Identifying different subgroups within the homeless population: Implications for housing policy and programs

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1 Identifying different subgroups within the homeless population: Implications for housing policy and programs Tim Aubry, Fran Klodawsky, Daniel Coulombe & Lara Mills Centre for Research on Community Services, University of Ottawa Abstract Using data collected through in-person interviews with a representative sample of 416 persons who are homeless in emergency shelters and drop-in centres in Ottawa, the paper presents results of a latent class analysis and a cluster analysis on a range of health-related variables. Results show that there are three distinct clusters of persons who are homeless characterized by different levels of severity of health problems. These clusters include an economically disadvantaged cluster of individuals relatively free of health difficulties (n = 232, 56%), another cluster with substance abuse problems (n = 103, 25%), and a third cluster with health difficulties (n = 80, 19%). Implications of these findings for policy and program planning are discussed Background Homelessness in Canada has been characterized by increasing numbers and increasing diversity over the last decade (Begin, Casavant & Chenier, 1999; National Housing and Homelessness Network, 2001) To capture this diversity, researchers have attempted to differentiate the homeless population into typologies according to demographic characteristics, contributing factors, and consequences of homelessness (Kuhn & Culhane, 1998; Morse, Caslyn, & Burger, 1992; Solarz & Bogat, 1990). Published research in this area has been conducted exclusively in the United States Much of the research has also been limited to examining homogeneous subgroups of the homeless population defined by age, sex, or some other characteristic Another limitation of the work to date is that it has been conducted mostly on small samples Objective The present research builds on this line of research and attempts to address its limitations by identifying health-related characteristics of different subgroups making up a relatively large heterogeneous homeless population in a Canadian city The objective of this study was to enhance our understanding of the diversity of the homeless population based on the presence or absence of various problems including substance abuse, mental illness, chronic conditions, and childhood stressors

2 Participants The Panel Study on Homelessness (2003), a research project of the Centre for Community Services at the University of Ottawa, conducted in-depth interviews with 416 homeless people during late 2002 and early 2003 Sample included 88 adult men, 85 adult women, 79 male youth, 81 female youth, 83 adults in families Most participants (64%) have experienced multiple episodes of homelessness and 67% had been homeless for a relatively short time in their most recent period of homelessness Eviction was cited most frequently as the main reason for current homelessness (29%), followed by inability to pay rent due to financial problems (23%) and conflict with family, spouse, partner or roommates (21%) Measures The Panel Study used a composite of new and existing quantitative and qualitative measures examining factors including respondents housing history, social support, life satisfaction, living conditions, health status, social services utilization and substance use For the present study, the SF-36 was used to measure levels of physical and mental health, the CAGE to assess for the presence alcohol abuse, the DAST to assess for the presence of drug use, and scales from the National Population Health Survey to investigate for the presence of chronic health conditions, utilization of health services, and childhood stressors. Other measures used for the present study were: one-item asking about the primary reason for current homelessness; and one-item on whether they had been told by a health care professional that they had a mental-health problem (mental health status) Procedures Data was collected through in-person interviews held in a private area in emergency shelters and in drop-in centres Participants were paid a $10 honorarium Analyses Latent class analysis and cluster analysis Number of clusters for the cluster analysis was determined by optimal solution produced by latent class analysis Results: Latent Class Analysis Optimal solution for the latent class analysis produced three groups of participants with distinct profiles on the measures (see Figure 1) Group 1 (n = 144, 35%) participants have the least severe profile and the highest probability of citing economic reasons as precipitating their homelessness Group 2 (n = 143, 34%) participants show the highest probability of substance abuse problems 2

3 Group 3 (n = 128, 31%) participants have the most severe profile with the higher probability of having health problems 1 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 Mental Health Ment. Health Diagnosis Physical Health Chronic Health Prob. Health Serv. Use Alcohol Abuse Drug Abuse Childhood Stressor Economic Reason Group 1 Group 2 Group 3 Results: Cluster Analysis Cluster 1 ( Economic Disadvantaged Cluster ) participants (n = 232, 56%) report higher levels of mental health, a lower number of chronic health conditions, lower levels of health care use, and lower levels of alcohol and drug use than the other two clusters Cluster 2 ( Substance Abuse Cluster ) participants (n = 103, 25%) show higher levels of alcohol and drug use and higher levels of health care utilization than the other two clusters Cluster 3 ( Health Problems Cluster ) participants (n = 80, 19%) are characterized by lower levels of physical health and mental health, and a greater number of chronic health conditions than the other two clusters 3

4 EconProb ChildStress DrugUse AlcUse HCareUse ChrHProb. PHealth MHDiag MHealth Cluster 3 Cluster 2 Cluster 1-1,5-1 -0,5 0 0,5 1 1,5 2 % Breakdown of Sampled Subgroups According to Each Cluster Sampled Subgroups: Cluster 1 (n = 232) Cluster 2 (n = 103) Cluster 3 (n = 80) Male Youth 53%(42) 37% (29) 10% (8) Female Youth 38% (31) 45% (36) 17% (14) Male Adults 57% (50) 23% (20) 20% (18) Female Adults 39% (33) 20% (17) 41% (34) Families 92% (76) 1% (1) 7% (6) 4

5 Conclusions Our findings indicate that the homeless population is made up of distinct subgroups differing on the level of severity of health and substance abuse problems The population includes a subgroup whose homelessness appears to be associated especially with economic difficulties For this economically disadvantaged subgroup, social policies targeting poverty are needed to address homelessness (Hulchanski, 2002): Social housing rent subsidies increased income support For other subgroups who are experiencing more severe health and substance abuse problems a combination of housing and support are recommended: Supported housing (portable intensive supports focusing on finding and maintaining housing [Morse, 1998]) supportive housing (Hulchanski, 2002) transitional housing particularly in cases where addictions are a prominent health problem (Novacs, Brown, & Bourbonnais, 2004) References Begin, P. Casavant, L. & Chenier, N.M. (1999). Homelessness. Ottawa: Library of Parliament, Parliamentary Research Branch, Document PRB 99-1E. Hulchanski, J.D. (2002). Housing Policy for Tomorrow s Cities. Ottawa: Canadian Policy Research Networks, Discussion Paper F/27. Morse, G.A., Calsyn, R.J. & Burger, G.K. (1992). Development and Cross-Validation of a System for Classifying Homeless Persons. Journal of Community Psychology, 20(7), Morse, G. (1999). A review of case management for people who are homeless: Implications for practice, policy, and research. In Practical Lessons: The 1998 National Symposium on Homelessness Research. (Fosburg, L., & Dennis, D. L., Eds.). Washington, DC: Department of Housing and Urban Development and the U.S. Department of Health and Human Services. National Housing and Homelessness Network (2001). State of the Crisis 2001: A report on housing and homelessness in Canada. Novacs, S., Brown, J., Bourbonnais, C. (2004). Transitional Housing: Objectives, Indicators of Success, and Outcomes. CMHC: Ottawa, ON. Solarz, A. & Bogat, A.G. (1990). When social support fails: The homeless. Journal of Community Psychology, 18(1),