Homelessness represents an enduring public health threat facing communities across the developed world. Children, families, and marginalized adults face life course implications of housing ...insecurity, while communities struggle to address the extensive array of needs within heterogeneous homeless populations. Trends in homelessness remain stubbornly high despite policy initiatives to end homelessness. A complex systems perspective provides insights into the dynamics underlying coordinated responses to homelessness. A constant demand for housing assistance strains service delivery, while prevention efforts remain inconsistently implemented in most countries. Feedback processes challenge efficient service delivery. A system dynamics model tests assumptions of policy interventions for ending homelessness. Simulations suggest that prevention provides a leverage point within the system; small efficiencies in keeping people housed yield disproportionately large reductions in homelessness. A need exists for policies that ensure reliable delivery of coordinated prevention efforts. A complex systems approach identifies capacities and constraints for sustainably solving homelessness.
Foreword by Nan Roman, President and CEO of the National Alliance to End Homelessness This book explains how to end the U.S. homelessness crisis by bringing together the best scholarship on the ...subject and sharing solutions that both local communities and national policy-makers can apply now. In the Midst of Plenty shifts understanding of homelessness away from individual disability to larger contexts of poverty, income inequality, housing affordability, and social exclusion. Homelessness experts Shinn and Khadduri provide guidance on how to end homelessness for people who experience it and how to prevent so many people from reaching the point where they have no alternative to sleeping on the street or in emergency shelters. The authors show that we know how to end homelessness—if we devote the necessary resources to doing so. In the Midst of Plenty: Homelessness and What to Do About It is an excellent resource for policy-makers, professionals in the homeless services system, and anyone else who wants to end homelessness. It also can serve as a text in undergraduate or masters courses in public policy, sociology, psychology, social work, urban studies, or housing policy. "The knowledgeable and thoughtful authors of this book—two brilliant women who know as much as anyone in the country about the nature of homelessness and its solutions—have done a great service by taking us on a journey through the history of homelessness, how our responses have changed, and how we can end it." — Nan Roman, President and CEO National Alliance to End Homelessness. "Shinn and Khadduri's new book is a thorough yet concise examination of what we know about the nature and causes of homelessness, and the crucial lessons learned. This critically important work provides a roadmap to restoring basic housing and income security as viable policy options, in the face of our daunting inequality divide that otherwise threatens millions with destitution and homelessness." — Dennis Culhane, Dana and Andrew Stone Professor of Social Policy, University of Pennsylvania "Marybeth Shinn and Jill Khadduri have combined their significant expertise to create an essential guide about the history of modern homelessness and to offer a clear path forward to end this American tragedy. Their policy recommendations on ending homelessness are culled from the best about what we know works." — Barbara Poppe, Executive Director US Interagency Council on Homeless, 2009-2014
Contact tracing is intended to reduce the spread of coronavirus disease 2019 (COVID-19), but it is difficult to conduct among people who live in congregate settings, including people experiencing ...homelessness (PEH). This analysis compares person-based contact tracing among two populations in Salt Lake County, Utah, from March–May 2020.
All laboratory-confirmed positive cases among PEH (n = 169) and documented in Utah's surveillance system were included in this analysis. The general population comparison group (n = 163) were systematically selected from all laboratory-confirmed cases identified during the same period.
Ninety-three PEH cases (55%) were interviewed compared to 163 (100%) cases among the general population (P < .0001). PEH were more likely to be lost to follow-up at end of isolation (14.2%) versus the general population (0%; P-value < .0001) and provided fewer contacts per case (0.3) than the general population (4.7) (P-value < .0001). Contacts of PEH were more often unreachable (13.0% vs. 7.1%; P-value < .0001).
These findings suggest that contact tracing among PEH should include a location-based approach, along with a person-based approach when resources allow, due to challenges in identifying, locating, and reaching cases among PEH and their contacts through person-based contact tracing efforts alone.
We analyzed data from a cohort of Black and Latino men who have sex with men (MSM) in order to identify correlates of prevalent and incident incarceration, including potential predictors related to ...their status as sexual and gender minorities (SGMs). Baseline and follow-up self-administered survey data were examined from Los Angeles County participants' ages 18-45 years at enrollment who were either HIV negative or living with HIV, but recruited to over represent men who used drugs and men with unsuppressed HIV infection. Multivariable logistic regression models were developed to identify predictors of baseline incarceration history and of incident incarceration over study follow-up among 440 and 338 participants, respectively. Older age, Black race, low socioeconomic status, homelessness, stimulant use, and depression symptoms were associated with baseline incarceration history. The only SGM-related factor associated with baseline incarceration history was having experienced violence based on sexual orientation identity. Just one statistically significant, independent positive predictor of incident incarceration was identified: prior incarceration, whereas having four or more friends that could lend money was a statistically significant protective factor against incident incarceration. Fundamental Cause Theory provides a useful framework to explain identified predictors of incarceration. Addressing poverty, housing instability, inadequate access to health care, and their root causes is critical to reducing incarceration rates in this population, as is expanded access to both diversion and anti-recidivism programs and to evidence-based treatment for stimulant use disorders.
People experiencing homelessness are particularly vulnerable to experiencing stressful life events (SLEs) at some point in their lives; these SLEs are crucial for understanding the etiology and ...maintenance of homelessness. This study analyses the differences between men and women experiencing homelessness in the suffering of SLEs throughout their lives (childhood, adolescence, and adulthood). The sample consisted of a group of 293 people experiencing homelessness in Madrid (Spain): 156 men and 137 women. The results suggest that the number and type of SLEs experienced by men and women are different. In general, women experiencing homelessness suffer more SLEs than men in all periods of their lives. The differences in the level of sexual violence in childhood, sexual abuse in adulthood, and abuse by a spouse or partner are particularly striking. However, men experiencing homelessness score significantly higher than women for alcohol abuse, police complaints, arrest, and imprisonment throughout their lives. These findings have significant implications for the design of interventions and social policies that should be tailored to the specific needs of men and women who are homeless.
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