Homelessness In Delaware:: An Assessment.

The authors provide an assessment of trends and dynamics of homelessness in Delaware since 2007, when the last systematic study of this topic was released. Using population data on homelessness in the state, the authors present evidence that, after a period of apparent stability, homelessness in Delaware is currently at levels that are unprecedentedly high, while providers of homeless services have not adapted to this change. As a first step to addressing this alarming trend, the authors call for stakeholders to regroup and develop a coordinated, statewide approach to address this problem.

Homelessness Among Persons on Delaware's Sex Offender Registry.

This study provides an in-depth analysis of homelessness among people on the Delaware Sex Offender Registry (SOR) between 2021 and 2023. Delaware's SOR, as a publicly accessible database, offers a uniquely comprehensive window into an unsheltered population among a group that is, collectively, at high risk of experiencing homelessness. We retrieved data from the Delaware SOR on two separate dates, which allowed us to track homelessness among offenders within the state over time. On November 15, 2021, 4.6 percent of the persons on the SOR were homeless. Fifteen months later, this homeless prevalence rate was 5.5 percent. Of the 120 people who reported homelessness on the November date, 56 of them (46.7 percent) were either still homeless or again homeless fifteen months later. This prevalence is significantly higher than rates among the general population, and, once homeless, a substantial proportion remained homeless for extended periods of time. The high rate of unsheltered homelessness among people on the Delaware SOR emphasizes the shortcomings in Delaware's ability to supply shelter for homeless individuals, as well as the additional restrictions people on the SOR experience in their ability to receive these services, which creates hardship for these individuals and reduces communal public safety by increasing the frequency of absconding.

Health & Housing in Delaware:: Matching Medicaid Claims and Encounters and the Community Management Information System Databases.

This study draws upon data from two databases: claims and encounters that were reimbursed by the state's Division of Medicaid and Medical Assistance (DMMA) and the Homeless Management Information System (HMIS) database that collects homeless services data on individuals experiencing homelessness. Records from both sets are matched to identify 838 adults who both experienced homelessness and were Medicaid eligible in 2019, and to select, through propensity score matching, an equal set of control observations who were similarly Medicaid-eligible but had no record of homelessness. Outcomes are compared based upon scores on the Charlson Elixhauser Comorbidity index, incidence of substance use disorder, inpatient, emergency department, and outpatient visits, and inpatient, emergency department, and outpatient costs. Using ordinary least squares regression models, we estimate homelessness (as indicated by use of homeless services) to be associated with excess costs of $4,611 (non-chronic homelessness) to $5,218 (chronic homelessness) per person over the course of 2019, compared to similar Medicaid enrollees who were housed.

Gauging and Responding to the Need for Home Repair Assistance in Delaware.

We review the extent of the need for home repair assistance for low-income homeowners in Delaware, and steps being taken to address this need. Delaware contains an estimated 25,000 homes owned by low-income households that need repair, of which an estimated 5,000 are in substandard condition. There is an estimated $96 million total cost associated with this home repair need, with eighty percent of this cost ($76 million) coming from the twenty percent (5,000) of these homes that are in substandard condition. In order to address this need for repair assistance, Delaware's three Habitat for Humanity organizations have designed the Statewide Healthy Homes Program, which centers on the intersection of health and housing. The vision of the Habitat for Humanity Statewide Healthy Homes Program is to increase capacity for home repair assistance across Delaware. Additionally, the program seeks to include partnerships with healthcare providers to ensure a holistic approach to home repairs, improving each resident's quality of life.

Prior Evictions Among People Experiencing Homelessness in Delaware.

Eviction is frequently a precursor to homelessness. This is an exploratory study that looks at a group of homeless adults who stayed in Delaware homeless shelters in 2019 and the extent by which their homelessness is preceded by an eviction filing. Specifically, we match records of homeless shelter use with records from a court-based database of eviction filings, both in Delaware, to determine the frequency and correlates of prior eviction among adults staying in Delaware shelter and/or transitional housing facilities in 2019. Results show that 21 percent of the people in the study group had records of eviction filings in the 2-year period prior to initial homeless services use. Recent history of eviction filings was much more prevalent among study group members who were homeless with their children (i.e., with families), who were Black, and/or who were female. These findings are consistent with prior research and demonstrate the potential of interventions designed to mitigate eviction to also reduce homelessness, especially among families with children.

Association Between Registered Sex Offender Status and Risk of Housing Instability and Homelessness among Veterans.

