More studies are needed that include rural areas, rural systems, and rural populations. Future research on people who are homeless in rural areas can build on the seminal first generation of work. The most relevant and rigorous methodologies developed for study of urban homeless populations and service systems, such as representative sampling, longitudinal designs, standardized instrumentation, and mixed qualitative and quantitative methodologies, can be adapted to explore the rural population that is still hidden to researchers. Some specific methodological challenges are outlined below.
Lack of common definitions. Development of a definition of the rural/urban continuum that captures the diversity across population densities and geographic locations is necessary for comparing findings across studies. Since rural populations in the United States are not homogenous, study results are often determined by how rural and homelessness are defined (National Institute on Drug Abuse, 1997). Whatever definitions are used must be carefully operationalized for each study and described to permit replication and comparison of findings (New Freedom Commission on Mental Health Subcommittee on Rural Issues, 2004; Rural Information Center, 2006; Strong et al., 2005). In addition, rural/urban typologies used in recent research on rural homelessness have been too crude to capture many true differences between rural and urban communities and between various types of rural communities. Given the apparent variation in medical and behavioral health problems by size and locations of rural communities, it will be necessary to study the epidemiology of health, mental health, and substance use disorders as a function of population density and geographic placement on a continuum rather than studying only dichotomous urban/rural or trichotomous urban/rural/suburban comparisons (National Institute on Drug Abuse & Community Epidemiology Work Group., 2001; Patton, 1988).
Sampling strategies. The most representative sampling strategy is desirable but often not considered feasible. A sampling strategy based on service sites must use a broad range of services across the range of rural areas (and not rely only on dedicated homeless services since they are frequently absent in smaller rural or frontier areas). Such sites might include, for example, welfare and other social service agencies, public and mental health departments, free clinics, employment centers, and other broad-based service programs (Aron, 2004). Many of the existing studies use such small numbers of rural subjects that characteristics of rural populations are masked by the usually larger urban sample. Also, variations in conditions between urban and rural populations or between varied types and sizes of rural communities are not possible to explore (e.g., differences in drugs used, psychiatric conditions experienced, or patterns of alcohol use) when insufficient rural sample sizes are used. Some aspects of research on rural communities may have limited generalizability, because rural communities exhibit unique regional character; for example, Appalachia and the western frontier have distinctive cultures that may affect homelessness through deeply held values such as importance of family structure, insularity, independence, and so forth. It is difficult to do cross-cutting research because of differences in the character of a given rural area compared to other types of rural areas, and compared to non-rural areas. Conducting multisite studies may clarify aspects of homelessness in rural settings that are site-specific.
Standardized instrumentation for needs assessment and outcomes assessment. Epidemiological studies with standardized instrumentation are needed to clarify the prevalence and severity of medical, mental health, and substance use problems among rural homeless persons. Comparisons across studies for rural populations and comparisons with other groups will be facilitated by appropriate standardized instruments on health status, mental health and substance use disorders, and other domains (e.g., service outcomes and family violence). Also, use of common designations of demographic characteristics (e.g., racial or ethnic group using Census categories) will further facilitate comparisons across studies and with normative populations.
Data sources. A primary difficulty in conducting rural research is finding suitable data sources. It is rare that homelessness is measured in national, regional, or even local surveys and, rarer still, for data to be classified as rural and urban. However, related data sources on other aspects of rural research may indirectly illuminate rural homelessness. Rural Research Needs and Data Sources for Selected Human Services Topics (Strong et al., 2005) provides a thorough examination of data sources available for three human service focal topics. The detailed descriptions of these data sources include an assessment of their strengths and weaknesses for rural research as well as information on their availability and cost to researchers (Strong et al., 2005). For example, data collected as part of the required point-in-time counts for HUD continuum of care applications and other data reports required by various federal grants may provide a source of comparable information on rural homeless populations. However, it is important to be attentive to the quality of the methods used to collect such data, which varies broadly across sites. Data on children who are homeless are collected in every locality by the school board or other entity responsible for funding received through the No Child Left Behind Act of 2001 (U.S. Department of Education, 2004), which requires jurisdictions to locate and enroll homeless children. While the Act endorses the collection of longitudinal data by states and school districts, those entities are not required to incorporate collected data into a longitudinal database. Nevertheless, datasets such as these may be useful for researchers examining rural homelessness.