Comparing Unsheltered and Sheltered Homeless: Demographics, Health Services Use and Predictors of Health Services Use.

Secondary data obtained through the 2015 point-in-time homelessness count and an administrative health care utilization database was used to identify differences in demographic characteristics, health service use, and predictors of health service use among people experiencing unsheltered and sheltered homelessness. Compared to sheltered participants, unsheltered participants had higher proportions of males and Caucasians, were younger, were more likely to use any type of health service and ED services, and used significantly more of any health service and ED and outpatient services. Results also confirm that health services utilization is a complex phenomenon predicted by a variety of predisposing, enabling, and need-related factors, including mental health problems. Together, these findings demonstrate important differences between people living unsheltered and those residing in shelters and they inform local health policy and program initiatives tailored towards these homeless populations.

A Pilot Study Using Mixed GPS/Narrative Interview Methods to Understand Geospatial Behavior in Homeless Populations.

Tracking the movements of homeless populations presents methodological difficulties, but understanding their movements in space and time is needed to inform optimal placement of services. This pilot study developed, tested, and refined methods to apply global positioning systems (GPS) technology paired with individual narratives to chronicle the movements of homeless populations. Detail of methods development and difficulties encountered and addressed, and geospatial findings are provided. A pilot sample of 29 adults was recruited from a low-demand homeless shelter in the downtown area of Fort Worth, Texas. Pre- and post-deployment interviews provided participant characteristics and planned and retrospectively-reported travels. Only one of the first eight deployments returned with sufficient usable data. Ultimately 19 participants returned the GPS device with >20 h of usable data. Protocol adjustments addressing methodological difficulties achieved 81 % of subsequent participants returning with sufficient usable data. This study established methods and demonstrated feasibility for tracking homeless population travels.

Predictors of VA and Non-VA Health Care Service Use by Homeless Veterans Residing in a Low-Demand Emergency Shelter.

When given a choice between VA and non-VA outpatient services, significantly more veterans chose to use VA medical and psychiatric services, but outpatient substance abuse-related services were used equally.

Deep in the heart of Texas: A phenomenological exploration of unsheltered homelessness.

The purpose of this qualitative study was to develop an in-depth understanding of the experience of unsheltered homelessness in Fort Worth, Texas. Eighteen individuals participated in the study; 13 were full-time residents of Fort Worth and 5 were traveling through the area via freight train. All reported long-term histories of unsheltered homelessness. Interviews were conducted in naturalistic settings; for example, on the street, under bridges, and in camps. Results indicated that the participants entered homelessness through diverse paths, but all of these paths were characterized by loss and social isolation. Many described homelessness as a threatening and dangerous experience; relying on strong street-based social networks and their own personal strengths for survival. Participants viewed shelter service providers as sources of stress and stigma to be avoided but heavily utilized street outreach services and faith-based missions. The overemphasis by providers on "fixing" people, rather than addressing immediate needs, made many participants ambivalent about traditional services. This study supports the use of nontraditional housing interventions and robust community-based approaches to care for individuals experiencing unsheltered homelessness.

Characteristics and service use of homeless veterans and nonveterans residing in a low-demand emergency shelter.

OBJECTIVES: This study examined use of U.S. Department of Veterans Affairs (VA) and non-VA services and predictors of service use among veterans and nonveterans who resided in a low-demand emergency shelter. METHODS: Equal numbers (N=110) of veterans and nonveterans recruited between January and June 2008 at a low-demand emergency shelter were interviewed about demographic characteristics, histories of military service and homelessness, general medical and mental functioning, current alcohol and drug problems and substance use, and use of medical, psychiatric, and substance abuse services. The Behavioral Model for Vulnerable Populations was used to identify need-based, enabling, and predisposing variables for analysis. RESULTS: Both groups reported high rates of arrest and incarceration, very low incomes, extensive histories of homelessness, and a similar need for services. However, significantly more veterans than nonveterans used psychiatric services, nonemergency medical services, and inpatient substance use services. Similar proportions of veterans and nonveterans used public non-VA health care services. Need-based variables appropriately predicted service use, but veterans and individuals with insurance were also more likely to access services. CONCLUSIONS: The veterans and nonveterans residing in a low-demand shelter faced several barriers to escaping homelessness. Both groups made similar use of non-VA services, but veterans used more services overall because of their access to VA services. The predictive power of insurance indicated that veterans may experience barriers to care despite the availability of VA services. The presence of veterans in this low-demand shelter may represent evidence of barriers to veteran and other public housing services.

Do official hospitalizations predict medical vulnerability among the homeless?: a postdictive validity study of the vulnerability index.

The current study tested the postdictive validity of the Vulnerability Index (VI), an instrument used to assess medical vulnerability among people who are homeless. It also examined the relationship between hospitalization records and self-reported health status. The VI is based on self-reports of hospital utilization and chronic health conditions. Data were collected over a one-year period from individuals receiving homeless services in a southwestern city (N = 97, 53.3% male, 57.7% African American). Vulnerability Index scores and three subcomponents of the measure (chronic health conditions, substance use, and mental health problems) were regressed on official reports of past-year hospitalizations, controlling for gender and race, using four separate regression models. Official hospitalization records significantly predicted overall VI scores, but they did not predict the subcomponents of the measure. Results show that, within the current sample, official hospital records are predictive of overall VI scores and are correlated with self-reported hospitalization. The lack of relationship between hospital records and subcomponents of the VI may indicate an underutilization of health care for those with serious health conditions.