The Importance of Context in Understanding Homelessness and Mental Illness: Lessons Learned From a Research Demonstration Project

Research reports on the housing outcomes for persons who are homeless and mentally ill have focused on client characteristics, program type, and services as independent variables, with mixed results. From social work practice, evaluation theory, and public policy perspectives, context is an important variable. Yet, it has received scant research attention in studies of the outcomes of persons who are mentally ill and homeless. This article summarizes research results from a demonstration project providing outreach or linkage services to this target population, illustrating the significant impact of context variables (site and recruitment source) on client characteristics, implementation, qualitative and quantitative service assessments, and housing outcomes. The discussion suggests how these contextual factors may operate, and it goes on to make recommendations to improve social work research and practice concerning the important dimensions of context that should be assessed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69136/2/10.1177_104973159800800203.pd

Access to housing subsidies, housing status, drug use and HIV risk among low-income U.S. urban residents

<p>Abstract</p> <p>Background</p> <p>Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents.</p> <p>Methods</p> <p>Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis); access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10) were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior.</p> <p>Results</p> <p>Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the street or in a shelter, or temporarily doubling up with friends, acquaintances or sex partners. Living with friends, acquaintances or sex partners was associated with greater sexual risk than those living on the street or in other stable housing situations.</p> <p>Conclusions</p> <p>Results suggest that providing low-income and supportive housing may be an effective structural HIV prevention intervention, but that the availability and accessibility of these programs must be increased.</p