Despite the general conviction that homelessness is a unitary phenomenon, there is ample evidence that persons without permanent living arrangements differ significantly among themselves (Culhane and Metraux, 1999). Recognition of this heterogeneity has led to attempts to classify subgroups of homeless persons (herein referred to as subtypes) according to a variety of characteristics and dimensions, such as (chronicity, substance abuse, psychopathology, and childhood vulnerability factors). An important consideration in the search for subtypes of homeless persons is the specification of essential environmental, situational, and personal characteristics that have a direct role in the development, patterning, and course of homelessness.
The goal of this chapter is to review conceptual issues and methodological strategies for developing a typology of homeless families with children. In particular, the chapter examines the feasibility of using a multidimensional conceptual and analytic strategy to determine how best to identify distinct subgroups of families with specific constellations of risk factors and service needs. The ultimate goal of this chapter is to inform both clinical practice and public policy, including the need for effective interventions and prevention programs.
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Background Issues
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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).
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Typologies Based on Features of Homeless Persons
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The first approaches to typologies of homeless persons were based on differing features of certain groups of homeless people, developed in part to describe the population and in part to ascribe a causal relation of these features to homelessness. Such studies, published from 1912 to the 1980s, have been reviewed by Louisa Stark (1992). Nearly all of these studies were derived from surveys of single homeless persons and were based on homeless shelter-based populations. Despite the fact that homeless people were typecast in different ways at different times, several major types were described: First, people were classified as unemployed workers, alcoholics, mentally ill, and chronically physically ill or disabled. Elderly people and “bums” constituted two additional, albeit much smaller, groups. Recognizing the heterogeneity of homeless people, Bahr and Caplow (1973) attempted to reduce this diversity to a single operational feature. They postulated a Durkheim-like concept of disaffiliation, a detachment from social roles and institutions, as a common pathway to homelessness. They distinguished three major categories of disaffiliation resulting from external changes that leave the individual with few affiliations: (1) society withdrawing from the individual in periods of economic depression, war, persecution, etc; (2) from individual choice (opting out of societal roles); and (3) handicap or lifetime “unsocialization” resulting from mental illness or other chronic disorders (Bahr and Caplow, 1973). This theory lost ground in the next 2 decades as studies showed that homeless people had a network of social roles and institutional or personal affiliations, albeit usually not with rich people.
This typological approach continued even after the growth of homelessness and changes in the homeless population that included younger homeless single people and families in the 1980s. For instance, Fischer and Breakey (1985) grouped mission users into the chronically mentally ill, the chronic alcoholic, street people, and the “situationally distressed.” Other typologies of some of these groups were subsequently published, some of which were highly disaggregated. For instance, Shepherd (2000), who used cluster analysis with a population of homeless adults, distinguished 11 profiles (malingerers, depression with alcoholism, symptom minimizers, psychotic avoiders, service avoiders, newly homeless, local ethnic minority, women with children, healthy family, other-Caucasian, and nondrug users).
The 1980s saw homelessness emerge as a major social problem, and several streams of research on the homeless population were initiated (see Institute of Medicine [1988] and Jahiel [1992a] for reviews). The only common factor in this very heterogeneous homeless population was extreme poverty, associated with a decrease in low income housing in the late 1970s and 1980s (e.g., Calsyn and Roades, 1994). The concept of homelessness as a manifestation of extreme poverty began to replace that of homelessness as social disaffiliation. Homelessness was seen as an aggregate rather than an individual problem due to the disequilibrium between the number of poor people and the number of low-income housing units: a certain number of people had to become homeless at a given time unless the housing supply was increased, and environmental, situational, and personal characteristics determined who was most vulnerable to become part of that population (McChesney, 1992a).
Some years ago, Jahiel (1987) described a dichotomy between two types of homelessness: benign homelessness and malignant homelessness. Benign homelessness means that the state of homelessness causes relatively little hardship, lasts for a short time and does not recur soon. For these people, it is relatively easy to gain back a home and a stable tenure on that home. Malignant homelessness means that the state of homelessness is associated with considerable hardship or even permanent damage to the person who is homeless. It lasts for a relatively long time or recurs at short intervals; extraordinary efforts must be expended to gain back a home with a stable tenure, and these efforts are often unsuccessful.
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Typologies Based on Trajectories of Homelessness
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In the 1980s a series of national and local studies were undertaken to enumerate homeless people. Although these studies had considerable methodological difficulties, they revealed the great variety of sites used by homeless people. Some classifications of homeless persons were proposed according to where homeless people spend their nights. For instance, based on field studies of samples throughout Ohio, Roth et al., (1985) classified homeless people as street people, shelter people, and resource people (the latter including people who doubled up with family or friends). Doubled-up people, the largest category by far, had not been studied before the 1980s. Further studies showed that they were a large source of “literal homelessness” (Weitzman, Knickman, and Shinn, 1990) and that there was considerable back and forth movement among these three groups.
The same cohort of 1980s studies also provided valuable information about the way people became homeless, yielding two main groups: the majority became homeless because they could not pay for their housing; a lesser number became homeless because they fled abusive environments (battered spouses, runaway youth) or were thrown away from their home by parents or partners. Finally, the same studies showed that many people were recurrently homeless and pointed to three groups of homeless persons: new (homeless for the first time), episodic (recurrent homelessness) and chronically homeless (continuously for more than a year [see, for instance, Ropers, 1988]).
A more recent contribution (Mackenzie and Chamberlain, 2003) introduces the concept of homelessness careers. It identifies homelessness as a career process for a series of transitional stages in the development of any form of biographical identity, (i.e., people passing through various phases before they acquire the identity of homeless persons). They distinguish three pathways: (1) the housing crisis career, with poverty, accumulating debt, unstable housing, and eviction preceding homelessness; (2) the family breakdown career, with abuse or violence associated frequently with return to an abusive home and recurrence of that process until a final break occurs; and (3) the youth homelessness career continuing into adulthood for people who have been homeless since their teens.
