepts in the real-world [ 7 ]. This is achieved by graphically representing the causal reasoning relationships between vague or un-crisp concepts [ 6 , 8 ]. FCMs allow scientists to construct virtual worlds in which some of the complex and interdependent concepts of a scenario can be captured and their interactions or causal relationships modelled. Knowledge representation in these maps has an acquisition-processing trade-off. FCMs, by providing a fuzzy graph structure for systematic causal propagation and ease in processing fuzzy knowledge, are applicable in soft-knowledge domains such as the social sciences. At the core of the FCM structure are the concepts to be studied and modelled. Concepts can be understood to represent actors or the parts of the environment which have impact on some phenomenon of interest (and each other), such as those included in the simple FCM of heart disease illustrated in Figure ​ Figure2 2 .

Example of a simple FCM to assess heart disease.

The concepts, determined empirically, which relate to heart disease in this model include: exercise (E), food habits (FH), cholesterol (C), blood pressure (BP), and body weight (BW). The links, directionally joining the concepts, represent the fuzzy causal relationships.

Concepts which have no impact on other concepts are not represented via links on the map, however are represented in the subsequent constructed adjacency matrix W and denoted, 0.

As can be seen in Figure ​ Figure2, 2 , there is no direct effect of BW on C and therefore no link is drawn between these two concepts. The weight values {−1,0,1} are used at this stage for simplicity and testing the FCM and are later refined through the application of empirical linguistic terms and modifiers processed through FL.

The use of an FCM is particularly advantageous for graphically representing the interacting relationships of concepts which appear in phenomena related to social science, political science, organizational theory, military science, and international relations [ 8 ]. The connection matrix, W , may also be defined algebraically, demonstrating the influence concepts have on one another [ 7 ].

Let us denote the i t h concepts of a system as C i . Then the value A i , of a concept C i , expresses the quantity of its corresponding physical value. The FCM converges to a steady state when:

At each step, the value A i of a concept is influenced by the values of concepts-nodes connected to it and is updated according to the following formula:

where A i ( k ) is the value of concept C i at step k, A j ( k ) is the value of concept C j at step k, W ji is the weight of the interconnection from concept C j to concept C i and f is the threshold function used to bound the transformation to a limit cycle. In this example, f ( x ) is a sign function defined in MATLAB [ 9 ] with the following functionality:

Following our heart disease example, consider: the concept, E, is active for some individual. Therefore, E =1. No information is available for all other concepts in the map. Therefore, F H =0, C =0, B W =0, and B P =0. This is expressed by a vector C 1 = (1,0,0,0,0,0). According to equations 2 and 3, the processing is listed in Table ​ Table1 1 .

FCM processing when excercise = 1

The right arrow indicates the threshold function operation in Equation 3. The above results demonstrate that it takes four steps for the system to converge to a stable state (limit cycle). The vector C 4 demonstrates that the increase in E eventually leads to decreases in C, BW, BP, and HD.

The FCM created for our study provides a graphical description of homelessness and facilitates increased understanding of this complex social problem. Through simulation, the usefulness of such a model is demonstrated and implications for its use in policy decision-making are explored. As shown, FCMs related to complex social problems, allow for refinement of knowledge through graphical understanding and simulations that may be useful in improving social policies with the goal of reducing homelessness.

Virtual common-sense map of homelessness

First a virtual common-sense map was built based on the researchers’ personal and historical knowledge of the factors which they perceived to affect homelessness. Using homelessness as the central hub of the map, concepts which directly or indirectly, positively or negatively affected homelessness, and each other, were linked through directed edges. Each edge was assigned a weight depending on whether the antecedent concept exerted a positive effect (+1) or a negative effect (−1) on the consequent concept (Figure ​ (Figure3). 3 ). Three prototypical cases were then developed and the model was run to ensure it would function in accordance with the determined relationships prior to the actual weights on the edges being refined through a literature search for the linguistic terms.

Virtual common-sense map of homelessness.

Experimentation: Virtual common-sense map

Experimentation with the virtual common-sense model was conducted to ensure that it would perform as expected and reach a stable state after iterating prior to the input of the actual weight values. Sample cases were constructed with the goal of describing an extreme case, most likely to result in homelessness; an extreme case, least likely to result in homelessness; and a middle case, more closely representing the possibilities of the real world, in which the likelihood of homelessness would be uncertain, see Table ​ Table2. 2 .

Summary of expected outcome, concepts activated and iteration process for three sample cases

• Case 1 : In this scenario, the protective factor of rental subsidy was incapable of preventing the negative social factors, criminal justice system involvement, addictions, and mental illness from overwhelming the model - resulting in certain homelessness.

• Case 2 : In this scenario, the protective factors of education and increased income resulted in the elimination of the need for non-government assistance and a decrease in the likelihood of criminal justice system interaction. This is a highly likely outcome given that those with higher incomes and education are better able to identify and seek help for their mental illnesses which increases the likelihood that they will avoid incarceration. However, the strength of income and education as protective factors against increasing mental illness is shown to be ineffective and the level of mental illness continues to rise. Despite the increase in mental illness, education and income will ensure an ongoing ability to provide shelter, resulting in homelessness being an extremely unlikely outcome.

• Case 3 : In this scenario, at the end of iteration 1, the effects of addiction, prior criminal justice system involvement, and family breakdown are held at bay by the protective factors of income, education and counselling. However, due to the known cumulative negative effects of addiction, social isolation increases, signalling the likelihood that, over time, there will be an increased possibility of family breakdown and greater challenges controlling the addiction resulting in the increased likelihood of crime. Iteration 2 demonstrates the actions of all the concepts present in iteration 1 continuing to exert force on the model with the addition of an increase in mental illness caused by the ongoing addiction resulting in an increasing likelihood of homelessness. As the model continues to iterate, the addictions contribute to increasing social isolation and criminal behavior resulting in a greater likelihood of family breakdown. At this point the protective factors of education, income and counselling are overwhelmed by the ongoing addictions and resulting mental illness and crime and the likelihood of homelessness rises. However, given that education and income continue to exert force, homelessness is not a certainty.

Given the fully explainable results of the model and the fact that it was able to achieve stability after iterating, it was determined that the model functioned properly, and the process of refining the concepts through the search of timely empirical literature was conducted.

Fuzzy Cognitive Map of homelessness supported by empirical studies

To refine the edge weights on the FCM, timely, empirical literature was searched. The original causal map was referred to for the paired concepts such as, education and homelessness. These linked terms were then searched using the academic search engine, Google Scholar. Numerous articles were retrieved and scanned for each pair of linked concepts using only recently published (since the year 2000), peer reviewed, empirical articles. This culminated in the capture of three linguistic statements per concept pair for use in refining the map (see Table ​ Table3). 3 ). Linguistic statements were required to be in the antecedent - consequent form as earlier described. In the process of searching, paired concepts were refined (edges and concepts added and removed from the virtual common-sense map Figure ​ Figure3 3 after though deliberation with research team) resulting in a final map of 14 concepts and 31 edges (Figure ​ (Figure4). 4 ). To maintain the semantic consistency amongst various concepts, Oxford Canadian Dictionary [ 10 ] was followed.

Linguistic terms and the references

Fuzzy Cognitive Map with qualitative weighted edges.

To calculate the quantitative weight values for each edge, first the qualitative weight values for each of the retrieved linguistic terms was assessed. A Likert-type scale was devised to determine the qualitative weight of each linguistic term. The values, Very Low (VL), Low (L), Medium (M), High (H), and Very High (VH) were used to categorize each term. We only consider five qualitative values for the sake of simplicity. However, the scale could be less or more than five, depending on the intricacies of the system under consideration. Consensus on meaning was achieved through discussion and vote. This process resulted in a scale of ordered and ranked values for each concept pair. For example, it might be stated in one peer-reviewed study that the effect of concept A on concept B was, “profound”; whereas another article may state that the effect was, “significant”. These statements, “profound” and “significant”, would be then ranked on the Likert- type scale in reference to their absolute meaning as well as their relative meaning. Thus, “profound”, would be valued as VH and “significant” would be valued as H. In the case of disagreement or uncertainty regarding the precise meaning of the words, Oxford Dictionary Online was referenced for definitions and synonyms. A word bank was constructed during this process listing all the retrieved terms for both comparative reference and to ensure consistency in the rankings, see Table ​ Table4. 4 . Once the different qualitative weight values were determined for each linguistic term, they were then collected into their groups of three and applied to the revised FCM.

Categorization of linguistic terms extracted from literature

Subsequent to the information from the literature review having been transferred to the FCM, the resulting map contained the concepts, the antecedent - consequent relationships indicated via edges, the weight value of each edge (five qualitative, linguistic terms - VL, L, M, H, VH), and the sign value showing the type of the influence (+ or −). Following the application of the qualitative values to the FCM the values were then converted to quantitative weight values using FL theory. Each link was first expressed as a fuzzy rule then used in the Fuzzy Inference System (FIS) to generate a crisp numeric value. For example, if the linguistic term retrieved from the literature was: “The impact of concept A is profound on concept B”. It would then be converted to: “The impact of concept A is VH on concept B”. This graded statement would then be transformed using the rule statement:

The linguistic term ON is a binary variable. VH is defined using the triangular fuzzy membership function, as shown in Figure ​ Figure5. 5 . ON denotes the presence of the concept and VH denotes the weight value (qualitatively). For simplicity sake, triangular membership functions have been used as suggested in [ 85 ]. Interested readers can find more detailed explanation on membership functions in [ 86 ].

Triangular membership function.

• Example 1: As explained in the previous section, all qualitative values assigned to the edges came from the literature review. As shown in Figure ​ Figure6, 6 , “addiction” has a positive impact on homelessness. This means that an increase in addiction in a society will lead to an increase in levels of homelessness. The three linguistic terms related to “addiction”, extracted from the literature, were converted to the fuzzy notion of rules as follows:

Impact of addiction on homelessness.

•The degree of impact was then converted from its qualitative value (M, H, VH) to its quantitative value of 0.648 using FL concepts as described in [ 87 ]. All three studies indicated that as levels of addiction increase they exert a positive effect resulting in increases in levels of homelessness. Therefore, it can be stated that addictions affect homelessness by a factor of +0.648.

• Example 2 : As shown in Figure ​ Figure7, 7 , education has a negative effect on homelessness. This means that with higher levels of education in a society there will be lower levels of homelessness. Therefore, the impact of education on homelessness is modeled as negative - increases in education lead to decreases in homelessness. All literature scanned indicates that as education rises, homelessness falls. The first study stated that the impact of education on homelessness was low , the second, medium , and the third, high . This information is captured to construct a rule base for a Fuzzy Inference System (FIS). For each edge, we constructed an individual FIS and the defuzzified value, in this case 0.5, is assigned to the edge. More information about the procedure can be found in [ 87 - 90 ].

Impact of education on homelessness.

•Similarly, each edge was given a quantitative weight by converting the qualitative values gleaned from the literature search. Once all links on the map had been fully articulated with the rankings of each of the 93 linguistic terms (three for each link), we refined the virtual FCM (shown in Figure ​ Figure4) 4 ) by substituting quantitative values for the previous qualitative values (see Figure ​ Figure8 8 ).

Fuzzy cognitive map with calculated quantitative weights assigned to edges.