Research is limited about whether and to what extent registered sex offenders (RSOs) face an increased risk of housing instability. The intersection of RSO and housing instability is particularly salient for veterans as there are disproportionately higher rates of veterans among both RSOs and homeless populations. This study assessed the relationship between RSO status and risk of housing instability and homelessness among military veterans. We matched a list of 373,774 RSOs obtained from publicly available sex offender registries in 19 states with a cohort of 5.9 million veterans who responded to a brief screening for housing instability administered throughout the Veterans Health Administration between 2012 and 2016. Logistic regression estimated adjusted odds of any housing instability and homelessness among veterans identified as RSOs. Veterans identified as RSOs had 1.81 (95% confidence interval [CI] 1.46-2.25) and 2.97 (95% CI 1.67-5.17) times greater odds of reporting any housing instability and homelessness, respectively, than non-RSOs. Findings represent some of the strongest evidence to date for the high risk of housing instability and homelessness among RSOs, suggesting a clear gap in policy and programmatic responses to their unique housing needs. Evidence-based alternative approaches to residence restriction laws may reduce recidivism and protect public safety.

Health Service Access Among Homeless Veterans: Health Access Challenges Faced by Homeless African American Veterans.

Veteran homelessness is a public health crisis, especially among the disproportionate number of minority veterans in the homeless veteran population. African American homeless veterans in particular face unique challenges accessing appropriate health care services to meet their medical needs. Their needs are often underrepresented in the literature on veteran homelessness. Drawing together over 80 studies and government reports from the last two decades, this review provides a timely synopsis of homeless veterans' health care access, with a particular focus on the barriers faced by African American veterans. This review employs Penchansky and Thomas' Access Model to frame health access barriers faced by homeless veterans, dialing in on what is known about the experience of African American veterans, within the five dimensions of access: Availability, Accessibility, Accommodation, Affordability, and Acceptability. Actionable guidance and targeted interventions to address health access barriers for all veterans are delineated with a focus on the need to gather further data for African American homeless veterans and to consider tailoring interventions for this important and underserved group.

Characteristics Associated with Homeless Pregnant Women in Columbus, Ohio.

INTRODUCTION: The effects of homelessness on pregnant women are substantial. We aim to identify key characteristics of a group of women identified as homeless and pregnant in order to understand their history of housing, family composition, health, and demographics as a first step for future intervention. METHODS: We present cross-sectional survey data on a sample of 100 women reporting homelessness and pregnancy in the prior year in Columbus, Ohio, identified through social service and housing not for profit agencies. Our analysis uses data collected from a survey of health behaviors, housing, employment status, and demographics. Continuous measures are described with means and standard deviations, and categorical variables are described with percentages. RESULTS: The majority (81%) of the women identified as African American. Over 95% of the women were single, and 74 women reported a prior pregnancy. Almost half of the women reported being behind on rent at least one time in the last 6 months, and 43% indicated that they had lived in more than three places in the last year. Approximately 34% of the sample reported cigarette use during pregnancy, while 12% and 30% reported alcohol and illicit drug use, respectively. DISCUSSION: Women who were pregnant and experiencing homelessness in our study reported a multitude of complex and severe problems ranging from high rates of substance use, longstanding housing insecurity and financial stress. Programs hoping to successfully support women will need to address a variety of service needs while recognizing the resilience of many women.

At the Intersection of Homeless Encampments and Heroin Addiction: Service Use Barriers, Facilitators, and Recommendations from the City of Philadelphia's Encampment Resolution Pilot.

We provide an overview of the pilot and evaluation measures used for an independent evaluation of the Encampment Resolution Pilot (ERP) wherein the City of Philadelphia closed two homeless encampments in May 2018 and sought to assist those displaced by the closures with housing and treatment services. The evaluation used the Rapid Assessment, Response, and Evaluation method to collect qualitative findings on service use barriers and facilitators from open-ended interviews with people staying in the encampments (N = 27) and service providers (N = 10). We assessed how the ERP allowed providers to "push the system" by removing access barriers, and providing amenable, effective, and accessible housing and drug treatment services that led to more widely adopted best practices. However, there was a clear need for additional supportive services and aftercare for those exiting treatment. Providers also cited a need for more integrated medical and mental health services.

Pathways into homelessness among post-9/11-era veterans.

Despite the scale of veteran homelessness and government-community initiatives to end homelessness among veterans, few studies have featured individual veteran accounts of experiencing homelessness. Here we track veterans' trajectories from military service to homelessness through qualitative, semistructured interviews with 17 post-9/11-era veterans. Our objective was to examine how veterans become homeless-including the role of military and postmilitary experiences-and how they negotiate and attempt to resolve episodes of homelessness. We identify and report results in 5 key thematic areas: transitioning from military service to civilian life, relationships and employment, mental and behavioral health, lifetime poverty and adverse events, and use of veteran-specific services. We found that veterans predominantly see their homelessness as rooted in nonmilitary, situational factors such as unemployment and the breakup of relationships, despite very tangible ties between homelessness and combat sequelae that manifest themselves in clinical diagnoses such as posttraumatic stress disorder. Furthermore, although assistance provided by the U.S. Department of Veterans Affairs (VA) and community-based organizations offer a powerful means for getting veterans rehoused, veterans also recount numerous difficulties in accessing and obtaining VA services and assistance. Based on this, we offer specific recommendations for more systematic and efficient measures to help engage veterans with VA services that can prevent or attenuate their homelessness. (PsycINFO Database Record

Homelessness following disability-related discharges from active duty military service in Afghanistan and Iraq.