By focusing on people in homeless shelters in two cities and developing a city-wide information retrieval of administrative data from shelters, Dennis Culhane opened the way for very large and relatively accurate data collection projects. Kuhn and Culhane (1998) applied cluster analysis together with an information retrieval system to trace homeless persons through the shelters in Philadelphia and New York to produce three groups of homeless persons—transitionally, episodically, and chronically homeless—by number of shelter days and number of shelter episodes. Transitional, episodically, and chronically homeless constituted, respectively 80 percent, 10 percent and 10 percent of shelter users. However, the latter group consumed over 50 percent of shelter beds. These data were cited in congressional hearings that led to Federal appropriation of funds for initiatives to end chronic homelessness (U.S. Department of HUD, 2002 and 2004).
Kuhn and Culhane reported differences in racial origin, age, and physical and mental conditions among the three groups. However, they dealt with a selected population (shelter only and two cities). In studies of the users of a Toronto shelter, Goering and colleagues (2002) found little difference between transitional and episodic groups. In studies of chronically, episodic, and housed adults attending a detoxification program who were followed for 2 years, chronic homelessness was associated with poorer scores over time on a mental health instrument but not on a health-related quality of life instrument (Kertesz et al., 2005).
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Typologies of the Homeless Environment
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The European Homelessness organization FEANTSA (The European Federation of National Organizations Working with the Homeless) recently presented a European Typology of Homelessness and Housing Exclusion (ETHOS) with four main conceptual categories (Roofless, Houseless, Insecure Housing, and Inadequate Housing) and a large number of operational subcategories (FEANTSA, March 2005). This is a new perspective on typology: a typology of the environments associated with becoming and being homeless.
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Typologies of Homeless Families
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While homeless families have been a topic of concern prior to 1980, studies of homeless families started only in the 1980s. Early studies of homeless families are reviewed by McChesney (1995). More recent studies of homeless families have revealed several risk factors and protective factors (Bassuk et al., 1997; Rog et al., 1995). Wong et al., (1997), using Culhane’s methodology, have investigated predictors of exit and re-entry among family shelter users in New York City. Families with housing vouchers had fewer re-admissions to shelters, and those with more children, minority status, pregnancy, and public assistance had more re-admissions. Bassuk et al., (2001) compared multiply homeless women with first-time homeless. A history of childhood abuse and adult partner violence were predictors of recurrence of homelessness. Qualitative studies have yielded more evidence on which to build typologies of homeless families. Based on ethnographic studies in Los Angeles, McChesney (1992b) described four types of homeless families: unemployed couples; mothers leaving relationships; mothers receiving Aid to Families with Dependent Children (AFDC), and mothers who had been homeless teens (the latter includes a subtype of mothers who have never had a home in their entire life).
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Summary
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Based on the literature on subtyping of homeless individuals and families, there is some evidence to suggest that most of the attempts to classify this population, either according to a priori domains or according to multivariate statistical techniques, have identified two broad types of homelessness that can be arranged on a single continuum ranging from relatively simple, benign, time-limited, uncomplicated cases (e.g., situationally distressed, resource people, new homeless, transitional) to more complicated, “malignant” chronic, multiproblem cases (e.g., chronically mental ill, chronic alcoholic, street people (Fischer and Breakey, 1985), shelter people (Roth et al., 1985), episodic, chronic (Ropers, 1988; Kuhn and Culhane, 1998), multiply homeless (Bassuk et al., 2001). As discussed later, this simple dichotomy may be a good place to begin in the development of a useful typology of homeless families.
What is the experience from other fields such as psychiatry, criminology, and alcoholism?
There is along tradition of typological research in psychiatry, alcoholism, and criminology that may be useful in the development of typological approaches to the description and management of homeless families. For example, the fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (APA, 1994), which is used primarily for clinical and reporting purposes, describes subtypes for schizophrenia, schizoaffective disorder, anxiety disorders, affective disorder, delusional disorder, and substance induced psychotic disorder. These subtyping schemes are derived primarily from clinical experience rather than from empirical research, and each one relies on a different organizing principle. The subtypes of schizophrenia (paranoid, catatonic, disorganized, undifferentiated, and residual), for example, are organized on the basis of “the clinical picture,” which presumably refers to presenting symptoms. The subtypes of schizoaffective disorder (bipolar type, depressive type) are organized according to affect disturbance. The subtypes of delusional disorder (erotomanic, grandiose, jealous, persecutory, somatic, mixed) are organized according to the predominant delusion. What these psychiatric subtyping schemes have in common is their attempt to classify psychiatric patients who share the same general condition into more meaningful or clinically useful subgroups.
In the field of alcoholism, the tradition of clinical subtyping according to single domains extends back to the 19th century (Babor, 1998; Babor and Dolinsky, 1988) and includes the domain of childhood vulnerability factors, family history of alcoholism, onset age, dependence, severity, and co-morbid psychopathology. Over the past century there has been an evolution of typological theory from these single domain subtypes, such as familial and nonfamilial alcoholism, to multidimensional typologies, based on a variety of defining characteristics, such as etiological elements, personality characteristics, drinking patterns, and course of illness (Babor, 1998). This evolution in typological thinking has been in part influenced by the development of multivariate statistical techniques as well as reliable and valid measurement procedures that make it possible to search for homogeneous subgroups within a population of alcoholics. Similar to the simple dichotomy suggested above in the review of the homeless typology literature, the alcoholism typology literature has identified a low severity, low vulnerability subgroup (Type A) and a high vulnerability, high severity subgroup (Type B) (Babor et al., 1992).
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