Experimentation with the weighted Fuzzy Cognitive Map

Experimentation with the weighted FCM was conducted, (see Algorithm 1), to ensure that it would perform as expected and that the map had captured the dynamics of the factors which affect levels of homelessness. We applied tanh = e 2 x − 1 e 2 x + 1 as the transformation function f of Equation 2. This choice is made as we are interested in understanding the impact of increase or decrease of initial concept values on the overall stability of the map [ 91 ].

Prototypical scenarios, similar to those used for the simplified FCM (Figure ​ (Figure3), 3 ), were constructed with the goal of finding the extreme case most likely to result in homelessness, the extreme case least likely to result in homelessness and several middle cases, more closely representing the possibilities present in the real world, where levels of homelessness are less certain.

The output of each prototypical case was interpreted through knowledge gleaned during the literature search/scan and the opinion of the criminologist-researcher on the team. Each example case had a variety of concepts activated at varying levels. The models were then permitted to iterate as necessary to reach a stable state (no further movement, positive or negative, for all concepts in the model). Final iterations are reported for each model.

• Case 1: Most likely to result in homelessness. The concepts of addiction, family breakdown, government assistance, and mental illness were activated at levels considered sufficiently high to dominate the system leading to certain homelessness as shown in Table ​ Table5. 5 . It has been empirically determined that these concepts are often found together and often precede homelessness [ 52 , 70 , 83 ]. Addiction and mental illness are often co-morbid and both commonly precede family breakdown [ 51 ]. During times of increased addiction and mental illness in society it is the usual reaction of the government to put into place policies and funding which will address these problems [ 93 ].

Simulating the result for case 1

•Tracking the effect of these concepts at strengths set to approximately 0.50, the graph initially shows that government assistance is at a lower rate and then sharply rises to address the increasing levels of addiction, mental illness, and family breakdown in the modeled society. However, it takes little time before the triple threat of addiction, mental illness and family breakdown overwhelm the system and levels of homelessness rise dramatically where they remain at a steady, high rate (indicated by the flat line at the top of the graph, Figure ​ Figure9 9 ).

Activated concepts at levels most likely to result in homelessness with graphical representation of impact of concepts on levels of homelessness over time.

• Case 2: Least likely to result in homelessness. The concepts of addiction, education, income, family breakdown, and social network support were activated at levels considered sufficiently high to dominate the system leading to a certain outcome of no homelessness as shown in Table ​ Table6. 6 . In this case, the protective factors of education, income, and social network support protect society from the negative effects of addiction and prevent homelessness. The link between higher levels of education and higher levels of income have been well documented [ 72 ]. Given that education prepares individuals to think creatively and to problem-solve, it is surmised that those with higher levels of education would have a greater ability to negotiate the complex rules that often are associated with government assistance. Those who are wealthy and educated are also much more likely to be capable of identifying and acquiring the services they might need, such as being able to pay for family counseling rather than being wait-listed for government supplied family counseling.

Simulating the result for case 2

•From Figure ​ Figure10, 10 , it is noted that this model shows a initial dip in levels of income and education in the first iterations as society attempts to deal with the addictions and threat to family cohesion that result from the addictions. However, very quickly, the protective factors of income, education, and social network support overwhelm the negative factors and the threat of homelessness diminishes and remains at levels close to zero (as indicated by the flat line at the bottom of Figure ​ Figure10). 10 ). Over time, the threat of family breakdown is also eliminated and income and education both rise back to their initial levels.

Activated concepts at levels least likely to result in homelessness with graphical representation of impact of concepts on levels of homelessness over time.

•This second model demonstrates the critical importance of factors such as income - which lead to health, acquisition of knowledge, better food and health care; and education - which lead to wealth and all the positive factors which wealth can purchase. Though addictions are shown as present in this modeled society, the low levels are unable to overwhelm the model. Through model testing it became apparent that levels of addiction lower than 0.30 often fail to overwhelm the positive factors, as long as social support and education are both present at fairly high levels, see Figure ​ Figure10. 10 . Much of the empirical literature support this [ 41 , 59 , 78 ]. Those with high levels of social support such as family, church, social groups, community groups, school friends and community friends are often better able to weather threats such as addictions and family breakdown.

• Case 3: Uncertain outcome of homelessness. In this model, we activated low levels of addiction and social network, high levels of education and income, and moderate levels of family breakdown as shown in Table ​ Table7. 7 . In this case, the protective factors of education and income delay the onset of homelessness but are insufficiently strong to prevent rising levels as the model iterates. Over time, due to family breakdown and the diminishing social network support, addictions begin to rise and as addictions rise, the likelihood of homelessness rapidly increases. This model demonstrates, once again, the importance of family and social support as well as the incredibly negative effects of drug addiction, both as a cause and result of family breakdown.

Simulating the result for case 3

•As in the case of the common-sense map of homelessness (Figure ​ (Figure3), 3 ), this final model (Figure ​ (Figure11), 11 ), acted in a manner which was fully explainable based on information acquired during the literature search and prior knowledge of the research team. This allowed for confidence that the model was functioning as it ought to and that we had captured not only a number of the integral aspects which contribute to homelessness, but that they were functioning in the direction and strengths which approximated real-life conditions.

Activated concepts at levels most closely representing a typical real-world case with graphical representation of the impact of concepts on levels of homelessness over time.

Analysis of network concepts

The purpose of this network analysis is to compare the degree of impact each of the concepts exerts on the model. During network analysis, we varied the initial value of a single concept from 0.1 to 1 while keeping the initial values of all other concepts at a static level; except for the concept representing homelessness. After several iterations, the value of homelessness was recorded. Then, for each factor, a plot of the value of homelessness versus the initial value of the concept was recorded. Ideally, for a factor with a positive effect on homelessness, the value of homelessness should increase as the value of the factor increases, gradually converging to a positive value. Concepts which have the reverse - a negative effect on homelessness, should demonstrate a decrease in homelessness as they are increased. Concepts which have higher convergent rates should demonstrate a greater impact on levels of homelessness.

To conduct the network analysis we first set the initial values for all concepts at a level of 0.5 and checked the levels of homelessness after 5 iterations. At this level and number of iterations, the majority of the plots resulted in a straight line at a value of +1. This told us that the initial value of the factor (0.1 to 1) made no difference on levels of homelessness and, obviously, was no help to our analysis. After analyzing the map, we tried reducing the level of the initial values for all concepts as well as reducing the number of iterations. Through a gradual reduction process we found that by setting the initial concept values at 0.01 and running three iterations we were able to generate reasonable and useful plots (see Figure ​ Figure12) 12 ) which could then be compared for effects on levels of homelessness.

Comparison of the affects of individual concepts on levels of homelessness (a) shows the impact of Addiction, Criminal Justice System, Cost of housing and Social Network on Homelessness (b) highlights the impact of Education, Family Breakdown, Government Assistance and Income on Homelessness and (c) depicts the impact of Mental Illness, NGO, Poverty and Childhood hardships.

Plots can be examined in pairs or groupings so that the effect of the concepts on levels of homelessness can be compared for both intensity and speed. For example, in comparing the plots for, “Addictions”, and, “Cost of Housing”, it can be seen that they both are monotonically increasing. However, the plot for “Addictions” demonstrates a more dramatic increase, resulting in a quicker convergence to +1 than does the plot for “Cost of Housing”. Therefore it can be concluded that addictions have a greater impact on homelessness than does cost of housing.

Another way to visually analyze the impact of various factors on homelessness is through box plota (see Figure ​ Figure13). 13 ). Making the same comparison, “Addictions” to “Cost of Housing”, it can be seen that the plot of “Addictions” has a narrower median and longer lower quantile. The size of the box determines the variability of concepts, for instance, the size of the box of “Cost of Housing” is greater than size of the box of “Addictions” indicating that the impact of housing cost is more variable and hence not a strong indicator [ 94 ].

Boxplot comparison of the affects of individual concepts on levels of homelessness.

Measure of centrality

Another approach to analyze the most influential factor is through measures of centrality . There are also other measurements for analyzing an FCM, but here we focus on this property. In this subsection, we describe the results of the analysis based on two types of centrality: degree centrality and closeness centrality. Degree centrality of each node/concept, in a given weighted and directed graph, is defined as the sum of the absolute values of the weights of the outgoing and incoming edges [ 8 , 95 ]. For the node, x , of the graph G =< V , E > the degree centrality is mathematically defined as:

where w xy and w yx are the weights of the edge from x to y and the edge from y to x , respectively. Degree centrality of a graph indicates how strongly a concept node in a FCM affects other concept nodes of the graph [ 96 ].

Closeness centrality of a node is the inverse of the sum of the lengths of the shortest paths between that node and all other nodes. For the node, x , of the graph G =< V , E >, the closeness centrality is mathematically defined as:

where d xy denotes the length of the shortest path from node x to node y . Closeness centrality indicates how quickly a concept node affects other nodes of the FCM [ 96 ].

Note : For closeness centrality the distance measured between each pair of nodes is the inverse of the weight of the corresponding edge in the FCM. If there is no edge between nodes then the distance from the one node to the second node would obviously be infinite. Since the FCM is not strongly connected, the length of the shortest path for some pairs of nodes is, in fact, infinite. This then causes the closeness centrality for that node to drop to zero. For example, the length of shortest path for each node to the node, “Cost of Housing”, is infinite. This makes the centrality of all nodes to be zero. To conquer this problem, we choose a numerical value which is large enough to be considered as an infinite value. Since the distance measure between each pair of nodes is defined as the inverse of the weight between the nodes of the FCM, the greatest distance between each two nodes would be 4. This value is corresponding to the edge between “poverty” and “addiction”, whose weight is 0.25. The FCM has 14 concepts, thus each path of the FCM will, at most, have 13 edges. Therefore, the length of each path will be at most 4×13=52, which is still an overestimation of the paths in the graph. Regarding this value, we picked 100 as an large enough value. This approach is similar to the Big-M method described in operation research theories [ 97 ]. Please note that changing 100 to a greater value, may change nodes’ closeness centrality, but the order of the nodes’ closeness centrality will not change.

The result of the degree and closeness centrality computation in our FCM is displayed in Table ​ Table8. 8 . As shown, the concept “Education” has the greatest degree centrality while the concept “Cost of Housing” has the least. This means that “Education” gives and receives the greatest direct influence on all other concepts, whereas “Cost of Housing” gives and receives the least. Closeness centrality was determined to act similarly to degree centrality in that “Education” has the greatest amount of degree centrality whereas “Cost of Housing” has the least. This means that “Education” exerts the greatest force on the map in reference to closeness centrality with changes in “Education” resulting in the most prominent changes in the other concepts. Likewise, changes in “Cost of Housing” would result in the least amount of change in all other concepts. These results are consistent with the results of the overall experiment.

Degree centrality and closeness centrality of every concept

This study demonstrates the efficacy of using FCM to graphically represent and simulate the actions and interactions present in the social, personal, and structural factors related to homelessness. The FCM is particularly suited to modeling this type of problem due to its ability to incorporate vast amounts of information, synthesizing what is known about a problem and then allowing for meaningful simulations. The FCM is particularly suitable due to its dynamic nature and ability to simulate potential policy changes and show predicted outcomes on levels of homelessness. Further, the FCM helps to identify those factors that exert the greatest impact in a complex system, in this case: affordable/appropriate housing, access to social support services for those with addictions/mental illness, family support for those with children, positive community support and rental supplements.

