Abstract
OBJECTIVES: A longer duration of homelessness is associated with poorer health outcomes. Following this logic, policies that aim to reduce repeated episodes of homelessness by addressing its root causes can result in better long-term health. This paper explores how many people return to the shelter in a Canadian context and examines factors related to returns to homelessness.
METHODS: The sample included 634 adult men who participated in transitional programming at a large homeless shelter in Montreal, Quebec between 2011 and 2014. Descriptive statistics, survival analysis and multinomial logistic regression techniques were used to examine how psychosocial elements, demographic characteristics and contextual factors were related to returns to the shelter over a one-year follow-up period.
RESULTS: Approximately 38% of the sample returned to the shelter within a year of program departure. A return was positively associated with a lack of support from friends and family (p < 0.05) and an imposed departure from the shelter (p < 0.05). Poor support was also associated with a faster time to return (p < 0.05) to the shelter, as was an imposed departure (p < 0.01).
CONCLUSIONS: Building social networks and altering programs to accommodate those at high risk of an imposed departure may lead to fewer returns to homelessness and subsequently better health outcomes.
Key Words: Homelessness, returns, psychosocial, policy
Résumé
OBJECTIFS: L’itinérance prolongée est associée à de mauvais résultats sanitaires. Suivant cette logique, les politiques qui visent à réduire les épisodes répétés d’itinérance en abordant leurs causes fondamentales peuvent mener à une meilleure santé à long terme. Notre article explore dans un contexte canadien le nombre de gens qui retournent dans les refuges et examine les facteurs liés aux retours à l’itinérance.
MÉTHODE: L’échantillon comprenait 634 hommes adultes ayant participé à des programmes de transition dans un grand refuge pour sans-abri à Montréal (Québec) entre 2011 et 2014. Nous avons employé des techniques de statistique descriptive, d’analyse de survie et de régression logistique multinomiale pour examiner en quoi les éléments psychosociaux, le profil démographique et les facteurs contextuels étaient liés aux retours au refuge sur une période de suivi d’un an.
RÉSULTATS: Environ 38 % des personnes de l’échantillon sont retournées au refuge au cours de l’année suivant leur départ du programme. Un retour était associé positivement au manque d’appui des amis et de la famille (p < 0,05) et au départ imposé du refuge (p < 0,05). Le manque d’appui était également associé à un retour plus rapide (p < 0,05) au refuge, tout comme le départ imposé (p < 0,01).
CONCLUSIONS: La création de réseaux sociaux et la modification des programmes pour tenir compte des personnes à risque élevé de se voir imposer de partir pourraient réduire le nombre de retours à l’itinérance et améliorer par la suite les résultats sanitaires.
Mots Clés: itinérance, retours, psychosocial, politique
Footnotes
Conflict of Interest: None to declare.
References
- 1.Frankish CJ, Hwang SW, Quantz D. Homelessness and health in Canada: Research lessons and priorities. Can J Public Health. 2005;96(Suppl2):S23–29. doi: 10.1007/BF03403700. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Hwang SW. Homelessness and health. Can Med Assoc J. 2001;164(2):229–33. [PMC free article] [PubMed] [Google Scholar]
- 3.Levy BD, O’Connell JJ. Health care for homeless persons. N Engl J Med. 2004;350(23):2329–32. doi: 10.1056/NEJMp038222. [DOI] [PubMed] [Google Scholar]
- 4.Piliavin I, Sosin M, Westerfelt AH, Matsueda RL. The duration of homeless careers: An exploratory study. Soc Serv Rev. 1993;67(4):576–98. doi: 10.1086/604012. [DOI] [Google Scholar]
- 5.Sosin M, Piliavin I, Westerfelt H. Toward a longitudinal analysis of homelessness. J Soc Issues. 1990;46(4):157–74. doi: 10.1111/j.1540-4560.1990.tb01804.x. [DOI] [Google Scholar]
- 6.Wong Y-L, Piliavin I. A dynamic analysis of homeless-domicile transitions. Soc Probl. 1997;44(3):408–23. doi: 10.2307/3097185. [DOI] [Google Scholar]
- 7.Canada, Parliament, Senate. Standing Senate Committee on Social Affairs, Science and Technology. 2002. [Google Scholar]
- 8.Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS Med. 2008;5(12):e225. doi: 10.1371/journal.pmed.0050225. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Hurtubise R, Babin P-O, Grimard C. Understanding Shelters: An Overview of the Scientific Literature. Département de service social, Université de Sherbrooke, Département de sociologie, UQÀM: CRI Collectif de recherche sur l’itinérance, la pauvreté et l’exclusion sociale, Montreal, Quebec; 2007. [Google Scholar]
