There are a number of gaps in current research on people who are homeless in rural areas. Gaps with regard to rural homelessness research are only one aspect of a much larger research gap with regard to rural human services knowledge. In the absence of current empirical studies of rural human services conditions, needs, and programs, policymakers must either ignore rural differences or make assumptions about them. For all these reasons, rural human services research deserves a high priority (Strong et al., 2005). Members of the Expert Panel on Rural Homelessness and others interviewed strongly agreed that rural homelessness research, informed by both available data and current work in the field, must be supported and undertaken in order to inform policy (Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2006). The following study areas are recommended.
Special populations.Persons without housing in rural areas are not homogeneous populations their diversity cannot be overemphasized (Patton, 1988). Moreover, parts of the country, such as Appalachia, the Midwest, the western frontier, and the rural South, have distinctive cultures or regional characteristics informed by local factors such as geography, history, and economy that may have an impact upon the prevalence and trajectory of homelessness (Housing Assistance Council, 1991). Differences between rural and urban populations are often masked by the characteristics of larger urban samples. In order to focus on rural communities, an overrepresentation of rural subjects and rural areas in future homelessness research may be necessary. More research is required to better document the special subpopulations, their sizes, distinctive characteristics, specific service or housing needs, cultural differences, and geographic characteristics of the areas that affect service provision. Both community size and proximity to urban areas have a profound impact on a communitys ability to develop and maintain a formal social services network for the areas residents, including its homeless persons (Patton, 1988). Research is needed to identify the needs of these diverse populations and to develop effective housing and service interventions. However, the existing research is sparse and uneven. Specific next steps in research should include a staged series of studies on homelessness and near homelessness in rural and frontier environments (Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2006). The initial stage would include formative qualitative research to lay the foundation for subsequent research, including interviews with frontline service providers (social service program staff, housing authorities, social workers, treatment providers, outreach workers, school staff, and others living and working in rural and frontier areas). Additional efforts would include key-informant interviews and focus groups with people who are homeless or at risk for homelessness. This initial stage would lead to a second stage of carefully crafted survey research, including needs assessments and access to services for persons who are homeless (or at risk) and systematic assessment of systems of service programs. These two stages would inform the third stage, which is development of specific intervention strategies that would include program evaluations. The fourth stage would be dissemination of effective practices to other areas and evaluation of effectiveness in the new sites.
Longitudinal studies of rural homelessness. Rigorous studies of the course of homelessness can help identify precipitating events for a homeless episode in rural communities and pathways out of homelessness for an array of community types across the urban/rural continuum. More rigorous longitudinal research is needed on medical and behavioral health problems among rural homeless persons. Such research should include variations among different types of rural communities, between rural and frontier communities, and between homeless and non-homeless persons in rural areas.
Discharge planning and homelessness prevention. People in rural areas are at risk for homelessness (as in many urban areas) when discharged from public institutions including public hospitals, respite care, psychiatric wards, board and care homes, correctional facilities, foster placements, and other settings (Patton, 1988). Development and evaluation of strategies for discharge planning should avoid missed opportunities to make critical interventions that would follow the persons into the community to help support them against homelessness.
Services research. Research suggests that homeless persons in rural areas are underserved compared to homeless populations in more urban areas. Studies are needed that assess and monitor the availability, accessibility, quality, and outcomes of medical, mental health, alcohol, and drug abuse services for homeless and other indigent individuals in rural areas. Resources include information compiled from nontraditional sources to expedite compilation of good working models or practices from, for example, expert panels, regional meetings, and provider networks. Longitudinal research with large representative samples from across the rural/urban continuum is needed to measure the larger demand for and access to needed services in rural communities (whether broad or homeless-specific services) with consideration for stigma, confidentiality, perceived availability, true availability, and cultural sensitivity (Office of Rural Mental Health Research, 2003). Success for homeless persons is expected to be greater if people can be served early and in their own communities. Research is needed to determine how to make the best use of limited service funds whether to serve people in their own smaller or remote communities or to centralize services in larger communities. Some services may best be provided locally and others in centralized settings; if so, it is important to distinguish these services. Rural communities are becoming increasingly diverse, and research is needed to identify the impact of changes in population size and composition on the demand for services and housing in rural communities. Research is needed to help rural communities anticipate and plan for needed changes in the local service delivery systems (Office of Rural Mental Health Research, 2003).
Identify best practices for rural settings. There is a paucity of research about best practices for meeting the needs of homeless persons in rural areas, whether adults, families with children, or unaccompanied youth. Research is needed on the effectiveness of case management, supportive housing models, or other models for housing and service delivery for the array of rural and frontier populations. As outlined by the New Freedom Commission on Mental Healths Subcommittee on Rural Issues (2004), most rural advocates believe that because of scarce resources, specialized services are not practical and that service providers are obliged to provide the full range of services to the full spectrum of persons in need. Research is needed to determine which is more cost-effective: addressing homeless persons as a special separate population or together with the low-income housed rural population. Communities that have adequate infrastructure can test the relative efficacy of adapting local mainstream programs to serve homeless clients versus creating homeless-specific services. Studies are needed to assess access to care for both general and specialized health needs. Adaptation of evidence-based practices implemented in urban areas as well as development of models specifically designed for rural areas should be pursued. Developing best practice models should include examination of workforce issues needed to implement model programs and testing the cost-effectiveness of service and housing programs in rural areas generally, including remote rural and frontier communities.