The problem of homelessness is really situated in factors that occur at the micro-, meso-, and macro-levels of society; future research should aim to refine the FCM by sorting factors into their appropriate levels thereby allowing differentiation between what the individual is potentially capable of controlling and that which he or she is not. This would allow for clearer identification of where government policy changes would have the greatest effect. Future refinements must also capture the effect of time. Many factors affect the system differently as time progresses (i.e., unemployment insurance) and this would help to make the system more closely replicate reality. Future maps may also wish to include factors which affect the system but which did not make it into this one such as early brain injury in childhood, sexual/physical/emotional abuse in childhood, and learning disabilities - all of which have been shown to affect levels of homelessness.

The initial construction of this map demonstrated the disparity between the empirical truth of homelessness and what the researchers had learned over a lifetime of media and social propaganda. This has implications for government policy-making and, again, demonstrates the usefulness of FCMs for describing complex social problems such as homelessness.

The FCM built to model the complex social system of homelessness reasonably represented reality for the sample scenarios. This provided evidence that FCMs are a viable alternative for conceptualizing homelessness and that a literature search of peer reviewed, academic literature is a reasonable foundation upon which to build the model. Further, it was determined that the direction and strength of relationship between concepts included in this map are a reasonable approximation of their action in reality. However, the concept, homelessness , in this study, is used as a consequent variable. In reality, many of the concepts including homelessness concept could be an antecedent concept resulting in more complex loops. The flexibility of limiting the complexity is one of the advantages of constructing and using FCMs for social science research.

Dynamic modeling does, however, have it’s limitations and this work should be regarded as purely exploratory. For one, by basing our concepts off of peer reviewed literature that was searched semi-systematically there is a possibility of not capturing all possible terms. Future work should search for papers and terms in a similar fashion as systematic or scoping reviews where inclusion and exclusion criteria are highly scrutinized and analyzed by several research team members. A second limitation concerns the interpretation of the results from the FCM. FCMs, and dynamic models more broadly, have the luxury of experimenting with problems in an environment that is encapsulated from the real-world. It should be noted that every societal issue carries with it its own contextual element that cannot always be captured by a modeling environment. Further, FCMs do not fully replicate the mirco-level interactions that may prove to be powerful in determining meso- and macro-level outcomes. Future work should aim to incorporate these influences in to their models and interpretations as best possible. Lastly, dynamic models are exploratory and we can not reasonably assume that outcomes presented in this research will be realized in the real world.

This research provides empirical support for the usefulness of this model, not only for researchers and social scientists, but for others who reside within a society where homelessness is experienced. This model is based on a limited collection of published, peer reviewed scholarly articles but despite this limitation, does justify the use of FCM techniques as a useful tool to analyze the complex situation of homelessness. The role of FCM for the purpose of modelling complex social systems has been strongly supported by this research and should continue to be utilized in future studies.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

VKM and VD conceived the idea and formulated mathematical model. TW, SN, PG, RC and VKM implemented the computational model. HKM, CF wrote the paper along with VKM. All authors critically analyzed the simulations, reviewed the manuscript, read and approved the final version.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1472-6947/13/94/prepub

Acknowledgements

Initial work on this research project was conducted during the IRMACS Modelling Summer School. This research was supported by the SFU CTEF MoCSSy program. We are also grateful for technical support from the IRMACS Centre, Simon Fraser University, BC.

