The chapter begins with a review of the relevant scientific and clinical issues guided by the following questions: What is the purpose of typological classification? How can current knowledge about the epidemiology of homeless families contribute to the development of a typology? What are the existing typologies and risk factors relevant to typological classification, as well as methodological approaches used to derive typologies? What is the experience from other fields such as psychiatry, criminology, alcoholism?
What is the purpose of the typological classification?
Several possible functions suggest themselves: theoretical, clinical, and practical. Theoretical functions are those that deal with fundamental questions about the mechanisms through which individuals and families become homeless and continue in this condition. The condition of living in stable housing within a stable community that is supported by local and national government bodies is considered a fundamental right of a civil society. Why some members of society are excluded from this fundamental right is critical to the development of effective methods of remediation and prevention.
A second function of typological formulations is to facilitate client-service matching. Here the concern is with efficient use of scarce resources, including cost-effectiveness. The idea of treatment matching has been popular in psychiatric research, guided by the assumption that treatment outcomes can be improved by matching patients with the most appropriate level, modality, and intensity of care. Service matching is a broader perspective that includes not only clinical interventions but other kinds of services, such as housing, income supplements, and case management, among others.
How can current knowledge about the epidemiology of homeless families contribute to the development of a typology?
Research over the past 25 years has yielded an extensive body of knowledge on the prevalence and determinants of persons who are homeless and, of particular relevance to the present project, families that are homeless. Some key epidemiological findings are summarized as follows:
- The population is heterogeneous with regard to homelessness history. Population-based longitudinal studies in New York and Philadelphia show that 80 percent of persons using shelters are newly homeless with a short duration of homelessness; 10 percent are recurrently homeless; and 10 percent are long-term homeless (more than a year) (Culhane and Metraux, 1999). Homeless families show a similar distribution. In New York City, homeless families were grouped in three categories; 52 percent were transitional (average of 1.2 episodes of homelessness, of average duration of 59 days); 43 percent were intermediate (average of 1.2 episodes of homelessness of average duration of 211 days); and 5 percent were episodic (average of 3.3. episodes of homelessness, of average duration of 345 days (Culhane, 2004)
- The homeless population is very large. Earlier studies underestimated the extent of homelessness in part because of designs that selected the long-term homeless, and in part because of the hidden nature of a good part of the population, especially those that are doubled up with families or friends. Later studies correcting for some of these factors, especially retrospective telephone surveys of the general population (Link et al., 1994), showed a much larger prevalence of homelessness at some point in life. Homeless families with children have been the fastest growing segment of the homeless population during much of the past 2 decades.
- The one feature that homeless people, including homeless families, have in common is poverty (IOM, 1988; Jahiel, 1992a). Many poor people are not homeless, but nearly all homeless people are very poor. Because of this they contribute to an excess demand for low-cost housing, and those with features that might provide an additional barrier to housing are at a competitive disadvantage.
- Certain types of homeless families are much more prevalent than others (Bassuk et al., 1996; Weitzman, Knuckman, and Shinn, 1990; McChesney, 1995; Culhane, 2004): single mother families; families where the parent was a foster child or never had a real home; families where the parent has had a long history of abuse; families fleeing imminent or continuing abuse; and African American and Hispanic ethnic minorities.
- A small proportion of homeless individuals and homeless families are more salient and consume shelter and other services disproportionate to their numbers (Kuhn and Culhane, 1998). They include people or families that are chronically homeless, and families in which one or more members have mental disorders, substance abuse, illiteracy, and not infrequently physical or mild mental disabilities; often, there is significant overlap of these problems in the same individual. Given the hardships of homeless life, the word “multiproblem” is an understatement for these families.
- The number of homeless children has been estimated at 1.3 million in 2000 by the Urban Institute and 1.2 million in 2001 by the National Coalition for the Homeless. Despite better controlled studies of homeless children (Buckner, 2005), there still is relatively little in the way of systematic research on children whose families are homeless. Severe hunger is more frequent among homeless children than housed low-income controls (Weinreb et al., 2002). In addition, multiple barriers to education have been reported, including lack of schooling, multiple transfers, transportation problems, and lack of needed educational services such as special education (Rafferty and Rollins, 1989; Rafferty and Shinn, 1991; Whitman et al., 1992; Vostanis and Cumella; 1999; Masten et al., 1997). These children also have an increased rate of being in foster care or welfare service if parents are or have been homeless (Zlotnick et al., 1998; Culhane et al., 2003). Education reform through the McKinney Act has improved the situation somewhat but much remains to be done.
- Pregnancy has an elevated prevalence in homeless women. Pregnancy is relevant to a potential typology in several ways: it is a risk factor for homelessness (Shinn et al., 1998), it is associated with increased perinatal morbidity, and is sometimes followed by disorders in bonding (Whitman et al., 1992).
In summary, epidemiology provides valuable information about prevalence, incidence and determinants of homelessness. The epidemiology of homelessness and of homeless families provides important insights into the potential usefulness of an empirical typology. First, homeless people and homeless families are homogeneous with regard to poverty, but heterogeneous in terms of their personal characteristics and service needs. Second, there seems to be a simple dichotomy separating complicated, multiproblem homeless families from relatively uncomplicated homeless families, who are more likely to be temporarily homeless and require fewer services. Third, epidemiology suggests that the prevalence of homelessness changes with a variety of economic and social conditions, as does incidence. Political considerations and public policy, particularly policies affecting the public “safety net” and resource allocations for social welfare programs, can have dramatic effects on the number of homeless persons and their personal and demographic characteristics. Without putting homelessness into a proper historical and socioeconomic perspective, any typology of homeless families may turn out to be a historical artifact.
What are the existing typologies and risk factors relevant to typological classification, as well as methodological approaches used to derive typologies?
From common knowledge in the field, one would expect three main groups to emerge in general discussions of a useful typology: (1) families that are homeless for economic reasons (e.g., cannot pay rent, loss of employment, low paying jobs that cannot cover the rent, loss of welfare support); (2) families that have left one family member’s home because of abuse or fear thereof, usually a single female headed family; and (3) families that can be indexed as having a serious health or social problem (substance abuse, mental health, chronic illness or disability, criminal record, etc). There are also two smaller groups: (4) families that have lost their home in a disaster (earthquake, war, etc); and (5) migrant families (families that have a home elsewhere but have moved to another area (in the same or different country) where they do not have a home).