BACKGROUND: Many dynamics in the relationship among military service-related disabilities, health care benefits, mental health disorders, and post-deployment homelessness among US Veterans are not well understood. OBJECTIVES: Determine whether Veterans with a disability-related discharge from military service are at higher risk for homelessness, whether Veterans Health Administration (VHA) service-connected disability benefits mitigates that risk, and whether risks associated with discharge type, service-connected disability, or the interaction between them vary as a function of mental health disorders. METHODS: Retrospective cohort study of 364,997 Veterans with a disability-related or routine discharge and initial VHA encounter between 2005 and 2013. Logistic regression and survival analyses were used to estimate homelessness risk as a function of discharge status, mental health disorders, and receipt of VHA disability benefits. RESULTS: Disability-discharged Veterans had higher rates of homelessness compared to routine discharges (15.1 verses 9.1 per 1000 person-years at risk). At the time of the first VHA encounter, mental health disorders were associated with differentially greater risk for homelessness among Veterans with a disability discharge relative to those with a routine discharge. During the first year of VHA service usage, higher levels of disability benefits were protective against homelessness among routinely-discharged Veterans, but not among disability-discharged Veterans. By 5-years, disability discharge was a risk factor for homelessness (AOR = 1.30). CONCLUSIONS: In the long-term, disability discharge is an independent risk factor for homelessness. While VHA disability benefits help mitigate homelessness risk among routinely-discharged Veterans during the early reintegration period, they may not offer sufficient protection for disability-discharged Veterans.

Migration by Veterans Who Received Homeless Services From the Department of Veterans Affairs.

We examined migration patterns among 113,400 homeless veterans, focusing on the prevalence and the basic geographic patterns of this migration. Data were for all veterans who initiated use of Veterans Affairs homeless services in 2011 or 2012; and we followed them using Veterans Affairs administrative records for up to 2 years following this initial contact. Results showed that 15.3% of the veterans migrated across regions while homeless. Those who were homeless for longer periods were more likely to migrate, and migration, were it to occur, was most likely earlier on in veterans' homelessness episodes. There were no clear geographic correlates that explained the dynamics of this migration as, overall, in-migration tended to roughly balance out-migration in a region. These findings suggest that concerns about the extent of migration and its impact on localities are exaggerated, but also sets forth an agenda for more in-depth study of these data to gain a deeper and more expansive understanding of this phenomenon.

Posthumously Assessing a Homeless Population: Services Use and Characteristics.

OBJECTIVE: Data on services use, characteristics, and geographic distribution of homeless individuals who died in Philadelphia from 2009 to 2011 provided perspective on assessments of the homeless population that rely on conventional counts and surveys. METHODS: Data from the City of Philadelphia Medical Examiner's Office were used to parse homeless decedents into three groups on the basis of use of homelessness services (known users, occasional users, and nonusers), and differences among the groups were assessed by using descriptive and multivariate methods. RESULTS: Of 141 adult decedents, 49% made substantial use of the homelessness services system (known users), 27% made occasional use of these services (occasional users), and 24% had no record of use of homelessness services (nonusers). Compared with known users, nonusers and occasional users were less likely to have had a severe mental illness diagnosis or to have received either disability benefits or Medicaid coverage and were more likely to be white. Nonusers and occasional users were also more likely than known users to have died in outlying parts of the city. CONCLUSIONS: More conventional homeless surveys and enumerations miss a substantial portion of the homeless population. Including these "hidden homeless" persons would alter perceptions about the composition of Philadelphia's homeless population, lowering estimates of the incidence of psychiatric disability and increasing estimates of racial diversity.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

Screening for homelessness among individuals initiating medication-assisted treatment for opioid use disorder in the Veterans Health Administration.