• Strand R. Helping the homeless: the struggle between community values and political ideologies. Master’s thesis, Athabasca University; Athabasca, Alberta, 2003.
• International Network for Economic, Social and Cultural Rights, NY USA [ http://www.escr-net.org/docs/i/1186570 ]
• Ruggie J. Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development. 2008. [ http://www.refworld.org/docid/49a5223b2.html ]
• Metro Vancouver homeless count 2011 preliminary report. 2011. [ http://stophomelessness.ca ]
• Shelton KH, Taylor PJ, Bonner A, van den Bree M. Risk factors for homelessness: evidence from a population-based study. Psychiatr Serv. 2009; 60 (4):465. [ PubMed ] [ Google Scholar ]
• Giles BG, Findlay CS, Haas G, LaFrance B, Laughing W, Pembleton S. Integrating conventional science and aboriginal perspectives on diabetes using fuzzy cognitive maps. Soc Sci Med. 2007; 64 (3):562–576. [ PubMed ] [ Google Scholar ]
• Dickerson J, Kosko B. Virtual worlds as fuzzy cognitive maps. Presence. 1994; 3 (2):173–189. [ Google Scholar ]
• Kosko B. Fuzzy cognitive maps. Int J Man-Mach Stud. 1986; 24 :65–75. [ Google Scholar ]
• Sivanandam S, Sumathi S, Deepa S. Introduction fuzzy logic using MATLAB. New York, USA: Springer Verlag; 2007. [ Google Scholar ]
• Barber K. The Canadian Oxford Dictionary. Canada: Oxford University Press; 1998. [ Google Scholar ]
• Greenberg GA, Rosenheck RA. Jail incarceration, homelessness, and mental health: a national study. Psychiatr Serv. 2008; 59 (2):170–177. [ PubMed ] [ Google Scholar ]
• Baldry E, McDonnell D, Maplestone P, Peeters M. Ex-prisoners, homelessness and the state in Australia. Aust N Z J Criminol. 2006; 39 :20–33. [ Google Scholar ]
• Rosenheck R, Greenberg G. Mental health correlates of past homelessness in the national comorbidity study replication. J Health Care Poor Underserved. 2010; 21 (4):1234–1249. [ PubMed ] [ Google Scholar ]
• DeFina R, Hannon L. The impact of mass incarceration on poverty. Crime Delinquency. 2009; 59 (4):138S–159S. [ Google Scholar ]
• Johnson R. Ever-increasing levels of parental incarceration and the consequences for children. NY: Russell Sage Foundation; 2009. 177–206. [ Google Scholar ]
• Oliver P, Sandefur G, Jakubowski J, Yocom JE. The effect of black male imprisonment on black child poverty. Department of Sociology, University of Wisconsin, Madison. (2006) [Unpublished manuscript] [ http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.150.8586 ]
• Western B. Mass imprisonment and economic inequality. Soc Res: Int Q. 2007; 74 (2):509–532. [ Google Scholar ]
• Western B, Pettit B. Incarceration & social inequality. Daedalus. 2010; 139 (3):8–19. [ PubMed ] [ Google Scholar ]
• Freeman R. Can we close the revolving door? Recidivism vs. employment of ex-offenders in the US. Urban Institute Roundtable: Employment Dimension sof Prisoner Reentry and Work: Understanding the Nexus Between Prisoner Reentry and Work. 2003. New York University Law School. [ http://www.urban.org/UploadedPDF/410857_freeman.pdf ]
• Chui W. Pains of imprisonment: narratives of the women partners and children of the incarcerated. Child Fam Soc Work. 2010; 15 (2):196–205. [ Google Scholar ]
• Wong SK. Reciprocal effects of family disruption and crime: a panel study of canadian municipalities. West Criminol Rev. 2011; 12 :43–63. [ Google Scholar ]
• van Laere IR, de Wit MA, Klazinga NS. Pathways into homelessness: recently homeless adults problems and service use before and after becoming homeless in Amsterdam. BMC Public Health. 2009; 9 (1):3. Publisher: BioMed Central Ltd. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Benzies K, Rutherford G, Walsh CA, Nelson A, Rook J. Homeless shelter residents: Who are they and what are their needs within a context of rapid economic growth? Currents: New Scholarship Hum Serv. 2010; 7 :1–18. [ Google Scholar ]
• Waters J, Roberts A, Morgen K. High risk pregnancies: Teenagers, poverty, and drug abuse. J Drug Issues. 1997; 27 (3):541–562. [ Google Scholar ]
• Yankauer A. The deadliest plague. Am J Pub Health. 1989; 79 (7):821–822. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Buu A, Mansour M, Wang J, Refior SK, Fitzgerald HE, Zucker RA. Alcoholism effects on social migration and neighborhood effects on alcoholism over the course of 12 years. Alcohol, Clin Exp Res. 2007; 31 (9):1545–1551. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hamilton AB, Poza I, Washington DL. Homelessness and trauma go hand-in-hand: pathways to homelessness among women veterans. Women’s Health Issues: Official Publication Jacobs Inst Women’s Health. 2011; 21 (4 Suppl):S203–209. [ PubMed ] [ Google Scholar ]
• Shinn M, Gottlieb J, Wett JL, Bahl A, Cohen A, Baron Ellis D. Predictors of homelessness among older adults in New York City. J Heal Psychol. 2007; 12 (5):696–708. [ PubMed ] [ Google Scholar ]
• Gray D, McDonald T. Does the Sophistication of use of unemployment insurance evolve with experience? Can J Econ. 2012; 45 (3):1220–1245. [ Google Scholar ]
• Lalive R, Van Ours J, Zweimuller J. How changes in financial incentives affect the duration of unemployment. Rev Econ Stud. 2006; 73 (4):1009–1038. [ Google Scholar ]
• Lemieux T, Milligan KS. Incentive effects of social assistance: A regression discontinuity approach. USA: National Bureau of Economic Research Cambridge, Mass; 2004. [ Google Scholar ]
• Higgitt N, Wingert S, Ristock J. Voices from the margins: experiences of street-involved youth in Winnipeg. University of Winnipeg; Winnipeg, Manitoba, Canada: ; 2003. [ http://www.uwinnipeg.ca/faculty/ius/{iusweb}_backup/pdf/Street-kidsReportfinalSeptember903.pdf] [ Google Scholar ]
• Thomas BJ. A qualitative study of socioeconomic status, post-secondary education plans, and educational aspirations of students from a michigan public school. Soc Today. 2011,. 9 . [ http://www.ncsociology.org/sociationtoday/v91/education.htm ]
• Clarke M, Feeny S. Education for the end of poverty: implementing all the Millennium Development Goals. New York: Nova Science Publication Inc; 2007. [ Google Scholar ]
• Khan H, Williams JB. Poverty alleviation through access to education: Can E-learning deliver? 2006. [Working paper series. http://papers.ssrn.com/sol3/papers.cfm? {abstract}_id=1606102]
• Riddell WC, Song X. The impact of education on unemployment incidence and re-employment success: Evidence from the U.S. labour market. Labour Econo. 2011; 18 (4):453–463. [ http://www.sciencedirect.com/science/article/pii/S0927537111000054 ] [ Google Scholar ]
• Johnson RW. Rising senior unemployment and the need to work at older ages. Tech. rep. 2009.
• Lauer C. Education and unemployment: A French-German comparison. Washington: ZEW Discussion Paper; 2003. [ http://www.urban.org/uploadedpdf/411964_{senior}_unemployment.pdf ] [ Google Scholar ]
• Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008; 112 (5):970. [ PubMed ] [ Google Scholar ]
• Jamison E, Jamison D, Hanushek E. The effects of education quality on mortality decline and income growth. Econ Educ Rev. 2007; 26 (6):772–789. [ Google Scholar ]
• Woodford M, Mammen S. Escaping poverty: rural low-income mothers’ opportunity to pursue post-secondary education. Career Tech Educ Res. 2010; 35 (2):81–102. [ Google Scholar ]
• Sullivan JX, Turner L, Danziger S. The relationship between income and material hardship. J Policy Anal Manag. 2008; 27 :63–81. [ Google Scholar ]
• McNaughton CC. Transitions through homelessness, substance use, and the effect of material marginalization and psychological trauma. Drugs: Educ Prev Policy. 2008; 15 (2):177–188. [ Google Scholar ]
• Early DW. An empirical investigation of the determinants of street homelessness. J Housing Econ. 2005; 14 :27–47. [ Google Scholar ]
• Kushel MB, Hahn JA, Evans JL, Bangsberg DR, Moss AR. Revolving doors: imprisonment among the homeless and marginally housed population. Am J Pub Health. 2005; 95 (10):1747. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Conklin TJ, Lincoln T, Tuthill RW. Self-reported health and prior health behaviors of newly admitted correctional inmates. Am J Pub Health. 2000; 90 (12):1939–1941. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, Burke M, Lewis G. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet. 2007; 370 (9584):319–328. [ PubMed ] [ Google Scholar ]
• D’Souza D, Perry E, MacDougall L, Ammerman Y, Cooper T, Wu Y, Braley G, Gueorguieva R, Krystal J. et al. The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology. 2004; 29 (8):1558–1572. [ PubMed ] [ Google Scholar ]
• Cleary M, Hunt G, Matheson S, Siegfried N, Walter G. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev. 2008. (1): CD001088. [ PubMed ] [ CrossRef ]
• Mallett S, Rosenthal D, Keys D. Young people, drug use and family conflict: Pathways into homelessness. J Adolescence. 2005; 28 (2):185–199. [ PubMed ] [ Google Scholar ]
• Schafer G. Family functioning in families with alcohol and other drug addiction. Soc Policy J N Z. 2011; 37 :1–17. [ Google Scholar ]
• Booth RE, Crowley TJ, Zhang Y. Substance abuse treatment entry, retention and effectiveness: out-of-treatment opiate injection drug users. Drug Alcohol Dependence. 1996; 42 :11–20. [ PubMed ] [ Google Scholar ]
• Weisner C, Matzger H, Kaskutas LA. How important is treatment? One-year outcomes of treated and untreated alcohol-dependent individuals. Addiction. 2003; 98 (7):901–911. [ PubMed ] [ Google Scholar ]
• Fiorentine R, Anglin MD. More is better: Counseling participation and the effectiveness of outpatient drug treatment∗ 1. J Subst Abuse Treat. 1996; 13 (4):341–348. [ PubMed ] [ Google Scholar ]
• Hahn RA, Kleist DM. Divorce mediation: Research and implications for family and couples counseling. Fam J. 2000; 8 (2):165–171. [ Google Scholar ]
• Carr A. Evidence-based practice in family therapy and systemic consultation. J Fam Ther. 2000; 22 :29–60. [ Google Scholar ]
• Carr A. The effectiveness of family therapy and systemic interventions for adult-focused problems. J Fam Ther. 2009; 31 :46–74. [ Google Scholar ]
• Landau J, Garrett J. Neurobiology and Addiction: Assisting the Family and Support System to Get Resistant Loved Ones into Treatment. Washington: American Family Therapy Academy, Inc.; 2008. 29–37. [ Google Scholar ]
• Zorza J. Woman battering: A major cause of homelessness. Clgh Rev. 1991; 25 :421. [ Google Scholar ]
• Neale J. Homelessness amongst drug users: A double jeopardy explored. Int J Drug Policy. 2001; 12 (4):353–369. [ Google Scholar ]
• Yoder KA, Whitbeck LB, Hoyt DR. Event history analysis of antecedents to running away from home and being on the street. Am Behav Sci. 2001; 45 :51–65. [ Google Scholar ]
• Alvi S, Scott H, Stanyon W. We are locking the door: family histories in a sample of homeless Youth. Qual Rep. 2010; 15 (5):1209–1226. [ Google Scholar ]
• Tyler KA. A qualitative study of early family histories and transitions of homeless youth. J Interpers Violence. 2006; 21 (10):1385–1393. [ PubMed ] [ Google Scholar ]
• McNiel DE, Binder RL, Robinson JC. Incarceration associated with homelessness, mental disorder, and co-occurring substance abuse. Psychiatr Serv. 2005; 56 (7):840–846. [ PubMed ] [ Google Scholar ]
• Fertig AR, Reingold D. The characteristics and causes of homelessness among at risk families with children in twenty american cities. Soc Serv Rev. 2008; 82 (3):485–510. [ Google Scholar ]
• Dixon L, McNary S, Lehman AF. Remission of substance use disorder among psychiatric inpatients with mental illness. Am J Psychiatry. 1998; 155 (2):239–243. [ PubMed ] [ Google Scholar ]
• Wesley-Esquimaux CC, Snowball A. Viewing violence, mental illness and addiction through a wise practices lens. Int J Mental Health Addict. 2010; 8 (2):390–407. [ Google Scholar ]
• Kessler RC, Walters EE, Forthofer MS. The social consequences of psychiatric disorders, III: probability of marital stability. Am J Psychiatry. 1998; 155 (8):1092–1096. [ PubMed ] [ Google Scholar ]
• Frank RG, Gertler P. Mental health and marital stability. Int J Law Psychiatry. 1991; 14 (4):377–386. [ PubMed ] [ Google Scholar ]
• Callan S, Baggaley M, Bolton D, Farmer P, Fonagy P, Frank I, Gill M, Gray R, Leach P, McAttram M, Thompson C. Mental Health: Poverty, ethnicity, and family breakdown. The Centre for Social Justice, UK, 2011. [ http://www.centreforsocialjustice.org.uk/UserStorage/pdf/Pdf\%20reports/MentalHealthInterimReport.pdf ]
• Marshall E, Stralow A. Responding to the health and well-being needs of homeless and marginalised young people in NSW: where are we going? Parity. 2009; 22 (9):29–30. [ Google Scholar ]
• Khan F, Pieterse E. The homeless people’s alliance: purposive creation and ambiguated realities. Voices Protest: Soc Movements Post-Apartheid South Afr. 2006. pp. 155–178.
• Brown KA, Keast RL, Waterhouse JM, Murphy GD. European Group of Public Administration Conference, Malta; 2009. Social innovation to solve homelessness : wicked solutions for wicked problems. [ http://eprints.qut.edu.au/29936/ ] [ Google Scholar ]
• Walker-Dalhouse D, Risko VJ. Homelessness, poverty, and children’s literacy development. Reading Teach. 2008; 62 :84–86. [ Google Scholar ]
• Occidental College, Los Angles, California. [ http://oxy.dev.guidance.com/sites/default/files/assets/UEP/Comps/2011/Chloe\%20{Lee}_ABCs\%20to\%20Improve\ %20Homeless\%20Education.pdf ]
• Friedman D. Social impact of poor housing. London: Ecotec for the National Housing Federation; 2010. [ Google Scholar ]
• Burt MR, Aron LY, Valente J. Helping America’s homeless: Emergency shelter or affordable housing? Washington, DC: The Urban Institute Press; 2001. [ Google Scholar ]
• Zlotnick C, Robertson MJ, Lahiff M. Getting off the streets: Economic resources and residential exits from homelessness. J Commun Psychol. 1999; 27 (2):209–224. [ Google Scholar ]
• Shinn M, Baumohl J, Hopper K. The prevention of homelessness revisited. Anal Soc Issues Pub Policy. 2001; 1 :95–127. [ Google Scholar ]
• Quigley JM, Raphael S, Smolensky E. Homeless in America, homeless in California. Rev Econ Stat. 2001; 83 :37–51. [ Google Scholar ]
• Crane M, Byrne K, Fu R, Lipmann B, Mirabelli F, Rota-Bartelink A, Ryan M, Shea R, Watt H, Warnes AM. The causes of homelessness in later life: findings from a 3-nation study. J Gerontology Series B: Psychol Sci Soc Sci. 2005; 60 (3):S152–S159. [ PubMed ] [ Google Scholar ]
• Hardesty M, Black T. Mothering through addiction: a survival strategy among Puerto Rican addicts. Qual Health Res. 1999; 9 (5):602–619. [ PubMed ] [ Google Scholar ]
• Beiser M, Hou F, Hyman I, Tousignant M. Poverty, family process, and the mental health of immigrant children in Canada. Am J Pub Health. 2002; 92 (2):220–227. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Zinn M. Family, race, and poverty in the eighties. Signs. 1989; 14 (4):856–874. [ Google Scholar ]
• Faez F, Ghodsypour S, Brien CO. Vendor selection and order allocation using an integrated fuzzy case-based reasoning and mathematical programming model. Int J Prod Econ. 2009; 121 (2):395–408. [ http://www.sciencedirect.com/science/article/pii/S0925527307000679 ] [ Google Scholar ]
• Ross TJ. Fuzzy logic with engineering applications. Chennai, India: Wiley Online Library; 1995. [ Google Scholar ]
• Mago V, Mehta R, Woolrych R, Papageorgiou E. Supporting meningitis diagnosis amongst infants and children through the use of fuzzy cognitive mapping. BMC Med Inf Decis Making. 2012; 12 :98. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Mago VK, Bakker L, Papageorgiou EI, Alimadad A, Borwein P, Dabbaghian V. Fuzzy cognitive maps and cellular automata: An evolutionary approach for social systems modelling. Appl Soft Comput. 2012; 12 (12):3771–3784. [ http://www.sciencedirect.com/science/article/pii/S1568494612001081 ] [ Google Scholar ]
• Giabbanelli PJ, Torsney-Weir T, Mago VK. A fuzzy cognitive map of the psychosocial determinants of obesity. Appl Soft Comput. 2012; 12 (12):3711–3724. [ http://www.sciencedirect.com/science/article/pii/S1568494612000634 ] [ Google Scholar ]
• Pratt S, Giabbanelli P, Jackson P, Mago V. Intelligence and Security Informatics (ISI), 2012 IEEE International Conference on. Arlington, VA: IEEE; 2012. Rebel with many causes: A computational model of insurgency; pp. 90–95. [ Google Scholar ]
• Tsadiras AK. Comparing the inference capabilities of binary, trivalent and sigmoid fuzzy cognitive maps. Inf Sci. 2008; 178 (20):3880–3894. [ Google Scholar ]
• MathWorks. Vectorization. 2012. [ http://www.mathworks.com/help/matlab/{matlab}_prog/vectorization.html ]
• Seddon T. Youth, heroin, crack: a review of recent British trends. Health Educ. 2008; 108 (3):237–246. [ Google Scholar ]
• Norman G, Streiner D. Biostatistics: the bare essentials. Shelton, Connecticut, USA: People’s Medical Publishing House; 2007. [ Google Scholar ]
• Ozesmi U, Ozesmi S. Ecological models based on people’s knowledge: a multi-step fuzzy cognitive mapping approach. Ecol Model. 2004; 176 (1-2):43–64. [ Google Scholar ]
• Obiedat M, Samarasinghea S, Strickert G. 19th International Congress on Modelling and Simulation 2011. Perth: Modelling and Simulation Society of Australia and New Zealand; 2011. A New Method for Identifying the Central Nodes in Fuzzy Cognitive Maps using Consensus Centrality Measure; pp. 1084–1091. [ Google Scholar ]
• Bronson R, Naadimuthu G. Schaum’s outline of theory and problems of operations research. New York: Schaum’s Outline Series; McGraw-Hill; 1997. [ Google Scholar ]

Approaching Homelessness in America Research Paper

Executive summary, introduction, the problem of homelessness, policy intervention.