- 10.Gaetz S. Safe streets for whom? Homeless youth, social exclusion, and criminal victimization. Can J Criminol Crim Just. 2004;46(4):423–55. doi: 10.3138/cjccj.46.4.423. [DOI] [Google Scholar]
- 11.Novac S. Justice and Injustice: Homelessness, Crime, Victimization, and the Criminal Justice System. Toronto, ON: Centre for Urban and Community Studies, University of Toronto; 2011. [Google Scholar]
- 12.Hwang SW. Mortality among men using homeless shelters in Toronto, Ontario. J Am Med Assoc. 2000;283(16):2152–57. doi: 10.1001/jama.283.16.2152. [DOI] [PubMed] [Google Scholar]
- 13.O’Reilly-Fleming T. Down and Out in Canada: Homeless Canadians. Toronto, ON: Canadian Scholar’s Press; 1993. [Google Scholar]
- 14.Rokach A. Private lives in public places: Loneliness of the homeless. Soc Indic Res. 2005;72(1):99–114. doi: 10.1007/s11205-004-4590-4. [DOI] [Google Scholar]
- 15.Caton CLM, Dominguez B, Schanzer B, Hasin DS, Shrout PE, Felix A, et al. Risk factors for long-term homelessness: Findings from a longitudinal study of first-time homeless single adults. Am J Public Health. 2005;95(10):1753–59. doi: 10.2105/AJPH.2005.063321. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Kuhn R, Culhane DP. Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: Results from the analysis of administrative data. Am J Commun Psychol. 1998;26(2):207–32. doi: 10.1023/A:1022176402357. [DOI] [PubMed] [Google Scholar]
- 17.Wong Y-LI. Patterns of homelessness: A review of longitudinal studies. In: Culhane DP, Hornburg SP, editors. Understanding Homelessness: New Policy and Research Perspectives. Washington, DC: Fannie Mae Foundation; 1997. pp. 135–64. [Google Scholar]
- 18.Gouvernement de Québec. L’itinérance au Québec—Premier portrait. Montreal, QC: Ministère de la Santé et des Services sociaux du Québec; 2014. [Google Scholar]
- 19.Latimer E, McGregor J, Méthot C, Smith A. Je Compte MTL 2015: Dénombrement des personnes en situation d’itinérance à Montréal le 24 mars 2015. Montreal, QC: Je Compte MTL 2015; 2015. [Google Scholar]
- 20.Nazareth House. Un repas, un toit et du répit/Food, Shelter, Relief. 2014. [Google Scholar]
- 21.Abt Associates. Arizona Statewide Program Evaluation Project: Arizona Self-Sufficiency Matrix. 2006. [Google Scholar]
- 22.Mayock P, Corr ML, O’Sullivan E. Homeless young people, families and change: Family support as a facilitator to exiting homelessness. Child Fam Soc Work. 2011;16(4):391–401. doi: 10.1111/j.1365-2206.2010.00753.x. [DOI] [Google Scholar]
- 23.Rossi PH, Wright JD. The urban homeless: A portrait of urban dislocation. Ann Am Acad Pol Soc Sci. 1989;501:132–42. doi: 10.1177/0002716289501001009. [DOI] [Google Scholar]
- 24.Sedky N, Lambert K, McBain B. Pathways Out of Homelessness—Regional Study 2011. 2011. [Google Scholar]
- 25.Zlotnick C, Tam T, Robertson MJ. Disaffiliation, substance use, and exiting homelessness. Subst Use Misuse. 2003;38(3–6):577–99. doi: 10.1081/JA-120017386. [DOI] [PubMed] [Google Scholar]
- 26.Zugazaga C. Understanding social support of the homeless: A comparison of single men, single women, and women with children. J Contempor Soc Serv. 2008;89(3):447–55. [Google Scholar]
- 27.Aubry T, Klodawsky F, Coulombe D. Comparing the housing trajectories of different classes within a diverse homeless population. Am J Commun Psychol. 2012;49(1–2):142–55. doi: 10.1007/s10464-011-9444-z. [DOI] [PubMed] [Google Scholar]
- 28.Anucha U, Smylie L, Mitchell C. Exits and Returns: An Exploratory Longitudinal Study of Homeless People in Windsor-Essex County. Ottawa, ON: Canada Mortgage and Housing Corporation; 2007. [Google Scholar]
- 29.Rosenthal R. Straighter from the source: Alternative methods of researching homelessness. Urban Anthropol Stud Cult Syst World Econ Dev. 1991;20(2):109–26. [Google Scholar]
- 30.Office municipal d’habitation de Montréal. The OMHM in Facts and Figures. OMHM—Office municipal d’habitation de Montréal. 2011. [Google Scholar]
- 31.OMHM. Assessing and Ranking Applications and Waiting Lists. OMHM—Office municipal d’habitation de Montréal. 2011. [Google Scholar]
- 32.Plan d’action montréalais en itinérance 2014–2017: Parce que la rue est une impasse. City of Montreal, 2014. Available at: https://ville.montreal.qc.ca (Accessed November 15, 2015).
- 33.Patterson ML, Currie L, Rezansoff S, Somers JM. Exiting homelessness: Perceived changes, barriers, and facilitators among formerly homeless adults with mental disorders. Psychiatr Rehabil J. 2015;38(1):81–87. doi: 10.1037/prj0000101. [DOI] [PubMed] [Google Scholar]
- 34.Ravenhill M. The Culture of Homelessness. Aldershot: Ashgate. 2008. [Google Scholar]