OBJECTIVE: To determine the prevalence of homelessness and risk for homelessness among veterans with opioid use disorder initiating treatment. SETTING: Addiction treatment programs operated by the US Department of Veterans Affairs (VA). PARTICIPANTS: All veterans initiating treatment with methadone or buprenorphine for opioid use disorder between October 1, 2013 and September 30, 2014 (n = 2,699) who were administered the VA's national homelessness screener. MAIN OUTCOME MEASURES: Self-reported homelessness or imminent risk of homelessness. RESULTS: The prevalence of homelessness was 10.2 percent and 5.3 percent were at risk for homelessness. Compared to male veterans, women veterans were less likely to report homelessness (8.9 percent vs 10.3 percent) but more likely to be at risk (11.8 percent vs 4.9 percent). By age group, veterans aged 18-34 and 45-54 years most frequently reported homelessness (12.0 and 11.7 percent, respectively) and veterans aged 45-54 and 55-64 years most frequently reported risk for homelessness (6.5 and 6.8 percent, respectively). CONCLUSIONS: The prevalence of homelessness in this population is approximately 10 times that of the general veteran population accessing care at VA. Screening identified a substantial number of veterans who could benefit from VA housing assistance and had not received it recently. Programs to address veteran homelessness should engage with veterans seeking addiction treatment. Integration of homelessness services into addiction treatment settings may, in turn, improve outcomes.

Validation of self-reported veteran status among two sheltered homeless populations.

OBJECTIVES: We assessed the accuracy of self-reported veteran status among sheltered homeless adults to assess the reliability of using self-report to determine the number of veterans in homeless populations and examine whether there are demographic correlates to inaccurate reporting of veteran status. METHODS: Records on 5,860 sheltered adults from Columbus, Ohio, and 16,346 sheltered adults from New York City (NYC) were matched with U.S. Department of Veterans Affairs (VA) records. We analyzed the agreement between veteran self-reporting and official records using descriptive measures, diagnostic tests, and logistic regression. RESULTS: The degree of concordance was moderate. Using VA records rather than self-report data to determine veteran status increased homeless veteran prevalence rates by 27% in Columbus and 39% in NYC. Veterans with discordant veteran status (i.e., false positive or false negative) showed lower levels of services use in the VA (both cities) and in the municipal shelter system (NYC only). Younger veterans and women were at higher risk of not being identified as veterans. CONCLUSION: Administrative records can help to more accurately identify homeless veterans and to connect them to available services and benefits.

Risk factors for becoming homeless among a cohort of veterans who served in the era of the Iraq and Afghanistan conflicts.

OBJECTIVES: In this population-based cohort study, we assessed baseline risk factors for homelessness, including the role of service in the Iraq or Afghanistan conflicts, among a large cohort of recent veterans. METHODS: Data for this study came from administrative records for 310,685 veterans who separated from active military duty from July 1, 2005, to September 30, 2006. We used survival analysis methods to determine incidence rates and risk factors for homelessness, based on baseline data for military factors, demographic characteristics, and diagnoses of behavioral health disorders and traumatic brain injury. RESULTS: Service in Iraq or Afghanistan and, more specifically, posttraumatic stress disorder among veterans deployed there, were significant risk factors of modest magnitude for homelessness, and socioeconomic and behavioral health factors provided stronger indicators of risk. Gender was not a significant indicator of differential risk. CONCLUSIONS: Although service in Iraq and Afghanistan was significant, socioeconomic and behavioral health indicators show more promise in efforts to use administrative data to inform prevention efforts by identifying veterans who are at elevated risk for becoming homeless upon their return to civilian life.

Comparing neighborhoods of adults with serious mental illness and of the general population: research implications.

OBJECTIVE: The International Classification of Functioning, Disability and Health emphasizes the importance of assessing the impact of environmental factors on functioning and disability. Drawing on this emphasis, this study used a set of objective measures to compare the characteristics of neighborhoods of adults with serious mental illness and of the general population. It also examined the relationship between neighborhood characteristics and neighborhood concentration of persons with serious mental illness. METHODS: The sample comprised 15,246 adults who were treated for serious mental illness in Philadelphia between 1997 and 2000. Principal-components analysis of 22 neighborhood characteristics resulted in an ideal-factor solution of six components. The mean values of each component in neighborhoods of persons with serious mental illness were compared with values in an equally sized group of neighborhoods created by randomly generated addresses representative of the city's general population. Ordinary least-squares regression was used to assess the association between neighborhood characteristics and neighborhood concentration of persons with serious mental illness. RESULTS: Neighborhoods in which adults with serious mental illness resided had higher levels of physical and structural inadequacy, drug-related activity, and crime than comparison neighborhoods. Higher levels of physical and structural inadequacy, crime, drug-related activity, social instability, and social isolation were associated with higher concentration of persons with serious mental illness in the neighborhood's adult population. CONCLUSIONS: The differences in neighborhood characteristics identified in this study point to factors that merit closer attention as potential barriers or facilitators in the functioning, participation, and community integration of persons with serious mental illness.