Homelessness has continued to be the most evident forms of systematic failure within the American society. For a long time, the majority of homeless people were simply individuals but the harsh economic conditions within the country have made more families and children homeless as well. This raises a big issue considering that 42% of these children are aged six years and below.

Seventy-five percent of homeless children are of elementary school going age. This has created a need for policy intervention, which can make it possible for these homeless people to live a more comfortable life that is free of upheavals.

These policy interventions must adequately deal with housing, psychological and social needs that cannot be accessed by homeless persons. Teachers should also be trained to deal with problems experienced by homeless schoolchildren in order to ensure counseling.

The issue of homelessness in America is one that has proved to be a big challenge to policy makers and social systems. Homelessness has become one of the most visible signs of failure as regards efficient planning, which burdens cities and state governments in America.

A homeless person is the one that cannot access a regular and fixed residence (Herbert, 1976). This paper is going to highlight the problem of homelessness, policy frameworks and policy recommendations that can help deal with this challenge.

The phenomenon of homelessness has been found to be more prevalent in urban areas than in rural areas of America because of large numbers of people residing within these urban settlements. This has created a burden on the system, which has made it difficult for some people to find decent accommodation and shelter that can cater for their needs.

The increase in population being experienced has made it difficult for urban authorities to construct decent shelter for large numbers of people needing accommodation. This has had an effect of pushing many to the streets thereby increasing the number of people within America who cannot afford rent or buy good housing units.

It is estimated that the majority of those who are homeless live in central cities and they constitute 71% of all the people who are homeless in America (Drake, 2002). Twenty-one percent of the homeless live in suburbs while the remaining portion lives in rural areas of America.

This issue therefore requires a strong participation by the federal government and other state governments to come up with ways in which these challenges can be addressed.

The homeless do not enjoy any dignity as a result of deprivation and poor conditions, which they face and are a stark reminder of the torment they have to undergo just to survive. The homeless people living in rural areas of America face difficulties in finding shelter and they are exposed to various harmful weather conditions that are a threat to their health.

The major causes of homelessness have been found to be economically related. This means that homelessness results from job loss, unemployment and poverty. All these factors make it difficult for a number of people to afford decent housing and as a result, they are faced with difficult circumstances forcing them to become homeless.

It is estimated that the number homeless people in America increased by 20,000 from 2008 to 2009 translating to an increase of about 3%.

This means that if the number of people who find themselves deprived of decent shelter remain unchecked, there could be bigger implications that the society might have to care for (Radin, 2000). The homeless in the country can be categorized into families, individuals, unsheltered and deprived children. All these groups form a significant segment of people who cannot access shelter in America.

The majority of states in the country have had an increase in the number of people who are homeless, with the largest number being registered in Louisiana. The consequence of homelessness is a social issue that America cannot continue to ignore. The condition threatens the dignity of some Americans in a country that is reputed to have the strongest economy in the world.

A worrying trend is that the number of family households that are homeless has increased and this is a situation that should be redressed as fast as possible. The homeless families increased by more than 3200 households between 2008 and 2009, with the majority of these being in Mississippi. These families are larger in number, which has created a major challenge to the social systems within the country.

Several homeless people live in the streets, where they cannot access basic shelter. This creates a problem that is hard to deal with. It is estimated that four out of ten homeless persons in the country cannot access good shelter and live in places that are not fit for human habitation. These exposes such people to various security and health risks making the conditions that they live in hazardous to their wellbeing.

They are likely to be exposed to cold weather and rain, which can make them acquire chest infections such as pneumonia. They are also exposed to vices and the possibility of bodily harm from criminals who may perpetrate acts of violence against them. Some of these people can be easily lured into criminal activities thereby creating social problems to the society.

The economic hardships that were experienced within the US economy because of the recent recession contributed high levels of homelessness in the country. The majority of homeless persons in the country cannot access public social services in form of healthcare, education and shelter, making them not to fit within the context of American society.

The homeless are not able to access preventive remedies that can be effective in making them not susceptible to diseases because of the risks that exist within the environment. Homeless people cannot get routine check ups for diseases such as diabetes, heart diseases, and cancer because they lack medical insurance.

The health system within the country does not offer ways in which they can be able to access health services at an affordable cost.

The homeless are more likely to be admitted to emergency rooms in hospitals for acute illnesses, which make them stay longer in health facilities compared to other Americans from low-income groups.

This is because they are not able to get preventive care to the health conditions that they face, making it difficult for them to recover quickly from acute illnesses. The mortality rates of the homeless are higher compared to those of other population segments, with their life expectancies being estimated to be below 45 years.

This makes the mortality rate of the homeless people living in America to be more than four times higher than that of the rest of the population living in the country. The harsh conditions that the homeless experience within their environment make them predestined to a shorter life cycle in comparison to other people within the country (Kuhlman, 1994).

The phenomenon of homelessness in the country has also brought about problems to children who are more vulnerable to dangers that emanate from horrifying lifestyles. It is estimated that one out of every fifty children in America are homeless because of several problems that exist within families.

This drives these children out of their homes. The children are driven out of their homes mainly because of parental neglect and abuse hence forcing them to the streets. Most of these children are exposed to depression, violence and anxiety, which affect their character when they become adults. Some are tempted to engage in criminal activities and other undesirable vices.

Texas, Louisiana and Georgia have the highest number of homeless children in America. This is because of destruction of property and loss of lives caused by Hurricane Katrina. The increasing number of homeless children affects social welfare programs that exist across different states in the country. Since it is estimated that forty-two percent of children are below years.

This makes their educational and healthcare needs limited compared to children from other families. These numbers create a terrifying situation for the country because there might be a higher number of homeless children in future because of inadequate budgetary and social support needed to eradicate the problem.

Some children are exposed to various forms of abuse when they are homeless, ranging from sexual abuse, drug abuse, initiation to crime and sexual violence. These children are exposed to an environment whereby such vices are common and as a result, they are likely to be psychologically and emotionally affected as they grow up.

Girls are at a higher risk of being sexually abused, and are more vulnerable because they are weaker and may not be able to defend themselves adequately.

Such girls may become pregnant at a very young age making it difficult for them to access job opportunities that they can depend on to sustain themselves and their children. This creates a situation where more people are not able to acquire quality shelter leading to prevalence of homeless families in the country.

There is a possibility of homeless children becoming juvenile delinquents. The justice system can be burdened with cases of criminal acts committed by minors hence creating social problems for the country. The high levels of violence and criminal acts experienced by the homeless may embolden them to become craftier as far as survival techniques and crime are concerned.

It has been noted that victims of physical or sexual violation are more likely to turn out more violent, especially if they do not receive any form of counseling (Kraft, & Furlong, 2010). Children develop sadistic instincts, which justify the use of violence to acquire any form of material possession without any regard to the likely consequences of their action.

The chronic homeless people should be supported to access housing services as quickly as possible so that they can be protected from vagaries of nature. The homeless policies nationwide must be structured to deal with the first time homeless people in order to help them settle as quickly as possible before they can be offered ways in which they can rebuild their lives.

Some homeless people are known to suffer from serious conditions of alcoholism and drug abuse and as such, they must be housed within shelters from which they can be offered health services (Kusmer, 2003). A combined health and housing plan help such addicts to recover quickly and help them live a positive life with a roof over their heads.

There are a number of solutions to the problem of homelessness such as political, perceptual and personal solutions. Perceptual policy is more costly and time consuming because it relates to changing the views of members of society. As an alternative, the policy is applicable only after solving political problems.

Personality policy is another alternative to the problem but it is more specific meaning that individuals themselves can come up with ideas on how to improve their lives. Community-based organizations can help individuals accomplish personal missions. Political solutions are more important because they consist of governmental action. It is about coming up with sound policies that aim at eliminating the problem.

It takes place in government that is, in the legislature, judiciary or executive. In this paper, more emphasis will be put on the executive branch because it is concerned with public policy.

The government must come up with policies that guarantee affordable housing, timely prevention and rapid re-housing plans, all-inclusive mental health services and increased social help (Drake, 2002). Policy makers from government are the only officers charged with designing all public programs.

State agencies must formulate key policies and legislations that aim at eradicating homelessness. The intention of homelessness legislation is to facilitate eradication of homelessness and reduce the load that lead to homelessness. For instance, the “No Child Left behind Act”, which was approved in 2001 ensures that schools do not discriminate homeless children by coming up separate classes.

In fact, it is a criminal offence to exercise discrimination against homelessness. Besides, one of the key aims of the McKinney-Vento Homelessness Assistance Act was to put off schools from keeping out learners who could not provide contacts of their houses.

The Chronic Homelessness Initiative Act created by Bush aimed at ending persistent homelessness by the year 2012.

To help in realizing this objective, the head of state collaborated with the Department of Labor (DOL) and the Department of Housing and Urban Development (HUD) to form a plan that helps homeless persons obtain shelter and employment in quite a few communities. The tenets of the policy should be implemented fully to guarantee homeless people security.

In conclusion, homelessness is a social problem that has to be dealt with in order to ensure the American society does not suffer negative consequences. There should be effective policies that deal with the issue of homelessness comprehensively. Homelessness is an issue that policy makers have tried to handle in many years. However, the solutions and policies have not been conducive to the homeless people.

The Bush’s regime tried to solve the issue by coming up with a policy aimed at preventing segregation and discrimination of the homeless children. The Obama regime established another policy referred to as no child left behind, although it was not successful at the start.

Overall, affirmative action should be taken to guarantee equality in society. The problem of homelessness can be solved in case policy makers pay attention to the existing policy frameworks.

Drake, H. (2002). Constantine and the Bishops: The Politics of Intolerance . Baltimore: Johns Hopkins University Press.

Herbert, S. (1976). Administrative Behavior (3rd ed.). New York, NY: The Free Press.

Kraft, M., & Furlong, R. (2010). Public Policy: Politics, Analysis, and Alternatives (3rd ed.). New York, NY: CQ Press.

Kuhlman, L. (1994). Psychology on the streets: mental health practice with homeless persons . New York: J. Wiley & Sons.

Kusmer, L. (2003). Down and Out, On the Road: The Homeless in American History . Oxford: Oxford University Press.

Radin, B. (2000). Beyond Machiavelli: Policy Analysis Comes of Age . Georgetown: Georgetown University Press

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2019, May 16). Approaching Homelessness in America. https://ivypanda.com/essays/homelessness-in-america-research-paper/

"Approaching Homelessness in America." IvyPanda , 16 May 2019, ivypanda.com/essays/homelessness-in-america-research-paper/.

IvyPanda . (2019) 'Approaching Homelessness in America'. 16 May.

IvyPanda . 2019. "Approaching Homelessness in America." May 16, 2019. https://ivypanda.com/essays/homelessness-in-america-research-paper/.

1. IvyPanda . "Approaching Homelessness in America." May 16, 2019. https://ivypanda.com/essays/homelessness-in-america-research-paper/.

Bibliography

IvyPanda . "Approaching Homelessness in America." May 16, 2019. https://ivypanda.com/essays/homelessness-in-america-research-paper/.

