Few long-term studies of the course of homelessness following initial housing loss have been carried out. However, available information on the characteristics of those who end up homeless for long periods of time indicates that older age, persistent unemployment, poor family support, arrest history, poor functioning and coping skills, a history of placement in the child welfare system, and recent victimization are important factors in determining the risk for chronic homelessness.
Caton et al. (2005) examined risk factors for chronic homelessness among newly homeless men and women admitted to New York City shelters for single homeless adults. Participants were interviewed upon entry into the shelter and followed for 18 months. A longer duration of homelessness was related to older age, past or current unemployment, a lack of earned income, poorer coping skills, less adequate family support, a history of substance abuse treatment, and an arrest history. The most important predictors of long-term homelessness were older age and arrest history. Park, Metraux, and Culhane (2005) reviewed administrative data on a cohort of over 11,000 sheltered homeless adults from the New York City Department of Homeless Services, the agency that oversees the shelter care system, and the New York City Administration for Childrens Services, the agency responsible for placement of children through the child welfare system. A history of placement in the child welfare system was associated with an increased likelihood of repeat stays in the adult shelter system. Importantly, Lam and Rosenheck (1998) found that recent victimization negatively impacts both duration of homelessness and quality of life, suggesting a critically important role for trauma-informed services in homelessness prevention as well as in interventions for people who are chronically homeless.
Further understanding of chronic homelessness risk can be gleaned from studies of homelessness onset in which homeless people are contrasted with people who have never experienced housing loss. These studies identify how the characteristics of homeless people differ from the characteristics of other people who have extremely low incomes but seem to manage without becoming homeless. It has been suggested that mental illness may play a role in initiating homelessness for some people, but it is not likely that mental illness alone functions as a risk factor for future housing loss (Sullivan, Burhham, & Koege, 2000). Among factors that distinguish homeless people from stably housed people, substance abuse ranks high (Drake et al., 1991; Susser et al., 1991; Caton et al., 1994; Caton et al., 1995; Goering, 1998; Caton et al., 2000; Winkleby & White, 1992; Early, 2005; Folsom et al., 2005; Whaley, 2002).
In a study contrasting homeless people with a matched, never-homeless sample, North et al. (1998) found that chronicity of homelessness was associated with symptoms of alcohol use disorder, schizophrenia, and antisocial personality disorder, as well as an earlier age of onset of drug use disorder and Axis I and Axis II psychopathology. The association of homelessness and Axis I disorder has also been reported by Folsom et al. (2005). For people suffering from illnesses such as schizophrenia, for which ongoing use of services is indicated, homelessness has been found to be associated with decreased use of needed services (Caton et al., 1994). Family experiences, such as out-of-home placement in childhood (Susser et al., 1991; Caton et al., 1994; Winkleby & White, 1992; Park, Metraux, & Culhane, 2005), parental and family instability (Caton et al., 1994), poor care from a parent (Herman et al., 1997), and inadequate family support in adulthood (Caton et al., 2000) have been found to be another domain that has distinguished homeless people from those who are stably housed. In the Zugazawa (2004) study, nearly one-third of single homeless women had histories of foster care placement in childhood.
Finally, characteristics reflective of opportunity differences, such as educational achievement (North et al., 1998; Caton et al., 2000), have been found to distinguish homeless individuals from never homeless people in cross-sectional studies. Mojtabai (2005) studied self-reported reasons for homelessness among people defined as mentally ill in the NSHAPC study and those not defined as mentally ill. Both groups attributed their homelessness to inadequate income support, unemployment, and the lack of appropriate housing. Findings underscore the important role of structural solutions, such as expanding the availability of adequate and affordable housing, creating job training and work opportunities, and ensuring that entitlement income is at a level to meet basic needs, in the prevention of long-term homelessness.