• Homelessness in Canadian Society
• The Effects of Homelessness in Ohio
• Homelessness: Making Reasonable Lodging for Children and Families
• How Social Media Network Can Change the Attitude of Australian Youth
• Millennium Development Goals in Kenya, Ivory Coast, Haiti, and Chad
• Judicial Corruption in Developing Countries
• Is Poverty of Poor Countries in Anyway Due to Wealth of the Rich?
• Rural Poverty in Indonesia

Monthly payments of $1,000 could get thousands of homeless people off the streets, researchers say

• Show more sharing options
• Copy Link URL Copied!

A monthly payment of $750 to $1,000 would allow thousands of the city’s homeless people to find informal housing, living in boarding homes, in shared apartments and with family and friends, according to a policy brief by four prominent Los Angeles academics.

Citing positive preliminary results of pilot studies in several cities, including Los Angeles, they argue the income could provide access to housing for a portion of the population who became homeless primarily as the result of an economic setback. This could ultimately save millions of dollars in public services, they argued, and leave the overstretched and far more expensive subsidized and service-enriched housing for those who have more complicated social needs.

“If the idea is to reduce the number of people on the street, definitely the fastest way to do that is money and not this incredibly complex system that we have built up primarily to help people with serious disabilities,” said lead author Gary Blasi, a professor emeritus in the UCLA School of Law.

The paper offers no prescriptions for how the payments should be funded or who should receive the money. Instead, the authors, coming from four separate disciplines, contrast the simplicity and documented effectiveness of basic income with the high cost and inadequate results of programs to provide standard housing for every homeless person.

“The truth is, we cannot afford not to do better than the current system, which spends a huge amount of money to house a small fraction of those in need,” they wrote.

That system, relying on housing navigators to “seek very scarce subsidized housing subject to strict criteria” is a “lengthy and expensive process” leaving thousands of rental subsidy vouchers unused and thousands of people unable to find housing.

More L.A. Latinos falling into homelessness, shaking communities in ‘a moment of crisis’

Homelessness among Latinos has shot up in Los Angeles County while other demographic groups have seen a decline over the last two years.

Oct. 28, 2022

“Providing interim housing during this process can be very costly, as is adding to the supply of housing,” they wrote.

Meanwhile, a source of readily available affordable housing goes untapped.

“Informal housing, once a subject of study only in developing countries, means housing that does not conform to the standards of the formal housing market,” they wrote. “It includes shared housing arrangements, housing that does not meet all code requirements, rooms rented in single-family homes.”

“There’s a vast informal rental market going on already all across California,” co-author Sam Tsemberis, a clinical community psychologist with the UCLA Department of Psychiatry, said in an interview. “People are renting out single-family homes. They have two or three beds in each of the bedrooms and are charging $400, $500 a month for people to sleep.”

Tsemberis is the founder of Pathways to Housing, a New York program that pioneered the Housing First approach now adopted across the nation as a model for housing chronically homeless people with compounding issues of mental illness and substance abuse.

Basic aid is not a substitute for housing first, Tsemberis said.

“This is for the group that has more resources internally, a work history, isn’t struggling mightily with mental illness or addiction,” he said.

Pointing to research by the Benioff Homeless and Housing Initiative at UC San Francisco, the authors suggest that more than half of people living on the streets fall into that category.

The study found that fewer than a third of a large sample of unhoused people in California had been tenants in “ordinary” housing before becoming homeless. “Most were last housed in a unit rented by someone else — i.e., the informal housing market. If they were required to pay rent, their median monthly rent was $450.19,” they wrote.

The authors cited a 2022 survey by Urban Institute of guaranteed income programs in Austin, Chicago and Arlington County, Virginia, that found cash subsidies provided more flexible housing support at lower cost, allowed recipients more dignity, avoided voucher discrimination by landlords and served people who were ineligible for government subsidies.

While those programs, and similar ones currently under way in Los Angeles County, are for a general population, a preliminary study by one of the authors has found that homeless people also benefit.

Ben Henwood, director of the Center for Homelessness, Housing and Health Equity Research at the USC Suzanne Dworak-Peck School of Social Work, designed a controlled study of a cash stipend pilot mounted by the San Francisco-based nonprofit Miracle Messages.

Early results were so promising that Henwood released a preliminary six-month analysis breaking down recipients’ spending as 36.6% food, 19.5% housing, 12.7% transportation, 11.5% clothing and 6.2% healthcare, leaving only 13.6% uncategorized.

“The idea that to give poor people money is controversial is just strange to me,” Henwood said. “Of course that will help.”

Blasi, a lawyer who has for decades engaged in litigation involving housing, welfare, homelessness, and redevelopment and started the Legal Aid Foundation of Los Angeles’ Eviction Defense Center in 1983, said Henwood’s study inspired the idea for the brief.

Along with Henwood and Tsemberis, Blasi brought in Dan Flaming, president of the Economic Roundtable.

Flaming has led research that documented the high cost of public services for chronically homeless people. He recently conducted a study that used predictive tools to identify individuals likely to be persistently homeless and provided them housing, mental health therapy and apprenticeship training for union jobs.

At its conclusion , twice as many participants were housed and 40% more were employed than at its inception.

“The larger perspective is that homelessness is a result of economic inequality and income at least as much as it is a lack of affordable housing,” Flaming said. “I don’t see a way that we can house our way out of homelessness. This is another tool, the tool providing people a basic income, that we need to be making a better use of.”

While not proposing a specific administrative plan, the authors point to a potential mechanism for implementing basic income: raising General Relief, the county program mandated to provide minimal assistance to people who are “destitute, unemployed and ineligible for any other form of assistance.”

“Liberal L.A. County hasn’t raised the GR grant in 40 years,” Blasi said.

Since the 1970s the rate has been $221 per month. If it had risen with inflation, it would be $1,008.

“Unsurprisingly, the County’s Department of Public Social Services reports that about 75% of the more than 100,000 General Relief recipients are homeless and have no stable address.” they wrote.

The paper anticipates, and counters, the potential objection that their plan would push people into substandard housing.

“There is no reason to think that housing will be worse than the last stable housing they had before becoming homeless,” it said.

“I don’t have any illusions that people are going to be living in places that middle-class people would find acceptable,” Blasi said.

Informal housing is no substitute for the thousands of units of supportive housing that are needed.

But “somewhere around half of the people on the street and in those encampments don’t need supportive housing,” he said. “They don’t. And they don’t qualify for it and they’re not getting into it,” Blasi said.

“We’re sort of communicating if you can just hang on for four years on the street, you’ll be troubled enough that you will rise to the top of our list. That’s just crazy.”

More to Read

Bass budget would reduce homelessness funding, scale back LAPD hiring goal

April 22, 2024

Mayor Bass’ ambitious housing program calls on L.A.’s wealthy. Can she pull it off?

April 21, 2024

Mayor Karen Bass urges L.A.’s wealthy to fund homeless housing

April 16, 2024

Start your day right

Sign up for Essential California for news, features and recommendations from the L.A. Times and beyond in your inbox six days a week.

You may occasionally receive promotional content from the Los Angeles Times.

Los Angeles Times senior writer Doug Smith scouts Los Angeles for the ragged edges where public policy meets real people, combining data analysis and gumshoe reporting to tell L.A. stories through his more than 50 years of experience covering the city.

More From the Los Angeles Times

Science & Medicine

Deadly overdoses fell in U.S. for first time in five years, new estimates show

May 15, 2024

Column: L.A.’s only Spanish-language children’s bookstore will soon get más grande

L.A.’s dirtiest cop: A mild-mannered traffic officer who moonlighted as a hit man

Climate & Environment

Wildfire weather is increasing in California and much of the U.S., report finds

When did the Holocaust End? Examining the Conclusion of a Dark Era and its Lasting Impact on World History

This essay about the Holocaust explores the dual themes of human depravity and resilience. It discusses the relentless continuation of the Nazi genocide as World War II was ending and the liberation of concentration camps by Allied forces. The essay also covers the Nuremberg Trials, the challenges survivors faced post-Holocaust, and the ongoing issues of anti-Semitism and genocide. It emphasizes the importance of remembrance and education to ensure that such atrocities are not forgotten or repeated.

How it works

The Holocaust stands as a profound testament to both the darkest capabilities of human nature and the extraordinary resilience inherent in the human spirit. As World War II neared its end, the relentless machinery of the Nazi genocide continued unabated, despite the shifting tides of battle. The encroachment of Allied forces into Nazi-occupied lands brought with it a sliver of hope in a period overshadowed by immense darkness. The liberation of the concentration camps underscored the resilience of the human spirit, as Allied troops were met with harrowing scenes of immense suffering endured by countless individuals.

The liberation of Auschwitz-Birkenau on January 27, 1945, marked a critical juncture in history. Soviet forces dismantled the camp’s ominous barbed wire and unlocked the gates to reveal chilling evidence of the atrocities committed—starved prisoners, horrific gas chambers, and the overwhelming smell of death. This scene was replicated as additional camps such as Bergen-Belsen, Dachau, and Buchenwald were liberated by Allied forces.

The termination of the Holocaust did not herald a straightforward conclusion but initiated a prolonged period of justice-seeking and healing. The Nuremberg Trials, convened in the aftermath, attempted to deliver justice to the architects of Nazi horrors. However, the trials also illustrated the profound difficulty of administering justice in response to such vast and heinous crimes, highlighting the fragility and limitations of legal systems against the backdrop of mass atrocities.

For the survivors, the post-Holocaust era posed new challenges as they sought to reconstruct their lives amidst the remnants of war and the persistent echoes of trauma. The psychological scars left by their experiences created lasting impacts that extended into subsequent generations.

Moreover, the end of the Holocaust did not extinguish the fires of anti-Semitism nor prevent future genocides. Despite the solemn vow of “Never Again,” the world has witnessed recurring instances of mass violence and ethnic cleansing since then. The enduring lessons of the Holocaust—spotlighting the dangers of hatred, bigotry, and indifference—remain crucially important in the modern era.

Reflecting on the Holocaust’s aftermath calls for a renewed commitment to remembrance and education, ensuring that the tragedies endured are neither forgotten nor repeated.

Ultimately, the conclusion of the Holocaust did not signify an end but the beginning of an ongoing journey toward recovery, understanding, and hope. As we navigate the shadows cast by this part of our history, we must continue to shine a light on the path ahead with dedication to remembrance, resilience, and a steadfast resolve to never forget.

Cite this page

When Did the Holocaust End? Examining the Conclusion of a Dark Era and Its Lasting Impact on World History. (2024, May 12). Retrieved from https://papersowl.com/examples/when-did-the-holocaust-end-examining-the-conclusion-of-a-dark-era-and-its-lasting-impact-on-world-history/

"When Did the Holocaust End? Examining the Conclusion of a Dark Era and Its Lasting Impact on World History." PapersOwl.com , 12 May 2024, https://papersowl.com/examples/when-did-the-holocaust-end-examining-the-conclusion-of-a-dark-era-and-its-lasting-impact-on-world-history/

PapersOwl.com. (2024). When Did the Holocaust End? Examining the Conclusion of a Dark Era and Its Lasting Impact on World History . [Online]. Available at: https://papersowl.com/examples/when-did-the-holocaust-end-examining-the-conclusion-of-a-dark-era-and-its-lasting-impact-on-world-history/ [Accessed: 15 May. 2024]

"When Did the Holocaust End? Examining the Conclusion of a Dark Era and Its Lasting Impact on World History." PapersOwl.com, May 12, 2024. Accessed May 15, 2024. https://papersowl.com/examples/when-did-the-holocaust-end-examining-the-conclusion-of-a-dark-era-and-its-lasting-impact-on-world-history/

"When Did the Holocaust End? Examining the Conclusion of a Dark Era and Its Lasting Impact on World History," PapersOwl.com , 12-May-2024. [Online]. Available: https://papersowl.com/examples/when-did-the-holocaust-end-examining-the-conclusion-of-a-dark-era-and-its-lasting-impact-on-world-history/. [Accessed: 15-May-2024]

PapersOwl.com. (2024). When Did the Holocaust End? Examining the Conclusion of a Dark Era and Its Lasting Impact on World History . [Online]. Available at: https://papersowl.com/examples/when-did-the-holocaust-end-examining-the-conclusion-of-a-dark-era-and-its-lasting-impact-on-world-history/ [Accessed: 15-May-2024]

Don't let plagiarism ruin your grade

Hire a writer to get a unique paper crafted to your needs.

Our writers will help you fix any mistakes and get an A+!

Please check your inbox.

You can order an original essay written according to your instructions.

Trusted by over 1 million students worldwide

1. Tell Us Your Requirements

2. Pick your perfect writer

3. Get Your Paper and Pay

Hi! I'm Amy, your personal assistant!

Don't know where to start? Give me your paper requirements and I connect you to an academic expert.

short deadlines

100% Plagiarism-Free

Certified writers

Sanford Celebrates the Class of 2024

Share this story.

Our newest graduates join more than 9,500 Duke Sanford alumni worldwide.

For undergraduates, public policy is a liberal arts major. Students learn to read critically, think analytically, and write concisely.

The celebrations coincided with Duke University's centennial celebration .

Families joined us from around the world.

Duke Sanford is one of the nation's premier schools of public policy, recognized both nationally and abroad for teaching, policy engagement and research.

The Sanford School of Public Policy graduation ceremonies on May 10 recognized more than 300 graduates from six academic programs this spring:

• Executive Master of National Security Policy (MNSP);
• International Master of Environmental Policy (IMEP);
• Master of International Development Policy (MIDP);
• Master of Public Policy (MPP);
• Public Policy doctoral program (PhD); and
• Public Policy undergraduate major (PPS).

Graduate Degree Ceremony Overview

Both the graduate (9AM) and undergraduate (1PM) ceremonies were introduced by Sanford Dean Judith Kelley. She began her remarks by connecting the graduating students to an ancient story of the “red thread” told through ancient Greek mythology, relating it to the thread of community that will always guide Sanford graduates back to their common roots.

As new members of the 9,500-plus Sanford alumni population that spans over 100 countries, Kelley reminded graduates of the lifetime of aspirations and expectations that await Sanford students.

Her address was punctuated by the inclusion of an actual red ribbon in each student program, a reminder not only of the Greek reference but also of her own Danish heritage, “The story of Theseus and Adriadne’s thread was part of the inspiration for what has become a concept in Scandinavian countries, including Denmark, my home country. “Den røde tråd.” The red thread,” said Kelley.

Distinguished Alumni Speaker Ryan Smith, MPP’14

The Distinguished Alumni Speaker was Ryan Smith, MPP’14. Currently serving as the Innovation Team Project Manager for the City of Durham, Smith delivered a poignant speech to the graduating class of 2024, reflecting on his journey and sharing insights gleaned from his experiences. Smith, who leads a rapidly growing department, expressed his deep honor in addressing the class and welcomed them as fellow alumni. He compared the graduates to his own team and welcomed them as alums. "I’m so glad you’re a part of our team. And I’m excited for what we can accomplish with the addition of your heart, talents, and experience that we could not have otherwise,” said Smith.

Reflecting on his own journey, Smith shared instances where he found purpose and joy in serving his community. He recounted initiatives such as the development of a legal services program, collaboration with formerly incarcerated individuals, and leading a branch of public safety focused on compassionate responses to behavioral health crises. Through these experiences, Smith emphasized the fulfillment derived from making a positive impact on society.

Smith acknowledged the inevitability of facing difficult days and encouraged the graduates to embrace them. He shared two guiding principles for navigating challenging times: drawing near to those impacted by their work and taking action despite limitations. "When you are working on really challenging issues, you have to make sure you’re taking time to draw close and center those most impacted and marginalized,” Smith expressed.

Drawing from his work with the Durham Community Safety Department, Smith emphasized the importance of empathizing with marginalized communities and centering their experiences in policymaking. He shared the story of Martin, a homeless individual struggling with mental illness, to illustrate the significance of understanding individual needs and addressing systemic barriers.

Smith emphasized the role of leadership in mobilizing collective efforts to address societal challenges. He recounted how his team collaborated with various stakeholders to establish emergency shelters for the homeless during cold weather, demonstrating the power of unified action in effecting change. "Leadership is about the ability to bring people together around a common challenge and finding a way forward, drawing upon the group’s collective power, resources, and talent."

Finally, Smith encouraged the graduates to celebrate small victories and to remain connected to their support networks. He emphasized the importance of cherishing every step forward and expressed optimism for the graduates' future endeavors.

"Don’t take the small wins for granted. Celebrate every step you can along the way."

Read more about Ryan Smith.  

2024 Richard Stubbing Award: Professor Mallory SoRelle

Mallory SoRelle with Senior Associate Dean of Faculty Manoj Mohanan.

Professor Mallory SoRelle won the 2024 Stubbing Award for teaching and mentoring graduate students. The award recognizes outstanding contributions to the school's graduate programs and commitment to the personal and professional development of their students.  

Senior Associate Dean of Faculty Manoj Mohanan announced the award during the 2024 Graduate Commencement ceremony, congratulating SoRelle for her extraordinary care for students and the greater Sanford community.

This award, established in honor of the late Richard Stubbing (a celebrated Sanford professor), is nominated by graduate students. SoRelle received numerous nominations, one of which included this summary of SoRelle's excellence in teaching.

“Professor Mallory SoRelle is deeply committed to teaching at all levels. This semester, she created a new undergraduate course on policy feedback with a hands-on survey lab component. She also teaches a core course for PhD first-year students, laying the foundation for a successful PhD journey. For me personally, she has been invaluable in terms of my professional and personal development. I would not be finishing my PhD this year with a tenure-track position without her.”

Read more about SoRelle and the Stubbing Award.  

3 PhDs awarded

Public Policy: Xinyue "Alison" Pei | Essays on Labor Market Dynamics and Innovation. Advisor: Prof Matthew S. Johnson. Posing with: Prof Kate Bundorf.

Environmental Policy: Maya Chandrasekaran| Energy Access, Time Use, and Women’s Empowerment in Low- and Middle-Income Countries. Advisor: Prof Marc Jeuland. Posing with Prof Subhrendu Pattanayak.

Environmental Policy: Zhenxuan Wang | The Economics of Energy Infrastructure and Climate Change. Advisor: Prof Robyn Meeks. Posing with: Robyn Meeks and Prof Billy Pizer.

Undergraduate Degree Ceremony Overview

Undergraduate speaker: laya sathyan.

Undergraduate speaker Laya Sathyan emphasized potential for positive change.

Laya Sathyan delivered Sanford’s 2024 student address. As a graduating student focused on Public Policy and Global Health, she began by expressing her gratitude for the opportunity to address her fellow graduates, faculty, and guests, reflecting on her journey since arriving at Duke in 2020. "If you're like me, you graduated high school by reaching for your diploma out of your car window, like picking up a hashbrown at the McDonalds drive-through,” said Sathyan, eliciting laughter from her classmates.

From there, Sathyan acknowledged the transformative power of her education at Duke and Sanford, emphasizing the importance of embracing change. She highlighted the impact of the pandemic on their academic journey and personal growth, noting the resilience required to navigate through unfamiliar circumstances. She compared her personal change to the potential for change in all people. "Sanford has changed all of us, in our maturity, capabilities, and understandings of the world,” she pointed out. "I hope we can all run towards [change] rather than away."

To illustrate this, Sathyan shared a powerful anecdote about Durham racial justice advocate Ann Atwater and C.P. Ellis, the former leader of the Durham Ku Klux Klan, demonstrating the transformative potential of forgiveness in overcoming deep-seated differences. She emphasized the importance of forgiveness as a catalyst for progress and unity in a divided world.

"Society has become more divisive and fragmented than ever before. We are encouraged to hate and to hate blindly with no compassion for those on the other side. As Sanford graduates, we have the power to either further this divide or bridge it."

In her closing remarks, Sathyan urged her fellow graduates to honor their education and continue the legacy of Sanford by advocating for positive change. She emphasized the importance of forgiveness, self-reflection, and the belief in the capacity for personal and societal transformation. "In a world that is marked by division, to love and forgive is a radical act,” said Sathyan.

She finished again encouraging the audience to embrace change. “I ask my classmates, the class of 2024, for one thing. Do not leave Sanford behind. This graduation marks our transformation from students into policymakers, advocates, and leaders. As you move forward into the next stage of your lives, I ask you to honor the gift that was our education here, and to carry Sanford, and everything this school stands for into the future. I ask you to remember the importance of forgiveness, to others and to yourself. And I ask you to remember that everyone has the capacity to change.”

Read more about Laya Sathyan.  

Fleishman Award Winner (Highest Grade Point Average)

Katie Heath, Hannah Galdes, Grace Endrud and Anisha Reddy posing with Sanford's founding director Joel Fleishman for whom the award is named.

Best Honors Thesis: Christina Wang

Christina Wang is Sanford’s 2024 Best Thesis winner with an Honors Thesis titled "What Do Americans Think Democracy Means?” which includes research that reflects her dedication to understanding democratic principles and amplifying the voices of the American people. Read more about Christina and her research.

Featured Video

2024 Terry Sanford Leadership Award Winner: Grace Endrud

Grace is one of two 2024 Terry Sanford Leadership Award winners, a prestigious award for public policy undergraduates at Duke. She says when she first came to Duke, she didn’t see herself as a leader, instead she focused on her work in the classroom. But when she applied for Duke’s Nakayama Public Service Scholars program, something clicked.

2024 Terry Sanford Leadership Award Winner: Chloe Nguyen

Chloe Nguyen is one of two winners of the 2024 Terry Sanford Leadership Award. Chloe is passionate about understanding the psychological drivers of intergroup conflict like political polarization and developing interventions to address them. 

More awards

• Charles B. Rangel Fellowship : Manon Fuchs
• Critical Language Scholarship : Manon Fuchs, Charles Hester and Samyuktha Sreeram
• Schwarzman Scholarship: Sejal Mayer-Patel
• Gaither Junior Fellowship: Kristin Zhu
• Fulbright Scholarship: Andrew Greene

Watch Fleishman and Terry Sanford Leadership Award Winners on stage.

Tifft Teaching Award: Lisa Gennetian

Named after the esteemed Susan Tifft, the Eugene C. Patterson Professor of the Practice of Communications and Journalism, this award celebrates educators who excel in guiding and nurturing undergraduate students.

Students nominated Lisa Gennetian for the 2024 award, and the praise for her instruction was glowing. Gennetian is Pritzker Professor of Early Learning Policy Studies at Sanford and is an applied economist who studies how poverty and policy interventions to alleviate it affect children’s development, education, and other outcomes.

Gennetian teaches the core microeconomics course for Sanford undergraduates. The many students who nominated her for this award praised her ability to make economics less daunting by engaging the class with accessible real-world examples, including from her own research.

The nominations called her a “phenomenal” and “passionate” teacher who cares deeply about her students, always wanting them to see how economic principles matter to understanding and addressing the policy problems they care about. Students appreciated her flexibility, accessibility, and sense of humor, as well as the welcoming and lively environment she created in the classroom.

Read more about Lisa Gennetian and the Tifft Teaching Award.  | Watch her receive the award

More Graduation Stories

We have profiled a wide variety of Duke Sanford School of Public Policy graduates. 

Matt LoJacono

Matt LoJacono is Sanford's Senior Public Relations Manager. With a focus on media relations, Matt oversees and nurtures connections between the institution and various outlets, ensuring effective communication about faculty, staff, and students. He is also responsible for crafting engaging news stories and in-depth articles that highlight the events and achievements within Sanford. As such, when the need arises, Matt is in charge of updating printed materials including the faculty guide throughout the year.

Matt holds a BA in Public Relations from George Mason University and an MS in Communication from North Carolina State University. He is an active member of the Public Relations Society of America, further expanding his and Sanford's network. Outside of work, Matt enjoys going to baseball games and is an avid fan of the Boston Red Sox.

Related Stories

2024 Graduation Stories: Solomon Ayehu

2024 Graduation Stories: Chloe Nguyen

Graduation Stories 2024: Grace Endrud

7 Best Ways to Shorten an Essay

• Smodin Editorial Team
• Published: May 14, 2024

Are you removing a lot of words and paragraphs from your essay but still not seeing the word count budge? Whether you’re meeting a strict word count or refining your message, reducing your essay’s length without sacrificing content quality can be challenging.

Luckily, besides just aiming for the minimum word count, there are some pretty simple solutions, like using artificial intelligence, conducting thorough research, and trimming unnecessary words. But there’s more.

In this guide, we’ll unpack some practical tips to help you make your essay concise and impactful. Time to make every word count!

7 Best Ways To Shorten an Essay

Here’s a detailed breakdown of the best ways you can shorten your essay:

1. Use Artificial intelligence

When we talk about academic writing, artificial intelligence (AI) can be a game changer, especially when it comes to reducing the length of your essays.

Tools like Smodin can help make your content more concise while enhancing overall quality. AI can help you shorten your essay through the following methods:

• Automated rewriting : AI rewriting tools can reformulate existing content to make it more straightforward while maintaining the original meaning.
• Sentence simplification : Algorithms can analyze your sentences and suggest simpler alternatives, helping eliminate redundant information and reduce word count.
• Research assistance : Certain platforms have AI-powered research tools that allow you to quickly gather the most relevant information. This ensures that every word in your essay contributes to your argument without unnecessary fillers.
• Plagiarism check : Ensuring your essay is plagiarism-free is crucial. For example, Smodin’s plagiarism detection tools help you identify and replace copied content with original, concise expressions.
• Instant feedback : Receive real-time suggestions on how to streamline your text, focusing on the essentials to effectively communicate your message.
• Reference generation : Automatically generate and insert citations in the correct format, which helps save you time while maintaining the academic integrity of your essay and keeping it short.

2. Identify Unnecessary Words and Remove Them

One of the simplest yet most effective ways to shorten your essay is by identifying and eliminating unnecessary words.

This approach helps decrease word count and sharpens your arguments, making your writing more compelling. You can identify and remove extra words by doing the following:

• Spot wordy phrases : Often, phrases can be condensed without losing meaning. For example, the phrase “due to the fact that” can be replaced with “because.” Be on the lookout for wordy phrases that increase word count needlessly.
• Remove unnecessary prepositional phrases : Prepositional phrases can be redundant or add unnecessary detail. Evaluate whether these phrases add value or just extra words. Cutting them can make sentences more direct.
• Avoid redundancies : Redundant pairs like “absolutely essential” or “future plans” can be reduced to one word without losing informational value.
• Trim excess adjectives and adverbs : Adjectives and adverbs can make writing better but can also lead to over-description. Use them sparingly, especially when they don’t contribute additional meaning to the nouns and verbs they modify.
• Fewer words; more impact : Aim for brevity by using fewer words to express the same idea. This will help to reduce the word count while making your writing more impactful and clear.

3. Tighten Sentence Structure

Tightening your sentence structure is crucial for making your essay more concise and readable. Use active voice to make your writing clearer and more dynamic. This is especially important in academic writing, where you have to get to the point quickly.

In academic essays, shifting from passive voice to active voice can shorten and strengthen your sentences. For example, instead of writing, “The experiment was conducted by the students,” you can say, “The students conducted the experiment.” This reduces the number of words and places the action directly with the subject, making your sentences more direct.

Combining two separate sentences into one can streamline your ideas and reduce redundancies. Look for opportunities where sentences can be merged without losing their significance. For example, “He wrote the book. It became a bestseller.” can be rephrased as “He wrote the book, which became a bestseller.”

Also, avoid unnecessary qualifiers and modifiers that don’t add substantial information. Sentences often become bogged down with these extras, making them cluttered and long.

4. Conduct Thorough Research

When writing essays, extensive research can make the final output a lot shorter. Effective research helps you gather precise information that’s relevant to your topic. This means you’ll write more directly and avoid needless elaboration. Here’s how you can conduct research effectively:

• Define the scope of your research : Determine what information is essential to the argument. This initial step will help you focus your research efforts and prevent irrelevant data.
• Identify key sources : Begin with scholarly databases and academic journals that offer peer-reviewed articles. These sources provide credible, authoritative information that can be crucial for academic writing.
• Use precise keywords : When searching for information, use specific keywords related to your essay topic. Precision here will help find the most relevant articles and studies, reducing time spent on unnecessary reading.
• Evaluate sources : Assess the relevance and reliability of each source. Check the publication date to ensure the information is current and relevant to your topic.
• Take notes efficiently : As you research, jot down important points, quotes, and references. Organize these notes according to the sections in your essay to make writing faster.
• Synthesize information : Combine information from multiple sources to build a strong argument. This will allow you to write comprehensively and with fewer words, as each sentence carries more weight.

5. Improve Your Paragraph Structure

Streamlining paragraphs can make your essay shorter and more digestible for the reader. With a well-structured paragraph, you can focus on a single idea supported by concise statements.

Begin each paragraph with a topic sentence that clearly states the main idea. This sentence sets the direction and tone, letting the reader know what to expect. It also helps ensure that every following sentence relates directly to the main idea.

Condense supporting information by merging ideas that logically coexist within a single sentence or phrase. After that, evaluate each sentence for its contribution to the paragraph’s main idea. Remove any information that is repeated or goes into too much detail.

Focus on providing evidence and explanations that directly support the main point. You should also end each paragraph with a sentence that reinforces the main idea and potentially links to the next paragraph. This creates smooth transitions and keeps the essay focused and cohesive.

6. Refine the Introduction and Conclusion

These sections frame your essay and influence how your arguments are perceived. Here are some ways to keep them concise yet effective.

Introduction

The introduction should be engaging and concise, clearly stating the purpose and scope of your essay. Begin with a hook that grabs the reader’s attention, followed by background information that sets the context. Incorporate your thesis statement early on, ideally at the end of the intro.

The conclusion needs to reinforce the thesis. Summarize key points in the essay and show how they support the thesis. Provide a final thought that leaves the reader with something to ponder.

Also, remember to keep it tight – the conclusion isn’t a place for introducing new ideas. It should wrap up the ones you presented and prompt the reader to pose their own questions.

7. Edit and Proofread

Keep your essay concise and error-free by allocating ample time for editing and proofreading. These processes scrutinize your work at different levels, from the overall structure to word choices and punctuation. Here’s how you can go about it:

Start by reading through your entire paper to get a feel for its flow and coherence. Check if all paragraphs support your thesis statement and if section transitions are smooth. This will help you spot areas where the argument might be weak, or wording could be clearer.

Focus next on paragraph structure. Ensure each paragraph sticks to one main idea and that all sentences directly support the idea. Remove any repetitive or irrelevant sentences that don’t add value.

Then, look for clarity and style. Replace complex words with simpler alternatives to maintain readability. Keep your tone consistent throughout the paper. Adjust the sentence length and structure to enhance the flow and make it more engaging.

Proofreading

Proofreading comes after editing. The focus here is catching typing errors, grammatical mistakes, and inconsistent formatting. It’s always best to proofread with fresh eyes, so consider taking a break before this step.

Use tools like spell checkers, but don’t rely solely on them. Read your essay aloud or have someone else review it. Hearing the words can help you catch errors you may have missed.

Lastly, check for punctuation errors and ensure all citations and references are formatted according to the required academic style. This and all of the above are areas in which AI can help get the job done with speed and precision.

Why You Might Need to Shorten Your Essay

Ever heard the expression “less is more”? When it comes to academic writing, it normally is. Keeping your essays concise offers several benefits:

• Enhances clarity : A shorter essay forces you to focus on the main points and critical arguments, reducing the risk of going off-topic. This clarity makes your writing more impactful and easier for the reader to follow.
• Meets word limits : Many academic assignments have a maximum word count. Learning to express your thoughts concisely helps you stay within these limits without sacrificing essential content.
• Saves time : For both the writer and the reader, shorter essays take less time to write, revise, and read. This efficiency is especially valuable in academic settings where time is usually limited.
• Increases engagement : Readers are more likely to stay engaged with a document that gets to the point quickly. Lengthy texts can deter readers, especially if the content has unnecessary words or redundant points.
• Improves writing skills : Shortening essays helps refine your writing skills. You become better at identifying and eliminating fluff, focusing instead on what really adds value to your paper.

Overall, adopting a more succinct writing style helps you meet academic requirements and polish your communication skills.

Why Use Smodin To Shorten an Essay

Using AI-powered platforms like Smodin to shorten your essay is both the simplest and the least time-consuming method available. Here’s why you should probably make Smodin your go-to essay shortener:

• Efficiency : Smodin eases the editing process, using advanced algorithms to quickly identify areas where content can be condensed without losing meaning.
• Accuracy : With its powerful AI, Smodin ensures that the essence of your essays stays intact while getting rid of unnecessary words, making your writing more precise.
• Ease of use : Smodin is user-friendly, making it accessible even to those who aren’t the most tech-savvy. Its easy-to-grasp interface allows for seamless navigation and operation.

Smodin’s offerings

• Rewriter : Available in over 50 languages, this tool helps rewrite text to be more concise.
• Article Writer : Assists in drafting articles that are crisp and to the point.
• Plagiarism and Auto Citation : Ensures your essay is original and correctly cited, which is crucial in academic writing.
• Language Detection : Identifies the language of the text, ensuring the right adjustments are made for clarity.

All these tools and more are what make Smodin an excellent choice for academics looking to reduce the length of their essays.

Final Thoughts

Word counts can be a real headache, especially when you need to say a lot with a little. Thankfully, by identifying unnecessary words, tightening your sentences, and using tools like Smodin, you can make your essay concise without losing its meaning. Remember, a shorter essay doesn’t just meet word limits; and it’s clear, more compelling, and more likely to keep your reader engaged.

Keep it short, keep it sweet, and make every word count! Get started for free right now with Smodin.